Nutrition for Hypermobility

Hypermobility and Nutritional Therapy

Hypermobility nutrition is a focus of my private practice, and many of my clients with complex health issues experience some degree of hypermobility.

This post doesn’t in any way presume to be exhaustive. Rather, it provides a selection of useful insights drawn from published literature and my clinical experience.

Please note that the topic headings below are a bit artificial. Every area affects all others. With pain managed, sleep often improves. With sleep improved, fatigue and pain often diminish. Everything is connected, which is why supporting the connective tissue health of hypermobile people is so important!

Another important caveat is that many hypermobile people are sensitive to foods, herbs, supplements, and food components in foods, herbs, and supplements. Thus, none of the items recommended here are absolutes, and the person’s individual sensitivities always need to be considered carefully.

Pain & hypermobility

Magnesium is often extremely helpful for hypermobile people experiencing pain. Beyond that, it’s important to find the right form and dosage for the person and the situation. To make a very long story short, I typically find the malate form most helpful form for people struggling with widespread musculoskeletal pain and the glycinate form the most helpful form for people with anxiety and premenstrual pain.

I’ve also used magnesium in taurate and in l-threonate form, among others, typically in combination with either malate or glycinate. The form and dosage are truly individual and dynamic.

PEA (palmitoylethanolamide) can be quite helpful for clients with pain, small fiber neuropathy, and mast cell activation issues. It is even helpful for some migraine sufferers whose migraines are triggered by mast cell activation and/or neuroinflammation. In my practice, I sometimes use it alongside curcumin.

As a clinical note, some of the targeted food, supplement, and lifestyle interventions I’ve found most effective for clients with joint pain and inflammation are:

Optimal hydration with water and electrolytes in amounts that improve mucus membrane function, digestion, skin quality, bowel function, mobility, and signs and symptoms of inflammation or edema.
Sunshine for appropriate vitamin D production and as a mild analgesic. Enough that it feels pleasant and not so much as to cause any type of rash, burn, orthostatic intolerance, POTS, or mast cell activation symptoms. The symptoms to look out for and the tolerance thresholds are individual and dynamic.
Daylight exposure, especially early in the day, helps set circadian rhythms and allows the body to better regulate cortisol and melatonin production, thus improving biochemical and metabolic processes in the body and improving quality of life.
Deep breathing, mindfulness practice, and healthy, enjoyable movement are incredibly supportive of good health – sleep, nervous system, metabolism, anti-inflammatory pathways, pain control, and more.
Laughter is an analgesic.
Homemade meat or fish stock, simmered long enough to cook any flesh thoroughly but not long enough to cause histamine responses – everyone will have their own dynamic threshold on this one. You can’t go wrong with a whole chicken or with a fish carcass (don’t forget the head!). Rooster comb is a great source of hyaluronic acid, and salmon nose cartilage is a great source of glucosaminoglycans that help rebuild connective tissue. The whole animal contains all the collagen types.
Turmeric in food (golden milk, curries) and curcumin supplements in highly bioavailable forms (I typically use Meriva).
Rose hips: rich in vitamin C, quercetin, ellagic acid, gallic acid, carotenoids, tocopherols, and tocotrienols, COX-1 and COX-2 inhibitor effect may be just one reason why rose hips perform well for arthritis pain.
Stinging nettle: contain quercetin, rich in minerals and in vitamin K, and increases the effect of NSAIDs (thus presumably allowing those needing to use NSAIDs to take them at a lower dose, reducing the damage to the gastrointestinal lining). Given its vitamin K content, anyone on an anti-coagulant should check with their medical team before taking stinging nettle.
Eggshell membrane – rich in proteoglycans and particularly helpful to those experiencing stiffness and decreased mobility. This may sound like a paradox, but it’s definitely a thing for many hypermobile people and can intensify with age and with the accumulation of injuries. Eggshell membrane is available as a supplement, but one can also get it from whole-food sources by adding well-washed organic pasture-raised eggshells to the broth or stock ingredients, and of course, imperfectly peeled boiled eggs with the membrane still attached are another handy source. The fresher the egg, the more the membrane will tend to adhere to the white of the boiled egg.
Horsetail (tea, extract, or capsules) is also supportive for connective tissue integrity and may reduce the pain and inflammation associated with osteoarthritis.
A high-quality fish oil (I like Wiley’s Finest) alongside vitamin E.

Fatigue & hypermobility

Fatigue is common in the hypermobile population, and secondary mitochondrial dysfunction is one reason for this. Standard support for mitochondria includes CoQ10, acetyl-L-carnitine, and NADH to support mitochondria. Additional nutrients needed for good mitochondrial health include vitamins B1, B2, and B3, and the minerals magnesium, manganese, and iron. It’s particularly important for manganese and iron to be present in just the right amount because these are minerals with a pretty narrow threshold between optimal levels to support good health and excessive levels that can cause oxidative stress and even neurological damage.

In addition to direct mitochondrial support via targeted nutrients, it’s important to support mitochondria via adequate rest, good HPA axis function, and a generally balanced lifestyle that aims to limit toxic exposures.

