Superpower or Supersyndrome? | Part 1

Hypermobility Spectrum Disorder

How a Superpower Can Become Your Achilles Heel


Dr. Aaron Hartman

June 26, 2023

The-Achilles-Heel

    One
    Root Cause


    What if I were to tell you I’ve discovered one root cause — one predisposing factor associated with the most common & complex issues doctors address every day?

    • Chronic Fatigue
    • Fibromyalgia
    • POTS
    • Dysautonomia
    • Long COVID
    • Mold Toxicity
    • Chronic Lyme Disease
    • Breast Implant Illness
    • Autoimmune Diseases
      (like Hashimoto’s Thyroiditis)
    • Gut Issues
      (like IBS & SIBO)
    • Mast Cell Activation Syndrome (MCAS)

    I’m refering to hypermobility spectrum disorder (HSD), formerly known as hypermobility type three, or hypermobility EDS. It’s also commonly described as simply as being double-jointed.

    For years, I’ve walked alongside patients with a litany of chronic issues like the list above. Eventually, I began to notice many of these patients shared something suprising: hypermobility.

    In this article, I’ll introduce you to hypermobility, explore why it is so common, some of its benefits (there are several), and how it morphs from a superpower to a supersyndrome — the root cause of countless chronic health issues.


    What is Hypermobility Spectrum Disorder?

    Simply put, hypermobility is a condition where a person’s connective tissues, joints, ligaments, and sinew that connect their muscles are stretchy or very flexible. We all know people (or are people) who are “double-jointed” and can bend fingers, arms or legs in ways that make others squirm. That’s one of the outward manifestions of hypermobility, but being hypermobile affects the connective tissue throughout our body—all the stuff that holds our bodies together.

    As the word spectrum implies, the hypermobility spectrum should not be viewed as binary (on/off). Hypermobility is not something you do or do not have. Rather, many of us are hypermobile to varying degrees.

    The word disorder, of course, implies that something is wrong. As we will discover, however, being on the hypermobility spectrum is not necessarily bad. In fact, it can be an advantage. If you have an extreme case, or if hypermobility leads to further health issues, it then becomes a disorder.

    Hypermobility is Not the Same as Ehlers-Danlos Syndrome

    Ehlers-Danlos Syndrome (EDS) and Marfan Syndrome are the severe extremes of the spectrum. People with Ehlers-Danlos can experience dislocated limbs or lenses in their eyes, and severe cases can result in strokes, aneurysms, or premature death. Marfan syndrome is another genetic variant, which typically affects males and can be associated with aortic aneurysms.

    If you start searching these syndromes online, you’ll be lead along a rabbit trail of rare and extreme cases. My advice to you is: don’t go down that path! These syndromes are extremely rare. I have practiced medicine in five countries on four continents, and seen over 100,000 patients. Of all of those patients, I’ve encountered maybe three patients with Marfan Syndrome and fewer than 10 with Ehlers-Danlos. On the flip side, I see hypermobility spectrum disorder every single day.


    How Common is Hypermobility?

    They say numbers don’t lie. Unfortunately, statistics can easily distort the truth. In trying to uncover just how prevalent hypermobility is, we need to work through some confusing and potentially deceptive statistics.

    Edge Case: Ehlers-Danlos

    Let’s begin with the extreme end of the hypermobility spectrum: Ehlers-Danlos Syndrome (EDS). According to the current medical literature, only 1 in 5,000 people have Ehlers-Danlos Syndrome. [1]

    1 in 5,000 is quite rare. But if EDS is so rare, why are so many people searching for it online? Google Keyword Planner estimates 100k – 1 million searches related to EDS on average per month. That’s a lot of people looking for answers to something that hardly anyone has. What’s going on?

