Hey, I'm Hyper mobile and if you're listening to this, I'm
guessing you might be too. Hi, my name is Alex and I'm your
hyper mobile host. And today we are talking all
about hyper mobility and your gut and this is one of those
things that needs to be talked about more.
So thank you for joining and I hope that you maybe share this
with a friend or talk with other people you think who might be
hyper mobile because this is an issue which has a lot of stigma.
Firstly, gut issues are embarrassing.
You know, we're going to, we'll talk in a second about some of
what's going to be in this episode, but you know, it's not,
it's not fun. It's also a sensitive subject.
There are, you know, I'll do the trigger warning now let's just
get out of the way. There are a lot of issues here
which are very sensitive and very challenging to talk about
for a variety of reasons. There are people out there who
have different kinds of eating disorders and there is evidence
to suggest that they are more prevalent in the hyper mobile
community. Of course, we're also going to
talk about things that are just embarrassing for some people
like diarrhea and Constipation. So if this is an episode, maybe
you're listening to with your kids.
I don't know what people listen to these days for fun, but if
you're listening to this and you want something which is
definitely going to be a super like family friendly, happy, yay
kind of vibe, this, this might not be that episode, but it'll
be really cool and really interesting.
So without a further delays, let's get started.
So gut issues and hyper mobility, they go together like
peanut butter and jam. They just, they they are two
things which I see for the most part.
Now I have to stress again my, my clinical role is as a UK
registered osteopath. So I'm not a medical doctor, but
I work with patients. They often come to see me
because of their muscle and joint pain.
And then I try my best to support them in terms of
improving all the other stuff they have going on by making
sure that they're getting that correct medical care and that
correct medical management. But gut issues are one of those
things I see in the vast majority of my patients for me
to see a hyper mobile patient. So typically this will be
someone with Hgds or HSD, occasionally another condition
or someone who's undiagnosed and on that diagnostic journey.
But for me, I'd say probably close to like 90% of my patients
have got issues. And bear in mind my patient
population are mainly people in their like 20s and 30s.
I do have patients of all ages, but I have a lot of patients on
that, kind of like younger side, 20s, thirties, 40s and so on.
So for them to be having serious gut issues at this age suggests
that there might be a link. Research of course is still
ongoing. I'm going to talk about one
study in particular in this episode which is super
informative and helpful, in which I suggest you maybe read
or speak with your medical doctor about it.
The whole point of what I've just said is gut issues are
common, OK? However, there are the
occasional patients who don't have any gut issues and I'll
I'll be doing their medical history.
And I typically start off because I try to be sensitive
when I ask people questions during a medical, medical
history. So I'll say tell me about your
relationship with food. That's how I typically like open
the door to that kind of questioning.
And then this occasional, very rare patient will just be like,
oh, it's great. And I ask them, you know, any
issues or, you know, blah, blah, blah.
And they're like, yeah, I eat pizza with no issues.
I can do whatever I want. My gut function is fine, No
issues with my stools, no family history.
Everything's like super rosy. And I'm just sitting there a
little bit jealous, quite frankly, because gut issues are
something that I do not personally have the best time
with, but there are hyperbole. Patients who do not have gut
issues. However, for the vast majority
of people who do, this episode's for you.
So I do have some notes with me today.
You're going to see me glancing off them okay, because it's hard
to remember all this stuff on camera, but gastrointestinal
symptoms and disorders of the the gut brain interaction are
common. So we need to think about why
this happens a little bit and how we get that kind of
connection, And we'll delve into that more later in this episode.
But we know that people with anxiety often have altered gut
function. We know that even in some
neurodivergent conditions like autism, we're starting to see
more and more evidence of gut dysfunction presenting in those
individuals as well. And again, I'm not an expert on
that subject, but we're seeing evidence clearly of a link
between gut and brain function, which is not surprising when you
consider that there are nerves that go to your gut and there's
connective tissue there and it all makes a complex system.
Now in terms of these individuals, these people who go
on to become people who get disorders of gut brain
interaction, my hunch is that these are going to be people and
they're often hyper mobile children who are the ones who
are saying, like, hey mom, my tummy hurts when I'm sad.
And if this is you, if you're an adult and your tummy hurts when
you're sad or your gut hurts when you're angry or you feel
things in your gut, maybe there's a link.
But again, we don't have research on that yet.
Now in terms of causation and corelation and association, what
we can say about gut issues, and we're talking here things like
diarrhea, Constipation, we're talking about things like
flatulence. And in all honesty, I mean, you
need to talk about it, which because it's hard when you're
when you're a young person in your 20s and you know you're
trying to navigate all that and then you're having issues with
upset tummy and flatulence, That's embarrassing early, early
feelings of fullness. We see things like rumination,
where food is coming up when it shouldn't.
