Functional Medicine for Ehlers-Danlos Syndrome: A Holistic Approach to Chronic Pain and Fatigue
Ehlers-Danlos Syndrome (EDS) is a complex, hereditary group of connective tissue disorders marked by joint hyper-mobility, skin hyper-extensibility, and tissue fragility. Affecting an estimated 1 in 5,000 individuals worldwide, EDS is often under diagnosed and misunderstood. The most common complaints among patients are chronic pain and fatigue—symptoms that are difficult to treat through conventional medicine alone.
Functional medicine, a systems biology-based approach, offers a compelling alternative. By addressing the root causes of illness rather than isolated symptoms, functional medicine may provide meaningful relief to EDS patients struggling with persistent fatigue and debilitating pain.
Understanding EDS: More Than Just Joint Hyper-flexibility
Ehlers-Danlos Syndrome includes 13 different subtypes, with hyper-mobile EDS (hEDS) being the most prevalent. Unlike other genetic variants of EDS that can be diagnosed with molecular testing, hEDS remains a clinical diagnosis based on symptoms.
According to a 2021 study published in American Journal of Medical Genetics, over 80% of hEDS patients report chronic widespread pain, while more than 75% cite fatigue as one of their most limiting symptoms. Many patients describe feeling as though they have the flu every day, yet conventional labs and imaging often return normal, leading to feelings of frustration and dismissal by the medical community.
This is where functional medicine offers a fresh, validating, and more thorough lens.
What Is Functional Medicine?
Functional medicine aims to understand the why behind symptoms. It views the body as one interconnected system and considers the influence of genetics, lifestyle, nutrition, environment, and even psychosocial factors.
As Dr. Mark Hyman, a prominent figure in the functional medicine movement, states:
"Chronic illness is not a single problem requiring a single drug. It’s a web of imbalances that need to be corrected holistically."
This approach is especially relevant for EDS, where no cure exists, and the goal is to optimize quality of life through tailored interventions.
Core Components of Functional Medicine for EDS
1. Thorough Patient Assessment
EDS patients often present with a wide array of symptoms, including:
Chronic joint pain
Recurrent subluxations and dislocations
Digestive issues (IBS, gastroparesis)
Fatigue
Sleep disturbances
Anxiety and depression
Postural Orthostatic Tachycardia Syndrome (POTS)
A functional medicine practitioner conducts a comprehensive intake, which may include:
Genetic screening (especially for rarer EDS types)
Nutrient deficiency testing (iron, B12, magnesium, D3)
Gut health analysis (SIBO, leaky gut, microbiome imbalance)
Sleep assessments
Hormone and cortisol level evaluations
Autonomic function testing
These insights inform personalized treatment strategies.
2. Targeting Chronic Pain: A Multifaceted Plan
Pain in EDS stems from joint instability, soft tissue injury, nerve compression, and even central sensitization—where the brain becomes overly reactive to pain signals.
A. Physical Therapy
Traditional PT often fails EDS patients. Functional medicine recommends specialized physical therapy focused on:
Isometric strengthening of joint-supporting muscles
Neuromuscular re-education
Low-impact modalities (hydrotherapy, Pilates)
Dr. Leslie Russek, a PT specializing in EDS, notes:
“Patients with hEDS often do better with slow, gentle, and consistent strengthening programs. Overloading their tissues can lead to setbacks.”
B. Anti-Inflammatory Nutrition
Chronic inflammation exacerbates pain. Functional medicine emphasizes:
A Mediterranean-style or Anti-Inflammatory diet (rich in vegetables, omega-3s, and lean proteins)
Avoiding processed foods, gluten (if intolerant), and added sugars
Incorporating turmeric, ginger, and magnesium-rich foods
A 2022 review in Nutrients confirmed that omega-3 supplementation led to significant pain reduction in chronic inflammatory conditions.