    The Literature Lag

    Medical literature takes 20–30 years to catch up with medicine. Thankfully, that time is getting shorter, but it takes years — sometimes decades — for the official statistics to catch up with what doctors see. EDS is largely overlooked in the traditional medical system (ERs, hospitals, medical universities) because only 1 in 5,000 have it … at least according to the official statistics. And while EDS truly is rare, many people may be dealing with serious degrees of the hypermobility spectrum (and searching for the rarest edge cases).

    Medical literature takes 20–30 years to catch up with medicine. Thankfully, that time is getting shorter, but it takes years — sometimes decades — for the official statistics to catch up with what doctors see.

    Assessing Hypermobility

    So what about hypermobility more generally? Some current literature suggests 1 in 30 adults has “hypermobile EDS,” a milder variant of EDS.[2] 1 in 30 is much more common. That means every doctor in the U.S. encounters this at least every other day (and probably overlooks it).

    But it’s worse than that.

    In pediatric psychiatry, a lot of energy is presently invested in studying neurodivergence. Autism Spectrum, once estimated at 1 in 600, then 1 in 300, is now estimated at 1 in 54. This radical re-estimate has lead many to question, “Is neurodivergence becoming more prevalent? Or are we developing better diagnostic criteria for it?” But as these pediatric psychiatrists research neurodivergence, they’re discovering 20% of kids are hypermobile.[3] 20% is a lot — that’s 1 in 5 kids.

    A Persistent Blind Spot

    Hypermobility isn’t always bad. In many cases, it’s a biological superpower (keep reading for more on that). If it’s not an obvious problem, then it’s easily overlooked. Consequently, a lot of people are hypermobile and don’t realize it. And when hypermobility does result in adverse health issues, that also gets overlooked. Therefore, people with fibromyalgia or chronic fatigue don’t realize they’re also hypermobile. People struggling with POTS or dysautonomia don’t know they’re also hypermobile. People with autoimmune, gut, or mold issues don’t know they’re also hypermobile.

    And because so few people are connecting the dots between connective tissue and these supposedly unrelated issues, that connection is largely overlooked. Hypermobility is not yet widely researched, and it’s not yet seriously counted.

    Which means there is a disparity in our statistics.

    Less than 20 years ago, mold-related illness supposedly didn’t exist; chronic Lyme disease wasn’t a known issue. Now we see it everywhere. In my clinical experience, with my eyes open to hypermobility, I can see that it’s ridiculously common. In 10 years, every doctor will discuss hypermobility — not because more people are becoming hypermobile, but because the diagnostic statistics will finally catch up to what is already happening.

    So, Just How Common is Hypermobility?

    One recent study cites 25–50% of young children (under the age of 10) exhibit signs of hypermobility, with prevalence dropping to 7–10% in school age children. Another study found that as many as 26% of college age students exhibit “Generalized Joint Hypermobility (GJH)” and 19.5% exhibit “joint hypermobility syndrome (JHS).”[4] These statistics are averages, with higher prevalence in women over men. While we wait for the scoring to standardize and the counting to improve, it is reasonable to assume 20% of the general population fall somewhere on the hypermobility spectrum. That’s 1 in 5 people in the U.S. — roughly 67 million — more than the combined population of New York, Los Angeles, Chicago, Houston, Dallas-Fort Worth, Miami, and Atlanta.

    In other words, a lot of people are hypermobile. You or someone you love is hypermobile.

    A lot of people are hypermobile. You or someone you love is hypermobile.

    Why is Hypermobility So Common?

    Hypermobility has significant survival benefits. Back in the day, if you were a little “loosey-goosey,” you could run a little faster. You could throw a spear a little farther. These physical skills provide a survival benefit. Think about your tall, lanky person that’s super athletic. Because hypermobility was an asset for survival, people were able to pass on their genes to more and more hypermobile people. We see it run in families who are naturally gifted at certain sports like volleyball, swimming, ballet, etc. Even some baseball pitchers and other elite athletes are hypermobile and it makes them better at their sport.


    What Are the Advantages of Hypermobility?

