POTS and Electrolytes: What the Salt Guidelines Say, From a Food Scientist Living With POTS

Jasmine Meagher, founder of Ritua
Jasmine Meagher, BSc Food Science and Nutrition
Founder, Ritua · 8 min read

I have spent my career formulating supplements, more than 250 of them. Then I was diagnosed with POTS, and suddenly the conversations I was having with my specialist were about the exact thing I work with every day: how much salt and fluid actually goes into your body, and how you get it there.

This guide is what I wish I had been handed on day one. It covers what POTS is, why salt and fluid come up in almost every conversation about it, what the published guidelines actually say, and how to turn "eat more salt" into numbers you can read off a food label. It is general information, written by someone living with POTS, not medical advice. Your own targets should always come from your doctor.

What POTS is

Postural orthostatic tachycardia syndrome, or POTS, is a form of chronic orthostatic intolerance. In plain terms, your body struggles to adjust when you move from lying down to standing up, and your heart rate climbs to compensate.

The Canadian Cardiovascular Society position statement defines it in adults as a sustained heart rate rise of at least 30 beats per minute within 10 minutes of standing, without a drop in blood pressure, alongside symptoms such as lightheadedness, palpitations and fatigue that have lasted more than three months.

It is far more common in women. In the largest survey of people with POTS to date, 94% of the 4,835 participants were female, and the median wait for a diagnosis was 24 months. If you are reading this while still waiting for answers, you are in very large company.

Why salt and fluid come up so often

POTS is not one single mechanism. The Canadian position statement describes several overlapping patterns, and one of them is hypovolaemia, meaning a reduced blood volume. With less fluid circulating, it is harder to keep blood moving back up to your heart and brain when you stand.

This is where salt comes in. Sodium is the main electrolyte your body uses to hold water in the bloodstream rather than passing it straight through. Drinking more water on its own only goes so far. Pairing fluid with sodium is the practical lever most clinicians reach for first, which is why "more salt, more water" is often the very first thing people with POTS are told.

What the guidelines actually say

Two sources come up again and again in Australia, and they line up closely:

  • The Canadian Cardiovascular Society (2020) gives salt and water a strong recommendation, based on low to moderate quality evidence, with a suggested range of 3 litres of water and 10 grams of salt (sodium chloride) a day.
  • The Australian POTS Foundation suggests aiming for 2 to 3 litres of water a day and increasing salt to 10 grams a day, which it equates to 4,000 mg of sodium, under medical supervision.

Two things are worth noticing. First, both are expressed as grams of salt, not sodium, which matters when you start reading labels. Second, both are starting points for a conversation with your doctor, not a number to adopt on your own. Your specialist may set you higher, lower or somewhere in between depending on your blood pressure, kidneys and other medications.

What the research on salt shows

For a long time, the salt advice rested more on physiology than on trials. That started to change with a 2021 crossover study in the Journal of the American College of Cardiology. Researchers put 14 people with POTS and 13 healthy controls on six days of a very low sodium diet and six days of a high sodium diet, then compared the two.

On the high sodium diet, the people with POTS had a larger blood and plasma volume, lower standing noradrenaline and a smaller rise in heart rate on standing than on the low sodium diet.

Two caveats keep this honest. The study was small and short, and the high sodium arm was 300 mEq a day, which is roughly 6,900 mg of sodium, set and monitored by researchers. Even on that diet, heart rates in the POTS group stayed well above the healthy controls.

So the research supports salt as a genuine piece of the puzzle, not a fix. That matches my own experience of it: one tool among several, used every day.

Turning grams of salt into milligrams of sodium

This is the part where my food science background earns its keep, because the guidelines talk in salt and Australian food labels talk in sodium. They are not the same number.

Salt is sodium chloride, and sodium makes up roughly 40% of it by weight. So:

  • 1 gram of salt contains about 390 mg of sodium
  • 10 grams of salt contains about 3,900 mg of sodium, which the Australian POTS Foundation rounds to 4,000 mg
  • A level teaspoon of table salt weighs roughly 5 to 6 grams, so about 2,000 to 2,300 mg of sodium

When you are checking an electrolyte drink, a stock cube or a packet of crackers, look at the sodium figure in the per serve column of the nutrition panel and add those up across the day. I go into label reading in more detail in my guide to comparing electrolytes in Australia, and into how much sodium a drink really needs in this piece on sodium per serve.

