Tendonitis and diet: what foods to avoid and favor?

Tendonitis is inflammation of the tendons. These tendons are composed of water (up to 70%), collagen, glycoproteins and proteoglycans, forming myofibrils. They have very little vascularity and are constantly remodeled just like bone tissue. Symptoms that result from tendinitis are often located where the tendon attaches to the bone. We therefore notice pain, particularly during movement of the limb or joint, because the tendon has generally rubbed too much against the sheath synovial which will then catch fire. The area is frequently tender and there is slight swelling.

The causes of tendinitis are mostly unknown. They occur in many cases at middle or advanced age and can also appear in pregnant women when the tendons become fragile (tendinopathy). They emerge gradually with the repetition certain movements and unsuitable postures. It is found in particular in athletes practicing intense sporting activity, which exerts pressure and overload on the tendons.

If excessive sports and repetitive movements are often blamed, diet also has its share of responsibility. Indeed, lack of hydration, coupled with poor eating habits, overweight and obesity, are often linked to acidification of the body, promoting inflammation and therefore tendinitis.

Diet is essential in the management of tendinitis. Many factors must be taken into account, whether in prevention (via acid-base balance and oxidative stress), in the relief of symptoms or recovery (via the balance of inflammatory processes).

• by harmonizing theacid-base balance, which is a state of balance between acidifying and basifying nutrients. The modern diet is too rich in food acidifiers which disrupts the functioning of cells and tissues. In the context of tendinitis, metabolic acidosis causes crystallization of the tendons leading to inflammation: tendinitis. Therefore, you should build your plate with 70 % d'alkalizing foods and 30% acidifying foods to rebalance the pH. Indeed, the diet will act in prevention and help reduce the inflammatory terrain induced by the acidity of the body, thanks to the reduction of acidifying foods and the increase of alkalizing foods.

• by limiting the oxidative stress, which is an imbalance between the production of free radicals and antioxidants. Favored by our modern lifestyle (unbalanced diet, stress, pollution), excess free radicals will have a deleterious impact on the body, promoting premature aging of cells. According to a study, this premature aging contributes to the genesis and maintenance of inflammation and the resulting lesions. THE antioxidants are nutrients naturally present in food and help reduce this oxidative stress by stabilizing free radicals. It is therefore recommended to move towards the consumption of foods rich in antioxidants to limit inflammation.

• by increasing intake of anti-inflammatory foods such as the omega-3, which are strongly involved in the inflammatory response, notably by calming inflammation. Omega 3s are polyunsaturated fatty acids and are precursors (actively participate in the production) of resolvins, maresins and protectrins, which are specialized pro-resolution mediators (SPMs). This complex of molecules helps resolve inflammation, then repair and restore tendon tissues to their initial state.

• by limiting the consumption of foods rich in pro-inflammatory fatty acids (omega-6 and saturated fatty acids). Today's diet tends to be pro-inflammatory (too muchsaturated fatty acids, d'omega-6, and not enough omega-3). Excess pro-inflammatory foods disrupt the action of the immune system, and induce longer and less qualitative healing of the tendons. In addition, the content of saturated fatty acids Long-chain SFAs, independent of total fat, can strongly affect adiposity, inflammation, and metabolic dysfunction. Indeed, a study of a 12% SFA diet, which most closely mimics the standard American diet, resulted in high adiposity, macrophage infiltration (inflammatory response), and insulin resistance. These three factors increase the risk of developing tendonitis.

• by optimizing water intake, in order to facilitate the elimination of excess acids through the urine. This is all the more important for athletes since they produce more acidic waste (lactic acid) which will be eliminated through urine. We can move towards waters rich in bicarbonates (but not too rich in sodium) because the latter alkalize the body and are considered a buffer solution by neutralizing H+ ions.

• by providing sufficient proteins, in order to optimize tendon regeneration, while respecting the acid-base balance. Indeed, proteins generate many acids during their degradation, such as hydrochloric acid, phosphoric acid, sulfuric acid and uric acid. However, they are essential to the body in the process of tendon regeneration. This is particularly the case for collagen and glycine, proteins and amino acids found largely in products of animal origin. The objective is to accompany protein consumption with alkalizing foods in order to limit the presence of acids.

These foods are rich in thrombogenic saturated fatty acids (palmitic acid, arachidonic acid) promoting development of excess inflammation. Be careful not to demonize these long-chain fatty acids, because they are major components of the myelin sheath in the cerebral nervous system. In fact, health authorities set thresholds not to be exceeded, but do not say to remove them.

We recommend you :

• to limit foods rich in saturated fatty acids : meats, butter, cream, cold meats, egg yolk, cheeses, palm oil, copra (coconut) oil, peanut oil.

• to limit the industrial products, often rich in palm oil, and therefore, in palmitic acid.

• For butter, it is preferable to favor margarine which is slightly basifying unlike butter which is slightly acidifying.

