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The short answer
You crave salt with POTS because the condition often comes with low blood volume, and salt helps your body hold on to fluid and push that volume back up, which eases the racing heart and dizziness on standing.That is also why extra salt and fluids are a standard first-line treatment. But a hormone paradox in POTS means your salt-retaining system does not work the usual way, so how much you actually need is individual, and you should follow your clinician's guidance, especially if you have high blood pressure or a kidney or heart condition.
When your body keeps asking for salt
If you have POTS and you find yourself salting food twice, drinking the pickle juice, keeping crisps in every bag and daydreaming about broth, there is a real reason, and it is not a lack of willpower. You crave salt with POTS because the condition often comes with low blood volume, and salt is one of the main levers your body has for holding on to fluid and raising that volume back up. More volume means more blood returning to the heart when you stand, which is exactly the thing POTS makes hard. So the craving is a sensible request from a system that is short on supply.
That is also why “more salt and fluids” is usually the first advice anyone with POTS hears. The physiology behind it is solid. The details are where it gets interesting, because POTS has a quirk that makes the whole salt story more complicated than “crave salt, eat salt, feel better.” Understanding that quirk is what turns the advice from a vague instruction into something you can actually use.
Why POTS often leaves you low on blood volume
Blood volume is simply how much blood is circulating in your vessels. It matters enormously for standing up, because gravity pulls blood down into your legs and belly the moment you are upright. A healthy system answers by tightening vessels and keeping enough blood coming back to the heart. If the tank is already low, there is less to return, the heart has to beat faster to keep output up, and you get the fast heart rate, dizziness and lightheadedness that define POTS.
Many people with POTS are running on a low tank. In a Vanderbilt study that measured it directly, people with POTS had significantly less plasma and total blood volume than healthy controls, with a total blood volume deficit averaging roughly 700 mL (Raj et al., 2005). Reviews of POTS describe this low blood volume, often alongside cardiovascular deconditioning, as one of the core mechanisms driving the orthostatic tachycardia (Fu and Levine, 2018; Raj, 2013). It is not the whole story of POTS, and not everyone with POTS is hypovolemic, but low volume is common enough that raising it is a first-line target.
Salt, specifically the sodium in it, is central to volume because water in the body follows sodium. Where sodium goes, fluid tends to stay. Hold on to more sodium and you hold on to more water, and your blood volume rises. That is the simple chain the craving is trying to complete. It also explains why people with POTS so often notice they pee out fluid quickly: if the body is not keeping sodium, the water leaves with it.
How salt raises blood volume and calms the racing heart
When sodium levels and fluid are adequate, blood volume holds up, more blood returns to the heart on standing, and the heart does not have to race to compensate. That is the logic behind salt loading, and a careful study has shown it is more than theory.
Researchers put 14 people with POTS (and 13 healthy controls) through six days of a low-sodium diet and six days of a very high-sodium diet, then measured what happened when they stood up. On the high-sodium diet, the jump in heart rate on standing was smaller, their total blood and plasma volume went up, and the surge of noradrenaline (adrenaline’s close cousin) on standing came down (Garland et al., 2021). In other words, more sodium meant more volume, a steadier heart and less of a stress-hormone scramble to stay upright.
This is the strongest reason the salt advice exists, and it is worth reading honestly: it was a short study at a research-level dose, and even on high sodium the POTS group’s numbers stayed worse than the healthy controls’. Salt helps; it is not a cure. For a fuller look at what the salt and fluid evidence does and does not support, see the science of salt and fluids for POTS.
The salt paradox: why the craving is a clue, not a gauge
Here is the quirk that makes POTS different from ordinary salt craving. In most people, running low on blood volume sets off a hormonal alarm. The kidneys release renin, which drives up angiotensin II and aldosterone, and those two hormones do two jobs at once: they tell the kidneys to hold on to salt and water, and they act on the brain to make you crave salt (Iovino et al., 2021). Craving salt when you are depleted is the system working as designed.
In POTS, that alarm is oddly quiet. The same Vanderbilt study that found low blood volume also found that, despite the low volume, renin activity was no higher than in healthy people and aldosterone was actually lower than expected. The researchers called it a “renin-aldosterone paradox” (Raj et al., 2005). The hormones that should be shouting “hold on to salt” are barely whispering, so the kidneys keep letting sodium and fluid go even while the body is short.
Two useful ideas come out of this. First, your craving is a reasonable read on a real shortage, but it is not a precise gauge, because the hormonal machinery that normally tunes salt appetite to need is itself blunted in POTS. Second, it is a big part of why eating salt helps but does not cure: you are manually topping up a tank that keeps draining, rather than fixing the drain. That is why clinicians pair salt with fluids, compression and reconditioning instead of relying on salt alone.
How much salt, and who should be careful
Because the system is leaky, the amounts recommended for POTS are much higher than general-population advice, which aims to limit salt. For people with suspected low blood volume, the 2015 Heart Rhythm Society consensus statement suggests roughly 10 to 12 grams of salt a day, about 4 to 5 grams of sodium, with 2 to 3 litres of fluid (Sheldon et al., 2015). Spreading it through the day, and pairing salt with water so the fluid has sodium to hold onto, tends to work better than one big hit.
| Way to get extra salt | Rough sodium | Worth knowing |
|---|---|---|
| Salt added to meals and snacks | About 0.6 g sodium per quarter teaspoon of salt | Easiest to adjust, spreads intake through the day |
| Electrolyte drinks or oral rehydration mixes | Varies widely, read the label | Pairs sodium with fluid; see our electrolyte drink guide |
| Salt tablets | A few hundred mg to about 1 g sodium each | Convenient but easy to overdo; use only if your clinician agrees |
| Broth, pickles, olives, salted nuts | Varies widely | Food-based, gentler on the stomach than tablets for some |
Salt loading is not for everyone, and more is not automatically better. It is aimed at people whose blood volume is low and whose blood pressure can handle it. If you have high blood pressure, kidney disease, heart failure, or the high-blood-pressure (hyperadrenergic) pattern of POTS, extra salt can do harm, and your clinician may want you to limit it instead. New swelling, headaches, breathlessness or a climbing blood pressure are all reasons to stop and check in. The right amount is the amount you and your clinician agree on, not the most you can stomach. The broader toolkit, including compression and medication, is laid out in how POTS is treated, and the volume problem itself in low blood volume in POTS.
