SALZ WISSENSCHAFT
Wenn bei Ihnen das posturale orthostatische Tachykardiesyndrom (POTS) diagnostiziert wurde, hat Ihr Arzt Ihnen wahrscheinlich geraten, Ihre Flüssigkeits- und Salzaufnahme drastisch zu erhöhen.
Dafür gibt es mehrere Gründe, und da jeder POTS-Patient etwas anders ist, kann der individuelle Bedarf an Salz stark variieren, wobei einige Ärzte 3.000 mg Natrium und andere bis zu 10.000 mg empfehlen.
Changes in Blood Pressure and Blood Distribution
Wenn eine Person von einer liegenden in eine sitzende Position oder von einer sitzenden in eine stehende Position übergeht, wird die Kopfposition ihres Körpers relativ zu ihren Füßen plötzlich viel höher. Die Schwerkraft zieht das Blut nach unten in Richtung der Füße. Um dem Gehirn weiterhin optimale Mengen an Blut und Sauerstoff zuzuführen, muss ihr Körper den Blutdruck schnell anpassen, um das Blut von ihren Füßen wegzuziehen und es zu ihrem Herzen und Kopf zu „drücken“. Bei einer Person ohne POTS verengen sich die Blutgefäße in den Beinen und die Herzfrequenz steigt während dieses Vorgangs leicht an, jedoch nur für einige Sekunden.
Es gibt ein Problem mit diesem Prozess bei Menschen mit POTS. POTS wird durch ein Problem mit dem autonomen Nervensystem verursacht – dem System, das die „automatischen“ Funktionen des Körpers wie Herzfrequenz, Atmung, Verdauung und Blutdruck steuert. Wenn dieses System behindert ist, hat es der Körper des POTS-Patienten schwerer, das Blut von den unteren Extremitäten zu Herz und Gehirn umzuverteilen. Wenn sie ihre Position ändert, gelangt das Blut daher nicht effizient zu ihrem Kopf, was zu Benommenheit, Herzrasen und in einigen Fällen zu Ohnmacht führt. ( Erfahren Sie mehr über Änderungen des Blutdrucks und der Blutverteilung .)
Low Blood Volume
Additionally, many POTS patients have hypovolemia, or low blood volume. The exact causes for this are not known, but low blood volume contributes to lowered blood pressure or difficulties distributing blood throughout the body even when the blood pressure is normal. Rapid changes in blood pressure and blood distribution must occur to keep oxygen flowing to the brain as a person changes position. A person with hypovolemia must fight an uphill battle when she changes position, because there is less blood to “pull” from her feet and “push” to her head than in a person without POTS. (Learn more about low blood volume.)
Low Aldosterone Levels
Sodium, along with water and potassium, is critical to the body’s ability to manage blood pressure. Sodium levels are regulated by the hormone aldosterone, which is released when concentrations become too low, promoting the reabsorption of sodium back into the bloodstream in the kidneys. This restores an appropriate balance of electrolytes.
In some instances, POTS patients experience low levels of aldosterone, which inhibits their bodies’ ability to reabsorb enough sodium to adequately manage blood volume and blood pressure. (Learn more about low aldosterone levels.)
The Solution: Add Salt
Bei POTS-Patienten kann eine erhöhte Natriumaufnahme bei niedrigem Blutdruck, geringem Blutvolumen und einer allgemeinen Verbesserung der Blutverteilung im ganzen Körper helfen. Zusätzlich zu Salz wird den Patienten empfohlen, mindestens zwei Liter Wasser pro Tag zu sich zu nehmen und mindestens alle zwei Stunden Wasser zu trinken. Die erhöhte Flüssigkeitsaufnahme sollte auch dazu beitragen, das Blutvolumen zu erweitern und POTS-Symptome zu reduzieren. ( Erfahren Sie mehr über das Hinzufügen von Salz .)
Die genaue Natriummenge variiert von Patient zu Patient. Am besten konsultieren Sie Ihren Arzt, um die für Sie richtige Stufe zu ermitteln. Einige Vitassium-Konsumenten nehmen nur zwei Kapseln pro Tag ein, was 500 mg zusätzlichem Natrium entspricht. Andere nehmen mehr als acht pro Tag ein, was mehr als 2.000 mg zusätzlichem Natrium entspricht. Denken Sie daran, dass diese Patienten auch zusätzliches Salz durch ihre Ernährung erhalten, die normalerweise reich an salzigen Lebensmitteln wie Salzkartoffeln, Eiern oder Getränken wie V-8 ist.
Bitte besuchen Sie diese Seite für eine detaillierte Gebrauchsanweisung für Vitassium .