    Several benefits come with the increased flexibility and larger cerebellum connected with hypermobility:

    Running

    First, people who are more flexible tend to be a little faster when they run. Many people with hypermobility can stretch their hips and legs out a little more to increase their stride. The running pattern can look a little different but this advantage gives every stride a bit more distance.

    Jumping

    Hypermobility can also enable some people to jump a little higher, which can make great basketball or volleyball athletes. I remember looking at a picture of the female national volleyball champions at the University of Nebraska after they’d won a volleyball tournament. The young ladies sat on the ground in a W position with their legs splayed out. Their fingers were longer than the palms of their hands. As they were screaming, you could see how their faces were actually a bit narrow and long. In the picture, I noticed many of the typical patterns of someone with hypermobility. And they were national champions.

    Swimming

    You’ve likely seen a picture of Michael Phelps with his arms spread out; his “wingspan” longer than his height. Or maybe you’ve seen the photo of him with his arms wrapped around his back, his shoulder dislocated. That ability to stretch a little farther and having such a long arms has made him the fastest man in the world in water.

    Coordination

    People with hypermobility generally have a cerebellum that is a little larger than average. The cerebellum, also known as “the little brain” is the center of coordination. Without training, people with hypermobility can be more clumsy or awkward. But when people with a larger cerebellum do train, they can become super athletes.

    Increased Ability to Focus

    You may be surprised to discover people with hypermobility often experience cognitive benefits as well, but hypermobility is also associated with coordination of thought. These people tend to have the ability to hyper-focus and to think more precisely, which can be very beneficial if you’re a high-performing executive or athlete.

    The benefits of hypermobility are many and varied. Hypermobility can be a significant physical and cognitive advantage. However, today we live with nutrient deficiencies, lack of sleep, toxin exposures, sedentary lifestyles, chronic stress, chronic infections, and mold exposure. So what was a survival benefit has now become a health risk. What should be a biological superpower often becomes our Achilles Heel.


    The Achilles Heel:

    What Are the Disadvantages of Hypermobility?

    While there are benefits, hypermobility also comes with drawbacks and risk factors:

    Nutritional Deficiencies

    The flexibility of connective tissue that accompanies hypermobility can increase your risk for certain nutrient deficiencies. Hypermobile tissues require nutrients like vitamin C, trace minerals, protein, and collagen. Unfortunately, in the last 50 years, we’ve removed many of these important components from our diet.

    • Callagen: Important sorces of callagen — bone broth, organ meats, and eating meat on the bone — are rare in current diets.
    • Trace Minerals: We eat too many processed foods, and we’re not getting the trace minerals we used to get from eating plants.
    • Protein: Many of us are also eating insufficient levels of the protein we need.

    Inadequate intake of these critical nutrients can affect anyone’s immune system, bone structure, and many other systems in the body. For people with hypermobility, who have an increased need, these deficiencies can be especially problematic.

    Quick Tip: We understand … not everyone is ready to start eating liver again, even if it provides significant health benefits for hypermobility. If that’s you, try our recommended partner: Pluck. Pluck is a mixture of spices to put on food, popcorn, or to use in cooking that is based on clean freeze dried organ meat. Learn More (and get a 10% discount).

    Digestive Issues

    If you’ve been following me online, you probably know that most, if not all, chronic diseases are related to gut health. Many even claim that all chronic diseases begin in the gut. Hypermobility is a big player here.

    Hypermobility affects digestion and gut motility — setting you up for issues like gut bacteria imbalances, dysbiosis, SIBO (small intestine bacterial overgrowth), decreased pancreatic function, reduced digestive enzyme secretion, and decreased stomach acid production. Lower stomach acid can also affect your body’s ability to absorb nutrients. I often find that my hypermobile patients are low in B vitamins, magnesium, and other minerals.

