NUTRITION

Nutrition plays a

pivotal role in

managing complex chronic

conditions

Dystautonomia & POTS

Patients with POTS often benefit from specific nutritional strategies to support blood volume, vascular tone, and autonomic regulation.

One key recommendation is to consume small, frequent meals. Large meals can divert blood to the gastrointestinal tract, lowering central blood volume and exacerbating symptoms such as dizziness, fatigue, and tachycardia.

Additional strategies—high sodium/fluid intake when appropriate to improve preload and blood pressure regulation.

Mast Cell Activation Syndrome

MCAS nutrition management is highly individualised. Patients often face complex food triggers and a risk of over-restriction. Dieticians trained in MCAS help patients identify tolerances while maintaining nutritional adequacy.

Key Areas of Support:

  • Identify Food Triggers Without Excess Restriction: Unnecessary elimination can worsen nutrition status and increase food anxiety.

  • Manage Histamine Load: A low-histamine diet or DAO enzyme may help, but these should only be pursued with guidance.

  • Ensure Nutrient Adequacy: Gastrointestinal tract symptoms and restricted diets often lead to nutrient deficiencies, especially without supervision.

  • Prevent Malnutrition and Disordered Eating: Chronic restriction increases anxiety, MCAS flare risk, and undernourishment.

MCAS: Individualised Trigger Management

Triggers vary widely but may include:

  • Alcohol

  • Heat or sun exposure

  • Mould

  • Additives/dyes in medications

  • Exercise or physiological stress (including from malnutrition)

MCAS management should aim to reduce symptoms while preserving quality of life and dietary variety.

Diagnostic Clarity

Histamine intolerance is not an allergy. It occurs when the body can’t break down histamine efficiently, leading to symptoms.

Diagnosis should be guided by a gastroenterologist or immunologist—not unvalidated IgG or food sensitivity panels, which can cause excessive, unnecessary avoidance.

Supplements

Many patients take multiple supplements without realising that overlapping products may exceed safe intake levels.

Common hidden sources include:

  • Multivitamins (may already contain CoQ10, vitamin C, or B-complex vitamins)

  • Green powders and meal replacements (often enriched with amino acids or herbal extracts)

  • Fortified foods (cereals, protein bars, and beverages)

  • Energy drinks (frequently contain excess B vitamins, amino acids, or stimulants)

NB - Patients should have their full supplement list reviewed by a registered dietitian to ensure safety, prevent side effects, and identify unnecessary additions.

Prioritise Whole Foods

Whole food sources provide not only essential nutrients but also bioactive compounds, fiber, and antioxidants that improve absorption and reduce oxidative stress. Examples include:

  • Alpha Lipoic Acid - Spinach, broccoli, tomatoes

  • CoQ10 - Fatty fish, nuts, seeds

  • Arginine - Turkey, soybeans, pumpkin seeds

  • Vitamin C - Citrus fruits, bell peppers, strawberries

Whenever possible, food-first strategies are preferred over high-dose supplements.

Supplements: Quality & Cost

If supplementation is necessary, patients should be guided toward third-party-tested products. Over-the-counter supplements often contain fillers, contaminants, or poorly disclosed dosing. Given that high-quality products may be costly, clinicians should consider more affordable, nutrient-dense food alternatives or low-cost supplement brands to support long-term adherence.

Monitor for Intolerance

Some supplements, particularly amino acids like arginine or citrulline, can cause gastrointestinal symptoms such as cramping, bloating, or diarrhea. Patients with metabolic conditions (e.g., diabetes, insulin resistance, or dysautonomia) may also respond differently to amino acid-based supplements. Dieticians can guide dosing and monitor tolerance.

Dieticians’ Role in Supplement

  • Comprehensive evaluations to eliminate redundancy and avoid harm.

  • Food-first strategies before high-dose supplementation

  • Patient education to correct misinformation and optimize nutrient delivery

Optimising Absorption

Some nutrients, such as curcumin, have poor bioavailability and require specific timing or delivery methods to be effective. For example:

Curcumin should be taken with a fat-containing meal and may be paired with piperine (black pepper extract) to enhance absorption. It should be used cautiously in patients with gallbladder disease, kidney stones, diarrhoea, or pancreatic insufficiency.

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