Top

Published in:

01-12-2021 | Ehlers-Danlos Syndrome | Gastroenterology, Critical Care, and Lifestyle Medicine (SA McClave and M Eisa, Section Editors)

Nutritional Implications of Patients with Dysautonomia and Hypermobility Syndromes

Authors: Toan Do, Sarah Diamond, Caitlin Green, Malissa Warren

Published in: Current Nutrition Reports | Issue 4/2021

Abstract

Purpose of Review

Dysautonomia and hypermobility syndrome are two distinct but often overlapping clinical conditions that are recognized for their complex multiorgan system afflictions. The purpose of this review is to investigate dietary strategies to reduce symptoms and augment quality of life in this growing patient population.

Recent Findings

There is increasing evidence supporting dietary modifications to include food rich in probiotics and prebiotics, along with fiber supplements to reduce gastrointestinal symptoms. Adequate salt and fluid intake may reduce orthostatic hypotension symptoms. Dietary supplements may help with osteoarticular, musculoskeletal, and fatigue symptoms.

Summary

Individualized diet strategies and supplements can reduce the multiorgan system symptoms observed in dysautonomia and hypermobility syndrome.

Beighton P, Paepe AD, Steinmann B, Tsipouras P, Wenstrup RJ. Ehlers-Danlos syndromes: Revised nosology, Villefranche, 1997. Am J Med Genet. 1998;77(1):31–7. https://doi.org/10.1002/(SICI)1096-8628(19980428)77:1%3c31::AID-AJMG8%3e3.0.CO;2-O.CrossRefPubMed

Gazit Y, Nahir AM, Grahame R, Jacob G. Dysautonomia in the joint hypermobility syndrome. Am J Med. Jul. 2003;115(1):33–40. https://doi.org/10.1016/s0002-9343(03)00235-3.CrossRefPubMed

Simmonds JV, Keer RJ. Hypermobility and the hypermobility syndrome. Man Ther. Nov. 2007;12(4):298–309. https://doi.org/10.1016/j.math.2007.05.001.CrossRefPubMed

Axelrod FB. Familial dysautonomia. Muscle Nerve. 2004;29(3):352–63. https://doi.org/10.1002/mus.10499.CrossRefPubMed

Eshak N, et al. Dysautonomia: an Overlooked neurological manifestation in a critically ill COVID-19 patient. Am J Med Sci. Oct. 2020;360(4):427–9. https://doi.org/10.1016/j.amjms.2020.07.022.CrossRefPubMedPubMedCentral

Becker K, Görlach I, Frieling T, Häussinger D. Characterization and natural course of cardiac autonomic nervous dysfunction in HIV-infected patients. AIDS. May 1997;11(6):751–7.CrossRef

Pearson J, Axelrod F, Dancis J. Current concepts of dysautonomia: neuropathological defects*. Ann N Y Acad Sci. 1974;228(1):288–300. https://doi.org/10.1111/j.1749-6632.1974.tb20517.x.CrossRefPubMed

Shohat M, Weisz Hubshman M. Familial dysautonomia, in GeneReviews®, M. P. Adam, H. H. Ardinger, R. A. Pagon, S. E. Wallace, L. J. Bean, G. Mirzaa, and A. Amemiya, Eds. Seattle (WA): University of Washington, Seattle, 1993.

DiBaise JK, Lunsford TN, Harris LA. The POTS (Postural Tachycardia Syndrome) epidemic: hydration and nutrition issues, Pract. Gastroenterol. 2019; p. 10.

10.

Blitshteyn S. Vitamin B1 deficiency in patients with postural tachycardia syndrome (POTS). Neurol Res. Aug. 2017;39(8):685–8. https://doi.org/10.1080/01616412.2017.1331895.CrossRefPubMed

11.

DiBaise JK, Harris LA, Goodman B. Postural Tachycardia Syndrome (POTS) and the GI tract: a primer for the gastroenterologist. Off J Am Coll Gastroenterol ACG. Oct. 2018;113(10):1458–67. https://doi.org/10.1038/s41395-018-0215-4.CrossRef

12.

Mandel D, Askari AD, Malemud CJ, Kaso A. Joint Hypermobility Syndrome and Postural Orthostatic Tachycardia Syndrome (HyPOTS), Biomed. Res. Clin. Pract. 2017;2(2). https://doi.org/10.15761/BRCP.1000132.

