A person eats a bowl of fresh green salad with mixed leafy greens and purple vegetables, demonstrating a vegan meal option.

Keto Diet for POTS: What to Know Before You Try It (Plus Vegan and Paleo)

If you live with Postural Orthostatic Tachycardia Syndrome (POTS), you already know how much diet can affect your symptoms day to day. 

Many people consider starting a keto diet for POTS, since the diet's popularity for weight loss and energy often runs headfirst into the very things POTS management depends on: sodium, fluid balance, and stable blood volume.

Vegan and paleo diets raise similar questions, just for different reasons. With so many popular diets making headlines, it can be tough to know which ones might actually help your symptoms and which ones could quietly make them worse. 

We’ll break down exactly what keto specifically does to sodium and hydration levels, how vegan and paleo diets compare, and what a more POTS-friendly approach to eating actually looks like.

Key Takeaways

  • Popular Diets May Not Meet POTS Nutritional Needs: While diets like keto, vegan, and paleo are popular, they may not align with the specific requirements of POTS patients. These restrictive diets can make it difficult to meet the increased sodium and fluid intake essential for managing POTS symptoms.
  • Personalized Nutrition is Key for POTS Management: One-size-fits-all diets often fall short for POTS patients. Instead of following strict diet trends, prioritize getting enough sodium and hydration to support your health. Consulting with a healthcare provider or registered dietitian specializing in POTS can help create a tailored diet plan that supports your unique needs and symptoms.

Understanding the Nutritional Needs of POTS Patients

It’s important to understand that individuals with POTS have different, unique nutritional needs. Creating an effective POTS diet plan involves balancing sodium intake, hydration, and overall nutrition. Let's go over what that might look like.

A High-Sodium Diet

Experts recommend consuming approximately 10–12 grams (1.75 to 2.1 teaspoons) of salt per day to help manage symptoms like dizziness and fatigue.¹ However, the quality of salt matters.

Buoy Rescue Salt is unrefined and hand-harvested, containing over 87 trace minerals that support hydration, energy, and overall health.

Still unsure of how to incorporate salt into your diet? Explore best practices and why salt helps manage POTS symptoms to get a clearer picture. 

Balanced Nutrition

A well-rounded diet is crucial for people with POTS. Focus on consuming a variety of nutrients to support overall health and symptom management, such as:

  • Complex carbohydrates for sustained energy
  • Lean proteins for muscle health
  • Healthy fats for hormone balance
  • Fruits and vegetables for vitamins and minerals

A whole foods approach is recommended, but be mindful of adding salt to meet high sodium needs. 

Other Diet Considerations

Beyond sodium and hydration, POTS patients should also:

  • Pay attention to potassium and magnesium intake
  • Some may benefit from moderate carbohydrate reduction
  • Consider food triggers and potential IBS connections

Always consult with a healthcare provider before making significant dietary changes. These nutritional requirements can make certain popular diets challenging or even potentially harmful for POTS patients. 

Proper Hydration With Buoy

Studies show that people with POTS should aim to drink at least 2-3 liters (8-10 cups) of fluids daily.⁷ Consider adding Buoy Rescue Drops to your water and other beverages to maintain a proper balance of electrolytes and minerals. Our formula includes high-sodium content and is 6x stronger than our everyday drops for intense depletion and rapid recovery. Simply sprinkle a pinch of Rescue Salt directly on your tongue, into a beverage, or on top of your food.

Browse through additional hydration tips for POTS to learn how to manage your symptoms more easily. 

Is It Safe to Follow a Keto Diet for POTS?

The ketogenic diet, known for its high-fat, low-carb approach, has gained popularity for its potential weight loss benefits. When you have POTS, a keto diet may present some challenges:

  • Electrolyte Imbalance: The early stages of keto often lead to a significant loss of water and electrolytes as your body adjusts to burning fat instead of carbs. This can worsen POTS symptoms like dizziness and fatigue, which are already sensitive to electrolyte fluctuations.
  • Dehydration Risk: The keto diet can have a diuretic effect, increasing the risk of dehydration, a major concern for people with POTS, who need to maintain fluid balance to manage symptoms like lightheadedness and fatigue.
  • Limited Sodium Sources: Many high-sodium foods, such as bread and processed snacks, are restricted on keto. This can make it challenging for POTS patients to meet the high sodium intake needed to maintain blood volume and proper circulation.
  • Reduced Carbohydrates: The drastic reduction in carbs can lead to issues with blood volume and energy levels, both of which are critical for POTS patients. Carbohydrates help maintain blood volume, and a deficiency could exacerbate POTS symptoms like fatigue and dizziness.²

While a modified keto diet might be possible for some POTS patients, you should consult with your healthcare provider to ensure it meets your specific needs.

Why a Keto Diet for POTS Requires Extra Attention to Sodium and Fluids

Starting keto changes more than carbohydrate intake. As carbohydrate stores decline, the body can lose additional water and sodium, particularly during the early transition to ketosis. For someone with POTS, that deserves extra attention because maintaining adequate fluid and sodium intake is already an important part of symptom management.¹

Keto can also remove familiar sources of dietary sodium while restricting an entire macronutrient category. That doesn't mean everyone with POTS needs to avoid keto, but it does make sodium intake, hydration, and overall nutritional adequacy important factors to plan for rather than address after symptoms change.

Can a Vegan Diet Support POTS Management?

