QUESTION

Sometimes I feel like I might pass out after a meal—particularly if I’ve eaten more than normal and try to stand up. Is this something serious?

ANSWER

It sounds like you may have a condition called postprandial hypotension—or in lay terms, low blood pressure after eating. This condition is common among older adults and can be easily managed. But it may also be a clue to other health issues.

Digestion, which begins in the stomach and small intestine, is hard work for the body. In order to provide the required extra energy and oxygen, some of the blood supply is redistributed to the stomach and small intestine. Normally, the body adjusts to the redistribution of blood and keeps blood pressure steady by speeding up the heart slightly and constricting certain blood vessels. However, in some people the adjustment may not happen quickly enough, causing a sudden temporary drop in blood pressure and decreased supply of blood to the brain. Symptoms such as blurred vision and dizziness can occur—as can actually passing out if an attempt is made to stand up.

Who’s at risk?

Postprandial hypotension is rare among younger people but quite common among older adults—and may in fact, affect one in three seniors. One reason is that the autonomic nervous system which controls internal body functions such as blood pressure becomes less nimble with age. Certain medical conditions—including diabetes, high blood pressure and atherosclerosis—that cause arteries to become stiffer and less responsive also increase risk. The likelihood of having one or several of these conditions also increases with age. A diagnosis of postprandial hypotension is generally made from symptoms…or by taking a blood pressure reading before and after a meal.

In most cases, postprandial hypotension is not dangerous. The main risk is injury from falls. But it’s a good idea to let your doctor know if you experience the symptoms.

Managing BP After Meals

Your doctor should first check your general health to rule out or address any medical condition, such as diabetes, that could be affecting your blood pressure. And if you are taking any medications that lower blood pressure, the dosage may need to be reduced or you may need to switch to another medication.

Generally, though, postprandial hypotension is well-managed with the following lifestyle changes…

  • Eat smaller, more frequent meals to reduce the demand for blood flow to your digestive system.
  • Eat more slowly and rest for a few minutes after eating before standing…then stand up slowly.
  • Drink more water with your meal to increase blood volume.
  • Limit sugar-added and highly processed foods, which require more energy (and more blood flow) to digest. Instead, focus your diet on fruits, vegetables and whole grains, which are digested more slowly.
  • Avoid or limit alcohol with meals, as alcohol depresses the nervous system and can contribute to bouts of low blood pressure.

If you have frequent episodes of low blood pressure after meals, your doctor may prescribe a medication, such as fludrocortisone acetate (Florinef), to prevent hypotension.