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Collagen for Soft Tissue Injury and Repair

Editor's Note: This article is a reprint.

Collagen for Soft Tissue Injury and Repair

It was originally published October 14, 2018. Mark Sisson, a former elite endurance athlete that qualified for the 1980 U.S. Olympic marathon trials, founder of the popular website Mark's Daily Apple and a leader in the paleo movement, was one of the first to help me understand the importance of burning fat for fuel.

Here — after we cover some of the basic benefits of high-intensity interval training and strength training, we segue to the topic at hand, namely the use of collagen for soft tissue injuries and repair, along with a few other useful fitness tips.

"How I came to [learn about collagen] was how I arrived at a lot of myepiphanies — I had a life crisis. I play ultimate Frisbee once a week, every weekfor the last 15 years now. But about five or six years ago, I started to developsevere Achilles' heel tendinosis.Ultimate Frisbee is a very fast-paced game … There's lots of running … [and it]requires a lot of agility, a lot of side-to-side quick movement, as well as rawspeed …I found over a couple of years, in my late 50s, that I was starting to get thesereal severe Achilles' problems. I couldn't sprint. My Achilles' were really tender.They were getting thick. I went to see an orthopedic surgeon [who] said, 'Youhave severe Achilles' tendinosis.' I go, 'What does that mean?' 'Well, you'rescrewed, basically. You can't play sports again' …An orthopedist in Southern California said, 'Well, here's what we're going to do.We're going to take the back of your heel, slit it open and scrape the Achilles'down to the raw meat. We're going to pack it up in a cast for three months, thenyou'll do nine months of rehab and you'll be 85% of where you were.' I'm like, 'No.That's not going to happen, Doc … 'I went back to my house and said, 'You know, there's something I was doingwrong here.' I started to do the analysis and I thought, 'Here I am stressing myAchilles', which is attached to the calves, so I'm really stressing the calves, theplantar fascia and everything around it, on a regular basis. I'm not giving mybody the raw materials it needs to recover from that stress. It is that simple.'"

Collagen for Soft Tissue Repair

Collagen-based tissue includes tendons, ligaments, cartilage and fascia — basically connective tissue — all of which tend to get weaker and less elastic with age. Injuries are also worsened by the fact that there's very little blood supply in connective tissue, which slows down recovery. While a muscle injury is fairly easy to fix and recover from, connective tissue require very specific raw materials, namely animal-based collagen such as gelatin and bone broth. This collagen material is amino acids that get incorporated into your body to become this matrix of connective tissue. Sisson adds:

"Even if you say, 'Well, I can get all of these raw materials from the amino acidsin the meat that I'm eating, or in the protein drinks that I'm drinking,' the reality isyou can get some of those, but not in the quantities that you probably need,particularly as you get older and particularly if you start stressing thesetendons, ligaments, cartilage and other connective tissue and fascia.Having done the analysis, I started supplementing 40 grams of collagen a day.Within four months, my Achilles' were better. I could have two scars on the backof my leg and be all pissed off about the surgery that I had that didn't quitecome out the way I was promised.But I'm here telling you that I just got off the track, where I ran 32 seconds for a200 at age 65. And that's the first time I've been to the track in probably sixmonths …If you talk about gelatin, collagen peptide or collagen bone broth, we're talkingabout the same peptide. We're talking about glycine, proline, hydroxyprolines —some of these really specific amino acids — dipeptide, tripeptide that actuallycross into the bloodstream as a unit and get incorporated into the body."

Your Body Selectively Takes Collagen Into Stressed Areas

The Achilles' tendon can be envisioned as a coiled spongy spring, full of fiuid. Each time you stress it, the tendon tightens, pushing the fiuid out. As the tendon relaxes, fiuid fiows back in. Sisson cites research showing that when subjects were given a collagen drink 15 minutes before performing a jump rope exercise, collagen peptides in the bloodstream surrounding the tissue were incorporated at over two times the normal speed.

"That was a fascinating study to me, which indicated that it's really happeningthe way I envisioned it — that the body will selectively take in these collagenpeptides into the area being stressed, particularly if you don't have any othersource of raw material in your diet,"

Sisson says.

"Even in the paleo world … you're eating choice cuts of meat, but you're notgnawing on the bones or the skin or the tendons or other nether parts of theanimal … Most of us don't make bone broth anymore. We've had decades of nothaving any access to collagen.I see it in pro-sports, where athletes are tearing anterior cruciate ligaments(ACLs), medial collateral ligaments (MCLs), tendons and all kinds of stuff. I'mgoing to have to say that a lot of this is because their diet is so horrible to beginwith, and then they don't take in supplemental collagen that I think would beprobably wise on their part."

