After I finished writing my glucosamine and chondroitin supplement guide and follow-up executive overview, I realized that what I had written could be disheartening. I don’t want to be solely the bearer of bad news, and I’ve also experienced firsthand how presenting only the negatives can fail to inspire change. Since one of the foremost goals of Climbing Nutrition is to improve your nutrition (and thereby your climbing), this isn’t ideal—and so I want to provide some tips on how you can hopefully improve the health and tenacity of your connective tissue.
To be certain, I also don’t want to provide false hope; if a diet or supplement does not or cannot work, I’m not going to hedge about it. The world of nutrition is filled with implausible and unproven advice, and it will remain a secondary goal of this website to actively fight against pseudoscientific nutrition, especially as it relates to climbers. But in many cases, if there is a worthless recommendation to debunk, there is also something of worth to recommend.
The unfortunate truth is that these recommendations are rarely, if ever, as strong or sexy as their pseudoscientific counterparts (hence the “might” in the post title). That’s the reality of science-based nutrition, though—there are no guarantees, and many areas that are potentially promising have a dearth of evidence, making it hard to know whether they’ll actually pan out. Regardless, these same recommendations are often healthy or helpful in at least some known factor, unlike many pseudoscientific recommendations that have virtually no worth when removed from their false promises.
Enough preamble, though! Here are four frequent tendon-related recommendations that have no scientific merit that should be skipped, and four changes I can recommend in their place.
Don’t Do: Supplement with Vitamin C
Vitamin C is commonly recommended for connective tissue health and healing because it’s a necessary ingredient in the formation of collagen—but if you don’t have enough vitamin C to effectively maintain your collagen, a strained pulley is the least of your worries because you’ll be bleeding from the gums and losing teeth as well.
Why would this happen? Well, let’s first examine how vitamin C actually influences the formation and final structure of collagen.
The complete protein “collagen” is a complex cord formed of numerous fibrils of tropocollagen that are themselves formed of three twisted polypeptide strands. On a molecular level, these twists in a chain of amino acids don’t “just happen”—they require special amino acids. In the case of collagen, the tight twists rely on the amino acid hydroxyproline, and the formation of hydroxyproline requires vitamin C.
Without sufficient vitamin C, the body cannot effectively form hydroxyproline, and without sufficient ability to form hydroxyproline the structure of collagen is compromised as the hydroxyproline is replaced with other amino acids that are less capable of twisting. This reduces the strength of the final collagen in the same way the strength of a rope would be compromised if none of the individual strands were twisted or braided together. And just like a weak rope, the weakened collagen breaks easily.
When our diet is severely vitamin C-deficient, we produce only weak collagen, resulting in the disease scurvy. Because our collagen is weak, wounds heal poorly (because our skin contains collagen), bruises occur regularly (because our blood vessels contain collagen), the gums begin to bleed and you might even lose teeth (because collagen helps hold our teeth in place). Thankfully, scurvy is rare today in the developed world because vitamin C is present in sufficient amounts.
The RDA for vitamin C is 90 milligrams for adult men and 75 milligrams for adult women, and you will easily get this much from your daily diet provided you have a single serving of fruits or vegetables; if you’re meeting the actual recommendation of 5-9 combined servings daily, there’s a very good chance you’re getting somewhere in the range of 200-400% the RDA for vitamin C. To protect your tendons, though, you don’t even need this much because scurvy can be prevented by consuming only roughly 10 milligrams of vitamin a day!
This isn’t to say you shouldn’t strive to get the full RDA of vitamin C daily (or at least as a weekly average)—you should for other health-related reasons—but rather that healthy collagen formation is one of the first functions of vitamin C, and that your body isn’t going to compromise on the integrity of your connective tissue unless it absolutely has to. Assuming you get at least minimal amounts of vitamin C a day, you are all but guaranteed to have sufficient vitamin C for the formation of hydroxyproline, and thus have nothing to worry about.
Do Instead: Eat More Phytonutrient-Rich Foods
Instead of worrying about a lone nutrient like vitamin C, you’d be better off simply increasing the amount of fruits and vegetables in your diet. Fruits and vegetables contain numerous phytonutrients, which are non-essential, non-vitamin, non-mineral nutrients that may augment our health in subtle ways. Some of these phytonutrients, such as the flavonoids proanthocyanidin (found in numerous fruits, but particularly berries) and quercetin (found in numerous vegetables, but particularly alliums), could have a special affinity for both connective tissue and muscle tissue.
Phytonutrients aren’t magic bullets against injury. At best we have limited in vivo, human data that suggests they may help—such as by increasing the speed at which musculoskeletal function returns to normal (outside of other antioxidant activity). This isn’t enough for me to tell you that any phytonutrient is guaranteed to to improve your connective tissue, but it is a start.
The thing is, though, even if future research shows that flavonoids and other phytonutrients do little to nothing for the tendons and ligaments, the foods you have to eat to get those phytonutrients are still great to have in your diet for other reasons. Unlike a recommendation for vitamin C—which is more likely to result in the purchase of some Emergen-C or vitamin C capsules than a bag of oranges—a recommendation to eat more phytonutrients can only be accomplished by making dietary changes. This means eating more fruits and more vegetables, and that’s an intervention I can rally behind regardless of whether they’ll have a direct, phytonutrient-related effect on your connective tissue.
Don’t Do: Supplement with Manganese
Manganese is a trace essential mineral that acts as a cofactor for prolidase, an enzyme important to collagen formation and breakdown. Inadequate dietary manganese would hypothetically cause issues with collagen metabolism, leading to symptoms akin to those of the genetic disease prolidase deficiency, such as skin lesions, ulcers, and rashes. I say “hypothetically” because we’ve never once witnessed an inadequate intake of dietary manganese in the wild!
In a controlled lab setting, we’ve experimentally induced manganese deficiencies by providing humans with ultra-low manganese diets—and sure enough, these diets result in scaly skin and rashes (among other issues). But in the real world, where manganese is an abundant mineral that is only needed by the human body in trace amounts, deficiencies just don’t happen!
Furthermore, even if you wanted to increase your daily manganese intake, you really wouldn’t be able to because the absorption of manganese probably relies on an easily saturatable transporter, which is basically like a single lane road—easily clogged. If that road can only handle 1,000 cars per hour then it doesn’t matter if 500,000 cars are lined up because only 1,000 are going to get through. Ergo, only a small amount of manganese can be absorbed per meal.
In fact, when all sources of dietary manganese are accounted for across a day, less than 5% of the manganese present is absorbed. This is common among the trace and ultratrace minerals because biologically there is no reason for why we should absorb a lot—we don’t need the excess trace minerals, they increase the risk of food-related nutrient toxicity, and they would increase the burden on the kidneys to excrete what we cannot use.
I’m not a fan of supplementing with any vitamin or mineral because research doesn’t support it outside of an acute deficiency, but in the case of manganese I’m doubly against it. Even if you take a 50 milligram supplement (over 2000% the AI), you’re unlikely to absorb more than around 0.015 milligrams—about the same amount you would absorb from any dietary source. That’s a pretty poor return on your investment.
