The Surprising Role of Dietetics in Hypermobility Care

Hypermobility: The Journey Begins with More Than Movement

When you hear 'hypermobility', you probably think of flexible joints that can bend significantly past a normal range of motion. But for those living with Hypermobility Spectrum Disorder (HSD) or Ehlers Danlos Syndromes (EDS), we know it's much more than just an impressive party trick. It’s a systemic connective tissue disorder that often involves whole body symptoms such as pain, fatigue, autonomic dysfunction, allergy-like symptoms and more.

While Dietetics is not the first therapy that most people think of for Hypermobility, it can serve as a quiet hero - addressing key pain points and helping to sustainably improve quality of life.

Why Dietetics? Because It’s More Than Just Food

For those living with Hypermobility, it's no surprise to learn that most people HSD and EDS experience gastrointestinal symptoms. A study published in 2021 found that 98% of 603 participants with HSD or hEDS met one or more criteria for a Functional Gastrointestinal Disorder.

The complex interplay between Hypermobility, dysautonomia and excessive mast cell activation affects gastrointestinal motility, anatomy, hormonal responses, function and more. This is where Dietetics comes into play.

What Dietetics at Connected Health Alliance is:

• Thorough investigation of gastrointestinal symptoms. We don’t just manage symptoms in isolation. We dive deep into the interconnected factors, identifying how they impact one another and developing strategies that address multiple points at once. This holistic approach is vital for managing the complexity of HSD/EDS.

• Guidance on pathology tests and investigations. We can provide advice on how to request specific pathology tests (e.g., blood, urine, stool tests, abdominal x-rays) from your GP. If you're not already working with our specialist GP, Dr. Megan Thomas, we can also help to advocate for some first-line EDS medical care to ensure you receive comprehensive support. We help you understand the results of any relevant tests, translating them into actionable steps that improve your health and quality of life.

• Gentle, sustainable dietary changes and meal planning. If dietary changes are needed, we help you explore them in a sustainable way, offering personalised meal planning strategies to suit your lifestyle, preferences, budget, needs and energy levels.

• Acknowledging clinician-associated trauma. We recognise that previous experiences with dietetics may have involved rigid, weight-loss-focused approaches or restrictive elimination diets. We aim to move away from these outdated models, promoting a trauma-informed approach where food re-introduction, flexibility and your goals are central.

• Evidence-based supplements. We guide you in trialling specific nutraceutical supplements that may be beneficial for correcting micronutrient deficiencies, improving bowel health, managing histamine sensitivity, optimising digestion, and more. Supplements are always optional, and we aim to introduce only one or two products at a time to minimise overwhelm.

• Accommodating your needs and providing ongoing support. We understand that managing HSD/EDS can feel overwhelming. As standard practice, we provide a full written Nutrition Care Plan within one week of your consultation, summarising strategies and additional resources to reduce the mental load. We also offer telehealth consultations for follow-up sessions to ensure continuous support.

• Trial and troubleshooting. Not everything works perfectly on the first try, and that's okay. We’re here to be curious, adapt our approach, and explore alternatives to ensure we find what works best for you.

  
  

What Dietetics at Connected Health Alliance is not:

• Food Police! We are not here to judge or dictate your eating habits. We understand that food serves many purposes - sensory, social, emotional, and more - and we respect that in our approach.

• Forcing elimination diets or major dietary changes without your capacity. If significant dietary changes are needed, we take a careful, patient approach, ensuring that you have the capacity to make adjustments without added stress.

• Weight-focused. Our approach is not centred on weight loss as a 'fix all' for health. Instead, we emphasise nourishing your body to support overall wellbeing, without focusing on the number on the scale. If weight loss is a goal, we address it with consideration of the many factors that can unintentionally contribute to weight gain, such as inflammation's impact on metabolic health, altered stomach emptying, nutrient absorption issues, and other relevant barriers.

• Rigid or one-size-fits-all approach. Every client is unique. We tailor our strategies to your specific needs and circumstances, striving to find workarounds and alternatives where necessary.

Our ethos is centred around the belief that people with hypermobility want to eat well, but barriers such as severe gut symptoms, limited functional capacity, and the impacts of POTS and MCAS often get in the way. When we help reduce these barriers and offer gentle meal planning support, most people naturally gravitate toward eating in a way that feels good and is nutritionally beneficial.

Starting Early: Six benefits of early intervention Dietetics in EDS/HSD

1. Stabilising mast cells by correcting micronutrient deficiencies. Many individuals with hypermobility have suboptimal levels of essential vitamins and minerals (such as Vitamin D, Zinc, Folate and Vitamin C), which can exacerbate MCAS. Early intervention and correction can help support mast cell stabilisation and work towards reducing inflammatory symptoms.

2. Optimising sodium and hydration for dysautonomia. Proper hydration and sodium intake are key in managing dysautonomia, a common issue in hypermobile humans. We help you tailor your fluid and electrolyte intake to support your autonomic nervous system - supporting more stable energy levels, gastrointestinal motility and physical capacity.

3. Troubleshooting energy dips, POTS episodes, gastroparesis, and sleep with blood sugar-focused investigations. Blood sugar imbalances (insulin resistance, reactive hypoglycaemia) often contribute to energy dips, POTS episodes, and gastrointestinal motility issues in Hypermobility. Early nutritional intervention can help improve blood sugar regulation with dietary change, supplements and/or advocacy for medications, and reduce the impact of these symptoms.

4. Improving gut function with targeted dietary strategies. Addressing gastrointestinal dysfunction with personalised dietary adjustments and lifestyle tips can lead to significant improvements in abdominal pain, nausea, bloating and overall gut health - helping you feel more at ease in your body. Our first step is usually to 'unpack' stool health (pun intended - constipation is a significant issue for most clients), identifying the factors at play and focusing on achieving regular, comfortable bowel motions.

5. Fully guided elimination diets – only when necessary and feasible. When elimination diets are needed, we ensure they are fully guided, and only introduced when you have the capacity to manage them. Our goal is always to avoid unnecessary restrictions by addressing upstream factors, and ensuring a gradual, manageable approach.

6. Support with meal planning. Meal planning is often a key part of managing symptoms effectively. We help you create resources to help you with whatever you are struggling with, tailored to your individual needs, and sustainable in the long term.

7. Advice on helpful, evidence-based nutraceutical supplements. Supplements can play a critical role in managing hypermobility-related conditions. We provide evidence-based guidance on which nutraceuticals may support your health and wellbeing.

Dietetics as a Gateway to Other Treatments

Starting with dietetics can give you a head start on addressing the symptoms of hypermobility while waiting for other specialised care (e.g. waiting for availability with our GP or physiotherapist). With proper nutrition, your body is better equipped to respond to physical therapies and medical treatments, hopefully leading to more effective outcomes.

Conclusion

Dietetics may not be the first therapy you think of when it comes to managing hypermobility, but its role in improving quality of life cannot be underestimated. From addressing gastrointestinal issues to optimising micronutrient levels and supporting overall health, dietetics offers a valuable, holistic approach to managing HSD/EDS and their associated symptoms.

Romy O'Brien - Accredited Practicing Dietitian

Romy is an Accredited Practicing Dietitian with a special interest in Hypermobilty & Co and metabolic health, practicing across Connected Health Alliance and Savvy Dietetics.

She has availability for Nutrition & Dietetic consultations in person at our Wollongong Clinic on Tuesday afternoons and Fridays - for new and existing clients of Connected Health Alliance. Click here to schedule your appointment!