26 November 2015

Tendon Pain - Could your diet be a problem?

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!


Brendan said...

"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."

Hi Dave, I remember a while ago on your blog you advocated reading Racing Weight (which I did!) for diet advice. Do you still stand by that or has your thinking changed?

Dave MacLeod said...

The short answer is possibly not. It has some advice which is good and some which is looking increasingly incomplete (not necessarily wrong). That book was always limited by its target audience of endurance athletes. So following it's advice strictly was never 100% appropriate for climbers. There is no single source of diet advice I know of to recommend for climbers.

When it comes to weight loss in particular, the issue is that there many methods of losing weight successfully in the short term, but almost all (but not all!) fail in the long term, as I am continuing to discover myself. Unfortunately, the long term has a nasty habit of catching up with you.

It took me a long time to have enough confidence in my thoughts on climbing injuries to publish Make or Break. I am even more cautious when it comes to diet, not least because the controversies going on in that field make sports medicine look like a picture of academic agreement utopia.

Matt Fuller said...

I attended a lecture with a sports nutritionist working for one of the big cycling teams and he also pointed out the link between tendon inflammation and diet. He has seen long-term Achilles tendon problems disappear with just changing diet from margarine to butter, as it better balances the types of fats we tend to eat in the West.

The problem, as you say, is that the plural of anecdotes is not evidence, but the vast majority of people could eat better, and they know it too.

Brendan said...

Thanks for replying, Dave.

I've found getting reliable advice on nutrition/diet/weight loss to be an absolute minefield and like you say, there isn't much advice out there specifically for climbers, so I've always been interested in your thoughts. Looking forward to reading them if you decide to write more on the subject!

Richard AG said...

The ultimate conclusion is surely that, on all counts, a whole food, plant-based diet is potentially the answer to these problems. Plants provide all of the nutrition we need without the "bad" elements associated with dairy and meat.

A fascinating blog, thanks Dave. Like you, I feel that the link between nutrition and body health is so much stronger than is currently being promoted.

Incidentally, have you read/watched the views of T.Colin Campbell, Caldwell Esselstyn and others? If so, what are your thoughts? They put a very convincing case forward for the fact that many "western" conditions can be greatly improved or even cured through diet. Whilst, at times, I feel that their is more to it than just what they say (the power of the mind to heal is pretty much ignored in their views), they do have some very important information to put forward but the vested interests are certainly not going to let them have a free rein.

Interesting stuff. Maybe see you down at Kilmallie one Saturday and you can expand on your views.

Dave MacLeod said...

Richard, I certainly agree that diet is important, and that a plant based diet can be healthy, if difficult. But not because it excludes meat and dairy!