How Does Our Diet Impact Tendon Health?
- Storm Baynes-Ryan
- Nov 12
- 4 min read
Looking at humans from a whole organism lens means that of course nutrition is going to impact both short-term and long-term health. What we have not elaborated on significantly is "does it impact our tendon health?
I recently read the review "the impact of nutrition on tendon health and tendinopathy" which reviewed 19 publications (out of over 8,000 that looked like they could be relevant) and came up with the following information.
A note: this is not a causation relationship, but rather is correlation, and we need to be judicious about how we use this information. e.g. a western vs meditteranean diet showed no difference in Achilles tendon thickness, but this also didn't check on protein levels or quality of diet. And again, all of these things are multifactorial and one thing cannot be the only input into tendon or human health.
The other caveat here is that the studies were of poor quality and very few studied the same thing, so this is all to be taken with a grain of salt.
Intakes of alcohol do impact tendon health (but studies were varied)
Here's what was found
Increased alcohol consumption (more than 1-2 times per week) improves the outcome (pain and functional outcomes) after rotator cuff surgery (but this was not confirmed, please don't use this as advice!)
Moderate weekly alcohol intake (men: 7-13 drinks, women: 4-6 drinks) may increase the chance of Achilles tendinopathy but doesn't seem to cause Patellar Tendinopathy *(knee).
Long term alcohol intake (men: >13 drinks, women: >6 drinks)) is a risk factor for onset and severity of rotator cuff tears.
Another study found that there was no association with rotator cuff tendinitis [sic].
While it's pretty inconsistent above - alcohol's toxic effects may cause inhibitions in collagen synthesis. (Rat model, but logic says it's also likely to impact humans)
What you can do:
TL:DR: small amounts of alcohol, irregularly e.g. less than 4 units of alcohol per day, 2 days per week, logically, seems to be the best for tendon healing, outside of abstinence.
Collagen
Tendons are mostly made of collagen (previous blog)- we need it on an ongoing basis for connective tissue health.
The studies looked at pain, function and other clinical measures after taking collagen for varying periods of time. Findings depended on the dose and duration of dose, and in most studies, improved function and or improved structure of tendons in tendinopathy.
Dosage of more than 6 months seems to be required, and it seems to be able to change pain pain without much change in function in surgery.
In non-surgical treatment, adding collagen can improve pain, range and function.
From this research, we don't really know the optimal dosage, timing or duration for collagen at this point, however, this article mentions a dosage of 15g/day collagen, but that this is less superior than 30g whey protein per day, thought to be due to the decreased leucine content in collagen. (more on that one later).
What you can do:
TL:DR - collagen can be helpful at doses of more than 15g for a period of 6 months in some situations. Here's the protocol I use.
Other Nutrients:
Other studies reported in this overview used substances with possible anti-inflammatory effects, or those which can help with collagen formation.
Some used MSM + collagen, as well as varying other substances that have been used in only one study. Because there was a combination of substances, it's hard to know if any of these are helpful, or if it's the combination.
Adding the amino acide leucine may be helpful in tendon growth when combined with strength training - the leading idea behind this is increased training + leucine for muscle growth --> increased muscle bulk and tendon bulk --> decreased mechanical stress on the tendon. (this is very helpful when we think of the tendon not being able to change and the mechanical silence of tendon degeneration. Leucine is an amino acid but is also found in many high protein foods.
What you can do:
TL:DR Leucine + strength training may increase tendon size and provide increased capacity for load.
Omega Three and DHA
Essential fatty acids (Omega 3 and DHA in the studies) improved short term pain in two studies - however, the research is inadequate to determine whether it actually improved tendons and or pain, or not. This would be a n=1 situation, if you want to try it, then it may help or may not.
A final study used food education, acupuncture and some enzymes, which increased function and decreased pain compared with standard exercises. This study while positive, was a group of n=1 (which is how it works in real life), but the information cannot be extrapolated to a general population.
What you can do:
TL:DR
If it feels like it's helpful - it could be. Research has started but it's not of high quality and interventions seem to help for some people, and not others. It could just be expensive wee.
Overall Nutrient Intake:
The highest quality evidence for nutrients for tendons is
decreasing alcohol intake to less than 4 standard drinks 2 nights per week
increasing collagen to 15g daily for 6 months and trialling,
omega 3 + DHA (if it sits well with you,)and
increasing protein intake which would increase leucine intake.
Overall
We still don't know all the things we need to, but we can use this as a stepping stone in our treatment protocols to see what works. Some interventions need longer periods of time, so budgetary constraints may mean we trial some things over others.
What else you can do:
If you have concerns about your tendons, (think tennis elbow, Achilles tendon, front of knee pain, tennis elbow/golfers elbow, grumbling shoulders) and your pain is more than 3/10 and it's interfering in your daily life, it's a really good idea to get it managed earlier rather than later. Email me storm@thatfarmingphysio.com to make an appointment to make a plan together.
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