Both my daughters (6th/8th grade) are in sports. Recently, I have seen two of their close high school aged friends suffer knee ligament tears. That, plus seeing this recent article, ACL TEARS CAN CAUSE HARMFUL CHANGES TO YOUR BRAIN1 made me want to dive a little deeper.
Increasing Ligament Injuries
Anterior cruciate ligament (ACL) injuries in teens are increasing at 2.3% annually, with girls being in the highest risk2. My daughters, and their friends, are in this highest risk age range. Further, female subjects had a roughly 3 times greater incidence of ACL tears in soccer and basketball versus male subjects, in another study3.
Ligaments are collagenous, fibrous tissue that connects bones to other bones. Similar, but distinct, tendons are collagenous, fibrous tissue connecting bones to other bones. A devastating tendon injury is the Achilles. For Seahawks fans, that is the one Richard Sherman inured to end his career in Seattle.
Tendons and ligaments have much less blood supply than muscles. This makes healing a longer process for these tissues.
Looking around, I saw two areas of focus surrounding prevention. One I agree with and one I’m skeptical. The best intervention is largely absent from the top hits, which we will get to in the next section.
Strength training is critical in both kids and adults – turns out your life depends on it.Specifically on preventing ligament injuries, evidence points to a variety of plyometrics, neuromuscular training, and strength training4. The American Academy of Pediatrics also signs on to neuromuscular training while noting bracing has insufficient data to support its role as a preventative. Further, bracing after an ACL does not improve functional performance and may reduce running speed5.
I am constantly trying to build strength building exercises into my daughters routine.
A lot of experts weigh in along the lines of overuse and year-round competition6. I can’t square this with the known concept of repetition being helpful in development.
Overuse and enhanced competition only makes sense if there is another factor hindering recovery – and there is, so on to the next section.
Dietary Risks – The Missing Ingredient
As a population, we don’t support our ligaments and tendons under the Standard American Diet (SAD). These are the top 3 areas.
We eat muscle meats. We don’t consume cuts with connective tissues (ligaments/tendons) or bone preparations in significant amounts – those with collagen sources. Therefore, many collagen powders and bone
If we want to support ligaments, it helps to provide the raw materials needed for recovery and growth.
Blood Sugar Provocations & Inflammatory Seed Oils
When I write about Eating For Health, the first step is always what to avoid. Foods that spike blood sugar and those with inflammatory oils are necessary avoidances. For connective tissue health, we have direct mechanisms heightening the importance food choices.
Blood Sugar Provocations
Blood sugar (glucose) is an important fuel. However, foods that cause rapid and pronounced increases upon eating come with consequences. Sugar increases blood glucose rapidly. Processed grains and flours even more rapidly – yes more than sugar itself. Combine the two (cookies anyone?), the effect is additive. Even though your glucose levels recede eventually, damage occurs with and during the excursion.
I wrote an article Rescue Vitamin C From Sugar that detailed how glucose competes with Vitamin C. As blood sugar rises, Vitamin C entry at the cellular level slows.
How does this matter for ligaments?
Vitamin C takes part in collagen synthesis. Spike your blood glucose, hinder Vitamin C entry, slow collagen synthesis.
Sugar binds to and alters proteins in a process called glycation. This is the same reaction as browning meat. As part of this reaction, metabolites form called Advanced Glycosylated End products (AGEs). This is normal and present in all of us. However, with increased glucose levels, we get more glycation and AGEs, which becomes damaging to many structures as levels rise.
AGEs accumulate in long-lived tissue proteins like collagen in bone and tendon causing changes in their properties7. AGEs can precipitate a loss of elasticity in collagenous tissues8. In tendons, AGEs diminish sliding (they become stickier and less pliable)9 and suppress function10.
High heat (BBQ, frying, etc) can form AGEs as well. Remember, glycation is the same reaction as browning meat and grill marks. However, we likely form more internally after glucose-spiking meals.
Krispy Kreme sound good about now?
Omega-3/6 Fatty Acids
Most know the omega-3 fatty acids in fish oils are beneficial, mainly by promoting anti-inflammatory pathways. But that’s not all.
Omega-3’s enhance collagen formation in ligaments11.
Here’s the challenge.
Omega-3’s need to be in a proper balance with Omega 6’s to exert meaningful effects. Too much 6 and/or not enough 3, benefits decline.
I know my kids don’t like fish, but if yours do, I bet it isn’t a daily menu item.
Vegetable oils, also known as industrial seed oils, are predominantly omega 6. These are in all processed foods and restaurants. These junk oils are catastrophic to general health, but with ligaments/tendons, decreased collagen formation is the issue.
Beyond oils, grain fed meats are much higher in omega 6 than grass fed.
Your blood omega 6 to 3 ration should be around 3:1. However, many Americans are commonly approaching 25:1. This means we are likely to see depressed Omega 3 collagen support in the ligaments.
Eating For Health is primary. And to start we must limit exposure to some key avoidances.
-Vegetable/industrial seed oils (use avocado, butter, ghee, etc)
-processed flours and grains (wheat, corn, etc). Don’t fall for the whole grain trap, they spike blood sugar the same as sugar.
-anything with added sugar.
If you are buying food from a big company in a package, watch out. Here is a recent analysis I did on the USDA food database.
Just look how 75% of the branded foods have either a sweetener or a starch. Almost 40% have all sugar spiking with omega-6 oils.
Let’s look at a couple common examples we face in real life.
Let’s just look at a simple teriyaki or Chinese menu item – any chicken / fried rice dish. They fry both in junk oils, which also change your brain (read about that here). Rice causes a spike in blood sugar by itself. Then add the flavor, teriyaki is mostly sugar with soy sauce.
Blood glucose shoots up.