A vegan diet, centered around plant-based foods, can be nutritious and beneficial for many people. However, for POTS patients, you should consider these aspects of the diet beforehand:

  • Lower Sodium Content: Many whole plant foods are naturally low in sodium, making it harder to meet the high-sodium requirements needed to manage POTS symptoms.
  • Potential Nutrient Deficiencies: Without careful planning, vegan diets may lack certain nutrients crucial for POTS patients, such as B12 and iron.
  • Hydration Concerns: Some vegan diets high in fiber can increase water needs, potentially complicating hydration management for those with POTS.³⁴

While it's possible to manage a vegan POTS diet, it requires careful planning and often supplementation to meet all nutritional needs.

The Impact of the Paleo Diet on POTS Symptoms

The paleo diet, focused on whole foods our ancestors might have eaten, seems like it could align well with POTS management.³ However, it too has some potential pitfalls:

  • Sodium Restriction: Many paleo diet plans advocate for reducing sodium intake, which directly conflicts with POTS management needs.
  • Potential Carbohydrate Reduction: Just like the keto diet, some versions of paleo reduce carbohydrate intake. For POTS patients, this can lead to issues with blood volume and energy levels.⁵

Dietary Modifications for POTS Patients

Instead of adhering strictly to trendy diets, people with POTS often benefit more from a tailored approach that prioritizes:

  • Increased Sodium Intake: Aim for the recommended 3,000 to 10,000 mg of sodium daily, as advised by your healthcare provider.
  • Proper Hydration: Consume adequate fluids, often with added electrolytes.
  • Balanced Nutrition: Focus on a variety of nutrients to support overall health and POTS management.
  • Regular Meals: Eating smaller, more frequent meals can help maintain steady blood sugar and minimize symptoms.⁶

When it comes to managing POTS with diet, this tailored strategy often proves more effective than following popular diet trends that may not address the specific challenges of POTS management.

Tips for Choosing the Right Diet for POTS Management

The best diet for POTS is one that's personalized to your specific needs and symptoms. When considering any diet plan, keep these tips in mind:

  • Consult Your Healthcare Team: Always discuss significant dietary changes with your doctor or a registered dietitian familiar with POTS.
  • Prioritize Sodium and Hydration: Any diet plan should allow for adequate sodium intake and proper hydration.
  • Listen to Your Body: Pay attention to how different foods and eating patterns affect your symptoms.
  • Be Flexible: The best diet for POTS management may involve elements from various eating styles, tailored to your individual needs.
  • Focus on Nutrient Density: Choose foods that provide a wide range of essential nutrients to support overall health.

Ultimately, the best way to manage POTS with diet is to follow an eating plan that's personalized, flexible, and developed in consultation with healthcare professionals.

Get more tips and expert advice on optimizing your POTS diet and nutrition.

Before Starting a Keto Diet With POTS, Look at the Whole Plan

A diet can meet its carbohydrate target and still fall short of what you need to manage POTS. Before making a restrictive change, consider how the full eating plan will affect the sodium, fluids, electrolytes, calories, and nutrients you're getting each day.

This is also why your experience may differ from someone else's. POTS symptoms and nutritional needs vary, and dietary changes that work for one person aren't automatically appropriate for another.⁴

Rather than treating ketosis itself as the goal, work with your healthcare provider or registered dietitian to determine whether a keto diet can accommodate your prescribed sodium and fluid needs while still providing adequate overall nutrition.

Build a Keto Diet for POTS Around Your Needs

A keto diet for POTS can make sodium and hydration more complicated, while vegan and paleo diets introduce their own nutritional considerations. None of that means there is one diet every person with POTS should follow.

A better starting point is the foundation of your individual POTS management plan: the sodium and fluid intake recommended by your healthcare provider, balanced nutrition, and attention to how meals affect your symptoms.

If increasing sodium is part of that plan, Buoy Rescue Salt provides a simple way to add salt to food or beverages, while Buoy Rescue Drops can be added to drinks for electrolyte support. Before starting keto, vegan, paleo, or another restrictive diet, talk with your healthcare provider or a registered dietitian familiar with POTS. Your eating plan should work with your nutritional and hydration needs rather than making them harder to meet.

References

¹Sheldon R.S., Grubb B.P., 2nd, Olshansky B., et al. 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope. Heart Rhythm. 2015;12(6):e41–e63. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5267948/

²Standing Up to POTS. (n.d.). Nutritional Strategies to Help Manage POTS. https://www.standinguptopots.org/nutritionstrategiesPOTS

³Holloway, A. (2023, March 25). Diet and Fluids. PoTS UK. Medically approved by Dr Lesley Kavi and Chloe Hall. https://www.potsuk.org/managingpots/diet-and-fluids-2/

⁴DiBaise, J.K., Lunsford, T.N., & Harris, L.A. The POTS (postural tachycardia syndrome) epidemic: Hydration and nutrition issues. University of Virginia. Accessed March 1, 2024. https://med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2019/06/POTS-June-2019.pdf

⁵Berggren, T., Marchand, R., Barrios, A., Mitchener, C., Jones, A., Scherr, R. E. & Zidenberg-Cherr, S. (2018). Nutrition and Health Info Sheet: The Paleo Diet for Health Professionals. Center for Nutrition in Schools, Department of Nutrition, University of California, Davis. https://nutrition.ucdavis.edu/sites/g/files/dgvnsk426/files/inline-files/fact-pro-paleo-diet.pdf

⁶Cleveland Clinic. (2022). Postural Orthostatic Tachycardia Syndrome (POTS). https://my.clevelandclinic.org/health/diseases/16560-postural-orthostatic-tachycardia-syndrome-pots

⁷Water Ingestion in Postural Orthostatic Tachycardia Syndrome: A Feasible Treatment Option? (2019). The Journal of Innovations in Cardiac Rhythm Management, 10(2), 3545–3551. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252859/

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