Summaries of Research Articles
Wenn Sie mehr in diese Themen eintauchen möchten, finden Sie unten eine Auswahl von Forschungsartikeln zur Natriumergänzung bei POTS, EDS und orthostatischer Intoleranz bei älteren Menschen:
Gesunde, freilebende Personen können allein durch normale Ernährung ein Natriumgleichgewicht erreichen. Es ist anerkannt, dass Menschen mit westlicher Ernährung im Durchschnitt bereits ausreichend (oder überschüssiges) Natrium zu sich nehmen. Vitassium kann dazu beitragen, bestimmte Bevölkerungsgruppen, die von einer überdurchschnittlich hohen Natriumaufnahme profitieren könnten, mit zusätzlichem Natrium aus der Nahrung zu versorgen. In vielen Fällen versuchen Verbraucher, die Natriumaufnahme als ersten Versuch zu erhöhen, um bestimmte zugrunde liegende Symptome im Zusammenhang mit einer hohen Natriumausscheidung oder einer schlechten Natriumretention zu lösen, die charakteristisch für Erkrankungen wie das posturale orthostatische Tachykardie-Syndrom (POTS) und das Ehlers-Danlos-Syndrom sind ( EDS), oft unter der Empfehlung und Anleitung ihres Arztes als nicht-medikamentöse Erstlinienbehandlung zusammen mit zusätzlicher Flüssigkeitsaufnahme, Bewegung und anderen Änderungen des Lebensstils.
Eine zusätzliche Natriumaufnahme kann für bestimmte Menschen auch von Vorteil sein, um die richtige Flüssigkeitszufuhr zu unterstützen. Ohne Natriumersatz ist die Flüssigkeitsaufnahme mit einer Verringerung des Durstes und einer gesteigerten Diurese verbunden, obwohl weiterhin ein erhebliches Flüssigkeitsdefizit besteht. In Kombination mit einer erhöhten Salzaufnahme ist die richtige Flüssigkeitszufuhr der Schlüssel zu einem vermeidbaren und behandelbaren Flüssigkeitsungleichgewicht.
Die folgenden Referenzen sind unten als Hyperlinks verfügbar, und die wichtigsten Aufzählungspunkte in Bezug auf die Implementierung der Natriumergänzung sind für jeden Artikel umrissen.
Postural Orthostatic Tachycardia Syndrome (POTS)
Vernino S, Bourne KM, Stiles LE, Grubb BP, Fedorowski A, Stewart JM, Arnold AC, Pace LA, Axelsson J, Boris JR, Moak JP, Goodman BP, Chémali KR, Chung TH, Goldstein DS, Diedrich A, Miglis MG, Cortez MM, Miller AJ, Freeman R, Biaggioni I, Rowe PC, Sheldon RS, Shibao CA, Systrom DM, Cook GA, Doherty TA, Abdallah HI, Darbari A, Raj SR. Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1. Auton Neurosci. 2021 Nov;235:102828. doi: 10.1016/j.autneu.2021.102828. Epub 2021 Jun 5. PMID: 34144933; PMCID: PMC8455420.
Highlights: To expand blood volume, patients should have a minimum intake of 2 to 3 L of water per day along with increased sodium intake. Most clinicians recommend oral sodium intake to avoid potential complications of intravenous access. Sodium intake can be increased to 3 to 10 g daily using ordinary table salt (1 tsp. is approximately 2.3 g sodium), salt tablets or electrolyte solutions.
Garland EM, Gamboa A, Nwazue VC, Celedonio JE, Paranjape SY, Black BK, Okamoto LE, Shibao CA, Biaggioni I, Robertson D, Diedrich A, Dupont WD, Raj SR. Effect of High Dietary Sodium Intake in Patients With Postural Tachycardia Syndrome. J Am Coll Cardiol. 2021 May 4;77(17):2174-2184. doi: 10.1016/j.jacc.2021.03.005. PMID: 33926653; PMCID: PMC8103825.
Highlights: Patients received 6 days of LS (10 mEq sodium/day) or HS (300 mEq sodium/day) diet. In POTS patients, high dietary sodium intake compared with low dietary sodium intake increases plasma volume, lowers standing plasma norepinephrine, and decreases changes in heart rate.
