Hypermobile Ehlers-Danlos Syndrome and Naturopathic Medicine: A Holistic Approach to Care

What is hypermobile Ehlers-Danlos Syndrome (hEDS)?

Hypermobile Ehlers-Danlos Syndrome (hEDS) is a hereditary connective tissue disorder marked by generalized joint hypermobility, joint instability, and chronic pain. People with hEDS often experience soft, hyperextensible skin that may bruise easily and form atrophic scars. Beyond these, the condition frequently coexists with a host of systemic features including autonomic and gastrointestinal dysfunction, chronic fatigue, migraines, and anxiety disorders – all contributing to a complex, lifelong management journey.

Prevalence: Estimates vary, but hEDS is the most common subtype of Ehlers-Danlos Syndrome - making up 80-90% of all EDS cases. Population-based studies suggest a diagnosed prevalence of about 1 in 3,100 people, though other estimates range from 1 in 3,100 to 1 in 5,000. Broader estimates across all EDS types put prevalence at about 1 in 5,000, though again hEDS may be higher due to underdiagnosis. 

Frequently Asked Questions about hypermobile EDS:

1. How common is EDS?

   1. It's likely very underestimated. Many experts believe most figures underestimate the true prevalence, as many people remain undiagnosed due to the conditions' varied presentation and lack of lab testing markers. 

2. Who’s more diagnosed?

   1. While hEDS can impact any race or ethnicity, females are diagnosed far more often than males - sometimes at a ratio as high as 9:1. This disparity may reflect biological differences, hormonal influences, and/or disparities in healthcare access and symptom reporting. 

3. What is the most common age of diagnosis?

   1. Symptoms often begin in childhood or adolescence, yet formal diagnosis is commonly delayed - many people receive the diagnosis in their 20s to 40s.

4. Is testing available? How is a diagnosis made?

   1. Unlike other EDS subtypes, hEDS lacks a known genetic marker or diagnostic test; diagnosis relies entirely on clinical criteria.

2017 International Criteria - diagnosis requires meeting all three core criteria:

• Generalized joint hypermobility - via Beighton score or equivalent.

• Additional connective tissue features - e.g., soft/velvety skin, atrophic scarring, hernias, family history, musculoskeletal pain

• Exclusion of other connective tissue disorders - such as Marfan syndrome, vascular or classical EDS, skeletal dysplasias, neuromuscular conditions, or autoimmune connective tissue diseases 

5. So it's a Diagnosis of Exclusion?

   1. Indeed, hEDS is a clinical diagnosis of exclusion, meaning similar disorders must be ruled out through careful evaluation. 

      
      

6. What are other conditions that cause hypermobility?

   1. Conditions such as Marfan syndrome, Loeys-Dietz syndrome, and classical or vascular EDS must be considered and excluded based on symptoms, family history, and (when available) genetic testing. 

      
      

      

7. What are Potential Complications?

   1. Beyond Joint Pain and Hypermobility, hEDS can impact many body systems, leading to a wide range of complications:

      • Musculoskeletal and Pain Issues:

        • Frequent joint dislocations and subluxations, strains and sprains, leading to chronic pain and early-onset arthritis

        • Chronic musculoskeletal pain significantly affects physical and psychological wellbeing

      • Dysautonomia and Cardiovascular:

        • Many individuals experience autonomic dysfunction such as POTS, orthostatic intolerance, dizziness, and fainting

        • Cardiovascular manifestations may include mitral valve prolapse and aortic root dilation, though they are typically not life-threatening in hEDS - it is still important to monitor these features 

      • Gastrointestinal and Pelvic:

        • Up to 75% of people with hEDS experience GI issues, including reflux, bloating, irritable bowel, constipation, diarrhea, hernias, and organ prolapse

        • Voiding dysfunction and urinary incontinence are also common, as pelvic floor tissues can be compromised

      • Gynecological and Reproductive:

        • Patients report infertility at about 44% and miscarriages around 28%; these rates are higher than the general population

        • Other pregnancy-related complications, e.g., pelvic organ prolapse, prelabor rupture of membranes, preterm labor may occur, though data varies

