In my four years of having a POTS diagnosis, I’ve learned (sometimes the hard way!) what can make my POTS worse. Knowing these POTS triggers, like the summer heat, dehydration, and my menstrual cycle, has helped me adapt to a lifestyle where I’m prepared for these triggers or avoid them altogether. Wondering what else can cause a POTS flare-up? Keep reading to find out!
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1. Hot Environments
I love summertime — the sunshine, lush greenery and flowers, and perfect weather for hiking, camping, and beach days are things I look forward to every year. But the heat and humidity of summer do not love me, more specifically, my POTS. Hot environments and being overheated are hands-down the most difficult POTS triggers that I deal with because they never fail to make me symptomatic.
Curious why? It’s because any kind of hot environment, whether that’s a steamy shower, a jacuzzi, the beach, or even just your backyard on a hot day, encourages vasodilation, or the widening of blood vessels. Vasodilation promotes blood pooling, making circulation inefficient. This means that our bodies need to work extra hard to get enough blood back up to our hearts and brains where it’s needed, and this extra work can cause POTS to get worse.
But don’t worry, I have a few tricks to combat the heat with POTS in a dedicated blog post on the topic!
Products That Help Me in the Heat
- Elasto-Gel Cold Therapy Wrap
- Chill Pal Cooling Towel
- Electrolyte replenishers (popular options are Liquid IV, Nuun Sport tablets, and LMNT)
- VIM & VIGR compression socks
As you may have noticed from my bio, I love to drink coffee in all forms. So, you can imagine how hard it is to have caffeine trigger POTS symptoms. Have I stopped drinking coffee altogether? No!
For me, too much caffeine triggers POTS symptoms. Obviously, I’ve experimented with this to figure out the right balance of what I can handle. Personally, I am fine if I drink my one morning cup of coffee.
But drinking a second cup or more in the afternoon often proves to be more than my body can handle. Hello, tachycardia! Here comes insomnia and dehydration! I see you, shaking hands! It’s a fine line between just enough caffeine and too much, so I try not to upset that delicate balance.
Interestingly, drinking small amounts of caffeine actually helps my symptoms because I find that it raises my blood pressure slightly. Since my blood pressure tends to be lower in the morning, this is helpful. Again, it’s all about finding the right balance for YOU. Some POTS patients cannot handle any caffeine whatsoever.
Another big POTS trigger? Alcohol. Drinking alcoholic beverages can cause hypotension and dehydration, which can make POTS worse. Alcohol also interacts with many medications, so you may not be able to drink alcohol depending on what prescriptions you take.
However, with the guidance and approval from my doctor, I can drink alcohol in moderation as long as I stay hydrated. I’ll emphasize that this is completely unique to me and where I’m at in managing my symptoms. If I’m not feeling well, I’ll pass on the alcohol and make a mocktail or drink a flavored seltzer water instead.
As with caffeine, some POTS patients cannot tolerate alcohol at all and should avoid it completely. Be sure to talk to your doctor before consuming alcohol to determine if it’s safe for you!
4. Diuretic Medications
Diuretic medications essentially flush water and salt out of the body, and they’re often prescribed to treat high blood pressure. However, other medications can have diuretic effects as well. Anything that rids the body of water and salt can trigger POTS symptoms.
This 2013 article explains why certain medications with diuretic effects can worsen tachycardia (scroll to “Pharmacological Treatment of POTS”). Years ago, I took Spironolactone to help with hormonal acne, but I had to stop it immediately because I thought I was having heart problems. This medication acts as a strong diuretic and is primarily used to lower blood pressure. It’s no wonder I felt like I needed to go to the ER!
A similar compound called drospirenone is used as a progestin in Yaz and Yasmin birth controls. So if you have POTS and need to take an oral contraceptive, explore options that use a different progestin.
If you have POTS, consult your doctor about switching to other medication options that don’t have diuretic effects. And if you’re unsure about a drug’s effects, don’t hesitate to ask a pharmacist before starting a new prescription.
5. High Stress
I don’t know about you, but when I’m really stressed about something, say giving a presentation at work, I tend to feel a certain way: my heart races, I get palpitations, it feels harder to breathe, I lose my appetite, and I sweat. Then, once the stress-inducing event is over, I feel completely wiped out. Now, what do a lot of those symptoms sound like? POTS symptoms.
What I’m getting at here is that stress makes my POTS feel so much worse. I feel a lot of those symptoms just standing up from sitting (heart racing, short of breath) and if I’m standing for too long — or putting my body under prolonged stress — I get full-body exhaustion afterward. So, as someone with POTS, being under too much stress kind of feels — to me — like walking all day and not being able to sit down enough to rest.
That’s why managing stress is really important.
Unfortunately, you can’t wish away the stressors in your life. But you can find ways to relieve yourself of the toll it takes on your body. You can do this by starting a new hobby, hanging out with friends or family, venting to a support system, meditating, exercising, deep breathing, crafting, or any number of other things. Practicing a change in perspective can also alter your mindset toward certain stressors and can help you to better cope with them.
6. Overexerting Yourself
Exercise is a fantastic method for treating POTS. However, one of the most prominent symptoms of the syndrome is exercise intolerance. Too much exercise that we aren’t conditioned to handle yet actually triggers POTS symptoms. More specifically, it can make you feel more tired until your body adapts and conditions itself to handle exercise and increased activity.
Following the Levine Protocol is one of the best ways to slowly condition your body to better tolerate exercise and to avoid overexerting yourself. I used this step-by-step guide when I was first diagnosed with POTS because I struggled to exercise without being exhausted the following day. If you haven’t tried it, talk to your doctor about the program to see if it’s right for you.