Low PA, Sandroni P, Joyner M, Shen WK. Postural tachycardia syndrome (POTS). J Cardiovasc Electrophysiol. 2009;20(3):352-358. doi:10.1111/j.1540-8167.2008.01407.x
Highlights: Management always involves expansion of plasma volume with high salt and high fluid intake. All patients with POTS require a high salt diet, copious fluids, and postural training. The hypovolemic patient will do well with expanding plasma volume with generous salt intake and fludrocortisone. The salt intake should be between 150–250 mEq of sodium (10–20 g of salt). The patient should have at least 1 glass or cup of fluids with their meals and at least 2 at other times each day to obtain 2–2.5 L/day.
Abed H, Ball PA, Wang LX. Diagnosis and management of postural orthostatic tachycardia syndrome: A brief review. J Geriatr Cardiol. 2012;9(1):61-67. doi:10.3724/SP.J.1263.2012.00061
Highlights: Increasing sodium intake by taking salt tablets or an electrolyte solution helps expand blood volume, which will alleviate the hypotension some POTS patients suffer. Some physicians suggest patients take ten to fifteen grams of sodium daily, which is equivalent to 5.85 g (approximate. 250 mmol, 250 mEq) of sodium. Sodium chloride 0.9% infusion has been reported very beneficial in decreasing symptoms in POTS patients and improving quality of life.
Sheila Carew, Margaret O. Connor, John Cooke, Richard Conway, Christine Sheehy, Aine Costelloe, Declan Lyons, A review of postural orthostatic tachycardia syndrome, EP Europace, Volume 11, Issue 1, January 2009, Pages 18–25
Highlights: Salt supplements may be considered. Blood volume is low in many patients with POTS. The tachycardic response to upright posture correlates with the severity of hypovolemia.
Raj SR. Postural tachycardia syndrome (POTS). Circulation. 2013;127(23):2336-2342. doi:10.1161/CIRCULATIONAHA.112.144501
Highlights: Patients with POTS should avoid aggravating factors such as dehydration and extreme heat. To ensure adequate hydration, we ask our patients to consume 8 to 10 cups of water daily and to increase their sodium intake to up to 8 to 10 g/d. If this cannot be accomplished with dietary modification, supplemental NaCl tablets (with meals) can be used
Paturel, Amy. "Take a Stand: A neurologic disorder known as POTS causes dizziness and fainting—and frustration, due to lack of awareness and inadequate treatment." Neurology Now 11.1 (2015): 44-47.
Highlights: Recommendation is sodium, fluid, exercise, compression garments, medication; Salt helps the body retain water, which in turn increases blood volume. Drinking more fluids, especially in combination with salt, helps expand blood volume and increase blood flow. Most doctors recommend two to three liters per day of hydrating fluids such as vegetable or tomato juice, coconut water, decaffeinated tea with salt, or chicken broth.
Orthostatic Intolerance
Claydon VE, Hainsworth R. Salt supplementation improves orthostatic cerebral and peripheral vascular control in patients with syncope. Hypertension. 2004 Apr;43(4):809-13. doi: 10.1161/01.HYP.0000122269.05049.e7. Epub 2004 Feb 23. PMID: 14981050.
Highlights: Patients receive 6 g slow-release sodium chloride tablets (HK Pharma) and were reassessed after 2 months. Salt loading in posturally related syncope patients increases orthostatic tolerance and improves cerebrovascular and peripheral vascular control without affecting blood pressures. These changes are likely to contribute to the beneficial effects of salt loading in these patients.
Mtinangi BL, Hainsworth R. Early effects of oral salt on plasma volume, orthostatic tolerance, and baroreceptor sensitivity in patients with syncope. Clin Auton Res. 1998 Aug;8(4):231-5. doi: 10.1007/BF02267786. PMID: 9791744. (abstract only)
Highlights: Tests were carried out in patients with poor orthostatic tolerance and low initial urinary salt excretion, before and after 7 or 3 days of salt loading (120 mmol/d). Implications consist of beneficial effects of salt in some patients and show that all these changes occur within 3 days.
Vasovagal or Neurocardiogenic Syncope
Williams EL, Raj SR, Schondorf R, Shen WK, Wieling W, Claydon VE. Salt supplementation in the management of orthostatic intolerance: Vasovagal syncope and postural orthostatic tachycardia syndrome. Auton Neurosci. 2022 Jan;237:102906. doi: 10.1016/j.autneu.2021.102906. Epub 2021 Nov 11. PMID: 34823150.
Highlights: short-term (~3 months) salt supplementation improves susceptibility to Vasovagal Syncope (VVS) and associated symptoms, with little effect on supine blood pressure. In patients with VVS, salt supplementation is associated with increases in plasma volume, and an increase in the time taken to provoke a syncopal. Salt supplementation also improved symptoms, plasma volume, and orthostatic responses in patients with POTS.