Do Instead: Consume Sufficient Calories (and Carbohydrates)
You can’t increase collagen production in your tendons and ligaments above normal, healthy levels—it’s a basic tenet of science-based biology that “healthy” is optimum, and there’s no further level to be achieved—but there are ways you can decrease or impair your collagen production. One potential way is by increasing your resting cortisol levels, which can happen dietarily by consuming inadequate calories or carbohydrates.
It’s repeatedly been found that not consuming sufficient calories increases resting cortisol levels (two studies linked here for reference). Generally, these studies use a greater degree of caloric restriction in order to produce weight loss, which is a greater degree of restriction than most climbers adhere to. Cortisol doesn’t suddenly spike when calories drop below a certain threshold, however, but increases gradually as it slowly becomes more necessary.
Beyond the effects of caloric restriction, the restriction of carbohydrates is likely to produce even further increases in cortisol. Cortisol helps prevent our blood glucose from dipping (and thereby harming our brain) by increasing insulin resistance and catabolizing skeletal muscle in order to free up amino acids for gluconeogenesis (literally, “new glucose creation”). Thus, for obvious reasons cortisol becomes more and more necessary as dietary carbohydrates become scarcer because because our body is forced to produce more and more of its own glucose.
(This is also why cortisol spikes during exercise, particularly long-lasting endurance exercise—after we exhaust our muscle glycogen, the muscles start taking glucose from the blood. Eventually the body is forced to respond by cutting off the muscles’ glucose supply through cortisol release, thereby preserving the remaining glucose for the brain and increasing the creation of new glucose.)
In the past, cortisol (hydrocortisone) and cortisone shots were a standard treatment for tendon injuries, but they’ve fallen out of favor in light of significant evidence that tendon healing and strength are actually impaired by the hormone. In general, cortisol is also an anti-anabolic hormone, meaning it downregulates the production of new proteins. This suggests that tendon production and repair could be compromised when cortisol levels are unnaturally high for significant periods of time (though local levels in the tendons will never be as high as during a shot).
Now, I don’t want to oversell the calorie/carbohydrate/cortisol/connective tissue connection; I just want to highligh a potential area for improvement, an area that I frequently see climbers lack in. Cortisol can spike due to numerous other causes (lack of sleep, general life stress, excess exercise without rest), and there are also numerous, more important factors in all tendon and ligament injuries. It’s still a potential risk factor, however, and when combined with the other general downsides of not consuming sufficient calories for your level of activity (such as increased muscle fatigue, weakness, and recovery time)—all of which can also predispose one to injury—it might be something to think about. And since a higher-carbohydrate diet is likely to provide performance benefits as well, there’s no real downside.
Don’t Do: Take Vitamin or Mineral Supplements (Including Multivitamins)
Occasionally, other vitamins and minerals are also noted for their connective tissue health properties. Instead of going through them one at a time as I did with the pro-collagen favorites vitamin C and manganese, I’m going to approach and debunk them en masse.
The #1 problem with recommending any vitamins and minerals to improve connective tissue health or healing is that deficiencies are relatively uncommon (just as we saw with vitamin C and manganese). And when we then move away from the nutrients that play direct roles in the biology of your connective tissue and towards the ones that play at best minor and indirect roles, it just becomes less and less likely that supplementation can change or influence anything pertinent. It’s beyond grasping at straws; it’s essentially saying “vitamins and minerals are important to your tendons because you need vitamins and minerals to live.”
Contrary to what is commonly believed, vitamins and minerals are not capable of improving health beyond normal levels of intake, which are reflected through scientifically established RDAs and AIs. Just like you can’t improve the health of your car by doubling the amount of oil or coolant, you can’t improve your health by doubling your vitamin or mineral intake. Each vitamin and mineral has a role to play in our health, and once we have sufficient amounts of a nutrient to perform those tasks there is no benefit to consuming more.
If you suspect you have a vitamin or mineral deficiency, go to a doctor and get tested. Such deficiencies are rare today, however, with our abundant and diverse diets—not to mention food fortification and enrichment—so the chances of being diagnosed with one are slim.
Do Instead: Eat a Diverse, Healthy Diet
There isn’t a single vitamin or mineral supplement that works to do anything aside from replete nutrient levels in an acute deficiency. Whenever we see positive results in the scientific literature for a particular vitamin or mineral, it’s inevitably in a population that has dietary deficiencies or insufficiencies in regards to the nutrient in question.
On the other hand, there is a plethora of research out there to support eating a healthy diet that contains a diversity of whole foods. From the standpoint of general health, we know that eating more fruits and vegetables, legumes, whole grains, mushrooms, roots, and fish is beneficial. We might not have specific data on these diets in terms of tendon and ligament health, but we can say for certain that eating more of the above foods will be far more likely to increase your connective tissue health than taking a supplement that has virtually no supporting evidence (and certainly none in regards to the connective tissue).
So ditch the multivitamin and individual vitamin/mineral supplements and use the money to buy more healthy, whole foods instead. You’ll enjoy them more, and they’ll do a lot more for your health in general.
Don’t Do: Consume Collagen-Based Proteins
There’s a term for the type of belief that underlies collagen-based proteins: sympathetic magic. Sympathetic magic is, simply put, the belief that like influences like. A common example is the belief that certain foods are aphrodisiacs because they superficially resemble the genitalia—but in this case, it’s the idea that consuming something made of collagen will be good for your own collagen.
Unfortunately, there’s no evidence that consuming a collagen-based protein is really good for anything because collagen-based proteins are merely poor-quality proteins. Poor-quality proteins only contain a limited amount of essential amino acids, and while they may be rich in the particular amino acids found in collagen there is no evidence that they will actually increase collagen production.
Beyond the false concept of sympathetic magic, there’s really no reason to believe that eating collagen would increase collagen production anymore than there’s a reason to believe eating liver would be helpful for cirrhosis or eating eyeballs would improve your sight. Proteins are made of amino acids, and the source of those amino acids is mostly irrelevant; as long as you get all the amino acids you need in the amounts your body needs them, then your collagen production will be ideal.
Do Instead: Eat More High-Quality Proteins
Collagen-based proteins are just poor quality proteins. When you eat a high-quality protein, you get everything you’d get from a collagen-based protein and then some.
A high-quality protein is also more likely to stimulate collagen production in the connective tissue in the first place. Much less work has been done on tendon protein synthesis than on muscle protein synthesis, but some research suggests they are connected, which carries the implication that the same things that are good for muscle protein synthesis (notably leucine-rich proteins) would be good for tendon collagen synthesis as well.
This muscle/connective tissue relationship has been further demonstrated by a rat study in which a leucine-rich diet increased the hydroxyproline content of tendon collagen (remember how hydroxyporoline is necessary for tendon strength?). Rat studies do not always translate well to humans, but in the case of generic muscle and tendon protein synthesis it’s likely there is significant crossover since it’s a pathway common to all mammals.