But exercise isn’t the only culprit here. Too much activity, in general, can worsen POTS symptoms. That’s why you shouldn’t plan to do all the housework, garden, grocery shop, and cook a big meal all in one day.
I know how it goes: You feel great on a low-symptom day and want to keep doing more because it’s wonderful to feel so great and full of energy, but then you regret it the next day when you feel a symptom flare. Try not to overdo it in one day, and use your spoons wisely!
7. Menstrual Periods
From what I’ve heard from other POTS patients, I’m not the only one whose cycle triggers POTS symptoms. I have definitely noticed that my symptoms get worse when I’m on my period, and immediately after it ends.
A 2012 study investigating POTS, lightheadedness, and gynecological disorders found that POTS patients reported more lightheadedness during all phases of the menstrual cycle in comparison to healthy controls. However, lightheadedness increased for both groups during menses, which may be related to shifts in estrogen levels. So, there you have it: Periods can make you feel dizzier.
While you can’t really avoid your periods, you can stock up on POTS products and have a list of pro tips in hand to use when that time of the month rolls around. And you can pamper yourself a little extra when you’re on your cycle, too. Me? I’ll be eating anything and everything with chocolate, taking it easy, and carving out some reading time. How about you?
8. Standing Too Long
Prolonged standing—especially standing still—almost never fails to trigger my symptoms. (Remember my comparison in the stress section?) But here’s the why: Being upright compromises circulation in POTS patients, so that’s why it feels so much worse to stand. Prolonged standing is a nightmare for me, but the worst of it isn’t the increased heart rate or fatigue — it’s the pain. Foot and leg pain to be exact.
To help this pain, I’ll wear compression socks, such as those made by VIM & VIGR, when I know I’ll be on my feet for a long time. (As long as it isn’t summer; I get way too hot to wear knee-high socks all day in summer.) I also minimize my time standing completely still. You’ll often catch me shifting my weight, nonchalantly performing calf raises in a crowd, or bending my legs in an effort to promote circulation. It’s not a cure, but it definitely helps!
9. Sitting Too Long
I know, I just told you not to stand for too long with POTS, and now I’m telling you that sitting too long is a trigger, too? What?!
This truly is a case of striking the right balance. Standing for too long can encourage blood pooling in the lower half of your body, so sitting and getting your legs up can help circulation. But if you sit for too long without moving, guess what, you’re also encouraging blood to pool and decreasing circulation. It can also make you feel more lightheaded and faint when you finally do stand up.
I added this trigger because I know how tempting it is to stay off your feet all day and limit movement when your POTS is feeling absolutely terrible. I get it; I’ve been there. It wasn’t until I learned how unhelpful this could be for my circulation that I got myself to keep moving throughout the day, even if that just meant sitting on the edge of my bed and doing calf raises or marches in place.
Nowadays, when I work all day, I make sure to get up at least once per hour to walk around for a minute or two. If I’m stuck in long meetings, I’ll stretch and flex my leg muscles under my desk or shift positions frequently.
Whatever movement you are capable of doing, do it! Any movement periodically through the day is better than none at all.
10. Eating Large Meals
You know that impending food coma feeling you get right after finishing Thanksgiving dinner each year? That sleepiness isn’t just from the turkey; it’s also because of the quantity of food you’ve just eaten. The technical term for a food coma is postprandial somnolence, or post-meal sleepiness (but “food coma” is much more fun to say, am I right?).
While a healthy person may only feel sleepy after large meals, especially those high in fat or carbohydrates, a POTS patient can experience a full fledge of symptoms. According to one 2011 review, many POTS patients report feeling worse after eating large meals, particularly ones high in carbohydrates. The authors of this medical review suggest eating smaller, more frequent meals instead, and balancing carbs, protein, and fat each time you sit down for a meal.
In light of that, I try to split my meals into 4-5 smaller meals throughout the day. I am a classic grazer! For example, I eat breakfast, a mid-morning snack, lunch, an afternoon snack, and dinner. Sometimes, I’ll have another small snack after dinner if I eat earlier in the evening. If you want to read more about this, check out my post on POTS diet tips.
Remember, these aren’t huge portion sizes here. If you’re eating more frequently, then you don’t need to consume large quantities at a time.
Pinpointing and avoiding POTS triggers are both highly individual and important in managing this chronic condition. Once you have a better idea of triggers that worsen your symptoms, you can take steps to minimize them and better prepare for them and be on your way to feeling stronger, happier, and healthier!
Let me know in the comments below what POTS triggers are the worst for you!
- Dysautonomia International: Lifestyle Adaptations for POTS. Accessed May 31, 2020. http://www.dysautonomiainternational.org/page.php?ID=44.
- Mathias, Christopher J., David A. Low, Valeria Iodice, Andrew P. Owens, Mojca Kirbis, and Rodney Grahame. “Postural Tachycardia Syndrome—Current Experience and Concepts.” Nature Reviews Neurology 8, no. 1 (June 2011): 22–34. https://doi.org/10.1038/nrneurol.2011.187.
- Peggs KJ, Nguyen H, Enayat D, Keller NR, Al-Hendy A, Raj SR. Gynecologic disorders and menstrual cycle lightheadedness in postural tachycardia syndrome. Int J Gynaecol Obstet. 2012;118(3):242‐246. doi:10.1016/j.ijgo.2012.04.014
- Raj, Satish R. “Postural Tachycardia Syndrome (POTS).” Circulation 127, no. 23 (November 2013): 2336–42. https://doi.org/10.1161/circulationaha.112.144501.
- “What You Need to Know about Water Pills (Diuretics).” Mayo Clinic. Mayo Foundation for Medical Education and Research, October 19, 2019. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/diuretics/art-20048129.