El-Sayed H, Hainsworth R. Salt supplement increases plasma volume and orthostatic tolerance in patients with unexplained syncope. Heart. 1996;75(2):134-140. doi:10.1136/hrt.75.2.134
Highlights: Participants took capsules containing 10 mmol sodium chloride or placebo (12 per day). In the open study, they took slow sodium (Ciba) (10 mmol, 12 per day). In patients with unexplained syncope who had a relatively low salt intake administration of salt increased plasma volume and orthostatic tolerance, and in the absence of contraindications, salt is suggested as a first line of treatment.
Highlights: In patients with recurrent vasovagal syncope (VVS) and no clear contraindication, such as a history of hypertension, renal disease, HF, or cardiac dysfunction, it may be reasonable to encourage ingestion of 2 to 3 L of fluid per day and a total of 6 to 9 g (100 to 150 mmol) of salt per day, or about 1 to 2 heaping teaspoonfuls. Salt supplementation increases plasma volume, with limited benefit in patients with already high salt intake.
Guzman JC, Armaganijan LV, Morillo CA. Treatment of neurally mediated reflex syncope. Cardiol Clin. 2013 Feb;31(1):123-9. doi: 10.1016/j.ccl.2012.10.007. PMID: 23217693.
Highlights: Non-pharmacological measures (such as salt and fluid intake) are simple and usually safe and should be tried as first-line therapy in patients with frequent syncope and no obvious contradictions (abstract only)
Dysautonomia In Teens/Adolescents
McLeod KA. Dizziness and syncope in adolescence. Heart. 2001;86(3):350-354. doi:10.1136/heart.86.3.350
Highlights: Increase in dietary salt. Often with the simple measures of reassurance, fluid, posture and salt, symptoms will improve significantly.
Kizilbash SJ, Ahrens SP, Bruce BK, Chelimsky G, Driscoll SW, Harbeck-Weber C, Lloyd RM, Mack KJ, Nelson DE, Ninis N, Pianosi PT, Stewart JM, Weiss KE, Fischer PR. Adolescent fatigue, POTS, and recovery: a guide for clinicians. Curr Probl Pediatr Adolesc Health Care. 2014 May-Jun;44(5):108-33. doi: 10.1016/j.cppeds.2013.12.014. PMID: 24819031; PMCID: PMC5819886.
Highlights: Adequate water and sodium intake are essential to maintain the intravascular blood volume. Patients are usually instructed to consume 64–80 oz of fluids (preferably caffeine free) and as much salt as their taste buds can tolerate. While some physicians use intravenous saline infusions in an effort to provide temporarily symptomatic relief, such treatment is costly and risks infection and blood clots, and is not advised. Oral intake of fluid and salt is preferred.
Hypotension in Elderly and Aging Patients
Gupta V, Lipsitz LA. Orthostatic hypotension in the elderly: diagnosis and treatment. Am J Med. 2007 Oct;120(10):841-7. doi: 10.1016/j.amjmed.2007.02.023. PMID: 17904451.
Highlights: In most cases, treatment of orthostatic hypotension begins with nonpharmacological
interventions, including withdrawal of offending medications (when feasible), physical maneuvers, compression stockings, increased intake of salt and water, and regular exercise. Liberal intake of salt and water to achieve a 24-hour urine volume of 1.5 to 2 liters may attenuate fluid loss commonly seen in autonomic insufficiency. In elderly patients with orthostatic hypotension related to deconditioning, an exercise regimen comprising swimming, recumbent biking, or rowing might lead to disappearance of symptoms.
Myalgic Encephalomyelitis
Rowe PC, Underhill RA, Friedman KJ, Gurwitt A, Medow MS, Schwartz MS, Speight N, Stewart JM, Vallings R, Rowe KS. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Diagnosis and Management in Young People: A Primer. Front Pediatr. 2017 Jun 19;5:121. doi: 10.3389/fped.2017.00121. PMID: 28674681; PMCID: PMC5474682.
Highlights: Low blood volume has also been found in some adult patients with ME/CFS. The initiation of treatments directed at OI can sometimes relieve ME/CFS symptoms in pediatric as well as adult patients.
Bateman L, Bested AC, Bonilla HF, Chheda BV, Chu L, Curtin JM, Dempsey TT, Dimmock ME, Dowell TG, Felsenstein D, Kaufman DL, Klimas NG, Komaroff AL, Lapp CW, Levine SM, Montoya JG, Natelson BH, Peterson DL, Podell RN, Rey IR, Ruhoy IS, Vera-Nunez MA, Yellman BP. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Essentials of Diagnosis and Management. Mayo Clin Proc. 2021 Nov;96(11):2861-2878. doi: 10.1016/j.mayocp.2021.07.004. Epub 2021 Aug 25. PMID: 34454716.
