Why Hydration Is So Important for EDS
If you’ve ever wondered why adding electrolytes to your water can make such a difference, you’re not imagining it.
If you’ve spent any amount of time in the Ehlers-Danlos syndrome (EDS) community, you’ve probably noticed that everyone seems to have a water bottle within arm’s reach. Hydration is one of those topics that comes up constantly, right alongside physical therapy, compression socks, and pacing. But unlike a lot of wellness advice floating around the internet, this one has a solid physiological explanation.
For many people with EDS, staying hydrated is actually about supporting a circulatory system that’s working under different circumstances than most people’s. Understanding why can completely change the way you think about hydration.
EDS is a connective tissue disorder. Your blood vessels are made of connective tissue.
When most people think about EDS, they think about joints that bend a little too far, frequent sprains, stretchy skin, or chronic pain. What often gets overlooked is that connective tissue exists almost everywhere in the body.
Collagen, one of the body’s main structural proteins, helps provide strength and support to your ligaments, tendons, skin, fascia, pelvic floor, digestive tract, heart valves, and blood vessels. That means when collagen isn’t functioning as expected, the effects can extend far beyond your joints.
Your blood vessels, for example, are constantly expanding and contracting throughout the day. Every time you stand up, exercise, or even digest a meal, your circulatory system is making tiny adjustments to keep blood moving where it needs to go.
For many people with hypermobile EDS, those blood vessels appear to be more compliant, meaning they’re stretchier and don’t always tighten as efficiently as they should. Researchers are still studying exactly why this happens, but the end result is something many people with EDS know all too well: blood doesn’t always return to the heart as effectively as it should when you’re upright.
Gravity is a big factor.
Here’s a quick experiment to help get this point across: stand up.
Immediately, gravity starts pulling blood toward your legs and abdomen. If your body did nothing, less blood would make it back to your heart and brain. Normally, your nervous system responds almost instantly. Your blood vessels constrict slightly, your leg muscles help pump blood upward, and your heart adjusts just enough to keep everything running smoothly.
Most people never notice this happening, but if your blood vessels are more elastic than average, they may not squeeze back down as efficiently. More blood can stay in the lower half of your body, a phenomenon often called “blood pooling.”
That means your heart has a little less blood to pump with each beat. To compensate, it often beats faster. And because your brain is particularly sensitive to changes in blood flow, you might experience symptoms like:
Lightheadedness
Dizziness
Brain fog
Fatigue
Heart palpitations
Exercise intolerance
Feeling shaky when standing
Near-fainting or fainting
This is one reason many people with EDS are also diagnosed with autonomic disorders like Postural Orthostatic Tachycardia Syndrome (POTS). While not everyone with EDS has POTS, and not everyone with POTS has EDS, the overlap is significant enough that many specialists routinely evaluate for both conditions.
So where does hydration come in?
This is where everything starts to click. When healthcare providers recommend increasing fluids, they’re often trying to increase your “blood volume.”
Think of your circulatory system like a river. If there’s very little water flowing through it, it becomes harder to keep everything moving efficiently. If you increase the volume of water flowing through the river, it’s easier to maintain a steady current. Your circulatory system works in a similar way. Having more circulating fluid gives your heart more blood to pump and can make it easier to maintain blood pressure when you stand up.
For someone whose connective tissue already makes circulation less efficient, even a modest increase in blood volume can translate into meaningful symptom relief. That’s why so many people describe feeling less dizzy or simply more functional when they’re consistently hydrated.
Hydration is essentially helping your body compensate for its connective tissue disorder.
Why water alone isn’t always enough.
One thing that surprises a lot of people is that hydration isn’t just about water. Electrolytes, especially sodium, play an important role in helping your body retain the fluids you drink.
You can think of sodium as one of the factors that helps keep water where your body needs it. Without enough sodium, you may simply excrete much of the water you drink before it meaningfully increases your circulating blood volume.
That’s why many clinicians who treat dysautonomia recommend increasing both fluids and sodium together, provided it’s appropriate for your individual health needs. Some people get more sodium through their diet. Others add electrolyte supplements to their water throughout the day.
Hydration supports more than your circulation.
Circulation gets most of the attention, but hydration also supports connective tissues themselves. Cartilage is made up largely of water, allowing it to cushion your joints and absorb shock. The discs between your vertebrae rely on water to maintain their height and flexibility. Fascia and other soft tissues also depend on adequate hydration to function normally.
It’s important to be realistic here. Drinking more water won’t change the structure of collagen in EDS. It won’t reverse hypermobility or eliminate chronic pain, but it does help provide your tissues with the environment they need to function as well as they’re able, and a lot of people living with EDS find significant relief from hydrating properly.
Think of it this way: if your connective tissue is already working harder than average, giving it the resources it needs is one way of reducing the overall burden on your body.
Hydration is one tool, not the whole toolbox
One of the challenges of living with EDS is that there usually isn’t one intervention that changes everything. Instead, symptom management often comes from lots of small things working together: hydration, electrolytes, compression garments, physical therapy, strength training, pacing, sleep, nutrition, and medications when appropriate. Each one may only move the needle a little, but together, they can make daily life feel much more manageable.
That’s why hydration gets talked about so often in the EDS community. Not because it’s a cure, but because it’s one of the simplest, most accessible ways many people can support their body’s physiology every single day.
The bottom line.
If you’ve ever noticed that you feel better after consistently adding electrolytes to your water, there may be a very real physiological reason.
Because connective tissue is part of your circulatory system, EDS can affect the way blood moves through your body. Supporting blood volume through adequate fluids and electrolytes may help compensate for those differences, making it easier for your heart and nervous system to keep up with the demands of everyday life.
Hydration won’t cure EDS, of course, but it can make living with EDS a little easier.
Sources:
The Ehlers-Danlos Society. Dysautonomia. https://www.ehlers-danlos.com/dysautonomia/
The Ehlers-Danlos Society. Hypermobile Ehlers-Danlos Syndrome (hEDS). https://www.ehlers-danlos.com/heds/
Raj SR, Fedorowski A, Sheldon RS, et al. Diagnosis and management of postural orthostatic tachycardia syndrome. CMAJ. 2022;194(10):E378-E385. https://www.cmaj.ca/content/194/10/E378
Do T, et al. Nutritional Implications of Patients with Dysautonomia and Hypermobility Disorders. Nutrients. 2021;13(10):3402. https://www.mdpi.com/2072-6643/13/10/3402
Celletti C, Camerota F. The multifaceted and complex hypermobility syndrome (Ehlers-Danlos Syndrome Hypermobility Type): Evaluation and management through a rehabilitative approach. Clinical Terapeutica. 2013.
Hakim AJ, O’Callaghan C, De Wandele I, et al. Cardiovascular autonomic dysfunction in Ehlers-Danlos syndrome—Hypermobile type. American Journal of Medical Genetics Part C: Seminars in Medical Genetics. 2017.