A few years ago, I had noticed that when I stand up after having sat down for a while or from bed, I became quite dizzy. So I booked myself in with the GP and have them look me over and do a blood pressure test while I was Lying down and then after I stood up. They registered the huge drop in blood pressure and then they used a fancy word for it “orthostatic hypotension”. Hoping for a fix day instead told me I had to “live with it”. This was disappointing.
Fast forward to this year when I have decided to get myself down to a level of weight I was lost in my 20s along with a goal to keep that sustained. A key part of this is in fact not Just reducing fat but thinking about metabolism and older ammunition a body has to burn that fat. I have had some success in the last couple months but recently I noticed a huge level of fatigue in the morning. Through the course of the day we pulled out a blood pressure monitor, Which confirmed that I was nearing the threshold for low blood blood pressure (90/60). The main point here was I was symptomatic which is a more important indicator, apparently.
There in fact are a number of indicators of chronic low blood pressure including water retention and morning “brain fog”
After investigating online it seems there are ““ lifestyle changes” One can adopt to help alleviate low blood pressure. There are also medications if it’s chronic. After this revelation I was annoyed that NHS had not given me the heads up on this. Why did the GP instead tell me to just live with this? What lifestyle changes should I be trying and should I measure my blood pressure when I am not symptomatic?
ChatGPT Thinking
Why might the GP have said “you have to live with it”?
There are a few possible reasons — not necessarily good communication, but clinically plausible:
-
Low BP is often not treated with medication unless it is severe, persistent, dangerous, or due to a treatable cause.
Many people with naturally low BP are not medicated because the treatment can overshoot and cause high BP, fluid retention, headaches, urinary issues, or other problems. -
If no dangerous cause was found, they may have meant “manage it” rather than “nothing can be done.”
But if they did not give you practical advice — fluids, salt discussion, standing techniques, compression, medication review — that was a missed opportunity. -
Orthostatic hypotension is often managed by addressing triggers.
NICE notes that management includes education about factors that influence BP, including sudden posture changes, heat, alcohol, and large carbohydrate-rich meals. It also says that if systolic BP falls by 20 mmHg or more on standing, medication should be reviewed, later BP measurements should be taken standing, and specialist referral considered if symptoms persist. (nice.org.uk) -
Medication may not be appropriate unless lifestyle measures fail or there is autonomic dysfunction.
Drugs such as fludrocortisone or midodrine can be used in some cases, but they are not casual “low BP tablets”; they need monitoring and are usually reserved for more troublesome or specific cases. NICE discusses midodrine for orthostatic hypotension due to autonomic dysfunction, with careful evaluation of benefit and risk. (nice.org.uk)
So: your annoyance is understandable. “Live with it” is not a satisfying explanation. A better message would have been: “This is often managed rather than cured; here are the strategies, red flags, and when to come back.”
Important given your recent weight-loss/metabolism changes
Because you are now getting new or worse morning fatigue/brain fog and BP near 90/60, it would be sensible to book a routine GP review, especially if this is a change from your usual baseline.
Weight loss, calorie restriction, lower carbohydrate intake, fasting, increased exercise, reduced salt intake, dehydration, alcohol, and some supplements/medications can all make orthostatic symptoms worse. Morning symptoms can be worse because you have gone several hours without fluid or salt intake.
Also, persistent low BP symptoms can sometimes be linked with things worth checking, such as:
- dehydration or low salt intake
- anaemia / low ferritin
- thyroid disease
- diabetes/autonomic issues
- adrenal problems
- heart rhythm issues
- medication effects — including BP tablets, diuretics, antidepressants, erectile dysfunction meds, sedatives, opioids, and some Parkinson’s meds
- rapid weight loss or under-fuelling
The British Heart Foundation notes that low BP can be associated with medicines and underlying conditions including diabetes, thyroid problems, Parkinson’s disease, heart failure and arrhythmias. (bhf.org.uk)
Lifestyle changes worth trying
1. Hydration: make mornings deliberate
Try drinking water soon after waking, before standing for long. NHS advice commonly points to around 6 to 8 glasses of fluid per day, though your needs may be higher with exercise, sweating, dieting, low-carb eating, or hot weather. (bhf.org.uk)
Practical approach:
- Keep water by the bed.
- Before getting up: sit up, drink some water, wait a minute or two.
- If you exercise in the morning, hydrate first.
- Watch for dark urine, headaches, dry mouth, or worsening symptoms after caffeine/alcohol.
Do not massively overdo plain water without electrolytes, especially if dieting hard — too much water with too little salt can make you feel worse.
2. Discuss salt — don’t just start megadosing it
Increasing salt can help some people with postural hypotension because it expands blood volume, but it should be done carefully, especially if you have kidney disease, heart disease, high BP episodes, migraines, oedema, or are on certain meds. Mayo Clinic specifically says increasing salt should be discussed with a healthcare professional because too much can create new risks. (mayoclinic.org)
A practical GP conversation:
“My BP is often around 90/60 with symptoms. Would increasing dietary salt or using electrolyte drinks be appropriate for me?”
If you are dieting and eating very “clean”, you may have unintentionally cut salt quite low.
