SHOULDER PAIN TENDONITIS WHAT CAN I DO

Weight Status, High Cholesterol and Tendonitis

Pamela A. Popper, Ph.D., N.D.

Wellness Forum Health

Tendonitis is usually attributed to an injury resulting from overuse or excessive athletic activity. But at least one third of people who develop tendonitis are not physically active[1]. Being overweight has been associated with tendinopathy, but in both upper and lower limbs[2], which means that the condition cannot be attributed to the impact of weight alone. In other words, tendonitis is cause by factors other than exercise and weight, and one of those is plasma cholesterol.

Tendonitis frequently occurs in people with familial hypercholesterolemia[3], since cholesterol accumulates in the tendons, causing structural changes in the collagen.[4] [5] But the effect is not limited to people with extremely high cholesterol levels. In fact research has shown a connection between cholesterol levels and tendon ruptures.[6] [7]

A research group performed a meta-analysis of 17 studies including 2612 participants to evaluate the connection between higher cholesterol levels and tendonitis.[8] The analysis showed that people who had altered tendon structure also had higher total cholesterol, LDL cholesterol, and triglycerides, and were significantly more likely to have higher pain levels. Women, but not men, who took statin drugs were more likely to have a ruptured Achilles tendon.

The researchers could not completely rule out reverse causation – injured tendons can result in reduced physical activity, which can then result in increased cholesterol levels. But they stated that there is ample evidence from published studies showing that high cholesterol levels alter tendon structure in several species[9] [10] and that aggressive treatment with drugs to lower cholesterol reduces tendon thickness, increasing the risk of injury.[11]

Furthermore, the researchers say, higher cholesterol levels result in accumulation of cholesterol in macrophages and other immune cells which increases inflammation levels, which then can lead to tendonitis.

This is important information that should guide many decisions regarding diet and lifestyle habits and healthcare. High cholesterol is not only associated with increased risk of heart disease[12] and cancer[13] [14], but, according to a significant body of research, is also associated with increased risk of tendonitis. People now have another reason to be diligent about keeping their cholesterol levels low.

Being overweight increases the risk of almost every degenerative disease, causes damage to the joints, and increases the risk of tendonitis. This is due not only to the increased pressure from excess weight on the joints, but to increased inflammation levels in most overweight individuals. People now have another reason to achieve and maintain optimal weight status.

Athletes often eat a diet high in animal protein and fat, which increases the risk of high cholesterol levels.[15] [16] They eat this way because they are told that this will help them to build muscle mass and improve performance. Muscle mass is not built in the kitchen, but rather through strength training, and it is not necessary to eat animal foods in order to optimize athletic performance. But we now know that eating a diet high in animal foods can increase the risk of tendon rupture, which can sideline all physical activity for a significant period of time. Athletes have yet another reason to eat a plant-based diet instead of a diet high in animal foods, fat, and cholesterol.

People who have injured or ruptured tendons should be told that adoption of a plant-based diet will reduce their inflammation levels, their cholesterol levels[17] [18], and their weight, which in turn will reduce their risk of a recurrence of tendonitis. Adoption of a low-fat, plant-based diet often results in discontinuation of statin drugs, which have limited efficacy and many side effects in addition to increased risk of tendon rupture.[19] [20]

In conclusion, a plant-based diet is more effective and protective for a variety of health issues, including tendon health, than one centered around animal foods.

[1] Rolf M, Movin T. “Etiology, Histopathology, and Outcome of Surgery in Achillodynia.” Foot and Ankle International September 1997;18(9):565-569

[2] Abate M, Schiavone C, Di Carlo L, et al. “Prevalence of and risk factors for asymptomatic rotator cuff tears in postmenopausal women.” Menopause 2014;21:275-280

[3] Junyent M, Gilabert R, Zambon D et al. “The Use of Achilles Tendon Sonography to Distinguish Familial Hypercholeterolemia from Other Genetic Dyslipidemias.” Arteriosclerosis, Thrombosis, and Vascular Biology 2005;25:2203-2208

[4] Adams C, Bayliss O, Baker R et al. “Lipid deposits in ageing human arteries, tendons and fascia.” Atherosclerosis 1974;19:429-440

[5] Finlayson R. Woods S. “Lipid in the Achilles tendon. A comparative study.” Atherosclerosis 1975;21:371-389

[6] Mathiak G, Wening J, Mathiak M et al. “Serum cholesterol is elevated in patients with Achilles tendon ruptures.” Arch Orthop Trauma Surg 1999;119:280-284

[7] Ozgurtas T, Yildiz C, Serder M et al. “Is high concentration of serum lipids a risk factor for Achilles tendon rupture?” Clin Chim Acta 2003;331:25-28

[8] Tilley B, Cook J, Docking S, Gaida J. “Is higher serum cholesterol associated with altered tendon structure or tendon pain? A systematic review.” Br J Sports Med published online doi:10.1136/bjsports-2015-095100

[9] Beason D, Abboud J, Kuntz A et al. “Cumulative effects of hypercholesterolemia on tendon biomechanics in a mouse model.” J Orthop Res 2011:29:380-383

[10] Beason D, Hsu J, Marshall S et al. “Hypoercholesterolemia increases supraspinatus tendon stiffness and elastic modulus across multiple species.” J Shoulder Elbow Surg 2013;22:681-686

[11] Tsouli S, Xydis V, Argyropoulou M et al. “Regression of Achilles tendon thickness after statin treatment in patients with familial hypercholesterolemia: an untrasonographic study.” Atherosclerosis 2009:205:151-155

[12] Stamler J, Wentworth D, Neaton J. “Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT).” JAMA 1986 Nov 28;256(20):2823-8

[13] Seyfried T. Cancer as a Metabolic Disease John Wiley and Sons New Jersey page 67

[14] Campbell TC, Campbell T The China Study Ben Bella Books Dallas Texas 2004 pp 78-79

[15] Hegsted D. “Serum-cholesterol response to dietary cholesterol: a re-evaluation.” Am J Clin Nutr August 1986;44(2):299-305

[16] Sacks FM, Miller L, Sutherland M, et al. «Ingestion of egg raises plasma low density lipoprotein in free-living subjects.” Lancet. 1984 Mar 24;1(8378):647-9

[17] Gardner C, Coulston A, Chatterjee L, Rigby A, Spiller G, Farquhar J. “The Effect of a Plant-Based Diet on Plasma Lipids in Hypercholesterolemic Adults: A Randomized Trial” Ann Intern Med. 2005;142:725-733

[18] Ornish D, Scherwitz LW, Billings JH et al. “Intensive lifestyle changes for reversal of coronary heart disease.” JAMA. 1998 Dec 16;280(23):2001–7.

[19] Mansi I, Frei CR, Pugh MJ, Makris U, Mortensen EM. Statins and musculoskeletal conditions, arthropathies, and injuries. JAMA Intern Med 2013; DOI:10.1001/jamainternmed.2013.6184

[20] Muldoon MF et al “Effects of Lovastatin on cognitive function and psychological well-being.”

Am J Med 2000 May;108(7):538-546