Hypermobility and the Gut: Inside a Dietitian’s Counselling Session

When living with hypermobility, gastrointestinal (GI) symptoms often feel like an unpredictable companion. Reflux, bloating, fatigue after meals, or sudden bowel changes can make daily life challenging and confusing. Nutrition counselling offers a structured, evidence-based way to understand these symptoms, identify triggers, and build strategies that support both gut health and overall wellbeing.

As a clinical dietitian working in hypermobility care, I want to give you a clear picture of what happens during dietetics counselling sessions, so you know what to expect, what the potential intervention approaches are and how we can optimize your care by collaborating with other healthcare professionals when needed. 

Many patients with hypermobility experience GI symptoms that fall into four overlapping clusters:

1. Upper GI Dysmotility

   Reflux, swallowing difficulties, nausea, or delayed stomach emptying

   Often linked to connective tissue laxity affecting the oesophagus and stomach, or autonomic dysfunction slowing motility

2. Systemic / Autonomic-Linked GI Symptoms

   Fatigue, dizziness after meals, food intolerances, or hives

   These may reflect mast cell activation (MCAS) or dysautonomia, where the nervous system struggles to regulate digestion and circulation

3. Motility-Related Dyspepsia

   Bloating, nausea, or early fullness

   Commonly associated with small intestinal bacterial overgrowth (SIBO), delayed transit, or visceral hypersensitivity

4. IBS-Like Bowel Pattern

   Alternating constipation, diarrhea, or sudden bowel urgency

   Reflects dysregulated motility and heightened gut sensitivity, often worsened by stress or dietary triggers

Recognizing which cluster your symptoms fit into helps guide both assessment and management. Your first counselling session is about building a complete picture of your health. Information you can expect to be asked about:

• Medical history: Hypermobility often overlaps with thyroid conditions, MCAS, or dysautonomia (POTS) or other existing or new symptoms may be present like light-headedness, chronic fatigue, brain fog, incontinence, swelling, hives, pain…

• Detailed symptom mapping: We’ll explore your GI symptoms, their timing, intensity, and correlation to specific meals and ingredients. Some of the underlying GI conditions that may also me present include gastroparesis, heartburn, food sensitivities, chronic or acute constipation/diarrhea, functional nausea, hernias, celiac disease, Crohn’s disease…

• Lifestyle: Sleep, stress, physical activity, and hydration all influence gut function.

• Diet history/recall: We’ll look at what you eat in terms of quantity and quality (food groups, leftovers, food restrictions…) and your eating routine and habits overall (like emotional eating).

  
  

Our sessions are collaborative; you bring your lived experience, and we bring structured frameworks to connect the dots. Dietetics counselling is not about restriction; it’s about building a personalized plan that respects your sensitivities while ensuring nutritional adequacy. 

• Key approaches revolve around smaller, frequent meals, low-histamine rotations for MCAS-related flares, gentle low-FODMAP and anti-inflammatory swaps, fibre type adjustments (soluble vs. insoluble), gluten free or dairy free eating patterns, semi-elemental diets and other personalized interventions.

• SMART goals: Specific, achievable steps such as tracking symptom intensity after introducing a certain fiber type for example. 

• Resource support: Patient-friendly handouts, trackers, and visual guides to make nutrition practical and approachable.

• Empowerment focus: Understanding why symptoms occur helps reduce fear and build confidence in managing them.

Lab Tests That Can Provide Insight

While dietetics counselling focuses on food and lifestyle, lab tests can shed light on underlying mechanisms as well as eliminate other related deficiencies and conditions to paint a clearer picture on symptom origin. Depending on your symptoms, your dietitian may consider the need for certain lab works and/or coordinate with your doctor to order specialized ones. 

• Breath tests for SIBO or carbohydrate malabsorption

• Gastric emptying studies for suspected gastroparesis

• Serum tryptase or histamine markers for MCAS

• Thyroid function tests for hyperthyroidism or hypothyroidism

• Stool analysis for microbiome balance, inflammation, or malabsorption

Coordination with Other Healthcare Professionals

Hypermobility care is multidisciplinary. Dietitians often coordinate with:

• Gastroenterologists for diagnostic testing and medical management.

• Allergists/Immunologists for MCAS or food intolerance evaluation.

• Cardiologists or neurologists for dysautonomia and postural orthostatic tachycardia syndrome (POTS).

• Physiotherapists for movement and posture strategies that reduce reflux or motility strain.

• Psychologists or therapists for support with disordered eating history, stress, or gut-brain axis regulation.

  
  

This team-based approach ensures that nutrition counselling is integrated into your broader care plan.

Dietetics counselling in hypermobility is about more than food, it’s about understanding the mechanisms behind your symptoms, structuring sessions to uncover patterns, and building a treatment plan that empowers you and guide you to having a better quality of life. By mapping symptoms into clusters, reviewing intake, integrating lab insights, and coordinating with other professionals, we create a framework that supports both gut health and overall wellbeing.

Stay tuned for more on the various GI symptom clusters related to hypermobility. Think about which one resonates most with your experience, and discuss it with your dietitian.

Post written by MEND-CO Registered Dietitian Hiba Agha