13.

Baguley IJ, Slewa-Younan S, Heriseanu RE, Nott MT, Mudaliar Y, Nayyar V. The incidence of dysautonomia and its relationship with autonomic arousal following traumatic brain injury. Brain Inj. Oct. 2007;21(11):1175–81. https://doi.org/10.1080/02699050701687375.CrossRefPubMed

14.

Goldstein DS, Robertson D, Esler M, Straus SE, Eisenhofer G. Dysautonomias: clinical disorders of the autonomic nervous system. Ann Intern Med. Nov. 2002;137(9):753–63. https://doi.org/10.7326/0003-4819-137-9-200211050-00011.CrossRefPubMed

15.

Yukawa S, Tahara K, Shoji A, Hayashi H, Tsuboi N. Acute pan-dysautonomia as well as central nervous system involvement and peripheral neuropathies in a patient with systemic lupus erythematosus. Mod Rheumatol. Oct. 2008;18(5):516–21. https://doi.org/10.3109/s10165-008-0087-3.CrossRefPubMed

16.

Su XW, Palka SV, Rao RR, Chen FS, Brackney CR, Cambi F. SARS-CoV-2–associated Guillain-Barré syndrome with dysautonomia. Muscle Nerve. Jun. 2020. https://doi.org/10.1002/mus.26988.CrossRefPubMedPubMedCentral

17.

Sendur OF, Odabasi BB, Turan Y. An overlooked diagnosis in rheumatology: benign joint hypermobility syndrome. J Musculoskelet Pain. Aug. 2010;18(3):277–87. https://doi.org/10.3109/10582452.2010.501303.CrossRef

18.

Bohora S. joint hypermobility syndrome and dysautonomia: expanding spectrum of disease presentation and manifestation. Indian Pacing Electrophysiol J. Apr. 2010;10(4):158–61.PubMedPubMedCentral

19.

Malfait F, et al. The 2017 international classification of the Ehlers-Danlos syndromes, Am. J. Med. Genet. C Semin. Med. Genet. Mar. 2017;175(1):8–26. https://doi.org/10.1002/ajmg.c.31552.

20.

Grahame R. Joint hypermobility syndrome pain. Curr Pain Headache Rep. Dec. 2009;13(6):427. https://doi.org/10.1007/s11916-009-0070-5.CrossRefPubMed

21.

Bridges AJ, Smith E, Reid J. Joint hypermobility in adults referred to rheumatology clinics., Ann. Rheum. Dis. Jun. 1992;51(6)793–796.

22.

Schondorf R, Low PA. Idiopathic postural orthostatic tachycardia syndrome: an attenuated form of acute pandysautonomia? Neurology. Jan. 1993;43(1):132–7. https://doi.org/10.1212/wnl.43.1_part_1.132.CrossRefPubMed

23.

Sheldon RS, et al. 2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm. Jun. 2015;12(6):e41–63. https://doi.org/10.1016/j.hrthm.2015.03.029.CrossRefPubMedPubMedCentral

24.

Freeman R, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res Off J Clin Auton Res Soc. Apr. 2011;21(2):69–72. https://doi.org/10.1007/s10286-011-0119-5.CrossRef

25.

Raj SR, Stiles LE. Special issue for the silver anniversary of Postural Tachycardia Syndrome. Auton Neurosci Basic Clin. Dec. 2018;215:1–2. https://doi.org/10.1016/j.autneu.2018.03.003.CrossRef

26.

Shaw BH, et al. The face of postural tachycardia syndrome - insights from a large cross-sectional online community-based survey. J Intern Med. Oct. 2019;286(4):438–48. https://doi.org/10.1111/joim.12895.CrossRefPubMedPubMedCentral

27.

Garland EM, Celedonio JE, Raj SR. Postural tachycardia syndrome: beyond orthostatic intolerance. Curr Neurol Neurosci Rep. Jul. 2015;15(9):60. https://doi.org/10.1007/s11910-015-0583-8.CrossRefPubMedPubMedCentral

28.

Bourne K, Stiles L, Shaw B, Raj S. Socioeconomic and financial impact of postural tachycardia syndrome: data from a patient cross-sectional survey. Can J Cardiol. Oct. 2018;34(10):S194–5. https://doi.org/10.1016/j.cjca.2018.07.119.CrossRef

29.