We see things like different types of digestive pain, all of
these different things we see in hyper mobile individuals and we
know and the researchers at this present moment are very
confident in saying that there is certainly an association and
a correlation. So we know.
So when we look at a hyperbole population, there is a greater
there seems to be evidence of some kind of a link between
hyperbole individuals and gut issues that we see in people.
However, as of this point in time, what is it?
It's August 2023. Summer is almost over.
We don't know the exact mechanism that's causing this,
and I'm going to share my unresearched hypothesis on that
today. So if this interests you, you're
going to get to hear my theories.
However, oh by the way, I'm going to put some tips at the
end on things that I do with patients, like little tips,
strategies, things you can speak with your medical doctor about
that might help you. So stay tuned for that.
However, before we go any further, we have to talk about
something really, really serious and this is something I hate in
my clinical work. It's the single hardest thing
about my work. It causes me an overwhelming,
sometimes an overwhelming amount of stress.
It's so stressful, but when you work with patients who have
chronic health issues and especially the hyper mobile
population who are my favorite forever and always, however,
they do cause me stress. We see the situation where this
person has, for example, gut pain and they have a change in
bowel habit and we play the I call it a game.
I don't mean in like a funny sense, I mean kind of, you know,
in a maybe dark humor sense. We play this game of like, is
it, is it HEDS stuff? Like, is it HSD stuff?
Is it, you know, one of their diagnosed condition stuff or is
it something sinister, something else, something perhaps even
like bowel cancer? And this is where things get
hard, they get clinically complicated and they get
downright dangerous sometimes. So I want to just read actually
a a quotation from Deborah James.
She's a she was a Dame in the UK How a woman in the UK who
received a Dame hood, as they do over here.
And she writes about her experience and her kind of like
how she first presented with bowel symptoms.
And this struck A chord with me because it sounds exactly like
what I hear from my patients. And although most of the time
it's nothing serious, if we if we say that sometimes it is.
And as regardless with anyone, I don't care if the patient's 90.
I think we need to manage everyone like their life really
matters. And like we, you know, we want
to protect their best health outcomes.
However, especially for younger patients, we really, really need
to be on it and we need to not be missing cases where we could
potentially, you know, save someone's life, protect that
person who maybe she's someone's daughter, maybe she's someone's
mother. May, you know, we people, I try
and remember that every single patient I see, they're they're
usually loved by people and they matter and they bring good into
the world. So we need to always, always be
taking everything so seriously and on the lookout for those
scary and serious causes of symptoms, which most of the time
are going to be nothing. But anyways, here's the quote,
OK? Deborah James says I'm the
perfect example of a hypochondriac, one that
immediately thinks dizziness means a brain tumor, a cough
means lung cancer, and blood in the stools means bowel cancer.
However, years of CBT has meant that I've learned to rationalize
almost every ailment inducing symptom, the last year of a
change in bowel habits that I put down to too much wine, a new
job, and stress of trying to be that fulltime working supermom.
If only someone believed me earlier that I wasn't crying
wolf. When in my normal nervous GP
Question Time, I tell the doctor that I think I have bowel
cancer. I'm actually laughed at not one
time, but three times over the course of six months, despite
being reassured on numerous occasions that I must have I BS
hemorrhoids or at worse colitis. My blood test and stool sample
came back normal, so everything must be fine.
And yet I was still losing weight, passing blood, going
what felt like 100 times a day and feeling shattered.
So this quotation really struck A chord with me because as like
this is from someone who had bowel cancer and who died of
bowel cancer, I believe she passed away when she was 40 and
it was about a year ago, I think now.
But anyways, this quotation could have been just as easily
from someone who's hyper mobile. I see patients all the time who
have chronic diarrhea who have issues with hemorrhoids, for
example, and sometimes it is hemorrhoids causing blood in the
stool. But what scares me is just when
there's what I believe to be not careful enough management.
So I'll see patients who tell me about all these symptoms and and
people do tend to open up to me a bit.
I think it's just because I'm, I'm lucky in that in my work as
someone who works in the private healthcare system, I do have
more time with my patients and that does that helps patient
safety immensely. But I'll talk with my patients
and they say, you know, I was told that I had IBS through a
phone consultation that lasted 5 minutes and I had no testing.
And we didn't really talk about anything.
Like, you know, the way that you've talked with me and that
always makes me scared. I don't like that.