      • Ocular, Oral, and Anesthesia-Related:

        • Ocular issues can include myopia, dry eyes, and eyelid laxity; more severe findings like lens subluxation are less common in hEDS but still possible

        • Oral/dental issues may include a high palate, dental crowding, TMJ dysfunction, periodontal disease, and challenges with local anesthesia due to tissue differences

      • Bone Health:

        • While bone density issues like osteopenia may be present, they often result from reduced physical activity and GI absorption rather than a primary bone pathology

      • Surgical and Healing Concerns:

        • Fragile tissues, prolonged healing, and bleeding risks make surgery more complicated, even for minor procedures

        • Organ and vascular rupture - though more characteristic of vascular EDS - have been reported in hEDS and warrant caution

9. What are the potential causes of hEDS?

   1. It is a genetic disorder affecting collagen. There currently is no known genetic cause of the hypermobile subtype, however research is being performed to identify the root cause through the HEDGE study. Current research on hEDS at the Norris Lab in South Carolina has discovered a potential genetic marker, KLK15. hEDS is inherited in an autosomal dominant pattern. 

Getting a comprehensive evaluation of hEDS:

Since hEDS is a clinical diagnosis, there is no specific test to confirm the diagnosis. When evaluating for hEDS, the Beighton Score is utilized during the physical examination. A knowledgeable practitioner will also assess for related conditions associated with hEDS such as MCAS (Mast Cell Activation Syndrome), and consider an echocardiogram to assess the heart structure and function.

Common Prescription Treatment for hEDS:

For pain management: anti-depressants including duloxetine or venlafaxine could be utilized however these pharmaceuticals carry the risk of side effects.

Side effects of duloxetine include: body aches or pain, cough, difficulty having a bowel movement (stool), dry mouth, ear congestion, frequent urination, headache, lack or loss of strength, loss of appetite, loss of voice, muscle aches, nausea, sleepiness or unusual drowsiness, sneezing, sore throat, stuffy or runny nose, sweating increased, trouble sleeping, weight loss.

Side effects of venlafaxine include: change or problem with discharge of semen, decreased interest in sexual intercourse, inability to have or keep an erection, lack or loss of strength, loss in sexual ability, desire, drive, or performance, severe headache, sweating.

These prescriptions do not address the root cause of hEDS however could aid in reducing symptoms.

Naturopathic Treatments for symptoms of hEDS:

Living with hypermobile Ehlers-Danlos Syndrome (hEDS) can feel overwhelming. Beyond joint instability and pain, many people also experience fatigue, digestive problems, dizziness, and challenges with wound healing. Because the condition affects connective tissue throughout the body, symptoms often touch nearly every aspect of daily life.

While there is currently no cure for hEDS, naturopathic medicine offers a whole-person approach that focuses on improving resilience, reducing discomfort, and supporting long-term health.

By addressing lifestyle, nutrition, and the body’s natural healing processes, naturopathic care can complement conventional management strategies.

In this blog, we’ll explore practical naturopathic treatments for common hEDS symptoms, including:

• Dietary recommendations to support connective tissue health and reduce inflammation, support through a functional nutritionist is highly recommended.

• Lifestyle strategies to improve stability, energy, and overall well-being

• Herbal remedies that can calm pain, ease digestion, and strengthen tissue

• Hydrotherapy approaches to support circulation and joint comfort

  
  

Together, these natural tools can empower patients with hEDS to better manage their symptoms and improve their quality of life.

The information in this blog is for educational purposes only and is not intended as medical advice. It should not be used to diagnose, treat, cure, or prevent any disease. Every person with hypermobile Ehlers-Danlos Syndrome (hEDS) has unique health needs, and treatments should be tailored to the individual. Always consult with a licensed healthcare provider—including your primary care physician or a qualified specialist—before beginning any new dietary, lifestyle, herbal, or hydrotherapy interventions.

Dietary Recommendations for Hypermobility:

Food types to eat for managing hypermobile Ehlers-Danlos Syndrome with examples

Protein-Rich Foods:

• Connective tissue is built from collagen and elastin, both of which require adequate protein.