Molodecky NA, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review, Gastroenterology. Jan. 2012;142(1)46–54.e42; quiz e30. https://doi.org/10.1053/j.gastro.2011.10.001.

30.

Simpson MMR. Benign joint hypermobility syndrome: evaluation, diagnosis, and management. J Am Osteopath Assoc. Sep. 2006;106(9):531–6. https://doi.org/10.7556/jaoa.2006.106.9.531.CrossRefPubMed

31.

Remvig L, et al. Epidemiology of general joint hypermobility and basis for the proposed criteria for benign joint hypermobility syndrome: review of the literature, J Rheumatol.

32.

Reuter PR, Fichthorn KR. Prevalence of generalized joint hypermobility, musculoskeletal injuries, and chronic musculoskeletal pain among American university students, PeerJ. Sep. 2019;7. https://doi.org/10.7717/peerj.7625.

33.

Steinmann B, Royce PM, Superti-Furga A. the Ehlers-Danlos syndrome, in Connective Tissue and Its Heritable Disorders, John Wiley & Sons, Ltd, 2002;431–523.

34.

De Wandele I, et al. Dysautonomia and its underlying mechanisms in the hypermobility type of Ehlers-Danlos syndrome. Semin Arthritis Rheum. Aug. 2014;44(1):93–100. https://doi.org/10.1016/j.semarthrit.2013.12.006.CrossRefPubMed

35.

Celletti C, et al. Orthostatic intolerance and postural orthostatic tachycardia syndrome in joint hypermobility syndrome/Ehlers-Danlos syndrome, hypermobility type: neurovegetative dysregulation or autonomic failure?, BioMed Research International. Feb. 12, 2017. https://www.hindawi.com/journals/bmri/2017/9161865/ (accessed Feb. 17, 2021).

36.

De Wandele I, et al. Orthostatic intolerance and fatigue in the hypermobility type of Ehlers-Danlos syndrome. Rheumatology. Aug. 2016;55(8):1412–20. https://doi.org/10.1093/rheumatology/kew032.CrossRefPubMed

37.

Wallman D, Weinberg J, Hohler AD. Ehlers-Danlos syndrome and postural tachycardia syndrome: a relationship study. J Neurol Sci. May 2014;340(1–2):99–102. https://doi.org/10.1016/j.jns.2014.03.002.CrossRefPubMed

38.

Kanjwal K, Saeed B, Karabin B, Kanjwal Y, Grubb BP. Comparative clinical profile of postural orthostatic tachycardia patients with and without joint hypermobility syndrome. Indian Pacing Electrophysiol J. Apr. 2010;10(4):173–8.PubMedPubMedCentral

39.

Castori M, Morlino S, Pascolini G, Blundo C, Grammatico P. “Gastrointestinal and nutritional issues in joint hypermobility syndrome/Ehlers–Danlos syndrome, hypermobility type,” Am. J. Med. Genet. C Semin. Med. Genet. 2015;169(1):54–75. https://doi.org/10.1002/ajmg.c.31431.

40.

Castori M. Ehlers-danlos syndrome, hypermobility type: an underdiagnosed hereditary connective tissue disorder with mucocutaneous, articular, and systemic manifestations. ISRN Dermatol. 2012;2012: 751768. https://doi.org/10.5402/2012/751768.CrossRefPubMedPubMedCentral

41.

Zarate N, et al. Unexplained gastrointestinal symptoms and joint hypermobility: is connective tissue the missing link? Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc. Mar. 2010;22(3):252-e78. https://doi.org/10.1111/j.1365-2982.2009.01421.x.CrossRef

42.

Fikree A, et al. A prospective evaluation of undiagnosed joint hypermobility syndrome in patients with gastrointestinal symptoms. Clin Gastroenterol Hepatol. Oct. 2014;12(10):1680-1687.e2. https://doi.org/10.1016/j.cgh.2014.01.014.CrossRefPubMed

43.

Zhou W, Zikos T, Neshatian L, Nguyen L. S0476 high prevalence of methane predominant small bowel bacterial overgrowth and constipation in patients with hypermobile Ehlers-Danlos syndrome. Off J Am Coll Gastroenterol ACG. Oct. 2020;115:S238. https://doi.org/10.14309/01.ajg.0000703952.17443.b0.CrossRef

44.

