Click Here to Download this Blog Post – Why Does Standing Up Feel So Hard? The “Gravity Battle” in hEDS and HSD
(Part 19)
By Dr. Nicholas L. DePace, M..D., F.A.C.C – Cardiologist specializing in autonomic dysfunction, Ehlers-Danlos syndrome and POTS.
If you live with Hypermobile Ehlers-Danlos Syndrome (hEDS) or Hypermobility Spectrum Disorder (HSD), you probably know the feeling: you stand up to start your day, and suddenly your heart is racing, your head feels foggy, and you’re hit with a wave of exhaustion.
It turns out, your body is fighting a literal battle with gravity. For the vast majority of patients with these conditions, the “glue” that holds the body together (connective tissue) is stretchy, but the “wiring” that controls the body (the nervous system) is also glitching.
The Two Main “Wiring” Glitches
Your Autonomic Nervous System has two main branches: the Sympathetic (the gas pedal) and the Parasympathetic (the brake pedal). In hEDS/HSD, these often malfunction in two specific ways:
- Sympathetic Withdrawal (The Failed Gas Pedal): Usually, when you stand up, your sympathetic nerves tell your blood vessels to tighten up, pushing blood upward to your brain. In many patients, this signal fails. The “gas pedal” cuts out, blood pools in your legs, and your brain is left “starving” for blood flow.
- Parasympathetic Excess (The Stuck Brake): Sometimes, when your body is under stress, the “brake pedal” slams down too hard. This can cause sudden drops in heart rate or energy when you actually need a boost.
How “Poor Blood Flow” Mimics Other Illnesses
Because your blood isn’t being pumped efficiently to the top half of your body (a problem called poor perfusion), your organs start to send out distress signals. These signals are often mistaken for other serious diseases:
- Heart & Lungs: You might feel palpitations, chest pain, or shortness of breath. Often, the heart is perfectly healthy—it’s just struggling because it doesn’t have enough blood to pump!
- Brain & Mood: When the brain doesn’t get enough blood, it can cause brain fog, fatigue, and fainting. It can even trigger or worsen anxiety, depression, ADHD, or OCD. Your brain is essentially “revving” itself to stay awake and alert despite the low fuel.
- Digestion: These same nerves control how food moves through your gut. When the wiring glitches, you get stomach pain, bloating, or bathroom issues.
The Difference Between “Stretchy” and “Dangerous”
While hEDS and HSD are the most common types, there is a much rarer form called Vascular EDS (vEDS). It is vital to know the difference:
- hEDS/HSD: Usually involves “stretchy” skin, loose joints that pop out (subluxations), easy bruising, and chronic pain. While it makes life very difficult, it is not typically life-threatening.
- Vascular EDS: This involves the blood vessels and organs themselves being fragile. Red flags include a family history of aneurysms, ruptured blood vessels, or intestinal tears—especially in people under 40.
The Path Forward: Testing the Wiring
The good news is that your organs are usually healthy! The problem is the P&S (Parasympathetic and Sympathetic) nerves that tell them what to do.
Specialized testing can help your doctor see exactly how your “wiring” is misfiring. Once you understand your specific needs, you can start a treatment plan—like salt, fluids, compression gear, or medication—to help your body win the battle against gravity.
Where to Seek Expert Care?
It is important to seek out a clinician with expertise in EDS to make an accurate diagnosis and create a treatment plan. One of the nation’s leading centers is Franklin Cardiovascular Associates, under the direction of Nicholas DePace, MD, FACC. They are located in Sicklerville, New Jersey. franklincardiovascular.com, (856) 589-6034
About the Author
Nicholas L. DePace, MD, FACC is a board-certified cardiologist and Medical Director of Franklin Cardiovascular Associates. A graduate of the Mount Sinai School of Medicine, Dr. DePace has decades of clinical, academic, and research experience and has held faculty appointments as a Clinical Professor of Medicine, becoming one of the youngest full professors in Philadelphia at the time of his appointment.
Dr. DePace specializes in the diagnosis and treatment of autonomic nervous system dysfunction (dysautonomia), including POTS, autonomic dysfunction associated with Ehlers-Danlos syndrome (EDS), chronic fatigue, and anxiety-like conditions that are frequently misdiagnosed. He is nationally recognized for his work on parasympathetic and sympathetic (P&S) nervous system imbalance, a core mechanism underlying many complex chronic disorders.
In addition to treating patients from across the United States, Dr. DePace is a prolific clinical researcher and author of multiple nationally distributed medical textbooks published by Springer and W.W. Norton, focusing on autonomic dysfunction, mitochondrial disorders, cardiovascular disease, and mind–body medicine.
👉 View Dr. DePace’s professional profile
👉 View medical books by Dr. DePace