• Include a variety of lean proteins: fish, poultry, eggs, legumes, nuts, and seeds.

• Consider collagen-rich foods (bone broth, slow-cooked meats) or collagen peptides if tolerated.

  
  

Vitamin C–Rich Foods:

• Vitamin C is a cofactor for collagen synthesis.

• Include citrus fruits, bell peppers, kiwi, strawberries, broccoli, and leafy greens daily.

  
  

Copper, Zinc, and Manganese Sources:

• These trace minerals help stabilize collagen and elastin cross-linking.

• Copper: shellfish, sunflower seeds, dark chocolate.

• Zinc: pumpkin seeds, lentils, beef, chickpeas.

• Manganese: oats, brown rice, pineapple, pecans.

Omega-3 Fatty Acids:

• Help reduce inflammation and support joint health.

• Include fatty fish (salmon, sardines), chia seeds, flaxseeds, and walnuts.

  
  

Magnesium and Calcium for Muscle and Bone Support:

• Magnesium: leafy greens, almonds, pumpkin seeds.

• Calcium: dairy (if tolerated), fortified plant milks, sesame seeds, sardines.

  
  

Gelatin and Collagen Peptides:

• Provide glycine, proline, and hydroxyproline—amino acids essential for connective tissue repair.

• Can be added to smoothies, soups, or teas.

  
  

Hydrating, Electrolyte-Rich Foods:

• Many with hEDS also experience dysautonomia or POTS. Staying hydrated with electrolytes (coconut water, bone broth, lightly salted water, fruits, and vegetables) can help maintain circulation and tissue perfusion.

  
  

Anti-Inflammatory Foods:

• Brightly colored fruits and vegetables, turmeric, ginger, green tea, and extra virgin olive oil help calm systemic inflammation that worsens pain and tissue breakdown.

  
  

Avoid Excess Processed Foods and Refined Sugar:

• These can increase systemic inflammation and impair tissue healing. Focus instead on whole, nutrient-dense foods.

  
  

Lifestyle Recommendations for Hypermobility:

Stay Well Hydrated:

• Proper hydration helps maintain joint lubrication and tissue elasticity.

• Aim for 8–10 glasses of water daily, adjusting for activity, climate, and individual needs.

• Add electrolytes (such as coconut water, mineral waters, or a pinch of sea salt) if you experience dizziness, palpitations, or symptoms of POTS/dysautonomia.

  
  

Gentle, Consistent Movement:

• Movement builds muscle tone, which helps stabilize hypermobile joints.

• Focus on low-impact exercises: swimming, cycling, Pilates, yoga (with modifications), or walking.

• Incorporate strengthening exercises under the guidance of a physical therapist familiar with hEDS—especially core and postural work to protect joints.

• Avoid activities with high injury risk, such as heavy lifting, contact sports, or excessive stretching.

• Working with a EDS or hypermobility knowledgeable physical therapist or trainer is crucial.

  
  

Posture and Ergonomics:

• Use supportive chairs, cushions, and braces when needed to reduce strain.

• Pay attention to workstation setup if you sit for long periods—proper alignment can prevent unnecessary pain and instability.

  
  

Stress Reduction and Nervous System Support:

• Chronic stress worsens pain perception and can increase muscle tension.

• Mind-body practices such as breathing exercises, meditation, tai chi, or restorative yoga can help regulate the nervous system.

• Consistent, restorative sleep supports tissue repair and energy balance.

  
  

Pacing and Energy Management:

• Many people with hEDS live with fatigue and pain flares. Learn to pace activities and schedule rest periods to avoid overexertion.

• Breaking tasks into smaller steps and using assistive tools when needed can conserve energy and protect tissues.

  
  

Protecting Joints in Daily Life:

• Use joint-friendly strategies: lifting with support, avoiding “locking out” knees and elbows, and using braces or kinesiology tape if recommended.

• Maintain a safe, supportive home environment (non-slip mats, proper footwear, and good lighting) to reduce fall risk.

Herbal Support for Hypermobility:

For Connective Tissue Support:

• Gotu Kola (Centella asiatica): Traditionally used to strengthen connective tissues, support collagen synthesis, and promote wound healing.