McCorry LK. Physiology of the autonomic nervous system, Am. J. Pharm. Educ. Aug. 2007;71(4). Accessed: Feb. 02, 2021. [Online]. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1959222/.

45.

Tougas G. The autonomic nervous system in functional bowel disorders, Gut. Dec. 2000;47(90004):78iv–7880. https://doi.org/10.1136/gut.47.suppl_4.iv78.

46.

Rodgers KR, Gui J, Dinulos MBP, Chou RC. Ehlers-Danlos syndrome hypermobility type is associated with rheumatic diseases, Sci. Rep. Jan. 2017;7. https://doi.org/10.1038/srep39636.

47.

Tomasello G, et al. Nutrition, oxidative stress and intestinal dysbiosis: Influence of diet on gut microbiota in inflammatory bowel diseases. Biomed Pap. Dec. 2016;160(4):461–6. https://doi.org/10.5507/bp.2016.052.CrossRef

48.

•• Ganesh R, Bonnes SLR, DiBaise JK. Postural tachycardia syndrome: nutrition implications. Nutr Clin Pract. 2020;35(5):818–25. https://doi.org/10.1002/ncp.10564. Most current nutritional implication of inidividuals with POTS.

49.

•• Tseng AS, et al. Factors associated with use of nonoral nutrition and hydration support in adult patients with postural tachycardia syndrome. J Parenter Enter Nutr. A. 2019;43(6):734–41. https://doi.org/10.1002/jpen.1493. Recognizing that due to poor oral tolerance, individuals with POTS may require non-oral nutritional support.

50.

Venegas-Borsellino C, Kwon M. Impact of soluble fiber in the microbiome and outcomes in critically ill patients. Curr Nutr Rep. Dec. 2019;8(4):347–55. https://doi.org/10.1007/s13668-019-00299-9.CrossRefPubMed

51.

Halmos EP. Role of FODMAP content in enteral nutrition-associated diarrhea. J Gastroenterol Hepatol. 2013;28(S4):25–8. https://doi.org/10.1111/jgh.12272.CrossRefPubMed

52.

Pinto-Sanchez MI, et al. Gluten-free diet reduces symptoms, particularly diarrhea, in patients with irritable bowel syndrome and antigliadin IgG. Clin Gastroenterol Hepatol. Aug. 2020. https://doi.org/10.1016/j.cgh.2020.08.040.CrossRefPubMedPubMedCentral

53.

Guandalini S. Probiotics for prevention and treatment of diarrhea., J. Clin. Gastroenterol. 2011;45(Suppl. 3):S149–S153. https://doi.org/10.1097/MCG.0b013e3182257e98.

54.

Yang J, Wang H-P, Zhou L, Xu C-F. Effect of dietary fiber on constipation: a meta analysis. World J Gastroenterol WJG. Dec. 2012;18(48):7378–83. https://doi.org/10.3748/wjg.v18.i48.7378.CrossRefPubMed

55.

Martinez-Guryn K, Leone V, Chang EB. Regional diversity of the gastrointestinal microbiome. Cell Host Microbe. Sep. 2019;26(3):314–24. https://doi.org/10.1016/j.chom.2019.08.011.CrossRefPubMedPubMedCentral

56.

Kim CH. Immune regulation by microbiome metabolites. Immunology. Jun. 2018;154(2):220–9. https://doi.org/10.1111/imm.12930.CrossRefPubMedPubMedCentral

57.

Chang EB, Martinez-Guryn K. Small intestinal microbiota: the neglected stepchild needed for fat digestion and absorption. Gut Microbes. Mar. 2019;10(2):235–40. https://doi.org/10.1080/19490976.2018.1502539.CrossRefPubMed

58.

Kau AL, Ahern PP, Griffin NW, Goodman AL, Gordon JI. Human nutrition, the gut microbiome and the immune system. Nature. Jun. 2011;474(7351):327–36. https://doi.org/10.1038/nature10213.CrossRefPubMedPubMedCentral

59.

