Aidan:

Hello and welcome to the Ideal Nutrition Podcast. My name is Aidan Muir and I’m here with my co-host, Leah Higl. And this is episode 125, where we’re going to be talking about nutrition for tendon issues. And anybody who knows me or has seen me training or anything like that knows that I personally have had a lot of tendon issues over the last probably like three years or so, four years, I don’t know, it’s been a while.

I was pretty much injury-free up until at the age of 24 and they’re just banned every 10 years. And it’s one of those things that’s obviously inspired me to go massively down the rabbit hole because nutrition is only one component of this kind of thing. So I’ve gone massively down the rabbit hole of nutrition and training obviously, but like how you train is probably more important, but there is a lot of things we can do from a nutrition perspective still. And because it’s such a big topic, I wasn’t overly prepared to do a massive episode on this.

I really want to focus one main thing. There was a relatively recent systematic review that came out that was titled ‘the impact of nutrition on tendon health and tendinopathy a systematic review’, and this review was largely focused on both preventing and managing tendinopathy and while there are so many areas that we can discuss on this topic, I want to focus on this review because it just summarized so many things so nicely with some key takeaway things that we can focus on so that’s why I wanted to go with this angle today.

Leah:

Yeah I think this review really helped cut all the messy stuff around this topic and really get to the nitty gritty of things that you can action on. So we’re going to start in a really easy win spot, and that is alcohol consumption.

Alcohol, in higher amounts, is linked with tendinopathy. I don’t know if that’s necessarily like a hot take in terms of something that you’d be surprised about it making your health worse, but there does seem to be a pretty clear link between these two things. And the mechanism proposed here is largely related to a decrease in collagen synthesis, but there absolutely can be other factors at play and other explanations.

For example, displacing other nutrients, generally less quality diet, poorer recovery, heaps of things to consider when it comes to alcohol consumption. But either way, limiting alcohol consumption, minimizing it does seem to be a good option here and an easy win for sure.

Aidan:

Another big one is gelatin and hydrolyzed collagen, which they’re basically interchangeable for the purpose of this. The majority of gelatin hydrolyzed collagen studies have shown improved clinical and structural outcomes. This study or this review featured eight studies using them and seven out of those eight showed improved outcomes. Key note here, every now and then you see people on Instagram saying that there’s not enough research on this topic. But when we’ve got eight studies and seven have shown benefits, it’s not a hot take to be like, well, maybe this could help. Like it’s not me saying like this definitely helps, it’s just the evidence is leaning in favor of that.

And then when you look at 7 out of 8, it makes you wonder what happened in that 8th study. And the thing that happened in that 8th study is they only used 2 grams per day. Whereas I typically recommend 15 to 25 grams. If I showed you research on protein powder and a bunch of studies used 30 grams, which is like a scoop, right? And then one study used 4 grams and that study that used 4 grams didn’t show benefit, you wouldn’t read too much into that.

Leah:

You would just discount that study as like not relevant.

Aidan:

Yeah. So the other seven found benefits. On the other end of the spectrum, I don’t want to oversell this because many of those studies featured in this review also included other ingredients. We know that there’s multiple things that can impact tendon health. And what if in some of those cases, it wasn’t the collagen doing anything, it was other ingredients that did stuff. So it’s a little bit less clear than it sounds, but hearing that as a bit of a summary is pretty useful to be like, okay, like the research is a little bit in favor of collagen for collagen synthesis in the body and improving tendon health.

Leah:

Yeah. And talking a little bit about those other ingredients that were involved in this review. So some common ones that came up were curcumin, bozoella serrata, MSM and arginine. So all of those were used in studies throughout that review and were linked with positive outcomes. But once again, these, because these studies do often use or like this mix of ingredients, it’s really hard to pinpoint individually which ones have actually helped with tendinopathy and general tendon issues. But those are kind of some common ones that were in there.

