Salt and Water for POTS

Hello my Zebras and Spoonies! Thanks for coming and hanging out with me today, I am glad that you are here!

Today I am going to be talking about how to manage your fluid and sodium intake if you have a POTS diagnosis. This is something that is frequently asked about in the support groups that I am in, so I felt that it was important to tackle. And I only wanted to write it out once, because I’m lazy like that! I mean, come on, it is easier to share a post rather then rewriting it out every time, right?

The first thing to say about increasing water and salt consumption for POTS is that the reason we are all given different or vague instructions is that there aren’t any clear guidelines for this because there hasn’t been any research done on it. In fact, there is very little research done (I can find one, ever) on the amount of water required for people without any medical problems. This lack of research makes it pretty impossible for our providers to give us clear guidelines and numbers to aim for. Which is why they often give the vague advice of telling us to increase the amount of water and salt we consume without giving us any goals to aim for. That being said, there is a way to go about it.

Let’s start with the fact that if you are tracking your symptoms you are going to have a better way of knowing what is working for you and what isn’t. Because of that, I think that this process really requires that you have a medical journal that you track your symptoms in. This is an invaluable tool during this process because it will give you concrete data to look at and compare over time. This allows you to better assess if the changes you are making with your water and salt intake are having an impact on your symptoms.

If you need help setting up a medical journal, I have a post about that here: Medical Journaling. However, there are many ways to go about this and a search online will yield a lot of methods that other spoonies and zebras use.

Week 1: Getting the Baseline

When you start this process, you need to track a baseline week. Document your symptoms for a week to establish what your baseline is on the scales and tracker tools that you are using. This is a super important step because it let’s you know where you are right now. Without knowing your starting point you will having nothing to compare later data to and won’t be able to tell if things are improving or not. So, don’t skip this step. During this window, make sure that you are also writing down the amount of sodium and water that you are taking in. That will let you know what your starting point is, again this is super important.

The recommendation for a healthy adult without any medical problems is to drink 30mL of fluid for every 1kg they weigh. Thus, this is your starting point. Start out by making sure that you are at least drinking this much fluid every day.

There are some other useful numbers to know when you are trying to increase your blood volume with increased water and salt consumption:
1 gram of table salt equals 400mg sodium (the rest of it is chloride)
1 teaspoon of salt is 6 grams which equals 2400mg of sodium (that’s a lot)
100mg of sodium will cause your body to retain 240mL (1 cup) of water
960mL (about 1L or 4 cups) of water retained will increase your weight by 2 pounds or about 1Kg (0.9Kg precisely).

Ok, let’s look at how to use these numbers. If you want to make sure that your body can hold onto the fluids that you are drinking, you need to be sure that you are consuming enough sodium to allow your body to retain it. That means that you need to make sure that you are consuming 100mg of sodium for every 240mL (1 cup) of fluids that you are drinking.

We will look at myself as an example to figure out the starting point:

At my last weigh in, I was 210 pounds. That converts to 95.25Kg. You can use this conversion site to convert your weight easily.

Then we figure the amount of fluids. The starting point is 30mL per Kg. So, 95.25 x 30 = 2857.5 which means that my starting fluids need is 2858mL (rounding up) every day. To convert that to the number of 8 ounce glasses (1 cup) you divide the total by 240mL which is how many mL there are in 1 cup. So, 2858/240= 11.9 or 12 cups of water every day based on my weight.

Then you figure out the amount of sodium you need every day to go along with that fluid. 100mg of sodium will cause your body to retain 240mL (1 cup) of water. Thus, the idea is to consume 100mg of sodium for every 240mL (1 cup) you are drinking. Thus my starting point would be based on drinking 12 cups of water every day. That means that I would need to consume 1200mg of sodium every day to go along with that fluid.

And that would be where I would start: 12 cups of fluids every day with 1200mg of sodium every day.

