The Impact of Nutrition on Tendon Health

: On today's episode, the impact of nutrition on tendon health. Welcome to the podcast helping you overcome your proximal hamstring tendinopathy. This podcast is designed to help you understand this condition, learn the most effective evidence-based treatments and course, bust the widespread misconceptions. My name is Brody Sharp. I'm an online physiotherapist, recreational athlete, creator of the Run Smarter series, and a chronic proximal hamstring tendinopathy battler. Whether you are an athlete or not, this podcast will educate and empower you in taking the right steps to overcome this horrible condition. So let's give you the right knowledge along with practical takeaways in today's lesson. Hey everyone, just thought I'd let you know this episode was recorded on the run smarter podcast a couple of months ago and thought it would be extremely helpful for this particular audience. So enjoy. I am on Tom Goom's email list, which is he's a running physio. He has the runners workshop and online workshop, which I attended several years ago. But he came out with an email with those two months ago about the impact of nutrition and tendon health. And I've sort of taken on some of his points and said, that's an excellent topic for a podcast episode. And so decided to do it. His email mainly pointed towards a systematic review. And the title of that systematic review is the impact of nutrition on tendon health and tendonopathy, a systematic review. It's a 2022 paper and thought I'd use it. in this. And he also came up with a few expert opinions and clinical recommendations, which I'll list at the end of this episode as well. So I don't want to take all the credit. If you are interested and or if you haven't heard of Tom Goom, check out his stuff. He is the running physio. It is that's most of his tags on Instagram and his website and that sort of stuff. So go check him out. Okay, the Before I dive into the paper itself, we need to learn about collagen synthesis. It is a fancy term. The collagen is essentially like the major component of what a tendon makeup is. And the tendon or the collagen synthesis is just mainly the turnover of build up and breakdown of that particular substance. We need that to adapt. Think of it like your muscle, it gets sore when you do, like your bicep muscle, if you do a lot of bicep curls, it gets sore. It has these domes delayed onset muscle soreness. It breaks down temporarily in order to build up and get stronger. Think of that process when thinking of collagen synthesis, similar type of turnover, similar type of adaptation in order for tendons to raise their capacity. That's what we want to do for tendon rehab. That's a similar approach that we need to take with a tendinopathy. If a tendon has undergone a pathology, we need it to adapt to get stronger and become healthy again. So that's what we're referring to when it comes to that and becomes important in this paper. They say that the objective of this paper, which is, you know, sort of summarizes in the title, but this systematic review aimed to evaluate the impact of nutrition and on the prevention and treatment of tendinopathy. Usually when it comes to systematic reviews, we look at the, we sort of count it as like the highest level of evidence, but we do need to be careful when looking at the conclusions of systematic reviews, because what a systematic review does is scan, scour, sift through, all previously published papers on a certain topic and brings it all together. And so a systematic review is great, but it's only as good as the papers that it can collect. And so I could do a systematic review on, you know, basketballers between the ages of 18 and 21, increasing the height of their vertical leap in six weeks or 6 to 12 weeks and I can really narrow that down and say okay what interventions help improve that because if it's so narrow and I go scouring and I could only find maybe one paper I've done a systematic review on it, but it's only as good as what I return so we do need to be very careful with interpreting these things and we need to Evaluate how many papers and what the quality of those papers do return But let's dive into this paper so Like I said, I've gone through the title and the objective. Just to set the stage a little bit, which it talks about in this introduction, it says the pathological tendon is characterized by altered tissue homeostasis. So the substance or the makeup of this tendon is slightly altered. It says, given that diet plays a major role in the homeostasis of all tissues and poor nutrition, is one of the extrinsic factors that contributes to the development of a tendinopathy. Nutritional interventions such as intake of collagen are a plausible potential strategy to improve the prevention and healing of a tendinopathy. So they're sort of setting the stage for the hypothesis, I guess you could say. It also says that there's, it's been suggested that multiple nutrients such as collagen combined with vitamin C, may be more effective than single nutrient strategies, as many nutrients are involved in the tendon and collagen metabolism. So this is what they try to search for, or they're trying to test this hypothesis. And as systematic reviews go, they put out a search criteria. sifting through all that process they returned at the final stage 19 papers to then analyze and come up with some sort of conclusions. Let me scroll through what I've highlighted in this paper. Okay let's go to the discussion so the very end of the paper. One of the subheadings in this final weekly alcohol consumption, which they put in brackets is 7 to 13 drinks per week for men, and four to six drinks for women was associated with a modest increase risk of developing an Achilles tendinopathy, but not for patellar tendinopathy. So there was, um, it seemed like here there was one paper that sort of made that conclusion. If we go one level up they say excessive alcohol intake which is more than 13 drinks for men and more than six drinks standard drinks for women per week was a significant risk factor for the occurrence and severity of rotator cuff tears and so this is looking