Does your management of hypermobility consider the following areas of influence?
As discussed in Parts 1: Stress & Anxiety, and Part 2: Hormonal Cycles, hEDS and HSD management requires addressing more than musculoskeletal pain and subluxations/dislocations. Being that it is a connective tissue disorder, the altered collagen structure can affect all bodily systems including organs. The gastrointestinal system (GI) is one of the most under-reported of these systems due to chronic fatigue and pain elsewhere being primary life-limiting complaints.
Currently, there is no singular mechanism to determine the cause or development of symptoms in each individual and evidence-based guidelines are not (yet) available as there is widespread variability among patients. However, GI problems are becoming largely recognized as being a key issue within all types of EDS, affecting some 48-72% of patients, so it behoves patients & caregivers alike to turn some attention to addressing this important structure. Recognizing the digestive system's impact on the body from tissue health to pain management and fatigue can lead to better overall function and quality of life.
Digestive Health & Hypermobility
hEDS and HSD are associated with a litany of digestive problems, including but not limited to: Functional Dyspepsia, Irritable Bowel Syndrome (IBS), Celiac, Mast Cell Activation Syndrome, chronic diarrhea/constipation, gut dysmotility, delayed stomach emptying, acid reflux, chronic bloating, nausea, and food intolerances, to unfortunately only name a few.
It’s important to recognize that for optimal function, the GI system from mouth to anus relies on nerves, muscles, bacteria, digestive enzymes, and neurotransmitters to digest, assimilate, and evacuate foods. While its responsibilities include the more obvious break down and absorption of nutrients to sustain life, the roles played in mood regulation, immune system function, and subsequent inflammation are equally relevant.
Digestive health also relies on the integrity of the gut lining: a healthy lining is tightly bound without large gaps between microvilli to facilitate food being absorbed directly through cells or passed along to be expelled. Within the hypermobile population, all tissues in the body- including those supporting and lining the digestive tract - are likely to be more porous. This increased permeability negatively impacts absorption, motility, and can cause a heightened immune response along with changes in gut bacteria. For this reason, it’s not hard to see why the aforementioned digestive symptoms are all too common.
A Note About Mast Cells
Mast Cells play a regulatory role in the tissue remodeling and immune contraction processes that must occur subsequent to inflammation to restore homeostasis.
The intestine’s extracellular matrix (ECM) is in direct close contact with Mast cells (MC) that serve as our first line of immune defence (80% of our immune system lies in the gut). If there is a connective tissue problem resulting in increased intestinal permeability, food proteins that bypass cell absorption sneak through directly to our Mast Cells that, in turn, activate and release bioactive substances including histamine, heparin, serotonin, and enzymes.
Mast Cell Activation Syndrome (MCAS)- distinctly different than MC Activation Disease- is found increasingly often with those diagnosed with hEDS, POTS, and connective tissue disorders (up to 66% surveyed in one population). GI symptoms can include pain, discomfort, bloating, hive/rash outbreaks, many food intolerances, heart burn, IBS, cyclical vomiting, and diarrhea/constipation even in otherwise apparently healthy patients.
A more in depth look at MCAS and the link with EDS by Dr. Lawrence B Afrin is publicly available here and Mast Cells United provides an in-depth look at holistic patient-led management of MCAS.
What does this mean for you?
Our environment and food serve as our mainline communication with the gut and consequently, our immune system. Each individual may have to employ different strategies when sorting out tolerable food choices, eating volume or frequency, and environmental (stress) tolerance. Despite this, it's important to understand that a slow decline in wellness over time is not inevitable.
The food we choose to ingest dictates nutrients, communication, growth, and repair: You may not be what you eat but you do express what you eat and can optimize health based on daily choices. With that in mind, nutrition isn't simply a matter of macro & micronutrients or even calories for that matter. Such a simplistic approach would discredit how foods interact with the gut lining, particularly in those with hEDS or HSD, to regulate neurotransmitters, tissue health, hormones, inflammation and immunity.