After you have done a week of your medical journal, you’re going to want to compare your current intake with your starting intake. Take an average for the numbers. What was your average daily water intake during your baseline week? What was your average sodium intake for your baseline week? Now compare those numbers to your minimum starting point that you’ve calculated. Are you at this starting point already on both the fluid and the sodium? Most people aren’t and that’s alright. That’s why this is the starting point. If you are not at the minimum starting point, then that’s going to be your starting point.

However, if you are already consuming that amount, you are going to want to make an increase from your baseline. After all, you aren’t going to get any where if you don’t make changes, right? So, you will want to increase your fluid intake by 1 cup and your sodium intake by 100mg. So, if we use my numbers above and say that was also my weekly average, then I would want to increase to 13 cups of fluids and 1300mg of sodium every day. That would be the starting point, adjusted based on my consumption.

I also recommend that you make sure to adjust to ensure that your fluid and water consumption is at the ratio of 1 cup of water to 100mg of sodium. So, if your baseline week shows an average that has a different ratio, use the amount of water you consumed as your baseline and correct the sodium to be at the proper ratio. As an example, my goal is for 12 cups of water and 1200mg of sodium. If my weekly baseline reflected 13 cups of water and 1100mg sodium then my starting point would be 13 cups of water and 1300mg of sodium.

All that make sense so far? Don’t be afraid to ask me questions in the comments. I love questions!

Adjustment Weeks

Every week after that, you are going to increase your daily water by 1 cup and your sodium by 100mg. It is essential that you keep tracking your symptoms in your journal. At the end of every week, you’re going to consider how your symptoms are doing. Are things improving or getting worse?

While these numbers represent the general average for the way that the human body responds to water and sodium, it is important to keep in mind that it is an average and that this average was found in a controlled lab setting. We are not the average person. There are numerous things in play, including our health conditions that are not being taken into account with these basic equations. Even our diet is a factor that isn’t being considered. Things like caffeine can have an impact on the results. And we certainly don’t live in a lab. So, while these numbers are a useful starting point, it is important to keep their source and limitations in mind. In the real world, it is unlikely that we will achieve a magical ratio of 1 cup of water retention for every 100mg of sodium. But, we don’t need to either. These numbers are simply a place for us to start. The rest is based on your trial and your data.

There are many other factors that impact your fluid and sodium needs such as the heat and amount of exercise. This is why looking at week long stretches is more helpful then only considering a single day. However, if you live in an environment where the temperature varies greatly or you have a lot of variation in your activity levels or your health fluctuates a lot, you may need to increase your tracking intervals to 2 weeks rather then 1 week to improve your data set.

This is a slow process. But it is worth figuring out what works for you as an individual rather then shooting for random numbers that someone is guessing will be helpful. While we are all struggling with POTS, we are all very different. Thus, our fluid and sodium needs are also going to be different.

Finding the Balance

Your weekly evaluations are going to be what decides when you’ve found your magic numbers. At the end of every week, you’re going to ask yourself if your symptoms have improved, gotten worse or stayed the same?

If things have gotten worse, you are going to want to consider trying another week at those numbers. After all, it’s possible that you had a bad symptom week for a different reason. If you’ve repeated the week and are still seeing worsening symptoms, then you will want to drop back to the previous numbers and use those as your final numbers.

If things are staying the same or improving then keep going with the increases until you feel that you’ve reached either the maximum amounts that you can tolerate consuming or you feel that your symptoms are well managed. Then those will be your magic numbers.

Keep in mind that this is about finding balance, not finding a cure. Most of us have other medical conditions in addition to our POTS which can make high amounts of fluids or sodium difficult. But the point of this trial is to discover the highest amount that your body can tolerate and will ideally give you the best possible symptom control for your POTS. The truth is that many of us cannot achieve good symptom management with changes in water and sodium consumption alone.

This method can be used if you are newly diagnosed or if you have been on a POTS regime for years. It can be used to evaluate if your current fluid and sodium numbers are at their ideal. After all, our bodies change over time and that means that our treatment plans will need to change as well.

If you are interested in learning more about sodium, I have a post about that here that was part of my electrolyte series.

I hope that you found this guide helpful. Until we hang out again, stay well!

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