C. Supplements
Common supplements recommended (under supervision) for EDS-related pain include:
Magnesium glycinate – muscle relaxant, helps cramps
Vitamin B12 – Supports nerve health
Vitamin D – bone health and immune modulation
Collagen peptides – Supports connective tissue structure
3. Addressing Debilitating Fatigue
EDS-related fatigue is profound. Causes include poor sleep, nutrient malabsorption, mitochondrial dysfunction, and dysautonomia.
A. Sleep Optimization
Many EDS patients suffer from non-restorative sleep, insomnia, or sleep apnea. Functional approaches include:
Sleep hygiene education (consistent routine, reduced screen time)
Cognitive Behavioral Therapy for Insomnia (CBT-I)
Natural supports like melatonin, glycine, and magnesium threonate
Rule out sleep disorders with a polysomnography test
B. Correcting Nutritional Deficiencies
Fatigue often stems from:
Iron deficiency (even without anemia)
Vitamin D insufficiency
B-complex deficiencies
Mitochondrial stress
A study published in BMJ Open found that 40% of EDS patients had iron or B12 deficiencies, contributing to cognitive fog and exhaustion. Personalized repletion under functional medicine guidance is critical.
C. Autonomic Nervous System Support
POTS affects up to 80% of hEDS patients. It causes fatigue, dizziness, brain fog, and exercise intolerance. Functional strategies include:
High salt and fluid intake
Compression garments
Electrolyte supplementation (LMNT, Liquid IV)
Gentle recumbent exercise (e.g., rowing, recumbent biking)
Mast cell stabilizers if histamine intolerance is present
Integrative Therapies for EDS: Enhancing Functional Medicine Outcomes
Functional medicine embraces a multidimensional healing approach, where integrative therapies are not just complementary—they’re often essential. When used under the guidance of trained professionals and alongside conventional care, these methods can significantly improve the quality of life.
1. Acupuncture
How it works:
Acupuncture involves the insertion of ultra-fine needles into specific points along meridians in the body. These points are believed to influence energy flow ("qi") and stimulate the nervous system, releasing endorphins and promoting balance.
Why it helps in EDS:
Reduces Pain
Reduces central sensitization, where the nervous system is overly reactive to pain.
Promotes relaxation, which helps modulate the autonomic nervous system, particularly beneficial for patients with POTS and/or Anxiety.
Stabilizes mood
Improves blood flow and muscle relaxation, supporting hypermobile joints indirectly.
Improves communication with Vagus Nerve
Improves gastrointestinal functions
Improves Neuromuscular re-education
Scientific backing:
A 2020 systematic review in Pain Medicine found acupuncture effective in treating chronic musculoskeletal pain. Though not EDS-specific, many patients report symptom relief after 4–8 sessions.
Caution:
Due to tissue fragility in EDS, it’s crucial to work with an acupuncturist experienced in gentle techniques and aware of vascular fragility.
2. Massage Therapy
How it works:
Therapeutic massage manipulates soft tissues to reduce muscle tension, improve circulation, and activate the parasympathetic nervous system.
Why it helps in hEDS:
Reduces muscle spasms and compensatory tightness due to joint instability.
Improves lymphatic drainage, especially important for patients with mast cell activation syndrome (MCAS).
Provides gentle sensory input, helping patients with central pain syndromes.
Supports recovery post-physical therapy by reducing muscle fatigue and soreness.
Types of massage beneficial for hEDS:
Myofascial release (very gentle fascial stretching)
Manual lymphatic drainage (for MCAS-related swelling)
Craniosacral massage (see next section)
What to avoid:
Deep tissue massage is often contraindicated, as it can lead to bruising, pain flares, and tissue damage in EDS patients.
3. Craniosacral Therapy
How it works:
Craniosacral therapy (CST) is a very gentle, hands-on technique that aims to release tension in the tissues surrounding the brain and spinal cord. It involves subtle manipulation of the cranial bones, sacrum, and fascia.
Why it helps in EDS:
Alleviates headaches and migraines, common in hEDS due to cervical instability or CSF leaks.