Salt and fluid are one part of the plan

It is easy to fixate on salt because it is the thing you can buy. The same Canadian position statement lists it alongside other non-drug measures:

  • Exercise training, strongly recommended, starting with non-upright exercise such as rowing, recumbent cycling or swimming, at least 30 minutes every other day
  • Waist high compression garments, suggested at 20 to 30 or 30 to 40 mmHg
  • Reviewing medications that can make orthostatic symptoms worse, with your doctor

The Australian POTS Foundation adds avoiding common triggers like heat, prolonged standing and alcohol, and keeping sleep and meal times consistent. Salt works best as part of that whole picture, and a physiotherapist or exercise physiologist who knows POTS is worth their weight in gold.

Who should be careful with extra salt

For most Australians, the advice runs the other way. The Nutrient Reference Values set a suggested dietary target of 2,000 mg of sodium a day for adults, and the average intake already sits around 3,600 mg. A high salt intake is a deliberate, supervised choice for specific people, not a general wellness habit.

Talk to your doctor before increasing salt if you have high blood pressure, or kidney or heart disease, if you are pregnant or breastfeeding, or if you take medication that affects fluid or blood pressure. And if you are not sure whether your symptoms are POTS, get a proper assessment first. Several other conditions can look similar, and they are managed differently.

How I build it into my day

My specialist told me to lift my salt and fluids. The hardest part was never understanding why, it was actually doing it every day without it turning into a chore. A few things that help me:

  • Front load the morning. I get a big glass of fluid with sodium in before I leave the house, rather than trying to catch up at 3pm.
  • Keep sachets everywhere. Car, handbag, desk, gym bag. If it is not within reach, I do not drink it.
  • Track it for a week. Adding up the sodium on labels for a few days showed me how far off my target I actually was.
  • Watch the sugar. If I am drinking electrolytes every day, I do not want a spoonful of sugar with every serve, so I read the carbohydrate line as carefully as the sodium one.

It is one of my daily non negotiables, alongside compression, fluids and pacing. None of those on their own is the answer. Together, they are my routine.

The bottom line

Salt and fluid are recommended in POTS guidelines for a sound physiological reason, and the first controlled study on salt in POTS supports that. The published targets sit around 2 to 3 litres of fluid and 10 grams of salt a day, which is roughly 4,000 mg of sodium, and your own numbers should come from your doctor.

When I could not find a sugar free sachet with 1,000 mg of sodium that I actually wanted to drink every day, I formulated one. Ritua Hydrate has 1,000 mg of sodium, 190 mg of potassium and 70 mg of magnesium per sachet, sweetened with stevia and monk fruit. It is how I get sodium in before I leave the house, and if you want to try both flavours first, there is a four sachet sample pack.

This article is general information, not medical advice, and is not a substitute for guidance from your doctor, particularly if you are managing an existing health condition or taking medication.

Jasmine Meagher, founder of Ritua

Jasmine Meagher

BSc Food Science and Nutrition · Founder, Ritua

Jasmine is a food scientist who has developed more than 250 sports and wellness supplements, and she lives with POTS. She founded Ritua to bring evidence-based, TGA-compliant supplements to Australian women, and writes about the research behind every ingredient Ritua sells.

Common questions

How much salt do the POTS guidelines suggest?

The Canadian Cardiovascular Society suggests around 10 grams of salt and 3 litres of water a day. The Australian POTS Foundation suggests 2 to 3 litres of water and 10 grams of salt, about 4,000 mg of sodium, under medical supervision. Your doctor should set your own target.

Is 10 grams of salt the same as 10 grams of sodium?

No. Sodium is about 40% of salt by weight, so 10 grams of salt contains roughly 3,900 mg of sodium. Australian nutrition panels list sodium, so convert before you start adding things up.

Can I just drink more water?

Both guidelines pair fluid with salt, because sodium is what helps your body hold on to fluid rather than passing it straight through. Water alone is part of the picture, not the whole of it.

Are electrolyte drinks better than salt tablets or table salt?

Sodium is sodium, so the best option is the one you will actually use consistently and tolerate well. Some people prefer tablets, some salt their food heavily, and some find a drink the easiest way to get fluid and sodium in together. Many people use a mix.

Who should not increase their salt intake?

Anyone with high blood pressure, kidney or heart disease, anyone who is pregnant or breastfeeding, and anyone on medication that affects fluid or blood pressure should speak with their doctor first. Most Australians already eat more sodium than the 2,000 mg a day dietary target.

How much sodium is in a sachet of Ritua Hydrate?

Each 5.5 g sachet contains 1,000 mg of sodium, 190 mg of potassium and 70 mg of magnesium, with no sugar. It is made to be mixed into 500 ml of water.

Sources

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