And that's why part of my work is that I, I do try and support
patients and make sure, you know, I'll tell the patient,
look, you know, I think this was okay.
If, if it's a situation where it sounds okay or I'll say, you
know, I am quite concerned about this.
I am quite concerned that you didn't have time to talk with
the doctor about the blood in your stool or whatever, right.
So it's about that, that's it's about safety, patient safety.
Ultimately, this is what it's all about and with gut issues,
it is very nuanced and very, very complex.
And I do think that perhaps diagnosis of IBS, Irritable
bowel syndrome, that they're thrown out like, I don't know,
like it's a a free it's thrown out with a lot of without the
correct medical investigation that it should have in a lot of
the time. And you can go to your research
online, you can look into what a diagnosis of IBS should entail.
But it's not just something that you can say without having
checked that patient, without having done investigations,
without making sure that they're safe.
So anyways, gut issues. I'm going to talk about them
here. I'm going to provide a lot of
reasons why things might happen in hyper mobile bodies and why
things might be a bit weird. But at the end of the day, if
you leave with one message from this episode, the most important
thing is to firstly to know your normal and to know what's
abnormal from your normal. And knowing your normal is so
hard when you're a hyper mobile person because your body's
constantly changing. It's in a flux.
You don't know if it's going to be a good day or a bad day or
you know it's that. I talk about it being like a
tropical island, like in your body, instead of having a
constant climate, you have these, you know, thunderstorms
in the morning and sunshine in the afternoon and maybe a
rainbow later, maybe followed by hail like though it becomes
unpredictable. But as much as possible
hyperbole, patients need to be supported in learning what their
normal is, that if something gets weird, they're able to
clock it and they're able to flag it to their healthcare
provider, who they hopefully have, who is a hopefully
appropriately qualified and that they trust and that they feel
able to communicate to them about this stuff that that is
the most important thing. So that is my message for you.
Now moving on, there is an absolutely brilliant research
paper. It's a narrative review.
I believe it was published in 2022 and it's called hypermobile
elders dental syndrome and disorders of the
gastrointestinal tract. What every gastrointesterol
gastroenterologist, Well, I'm losing my words today, needs to
know if you are someone who's trying to get investigated for
gastro issues or if you're a gastroenterologist who's
listening to this and maybe you keep having these like
hypermobile people showing up and you don't know what's going
on. That paper looks awesome to me.
I've read through it a few times.
I think it's really well written.
I think it's very clear and it's very short.
Who doesn't love a short paper, but there they talk really about
the prevalence of different types of of gut issues that we
see in patients. We are seeing things like, for
example, an increased rate of celiac disease.
Potentially. We are seeing things like
potentially an increased rate of interception, which is when the
bowel kind of folds in on itself.
And those are two examples of different kind of things.
And that leads us into the next part of this episode.
We talk about like what's actually going on?
Why are hypermobile got so weird?
So here's my theory. Hypermobile got so weird for two
reasons. We have them.
Well, three, but we're going to start with two, OK.
Firstly, there's a mechanical side of everything.
So if you listen, if you've been listening to this long enough,
you know I always end up talking about mechanical issues and
inflammatory issues. So your gut is a tube.
It is a tube of connective tissue, which as you can imagine
is not the best thing for a lot of people who have connective
tissue disorders. I want to stress to you that you
are like a donut. So if we took your body, and I
promise this will make sense in a second, just just bare me out.
So just hear me out or bear with me or do both.
It's up to you. You are a donut, so you have a
tube, Your mouth is the start of the tube, your your bum is
banned and basically that space is hollow inside you.
So if you imagine a donut, your body is like the part that you
would eat and your gastrointestinal tract is that
hole in the middle. That's what that tube is.
Your gastrointestinal tract is where your body has to deal with
the outside world. When you eat food, you're taking
the outside world and you're putting it inside you.
And that's firstly, that's really, really cool and just
normal Physiology. I think guts are so interesting.
But secondly, that's why we see a lot of these different types
of issues with food sensitivities and allergies and
all these different things because you're being exposed to
your outside the outside world through your gut.
Because you, even though you might not have known it until
right the second you're a doughnut.
Now the problem is that the food you don't just like, take it and
you don't just go like lip, like drop it in your mouth and then
it just magically goes down. That's not how this works.
There are many, many steps to getting food from here to the
end of its journey. So starting at the the mouth, we
look from a mechanical perspective.
Again just talking about hyper mobile patients and some of the
mechanical issues they might encounter on the the journey of
food. You have to firstly chew the
food and a lot of hyper mobile patients have issues with their
teeth. We see gingivitis, we see
patients who have lost teeth, we see all types of dental issues.