    Detoxification

    Hypermobility can make it more difficult for people to remove toxins from their bodies. Hundreds of years ago, this was not as significant an issue. But in today’s environment, with water-damaged buildings (which includes 50% of the buildings in our country), increased environmental toxins, chemicals, and heavy metals, this can create a heavy toxic burden for everyone and especially those who cannot adequately detoxify.

    Consider that the average woman in the U.S. uses 12 products on her body per day, which contain 168 different chemicals. This is a heavy burden for all of us but can become overwhelming for people that are hypermobile and have a harder time detoxifying.

    Sleep Apnea

    People with hypermobility spectrum disorder tend to have narrow airway passages. These “skinny passages” may not be problematic at 20–30 years of age. Over time, however, things get looser causing upper airway resistance syndrome. This is commonly acknowledged by oral surgeons, dentists, and anesthesiologists, and overlooked by everyone else. If you have
    hypermobility, you might experience minimal symptoms like jaw pain, TMJ, cracked teeth, and receding gum lines, without realizing these are symptoms of mild sleep apnea.

    Sleep is critical for health; poor sleep can set you up for a long list of chronic diseases.

    Trauma

    The last health issue I want to mention here is trauma. Because of their underlying physiology, people with hypermobility tend to have a higher cortisol baseline. Elevated cortisol is great if you’re competing or in survival-mode, but chronically elevated cortisol can become very problematic over time.

    If you’ve been traumatized as a child, had a traumatic brain injury, been in a dysfunctional home, or were in a relationship with someone who was abusive, these things can set you up for a trauma-like response, which can cause brain inflammation that can last for years.

    Once again, trauma is never healthy; but for people withy hypermobility and elevated cortisol, the problem is exacerbated.


    Conclusion

    In Greek mythology, the hero Achilles was invulnerable save for the single spot where his mother held him as an infant, dipping him into the river Styx. That one weakness beceame his downfall in the Battle of Troy. Superpowers are like that. Superman has kryptonite. Spiderman runs out of web fluid. Black Panther’s vibranium is susceptible to sound waves. We could learn a thing or two from comic books (or the Iliad). Iron Man keeps improving his suit. Spiderman brings a lot of backup web cartidges. Superman works really hard to stay away from krytonite. And Achilles probably could have protected his heel.

    Hypermobility does not have to be your downfall. It can be a superpower.

    The first step, of course, is understanding how hypermobility may be affecting you personally. You’re probably wondering whether any of this applies to you personally. If hypermobility is a spectrum, where are you on that spectrum? We’ve designed a simple self-assessment to help you answer that question.

    Are You Hypermobile?

    Take the ConnectCODE Self Assessment to discover your individual ConnectCODE, and what impact hypermobility may have on your health.

    Take the Quiz


    Footnotes

    1. “The combined prevalence of all types of Ehlers-Danlos syndrome appears to be at least 1 in 5,000 individuals worldwide. The hypermobile and classical forms are most common; the hypermobile type may affect as many as 1 in 5,000 to 20,000 people, while the classical type probably occurs in 1 in 20,000 to 40,000 people. Other forms of Ehlers-Danlos syndrome are rare, often with only a few cases or affected families described in the medical literature.” Source | Back
    2. “Joint hypermobility, for example, is relatively common, affecting around 1 in 30 people. It’s unlikely to be caused by EDS if you do not have any other symptoms.” Source | Back
    3. “It is extremely common in children, having being reported in 25 to 50% of those younger than 10 years of age. The older you are the less likely it is you will be hypermobile. It affects 7 – 10% of school age children in the UK.” Source | Back
    4. “The study involved a convenience sample of 267 college and graduate students, aged 17–26. GJH was assessed using the Beighton score with a cutoff of 5/9, while JHS was assessed using the Brighton criteria. Injury history and symptoms were assessed by recall. Prevalence of GJH was 26.2 % overall (females 36.7 %, males 13.7 %). Prevalence of JHS was 19.5 % overall (females 24.5 %, males 13.7 %).” Source | Back