Because the mechanisms can vary so widely from one individual to the next, it becomes important to track symptoms and develop personal management strategies. For a great discussion by Dr. Qasim Aziz on the ins and outs of hEDS gut structure considerations, his open-access lecture is well worth watching.
Summary & Questions to Consider
- Stress: Pay attention to digestive changes under stress.
Environmental, physical, and mental sources of stress can affect the gut lining causing it to slow down and increase permeability with notable changes in gene expression & bacteria. With a digestive tract that is already prone to greater permeability, times of high stress may require dietary changes in an effort to consider reducing gastric load.
In simplest terms, the more complex (many ingredients), processed, or high sugar the food is, the harder it is on your GI system, particularly in times of stress. Both physical and psychological stress has been known to activate Mast Cells, exacerbating inflammatory responses within the body and promoting chronic pain: Stress management is imperative to figuring out tolerable food sources as you can react to a "safe" food if you're in a high stress state.
- Check Your Basics: Are you drinking, moving, and breathing?
Check out our blog on the Top 3 Habits: while not targeted at the hEDS or HSD population, these 3 health basics are ones that often get missed and can help dramatically improve digestive health and stress management.1. Ensuring adequate water intake will help improve tissue health particularly with a digestive tract that may be losing it frequently or becoming stagnant.2. Proper breathing mechanics can assist with gut motility due to the interaction of the diaphragm with surrounding organs. It is easy to overlook because many people believe this is too simple to be true ("breathing can't possibly do all that"), but please let this be a reminder that the human system is incredible in its design and in how all systems interact to maintain homeostasis and health.
3. Movement is a necessity with all beings and ensures, too, that your gut keeps moving. It doesn't have to be intense, it simply has to be consistent and within your capacity. Those with MCAS, despite fatigue and reported malaise, are strongly advised to keep moving regularly.
- Food: Have you eliminated any of the common allergens or irritants?
While there is no "perfect" diet for those with hEDS (or truly with any human), reducing some of the more common irritants has shown promise in managing inflammation, pain, nutrient absorption, weight management, energy, and daily life as a whole. Avoiding all processed foods, eating too much at once, or eating in a stressful state are all to be avoided for improving digestive health.
Check out our two posts on Constipation and on Bloat for suggestions on foods to consider eliminating (and why), in a step-wise process to find what works for you.
Further, the FODMAP, Gluten-Free, and Low Histamine guidelines can all be considered for problem-solving tolerable food choices.
- Medication: What may "fix" one problem may exacerbate another.
Opiates & NSAIDs, often used for pain management in this population, can severely impact gut function and lead to deterioration in symptoms thus perpetuating chronic pain. Chronic use can lead to tolerance (meaning it doesn't give you the pain relief and you need higher doses to get that effect), with diminishing returns and increased symptoms similar to persistent IBS.
Seeking treatment to help address some of the connective tissues & muscles in and around the gut can alleviate pain and improve function.
NB: Any and all medication changes should be thoroughly discussed with your primary care physician or specialists. Consider working with them to figure out how best to remove opiates and NSAIDs in a manner that addresses both musculoskeletal and GI systems.
- Supplements: Consider discussing supplements with your allied health care practitioner.
1. Vitamin D: Often found to be deficient, Vit D is critical for not only bone growth but it is also necessary for endocrine, immune, and cardiovascular system function. Deficiencies, common in hypermobile populations, are associated with increased inflammation, chronic fatigue, pain, and increased fracture risk.
2. Magnesium: Mg is involved in roughly 300 biochemical functions and can help reduce nerve & musculoskeletal pain as well as improve sleep.
3. Vitamin C: Vit C is a cofactor in collagen synthesis, is involved in neurotransmitter synthesis, and can help with detoxification processes.
Digestive Health is complex and changes over time. Sorting out the right individual approach consists of focusing first on small daily practices, being open to troubleshooting food tolerances/intolerances, managing stress, moving daily, and working with allied practitioners where necessary. With the right tools for you, GI distress no longer has to be a life-limiting step.