Other research around omega-3 specifically have been a bit hit and miss. There’s some research that has linked omega-3 intake and omega-3 supplementation with improved outcomes with tendinopathy, but other researchers found no difference. So again, like really hit and miss when it comes to Omega -3 specifically.

Aidan:

So now we’re going to take some outside the box thinking outside of that review. One of the starting points I want to touch on with collagen is if you ever hear me talking about the benefits of collagen for tendon stuff and the potential benefits that there might be, because even then I’m not fully convinced by the research, I’m just leaning in favor of it right now.

I specifically talk about it being collagen at a relatively high dosage, pre -workout, so prior to the rehab session or prior to the training session, either alongside vitamin C or making sure that you’ve got some vitamin C in your system, e.g. you’re not training fasted without vitamin C. I’m talking about a pre-workout, right? And part of the reason I do that is because in particular, there’s lot of research by a guy named Keith Bar, who has basically like, he’s just had them do that protocol. He’s had them have 15 to 25 grams of collagen.

about 40 to 60 minutes prior to a workout because that’s how long it takes for the amino acids to peak in the blood and everything like that. And then they do the session often featuring isometrics in his particular research, like heavy isometrics. But he’s been doing scans before and after of like, say they’ve got catalytinopathy, like he’s scanning their knee before and after, and we’re seeing physical changes that are pretty rare. As in we’re not seeing those changes with people just following a rehab protocol. We’re seeing structural changes.

Pretty promising, right? That’s part of why I’m high on it, because it’s like even though there’s not a massive amount of research, some of research we’ve seen has been very positive. I say this to lead into the fact that after this review that we’ve just talked about came out, one other study has recently been released where they used 30 grams of collagen post -workout. 30 grams is massive. I don’t think I’ve ever seen any other study on collagen that used 30 grams of collagen, but they did it post

Ideal Nutrition (06:52.684)
and they found no increase in muscle connective tissue synthesis. Firstly, that’s at odds with some of the other research using a pre -workout where they compared like collagen to casein, where casein found no increase in muscle connective tissue, but collagen did. But in this study, like I’ve seen a few people on social media using this as like a nail in the coffin being like, look how much collagen they use and there was no increase in connective tissue synthesis. Firstly, one study and secondly, it is post -workout which is different to the mechanism that I’ve proposed, but it adds to the body of research.

I’ve asked some pretty smart people in this space being like, do you think the collagen needs to be pre -workout? Do you reckon post -workout would be fine? And some of those smart people have been like, I think post -workout would be fine. And if this study was replicated multiple times, we would then be like, okay, it’s not fine. So it’s like, it adds to my opinion of the topic, even if it doesn’t massively swing things, if that makes sense. Other thoughts. General healthy diet is a good idea. We don’t have a ton of research on

other factors of nutrition and tendinopathy. Like there’s a few things here and there. Like if you have high cholesterol, that’s likely going to contribute to tendinopathy. If you have high blood glucose levels, that’s going to contribute, right? So being metabolically healthy is a good idea. But there’s a bunch of other things that are kind of obvious, but we don’t have clear data on. Like maybe having an antioxidant rich diet would help. Maybe having an anti -inflammatory style diet would help. We don’t see issues with people doing that through food. Sometimes in supplementation could be a different story, but that’s just generally a good idea.

avoiding specific nutrient deficiencies is a good idea as well. And the final thought that I personally have is in that review, we found like a bunch of different ingredients having potential benefits, but it’s really hard to pick which one found benefits. But if you were an athlete or just a general person with tendinopathy and you had the budget and you had the interest in doing it, you could theoretically just

Chuck the kitchen sink at it and get all of these ingredients so long as they’re not harmful. You could get curcumin, you could get fish oil, you could get that Boswellia serrata, you could have collagen, you can have all of these things and you can take them all. You could even mix your own ingredients together or you can buy a supplement. There’s many on the market that actually contain multiple ones of these things. There have been multiple studies that have used that approach where they’ve just chucked together five ingredients and it’s clearly improved outcomes.

