Understanding the Connection: Can hEDS cause vitamin D deficiency?

October 12, 2025 •

5 min read

According to past research, those with hypermobile Ehlers-Danlos Syndrome (hEDS) frequently have low vitamin D levels. While not a direct cause, the systemic nature of hEDS and its common comorbidities create a multi-layered risk that can lead to significant vitamin D deficiency over time.

Quick Summary

This article explains how hypermobile Ehlers-Danlos syndrome (hEDS) and its related conditions can lead to vitamin D deficiency. It covers underlying factors like gastrointestinal issues, malabsorption, and mast cell activation that affect nutrient status.

Key Points

Multi-Factorial Risk: hEDS doesn't cause vitamin D deficiency directly, but its systemic effects and associated conditions significantly increase the risk.
Gastrointestinal Issues: Connective tissue laxity affects gut motility and function, leading to malabsorption of nutrients, including fat-soluble vitamin D.
Mast Cell Activation: Comorbid MCAS can cause systemic inflammation and gastrointestinal distress, further hindering nutrient absorption and potentially affecting vitamin D metabolism.
Bone Health Vulnerability: Low vitamin D exacerbates existing bone health concerns in hEDS, such as lower bone mineral density and increased fracture risk.
Specialized Management Needed: Correcting vitamin D deficiency in hEDS often requires tailored supplementation and close medical monitoring due to potential absorption issues and the need for personalized dosing.
Overlapping Symptoms: Many symptoms of vitamin D deficiency, like fatigue and bone pain, overlap with those of hEDS, making it difficult to differentiate and diagnose without specific testing.

The Intricate Relationship Between hEDS and Vitamin D Deficiency

Hypermobile Ehlers-Danlos syndrome (hEDS) is an inherited connective tissue disorder that impacts various systems throughout the body, including the digestive tract. The resulting systemic issues, often combined with nutritional challenges, place individuals with hEDS at a significantly higher risk for developing nutritional deficiencies, particularly a lack of vitamin D. The connection is not caused by a single factor, but rather a perfect storm of compounding health issues.

Gastrointestinal Complications and Nutrient Malabsorption

Connective tissue is a fundamental component of the digestive tract, playing a vital role in the mechanical movements needed for digestion, a process known as peristalsis. For individuals with hEDS, the fragility and laxity of this connective tissue can lead to a range of gastrointestinal (GI) problems. These complications can impede the body's ability to digest food properly and absorb vital nutrients, including fat-soluble vitamins like vitamin D.

GI issues commonly experienced by those with hEDS include:

Delayed gastric emptying (gastroparesis), which can lead to nausea, vomiting, bloating, and feelings of premature fullness.
Irritable Bowel Syndrome (IBS) and functional dyspepsia, characterized by abdominal pain, bloating, and altered bowel movements.
Changes in gut motility, causing either chronic constipation or diarrhea.
Dysbiosis (an imbalance of gut bacteria) and increased gut inflammation.

These factors collectively disrupt the normal digestive process. The discomfort and symptoms can lead individuals to avoid certain foods or limit their intake, further restricting their dietary sources of vitamin D. The chronic inflammation and malabsorption make it difficult to absorb enough vitamin D even from adequate dietary sources or supplements, and diligent supplementation efforts may still fail to correct the deficiency.

The Role of Mast Cell Activation Syndrome (MCAS)

Mast Cell Activation Syndrome (MCAS) is a condition in which mast cells, a type of immune cell, become overactive and release excessive inflammatory mediators. This condition is a frequent comorbidity of hEDS and can contribute to nutrient deficiencies in several ways. The systemic inflammation triggered by MCAS can cause gastrointestinal distress, including abdominal pain, diarrhea, and bloating, further worsening malabsorption. Moreover, some studies suggest that vitamin D plays a role in stabilizing mast cells, and a deficiency could potentially exacerbate the inflammatory response characteristic of MCAS. This creates a cyclical problem where low vitamin D worsens MCAS symptoms, which in turn impairs absorption and drives vitamin D levels lower.

Compounding Risk Factors for Low Vitamin D

Beyond the primary mechanisms, other factors related to hEDS can also contribute to vitamin D deficiency:

Chronic Fatigue and Pain: The pervasive fatigue and pain associated with hEDS can significantly limit outdoor activities and sun exposure, a primary source of vitamin D synthesis.
Decreased Physical Activity: Reduced mobility due to joint instability and pain can lead to less bone-loading exercise. Vitamin D is crucial for calcium absorption and bone health, so low levels amplify an already existing vulnerability to reduced bone mineral density in some hEDS patients.
Medications: Certain medications used to manage hEDS symptoms or related conditions may interfere with vitamin D metabolism or absorption.