We'll do a dental episode one day, don't worry.
But we also see all TMTMJ issues, which makes chewing food
painful. So of course we have problems
there to begin with, and not even that's without even
considering about issues involving not feeling hungry.
And we're going to get into some of the neurology stuff later in
this episode. But you have to chew the food,
You don't have to swallow the food.
Swallowing is complicated. It's a series of movements which
is incredibly complex, and it's one of those things, if it
happens for you, you just take it for granted.
But for patients who have issues with it, it's something which
really does affect their quality of life and requires sometimes
very complex medical management. And it's one of those things
that I'm always looking out for in patients because I want to
make sure that we catch it early.
I don't like to miss things that can lead to problems because
then it sucks for the patient, It sucks for me.
So swallowing issues or something, I try to be very,
very quick to identify, but some people have very, very mild
issues. Maybe they'll just have a hard
time swallowing a pill, maybe their Airways.
A little bit different in terms of the anatomy.
But other people will have very serious issues where they they
really do struggle to swallow anything anyways.
So you have to swallow the food. Now the food goes down your
esophagus and you might not notice you've like little valves
along the way. So little like flaps throughout
your body. And their job is to hold stuff
in certain places. So you have little flaps which
are meant to like once food goes through it, hold it down in the
stomach and sometimes hyper mobile people have issues with
those flaps. From a mechanical perspective
with those valves, you're not going to be surprised.
Sometimes they're hyper mobile. And what this means is that food
that has gone down and should stay down does not always do
that. Sometimes it will kind of come
back up and that can present as different things.
You can have rumination where food is coming up all the way
back into the mouth and it's actually undigested.
So it's coming back up very, very quick.
You can also have things like hiatal hernias, which is where
one of the valves in your esophagus is not quite working
as it should. And that food is, is coming back
up and presenting almost as symptoms that we would refer to
as heartburn. However, moving on, let's
pretend that the food has made it to the stomach.
The food then has to get digested in the stomach.
Now there's a whole, like, you know, biochemical situation that
happens down here involving acid and all these other things,
which is really cool. We're going to leave set that to
the side for a SEC. But there's also a whole
mechanical process like where your stomach is literally
helping to kind of smoosh the food.
So your stomach does all these like, squishing motions.
I'm. I'm showing it with my hands if
you're watching on YouTube, hi. But like your stomach, it's
squishing the food to try and further smoosh it so it can then
go into your small intestine. So the food then gets into the
intestines. And this is where things start
to get, I was going to say more problematic, but there's
problems along the whole track. So this is just like different
problems, OK, but this is where some new problems crop up.
So we do a lot of absorption of nutrients in the small
intestine. It's very, very important And
unfortunately sometimes hypermobile people do have
issues with this. And This is why you'll see these
patients who thought like instead of just having normal
blood values for different vitamins and so on, they'll have
like slightly low but not that low that it's concerning.
But just they'll always they'll be patients who kind of they
have things going on in their blood work that aren't causing
them immediate harm, but we don't know why they're
happening. That's that's kind of like a
classic presentation that I see in my patients.
But with the small intestine, we will have issues with vitamin
absorption there, especially B vitamins.
And I think that that might happen partially and this is
just my hypothesis. Again, there's no research to
prove this at this point in time, although hopefully there
will be one day. But the food is moving either
too slowly or too quickly through the the small intestine
and the large intestine that that's my thought and let me
give you an example. So imagine that you have a
factory in a conveyor belt and certain things need to happen
along the conveyor belt at certain points in time.
So let's pretend that we're making little like wooden fire
trucks. I don't know.
We're make whatever we're making.
The belt cannot move too fast because if I have to assemble
the truck and then the next person has to be like painting
it and the final person has to like put a sticker on it, I
don't know if that belt is going too fast.
It's not going to happen. It's the end product is going to
look like a hot mess, but if the belt is moving too slow, then
the person at the end of the you know, the conveyor belt, they
might just go home at a certain point to go to sleep.
So again, we're gonna end up with a problem that that product
is not happening as it should, that series of events is not
happening as it should. So This is why.
Normal gut motility is very, very important.
Your food must move through you at the correct rate in order for
the correct things to happen at the correct time.
We could kind of just an episode there, to be honest with that.
That is like gut function summed up okay things need to happen in
the right way at the right time and stuff has to move through
you at the right speed. Now hyper mobile patients
classically will present when we get to kind of the the end
product of human digestion if you call it that's we're talking
stool, let's let's use that word for today.