Supports autonomic regulation, aiding patients with dysautonomia and anxiety.
Helps release tension in fascia and connective tissue, reducing overall body discomfort.
May improve TMJ dysfunction, often reported in hEDS.
Evidence and use:
Though clinical studies on CST remain limited, anecdotal evidence and clinical case series suggest benefits for neurological and chronic pain conditions. Many EDS patients report profound relaxation and reduced pain sensitivity following CST sessions.
4. Mindfulness-Based Stress Reduction (MBSR)
How it works:
Developed by Dr. Jon Kabat-Zinn, MBSR uses meditation, breathwork, and gentle yoga to cultivate awareness and acceptance of the present moment.
Why it helps in hEDS:
Reduces perceived pain intensity by changing how the brain processes discomfort.
Improves resilience to flares, preventing the downward spiral of stress-pain-fatigue.
Regulates the autonomic nervous system, supporting heart rate variability and lowering sympathetic overdrive.
Enhances emotional well-being, improving coping skills.
Proven results:
A 2019 study published in The Clinical Journal of Pain found that participants with chronic pain who practiced MBSR reported significant reductions in pain-related interference and depression after 8 weeks.
How to start:
Free apps like Insight Timer, Headspace, or Calm can be helpful.
In-person or online 8-week MBSR courses are offered worldwide.
Integrating guided meditations before bed may improve sleep quality.
A 2022 study published in Frontiers in Pain Research found that 38% of EDS patients used complementary therapies, with over 70% reporting mild to significant benefit.
The Mental Health Component
Living with an invisible, chronic condition takes a psychological toll. Anxiety, depression, and trauma histories are common in EDS. Functional medicine acknowledges the mind-body connection and integrates therapies like:
Cognitive Behavioral Therapy (CBT)
Somatic Experiencing or EMDR (for medical trauma)
Mindfulness-Based Stress Reduction (MBSR)
Dr. Alan Geller, a psychologist who works with EDS patients, explains:
“The nervous system becomes dysregulated over years of medical invalidation, trauma, and fear. Teaching patients to down-regulate that system is just as vital as treating the physical symptoms.”
The Role of Patient Empowerment
Functional medicine doesn’t view the patient as a passive recipient. It encourages:
Self-tracking of symptoms
Active participation in care decisions
Lifestyle ownership—from nutrition to stress reduction
This shift empowers patients who have often felt dismissed in traditional systems.
Challenges and Considerations
Despite its promise, functional medicine has limitations:
Some integrative therapies may not be fully covered by insurance, making cost a consideration for long-term care.
Quality varies—seek certified functional medicine practitioners (IFM.org).
Not all EDS symptoms can be “fixed”—the goal is management, not cure.
Patients should always inform their primary physician and work with a coordinated team, especially when integrating alternative treatments.
Conclusion: A Brighter Path Through Personalized Care
hEDS is a lifelong condition without a cure, but that doesn’t mean it’s untreatable. Functional medicine offers hEDS patients a hopeful, comprehensive path forward—one that addresses the entire person, not just the diagnosis. By optimizing nutrition, regulating the nervous system, strengthening the body, and supporting mental health, patients often experience improved function, reduced pain, and a better quality of life.
In the words of one patient interviewed for a 2023 EDS Society webinar:
“Functional medicine gave me my life back. I still have EDS, but now I feel like I have tools—and a team—on my side.”
At Dao Integrated Health, we specialize in providing compassionate, personalized care for individuals with Ehlers-Danlos Syndrome (hEDS) through a Functional Medicine lens. Our expert team understands the complex, multisystem nature of EDS and works collaboratively to address the root causes of chronic pain, fatigue, and dysautonomia. By integrating advanced diagnostics with evidence-based therapies and gentle integrative treatments like acupuncture, we help patients regain balance, resilience, and a higher quality of life. Whether you're newly diagnosed or seeking a more holistic approach to managing your symptoms, Dao Integrated Health is committed to guiding your healing journey with care and expertise. Contact us now!