3. Stand up in stages
This is simple but often effective:
- From lying: sit first, feet on floor, wait 30–60 seconds.
- Tense your calves/thighs before standing.
- Stand slowly.
- If dizzy, sit or lie back down immediately.
- Avoid jumping out of bed, especially after poor sleep, alcohol, fasting, or heavy exercise.
4. Use counter-pressure manoeuvres
When symptoms start:
- Cross your legs and squeeze thighs/buttocks.
- Clench fists.
- Raise one leg onto a step.
- March calves in place.
- Squat if safe.
- Sit or lie down if symptoms are strong.
These help push blood back toward the heart and brain.
5. Avoid big trigger meals — especially high-carb meals
Large meals, especially carbohydrate-heavy ones, can divert blood flow to the gut and worsen post-meal hypotension. NICE mentions large carbohydrate-rich meals as a factor influencing BP in orthostatic hypotension. (nice.org.uk)
Try:
- Smaller meals.
- More protein/fibre.
- Avoid huge carb-heavy breakfasts if mornings are your worst time.
- Be cautious with alcohol at meals.
6. Be careful with alcohol and heat
Alcohol dilates blood vessels and can worsen hypotension. Heat does the same — hot baths, saunas, hot showers, warm rooms, standing in the sun.
Try:
- Cooler showers.
- Sit down after a hot shower.
- Avoid standing still in warm environments.
- Hydrate before/after heat exposure.
- Limit alcohol, especially in the evening if mornings are bad.
7. Compression garments may help
Waist-high compression tights/stockings or abdominal binders can reduce blood pooling in the legs/abdomen. Knee-high socks may be less effective for true orthostatic hypotension, though some people still find them useful. Mayo Clinic notes waist-high compression stockings may improve blood flow and reduce symptoms. (mayoclinic.org)
This is worth discussing if symptoms are frequent.
8. Review your weight-loss strategy
Because your symptoms appeared during weight loss, consider whether you are under-fuelling.
Check:
- Are calories too low?
- Are carbs very low?
- Have you cut salt unintentionally?
- Are you exercising fasted?
- Are you losing weight too quickly?
- Are you getting enough protein?
- Any new supplements, diuretics, “fat burners”, caffeine increase, GLP-1 medication, or appetite suppressants?
If you are pursuing sustained fat loss, severe fatigue and symptomatic hypotension are signs to adjust the plan, not push harder.
Should you measure your BP when you are not symptomatic?
Yes — but do it in a structured way, not obsessively.
Measuring only when symptomatic tells you what is happening during episodes. Measuring when well gives your baseline, which is useful for your GP.
A good home log for 1–2 weeks:
| Situation | What to record |
|---|---|
| Morning before food/caffeine | BP + pulse lying or seated |
| After standing 1 minute | BP + pulse |
| After standing 3 minutes | BP + pulse |
| During symptoms | BP + pulse + what you were doing |
| Evening | seated BP + pulse |
NICE recommends lying/seated and standing measurements when postural hypotension is suspected, and repeated standing measurements over several minutes are commonly used. (nice.org.uk)
Also record:
- symptoms: dizziness, brain fog, weakness, nausea, palpitations, near-fainting
- meals, caffeine, alcohol
- hydration
- exercise
- sleep
- weight-loss rate
- medications/supplements
- whether symptoms improve with fluids/salt/lying down
The pulse is important. For example, if your BP drops and your heart rate rises a lot, that suggests your body is trying to compensate. If BP drops but heart rate barely changes, that may point in a different direction and is useful information for the GP.
When to seek medical help
Book a GP review if:
- symptoms are recurring or worsening
- you are near/below 90/60 with fatigue, dizziness, brain fog or weakness
- you have fainted or nearly fainted
- symptoms started after weight loss, diet change, new medication, or illness
- you have palpitations, breathlessness, chest discomfort, new headaches, or exercise intolerance
- you are getting morning symptoms regularly
Ask specifically about:
- postural BP measurement
- medication/supplement review
- blood tests: FBC, ferritin, U&Es/kidney function, thyroid, glucose/HbA1c, B12/folate, possibly morning cortisol if clinically indicated
- ECG if palpitations, fainting, chest symptoms, or unexplained fatigue
- whether referral is appropriate if symptoms persist
Seek urgent help / 999 if:
- you faint and injure yourself
- chest pain, severe breathlessness, stroke-like symptoms
- confusion that does not quickly resolve
- black/bloody stools, severe dehydration, persistent vomiting/diarrhoea
- signs of shock: cold/clammy, very weak, rapid breathing, collapse
Bottom line
You probably have orthostatic/postural hypotension, and while it may not be “curable” in a simple sense, it is often manageable. The core strategies are:
- hydrate deliberately
- discuss salt/electrolytes with your GP
- stand up in stages
- avoid heat, alcohol and huge carb-heavy meals
- consider compression garments
- review diet/weight-loss intensity
- keep a BP + pulse symptom log
- go back to the GP if symptoms are persistent or new/worse
And yes — measure BP when not symptomatic too, because your baseline and your standing response are both clinically useful.