Eating POTS

My POTS "diet" is a weird creature. I've had to change some basic things, and totally toss out some well-loved assumptions.  It's not anything established or proven over time, but I'm sharing it so you can learn from my experiences as I go.

This is less a list of foods and more a set of basic rules for eating in general. It has room for flexibility, and I find that important. I'm not a regimented sort of gal, but you could certainly make this more specific (daily meal plans, etc.) if you wanted to.

Rule #1 : Spread it out. Eating 6 smaller meals means the blood flow to your digestive system stays level during the day. When you eat, a rush of blood heads to your digestive organs... diverting flow from other areas. [1] In most people, the body just compensates on it's own. With POTS, the compensating mechanism is shot. I eat about every two hours when I am awake, although I tend to not snack after dinner. One thing I was concerned about is spreading out the meals without inadvertently eating too much. So, I used this nifty calculator   to figure out the total calories I need in a day. Then I divided it by 6, and the remainder I used to pad breakfast, lunch and dinner so they still felt relatively "normal." This gives me calorie "goals" for each meal.

Rule #2 : SALT!! Popular guidance says to try and take in 2+ teaspoons of salt per day. Yeah, that was sort of useless guidance for me because when I turn over a food item to read the nutrition info, it doesn't list "teaspoons of salt", it lists milligrams of sodium. So I looked up how much sodium is in a teaspoon of salt [2] and did the math and I figure I need at least 3,000 mg of sodium each day. My doctor approved this as a good starting point, and gave me the green light to go as high as 5,000 mg if needed. Divide your sodium goal by your number of meals and, voila! you have a sodium goal for each meal. Mine is 500 mg per meal. Now I can read labels and figure out if I'm on track, and add salt to adjust if I need to.

Rule #3 : WATER!! When I went through patient education at the Mayo Clinic, I was advised to drink 4 liters of water per day. It may sound intimidating, but if you just carry that water bottle everywhere and mentally tally your bottles throughout the day, you'll get it down. A 1 liter water bottle makes life a lot easier, because all I have to do is aim for 4 a day and call it good.

Rule #4: Less Carbs According to Dysautonomia Information Network, some folks with POTS respond well to a gluten free diet, and many respond well to a low-carb diet [3]. This probably has something to do with the relative effort it takes to digest carbohydrates - they make our tummies work harder, requiring more blood be diverted to the digestive system. This is likely to affect different people at different levels. For me, this was an easy change because I had already gone gluten free and I find gluten free baked goods to be generally crap. Seriously, I'm not a fan. So cutting the carbs was not a problem, since the carbs I was getting had the consistency and flavor of a cardboard box.

Rule #5: Coffee in the morning  This doesn't work for everyone, but for some people (myself included) a little bit of caffeine in the morning can be helpful. Caffeine is a stimulant, it raises your blood pressure [4] and that can be a nice thing for us POTS people. Some people with POTS can't tolerate it, though. Personally, I can't handle much. I stick with decaf, and only a couple cups in the morning.

So what does this look like in real life? Well, here's what my day maps out as:

8:00 am -    Breakfast : 300 Calories, 500 mg sodium
10:00 am -  Snack : 200 calories, 500 mg sodium
Noon -        Lunch : 300 Calories, 500 mg sodium 
2:00 pm -   Snack : 200 calories, 500 mg sodium  * 2 bottles of water by this time! *
4:00 pm -   Snack : 200 calories, 500 mg sodium
6:00 pm -   Dinner : 400 calories, 500 mg sodium
10:00 pm - Bedtime... 4 bottles of water by this time!

Sometimes I'll have another snack at 8:00 pm. If you total it up, my calorie intake is actually a bit on the low end. I did this for two reasons: 1) I'd like to drop a few pounds and 2) if I goof on the numbers or get hungry in the evening and snack again, I'm not totally overeating. I like "wiggle room." Especially in my jeans!

This is just what I'm doing and by no means an "approved for everyone" plan. My doctor at Mayo said he likes it, and so far I'm actually feeling better on it. I feel like I'm doing a better job of hitting my salt goals, for one thing. Eating so often is a definite adjustment, and it takes a bit of planning, but it's actually better for the body on a number of levels. So far, I'm liking it.

[1] http://www.ncbi.nlm.nih.gov/pubmed/7315967
[2] https://www.google.com/search?q=sodium+in+a+teaspoon+of+salt&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a
[3] http://www.dinet.org/what_to_avoid.htm
[4] http://www.webmd.com/mental-health/news/20020801/is-caffeine-bad-for-your-heart