Ask The Doctor: Dizziness

My doctor told me I have low-blood pressure; could that be causing my dizziness when I stand up?
Answered by Stephen T. Sinatra, MD

Absolutely it could. If springing to your feet causes you to feel light-headed, see black or white spots, or nearly keel over, you may have orthostatic hypotension. Put simply, orthostatic hypotension—orthostatic means “standing upright” and hypotension means “low blood pressure”—is the body’s temporary inability to adjust to changes in gravity. Usually when we stand up, our bodies automatically regulate blood flow as needed—by increasing heart rate and constricting blood vessels and veins, which increases blood pressure so blood can make it up into the brain. But when people with orthostatic hypotension stand up too quickly, venous blood pools in the legs rather than returning to the heart, blood pressure falls, and the brain does not get enough oxygen to maintain consciousness.

In the US we’re so preoccupied with high blood pressure and its risks (strokes, heart attacks, or heart failure) that we often overlook the dangers of low blood pressure (light-headedness, dizziness, occasional fainting spells). In fact, overzealous use of blood pressure–lowering medications is one of the primary causes of orthostatic hypotension.

Assuming you’ve ruled out other reasons for your dizziness—low blood sugar, dehydration, anemia, heart problems, medications—you can minimize, if not eliminate, your symptoms by making these simple changes.



Eat smart
Adding more salt increases volume expansion and therefore pressure in blood vessels, which is why people with high blood pressure should avoid it and those with too low blood pressure may want to add an extra dash. But that doesn’t give you license to tear into a bag of potato chips or load up on processed food. Instead, choose healthy salt sources. Swap your generic table salt for mineral-rich kosher salt, sea salt, Himalayan salt, or Celtic salt; munch on a dill pickle; or sip a cup or two of organic canned soup once a day. A handful of organic, salted nuts (cashews or almonds) also increases your salt intake—and provides plenty of healthy protein and minerals.
Eat smaller and more frequent meals throughout the day to prevent dizziness caused by low blood sugar, which exacerbates orthostatic hypotension. Be sure to balance each meal with low-glycemic carbohydrates (fruits, vegetables, and whole grains), healthy fats (olive oil, avocado, nuts, and seeds), and lean proteins (chicken, fish, eggs, lentils, and tofu).
Caffeine can temporarily raise blood pressure, so drink one to two cups of coffee or black or green tea in the morning, when blood pressure is at its lowest.
Drink plenty of fluids since dehydration can cause low blood pressure, and cut back on alcohol, which can cause low blood sugar, aggravating orthostatic hypotension.

Step it up
Engage in light exercise to get the blood flowing, such as walking (stairs or a flat surface), up to a half hour a day, especially if you spend a good portion of the day standing or sitting. You can split this into intervals (10 minutes, several times a day) if it works better for you. T’ai chi and simple stretches also improve circulation.
Upside-down yoga poses like Headstand, Handstand, even The Plough (above), increase circulation by improving venous return (moving blood back to the heart). Just be careful coming out of the poses, so you don’t get dizzy: Go into Child’s Pose first, and then rise up on the inhalation, moving slowly. Other poses (like backbends and twists) stimulate the adrenal glands, which favorably impact blood pressure.
Wearing tights or leggings under your clothes will help keep your venous pressure from falling too low when you stand.
Don’t sit with your legs crossed for long periods of time because it obstructs venous return.
Sleep with your head elevated 3 to 4 inches. And don’t jump out of bed right away. Rise slowly, and dangle your feet over the side before standing up.

Herbs under pressure
Take 400 to 600 mg of magnesium a day (half in the morning and half in the evening) and 99 mg potassium four to six times a day. These minerals help maintain healthy blood pressure, and you may be deficient if you have orthostatic hypotension.
Supplementing with licorice root each day will raise blood pressure. Drink a cup of licorice root tea in the morning. But you should probably alert your naturopath first so she can make sure your blood pressure doesn’t get too high.
Medical consultation and treatment may be necessary if your symptoms are severe. Your doctor may prescribe small doses (5 mg, three times per day) of a beta-blocker, such as Inderal. Florinef (a corticosteroid) may also be beneficial as it helps increase volume expansion. Alternately, if appropriate, your doctor may lower or eliminate your dosage of other medications affecting your blood pressure.

By Stephen T. Sinatra, MD,a Board-certified cardiologist and author of The Sinatra Solution: Metabolic Cardiology (Basic Health Publications, 2008)