Highlights: Although there are no approved treatments specific to ME/CFS, clinicians can reduce the severity of symptoms with standard pharmacologic and nonpharmacologic treatments. Nonpharmacological approaches for orthostatic intolerance include salt and fluid loading.
Ehlers Danlos Syndrome (EDS)
Mehr SE, Barbul A, Shibao CA. Gastrointestinal symptoms in postural tachycardia syndrome: a systematic review. Clin Auton Res. 2018;28(4):411-421.
Highlights: Between 60 and 80 percent of patients with HSD/hEDS have a disorder of orthostatic intolerance, such as POTS.
Do T, Diamond S, Green C, Warren M. Nutritional Implications of Patients with Dysautonomia and Hypermobility Syndromes. Curr Nutr Rep. 2021 Sep 12:1–10. doi: 10.1007/s13668-021-00373-1. Epub ahead of print. PMID: 34510391; PMCID: PMC8435108.
Highlights: Recommendations: Adequate salt and fluid intake may reduce orthostatic hypotension symptoms. Dietary supplements may help with osteoarticular, musculoskeletal, and fatigue symptoms. Individualized diet strategies and supplements can reduce the multiorgan system symptoms observed in dysautonomia and hypermobility syndrome.
Sjögren’s
Perzyńska-Mazan J, Maślińska M, Gasik R. Neurological manifestations of primary Sjögren's syndrome. Reumatologia. 2018;56(2):99-105. doi: 10.5114/reum.2018.75521. Epub 2018 May 9. PMID: 29853725; PMCID: PMC5974632.
Highlights: Neurological disorders are one of the most common extraglandular manifestations of pSS. Available literature data estimate the prevalence of neurological symptoms as about 8.5-70% of patients diagnosed with pSS. The most common neurological complication of pSS is peripheral neuropathy, autonomic neuropathy and in particular sensory polyneuropathy.
Gudesblatt, Mark, et al. “Autoimmunity & Autonomic Impairment: Preliminary Characterization of a Clinical Syndrome with Sjögren’s Features Associated with Novel Organ Specific Antibodies.” Neurology, vol. 86, no. Supplement 16, 20 Apr. 2016.
Highlights: Sjögren’s is the second most common cause of autonomic neuropathy, after diabetes, and has been associated with Postural Orthostatic Tachycardia Syndrome (POTS), Orthostatic Intolerance (OI), and other forms of dysautonomia.
Long COVID
Raj SR, Arnold AC, Barboi A, Claydon VE, Limberg JK, Lucci VM, Numan M, Peltier A, Snapper H, Vernino S; American Autonomic Society. Long-COVID postural tachycardia syndrome: an American Autonomic Society statement. Clin Auton Res. 2021 Jun;31(3):365-368. doi: 10.1007/s10286-021-00798-2. Epub 2021 Mar 19. PMID: 33740207; PMCID: PMC7976723.
Highlights: While the acute impacts of COVID-19 were the initial focus of concern, it is becoming clear that in the wake of COVID-19, many patients are developing chronic symptoms that have been called Long-COVID. Some of the symptoms and signs include those of postural tachycardia syndrome (POTS).
Larsen NW, Stiles LE, Shaik R, et al. Characterization of Autonomic Symptom Burden in Long COVID: A Global Survey of 2,314 Adults. Neurology. Published online April 28, 2022. doi:https://doi.org/10.1101/2022.04.25.22274300
Highlights: Moderate to severe autonomic dysfunction was seen in all LONG COVID groups in this study, independent of hospitalization status, suggesting that autonomic dysfunction is highly prevalent in the LONG COVID population and not necessarily dependent on the severity of acute COVID illness.
Mallick D, Goyal L, Chourasia P, Zapata MR, Yashi K, Surani S. COVID-19 Induced Postural Orthostatic Tachycardia Syndrome (POTS): A Review. Cureus. 2023 Mar 31;15(3):e36955. doi: 10.7759/cureus.36955. PMID: 37009342; PMCID: PMC10065129.
Highlights: Recent reports suggest that a significant percentage of COVID-19 survivors develop POTS within 6 to 8 months of infection. Prominent symptoms of POTS include fatigue, orthostatic intolerance, tachycardia, and cognitive impairment. The management of COVID-19-related POTS requires a comprehensive approach. Most patients respond to initial non-pharmacological options, such as increasing salt and fluid intake, however a pharmacological approach may be considered.