• Horsetail (Equisetum arvense): Provides silica, a mineral important for bone and connective tissue health.

For Digestive Support:

• Turmeric (Curcuma longa): Anti-inflammatory and antioxidant; helps reduce systemic inflammation and supports digestion.

• Ginger (Zingiber officinale): Relieves nausea, improves circulation, and offers mild anti-inflammatory effects.

• Chamomile (Matricaria recutita): Calms digestion and also soothes the nervous system.

  
  

For Nervous System Support:

• Skullcap (Scutellaria lateriflora): Calms nerve-related pain and reduces muscle tension.

• Passionflower (Passiflora incarnata): Supports relaxation, eases anxiety, and promotes better sleep.

• Lemon Balm (Melissa officinalis): Gentle nervine herb that helps with restlessness, digestive upset, and mild pain.

  
  

For Pain and Inflammation

• Willow Bark (Salix alba): A traditional natural source of salicylates, offering pain relief similar to aspirin (avoid if sensitive or allergic).

• Corydalis (Corydalis yanhusuo): Used in traditional Chinese medicine for pain management, particularly musculoskeletal pain.

• Boswellia (Boswellia serrata): Anti-inflammatory resin that may ease joint and connective tissue pain.

  
  

Hydrotherapy for Hypermobility:

Constitutional hydrotherapy is a specialized naturopathic treatment that uses alternating applications of warm and cool towels to the chest, abdomen, and back, often combined with gentle electrical stimulation to enhance circulation. This therapy is designed to improve the body’s ability to regulate itself, restore balance in the nervous system, and strengthen overall vitality.

For patients with hypermobile Ehlers-Danlos Syndrome (hEDS), constitutional hydrotherapy may provide several benefits:

• Supports Connective Tissue Healing: By enhancing circulation, constitutional hydrotherapy helps deliver nutrients and oxygen to tissues, which may improve collagen support and promote more efficient healing of micro-injuries common in hEDS.

• Eases Chronic Pain: The warm applications relax muscles and reduce tension, while the cool applications calm inflammation—together offering gentle pain relief without strain on the joints.

• Improves Digestive Function: Alternating thermal applications stimulate the digestive organs, which may help ease symptoms such as bloating, constipation, or abdominal discomfort often seen in hEDS.

• Balances the Nervous System: Many individuals with hEDS experience dysautonomia or heightened stress responses. Constitutional hydrotherapy supports parasympathetic activity, calming the nervous system and promoting restorative relaxation.

• Enhances Circulatory Health: By improving lymphatic and blood flow, this treatment may reduce fatigue, improve tissue nourishment, and assist with detoxification pathways.

  
  

Why this matters for hEDS patients: Because connective tissue fragility makes more forceful therapies risky, constitutional hydrotherapy offers a gentle, non-invasive, and whole-body approach that complements other naturopathic and conventional treatments.

At-home hydrotherapy options found below:

For Connective Tissue & Joint Support

• Warm Epsom Salt Baths: Magnesium-rich soaks relax tense muscles, reduce joint pain, and may support tissue recovery.

• Aquatic Therapy / Gentle Pool Exercise: Exercising in warm water reduces joint strain while building muscle strength for joint stability.

  
  

For Digestion

• Castor Oil Packs (with gentle heat): Applied to the abdomen, these can soothe digestive discomfort, reduce bloating, and calm abdominal pain.

• Warm Compresses: A warm abdominal compress after meals may promote relaxation of the digestive tract.

For Nervous System Regulation

• Neutral-Temperature Baths (92–96°F): Calms the autonomic nervous system, helping with anxiety, overstimulation, and sleep disturbances.

• Foot Baths (Warm or Contrast): Warm soaks before bed calm the nervous system, while alternating warm/cool foot baths can improve circulation and reduce feelings of restlessness.

For Pain & Inflammation

• Contrast Hydrotherapy (Warm → Cool): Applying warm compresses followed by brief cool compresses to painful joints improves circulation, reduces inflammation, and relieves pain.

• Warm Showers with Gentle Stretching: The heat loosens tissues, making it easier to stretch safely and reduce stiffness.