Because people with symptomatic hypermobility can have special challenges in achieving optimal nutritional status and achieving balance in daily life, including sleep, movement, emotional balance, etc., having a good personal and professional support system is essential. Most of my hypermobile clients benefit from a combination of physical therapy, emotional therapy, and nutritional therapy.

Other Connective Tissue Support

For capillary fragility, it is common to adjust levels of supplemental vitamin C as needed, with typical effective dosages ranging from 500 mg to 3,000 mg. We never want the dosage of vitamin C to cause digestive distress, and, in people with iron overload, it’s important to supplement needed vitamin C away from iron-rich foods.

Quercetin supplementation can be quite helpful for connective tissue support, especially in people who tend to have histamine and/or mast cell issues.

Zinc can be very helpful for people with a combination of slow wound healing, weak digestion, and a need for additional immune support.

For skin and mucous membrane integrity, Castori et al. recommend a combination of vitamins A, C, and E, polyphenols, prebiotics, probiotics, and polyunsaturated fatty acids. For dry mucous membranes, they emphasize the importance of optimal hydration, vitamin A, and acetyl-l-carnitine.

Cautious Supplementation Guidelines

While often recommended, B vitamin complexes are more of a mixed bag with hypermobile individuals due to a variety of factors that can make certain forms or combinations of B vitamins difficult to tolerate – they can affect methylation, vascular tone, neurotransmitter activity, histamine clearance, and more. Thus, B complexes aren’t my first go-to for hypermobile individuals, although in some cases, we have successfully tried and used them. I tend more towards targeted use of riboflavin, thiamin, choline, B6 as P5P, or other B vitamins based on the client’s presentation as a starting point, unless the client already has taken a B complex without adverse effects.

Zinc is very important to balance immune function and is a key antioxidant mineral. But at levels that exceed individual need, it can deplete copper, which is critical for collagen cross-linking and for the functioning of the DAO enzyme, responsible for clearing histamine. Zinc-copper imbalance may even interfere with immune and hormonal balance.

Thus my caution to practitioners referring to general guidelines is to individualize the supplements for each client. I find hair tissue mineral analysis to be a useful tool in guiding my individualized recommendations for minerals from food and supplement sources. And I like to start with food recommendations first. For example, I’ve only used supplemental manganese with two clients in my practice so far because targeted nutritional recommendations can truly go a long way.

Take-aways and limitations

When referred to appropriately within a framework of bio-individuality, the information presented in this article has the potential to be an asset to practitioners supporting hypermobile clients. The reality is that some people might read the article, with its lengthy list of potential recommendations, from the standpoint of “more is better” – an approach that can have several drawbacks:

Costs – the more supplements one takes, the higher the cost, and for clients on a modest fixed income, this can become a huge problem very quickly.
Sensitivity reactions, digestive overload – the more supplements one takes, the more likely it is that there will be a sensitivity.
Interactions between supplements or supplement-medication interactions.
The more supplements are used, the higher the chances that client and practitioner will miss some contraindication that may apply to the client.
When using probiotics, it’s important to have a sense of strain specificity. Some hypermobile people report intense reactions to products containing histamine-promoting strains.
Prebiotic foods and supplements are helpful generally, but it’s important to keep in mind that hypermobile clients have a higher probability than the average person of having small intestinal bacterial overgrowth (SIBO) and thus may be exquisitely sensitive to some prebiotics.

Conscientious Nutrition for Hypermobility Clients

I find it helpful to consider these questions before adopting one or more supplements:

What can we try first?
What’s the shortest list of supplements that will fit the client’s needs?
What’s the lowest effective dose? (for some things, this will be high)
What’s the shortest duration of time? (in some cases, this may be a long time or forever)
How long do we need to try the supplement before assessing the results? (for some supplements, we’re looking at 3-month timeframes or possibly longer)

It’s not a contest to take the most or the least supplements, but a process of tailoring the client’s supplement list to suit their dynamic situation from the perspective of covering their needs without going overboard. A couple of good reminders include:

More food, less superfood!
More nutrient-dense foods means less need for supplements
A healthy lifestyle limits the need for supplements
Water, sleep, sunshine, daylight, movement, and laughter are free but very valuable!

The strategies below can help limit supplement reliance:

Healthy lifestyle – reduce stress, slow down, live mindfully, move and rest appropriately
Healthy home – follow good practices for non-toxic home and body care, and remove toxic stressors before adding in supplements.
Healthy adjunct care – depending on the particular situation, some combination of physical therapy, psychotherapy, Reiki, craniosacral therapy, and gentle acupuncture, massage, or osteopathic care with a practitioner experienced in hypermobility will help keep the client in a balanced state of health and thus reduce the need for supplementation.
Healthy community – supportive and uplifting family, friends, and groups.

Reach out for individualized support

If you’d like to discuss working together, please schedule a complimentary call here. I love supporting clients with hypermobility concerns.

And if you’re a practitioner who would like to learn how to individualize your work with the hypermobile clients you serve in your practice, I’d love for you to join my case study mentoring group. Learn about that here.