These foods are rich in protein. As previously said, protein intake is important in the process of tendon regeneration. However, their metabolism promotes production of many acids. It will be essential to support their consumption with alkalizing foods. The main sources of protein are of animal origin such as meat, fish, eggs, seafood, but also offal and dairy products (especially cheese). We also find a lot of protein in certain plant products such as legumes and whole grains. Indeed, plant proteins also generate sulfuric acid, but remain less acidifying than animal proteins, because these foods contain alkaline precursors.

We recommend you :

• to avoid the excess of animal products: 1 meat, 1 fish or 2 eggs, and limit to 30 g of cheese per day maximum, or delete it if possible.

• to prefer the lean meats and lean fish which also make it possible to limit the consumption of inflammatory saturated fatty acids.

• to consume 2 to 3 times a week legumes such as chickpeas to vary your amino acid intake. They are less acidifying than meats, fish and cheeses.

• to accompany consumption of protein-rich foods with alkalizing foods, such as green or colorful vegetables (squash, carrots, spinach, peppers, cauliflower).

These products contain numerous additives such as preservatives, texture agents, or even sweeteners which acidify the body and promote oxidative stress, for the benefit of greater practicality and conservation. This is also the case for sodas, which are rich in empty calories and additives. These products should be limited as much as possible, particularly during phases of tendinitis. Additionally, sugar interferes with the elimination of uric acid.

We recommend you :

• to prioritize meals homemade, which will be adapted to your tastes and will not contain additives.

• to avoid all kinds of prepared dishes: if the list of ingredients is long, 4-5 ingredients or more with barbaric names, it is better to move on.

• Although some of the following foods are alkalizing, it is best to limit them : chocolate, confectionery, honey or even pastries.

• to limit or even dELETE sodas and sugary soft drinks, which are high in sweeteners and citric acid.

• to limit the consumption of fried foods like nuggets and breaded meats. This cooking method and these foods are sources of oxidative stress and cause the formation of pro-inflammatory advanced glycation products.

• to limit refined products which only provide empty calories (many calories and few micronutrients).

These foods are rich in omega-6. It has been proven that a diet too rich in omega-6 inhibits the anti-inflammatory effect of omega-3.

We recommend you :

• of decrease the intake of omega-6 if the latter are strongly present in your diet, in order to respect a omega-3/omega-6 ratio balanced at 1/5.

• limit foods rich in omega-6 pro-inflammatory like sunflower oil and grape seeds, preferring rapeseed oil for your low-temperature frying and seasonings, because it has a balanced ratio between omega-3 and omega-6.

• to alternate vegetable oils rich in omega-6, omega-3 and omega-9, in order to be close to the omega-3 / omega-6 balance, as is the case with rapeseed oil and hemp vegetable oil.

The major objective of hydration during periods of tendinitis is to eliminate as many acids as possible via urine in order to optimize tendon regeneration. Waters rich in bicarbonates (HCO3-) are the most indicated in urinary elimination, because bicarbonates correct blood and urinary pH by targeting the fats consumed. The bicarbonated waters are as follows: Saint-Yorre®, Vichy-Célestins®, Arvie®, Quézac®, Salvetat®, etc.

We recommend you :

• to drink 2 to 3 liters of water per day.

• to consume bicarbonated water in recovery after a sporting effort.

• of split your hydration at 1 glass of water every 2 hours (2 liters for 16 hours).

• of dELETE alcohol consumption, because alcohol does not hydrate, rather it weakens the tendons by dehydrating and stiffening them.

• In case of sweating (heat, physical activity, night sweats), it is imperative to drink more.

These foods are considered alkalizing according to the PRAL index (Potential Renal Acid Load) by Thomas REMER and Friedrich MANZ, who established a table grouping foods according to their impact on pH. Alkalizing foods are found in abundance in fruits, green and colorful vegetables, and oilseeds. The optimal base should consist of 70 % alkalizing foods.

We recommend you :

• to associate alkalizing foods with acidifying foods, your meal can consist of a chicken cutlet, potatoes and spinach for example.

• five to seven servings (80 g per serving) of fruits and vegetables of the season per day with a majority of green and colorful vegetables such as asparagus, beets, carrots, or even peppers, green beans and spinach.

• to direct you towards the alkalizing fruits following: apricots, avocados, bananas, lemons, dates, figs, strawberries, raspberries, peaches, apples, grapes.

• to favor raw fruits and vegetables to preserve a maximum of vitamins and of minerals.

• to direct you towards the starchy foods and the basifying legumes following: white beans, red beans, corn, potatoes.

• to favor the alkalizing dairy products following: goat's milk, drained white cheese and margarine.

• to spice up your dishes with parsley, cumin, curry, or even ginger which are very good alkalis, and in particular the turmeric, because it contains curcuminoids which are useful in reducing inflammation in the specific case of tendinitis.

These foods are rich in antioxidants, allowing to prevent inflammation. Among the main antioxidants, we find foods rich in vitamin C (strawberries, kiwi, citrus fruits), vitamin E (avocado, margarine, olive and rapeseed vegetable oils), carotenoids (yellow, orange and red fruits and vegetables). ) and polyphenols (green vegetables, spices and herbs). Generally speaking, antioxidants are present in large quantities in colorful fruits and vegetables, in oilseeds as well as in spices and herbs.