The Difference Between Collagen and Other Protein

As mentioned, the collagen Sisson recommends for soft tissue repair is high in glycine, proline and hydroxyproline, and relatively low in branched-chain amino acids, which are the primary ones that stimulate the mammalian target of rapamycin (mTOR), muscle anabolism and muscle building. For that reason, while 40 grams sounds like a lot, it does not count toward your daily protein intake, which I typically recommend keeping around 0.5 grams per pound of lean body mass. Above that, you start running the risk of overstimulating mTOR, which speeds aging and raises your risk for chronic disease, including cancer. Since mTOR is not stimulated by collagen peptides, you don't have to worry about exceeding your protein intake when taking a collagen supplement.

"Twenty grams a day is for my maintenance level of collagen,"

Sisson says.

"Butyou hit the nail on the head. Collagen is such a unique protein blend of aminoacids and it's so specific to collagenous material in the body that it does notsustain life.When you buy a collagen product and it says 10 grams per serving or 20 gramsper serving of protein, because it is protein and it has to say protein on it, whenyou look at the supplement facts panel on the back, it's zero of the daily value.In other words, it cannot sustain life."

Back in the '80s, a 500-calorie-a-day liquid protein diet was all the rage. Medifast and OPTIFAST were two of the big brand names. This liquid protein was in fact collagen. People believed they were getting 500 calories in the form of protein on a daily basis, but because it was collagen, it was not enough to live on. People actually died on this diet. I actually had a number of patients on this program in the mid-'80s before I understood nutrition. Now I realize that a 500-calorie partial fast can actually be very healthy but should only be done a few times a week, and must be cycled in with a high-protein, high- carb diet in a really specific sequence. Also, there are better proteins than collagen for a partial fast. I go into great details on this in my book, "Keto Fast." "They had congestive heart failure, arrhythmias and things like that, because it was not the right kind of protein to build muscle," Sisson says. On the other hand, as long as you didn't pursue it for too long or too exclusively, you could significantly improve health as it maximized autophagy.

"That's the good news-bad news … A lot of people wound up having great skin,hair and nails and lost some weight. That was the upshot of that. Anyway, it wassuch an interesting concept that even the World Health Organization, the U.S.Department of Agriculture and the Food and Drug Administration say, 'You can'tlive on collagen protein.'They're basically acknowledging that if you eat collagen protein, you're doing itfor skin, hair, nails, tendons, ligaments, connective tissue, bones and fascia — alot of structural components in our body that are well-served by doing a dailydose of some form of collagen.That's also why bone broth has become all the rage in the health food circles inthe last five years … Here's my shameless plug. I had such a great experiencewith supplementary collagen, I created a collagen product line within my PrimalKitchen food line, as I am so clear on people needing to supplement withcollagen on a regular basis."

Types of Collagen

While 28 different types of collagen have been scientifically identified, most supplements will contain one or more of just three of these, which are known simply as: Type 1 — collagen found in skin/hide, tendon, scales and bones of cows, pigs, chicken and fish Type 2 — formed in cartilage and typically derived from poultry Type 3 — fibrous protein found in bone, tendon, cartilage and connective tissues of cows, pigs, chicken and fish Types 1, 2 and 3 comprise 90% of the collagen in your body. When talking about collagen supplements, you also need to know the difference between unhydrolyzed (undenatured) or hydrolyzed (denatured) collagen. In their natural, hydrolyzed state, collagen molecules are poorly absorbed due to their large size. Hydrolyzation refers to a processing technique that breaks the molecules down into smaller fragments, thereby enhancing intestinal absorption. For this reason, most


collagen products are hydrolyzed. As for the difference between collagen and gelatin: Collagen is the raw material and gelatin is what you get when you cook the collagen.

"Bovine-sourced collagen are the basic element, probably covering 80% of thebases,"

Sisson says.

"There are different sources of different blends of collagenpeptides. Some are higher in proline. Some are higher in glycine. Some arehigher in hydroxyproline.But they all have kind of the same sorts of dietary peptides, just at relativelydifferent levels and different amounts … And then we have hyaluronic acid,which is another factor in some of these products.I'm basically saying that [you can] cover 80% of your needs with a 100% grassfed, naturally derived bovine source of Type 1 and a little bit of Type 2 collagen… As for the rest, you're just splitting hairs. That's how I feel about the Type 1and Type 2 stuff."