•• Kumar R, Sood U, Gupta V, Singh M, Scaria J, Lal R. Recent advancements in the development of modern probiotics for restoring human gut microbiome dysbiosis. Indian J Microbiol. Mar. 2020;60(1):12–25. https://doi.org/10.1007/s12088-019-00808-y. Importance of specific foods with probiotics that can help reestablish human gut microbiome.

60.

Shadnoush M, et al. probiotic yogurt affects pro- and anti-inflammatory factors in patients with inflammatory bowel disease. Iran J Pharm Res IJPR. 2013;12(4):929–36.PubMed

61.

Iqbal M, Qadir M, Mallhi T, Janbaz K, Khan Y, Ahmad B. Probiotics and their beneficial effects against various diseases. Pak J Pharm Sci. Mar. 2014;27:405–15.PubMed

62.

Manning TS, Gibson GR. Prebiotics. Best Pract Res Clin Gastroenterol. Apr. 2004;18(2):287–98. https://doi.org/10.1016/j.bpg.2003.10.008.CrossRefPubMed

63.

Miller MJ, Angeles FM, Reuter BK, Bobrowski P, Sandoval M. Dietary antioxidants protect gut epithelial cells from oxidant-induced apoptosis. BMC Complement Altern Med. Dec. 2001;1(1):11. https://doi.org/10.1186/1472-6882-1-11.CrossRefPubMedPubMedCentral

64.

Bjørklund G, Chirumbolo S. Role of oxidative stress and antioxidants in daily nutrition and human health. Nutrition. Jan. 2017;33:311–21. https://doi.org/10.1016/j.nut.2016.07.018.CrossRefPubMed

65.

Bielinska K, et al. High salt intake increases plasma trimethylamine N-oxide (TMAO) concentration and produces gut dysbiosis in rats. Nutrition. Oct. 2018;54:33–9. https://doi.org/10.1016/j.nut.2018.03.004.CrossRefPubMed

66.

Suez J, et al. Artificial sweeteners induce glucose intolerance by altering the gut microbiota. Nature. Oct. 2014;514(7521):181–6. https://doi.org/10.1038/nature13793.CrossRefPubMed

67.

Emamat H, Ghalandari H, Tangestani H, Abdollahi A, Hekmatdoost A. Artificial sweeteners are related to non-alcoholic fatty liver disease: microbiota dysbiosis as a novel potential mechanism. EXCLI J. May 2020;19:620–6. https://doi.org/10.17179/excli2020-1226.CrossRefPubMedPubMedCentral

68.

Rodriguez-Palacios A, et al. The artificial sweetener splenda promotes gut proteobacteria, dysbiosis, and myeloperoxidase reactivity in Crohn’s disease–like ileitis. Inflamm Bowel Dis. Apr. 2018;24(5):1005–20. https://doi.org/10.1093/ibd/izy060.CrossRefPubMedPubMedCentral

69.

•• Camilleri M. Leaky gut: mechanisms, measurement and clinical implications in humans, Gut. Aug. 2019;68(8):1516–1526. https://doi.org/10.1136/gutjnl-2019-318427. Demonstrating the importance of maintenance of the gastrointestinal barrier and disease manifestations.

70.

Leclercq S, et al. Intestinal permeability, gut-bacterial dysbiosis, and behavioral markers of alcohol-dependence severity. Proc Natl Acad Sci. Oct. 2014;111(42):E4485–93. https://doi.org/10.1073/pnas.1415174111.CrossRefPubMedPubMedCentral

71.

Engen PA, Green SJ, Voigt RM, Forsyth CB, Keshavarzian A. The gastrointestinal microbiome. Alcohol Res Curr Rev. 2015;37(2):223–36.

72.

Mathias CJ, Young TM. Water drinking in the management of orthostatic intolerance due to orthostatic hypotension, vasovagal syncope and the postural tachycardia syndrome. Eur J Neurol. 2004;11(9):613–9. https://doi.org/10.1111/j.1468-1331.2004.00840.x.CrossRefPubMed

73.

Shannon JR, et al. Water drinking as a treatment for orthostatic syndromes. Am J Med. Apr. 2002;112(5):355–60. https://doi.org/10.1016/S0002-9343(02)01025-2.CrossRefPubMed

74.

Puvi-Rajasingham S, Mathias CJ. Effect of meal size on postprandial blood pressure and on postural hypotension in primary autonomic failure. Clin Auton Res. Apr. 1996;6(2):111–4. https://doi.org/10.1007/BF02291232.CrossRefPubMed

75.