How to see whether salt is helping you
Because the hormone paradox makes everyone’s response a little different, the most useful question is not “should I eat salt” but “does salt actually steady me?” The honest way to answer it is to watch your own numbers and symptoms over a few weeks rather than judging it day to day, where a single bad night can mislead you.
A simple approach: keep your salt and fluids roughly steady for a couple of weeks and note how your standing heart rate, dizziness and energy track, then adjust with your clinician and watch again. The things to follow are your morning resting heart rate, your heart-rate rise on standing (a home stand test or a wearable can show this), and how often you get dizzy or crash. Patterns show up over weeks that no single day reveals.
The bottom line
Craving salt with POTS is your body asking for something it genuinely tends to run short of: blood volume. Sodium helps the body hold water and raise that volume, which eases the racing heart and dizziness on standing, and that is exactly why salt and fluids are first-line advice. The catch is a paradox: the hormones that normally make you retain and crave salt stay low in POTS, so the body keeps leaking it, the craving is a real but imperfect signal, and salt helps without curing. Extra salt steadies many people in controlled study, but the amount is individual, it is not safe for everyone, and it works best alongside fluids, compression and gradual reconditioning. Treat the craving as information, agree the dose with your clinician, and let a few weeks of your own data tell you whether it is working.
Sources
- Raj SR, Biaggioni I, Yamhure PC, et al. Renin-aldosterone paradox and perturbed blood volume regulation underlying postural tachycardia syndrome. Circulation, 2005.
- Garland EM, Gamboa A, Nwazue VC, et al. Effect of high dietary sodium intake in patients with postural tachycardia syndrome. Journal of the American College of Cardiology, 2021.
- Iovino M, Messana T, Lisco G, et al. Signal transduction of mineralocorticoid and angiotensin II receptors in the central control of sodium appetite: a narrative review. International Journal of Molecular Sciences, 2021.
- Fu Q, Levine BD. Exercise and non-pharmacological treatment of POTS. Autonomic Neuroscience: Basic and Clinical, 2018.
- Sheldon RS, Grubb BP, Olshansky B, et al. 2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm, 2015.
- Raj SR. Postural tachycardia syndrome (POTS). Circulation, 2013.
Questions people also ask about this
Is craving salt a sign of POTS?+
On its own, no. Lots of people crave salt for ordinary reasons, including sweating, a low-salt diet, pregnancy, or simply liking salty food. But a strong, persistent salt craving alongside a racing heart on standing, dizziness, lightheadedness and fatigue is a pattern worth mentioning to a clinician, because many people with POTS run low on blood volume and salt is one of the body's levers for raising it. Salt craving is a clue to discuss, not a diagnosis by itself.
How much salt should I have with POTS?+
The 2015 Heart Rhythm Society consensus statement suggests roughly 10 to 12 grams of salt a day, about 4 to 5 grams of sodium, along with 2 to 3 litres of fluid, for people with suspected low blood volume. That is far more than the general-population advice, and it is deliberately individualised. It is not right for everyone, and people with high blood pressure, kidney disease, heart failure or the high-blood-pressure form of POTS may need to limit salt instead. Do not start a high-salt regimen on your own; agree the amount with the clinician who knows your case.
Does eating more salt actually reduce POTS symptoms?+
In a controlled study, people with POTS who ate a very high-sodium diet for six days had a smaller heart-rate jump on standing, more blood volume and lower standing adrenaline than when they ate a low-sodium diet. So there is real physiology behind the advice. But the trial was short and used research-level doses, their numbers still were not fully normal, and long-term benefit has not been proven to the same standard. Salt and fluids are a reasonable first step for many, not a cure, and they work best as part of a wider plan.
Why do I crave salt but still feel awful even when I eat a lot of it?+
Partly because of a paradox in POTS. In most people, running low on blood volume raises the hormones renin and aldosterone, which tell the kidneys to hold on to salt and water. In many people with POTS those hormones stay low or unchanged despite the low volume, so the kidneys leak salt and fluid even when you are taking plenty in. That is one reason salt alone does not fix everything, and why pairing it with fluids, compression, leg counter-pressure and gradual reconditioning tends to help more than salt by itself.
Is there such a thing as too much salt with POTS?+
Yes. More is not always better, and very high intakes can raise blood pressure, strain the kidneys and heart, and cause swelling in people who are prone to it. The high-salt approach is aimed at people whose blood volume is low and whose blood pressure can tolerate it. If you notice new swelling, headaches, a rising blood pressure or breathlessness, or if you have any heart or kidney condition, talk to your clinician before adding more salt. The right amount is the amount your clinician agrees with you, not the most you can manage.
Written by
Austin Spaeth
Austin builds Autonomic, a private, offline journal for tracking autonomic recovery. He writes about HRV, POTS, dysautonomia and post-viral illness for the people living it, turning messy day-to-day data into signals you can actually act on.