To be sure, there’s nothing wrong with eating collagen-based foods. You can enjoy broths and gelatins in a healthy diet without believing they’ll simultaneously improve your tendons and ligaments (or skin, or hair, or whatever else they’re advertised to improve). But going out of your way to eat foods you don’t enjoy just because they’re rich in collagen—I’m thinking about the steamed fish skins my friend’s Taiwanese girlfriend insisted were good for my skin—isn’t worth your while. You should definitely avoid collagen-based protein powders like so-called “beef protein”, because these are the height of worthlessness.
In short, stick with high-quality proteins and leave the poor-quality, collagen-based ones alone for the foods you enjoy.
Summary
There are many recommendations for tendon and ligament health that are useless. They’re unsupported by science, and often lack even basic scientific plausibility. Sympathetic magic is a fun concept for science fiction, but less so for science reality.
There are also many things you can do that may positively influence your tendons and ligaments tissue. What’s even better is that these same recommendations are broadly supported by science-based nutrition research to be healthy, even if they don’t wind up being specifically beneficial to your connective tissue. This is the type of recommendation I favor—the type that has no downside and many upsides.
I cannot promise that you’ll render yourself impervious to elbow tendonosis, strained pulleys, or rotator cuff tears if you follow my recommendations—science-based nutrition never makes these sorts of promises. What I can promise is that you’ll be doing more for your health (and by extension, your connective tissue) by eating more, healthier foods than by singling out “pro-collagen nutrients”.
So here’s to your tendons and ligaments! Eat right, and eat enough, and they’ll take you far.
TL;DR
The following common recommendations have no scientific evidence:
- Vitamin C: The majority of individuals in developed countries consume enough vitamin C, and virtually all of them consume enough vitamin C to encourage normal collagen formation. When we lack sufficient vitamin C for normal collagen formation, we develop scurvy.
- Manganese: Manganese is one of the most uncommon mineral deficiencies, and has never been encountered in humans outside of the laboratory. Supplements are probably worthless because it’s unlikely we can absorb more than a tiny fraction in a single serving.
- Vitamin and Mineral Supplements in General: Vitamins and minerals are required by the human body for normal function, but once you consume enough to meet the levels needed for normal function (reflected by RDAs and AIs) then there is no evidence they can improve health further. Most vitamins and minerals play only minor or indirect roles in collagen formation, and even in the case of an acute deficiency most would not significantly affect your tendon or ligaments.
- Collagen-Based Proteins: Collagen-based proteins are low-quality proteins that lack most essential amino acids. There is no evidence they increase collagen formation (there is actually evidence they don’t), and they’re a waste of time and money unless they happen to be in a food you enjoy like broth or gelatin.
The following recommendations are scientifically evidenced to improve your health in general and have plausibility for improving tendon and ligament health:
- Phytonutrients: Some phytonutrients like proanthocyanidins and quercetin (found in berries and alliums, respectively, as well as other fruits and vegetables) have preliminary research suggesting they may influence tendon and ligament cells.
- Calories and Carbohydrates: Diets that are low in calories and carbohydrates can cause resting cortisol levels to increase. Cortisol can inhibit the formation of new tendon collagen and potentially increase breakdown. Increasing calories to sufficient levels to support your activity level and consuming enough carbohydrates to maintain normal blood glucose levels throughout the day can decrease resting cortisol levels.
- Eating a Healthy and Diverse Diet: A healthy and diverse diet containing fruits and vegetables, legumes, whole grains, mushrooms, roots, and fish is much more likely to improve your health and by connection connective tissue health than vitamin or mineral supplements.
- High-Quality Proteins: High-quality proteins contain the essential amino acids necessary to encourage normal protein formation. There is also evidence that muscle protein synthesis (which requires leucine-rich high-quality proteins) and tendon protein synthesis are linked, suggesting that high-quality proteins should encourage better collagen formation.
While I understand there is no evidence eating collagen will increase collagen formation in your body, the comparisons of eating eyeballs will improve your sight and eating liver will be helpful for cirrhosis are poor.
The function of tendons is much simpler than sight or liver functions and mostly structural, so the idea of providing your body with similar proteins that your body produces for structural building blocks is not as ridiculous as eating eyeballs for sight and liver for cirrhosis.
Sight is a complex mechanism involving electron transfer and many types of cells.
The liver detoxifies and breaks down complex molecules using many mechanisms and reactions.
Tendon is just the connective tissue between muscle and bone. It is not near as dynamic, reactive, and complicated as sight or the liver.
Perhaps a better comparison would be to state that eating muscle meat does not help build muscle mass… But there are many who say this does work. Now whether or not that means the molecules from the meat directly helps, contributes, and/or becomes the muscles in your body is arguable. Perhaps it is just the consumption of calories that provides the energy to help build muscle.
In any case, your comparisons are not one to one and misleading because you’re identifying highly complex functions where eating certain materials will not benefit their functionality.
Eating tendon may help your tendons.
Eating muscle may help your muscles.
Eating eyeballs will not help eyeballs which are complex structures.
Eating liver will not help your liver which is a complex structure.
The comparison was meant to illustrate the influence of sympathetic magic on dietary collagen, and sympathetic magic is the link between all the examples I used (as well as your own example of muscle). As acknowledged by yourself, there’s no evidence that eating collagen will increase collagen formation in the body. It doesn’t really matter that collagen is still a protein, and that proteins will all have at least a little influence on our bodily proteins—what matters is that some people firmly believe that eating collagen will improve collagen production, and the rationale (whether hidden or obvious) is that like will influence like. So really, my point is about how people derive their beliefs, and whether they’re rooted in science or fantasy.
To go a step further, let’s look at dietary muscle protein (meat) and our own muscles. Certainly, there’s a plethora of evidence to suggest that meat will influence muscle growth; it’s an essential amino acid-rich food, and in sufficient quantities it will be guaranteed to help you build muscle. But it’s not because the meat is functionally similar to our own muscles—though it actually is—it’s because meat has the right nutrients to feed our own muscles. This is no different that milk, or beans, or nuts and seeds, or a variety of other high-quality protein foods that bear zero resemblance or function to our own muscles; you can grow equally strong on a vegetarian diet that completely eschews meat.
To summarize: It doesn’t really matter whether a food does or does not actually influence similar parts of our body; what matters is for people to understand that when something does influence a similar part of the body, it does so because there’s a scientific reason, not because of sympathetic magic.
Hi
Although, I agree with much of your article there is actually some preclinical evidence that certain individual nutraceuticals may help. Especially vitamin C, see: https://www.ncbi.nlm.nih.gov/pubmed/18309503 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915461/.
While these studies may not be enough for a solid recommendation on supplementation for humans, the assertion that there is absolutely no scientific evidence for individual supplement use may not be correct. The clinical studies have often not been done but the potential for benefit may be there.