  
  

People with hEDS often have temperature sensitivity, fragile tissues, and autonomic issues like POTS. Hydrotherapy should always be gentle, never extreme. Start mild, observe how your body responds, and consult your physician before beginning a new regimen.

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Why Individualized Care Matters for hEDS

Hypermobile Ehlers-Danlos Syndrome (hEDS) affects each person differently. Symptoms can range from joint instability and chronic pain to digestive issues, fatigue, and dysautonomia. Because of this variability, there is no one-size-fits-all treatment. What works for one patient may not work—or could even worsen symptoms—for another.

At the Pacific Clinic of Natural Medicine (PCNM), we take a personalized, whole-person approach. Every patient works with a dedicated naturopathic physician and an integrated care team to:

• Understand the root causes of their symptoms, not just the surface-level effects.

• Develop tailored treatment plans that include diet, lifestyle modifications, botanical medicine, hydrotherapy, and other evidence-informed interventions.

• Minimize reliance on common pharmaceuticals that may provide temporary symptom relief but carry the risk of side effects.

• Empower patients with self-care strategies, education, and tools to support their long-term health.

  
  

The goal at PCNM is to solve the problem, not just manage it. By addressing the underlying factors contributing to hEDS symptoms, we aim to improve joint stability, pain management, digestive health, and overall vitality—all while helping patients feel supported, informed, and in control of their care journey.

References:

1. Buryk-Iggers S, Mittal N, Santa Mina D, et al. Exercise and Rehabilitation in People With Ehlers-Danlos Syndrome: A Systematic Review. Arch Rehabil Res Clin Transl. 2022;4(2):100189. Published 2022 Mar 4. doi:10.1016/j.arrct.2022.100189

2. Do, T., Diamond, S., Green, C. et al. Nutritional Implications of Patients with Dysautonomia and Hypermobility Syndromes. Curr Nutr Rep 10, 324–333 (2021). https://doi.org/10.1007/s13668-021-00373-1

3. Doyle TA, Halverson CME. Use of complementary and alternative medicine by patients with hypermobile Ehlers-Danlos Syndrome: A qualitative study. Front Med (Lausanne). 2022;9:1056438. Published 2022 Dec 14. doi:10.3389/fmed.2022.1056438

4. Duloxetine side effects: Common, severe, long term (2025) Drugs.com. Available at: https://www.drugs.com/sfx/duloxetine-side-effects.html (Accessed: 05 October 2025). 

5. Guedry SE, Langley BO, Schaefer K, Hanes DA. Integrative medicine for hypermobility spectrum disorders (HSD) and Ehlers-Danlos syndromes (EDS): a feasibility study. Disabil Rehabil. 2024;46(24):5854-5867. doi:10.1080/09638288.2024.2314713

6. Hakim A. Hypermobile Ehlers-Danlos Syndrome. 2004 Oct 22 [Updated 2024 Feb 22]. In: Adam MP, Feldman J, Mirzaa GM, et al., editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993-2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK1279/

7. Hedge (hypermobile Ehlers-Danlos Genetic Evaluation) study (2025) The Ehlers Danlos Society. Available at: https://www.ehlers-danlos.com/hedge/ (Accessed: 05 October 2025). 

8. Shah, N.D. and Wall, E. (2024) Nutritional considerations for Hypermobile Ehlers-Danlos syndrome, Practical Gastro. Available at: https://practicalgastro.com/2024/06/17/nutritional-considerations-for-hypermobile-ehlers-danlos-syndrome/ (Accessed: 05 October 2025). 

9. Song B, Yeh P, Nguyen D, Ikpeama U, Epstein M, Harrell J. Ehlers-Danlos Syndrome: An Analysis of the Current Treatment Options. Pain Physician. 2020;23(4):429-438.

10. (2025) The Norris Lab. Available at: https://www.thenorrislab.com/ (Accessed: 05 October 2025).

11. Venlafaxine side effects: Common, severe, long term (2025) Drugs.com. Available at: https://www.drugs.com/sfx/venlafaxine-side-effects.html (Accessed: 05 October 2025). 

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