We recommend you :

• to consume 5 to 7 servings (80 g per serving) of antioxidant fruits and vegetables per day, trying to include them at each meal.

• to introduce spices and aromatics to your dishes to provide maximum antioxidants and taste.

These foods are rich in anti-inflammatory omega-3. Omega-3 is found in small fatty fish and fatty fish oils, vegetable rapeseed oil,linseed oil, walnut oil, l'chia oil or even theperilla vegetable oil and thecamelina oil, but also in “Bleu Blanc Cœur” affiliated eggs and oilseeds.

We recommend you :

• to prefer rapeseed oil to usual cooking oils, because recent research has shown that this oil can be used for gentle cooking, such as meat, fish or vegetables in a pan, its smoke point being estimated at 107° C. In addition, this oil is the most balanced when it comes to the omega-3/omega-6 ratio.

• to favor fatty fish up to 2 fatty fish minimum per week.

• to accompany the consumption of fish fat with vegetables greens or colorful (squash, carrots, spinach) and potatoes.

• to have a omega 3 / omega 6 ratio greater than 1/5, that is to say 1 g of omega-3 for 5 g of omega-6.

• to direct you towards affiliated eggs "Blue White Heart"naturally enriched with anti-inflammatory omega-3, thanks in particular to a diet based on flax seeds rich in omega-3.

• Recipe idea: prepare salads based on fatty fish (mackerel, herring, salmon), colorful vegetables and oilseeds, seasoning with oils rich in omega-3 and particularly rapeseed oil, also rich in vitamin E.

Dairy products are often associated with negative shots, in particular because they promote inflammatory processes and therefore chronic inflammatory diseases such as tendinitis. Indeed, much research has been carried out in the past on the impact of milk and dairy products on the human immune system and the resulting inflammatory reactions. Unfortunately, studies have led to questionable conclusions due to confusing studies and inadequate evaluation methods.

A study was carried out by Agroscope and published in the scientific journal “Critical Reviews in Food Science and Nutrition”. It focused on the impact of dairy products on inflammatory reactions in humans in order to conclude once and for all on the pro-inflammatory or anti-inflammatory effects of dairy products.

Thus, 52 studies have demonstrated that dairy products have a slight anti-inflammatory effect in people with a disturbed metabolism such as overweight. As a result, they would only promote inflammation in people with milk hypersensitivities such as milk allergies.

Finally, in the context of tendonitis, the objective is to focus on types of dairy products because they do not all need to be limited. Indeed, just like meats and foods rich in protein, it is possible to consume dairy products (and in particular cheeses) if this consumption is accompanied by alkalizing foods. The latter must, however, be done in moderation.

We recommend you :

• For milk, cow's and sheep's milk should be limited in relation to their acidifying PRAL index. This PRAL index by Thomas REMER and Friedrich Manz allows the classification of all foods based on their impact on pH. Thus, the consumption of alkalizing goat's milk is highly recommended. You can also consume whole milk powder and skimmed milk powder, which are basifying milks.

• Concerning cheeses, almost all cheeses are very acidifying, so it is preferable to limit them or accompany them with alkalizing foods. We can nevertheless turn to drained white cheeses basifying products, or natural stirred and low-fat alkalizing yogurts. You can also opt for normal and low-fat yogurts on a bed of fruit which are slightly basifying according to the PRAL index.

The word “tendinitis” is a misnomer used to refer to tendon pain. The term "tendinopathy" is now preferred, but we can also speak of "tendinalgia" for a painful tendon, or "tendinosis" for a damaged tendon. We also use the term "tendinosis" for excess mechanical stress and repeated movement , and finally that of "tendinitis" in an inflammatory context. Finally, it may be that it is the sheath, which surrounds the tendons, which is affected. We then speak of "tenosynovitis".

Thus, to treat “tendinitis”, there are several areas of work.

• THE rest or immobilization by a splint or cast as well as the application of cold and the use ofessential oils for tendonitis are also effective. Patients are often given NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) for 7 to 10 days to reduce inflammation and pain.

• In some cases, the doctor may prescribe corticosteroids and anesthetics to be injected into the tendon sheath. Corticosteroid-induced crystallization in the joint or sheath may cause pain within 24 hours of injection.

• Finally, support by the masseur-physiotherapist is optimal, particularly for eliminating calcium deposits in cases of calcific tendinitis. The masseur-physiotherapist will massage the tendinitis and practice gentle stretching which will soften the tendons and repair the joints.

• Dietary care is important and optimally accompanies medical care. Food supplements do not seem recommended for acute tendonitis. However, for persistent chronic tendinitis, people attracted to the consumption of food supplements can turn to certain supplements based on curcuminoids found in turmeric ("curcumin"), of wisteria and of collagen peptides. These three supplements have shown interesting results in reducing chronic tendinitis. “Curcumin” has been the subject of interesting studies on the alleviation of joint pain and inflammation in the specific case of tendinitis. Peptides appear useful in the construction and regeneration of tendons, and glycine has shown benefits in the synthesis of tendon collagen fibers. Be careful, however, with the origin of food supplements; opt instead for brands recognized for their quality and which are certified without additives.