at um tendinopathies of various tendinopathies of the body rotator cuff being one of those um and so they seem to find uh a risk factor there, however they say, it was suggested that alcohol use may be a proxy for other variables that was not captured in this study. So trying to find if someone's an excessive alcohol taker, other things might be going on in their life that may have impacted or may have contributed to being a risk factor for developing a rotator cuff tear. They say despite inconsistent findings on the risk and severity of tendinopathies in humans, there is evidence that alcohol may inhibit collagen synthesis through toxic effects. And they reference another paper in after that quote. So maybe alcohol can potentially inhibit this collagen synthesis. What I was referring to before. Okay. Another subheading, collagen. So collagen supplements. They say the majority of these supplements were found to improve clinical and or structural outcomes in the treatment of tendinopathy. In these type of studies they examined the effect of a supplement containing collagen and the participants were not treated surgically and benefits of various clinical outcomes were found. Although most studies showed improvement after two to three months of supplementary use, the daily dose, as well as the type of collagen varied among interventions. So this is the issue when getting a whole bunch of papers, bringing it all together and trying to come up with a conclusion. It's like, okay, it seems like collagen may be helpful for clinical outcomes. But which collagen to take, how often to take it, when to take it varies from study to study. So it's hard to come up with an overall conclusion. But they do say all in all, collagen seems to be beneficial in the treatment of tendinopathy, but conclusions about optimal dosage, timing, duration, and type of collagen supplementation cannot be drawn yet. Okay, let me scroll through. So that's, I guess why I've highlighted that, that's sort of the major talking points and the major findings. They did try some other supplements which they didn't find much benefit with. You can always look through this. This is an open source paper as well. So if you want to look at the title and, um, scout through this yourself, you definitely can do that. They say conclusion due to the limited scientific quality and the variety amongst studies on nutrient intake, tendon location, study population and reported outcomes. it is impossible to draw definitive conclusions and formulate dietary requirements on the prevention and treatment of tendinopathy. They say findings on alcohol intake were inconsistent, but individual studies present important clinical implications for the use of dietary supplements on tendon health, of which especially those containing collagen-derived peptides seem to be beneficial in the treatment of tendinopathy. So, Um, it seemed at least they're grabbing some, uh, potential conclusions. Instead of just saying we can't come to any conclusions. There wasn't enough, uh, there wasn't enough quality in these papers that we gathered, so it's sort of raising some useful information. Okay. Um, below. Tom Goom's email, he sort of like referenced this paper and sort of some conclusions. He did manage to talk to a nutritionist. Fran Taylor is a nutritionist from Brighton and had, how many here? Five different topics on diet, supplements and tendinopathy. And so I thought this might be useful for you in this particular topic. So Fran suggests number one. Seek professional help from a dietitian and a nutritionist when it comes to this type of advice. Number two, limit alcohol consumption. So Fran seems to think that this is useful, seems to think possibly if we're drawing conclusions from this study that we just talked about, alcohol can create maybe a bit of a toxic environment and inhibit that collagen synthesis. Number three, eat a balanced diet and ensure energy needs are met. to properly fuel and repair and to properly fuel the repair and recovery process. We repair recover with energy with vitamins, nutrients, and the only way we can do that is with the food that we consume. If we don't do that, then the body has to start extracting energy from other sources and that's usually from your organs, your bones and as soon as we start extracting energy from that. you know, it's very, very tough to have optimal recovery. And we can run into some pretty poor outcomes and organs starting to become dysfunctional or not operating properly, brittle bones, you know, poor cartilage and all that sort of stuff. So we need to make sure we're giving out, we're fueling our body with the right building blocks in order to recover, that being recovering from a hard training session or that being recovering from an injury. Number four. Think about adding foods in rather than taking foods out. And there's a couple of dot points here. Include lots of color in your diet. So eat like rainbows, I think they say. Have a source of protein with each meal. Good sources include eggs, nuts, yogurt, salmon, lean meat, chickpeas, lentils, and tofu. And also have a portion of oily fish. once or twice per week. For example, salmon, mackerel, sardines, and anchovies. Vegan sources include walnuts, rapeseed oil, and flax seeds. And number five, coming from Fran Taylor, is collagen supplements are widely promoted to help with tendon health, but there is insufficient evidence on how beneficial these are. If you wanna take it, make sure it is informed. informed sport tested. So yeah, in Fran's case, the supplements, the collagen supplements, the still needing to gather further evidence, I guess, is where we're going for that. But some good helpful information when it comes to tendinopathies and some diet choices that you can make. Okay. While this was a quick little summary. I did want to providing some information about what you should do concurrently with these decisions that you decide to make. You decide to limit your alcohol, eat a rainbow, try some collagen supplements, those sorts of things. If you have a tendinopathy, here's also what you should be doing. And this is regardless of the tendinopathy you