Why this matters: OI tends to affect adolescent girls more than boy. This is a very important time for bone growth.³ The teen years are the years when bone density increases the most. Bone density doubles between childhood and young adulthood. Also, women have a lower bone density than men. Anything that interferes with increasing bone density during the teen years puts them at high risk for bone problems on into adulthood.

Bones that have lost calcium and minerals are not as strong. It is easier for them to break with very little injury or force. In severe cases, people can collapse a bone in their spine (a vertebrae) just by sneezing or rolling over in bed.

People with Orthostatic intolerance conditions like NMH and POTS as well as Chronic Fatigue Sydrome (CFS), as well as other chronic conditions, have a bigger chance of developing bone problems for a number of reasons.

1. Prolonged bedrest:

   This causes changes in how bones function.¹ Like most parts of the body, they are constantly removing damaged/old cells and replacing them. Normally, the number of cells created matches the number of cells destroyed. When a bone is immobilized or not used, the bone is broken down faster than it is being created. (Called bone resorption.) See the topic "bedrest" to learn more about the effect of bedrest on the bones. It takes astronauts up to 2 years for their bones to recover from a stretch of time in space.

2. Being homebound- lack of sunshine :

   This often means - in-the-house-bound. People who are homebound or bed bound don't get enough sunlight for their body to convert the Vitamin D to active vitamin that is necessary for bone growth. It only takes about 20 minutes in the daylight. The skin is able to synthesize the Vitamin D to the active form when it is exposed to the sun. Vitamin D is important because it helps the intestines absorb (take in the calcium) from the food you eat. Vitamin D is also important for muscles.

3. Lactose Intolerance:

   Many people with CFS also have lactose intolerance. (See Associated Conditions for more details). In the US, most people relay on milk products to get enough calcium. Milk products are often fortified with Vitamin D.

4. Cola drinks.

   Cola drinks affect how the body handle calcium in the kidneys. They can worsen bone loss.

5. No "weight-bearing" exercise

   Exercise where the body is standing up, putting weight on the bones in the legs and spine stimulates bone growth. (It's related to the problem with prolonged bedrest.)

Evaluation for bone problems: This is something you should talk over with your doctor. If you have been sick for a while and have been on prolonged bedrest - either continuous bedrest or 2-3 weeks of bedrest on and off over the last few months. To consider: bone density studies and measuring vitamin D levels.

In the meantime, there are a number of things you can do:

Check how much calcium you are getting in your diet including your multivitamin. You need at least 1500 mg/da.

Make sure you are getting enough Vitamin D3 in your diet/food.

Try to get some sun each day - just 20 minutes without sunscreen. If you have not been out in the sun for awhile, you should start with a few minutes with your skin uncovered, like your arms and legs. Watch for sunburn. Skip a day if you are red the next day then cut the time outside in half when you start again.

 

More about this topic later.

GI Conditions "Digestion - Stomach - Intestines"

There are a number of GI problems with orthostatic intolerance (OI). In a survey of people wthe POTS, A high number of people reported GI.⁸ GI symptoms seem to be a common and troublesome problem for people with OI. We will be addressing the research on it and related conditions in more detail in the near future.

What's causing the symptoms: It is hard to sort out what is causing the problem. It could be damage to the autonomic nerves that go to the stomach and intestines as part of the Autonomic Nervous System failure.

It could also be caused by the poor blood flow to the stomach and intestines that comes with low blood pressure. When there is low blood flow to the head, the body shifts the blood from the legs/ arms and stomach/intestines area to the chest and head. It makes the blood vessels to the stomach and intestines smaller so there is less blood that gets to them.

OI and other GI conditions: In some GI conditions, like Cyclic Vomiting Syndrome, orthostatic is common and treatment for the OI is recommended.^{9, 10} We will address Cyclic Vomiting Syndome in the near future. (Sign Up for notices)

Impact of managing OI on GI symptoms:

Sullivan did report that some of the upper GI symptoms got better when the orthostatic intolerance (OI) was better⁴. [Upper GI symptoms would be heartburn and esophageal reflux (GERD).]

Others have looked at GI symptoms in children, symptoms during Tilt Table Testing, POTS diagnosis and response to fludrocortisone.¹¹

What you can do: We offer suggestions about eating and orthostatic symptoms in Taking Care - Tricks to Avoid Getting Dizzy.

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One of the downsides of taking medication to increase blood pressure and blood flow when you stand up is that it can also increase blood pressure when you lie down.

For more detailed information, go to Supine Nocturnal Hypertension.