Updated January 10th, 2018
Doctors recommend salt to POTS patients for the sodium it contains. Remember salt is NaCl… sodium and chloride. The overloading of sodium causes the body to absorb some extra salt, and thereby extra fluid to boost blood volume. This in turn can increase blood pressure and reduce the dizziness and lightheadedness. Additionally, the higher blood pressure can bring down your heart rate. Beyond just dousing your food in ungodly amounts of salt there are other options to get the recommended amount of 5-10+ grams of salt a day into a POTSie diet.
Too Much Iodine?
A lot of salt is iodized to prevent iodine deficiency. This can be a great thing, because iodine is essential for thyroid function, but getting too much can cause issues. Specifically, excess iodine interferes with hormone synthesis, which can lead to thyroid inflammation. Iodine isn’t readily listed for many foods, but review the NIH fact sheet on iodine to see if you’re probably getting a sufficient amount from foods or from other supplements you’re taking. If so, ask your doctor if you should consider using non-iodized salt (at least in your salt shaker). Most healthy Americans meet or exceed the daily iodine requirement without the use of “discretionary” salt (salt added to taste, as by a salt shaker). This reveals a potential issue for most with POTS, because we’re asked to far exceed the daily recommended value for salt/sodium intake. However, patients may have lower dietary iodine due to low food intake or a narrow variety of foods they’re able to eat. It’s something worth evaluating to ensure you’re neither getting too much, nor too little.
Salt Products POTSies Love
These are great options for supplementing salt. Even if you’re able to get enough salt in on your average day, consider having some of these options on hand when you’re in a flare, which is especially important for times when you’re not able to eat as much.
Plain old salt tabs: 1 gram salt/394 mg sodium
You can get these at your local pharmacy without a prescription. Just ask the pharmacist. They usually run me about $10 for  1-gram tablets. If you do get a prescription from your doctor, good chance it’ll be at least half the cost. Not recommended on an empty stomach. These can be a little nauseating depending on the person and need to be taken with plenty of fluid.
DIY Salt Caps
You can make your own salt caps by buying empty pill capsules from Amazon and filling them with your salt of choice- standard table salt, Himalayan salt, sea salt or whatever salt makes you happy. Some POTSies recommend making your own, because salt tabs can be kind of pricey when taking multiple per day and can kind of taste like the ocean on the way down. Again, take with plenty of fluid.
Saltsticks: 215 mg sodium
Many POTSies love these caps. Beyond just sodium they also come with potassium, calcium and magnesium that are other essential electrolytes. It’s a great way to get in that salt along with some other beneficial minerals. SaltStick recommends an intake limit of ten (10) per day, which would be 2150 mg sodium. Added bonus, SaltStick donates 10% of sales to Dysautonomia International to support research, physician education, public awareness and patient empowerment programs. Learn more: http://saltstick.com/vitassiumpage/#community.
Nuun: ~360 mg sodium
These are hydration tabs you just pop into a glass of water to transform it into a flavored fizzy drink. I enjoy these. They have no sugar and almost as much sodium as 1 salt tab, along with a smattering of other vitamins like potassium, calcium, magnesium and Vitamin C. Many love these, but review ingredients for your sensitivities carefully because some have caffeine, also the older blends like “All Day” have stevia and sorbitol, while newer blends use avocado oil and monk fruit extract.
Hammer Endurolytes Fizz: 200 mg sodium OR Camelbak Elixir: 410 mg sodium
These products are very similar to Nuun. They are also hydration tabs with no sugar, artificial sweeteners or colors.
RecoverORS: ~326 mg sodium
This is a rehydration powder that many swear by. Nicknamed “adult pedialyte.” It’s made by clinicians, and is optimized to treat dehydration from things like diarrhea and food poisoning. Just mix with water and drink.
Normalyte Pure: ~851 mg sodium
A huge amount of sodium with NO preservatives, colors, artificial flavors or sweeteners. This was designed with input from the dysautonomia community. Many find this hard to palate, but some find it much better mixing this into a blend of water and juice. Consider trying their free samples before buying. Added bonus, Normalyte donates 10% of sales to Dysautonomia International.
Pedialyte: 240 mg sodium (packet form)
A popular choice among POTSies, especially when in a flare. It’s targeted to prevent dehydration in children with diarrhea or vomiting. The powder is mixed in water to create a flavored drink containing some sugar and a lot of electrolytes.
Liquid IV: 500 mg sodium
Some are using these. Has some other vitamins like potassium, vitamin C and a few B vitamins. Downside for some is the 11g of sugar, and stevia extract.
Banana Bags: 370 mg sodium
Some people love these for a flare. These may not be great for daily consumption given the megadosing of B vitamins. The 1000% daily value (DV) of B6 alone is worrisome for regular daily intake, given the risk for neuropathy. Also, many want to avoid the high folic acid (200% DV), especially if you have MTHFR mutations.
V8 Vegetable Juice: 420 mg sodium (per 8 oz serving)
If you can tolerate it, this can be a great choice for boosting both sodium levels and nutrition. An 8oz serving has more sodium than a 1 gram salt tab, and is a great source of Vitamin A and Vitamin C. Just be careful if you’re sensitive to histamine, because the main ingredient, tomatoes, are high in histamine.
Gatorade & Powerade
Everyone knows about these options, right? They can be a good choice when you’re not keeping much down and need the calories, but on a regular basis these drinks just have too much sugar to be healthy.
I was gifted a big bag of pink Himalayan salt that I kept next to the stove and sprinkled it on most food. It gets its gorgeous pink color from iron oxide that has leached into the salt crystals, and it’s actually not from the Himalayas as I would have expected, but from Pakistan. I’ve heard people rave about how much they love it, believing it’s healthier and more wholesome. Himalayan salt is touted as having many extra minerals and comes at a hefty price tag, but spectral analysis shows that these beneficial minerals are only found in trace amounts too tiny to have any effect on us, and more interestingly these minerals are found in addition to trace amounts of radioactive elements as well… again these amounts are too tiny to have any effect on us. I can’t find any legit scientific papers backing up any of these claims of it actually improving nutrition, and noted science skeptics have weighed in saying that it’s marketing hype. I guess I’ll have to agree, but Himalayan salt is just so very pretty and makes sprinkling salt onto food more enticing and that alone could be worth it for some. Read Pass the Salt (But Not That Pink Himalayan Stuff).
Have more salt options!? Share them!