The problem with preclinical evidence is that it is so often repudiated by clinical evidence. Preclinical evidence is needed to help flesh out hypotheses and provide a rationale for further testing, but what appears to be true from in vitro data—or from direct injection of vitamin C into a ruptured rat tendon—doesn’t always come to pass in human trials. Even when it does, we still would want to know its relative efficacy. For example, is vitamin C supplementation more or less effective than simply eating more vitamin C-rich foods? It’s not enough for an intervention to be effective, it must be more effective than existing treatments, particularly when one treatment is so readily available (eat more fruit). With this in mind, I still cannot in good conscience recommend vitamin C supplements, though I stand by my other recommendation to eat more fruits and vegetables instead; we know eating more phytonutrient-rich foods is healthy, even if it does nothing for your tendons, but the same cannot be said for supplements.
I thoroughly enjoyed the article and found it simple yet scientific. And it answered some of my questions about correlations between diet and tendonitis which is what I googled. I have been suffering from tendonitis is several areas of my body over the years; bursitis, Achilles, tennis elbow, and most recently sesamoiditis. I got to thinking maybe there’s a genetic link, (my brother told me he had Achilles tendonitis too) or a dietary one, specifically glucose which is known to cause inflammation. And I have a bad sweet tooth. There wasn’t much of an answer to my question of a genetic link, but I strongly suspect it could be a factor. If I inherited my Dad’s eyesight and my mom’s thick calves, then why not a predisposition to tendonitis? I had always blamed it on weight, but I recently lost 40 lbs before this latest problem with the sesamoid bones, so that alone didn’t seem to eliminate any predisposition to developing tendonitis. I thought age (I’m weeks away from 45) was a factor which I can do nothing about unless someone has found a way to turn back time. So, after reading your article, I came to several conclusions, one being supplementing was pointless, but if you read anything by Dr. Joel Wallach you would be led to believe there are no minerals or vitamins left in the soils. (I have family members in a pyramid scheme based on that claim.) Also, I should probably cut down on refined sugars in my diet because I know that’s just better for my body and probably would decrease general inflammation. Also, increase my fruit and vegetable intake on a daily basis which is common knowledge, but bears a more diligent effort on my part. I’ll admit I was hoping to find a definitive answer in the form of a supplement or reduction of something specific, but instead found sound advice to eat a well-balanced diet. That and more stretching and strengthening is probably the best antidote to this pesky problem of mine. Thanks for a great article!
I’m glad you found it helpful!
Hi, and thank you. I tore pretty profoundly a ligament in my lower back while stretching –I’m pretty flexible but that moment of “oh, just a leeeetle more stretch right there…” meant pop. I am a vegetarian of 24 years and know better to hope for too much nutritional healing, but darn it, those natural food store dried rosehips look yummy! Time to eat less, proceed with caution, and load up on water, locally sourced, of course. ☺
I think you’re article is influenced by the biased by your preconceived beliefs.
How about do actual science instead of performing witch hunts.
Did you really use the phrase “sympathetic magic”?? Claiming that the idea of collagen giving your body the constituent parts it needs to repair connective tissue is equivalent to something like homeopathy is downright irresponsible.
Just one example https://www.ncbi.nlm.nih.gov/m/pubmed/18416885/
The problem with the study you cited—and pretty much every other study done on collagen hydrosylate—is that it didn’t use a proper control. The question isn’t whether collagen-based proteins do anything at all, it’s whether they do anything better than more readily available, higher quality, cheaper protein sources. To test this, a lab would need to control diet for protein in general and then use protein supplements as the control group. Without this form of control, we should expect to see some apparent improvements in the collagen group because they are at least getting more protein, and that protein will have some effect on tendons, ligaments, etc.
Homeopathy may be a more patently ridiculous form of sympathetic magic, but the concept itself only suggests “like influences like”. I suppose different people will draw the line at different places, but to me the idea that eating collagen is good for collagen is emblematic of the type of dubious connections people make between food and health as it suggests there’s something collagen can do that no other protein can (or can do as well). Since we can say with biochemical certainty that collagen is just a string of amino acids and that digestion will render that complete collagen protein into its constituent amino acids along with some di- and tripeptides, we have no objective reason to believe dietary collagen can or should do anything better than another protein that contains the same amino acids—unless you believe that like influences like, that is.
Fascinating, well written and informative article, thank you. I’ve been having tendon problems in triceps, both feet, and my knee, and was actually considering collagen supplements, so you have saved me time and money, thanks doc!
I’ve got chronic tendonitis all over the place and every now and then I look around the internet to see if I can find any magic bullets (I used to climb and play squash back in the day but it’s out of the question now). Generally I find a load of advice pushing the latest fads: don’t eat carbs, don’t eat gluten, take omega n, take manganese, take vitamin D, use snake oil… I am a scientist, while I’m not in the life sciences it still obvious when someone is simply plucking their advice from uninformed guesswork (like ‘sympathetic magic’) combined with whatever diets and supplements are in vogue a the time. So an evidence based, informed article was a breath of fresh air. I’m vegetarian and I have a pretty good diet, it’s high in carbs, vegetables and cheese. I suppose I could try and eat a bit more protein. One question; in a vegetarian context, what would represent a ‘high quality protein’?
Thanks for the comment! Plant-wise, legumes are the best sources of protein, while many grains/pseudograins and nuts/seeds are of lower quality but can be used to supplement other meals. Depending on the specifics of your vegetarianism, though, dairy and eggs are also excellent choices protein-wise. I actually wrote a whole article about protein quality, if you’re interested—you can find it here!
http://jn.nutrition.org/content/129/10/1891.short
maybe not for tendons specifically… but gelatin is good for your joints in general.
The study you linked to above was performed in a somewhat curious way. Most importantly, both groups received the same amount of gelatin hydrolysate (10 milligrams per gram of body weight [mice]), but one group received gelatin that was radioactively marked while the other group received unmarked gelatin but some additional marked proline. The purpose of the experiment was to demonstrate that gelatin accrued in the cartilage of mice to a greater extent than just a free amino acid like proline—e.g., that peptides are absorbed intact and provide a greater utility—but since both groups received essentially the same treatment, I don’t find their results convincing. Yes, the marked gelatin group had double the radioactivity, but it had the advantage of being 100% marked; the marked proline group had about double the proline to work with, so it makes sense that only about half the proline actually got incorporated, and since our body can’t sort for radioactively marked vs. unmarked amino acids, we can assume statistically that’ll it take about half of each. Thus, the results don’t really show gelatin to be positive for cartilage, only that consuming gelatin leads to uptake of amino acids into our cartilage, which is true of all proteins (and my major overall argument against the lower-quality sources like gelatin and collagen).
Thank you for this article. I’m a runner and recently symptomatic with various tendonopathies. I’m registered for Berlin marathon so am especially bummed about this. I’ll read your article about protein. Anything to add about petite women? It’s often hard to know how to adapt nutrition info based on size and male/female. Oh and biking– all these awesome sports have their potential injury patterns. Thanks!
In terms of protein, there’s really not a lot to change for a petite woman—I would still recommend the same amounts, though it may require dietary tweaks (such as adding in supplementary sources like protein shakes) since 100-120 grams of protein is a relatively larger portion of food for a petite woman than a huge guy. Total calories will be very different, of course, but my basic recommendation to eat as much as you can while still maintaining weight is applicable in both cases.
