Astronauts in low-Earth orbit are free falling around the planet. This causes blood to accumulate in the body at the opposite end to the direction of travel.
Astronauts on the ISS experience a phenomenon, I forget the name, of swollen heads and skinny legs because of this accumulation.
Thus when they are “upside down”, which in this context means they’ve changed their orientation in relation to the direction they are free-falling, all they are doing is changing which part of the body the blood accumulates in.
Whichever way they are facing their heart is having to work harder because it’s not getting a gravity assist and other facets of the body’s design that promote efficient blood flow against the pull a gravity become far less effective.
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