•• Shen W-K, et al. 2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. Aug. 2017;14(8):e155–217. https://doi.org/10.1016/j.hrthm.2017.03.004. Fluid intake is a topic of debate in orthostatic hypotension but the guideline here is supporting of fluid intake.

76.

Lanier JB, Mote MB, Clay EC. Evaluation and management of orthostatic hypotension. 2011;84(5):10.

77.

Loughlin EA, et al. Increased salt intake for orthostatic intolerance syndromes: a systematic review and meta-analysis. Am J Med. Dec. 2020;133(12):1471-1478.e4. https://doi.org/10.1016/j.amjmed.2020.05.028.CrossRefPubMed

78.

Low PA, Singer W. Update on management of neurogenic orthostatic hypotension. Lancet Neurol. May 2008;7(5):451–8. https://doi.org/10.1016/S1474-4422(08)70088-7.CrossRefPubMedPubMedCentral

79.

Figueroa JJ, Basford JR, Low PA. preventing and treating orthostatic hypotension: as easy as A, B, C. Cleve Clin J Med. May 2010;77(5):298–306. https://doi.org/10.3949/ccjm.77a.09118.CrossRefPubMedPubMedCentral

80.

Busch A, et al. Vascular type Ehlers-Danlos syndrome is associated with platelet dysfunction and low vitamin D serum concentration. Orphanet J Rare Dis. Aug. 2016;11(1):111. https://doi.org/10.1186/s13023-016-0491-2.CrossRefPubMedPubMedCentral

81.

Holick MF, Hossein-Nezhad A, Tabatabaei F. Multiple fractures in infants who have Ehlers-Danlos/hypermobility syndrome and or vitamin D deficiency: a case series of 72 infants whose parents were accused of child abuse and neglect. Dermatoendocrinol. Jan. 2017;9(1): e1279768. https://doi.org/10.1080/19381980.2017.1279768.CrossRefPubMedPubMedCentral

82.

Mantle D, Wilkins RM, Preedy V. A novel therapeutic strategy for Ehlers-Danlos syndrome based on nutritional supplements. Med Hypotheses. Jan. 2005;64(2):279–83. https://doi.org/10.1016/j.mehy.2004.07.023.CrossRefPubMed

83.

Mohammed BM, et al. Vitamin C promotes wound healing through novel pleiotropic mechanisms. Int Wound J. 2016;13(4):572–84. https://doi.org/10.1111/iwj.12484.CrossRefPubMed

84.

Öner T, Guven B, Tavli V, Mese T, Yılmazer MM, Demirpence S. Postural orthostatic tachycardia syndrome (POTS) and vitamin B12 deficiency in adolescents. Pediatrics. Jan. 2014;133(1):e138–42. https://doi.org/10.1542/peds.2012-3427.CrossRefPubMed

85.

Sacheti A, Szemere J, Bernstein B, Tafas T, Schechter N, Tsipouras P. Chronic pain is a manifestation of the Ehlers-Danlos syndrome. J Pain Symptom Manage. Aug. 1997;14(2):88–93. https://doi.org/10.1016/s0885-3924(97)00007-9.CrossRefPubMed

86.

Ross J, Grahame R. Easily mised? Joint hypermobility syndrome, BMJ. Jan. 2011;342: c7167. https://doi.org/10.1136/bmj.c7167.CrossRefPubMed

87.

Castori M. Pain in Ehlers-Danlos syndromes: manifestations, therapeutic strategies and future perspectives. Expert Opin Orphan Drugs. Nov. 2016;4(11):1145–58. https://doi.org/10.1080/21678707.2016.1238302.CrossRef

88.

Castori M, Celletti C, Camerota F. Ehlers-Danlos syndrome hypermobility type: a possible unifying concept for various functional somatic syndromes. Rheumatol Int. Mar. 2013;33(3):819–21. https://doi.org/10.1007/s00296-011-2275-2.CrossRefPubMed

89.

Richy F, Bruyere O, Ethgen O, Cucherat M, Henrotin Y, Reginster J-Y. Structural and symptomatic efficacy of glucosamine and chondroitin in knee osteoarthritis: a comprehensive meta-analysis. Arch Intern Med. Jul. 2003;163(13):1514–22. https://doi.org/10.1001/archinte.163.13.1514.CrossRefPubMed

90.

