Low Blood Pressure: Causes, Symptoms, and Effective Management Strategies
Yes, low blood pressure can be dangerous too, and is surprisingly common. However, it’s not always a freak-out moment. Let’s have a closer look.
Understanding Low Blood Pressure
What is Low Blood Pressure?
Lower than 90/60mm Hg is considered abnormally low blood pressure.
While some people naturally just have low blood pressure and feel fine, the danger comes when sudden drops occur and you experience symptoms.
Common Causes of Low Blood Pressure
The American Heart Association says the underlying causes of low blood pressure can include things like prolonged bed rest, pregnancy, and dehydration. Some medications can lower blood pressure like diuretics, drugs for Parkinson’s disease, erectile dysfunction, or tricyclic antidepressants. Nutrient deficiencies like B12 and folate can lead to anemia which can lower blood pressure too.
More severe causes can include heart problems, and endocrine problems (hypothyroidism, Addison’s disease, low blood sugar, and others). Severe infection or allergic reactions can cause blood pressure to drop as well.
POTS, or postural orthostatic tachycardia syndrome, is also a cause of low blood pressure. Of course, this also has underlying causes like long COVID, mast cell activation syndrome, or Ehlers-Danlos Syndrome (hEDS).
Risk Factors Associated with Low Blood Pressure
The immediate issue is loss of consciousness and injury. You might have experienced standing up too fast, getting lightheaded, and feeling like you might faint. If your blood pressure goes too low, you can fall and can injure yourself. But the risks can be even greater than a gnarly bump on the head. According to the NIH, the danger of low blood pressure is that vital organs are not getting enough blood flow (and oxygen) and that can damage your organs.
Nausea, gastroparesis, and poor bowel motility seem to also be caused by low blood pressure events as caused by POTS. These gastrointestinal issues, over time, can lead to decreased nutrient intake, poor digestion, and IBS symptoms.
Recognizing Symptoms of Low Blood Pressure
The American Heart Association lists symptoms of low blood pressure as:
Dizziness or lightheadedness
Nausea
Fainting
Dehydration and unusual thirst
Lack of concentration
Blurred vision
Cold, clammy, pale skin
Rapid, shallow breathing
Fatigue
Depression
The feeling that your heart is skipping a beat, fluttering, or beating too hard or too fast.
Effective Management Strategies for Low Blood Pressure
Just like with high blood pressure, it helps to know the cause of your low blood pressure first.
Hydration and sodium
The easiest strategy is to start your day with a few pinches of salt in your water. You might already be drinking a lot of water. But by adding salt, you’re helping the salt stay IN your body and increase your blood volume. If you don’t like the taste of salt water, you can add extra salt to your food in the morning or use a flavored high-sodium electrolyte mix like LMNT.
I can’t overstate how important it is to get ahead of this hydration/sodium thing and stay ahead. The first thing you do when you wake up should be to drink water and consume a little salt (1-2 pinches). Then repeat before each meal or as needed to maintain adequate blood volume (being careful not to raise blood pressure too high). For my patients with POTS, this is my #1 recommendation.
Often when people switch to a very low carbohydrate diet, their sodium needs increase. If you’ve recently made a diet modification like this (like a keto diet) try adding some extra salt to see if you feel better.
Fasting is another time when more salt really helps. If you are doing a 24-hr fast (or longer), bump up your sodium intake to feel better and avoid headaches.
POTS is a common symptom of long COVID, autoimmune disease, or comorbidity of hypermobile Ehler’s-Danlos Syndrome. If you have POTS, using extra sodium is typically called for (anywhere from 3-10g sodium per day in some cases). Keep in mind, this isn’t the ONLY strategy for POTS. There are underlying causes that always need to be addressed as well.
Once again, home blood pressure monitoring becomes important to know if you’ve got your blood pressure high enough. Please refer to my earlier article on how to properly monitor your blood pressure at home.
Mast cell stabilization and histamine management
For people with POTS, the cause of low blood pressure can often be found in aberrant mast cell activity and too much histamine in the system.
Mast cells are a key part of our innate immune system. They are all over the body and when they are activated, they “degranulate” spilling out a variety of chemicals like tryptase, histamine, prostaglandins, and more. These can have profound local and systemic effects including vasodilation and a reduction in blood pressure. If this is the cause, then one needs to stabilize the mast cells (by finding what is triggering them). You can also use medications or botanicals like quercetin and vitamin C to stabilize them and support histamine breakdown pathways that rely on methylation (folate, B12, B6, B2, etc). This can be especially important during high pollen seasons when hay fever is in high gear.
Another part of this is to just reduce the total histamine load in the body by eating a lower histamine diet and using enzymes like diamine oxidase with food to assist in histamine breakdown.
I go over this in more detail in the article where I discuss hay fever, allergies, and histamine.
If you think you have POTS and histamine intolerance, I encourage you to book a call with me or another professional who is familiar with it or visit the Dysautonomia Project to learn more. I meet a lot of people who have a variety of odd symptoms like dizziness, rapid heartbeat, migraines, allergies, nausea, IBS, hives, easy bruising, hypermobility, chronic pain, edema, and sensory processing disorder or ADHD and don’t realize they are all part of the same thing and there are solutions for you.
Blood sugar
I’ve found that erratic blood sugar can contribute to POTS symptoms and blood pressure issues. When using continuous glucose monitoring with my clients who have POTS, we’ve seen that rapid drops in blood SUGAR can precipitate a POTS flare and other symptoms. The actually blood sugar levels are not extreme for most people. But even a rapid “spike” in an otherwise healthy range to 150mg/dl followed by a rapid drop down to 75mg/dl can be problematic. This is well within the range of normal blood sugar, but for people with dysautonomia, tighter blood sugar control helps. I always recommend a short-term CGM use to assess their glucose tolerance. But eating protein at the start of each meal and avoiding high glycemic foods like sugar, juice, high-sugar fruits, refined carbohydrates, and white rice can really help.
Physical activity
Being in a deconditioned state can lead to low blood pressure. Your heart needs to be strong and conditioned to pump your blood to all your organs. If you have been on bed rest for some time, have POTS due to post-viral illness or EDS, or just naturally have low blood pressure, getting regular exercise can help. For a deconditioned person, starting low and slow is the way to go with simple walking or an exercise bike. Always stay within your limits and don’t push past pain or dizziness. I encourage you to read this article which lays out appropriate exercise plans for POTS.
Medications and Treatment Options for Low Blood Pressure
Medications are beyond the scope of this article and my practice. However, some people with chronic orthostatic low blood pressure do receive helpful medications if you aren’t able to raise it naturally. If you are experiencing severe symptoms, you should definitely see a doctor. However, if you go in and they say there’s nothing wrong with your heart, you might need to be evaluated for POTS by cardiology. Be aware that it is unfortunately very common for doctors to miss this diagnosis and you may need to ask around for a provider familiar with POTS. Again, refer to the Dysautonomia Project or book a call with me or another provider experienced with this so we can direct you to the appropriate providers who will listen to your needs.
References
Fu, Q., & Levine, B. D. (2018). Exercise and non-pharmacological treatment of POTS. Autonomic Neuroscience, 215, 20–27. https://doi.org/10.1016/j.autneu.2018.07.001
The Ehler’s-Danlos Society: https://www.ehlers-danlos.com/
The Dysautonomia Project: https://thedysautonomiaproject.org/pots