But they will end up with a mixture often, very often of
diarrhea and Constipation and they don't know which.
But the the question that I ask patients is, have you ever had a
normal stool, which seems weird. But if you're a hyper mobile
person listening to this, perhaps this will actually seem
like a very normal question to you.
Because so many of my patients look at me and they say no, I do
not feel like I've ever had a normal stool.
And I've done social media content where I show like the
the Bristol Stool Chart which has pictures of different types
of stool and what's normal and what's considered Constipation
and diary and all this different stuff.
And like the hyper mobile person's a dream is to be.
I think it's a three on that chart and basically it very few
people are. Again, there are those hyper
mobile patients who have wonderful guts and I hate you.
I just just kidding. No, I'm very, very happy for
you. I just wish that every I wish
all of my patients could have normal gut function.
And of course one thing I don't want to forget to mention of in
terms of serious things And again, this episode is not
comprehensive. We need to do a whole series on
gut function. I would love if we could get
someone on here who knows a lot more than me about gut function.
But anyways, another issue I do want to mention, just because it
shows up on social media quite often too, is something called
gastroparesis. So this refers to when your
stomach stops digesting food. So again, a lot of things have
to happen to make that stomach work and to make food move down
the digestive tract and sometimes it stops.
And this is incredibly serious. This can result in this is I
would say, a life threatening. It is life threatening if it's
not managed appropriately. Absolutely.
But this is something which needs to not be missed.
And so often I will see patients, you know, these are
people who are losing weight and so on, but they're they're young
and they're often quite slender patients to begin with.
And then they're telling, you know, I've spoken to my doctor,
my doctor's ignoring me and that's when I have to get in
that position. So you know what, we we cannot
be ignored here because I don't feel happy with this management.
So you know, I'm going to figure out what we can do.
We we've got to sort this because it can lead to this
basically the stomach not being able to work properly anymore.
And then we have to of course look at different types of TPN
and different nutritional options which which involve
tubes and so on, which can of which are wonderful for the
patients who need them. But my goal is to always of
course, prevent people from from getting to that point ideally.
And again, remember I am a UK registered osteopath.
I'm just trying to support my patients when I see that they've
had certain things perhaps missed in their medical
management. But does everyone get
gastroparesis? No, they don't.
Not every hyper mobile person will get it.
Do some people get it? Absolutely.
And it's something we want to make sure that we're looking out
for 100%. And again, we will do a separate
episode on that. But in short, if you're having
people who are not able to keep food down, they're never hungry,
they're not eating, they're having things.
For example, a symptom of it can be that you are having food come
up, so you're being sick with food and it's hours later, but
it's still like it, you know, it hasn't been digested if you
don't get into too much detail there, but it looks like it
hasn't really been broken down. Those are some of the symptoms
of gastroparesis. Again, this is not an episode on
that. I'm not going to get into detail
here, but it's something which we really, really need to be
careful to not miss in patients and that every person should be
aware of. And I think patients should be
aware of these things because it helps the patients health at the
end of the day. And there's nothing wrong with
being a knowledgeable patient. I love my patients who are
knowledgeable. They teach me so much.
I call them my expert patients and we get to really work as a
team, which I think is the best way to do healthcare.
But yeah, gastroparesis, it exists.
It really sucks. And we need to get better at
identifying it in young people who look well but who feel
horrible before it gets to a point where it starts to cause a
lot of significant harm. Now I think we've talked about
most of the mechanical issues. I'm sure there's stuff I missed.
You know, if I missed stuff, put it in the comments, come, I
don't know, find me on e-mail, reach out to me.
I love hearing from this community, but moving on to the
inflammatory side. So we talked about, we talked
about the mechanical side. That's the ability of the stiff
tissue to to stretch and to compress and to function and
move stuff where it needs to be. However, we start to get into
the inflammatory side. We kind of touched on it a
little bit with the small in intestine.
Some of the how the inflammation there.
We didn't talk about the inflammation, we talked about
how the speed of food moving through the small intestine can
be problematic. But just to show how one part of
the gut can have two different issues.
You can also of course have inflammation in that small
intestine which affects nutrient absorption.
So you can have mechanical issues and most people will
interacting with inflammatory issues, which is what makes this
so complicated. But if we look at inflammation
for a second, we see of course a lot of of chronic what I refer
to as like subclinical inflammation in these patients
or they will have episodes that would potentially result in
higher markers of inflammatory markers showing up on blood
tests if they were tested. But at this point they feel too
well obviously to leave their home.