In general with injuries or *opathies, it’s important to keep in mind that healing is energy-intensive work, and so it becomes more important to really focus on getting enough calories not just to support your training but also your healing. So while protein is a big piece of the puzzle (and the most straightforward), calories are possibly even more important. Without sufficient calories, healing is delayed and injuries become extended.
Hope that helps!
Thanks for the common sense tour de force w/ well placed citations. The article recommendation of “phytonutrients” may smear out too much detail; it’s such a huge class of poorly characterized molecules at present. Nevertheless, I think this article finds the right tone and balance for our current knowledge. I bookmarked it to return when the nutritional shamans begin to chant about this or that ground up bone potion or special additive and I feel their trance coming over my shopping cart…
Nice to see a well researched, balanced article on the internet! And I’m especially impressed with the calm, reasoned tone that you’ve responded to people’s questions and critiques. If there were more people like you online, the internet may be a much friendlier place to be.
As to the article, I’m a mid 40’s man who has worked hard to lose weight this year but have found that as I lose weight, I have had to deal with some injuries, particularly tendon related. I have a good physio, who is doing a great job on the exercise front, but I think perhaps food wise the problem is that in trying to decrease my calories I may have decreased the carbohydrates too much. After reading this article, I think perhaps adding back in some carbohydrates (perhaps brown rice?) might help a lot.
Great article and recommendations. I am always looking for ways to improve my connective tissue and joints. I have a form of Elhers-Danlos Syndrome (EDS) that greatly affects my tendons and joints. I am easily injured and can have a lot of pain. I will definitely try out some of the recommendations.
However, I do also want to share my experience with collagen. I don’t know how or why, but it works for me. I take the time to research what I put in my body, and avoided collagen for MANY years because I read numerous times that it was ineffective and a waste of money. I would even laugh in the faces of friends who would recommend it to me. Almost two years ago, my level of chronic pain increased. I was disheartened and assumed I just needed to adjust and get used to this new normal. After reading some recommendations on the EDS discussion board, and In an act of desperation due to pain, I decided to try it out. I do not know what kind of witchcraft happened, but my level of joint pain has never been this low, even during my teenage years. I joke that I pay for the ‘placebo effect’, but whatever it is, it works for me. I honestly wish I would have tried it out sooner. Nothing will fix my joints, but this has made my life a lot more comfortable.
Nonsense, hydrolyzed collegen works.
Does it work better than a complete protein source, though? That’s the question we need to answer, and so far the evidence suggests it does not.
Some more links regarding return-to-play following ligament/connective tissue injuries. The second of the two is whether gelatin supplementation could increase collagen synthesis:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5371618/
https://www.ncbi.nlm.nih.gov/pubmed/27852613
The first article you linked to suggests something very similar to what I wrote, which is that high-quality proteins (specifically, leucine-rich proteins) appear to be beneficial in strengthening connective tissue. The second link has the same issue I always see with studies that find gelatin (or similar proteins) to be beneficial: poor choice of control. Comparing 15 grams of gelatin, a protein, to maltodextrin (a carbohydrate) doesn’t tell us whether gelatin is better, equivalent, or worse than any other protein when it comes to collagen synthesis. If a study demonstrated that gelatin was able to stimulate more collagen synthesis than whey protein, then we might have reason to suspect that there’s something special about providing the body with more of the amino acids found in collagen than needed; without that type of control, though, all we know is that providing amino acids stimulates the production of proteins, which we already knew happened and isn’t particularly surprising to see in the context of connective tissue.
It could be that we’ll discover more—as the first article you linked noted, we’re still in the infancy of research as to the effects of nutrition on connective tissue. In the meantime, there is little evidence that gelatin is superior to any other protein when it comes to connective tissue growth and repair, but plenty of evidence that it’s inferior for all other musculoskeletal purposes (and more expensive to boot).
Rigby, Scientific evidence by your own admission is highly suspect…Were cortisone injection subjected to scientific rigor? I know first hand that they cause more problems then they cure. Science said they were great and gave many millions of injections for many years. And now they’re saying, maybe the injections are not good..
And yet you strongly suggest if some nutrition idea isn’t backed by science it’s some sort of ‘magic’.
These are the standards we work with—scientific evidence will always be subject to future scrutiny, and long-held hypotheses will at times be completely overturned by new evidence. It doesn’t mean that scientific evidence has no value, and we certainly shouldn’t assume that because scientific evidence can at times lead us to erroneous conclusions that all types of evidence are equal. So yes, if a nutrition idea has no backing science I’m not going to give it the benefit of the doubt.
Your so down on manganese supplementation and you give a very good rationale, but what about the effect of people supplementing so many other minerals? Maybe you overlooked the possible effect of this? Couldn’t this cause a functional Mn deficiency similar to what occurs in the lab setting? I ‘ve read studies or reviews that show magnesium, calcium, phosphorus, iron, and other trace elements compete with Mn absorption. In particular i think of the higher magnesium supplementation, 400 to 500 mg, much higher than found in foods, but also consider those foods that are quite higher in magnesium such as seeds, nuts and legumes tend to be much higher in Mn (up to 5 to 10 mg for good servings), but also with phytic acid to balance or slow the rates of absorption. What if someone gets all the extra magnesium but not from Mn rich foods, by taking supplements? Then they don’t get the corresponding Mn levels and also have Mg to compete with the little they get. Also so many cereal product are fortified with extra iron. When you put all this together could this not cause a functional Mn def that would then required some proportionate and compensatory Mn supplementation?
I think there’s a bit of confusion here between Manganese (element symbol Mn) and Magnesium (element symbol Mg). Both are essential minerals, but the AI (adequate intake; insufficient data to determine and RDA) for manganese is only about 2 milligrams while the RDA for magnesium is a little over 300 and 400 milligrams for females and males, respectively. The AI for manganese assumes that we won’t really absorb very much of it because we won’t, and even if other minerals slightly reduce absorption we need so very little that it’ll never be a problem. As I mentioned, manganese deficiency is a purely hypothetical construct in the real world because it’s abundant enough in most of our foods (for our extremely low needs) that we cannot induce it to happen unless we literally remove it from the diet in a lab. So, supplements are completely unnecessary (and also ineffective due to poor absorption).
“Contrary to what is commonly believed, vitamins and minerals are not capable of improving health beyond normal levels of intake, which are reflected through scientifically established RDAs and AIs.”
Not necessarily true. It is a well-known fact that RDA’s are typically based on the dosage needed to avoid deficiency symptoms and NOT what is needed for optimum health or the healing of various health issues (such as tendon injury). Also, ‘one size fits all’ numbers like RDA’s do NOT reflect the fact that different people can have vastly different needs for vitamins. This is, of course, not a problem unique to healing tendons, but exists een when trying to maintain optimum health. RDAs should therefore be taken with a grain of salt rather than being looked at as something handed to us by God.
