At the 2015 world championships in Kazan, Russia, Katie Ledecky started feeling a little weird after dinner one night—hot and lightheaded. When she returned to training, she’d have a day or two of feeling okay, then a couple with zero energy. Sometimes, as she detailed in her new memoir Just Add Water: My Swimming Life, she’d get dizzy just walking around.
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Those symptoms led to a surprising diagnosis, as Ledecky revealed in her book: She had postural orthostatic tachycardia syndrome, or POTS. POTS is a type of dysautonomia, a disorder of your autonomic nervous system, which controls body functions you don’t have to think about (like your blood pressure and heart rate).
With POTS, symptoms occur when you change position, particularly when you go from lying or sitting to standing. As Ledecky describes it in her book,
“I pool blood in the vessels below my heart when I stand. My body then releases extra norepinephrine or epinephrine, which adds additional stressors on my heart, making it beat faster. Which, in turn, brings on dizziness, fainting, and exhaustion.”
Nine years later, she continues to live with the condition, but she doesn’t let it stop her from huge goals. Here’s how the four-time Olympian—she’s already won bronze at the Paris Games in the 400 meter freestyle, and is slated to compete in 800 meter freestyle, 1500 meter freestyle, and 4x200 meter freestyle relay as well—has managed the condition while continuing to rack up the hardware.
Ledecky keeps consistent with her workouts.
Though it can sometimes feel crappy, especially at first, exercise in general—and swimming specifically—is actually one of the most effective treatments for POTS, as SELF previously reported. With swimming, you don’t change positions much, and water acts like a compression suit to control blood pressure. That’s good news for Ledecky, who writes: “What are the odds that the prescriptive exercise for my particular disease would be…more swimming?”
It’s likely that her consistent training benefits her a ton, since cardio exercise boosts circulation and leads your body to create more blood over time, stabilizing blood pressure. All that swimming also builds a stronger heart and all-over muscle, which can more effectively pump that blood through her body.
She stays on top of her hydration.
The title of Ledecky’s book could also double as one of her treatment strategies. Drinking plenty of water keeps her blood pressure and blood volume high enough, which helps reduce POTS symptoms. According to Johns Hopkins Medicine, folks with POTS are generally advised to drink at least 2 to 2.5 liters of water a day.
Ledecky has also never had a drink of alcohol, she writes. That’s largely because she doesn’t want it to interfere with her training, but it’s good for POTS too—alcohol is dehydrating and also causes blood to flow to your skin instead of the rest of your body.
And adds extra salt to her diet.
Salt helps you retain fluids and offsets all that extra norepinephrine. In fact, folks with POTS might need between 3,000 and 10,000 milligrams (mg) of the mineral daily, which is way more than the typical government-recommended 2,300 mg guideline for the general population.
With daily steps like these, it also helps to have a solid support team. “Make sure you have good people watching out for you, encouraging you,” Ledecky told SELF in June. “For instance, my mom is always reminding me to stay on my salt and hydration.”
She trusts her medical team.
When Ledecky first felt sick, her coach at the time, Bruce Gemmell, recommended she see a specialist at Johns Hopkins. She feels fortunate that she received both a swift diagnosis and treatment that helped her get her condition under control—she knows that’s not always the case.
Physical therapist and strength coach Susie Spirlock, DPT, who has POTS herself, previously told SELF that it’s important to find medical and fitness professionals who take symptoms seriously and have experience treating the condition. They can help personalize a workout or exercise program that works for you and advise you on how to manage symptoms.
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When Ledecky’s feeling sick or “off,” she checks back in.
Anytime she’s low on energy or not performing well, POTS is the first thing that comes to Ledecky’s mind, as she writes in her book. She goes through a mental checklist: Is she drinking enough? Getting her salt? Staying cool? (Heat can be another trigger.)
Getting a virus can also trigger symptoms and make it harder to manage POTS; this happened to Ledecky when she was competing in the 2019 World Championships in Korea. So she’s even more diligent about her health.
She tries to keep a positive mindset.
In her book, Ledecky admits the POTS diagnosis wasn’t the best thing that ever happened to her. She didn’t share it publicly at first, in part because she didn’t want illness to shape the narrative about her before the Rio Games in 2016.
But now that she’s lived with it for nearly a decade and feels like she has it largely under control, she’s glad she can speak openly about it. “I thought it was important to tell my whole story, and that was a part of my story,” as she told SELF in June.
In fact, she’s come to see the upside: “It isn’t too much of a burden, and it keeps me even more tuned in to my health, which as I age in the sport is only a positive thing,” she wrote in her book. It hasn’t held her back thus far, she notes, and she’ll continue to compete as long as it stays that way. After all, as she told SELF earlier, she’s already hoping Los Angeles 2028 is in the cards.
Original article appeared on Self US