So they're kind of stuck there and what I'm talking about and
many of you're going to be familiar with this already, but
I'm kind of getting into the whole mast cell diseases and and
histamine area of all of this. So this is another area which is
quite contentious currently. There are a lot of unfortunately
medical doctors who seem to think that this is like a trend
and the patients are coming to them concerned about the stuff
because it's a trend. It's not, it's not.
So mask cells are a type of immune cell and they live in
your gut and in your connective tissue especially.
And I believe they also live in your brain as well.
But I I didn't double check my research before filming today.
So we'll do another episode of mask cells.
But anyways, mast cells live in different places in your body,
which are hugely problematic to hypermobile people and mast
cells. When they sense something that
that they think is a threat that your immune system thinks is a
threat, they rush to the scene of the crime.
So say for example, I eat something that they have some
spinach and spinach is high in histamine.
Who would have thought that a health food could potentially be
problematic for some people but mast cells will rush into the to
the gastrointestinal tract and they're going to start to
degranulate and dump histamine as well as a bunch of other
things. But again for another episode
histamine irritates tissues. It it does a lot of other things
but it it is an inflammatory, it's technically it's an auto
quite just halfway between a neurotransmitter and a hormone.
But it was going to up inflammation not at the site
where it is being dumped, basically.
So you're going to have start to have a lot of inflammation as
part of that reaction. And in simple terms, think of
like you know what a mosquito bites and you get a huge Weld
from it that, you know, maybe it's a lot bigger than what you
see on your friends or your other family members.
That can be, in some individuals a sign of something that's not
quite right potentially with their mass cells or they could
just have a histamine intolerance or something on the
the other side of that kind of diagnostic spectrum.
So we see issues with mass cells and histamine.
And I know I'm being broad here, but thank you for your
understanding because that's extremely technical stuff.
And this means that we see in these hypermobal patients a lot
of confusing stuff regarding food intolerances that doesn't
make sense for a lot of the patients and it often doesn't
make sense for the healthcare providers.
So these are people, these are patients typically who come to
me and I say, OK, so tell me about your relationship with
food and tell me what kind of like different nutritional
strategies you've tried or ways of eating.
I'm not a big fan of the word diet.
I kind of try to avoid it in my medical terminology, but I'll
say tell me about what kind of foods you eat, or if you avoid
any, and patients will tell me Often I've tried everything.
I've been like pescetarian, vegan, glutenfree, lactose free
keto, intermittent fasting. Like, these are patients who
will come to me and literally list like every nutritional,
strategy, diet, way of eating, whatever to ever exist.
And they're like nothing seems to work.
It seems like some things help a bit, but I'm so confused and I
can't figure out what's going on.
Now, My hunch is that often these people may have a
sensitivity to histamine. So what I then end up talking
with them about is how histamine can affect the gut and how we
need to start thinking about that.
However, it's not ever as straightforward as one thing I
wish it was I I would be so well rested.
My life would be so simple. But it's not that simple.
So of course histamine and muscle issues can play a role in
some patients got dysfunction and patients are going to be
like very concerned about this is where they're having extreme
symptoms after eating. So this could be like
debilitating gut pain. They're lying on the floor.
They're not sure if they're going to have diarrhea or vomit
like these types of like stronger reactions are things
where I'm thinking more potentially muscle issues or
histamine issues. However, there are many other
types of issues that affect hypermobile people as well in
terms of inflammation and the gut moving a bit further down
the gastrointestinal tract, we end up at the end.
And the most common symptom probably I do see in my
hypermobile patients is diarrhea, although often they
will have had Constipation issues as well.
But diarrhea because it's, it's stuff happening when it
shouldn't and where it shouldn't, it starts to damage
the, the tissue down there. If you're having chronic
diarrhea over time, it is not kind to the patient's rectum and
that again we can have injury occurring and inflammation.
They start to get very, very sensitized.
And this is where from an inflammatory perspective and
from a chronic pain perspective, and this is mentioned in that
brilliant narrative review that I referenced at the start, we
can start to potentially maybe even have sensitization of
different organs in terms of pain when you have different
injurious events. If you think of it like that
when you're eating food that's irritating your gut and you're
having an inappropriate inflammatory response and you're
having pain and nausea and diarrhea, that's that's an
that's an injury. It's like an ankle sprain.
It's, it's the same thing, different system, but that can
potentially result over time in a sensitization of tissues in
that region, which is maybe potentially partially wise.
Patients symptoms seem to get worse as they get older.
Now on top of all that, we do see increased rates of
inflammatory conditions in patients with HSD&HEDS including
celiac disease and research is still emerging, but the research
that is there suggests that this is the case.