I actually just wrote an article about RDAs, which will offer a better rebuttal than I can in the limited space of a comment. I’ll say this much here: RDAs (or rather EARs, estimated average requirements) are set based upon meeting 100% of the known functions of a given vitamin or mineral, even if consuming a lesser amount would not itself cause overt deficiency symptoms. In the early 2000s, reduction is risk of chronic disease was also added to the EAR determination process, so where the evidence exists that is an important factor in determining need as well. RDAs are determined from EARs by adding a large statistical margin (two standard deviations), so 97.5% of people consuming the RDA for a given nutrient will meet or exceed their need for it. That means it’s far more likely you’re getting more than you need of a nutrient than less. Again, though, the full article goes into much greater depth!
interesting, but it does not account for the effects of stress on our bodies in our modern lives. taking food based supplements should be recommended if one knows they may be deficient in these or is recommending by a doctor who has lab results in hand. as well, this does not account for poor circulation in the extremities, meaning you need to make it count. you are much better off in this case maximizing your intake with content than bulk, as you say, if a car can only travel on one lane and only carry so much, better make what it carries count. the advice here is sound, but in no way represents every individual, and seems to assume that everyone is genetically the same. there are many food based supplements available that can “make it count” by provided the essences of what you need in a concentrated package that is made from real food that you would eat. consuming too much fruit to get these extra nutrients, because of the high sugar content, can as well be unhealthy and lead to pancreas issues.
Where are your citations?
They’re linked to within the piece where relevant.
Well this is useless. Why not just have an article that just states you can’t do jack squat. You’re giving advice for someone looking for a pill and instead tell them to completely change their lifestyle. I think everyone realizes eating a healthy well balanced diet full of of fruits and vegetable will lead to being healthier. In this case a significant portion of the world would believe the cure is worse than the poison.
This article is more about combating the misinformation and pseudoscience spread by supplement peddlers than providing easy solutions. Unfortunately, there’s not a lot you can really do to influence connective tissue health in the short-term—but that doesn’t mean you should spend your money on worthless supplements because they make unsubstantiated claims to be beneficial.
As a physician and a health scientist with hypermobility, who has recent personal experience of recovering from tendonitis directly in response to Vit.C supplementation, after all else failed, I would like to point out that you may be overlooking individual variations in nutrient requirement that go beyond the norm. Such increased requirement tends also to affect people in the early stages of developing common chronic disease, such as type 2 diabetes and overweight, mostly associated with underlying inflammatory processes. In practice, many of your readers may have such increased requirements, without realising it, and therefore could be helped by nutrient supplements. I suggest Vit.D would be another example of a nutrient linked to bone and muscle health, in which a substantial proportion of the population have suboptimal intakes and so stand to benefit from supplementation. I think you’ll find that Government statistics show rather worrying prevalences of inadequate nutrient intake in certain population groups, and in fact they officially recommend taking a multivitamin as well as promoting fortification of flour and breakfast cereals. So, to say there isn’t cause for concern or potential for individuals to find relief from nutrient supplementation could be misleading.
Hi Brian
A few times in the comments and also in the original article you make reference to an idea/assumption that people using collagen are replacing their regular protein sources with collagen, leaving them with a deficit of high quality protein. Observation tells me people consume collagen supplements *in addition* to their existing protein intake rather than using it to replace some of their high quality protein sources. So I think that aspect of the article could be quite misleading.
I’ve had ongoing issues with bursitis and tendonitis that have lasted years. Once I added gelatinous cuts of meat to my diet along with gelatin powder or collagen powder those issues have greatly improved. Just anecdotal of course but nothing else worked before that. I also added in plenty of Vitamin C and silica too. Seriously. that combination fixed long-standing existing bursitis in a month or so. All pain gone.
Why is the idea that many people may have a deficit of the amino acids found in gelatin/collagen such a strange concept? We no longer eat the whole animal – most people are just eating muscle meats like chicken breast, steak and ground meat. These are high in methionine but low in aminos like glycine.
We know that collagen in humans is rich in particular amino acids. So, if people’s diet is low in those (and in other essential nutrients for connective tissue) then it seems quite logical that their connective tissues may be at greater risk of injury.
I’m not assuming that people are replacing a protein with a collagen, I’m looking at the studies which compare collagen protein to a non-protein placebo. My argument is that we can’t really know whether collagen is more effective than another high-quality protein source because they haven’t been compared. We can of course have both in our diet, and most people who eat meat do to at least a limited extent, but when we’re talking about supplementation (as in purposefully seeking out a nutrient in order to achieve a physiological goal) we don’t have evidence that people who are currently supplementing with collagen wouldn’t get a similar benefit just by having a protein shake instead.
The oddity of the gelatin/collagen argument is that none of the proteins we get from it are essential—we can make all of them ourselves. Some may be conditionally essential in specific situations (pregnancy, disease, childhood, etc.), but by definition non-essential amino acids can be created by the body in sufficient quantities to take care of all our metabolic needs (assuming a healthy diet and normal protein intake). We may consume less collagen now than we did before, but the hypothesis that we are hindered by our lower intake of collagenic amino acids hasn’t been borne out in the scientific literature yet, and so I’m skeptical of it. It’s possible we’ll discover unforeseen biochemical interactions limiting glycine synthesis in the face of, say, excess methionine intake, but there’s no actual evidence that this is true yet (though I keep my eye open).
I’m glad you’re doing better, anecdotally or not. It’s possible I’m wrong, and if scientific evidence suggests I am in the future I’ll gladly amend this article. Until then, if people are to consume collagen, I advise them to simply incorporate it into their diet in natural way rather than purposefully seeking it out as a supplement.
If you don’t have scurvy, then you have enough vitamin c for your collagen needs. You pulled that out of your ass. What wild arbitrary conjectures. A truly ignorant article.
The symptoms of scurvy are caused by loss of collagen production and repair, and the prevention of scurvy is accomplished with only around 10 mg of vitamin C daily (far below the RDA for both men and women). Beyond this level, we have no evidence that vitamin C has a direct effect on collagen production, and certainly no evidence that doses above the RDA are of any benefit to collagen formation at all.
A lot of comments about collagen here but I’m not here to debate that. I’ve been suffering from acute Achilles tendon pain. Ortho wants to do surgery. I’m on a low carb diet and rarely eat foods with vitamin c especially since it’s been cold where I live, so I haven’t been making my low carb smoothies with strawberries. Preparation for the surgery I purchased some organic chicken stock aka bone broth and full complex vitamin c with rose hips and acerola cherry. After four and a half months of pain I started taking the vitamin c preemptively before surgery even though I initially purchased it for post-op recovery. After taking it less than a week my pain in my Achilles tendon is gone. I certainly do not have scurvy nor are my teeth falling out or gums bleeding but apparently I must have had a vitamin c deficiency enough to make my Achilles tendon hurt enough to want surgery. I have made no other changes in my lifestyle or diet within the last week for the pain to stop other than simply taking this time released solararay vitamin c full complex. So I disagree with your comments in regards to supplements although I do agree with what you were driving at. Many bloggers are simply trying to make money off of affiliate marketing and are using cut copy and paste or simply rewording other blogs in order to monetize their blog. Even I continue without pain for another week, I’ll be calling the doctor to cancel surgery… And I could hardly walk in the morning prior to taking the vitamin c.
