Nutritional strategies to manage postural orthostatic tachycardia syndrome (POTS) and its comorbidities: A narrative review

Background Postural orthostatic tachycardia syndrome (POTS) is a heterogeneous disorder of the autonomic nervous system characterized by orthostatic intolerance and involvement of multiple organ systems. It commonly coexists with conditions such as hypermobile Ehlers–Danlos syndrome (hEDS), mast cell activation syndrome (MCAS), and a spectrum of gastrointestinal (GI) disorders. These overlapping conditions frequently manifest with shared GI symptoms such as nausea, bloating, abdominal pain, early satiety, and altered bowel habits that can substantially compromise nutritional status and quality of life. Aim This review synthesizes current evidence to outline practical, nutrition-based strategies for managing POTS and its commonly associated comorbidities. Methods Key nutritional domains relevant to POTS management, including fluid and sodium intake, meal timing and volume, and dietary composition, along with commonly associated comorbid conditions contributing to GI symptom burden, were identified a priori by the authors. These comorbidities include gastroparesis, hEDS, MCAS, disordered eating patterns, median arcuate ligament syndrome (MALS), functional GI disorders, and food intolerances. A comprehensive PubMed search was then performed to identify and synthesize relevant literature within each of these predefined domains. Summary Given the clinical heterogeneity of POTS and variability in associated conditions, a standardized dietary approach is unlikely to be effective. Instead, individualized nutrition strategies tailored to symptom patterns, GI tolerance, metabolic demands, and co-existing disorders are essential. Careful evaluation of overlapping comorbidities is critical to inform targeted, sustainable, and patient-centered dietary management.