And of course, I want to stress that with celiac disease,
although there are blood tests to test for it, these blood
tests are not perfect. And there is a percentage of
patients who will have celiac disease who will be missed on
the blood test and who will only show up if they have a small,
small intestine biopsy. However, that's expensive.
Our public healthcare system is going to do that.
I don't know. And if you're a hypermobile
person who's trying to kind of avoid surgical procedures, maybe
because you're worried a bit about outcomes from that, should
you be having a small intestine biopsy, you know, do the
benefits outweigh the risks? And maybe is it better to just
go onto a celiac diet as a trial?
Again, I don't know. I'm not a gastroenterologist,
but what I do know is we see increased rates of celiac
disease in hypermobile people. We also see increased rates of
inflammatory bowel disease. So this includes Crohn's disease
and ulcerative colitis. But in particular, we see an
increased prevalence of Crohn's disease in hypermobile
individuals. And again, we don't know if
one's causing the other, what exactly the interaction is, but
we do know that we see that there.
So again, that's just further evidence that we do have
inflammation in the gut, which affects how people feel and
affects how you digest food. And finally, the last thing
which I'm going to touch on very, very briefly because I
don't want to make this episode too long because I think it's
going to be a pretty long one. But we have the neurological
component. So your gut is controlled by
your neurological system. I'm specifically your autonomic
neurological system and I'm sitting here digesting food and
I'm not having to say like, OK, stomach go, OK, swell intestine,
do your thing. Like, I'm not having to like,
control my guy. It's just it's doing stuff on
its own. Luckily for now, yeah.
However, how does that neurological control happen?
That's not something we think about enough.
And one mechanism through which that neurological control
happens is a stretch reflex. So the tissue in the gut, when
food goes through it, it gets stretched and the stretching is
what starts to stimulate the mechanoreceptor.
So these are little bits of nervous tissue that are
sensitive to certain types of mechanical stimulation.
So in this case, when they experience stretch, that's when
they start to fire their signals.
And if you have someone with a hyper mobile gut, if their gut
is extra stretchy, are those those little neurological
stretch mechanoreceptors that are sensitive to stretch, are
they going to be receiving the same information?
Absolutely not as someone who has normal connective tissue in
their in their gut. So again that normal person,
they're going to have the group say we both eat a burger, normal
connective tissue person, they eat the burger and it's going to
stretch their gastrointestinal tract the right amount in the
right way at the right time and they're going to have the right
signal. So the right thing happens, the
hyper mobile person has the burger and then their gut is not
going to get the right amount of stretch because it's it's too
stretchy, it's too lax potentially.
They're not they're they're not getting the right information
and then their body can't do the right further actions.
So it's a whole series of of knock on consequences.
So neurological function is a a huge issue and there are even
things like viscera optosis which refers to organs
potentially sitting slightly lower than they should.
And of course, we have organ prolapse as well, which is when
organs are moving further down, especially in the pelvic region.
We talked about pelvic organ prolapse.
And will the will the position of an organ potentially affect
its function and in terms of neurological supply, intention
on the nerves, potentially. So it all gets really
complicated. And with the gut, we need to
think about, in summary, mechanical issues, inflammatory
issues and neurological issues. Now, what is something that you
can take away from today? What is something that you can
do so that you leave on a positive note and you feel like
you can do something maybe while you're waiting for that doctor's
appointment or maybe to talk with your doctor about your next
appointment. Here's what you can do.
Firstly, think about your normal.
What's normal for you? What's not normal for you?
Has stuff that's not normal for you been happening lately?
If so, definitely please please speak to your doctor or speak to
someone who's a qualified healthcare provider who cares,
who can then support you in speaking to your medical doctor
as well. I think it can be helpful to be
aware of histamine content in foods.
And again, I am extremely cautious when it comes to
anything involving eating disorders.
They are they, they kill people, they're harmful, they're
dangerous. And we have to be so careful
when talking with the patient population who which seems to
have a higher prevalence of them.
However, my thought on eating disorders and hypermobile
patients is how can you not have a complex relationship with food
when you keep trying to eat it and you keep feeling bad when
you eat? Of course, that's going to
complicate things. So something which I in my
clinical capacity as an osteopath, I very carefully try
to support my patients. And looking at and considering
and ideally speaking with the gastroenterologist about, is
looking at low histamine foods. Not in a restrictive sense, not
in a sense of avoiding it entirely because spoiler
histamines and everything. But if saying you know what,
maybe I'm not going to eat a chocolate bar at 10:00 PM at
night because I know my histamine levels are going to be
a bit higher due to my circadian rhythm and how that affects
that. Maybe I'm going to have one
square of chocolate earlier in the day.
