It happens more frequently than we care to admit. A new patient walks into your office with GI troubles. They have been to doctor after doctor and have tried treatment after treatment. But nothing works.
The unfortunate truth is that over one-third of new GI referrals walk in the door of functional medicine practitioners’ offices every day—yours likely among them—with no readily identifiable cause of their disorder.
So what can you do to help? How can you diagnose and treat a root cause that seems to defy common medical understanding? Working toward an answer requires outside-of-the-box thinking and making connections that others miss.
Could Hypermobility Be the Missing Link?
For many people, hypermobility—sometimes called “double-jointedness”—is little more than a unique party trick. Perhaps they can bend their thumb back to touch their forearm. Maybe they can put their foot behind their neck or easily do the splits. Regardless, that’s where it ends—something simple that amuses their friends.
Others, however, are not so fortunate. For these unlucky people with hypermobility disorders (HD), any perceived social benefits quickly fade due to the negative side effects that plague their health. Pain, fatigue, or chronic musculoskeletal issues may persist for these people, leading to a lifetime of symptom management.
Now, this is all fairly well-known by the medical community, but there is also a connection with the gut in some hypermobile patients—a link many doctors miss.
The key is the body’s connective tissues, such as collagen. Connective tissue serves as the “glue” that holds the body’s constituent parts together. With HD, these connective tissues stretch further than normal—which is why hyperextendable joints are such a dead giveaway.
The latest Kharrazian Institute Master Class focuses on the overlooked connection between hypermobility and the gut. Taught by Dr. Steven Sandberg-Lewis, How to Think Like a Functional Gastroenterologist presents a step-by-step, practical approach to decoding the presentations of complex digestive patients.
In the course, Dr. Sandberg-Lewis highlights critical, often-missed physiological factors—like hypermobility syndrome—that are major drivers of chronic GI issues. You can learn more and register here.
Hypermobility Disorders and Increased GI Risk
Joints are not the only places where connective tissues are found in the body. The GI tract also utilizes connective tissues, such as collagen. In people with HDs, the collagen in the GI becomes too “stretchy,” leading to all manner of health issues, including:
- Gastroesophageal reflux disease (GERD) – GERD affects over 50 percent of people with hypermobility.
- Tortuous and redundant colon – The colon of HD patients can over-elongate and develop too many bends and folds.
- Bowel issues – Constipation and diarrhea are common among those suffering from HD.
- Hernias – Hypermobile patients are much more prone to hiatal and sliding hiatal hernias.
- HD patients may even experience rectal prolapse.
In addition to the above list, PoTS (Postural Orthostatic Tachycardia Syndrome) and MCAS (Mast Cell Activation Syndrome) are frequent comorbidities with HD and further serve to complicate digestion. Not only that, but hypermobile patients suffer from celiac disease at a rate 10–20 times that of the general population.
Unfortunately, many practitioners lack an adequate understanding of the link between hypermobility and the gut, and as a result, they too often miss the fundamental root cause of their patients’ GI troubles.
Screening for Hypermobility in GI Patients
Hypermobility is strongly correlated with GI disorders, as we have laid out. And in one way, this is good news. It suggests a path forward to diagnosing and treating some of your most challenging GI cases—a path that is quick and easy to adopt.
At the center of this approach is a short screening technique for hypermobility, known as the Beighton score. The Beighton score involves testing five of the body’s joints—base of the thumbs, elbows, knees, knuckles of the pinky fingers, and the spine—to measure the amount of flexibility in each. After measuring joint angles, each joint is given a score up to 9, depending on how much hyperextension is present.
Additionally, the technique requires asking certain joint-health-related questions. A few examples from the Cleveland Clinic include:
- When you were younger, did you entertain your friends by warping yourself into different positions?
- Can you now (or could you ever) bend your thumb and touch your lower arm?
- Do you think of yourself as double-jointed?
Each “yes” answer is awarded one point, and all points from both parts of the test are tallied. The higher the score, the likelier it is that the patient has hypermobility. A score of 5 or above generally indicates hypermobility in patients under 50, while a score of 4 or more correlates with hypermobility in patients 50 and over.
The Beighton test excels as an option to add to your incoming GI patient assessments for several reasons. First, while it’s not a full diagnosis, it is a test you can do to quickly determine whether HD is a factor in gut-related health issues. Second, the test itself is easy to administer in your office or even on Zoom calls.
At the end of the day, HD is a major cause of digestive problems, and it’s worth taking the few minutes to administer the Beighton test as part of your intake protocol.
If you want to learn more about the connection between hypermobility and the gut—and how straightforward methods like the Beighton score can help you diagnose and treat complex GI patients—click here to register for Dr. Steven Sandberg-Lewis’s Master Class, How to Think Like a Functional Gastroenterologist.
How to Think Like a Functional Gastroenterologist
Identifying unique, effective tools to integrate into your practice, such as the Beighton test for GI patients, can be one of the most challenging aspects of care. The simple truth is, we cannot discover everything there is to know in functional medicine on our own. We need help.
That is why we created our Kharrazian Institute courses. Our goal is to give you access to the best minds in functional medicine so your practice can benefit from shared wisdom and your patients can get back to good health—for good.
In our newest Master Class, How to Think Like a Functional Gastroenterologist, Dr. Steven Sandberg-Lewis provides a time-tested clinical model to handle complex GI cases. Not only does he dig deeper into the link between HD and the gut, he also covers in detail subjects like:
- Addressing chronic inflammation by understanding the link between cortisol, DHEA, and inflammation, and how issues like gluten sensitivity can drive this imbalance.
- Identifying and treating gastroparesis, a common cause of nausea and vomiting frequently seen in patients with traumatic brain injuries.
- Differentiating between slow transit constipation and rectal dyssynergia to create effective treatment protocols for patients with constipation.
- Using neurofeedback (like LENS) and high-dose omega-3 protocols to promote neuroplasticity and heal the brain, even decades after a TBI, and resolve persistent TBI-related GI issues.
Dr. Sandberg-Lewis’s Master Class is your chance to tap into the knowledge he has accumulated from over 45 years of practice as a functional gastroenterologist. You will gain the practical know-how to start helping your most complicated GI patients finally get back to health.
Frequently Asked Questions
How are hypermobility disorders connected to gut issues?
Hypermobility affects the body’s connective tissues, including those in the GI tract. When these tissues stretch too easily, they can disrupt normal digestive function, leading to problems like GERD, constipation, diarrhea, or even hernias.
What are some common digestive problems seen in hypermobile patients?
People with hypermobility disorders often experience GERD, tortuous or redundant colon, constipation, diarrhea, and a higher risk of hernias and rectal prolapse. They can also have related conditions such as PoTS and MCAS, which can worsen GI symptoms.
How can practitioners screen for hypermobility in GI patients?
The Beighton score is a quick and simple screening tool that tests joint flexibility in the thumbs, elbows, knees, pinky fingers, and spine. A score of 5 or higher (for patients under 50) suggests hypermobility may be a contributing factor to GI symptoms.
Why is hypermobility often missed as a cause of digestive issues?
Many practitioners are unaware of the link between connective tissue disorders and gut health. Because of this, underlying hypermobility disorders often go unrecognized unless specifically tested for.
Where can practitioners learn more about the connection between hypermobility and the gut?
The Kharrazian Institute’s Master Class, How to Think Like a Functional Gastroenterologist, taught by Dr. Steven Sandberg-Lewis, explores the connection between hypermobility and the gut, along with practical diagnostic and treatment strategies for complex GI cases.