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For me, I care about finding out what works because it’s my job. But as an athlete, does it actually matter? Like if you take something that helps, does it matter if one of those five ingredients was doing nothing? So long as you’ve got improved outcomes, that’s the main thing. Yeah, I know when I’m injured or like if something’s putting me out of training, like my motivation to fix that is so high that I would be throwing the kitchen sink at it for sure. And I think a lot of athletes and a lot of people feel that way, particularly if you have ongoing tendon issues that can

super frustrating. yeah, decent approach there. So a little bit of a summary to finalize things before we wrap up. When it comes to tendon issues and nutrition interventions, it is really hard to tell when something has worked or is working. For example, like something that is super common, like if collagen has helped you, say 20%, like improve your outcomes by

but you were in the middle of like a powerlifting prep when you developed tendonopathy. Taking collagen for the rest of the prep likely wouldn’t be that noticeable because there are high odds that you’d have tendon pain regardless just because of the training that you’re doing. So regardless of the nutrition intervention, because of what you’re doing from a training perspective, you may not see that general improvement happen. If flare it up every week or multiple times per week, it doesn’t matter if you go time for improvement, it’s still going to get flared up.

Yeah, but it doesn’t mean that thing is not necessarily helping. It could be preventing it from getting worse, but it just, makes it really hard to like, guess, perceive some of these outcomes depending on what else you’re doing. It’s very similar logic like with creatine, like we recommend creatine to all of our lifters and a lot of our athletes. If creatine helps you one to 3 % in terms of performance output, you

likely be able to tell if you were a responder or a non -responder to something that was like such a small percentage change. But it’s worth taking anyway, just based on the fact that we do have research backing it up. So I think you can kind of take a similar approach with things like college and you’re like, it looks pretty promising. I don’t necessarily know if it’s helping, but like maybe it’s just worth taking based on what we know anyway.

Ideal Nutrition (11:36.494)
So yeah, with tendon issues, perhaps it is best to just like tick as many boxes as you can from a nutrition point of view in hopes that it will improve your outcomes. I know it can be frustrating for a lot of people to be dealing with these issues ongoing. So take what you want from this particular podcast. But in my opinion, I’d yeah, I’d be throwing the kitchen sink. Yeah, I think so. And with that 20 % problem that you highlighted, there was a thought I had when I originally came across Keith Barr’s

particularly because I was dealing with my own issues and trying to, I don’t want to say justify my own problems, but kind of be like, why can’t I solve this? And I started taking collagen and I didn’t notice much difference myself, right? Once again, I have the same view of you as the creatine thing about being like, I’m still going to take it regardless, right? But one of the problems I thought was I’m like, okay, let’s say you’re an athlete who trains to a certain level and you train to a certain level of pain and let’s use the power lifting prep as an example where you’re like, you just do the work, you get into pain.

What if the collagen allows you to do a little bit more work before you achieve that same level of pain? And then you just get stuck in this vicious cycle of just working until you get into pain. And it’s like, then the collagen wouldn’t solve the problem. What I thought would be a useful thing is like, what if a randomized control trial existed where they got people doing a rehab program who are actual like athletes and half of them get collagen, half of them don’t. And we just see what happens.

I had wondered if that problem was gonna still come up where it’s like, these people will not get better results because maybe it’s gonna train to the same level of pain or whatever. And we don’t have heaps of that research yet, but some has come out since I started talking about collagen. there’s like, for example, there’s one study on Achilles tendinopathy where they did calf raises and a return to run program. And the people in the collagen group experienced better pain scores and better function. At the 12 week mark, they were further ahead than the other group was.

So once again, like when you look at it from that angle, we can both be like, nutrition’s a small factor in this. You need the rehab program to be on point. You need your training to be on point. But if you do have that on point, it does speed up the process most likely. Where was the collagen? Where was the other ingredients? Like in that study, it was collagen. But if you did take the kitchen sink approach, it’s likely helpful. Yeah, I love that summary. This has been episode 125 of the Ideal Nutrition Podcast. Thank you for tuning in.