Many Pro Athletes are getting good results from the Gelatin and Vitamin C protocol for tendon repair. This was reported on in Outside Magazine. Also Prolozone treatments are getting good results. If you don’t mind being 10 years ahead of everyone else you can look into them.
I wrote a bit of an update in this article here:
An Update on Dietary Collagen Protein
There’s still a lot unknown on the topic, but I’m certainly curious to see where the science takes us.
Although I do believe in some of what you said, I strongly disagree with, “If you suspect you have a vitamin or mineral deficiency, go to a doctor and get tested. Such deficiencies are rare today, however, with our abundant and diverse diets—not to mention food fortification and enrichment—so the chances of being diagnosed with one are slim.” My number one issue with this is the first sentence. The reason for this is because there are many deficiencies that cannot be tested with a simple blood or urine test. One example is Magnesium. Magnesium is a mineral abundant in bones and soft tissues. The Mag in blood serum is only about 1-2% of total body stores. Our bodies are designed to keep enough Mag stores in our blood to not cause Hypomagnesemia. So if we are not getting enough Magnesium in our diet and on top of that, if our stomachs are not absorbing properly, guess where our body pulls the Mag in order to keep safe levels of it in our blood? Bones and soft tissues! So now, you take a trip to the doctors because you are having muscle and possibly even bone pain or muscle twitching so they run a blood serum to test for minerals and BOOM all normal. But are they? No lol. Many studies out there to prove this.
This leads me to my issue which is with your second sentence when you said deficiencies are rare. Do you have any studies to prove this? All I have read is how we are very deficient nowadays! With the fast food we eat which, in my opinion, is nothing but plastic and toxic ingredients. You can read the labels, it’s actually pretty disgusting what the FDA approves. This prevents our bodies from properly absorbing the nutrients we need which, like I said, there are hardly any nutrients in most fast foods anyway. Not only is this true, but the soil that our foods grow in is not as abundant in minerals as they used to be. All of this just to save a couple bucks for companies. Oh and lets not forget how ridiculously expensive ORGANIC, NON-GMO, PASTURE-RAISED, GRASS-FED foods are in the grocery stores. Another good thing to mention is that I have met many Gen-Zers today that have switch to a more vegan and vegetarian life style without really doing research on how the proper way to do it is. Look at how many milk alternatives are sold in grocery stores these days (which most are in fact fortified with calcium but I wanted to share this because of the switch in diet people are making). Even Burger King now has a vegetarian burger for G sake. I mean, every restaurant I go to now has a gluten-free, vegetarian, vegan, keto-friendly menu lol. There is no doubt that enough people have switched their diets around so much that even fast-food restaurants are offering alternatives which gives me the impression that there is quite a high demand. Some people don’t know what they are getting into and end up missing on many vital minerals and vitamins. We can also look at pharmaceuticals being so widely used that also reduces our vitamin/mineral levels through absorption.
My point is. A simple blood test cannot detect true deficiencies so easily unless you want to get a $5000 bone or muscle biopsy to check true levels so you cannot just go to a doctor and “get tested.” There are MANY people with deficiencies these days. In fact, I am 100% confident in saying that most people are walking around with deficiencies today. Possibly not so much to show symptoms so early on, but enough to possibly cause disease later on in life.
@Robert I am not surprised that you got better. As I said in my post, you cannot just run to the doctor and test for deficiencies as the article suggests. I too have been going through a tough time in regards to my back and health. I took a fluroquinolone antibiotic for a UTI last year and my health quickly went on a downward spiral. Not only is this drug toxic to many people but it really screwed with my levels of vitamins and minerals in my body. I find it too much of a coincidence that I felt very healthy before this and immediately now I feel like a 90 year old. These antibiotics are know to really degenerate tendons and that’s what brought me to this article, however, upon reading some sections, I was a bit disappointed. I did what the article suggests and went to my doctor to tests for MANY things. I spent thousands of dollars. All to realize on my own that I know I have several deficiencies that cannot be address by doctors because that is not their “skill level.” Many times I was prescribed a anti-anxiety med because lo and behold I also start getting anxiety and panic attacks after taking this antibiotic even with 0 history of anxiety lol instead of taking the time to acknowledge what an antibiotic can do they continued to offer me drugs. Here’s another lo and behold for ya, I started taking magnesium, vitamin D, and calcium in higher quantities than suggested by the RDA (don’t even get me started with these suggestions, they are ridiculously flawed) and BOOM ANXIETY GONE. Probably because I was so deficient in my minerals that I probably already had when I felt healthy but was exacerbated by Cipro. Not to mention I was a regular taker of tums before and also PPI’s which blocks absorption of vitamins and minerals.
I am NOT surprised that you got better and even more that you were about to get a surgery done when it was just a simple fix. You may not have had scurvy but people don’t get scurvy from one day to another. It’s a process! Thanks to our terrible western diet. You probably caught it in time because it’s a whole other process to get back to normal. These deficiencies ultimately are slow-moving time-bombs. It’s like a silent killer. You won’t notice until you are really bad and having symptoms like yours or mine. You are doing great taking control of your own health! Unfortunately, some people continue with unnecessary procedures and pharmaceutics not realizing that it can be something cheap and simple to fix, even though it may take time.
You are correct that serum magnesium levels aren’t particularly indicative of overall magnesium status, but I’m going to push back a little to see if I can explain why that might not matter. To begin, it’s important to note that we don’t have any strong clinical evidence that magnesium deficiency occurs in healthy people eating an unrestricted diet; magnesium deficiency has characteristic signs and symptoms, and these are rare-to-unheard of outside of the hospital (where health problems can lead to hypo- or hypermagnesemia). We could titrate back a bit and try to redefine what the signs and symptoms of poor magnesium status are, but this redefinition would require a lot of study—and actually, we’ve done quite a lot of research on the topic to arrive at the generally recognized signs and symptoms we currently observe for, so they’re pretty robust. If you’d like, you can look through the Institute of Medicine’s chapter on magnesium which goes through the research and reasons for their recommendations: https://www.nap.edu/read/5776/chapter/8.
We should also consider that the reason serum magnesium isn’t a good indicator works in both directions. Yes, when our blood magnesium dips we pull from other stores (mostly from the outside of the bone, where 30% of the bone magnesium resides in a non-structural fashion to provide a pool), but when blood magnesium is excessive we push it back into the stores. Concurrent with this, we also have renal control over magnesium status, so when serum magnesium is high we excrete more and when it is low we excrete less. In the GI tract, we also absorb more or less depending on magnesium status. In this way, we have multiple regulatory control methods to ensure that overall body magnesium stays at an appropriate level, and when magnesium status decreases we upregulate both the absorption and retention of serum magnesium, decreasing the amount of magnesium pulled from our pool and increasing serum magnesium so it may replenish that pool.