have, regardless of the stage, how severe it is, those sorts of things. Number one. management. Load management is just a fancy term to like say the overall calculation throughout the week how much your tendon is subjected to and whether that's too much, whether that's too little or whether it's in the sweet spot. We want to sort of stay in the sweet spot as much as possible. We don't want to underload a sore tendon because then it just gets weaker. We don't want to overload a tendon because then it just contributes to more of that pathology. So we need to make sure that we have this effective load management strategy. Um, some tips for you for most tendinopathies, especially tendinopathies of the lower limb, we are looking at slow, heavy, progressive strength training. So let's break that all down. Slow meaning the time under tension is quite high. So if you were doing a squat, we do put our tendons under load when we go into a squat, we're looking at three seconds down, two seconds up, so that's five seconds per rep, and then we may be doing three sets of eight, so we're looking at a good time under tension. So that's what I mean by slow. The opposite of that would be jumping. So we still do a squat and launch ourselves into the air, but that is still a strength exercise, but it's not slow. It's this rapid type of movement that when it comes to rehab for tendons, they prefer the slow stuff. Heavy was the second part of that slow heavy, heavy being as heavy as you can tolerate as heavy as the symptoms and your tendon and your injury can tolerate a little bit of pain during that exercise is totally fine. Usually poke into the twos or threes out of 10, but needs to settle relatively quickly afterwards, you can't be limping or have this ache or have this lingering symptom for hours after doing that exercise, definitely needs to return back to baseline within 24 hours. I like to put in brackets, you know, less than 12 hours is better, but once tolerated needs to, you know, be quite heavy. Slow, heavy, progressive strength training. So progressive meaning, yes, you might do slow and heavy stuff, but if you just stick to... 20 kilogram squats, which might be considered heavy for you, and you just stay at 20 kilograms for four weeks, you're not gonna see as much benefit, or you might even plateau in terms of your recovery, as opposed to every week, adding on two kilograms, or adding on five pounds, adding on 10 pounds, and just becoming, being progressive with your exercises as quickly as the tendon can tolerate, or as quickly as the tendon adapts. So slow, heavy, progressive strength training. That's what tendons tend to favor. Um, the third one I had written down here was avoiding aggravating factors. That might be elements in your running. That might be elements outside of your running, say for an Achilles tendinopathy. It might be minimalist shoes, or it might be speed work or it might be hills, like try to find which factors within your exercise regime, trigger or increase pain and really, you know, sort of pay attention to it and modify it. We're not saying stop running. We're saying modify the aggravating factors. If it's high hamstring tendinopathy, a lot of people find it uncomfortable with sitting. Okay, modify. What is your tolerance? Is it 30 minutes? If it is, then modify it to 20 minutes. Try to stand, try to sit with a cushion, try to modify those things so you can still sit. Similar to the running, we're not saying not running. We're not saying don't sit, we're saying modify these things so that we can get your symptoms under control. So modifying your aggravating factors. And the last one I had written down is just try to bridge the gap towards your goals as much as possible. If it's running, if it's running races, if it's running marathons, if it's a fast, hilly 5K, we wanna make sure that we have established a good rehab ladder to reach whatever goal you have. Every step of that rehab ladder towards that goal needs to be slow, incremental, and deliberate to get to the demands of whatever that goal is. So if it is hills, okay, we need to introduce hills at some stage, so find when that time is right. Find a conservative start for those hills and then find gradual progressions to meet the demands of how hilly it is for that race. Just make sure we have it all planned out. You can't just start running 40 minutes pain-free and then expect to jump straight into a race that's hilly and you're just not prepared for it. So bridge the gap between what your goals are. All right. Those are the things I just want to summarize. Just a quick little recap with Fran's advice, limit alcohol, balanced diet, making sure you're getting enough energy, making sure you're getting enough fuel, enough building blocks. Eat like with a lot of color, proteins, fishy oils. And if you did want to do some collagen stuff, make sure you consult the right people. Make sure you are load managing your tendons correctly, making sure slow, heavy, progressive strength training is in there somewhere within your rehab, modifying the aggravating factors, and then just have a nice established bridge, slowly working your way up the steps towards your goal. The other thing I'll probably add just to the very end, need to see improvements week by week, need to see improvements month by month. If we're not seeing that, something in your management has gone awry and you need to go... make tweaks here and there, try to uncover what that is. Like I said, this was a nice short, easy one, but hopefully with a lot of new information that you might not have heard. So good luck with your rehab this week and we'll catch you next time. Thanks once again for listening and taking control of your rehab. If you are a runner and love learning through the podcast format, then go ahead and check out the Run Smarter podcast hosted by me. I'll include the link along with all the other links mentioned today in the show notes. So open up your device, click on the show description, and all the links will be there waiting for you. Congratulations on paving your way forward towards an empowering, pain-free future, and remember, knowledge is power. Woo!