Or maybe you know what, I hate spinach.
I'm not going to eat spinach anymore.
I'm going to have pack toy and Asian greens instead because
spinach is high in histamine and pack toy is low.
Again, don't ask me why, I don't know, but making those little
kind of food swaps I think could be a really helpful place to
start. I will link a histamine food
list in the show notes. Again, I urge you, if you're
someone, especially if you're some of the history of
disordered eating, please speak with your healthcare provider
who's looking out for you, hopefully.
But it can be one of those things which starts to make
everything make sense for patients.
And I think it's just so, so helpful to be aware of Okay.
But I'm not in any way advising A restrictive diet to anyone's.
The show is not medical advice. This is literally my thoughts on
a bunch of stuff for informational purposes.
Now moving on as well, eating in smaller meals at regular
intervals can be helpful. So if you think of that conveyor
belt of chaos, we've stopped moving too fast, too slow, and
all of this going on. It can be helpful sometimes, I
think, to have to try to impose some regularity onto it.
Now of course if you're someone with a DHD this really
complicates things and I think it's about 1/3 of hyper mobile
people have a DHD so this gets really hard.
But if you can try and say look, I'm going to eat 4 meals during
the day and they're going to be at regular time intervals so my
gut kind of can start to learn what's happening.
I'm I'm, I'm imposing some structure on my hypermobile and
kind of chaotic gut that helps a lot of people often.
And finally a fun fact that many people won't be aware of, many
probiotics are histamine producing.
They actually are going to do the opposite of what you want.
So there are some probiotic supplements that are histamine
sequestering or histamine neutral and those are what you
want hyper mobile patients to be having.
I I cringe when I think of all the years like I did this, like
I would just buy probiotics, just look which ones are on
sale, what's on the shelf, what marketing looks cool, whatever,
it's not that simple. So please, please, when you're
buying probiotics, firstly make sure that the subspecies is
listed, so it should have like the the name of the probiotic
itself, but then it should have a little series of like numbers
and letters at the end of it. Please look for that because
that's a sign firstly that it's a good quality one because that
the subspecies matter and different subspecies can do
different things even within the same species.
Secondly, of course, be sensitive to the fact that you
need to be careful which ones you're taking.
So you can do stuff like what I do.
I literally call probiotic brands and I like try and speak
with a nutritional team or go do research online, but definitely
look into which one might be right for you in terms of a
histamine perspective. And finally, of course be
thoughtful about what you're taking and why you're taking it.
So even if something like a probiotic, I would say take it
for three months and try and have some type of an outcome as
you know maybe for you it's diarrhea, Has that frequency
decreased? Like, what are you trying to
achieve by by what you're doing? Don't waste your money on things
like. Be thoughtful about it.
And one last bonus tip, it might be worth looking into a
supplement called dimine oxidase.
So dimine oxidase helps to break down histamine, and we touched
on histamine briefly. It'll get its own episode one
day, but dimine oxidase literally goes and it mops up
the histamine. So the mast cells make the
histamine mess and the diamine oxidase goes and cleans it up
and puts it away. However and hyper mobile people,
we often see issues with diamine oxidase.
Their body's not producing enough of that enzyme, so
diamine oxidase is available as a supplement.
Again, be careful taking supplements.
Treat them like medicine. Speak with your medical doctor,
make sure they're not going to interact or cause any issues.
However, taking diamine oxidase can make a difference for a lot
of hyper mobile people and it's something which is one of those
supplements that I certainly put up there for my a lot of my
patients in terms of recommendations.
And it seems to do what it says on the 10th, and there's some
good research emerging. So that's exciting.
I hope you've learned something about gut issues today.
I hope you've managed to stay with me and I hope it's been as
straightforward as I could make this complex and convoluted
subject which really fits with hyper well guts themselves
because they are complex and convoluted often.
I of course if you have any questions please don't hesitate
to write in and be sure to check out my Hyperbole HQ Discord
membership. It is awesome.
We get into the nitty gritty on there.
It's nice having kind of more time in terms of these
consistent twice a week lives that I do and of course the
forum is amazing and I think there are still some founding
membership rates left so definitely go check that out
because they are limited and I think it's I think it's really
really helped a lot of people. I've gotten so much awesome
feedback on it and I, you know, I I'm happy because it feels
like it's the best corner of the Internet ever for hyper well
people and I'm just so proud of it and all honesty.
But yeah, thank you for joining me and see you next time.
Take care.