EDS and Your Gut
Adapted from a lengthy comment I originally made on the national EDNF FB page related to EDS and multiple “overlapping” disorders, including magnesium imbalance and gut problems. I posted the following text on the Michiana EDNF and Michigander Zebras group pages a few days back, and thought I would re-post here. As always, SHARE THIS INFO FREELY, ESPECIALLY WITH YOUR HEALTHCARE PROVIDERS.
EDS is a primary condition affecting connective tissue. If the primary condition could go away, any condition secondary to it should theoretically disappear. Since nobody has figured out how to make EDS go away, we are stuck with practically innumerable secondary conditions, as connective tissue is in every tissue of the body.
All EDS patients should educate themselves regarding the basics of the autonomic nervous system, including the enteric nervous system, which governs gut function.
Many people understand that the autonomic nervous system controls the “fight or flight” response. Specifically, the sympathetic portion of the autonomic nervous system drives the “fight or flight” response.
Far fewer realize that the autonomic nervous system controls the “rest and digest” response that offsets and balances the “fight or flight” response. Specifically, the parasympathetic portion of the autonomic nervous system drives the “rest and digest” response.
Enter the enteric nervous system.
Directly from Wikipedia: “The enteric nervous system (ENS) or Intrinsic nervous system is one of the main divisions of the autonomic nervous system and consists of a mesh-like system of neurons that governs the function of the gastrointestinal system. …the enteric nervous system is sometimes called a ‘second brain’”
http://en.wikipedia.org/wiki/Enteric_nervous_system
The enteric nervous system resides in the gut. Although it is subject to control from the brain and spinal cord, if connections are severed between brain, spinal cord, and enteric nervous system, the enteric nervous system will function independently (as if it has a mind of its own.)
I find the following documents from
http://foodintolerancemanagementplan.com very nicely describe the enteric nervous system in easily readable terms. See: Understanding the Human Gut and the Enteric Nervous System (ENS)
http://foodintolerancemanagementplan.com/documents/Understanding%20the%20Human%20Gut%20and%20the%20Enteric%20Nervous%20System.pdf
The same site lists numerous detailed references regarding enteric nervous system health, including dietary management of enteric disorders. See: Helpful Resources and Links and Research Papers, Studies and Donations
http://foodintolerancemanagementplan.com/documents/helpful%20resources%20&%20links.pdf
For example: Evidence-based dietary management of functional gastrointestinal disorders. The FODMAP approach.
http://www.ncbi.nlm.nih.gov/pubmed?term=20136989)
I will quote directly from “The enteric nervous system: New developments and emerging concepts”
http://www.um.edu.mt/umms/mmj/PDF/329.pdf :
“The ENS controls gut motility and secretion via local reflexes that are triggered by local distension of the intestinal wall, distortion of the mucosa, and chemical contents in the lumen. This neuronal regulation of GI functions is due to the liberation of specific neuromediators synthesized by functionally defined enteric neurons. In addition, ENS is involved in the control of immune and inflammatory processes throughout the gut. Thus, it is not surprising that any damage to ENS circuitries and in the neurotransmitters systems results in a wide array of gut disorders, including motor impairments, which are characterized by high morbidity. … with a markedly compromised patient’s quality of life and occasional fatal outcomes. …Besides a few exceptions, the mechanisms through which neural diseases cause gastrointestinal dysfunction, including motor abnormalities, remain poorly understood.”
Also: “ENS express all neurotransmitters so far known in CNS (more than 30 neurotransmitters). These include classical neurotransmitters such as acetylcholine (Ach), noradrenaline, serotonin, GABA and glutamate, but a great number of other neurotransmitter and hormones also participate in the regulation of functions in the GI tract: vasoactive intestinal polypeptide (VIP), nitric oxide, galanin, motilin, adenosine triphosphate, tachykinins, etc.”
In my opinion, the two most critical concepts touched upon in the quoted text are:
1) The ENS controls gut motility and secretion via local reflexes that are triggered by local distension of the intestinal wall, distortion of the mucosa, and chemical contents in the lumen. Connective tissue is what allows the intestinal wall to distort and distend when needed. This is where the connection lies between EDS and gut disorders!!!
2) Adrenaline and noradrenaline (epinephrine and norepinephrine) are catecholamines. When catecholamines have gone haywire (for example, in dysautomic conditions such as POTS), of course the enteric nervous system (and thus, the gut) is very specifically affected!!!
POTS is just one of the dysautonomic conditions which can occur in persons with or without EDS. For those familiar with POTS, it isn’t just about tachycardia. It’s a SYNDROME which includes gut disorders. POTS involves either an intrinsically “broken” autonomic nervous system (a primary dysautonomia) or an autonomic nervous system without intrinsic pathology that subsequently “misbehaves” due to specific controlling circumstances (a secondary dysautonomia). In the case of POTS comorbid with EDS, POTS is believed almost certainly to occur as a condition secondary to EDS. (The jury is still out as to exactly WHY EDS causes POTS, but there is little dispute regarding the high incidence of EDS sufferers who struggle with POTS.) In the broadest sense, both patients and practitioners need to understand that persons with dysautonomia can experience symptoms in ANY system affected by the autonomic nervous system. In fact, ALL systems are modulated by the autonomic nervous system; this means that dysautonomia can wreak havoc with just about anything! Perhaps the most commonly acknowledged symptoms are cardiovascular (tachycardia, orthostatic intolerance, fatigue, etc.), gastrointestinal (malabsorption, dysmotility, IBS, constipation, etc.), and amplification of pain in general. (Of course, the fact that the list of dysautonomia-associated symptoms are seemingly infinite – and the fact that dysautonomia is not “easy” to treat – is why dysautonomia generally makes practitioners want to hide under a rock when their patients mention it.)
Bottom line: for many of those with EDS, gut difficulties likely relate heavily to the enteric nervous system and are often associated with autonomic dysfunction such as POTS.