Alcohol and POTS: Why Drinking Makes Symptoms Worse

Has Alcohol Been Studied in POTS?

Not directly. Our team didn't find a trial that gave alcohol to people with POTS and measured what happened. What exists is an experiment in healthy volunteers that shows what alcohol does to the standing reflex, and reports from 2 related conditions where people say the same thing our patients do.

What Does Alcohol Do to Blood Pressure When You Stand?

When you stand, the blood vessels in your limbs tighten to keep blood from settling low. Alcohol switches that response off. In a double-blind trial, 14 healthy young volunteers were given alcohol on 1 day and a placebo on another, and then put through a test that pulls blood toward the legs the way standing does. After the placebo their blood pressure held until the strongest setting. After alcohol it fell at every setting, and at the strongest the drop in systolic pressure was 14 mmHg against 7 mmHg. The vessels in the forearm tightened as the stress increased on the placebo day and failed to tighten on the alcohol day (Narkiewicz, 2000).

Our team reads that through how POTS works. The fast heart rate on standing is a compensation that protects blood flow to the brain, and it leans on the vessels tightening at the same time. Take the tightening away and the heart has to cover more of the gap alone. That's our team's reading, and it hasn't been measured in POTS.

Why Do People With POTS Feel Worse After Drinking?

What our team has noticed is that a lot of people with autonomic problems don't feel good when they drink, so most of them move away from it by themselves. Very few patients with POTS ask whether they can have wine tonight. In our team's experience alcohol is inflammatory, it already tends to raise the heart rate, and it already tends to bring on flushing, hive-like rashes and stress responses. For most people it makes worse the symptoms they're already dealing with.

The same pattern shows up in related conditions. In 114 people with chronic fatigue syndrome seen at a specialist clinic, 2 in 3 had cut down on alcohol. The most common reasons were more tiredness after drinking, in 67%, more nausea in 33%, and worse hangovers in 23%, and most had made the change from personal experience without being advised to (Woolley, 2004). A long COVID clinic has also described 4 patients with new sensitivity to alcohol after the infection, while noting how little has been published on it (Eastin, 2023).

Our team also treats a bad reaction as a signal. If alcohol has become hard to metabolize, if 1 drink leaves you hung over, our view is that the body's ability to clear it isn't keeping up the way it should, and adding more to clear doesn't help.

Should You Avoid Alcohol With POTS?

Our team's advice is practical. Drinking heavily is a bad idea for anyone. If you're finding that you feel worse after a drink, it's reasonable to put alcohol on the shelf for now and work on getting healthy first. The aim is to get well enough that a drink is a choice again.

The same goes for people in concussion rehab. When patients ask our team whether it's okay to drink while they're working through a concussion, the answer is usually not right now.

Stimulants sit in the same category for people whose sympathetic system already runs high. Caffeine and other stimulants push that system further, and cutting back is a simple first step. What to eat and drink more broadly is on the POTS diet guide, and fluids and salt are on salt and water for POTS.

If you take medication for POTS or anything else, ask the physician or pharmacist who manages it how it interacts with alcohol.

Alcohol and POTS: FAQ