When people have issues with their tendons, such as tendonitis, the phrase “wear and tear” is often used with the diagnosis. But is that always the underlying issue causing these tendon disorders? Recent studies have shown there may be another factor contributing to these defects: your diet. Specifically, people with uncontrolled glucose levels, high cholesterol, and obesity could be at a higher risk for tendon and ligament damage. In this article, I will discuss:
• The structure of tendons and ligaments
• How high glucose levels and diabetes can affect your tendon and ligament health
• How elevated cholesterol can affect your tendon and ligament health
• How high fats and obesity can affect your tendon and ligament health
Tendon and Ligament Structure
Tendons bind muscle to bone, while ligaments bind bone to bone. When you think of tendon structure, think of a flexible bone. It is very sturdy and durable. While ligaments are less flexible than tendons, it is even tougher and sturdier than tendons. Both are very sturdy because of fibers called collagen. Collagen is a protein found all over the body, providing strength to things other than tendons and ligaments like the skin. Collagen is almost like a rope in its structure. It’s strong but flexible. These “ropes” all bundle together in ligaments and tendons to make them even stronger.
Elevated Glucose and Diabetes
The key here are AGEs. AGE stands for advanced glycation end product. AGEs are naturally produced by the body, especially as you age, but they can cause issues if their levels become too high. AGEs are commonly found in foods in the modern diet, as they add flavor and color, among other benefits. AGEs are often considered to be a contributing factor in diabetes. In AGE-rich diets, AGE levels in the body are increased. AGE levels are also increased in those with diabetes, as glucose is more available to make AGEs. In other words, the greater the levels of glucose are above normal, the greater the chance you increase the AGEs in your body.
Elevated AGEs can cause several issues that can result in increased risk for tendon damage. For one, they can change the structure of the tendon. As I talked about before, tendons and ligaments are mostly made up of strong, thick fibers called collagen. AGEs can form something called a cross-link with collagen, which changes the structure of the collagen. This will affect the structure of tendons and ligaments. This hurts the strength of the tendon or ligament, increasing the stress you put on it when you use it, increasing the risk for tendon or ligament damage. The other issue with AGEs is that it can affect the cells of your tendons and ligaments. AGEs binding to these cells has been shown to activate cellular pathways which damage the cell and trigger swelling. Many of these cells will die off with this damage, helping lead to the breakdown of tendons and ligaments.
It is well-known that LDL (low-density lipoprotein) is considered the “bad” cholesterol, while HDL (high-density lipoprotein) is the considered the “good” cholesterol. Your diet intake affects which type of cholesterol you are getting in your body. Those with high cholesterol due to genetics have a difficult time removing the LDL from their body. This can lead to issues with tendons and ligaments, as recent studies have shown. This LDL excess can trigger swelling and cell death, much like we saw with the elevated AGEs. Therefore, elevated cholesterol levels can contribute to tendon and ligament damage. Further research is being done on this area.
Elevated Fats and Obesity
Obesity has long been associated with tendon and ligament issues. With more body weight, there is increased stress on these structures. But recent studies have shown there is a relationship between obesity and issues with tendon and ligaments not affected by body weight. An increase in adipose tissue (tissue which holds fat) are seen with obesity. Adipose cells are a major signaling molecule in our bodies. The adipose cells release a molecule called a cytokine, which helps regulate swelling. With more adipose tissue in the body due to elevated levels of fat (as seen in obesity), there are more of these cytokines released to try to rid the body of the excess fat. This creates greater swelling throughout the whole body, leading to death of some of the cells in tendons and ligaments. With obesity, tendons and ligaments are affected by the high amount of stress the body weight is putting on them and the swelling produced by the increased adipose tissue. It is essentially double trouble for your tendons and ligaments.
Your nutrition is important for your health always, but now we are seeing that it also is important for your tendon and ligament health. Reducing AGEs in the diet by controlling your sugar levels and having a diet with fewer AGEs can increase the strength of your tendon and ligament health. Decreasing LDL cholesterol intake and maintaining a healthy body weight can also help. Certainly, freak injuries and disruption of tendons and ligaments can occur, but if you keep a healthy, full diet, you can decrease this risk!
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• Abate, Michele, Schiavone, Cosima, Vincenzo, Andia, & Isabel. (2013, January 11). Occurrence of tendon pathologies in metabolic disorders. Retrieved October 31, 2019, from https://academic.oup.com/rheumatology/article/52/4/599/1796925.
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