Reginster JY, et al. Long-term effects of glucosamine sulphate on osteoarthritis progression: a randomised, placebo-controlled clinical trial. The Lancet. Jan. 2001;357(9252):251–6. https://doi.org/10.1016/S0140-6736(00)03610-2.CrossRef

91.

Philippi AF, Leffler CT, Leffler SG, Mosure JC, Kim PD. Glucosamine, chondroitin, and manganese ascorbate for degenerative joint disease of the knee or low back: a randomized, double-blind, placebo-controlled pilot study. Mil Med. Feb. 1999;164(2):85–91. https://doi.org/10.1093/milmed/164.2.85.CrossRefPubMed

92.

Nicolson GL, Settineri R, Ellithorpe R. Lipid replacement therapy with a glycophospholipid formulation with NADH and CoQ10 significantly reduces fatigue in intractable chronic fatiguing illnesses and chronic lyme disease patients. May. 2012;2012. https://doi.org/10.4236/ijcm.2012.33034.

93.

Borum PR. Carnitine in parenteral nutrition. Gastroenterology. Nov. 2009;137(5):S129–34. https://doi.org/10.1053/j.gastro.2009.08.016.CrossRefPubMed

94.

Voermans NC, Knoop H, van de Kamp N, Hamel BC, Bleijenberg G, van Engelen BG. Fatigue is a frequent and clinically relevant problem in Ehlers-Danlos syndrome. Semin Arthritis Rheum. Dec. 2010;40(3):267–74. https://doi.org/10.1016/j.semarthrit.2009.08.003.CrossRefPubMed

95.

Zurier B. Essential fatty acids and inflammation., Ann. Rheum. Dis. Nov. 1991;50(11):745–746.

96.

Hakim A, Wandele ID, O’Callaghan C, Pocinki A, Rowe P. Chronic fatigue in Ehlers–Danlos syndrome—hypermobile type, Am. J. Med. Genet. C Semin. Med. Genet. 2017;175(1):175–180. https://doi.org/10.1002/ajmg.c.31542.

97.

Mehrabani S, Askari G, Miraghajani M, Tavakoly R, Arab A. Effect of coenzyme Q10 supplementation on fatigue: a systematic review of interventional studies. Complement Ther Med. Apr. 2019;43:181–7. https://doi.org/10.1016/j.ctim.2019.01.022.CrossRefPubMed

98.

Cox IM, Campbell MJ, Dowson D. Red blood cell magnesium and chronic fatigue syndrome. The Lancet. Mar. 1991;337(8744):757–60. https://doi.org/10.1016/0140-6736(91)91371-Z.CrossRef

99.

Singh A, Zapata RC, Pezeshki A, Reidelberger RD, Chelikani PK. Inulin fiber dose-dependently modulates energy balance, glucose tolerance, gut microbiota, hormones and diet preference in high-fat-fed male rats. J Nutr Biochem. Sep. 2018;59:142–52. https://doi.org/10.1016/j.jnutbio.2018.05.017.CrossRefPubMed

Title: Nutritional Implications of Patients with Dysautonomia and Hypermobility Syndromes
Authors: Toan Do
Sarah Diamond
Caitlin Green
Malissa Warren
Publication date: 01-12-2021
Publisher: Springer US
Keywords: Ehlers-Danlos Syndrome
Hypotension
Nutrition
Fatigue
Hypotension
Published in: Current Nutrition Reports / Issue 4/2021
Electronic ISSN: 2161-3311
DOI: https://doi.org/10.1007/s13668-021-00373-1

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose of Review

Recent Findings

Summary

Please log in to get access to this content

Other articles of this Issue 4/2021

How Does Fasting Affect Cognition? An Updated Systematic Review (2013–2020)

A Systematic Review of Health Promotion Programs to Improve Nutrition for People with Intellectual Disability

Impact of COVID-19 on the Intestinal Microbiome

Nutrition Therapy in Non-intubated Patients with Acute Respiratory Failure

Food Access, Food Insecurity, and Gun Violence: Examining a Complex Relationship

A Rapid Review of the Environmental Impacts Associated with Food Consumption in Australia and New Zealand

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials