26 November 2015
Since publishing my climbing injuries book Make or Break earlier this year, this is the first important paper released into the scientific field during the year which has really caught my attention. Co-authored by professor Jill Cook (one of the tendon pain research big guns worldwide), it reinforces the idea I put across in Make or Break that looking at tendon injuries simply as ‘overuse’ injuries may at best blinker us to other important causes, and at worse be plain wrong.
In this review, Cook explores the possibility that your cholesterol profile could possibly cause tendon pain. The evidence available shows association, not causation. Nevertheless, we shouldn’t ignore the data. Not only is it known that cholesterol accumulates in tendons, that people with the disease ‘familial hypercholesterolemia’ have much more tendon pain, but several studies show that various cholesterol parameters are associated with tendon pain.
Influences such as this, if causation could be ultimately demonstrated, help to explain the apparently unpredictable individual variability in tendon injury, if you are looking at the problem solely as a result of training errors.
So if we can’t ignore the data, we get to what we should do to improve our cholesterol profile. The paper points out that increased tendon pain is associated with the same cholesterol profile as cardiovascular disease, namely a lack of HDL cholesterol and an excess of LDL and blood triglycerides. Unfortunately, the world of medicine and public health is in a big fat mess when in comes to providing evidence based recommendations for how to improve our cholesterol profile.
If you want to learn just how messed up the situation is, read Nina’s book. Apart from teaching you a few seriously important lessons about trusting both science and government, it might even save your life if it turns out to be right. No joke.
Unfortunately the low fat, high carbohydrate diet (as well as the problem of the oils used in processed foods) that sportspeople are still widely recommended to eat may well cause just the bad cholesterol profile we are talking about (low HDL, high LDL, high triglycerides). Diet is not the only input of course.
My personal hunch is that this line of enquiry will continue to yield evidence we should listen to. At a basic level, the idea that human tissue is unbelievably plastic, responding to training with precisely regulated growth and maintenance responses could go so frequently awry simply by doing some training does not add up. It seems likely to me that there are some things missing from the picture. This could be one of those things.
I would urge anyone serious about their tendon health, their sport performance and their long term health to go right back to basics when it comes to diet and nutrition. It’s fair to say that the whole world of nutrition and health has been blown to bits in the past five years, and pieces are still falling back to earth. Meanwhile, some of the medical world and much of the public have yet to notice. And many vested interests are desperately trying to keep it that way. Personally, I have finally wriggled free from the paradigms I learned in University about sports nutrition and stand in a confused state of optimism mixed with distrust and scepticism. The problem is, we can't wait for better evidence - I have to eat something, in two hours time! So what to eat? I’m cautious about publishing my observations on my own diet and performance just yet. I will do when I feel a bit more comfortable and educated about what the hell is going on. But, I will tell you that I feel like I’m on an exciting journey!