I share your confidence that many people are walking around with dietary issues that show few or no symptoms in the short-term but will cause disease later in life—where I differ is that these dietary issues are directly related to nutrient status. I fully support diet improvement, and the collective body of evidence strongly suggests that eating a healthy diet defined by veggies, whole grains, legumes, fruits, fish, etc. will improve health status long-term and decrease disease morbidity and mortality; we don’t have the same evidence about vitamin and mineral supplements, which suggests inadequate status is not in fact a major issue because we do have strong evidence that these supplements are effective when status is clinically shown to be inadequate. The reason why a healthy diet should be so, well, healthy is complicated and multifactorial and beyond our abilities at this point to conclusively describe in a scientific manner, but we can definitely point to a myriad of minor factors that are impossible to combine together in any way other than diet (like fiber, inessential phytonutrients, caloric balance, diet schedule, relation of diet and exercise, and psychosocial factors of eating).
So, continue eating a good diet and encouraging others to do so, but I hope I’ve been able to convince you to worry a bit less about vitamins and minerals (or, at least, magnesium). Thanks for the comment 🙂
I think that eating collagen does improve your own body’s collagen production. The only evidence I have is my own experience. Once I start taking collagen within a few days my finger nails are much healthier and much stronger. I have no idea about the science, but it’s a fact. So I tend to think if my finger nails are looking healthier then the collagen is probably having positive effects on tendons, skin etc. My hair also feels healthier when Im taking collagen too.
I’m glad you’re nails are feeling stronger and healthier, but it is unlikely collagen is the driving factor in that change for a couple reasons. First, fingernails are not composed of living cells that can take up nutrients from our blood supply, but a protein called keratin that gets continually deposited (much like our hair). Once keratin is formed, nutrition cannot affect its composition, though potentially topical nutrients could have some effect. The growth rate of fingernails is very slow—roughly 1/8 an inch a month—so it would take months after a dietary change for the results to really be seen. The other problem is that keratin and collagen have significantly different amino acid profiles (notably keratin is high in the sulfurous amino acid cysteine while most collagen completely lacks it), so it’s unlikely collagen would have an effect on the growth of keratin. Thanks for the comment!
Super super interesting and helpful. Rare to read this quality of information and understanding in the internet. Perfect synthesis of various research topics. Please keep it up! Checking this out to better understand the healing process of my horses tendon and the various forms of treatment. Will adapt my treatment plan after having read this article. As you said yourself, in this topic mammals are quite comparable.
Thank you, and good luck with your horse!
Suggestion #1: DON’T supplement vitamin C!, followed by five paragraphs about the importance of vitamin C.
This article was very informative and there is a lot of good information on collagen and how it helps your tendons. There were different solutions you gave which makes it easier for many different people to find a solution that works for them – especially when it comes to diet. I think that science-based nutrition can be very unreliable at times, as well as there are so many different opinions which can be confusing.
One thing I would say is that there are supplements that can help, especially with tendons that are already inflamed. There are a lot of people like athletes you train constantly and they can’t afford to take months of exercise.
This article https://www.fitnesssolutionsplus.ca/blog/tendonitis-supplements/ was very helpful when it came to supplements. There are 5 recommendations for supplements.
Hello Brian,
Thank you for this article. As a dietitian I promote well rounded nutrition as much as possible, and when meeting with most patients, this tends to be a much better option than using supplements in place of food. However, in my research, there have been many times that a supplement has shown to have benefits beyond the RDA. I have seen this in my studies for things such as supplementation of creatine and beta-alanine with ergogenic effects, Vit. C in higher doses reducing time of cold symptoms (this was something I was once against and often used confirmation bias to argue), and regular intake of a multivitamin reducing the risk of cancer by 10% (but not disease). Unfortunately, I do not have these on hand to cite. Personally, after a recent Achilles rupture, I wanted to see if there were ways to help the process along during my tendon reparation. With all of this being said and this recent article here cited, wouldn’t you stay that there is a possibility that consumption of certain nutrients beyond RDA (I think you very well know this considering how articulate you are which is to meet the nutrient needs of all healthy persons, but does not necessarily mean there aren’t benefits beyond this, keeping in mind toxicity levels) could be beneficial? I truly believe that good wholesome nutrition is essential and that many supplements and diets con individuals into believing there is a magic cure, but from my experience, there seems to be benefits in some supplementation when used in the right situation.
Agrawal D, Shah A, Mehta KD, Jain R, Motlekar S. Role of nutritional supplements in the management of tendinopathies: focus on combination of type 1 collagen, vitamin C and mucopolysaccharides. Int J Res Orthop 2020;6:1355-61.
Well, the context is to get your vitamin C from food rather than supplements.
Unfortunately, the supplements the author of the linked to article recommends aren’t backed by scientific evidence. We’re all hoping for an easy solution to tendon problems, but time and an overall healthy diet appear to be the only tools we have at this point!
It’s possible, but without backing evidence it’s hard to know what’s helpful and what isn’t—and most likely, any benefit a supplement will have is going to be minor compared to the benefits of a good diet. As such, I’m hesitant to recommend any supplement, even if some may have use in specific situations.
https://jointspecialists.org/collagen-arthritis-treatment/
This study concludes the opposite as to whether Collagen supplements help. Our bodies stop producing collagen in the same quantities as we age…. supplementing this substance is a good idea once you get to 50, to prevent tissue and cartilage degeneration.
I find your article extremely biased against the use of supplements… yes a balanced diet is extremely important, and a healthy person should rely on that alone. But if there is a tendon issue… then I think it is perfectly reasonable to use supplements, not as you suggest illogical and a waste of money… there are many many studies on various supplements that indicate positive results on tendon health and healing. In Germany Bromelain is prescribed to help tendon healing for instance…
Equating this to some sort of sympathetic magic is extremely unhelpful and misleading as the first commentator pointed out. i would use anyone who reads your article to take it with a pinch of Bromelain.
So I had severe tendonitis or tendonosis in my biceps from climbing 5-6 hours a day for a few months straight about a year ago. I started taking coach horsts collagen and the pain that had been around for a solid month went away. I noticed it didn’t come back either. Is that placebo?? My tendons hurt without it. I’ve come off and gone back on just to create a control for myself and every time it definitely seemed to help.
The main question is whether a collagen supplement (essentially a low-quality protein supplement) would support collagen development better than a standard protein supplement like whey. As it stands, there isn’t evidence one way or the other, but given what we know about protein metabolism it seems likely that it wouldn’t. I stand to be corrected if higher-quality scientific studies are performed, but last I checked there aren’t any that compare collagen to whey (or other high-quality proteins), only collagen to a non-protein placebo in which case we would expect collagen to be superior.
I’m always keen to see the well-performed studies that suggest this or that supplement work, but in the absence of these studies I think it’s more reasonable to take the null hypothesis route and assume no effect. I’m open to being wrong, but I’ll need evidence to be persuaded!