The Impact on Bone Health

Vitamin D's role in regulating calcium and phosphate is essential for maintaining strong bones. For hEDS patients, who may already experience issues with bone mineral density (BMD) due to factors like lower mechanical loading and potentially smaller bone size, vitamin D deficiency presents a serious concern. Inadequate vitamin D can exacerbate osteoporosis, increasing the risk of fractures and worsening pain.

Comparing Factors in hEDS vs. General Population


Feature	General Population	Hypermobile Ehlers-Danlos Syndrome (hEDS)	Implications for Vitamin D Status
Gastrointestinal Function	Generally healthy, efficient nutrient absorption.	High prevalence of GI issues, including dysmotility and malabsorption.	Increased risk of malabsorption of fat-soluble vitamins, including vitamin D.
Inflammation	Acute, localized inflammation is typical.	Often experiences systemic inflammation, potentially related to MCAS.	Inflammation can disrupt metabolic processes and nutrient absorption.
Physical Activity	Varied, but often more consistent due to fewer limitations.	May be limited due to chronic pain, joint instability, and fatigue.	Reduced sun exposure limits natural vitamin D synthesis.
Nutritional Intake	Wider variety of foods, fewer dietary restrictions.	Prone to restrictive eating patterns due to food sensitivities and GI distress.	A limited diet can reduce intake of vitamin D-rich foods.

Managing and Supplementing Vitamin D in hEDS

For individuals with hEDS, addressing vitamin D deficiency requires a careful and individualized approach. The presence of malabsorption means that simply increasing oral intake may not be sufficient, and close medical supervision is critical to ensure proper dosing and monitoring.

Testing and Monitoring: A doctor should regularly check serum 25-hydroxyvitamin D levels, especially for those with malabsorption syndromes or comorbidities like MCAS.
Tailored Supplementation: Given the challenges with absorption, a healthcare provider might recommend higher daily doses or weekly/monthly doses of vitamin D3 (cholecalciferol) to correct a deficiency. In severe cases, high-dose therapy under medical supervision may be necessary.
Optimizing Absorption: In cases of severe GI issues, strategies to improve absorption might be explored, such as focusing on gut health, consuming vitamin D with dietary fat, or considering different delivery methods.
Dietary Focus: While supplements are often necessary, consuming foods rich in vitamin D like fatty fish (salmon, sardines), egg yolks, and fortified products remains important. Working with an EDS-aware dietitian can help manage dietary restrictions without compromising nutrient intake.
Safe Sun Exposure: For those who can tolerate it, a moderate amount of safe sun exposure can aid natural vitamin D production.

Conclusion

In conclusion, there is a clear and complex link between hypermobile Ehlers-Danlos syndrome and an increased risk of vitamin D deficiency. This heightened vulnerability stems from a combination of systemic issues, including gastrointestinal malabsorption, associated inflammatory conditions like MCAS, and lifestyle limitations imposed by chronic fatigue and pain. Effectively managing and correcting vitamin D deficiency in hEDS patients requires working with knowledgeable healthcare providers who understand these unique challenges. Through targeted testing, personalized supplementation, and holistic nutritional support, individuals can help mitigate the risks associated with low vitamin D and improve their overall bone health and quality of life. The Ehlers-Danlos Society offers valuable resources for managing the condition and its comorbidities. Ehlers-Danlos Society

Frequently Asked Questions

The fragile and lax connective tissue in individuals with hEDS can affect the digestive tract, leading to poor gut motility and function. This can result in delayed gastric emptying, IBS, and inflammation, all of which hinder the absorption of vitamins and minerals, especially fat-soluble vitamins like D.

Symptoms of vitamin D deficiency can include fatigue, muscle weakness, bone pain, depressed mood, and frequent infections. These can overlap with existing hEDS symptoms, making accurate diagnosis reliant on specific blood tests.

Yes, MCAS can contribute to vitamin D deficiency. The systemic inflammation associated with MCAS can exacerbate gastrointestinal issues, further impairing nutrient absorption. Additionally, some research suggests low vitamin D can affect mast cell stability, creating a negative cycle.

Vitamin D is crucial for regulating calcium and phosphate, which are necessary for strong bones. Since hEDS patients may already have compromised bone mineral density and an increased fracture risk, adequate vitamin D is vital for protecting bone health and preventing conditions like osteoporosis.

The most effective form is typically vitamin D3 (cholecalciferol). Due to potential malabsorption, some individuals with hEDS may require higher doses than the general population, which should be determined and monitored by a doctor. Vitamin D is a fat-soluble vitamin, so taking it with a meal containing some fat can enhance absorption.

Yes, other common deficiencies include iron, vitamin B12, and magnesium. Gastrointestinal issues, restrictive eating patterns, and comorbidities like POTS and MCAS all contribute to the higher risk of multiple nutrient deficiencies.

You should ask for a 25-hydroxyvitamin D blood test to check your levels. Discuss your specific gastrointestinal symptoms, eating habits, and any related comorbidities. This will help your doctor determine an appropriate and safe supplementation strategy, considering any malabsorption issues you may have.