I wrote before about how improving my oldest daughters school performance starting with ditching school lunch. Let’s have a look at a menu from our local middle school.
All blood sugar provoking, and a few adding frying oil too. “Homemade” or not, these are not helpful for ligament/tendon nor general health.
Under the current food environment, we can’t be perfect all the time. I wrote about strategies I use when faced with food that precipitates blood sugar spikes – I call them Glucose Guardians. Please read the article for details as to why, but a few supplements provide support in the presence of provoking foods. They can slow absorption, protect against oxidation, stabilize blood sugar/insulin levels, and more.
- Grape Seed Extract (GSE)
- Green Tea Extract
- N-acetylcysteine (NAC)
- N-Acetyl Glucosamine (NAG)
- Bitter Melon
- Vanadyl Sulfate + Chromium
The top 3 for sure, and power users can add the whole list.
We looked at Vitamin C above and in the article Rescue Vitamin C From Sugar – sugar competes again Vitamin C.
Supplementation is a good idea, especially if the diet isn’t optimal.
I prefer liposomal Vitamin C preparations. They encapsulate these in a fat layer, and this helps make them more bioavailable12.
My belief is all of us who aren’t eating fish daily should supplement with quality Omega-3 fish oils.
I like Omega 3 with phospholipids (a good summary of why here).
Unfortunately, we can’t shortcut on price. Fish oils are susceptible to damage during processing, don’t skimp!
I don’t see our menus drastically increasing non-muscle meat cuts, especially with my kids. So, collagen supplementation is a good idea. I like Bulletproof’s line of products here. Lot’s of good flavors and options.
Another good collagen source is bone broth – if from grass fed cows. Kettle & Fire has a good line. For an extra boost, you might even take the unflavored BP collagen and add it to a bone broth.
Yes, this may see a little woo woo for some.
But don’t skip it.
Grounding is connecting to the earth. The earth has a negative charge, and our cells desire that state as well. When disconnected, our charge weakens. When connected, we gain a negative charge – and normally feel better. Barefoot at the beach walking thru the ocean is a profound grounding activity, and a healthy one.
Problem is, we are disconnected. Shoes, pavement, houses, and our normal lives are all detached from a negative charge.
Research shows grounding moves charge through our connective tissue, improves blood flow13, reduces inflammation14, and more. Remember, ligaments/tendons have poor blood supply, so improving blood flow could be a major win.
If you can’t get to the ground, I recommend tech. That 3rd port on most plugins is the grounding plug. So, naturally, accessories are available.
Sheets for the bed are an awesome way to get grounded for an extended period. They have silver mesh sewn in and connect to the grounding port. Highly recommend.
You can also get grounding mats that are portable for placing anywhere so people can share.
Ok, you had a ligament injury. Now what?
First, double down on all the prevention techniques.
Muscle Inactivity / Brain Changes
The first article referenced above details changes in the brain occurring from lack of use. Not only can the muscles atrophy, the nerve highways shrink as well. Profound stuff.
Electrical Muscle Stimulation (EMS)
Since you can’t stimulate the muscle after surgery, the next best thing may be leveraging some electrical current. It turns out EMS is effective post-ACL15.
I have not used any EMS devices, but can pass along a couple recommendations from people I follow who have.
No, this isn’t a repeat. More of an emphasis.
Post ACL reconstruction, poor omega 6:3 ratio in the knee effects cartilage degradation and inflammation, potentially leading toward arthritis16.
Further, omega-3 supplementation is helpful in protecting muscle loss during disuse17. And, as we saw above, that is important.
We know Omega 3 supplementation to be beneficial for depression as well18. For kids, or anybody, missing substantial time with your teammates can devastate, not to mention a little depressing. The literature shows higher depression rates post-ACL19.
So, focusing on omega-3 supplementation appears to help in many areas.
Again, not a repeat here, but relevant info on healing.
Vitamin C supplementation is useful post ACL for driving collagen and reducing oxidative stress20. Very safe, low-risk strategy.
Ligament and tendon injuries are devastating. Witnessing them happen to our favorite sports teams is one thing. Seeing them happen to kids we know is more impactful.
Fortunately, and unfortunately, we can support connective tissues with dietary discretion. Good, because we have a way. Bad because it is hard – the standard food offerings wreck health.
I can attest to implementing these changes both being hard and good.
Dialing in the diet is way easier than dealing with an ACL injury. Please reach out if I can provide any help getting started.
- https://www.futurity.org/acl-tears-brains-2266462/ ↩
- https://pediatrics.aappublications.org/content/early/2017/02/20/peds.2016-1877 ↩
- https://www.ncbi.nlm.nih.gov/pubmed?Db=pubmed&Cmd=ShowDetailView&TermToSearch=18063176 ↩
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5577417/ ↩
- https://pediatrics.aappublications.org/content/133/5/e1437 ↩
- https://www.webmd.com/children/news/20170222/acl-tears-on-the-rise-among-kids-especially-girls#1 ↩
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5371572/ ↩
- https://www.hindawi.com/journals/omcl/2019/3085756/#B77 ↩
- https://www.ncbi.nlm.nih.gov/pubmed/23348249 ↩
- https://www.nature.com/articles/s41598-019-49062-8 ↩
- https://www.ncbi.nlm.nih.gov/pubmed/10632966 ↩
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4915787/ ↩
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576907/ ↩
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3576907/ ↩
- https://www.ncbi.nlm.nih.gov/pubmed/28819679 ↩
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6421636/ ↩
- https://www.frontiersin.org/articles/10.3389/fnut.2019.00144/full#B48 ↩
- https://www.nature.com/articles/s41398-019-0515-5 ↩
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5112339/ ↩
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6204628/ ↩
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