Nonorganic Collagen, Bone Broth Products Likely CAFO-Derived

Keep in mind that many collagen supplements are made from animal parts derived from animals raised in concentrated animal feeding operations (CAFOs), and may contain unwanted contaminants, including heavy metals, chemicals such as butylparaben, and drugs, including antibiotics. If you do not consume factory-farmed/CAFO meats , you likely should not be consuming CAFO collagen and bone broth products. While CAFO-derived collagen, bone meal or bone broth may not be acutely toxic, purchasing food products from factory farms is a problematic practice. I recommend eating mostly organic and grass fed foods — and that includes collagen from these sources — as each and every source will add to your overall toxic load. To avoid exposure to CAFO-related contaminants, make sure the product is "100% USDA Organic" and/or certified grass fed by the AGA.


On Dosage

When it comes to dosage, there are no hard and fast rules. Sisson, being willing to experiment on himself, decided for a larger-than-normal dose and took 20 grams of collagen twice a day to start. After a few months, he cut down to a maintenance dose of 20 grams a day.

"I thought, I'm just going to bathe my Achilles' in this raw material,"

he says.

"Ithink there's a rate limiter on how much your body can absorb … It's not likeyou're going to hurt yourself … [But] you still have to deaminate the excess.Some of it might be converted into glucose, because there's that wholegluconeogenic aspect of excess protein. I used to think I had high proteinrequirements but all of a sudden I was like, 'Geez, my daily protein requirementsmight be 50 to 75 grams a day.'I feel great doing that. Anything I eat beyond that isn't building more muscle,isn't causing me to burn more fat. It's just extra calories that the body has tofigure out what to do with.Again, do I convert it to glucose and burn it? Do I convert it to glucose and storeit as fat? Do I deaminate it and pee it out? Do I keep it temporarily in thenebulous amino acid pool or sink that's in the body?In the last couple of years as I look more into this whole protein thing, I don'teven think in terms of meal-to-meal or even day-to-day. I sort of look at proteinintake in three and four day clumps.If I get 180 grams of protein over three days, I don't care how it came in or whenit came in. That's enough to keep me going, because the body is so eficient atrecycling, particularly when you're fat-adapted and keto-adapted. It's so eficientat not feeling like it needs to dispose of that protein."

The Importance of Pulsing Your Protein and Carb Intake

Personally, I've found I need to pulse my protein intake. I'll restrict it below 15 to 40 grams a day a few days a week, then increase it to 70 to 100 grams on my strength training days or post partial fast. While you don't want to chronically stimulate mTOR, you also don't want to chronically suppress it. So, pulsing or cycling seems to be the best way to go about it. The same can be said for carbohydrates. While nutritional ketosis requires you to severely restrict net carbs while increasing dietary fats, chronic carb restriction is inadvisable. This is why I recommend cycling in and out of ketosis once you've established that your body can eficiently burn fat. As explained by Sisson:

"I don't like the word 'ketogenesis' because it connotes an excess of ketones inthe bloodstream. To think that you're going to have an excess of ketones in thebloodstream all the time for the rest of your life is ridiculous. I talk about keto inthe same breath that I talk about fat-adapted and keto-adapted. The term I useis 'metabolic fiexibility.'We want to be able to burn fat when it's available on our plate. We want to burnfat when there's no food available. We want to burn glycogen when it's in ourmuscles and there's none available.We want to burn carbohydrate on our plates, and when it's available [as] glucosein the bloodstream. We want to burn ketones when there's no glucose. And, asthe very last resort, we want to burn amino acids because it is a substrate in theabsence of other substrates.But metabolic fiexibility means we've developed this internal combustionsystem that is equally adapted, extracting calories from all these substrates,not just dependent on carbohydrate every three or four hours, which was the oldparadigm. But certainly, also not just adhering to a keto diet for the rest of yourlife with no more than 20 or 30 grams of carbs a day."

Living Your Best Life

While I believe wearable fitness trackers, like an Oura ring that has no EMF when it is airplane mode, can be valuable, Sisson is a self-proclaimed "anti-wearable tech person." Instead, he believes it's important to become more intuitive in your approach to lifestyle choices.

"How do you look, feel and perform? When you wake up in the morning and youdo a workout, are you ready for that workout? Do you feel like doing thatworkout? Are you excited about the workout? Do you have enough energy whenyou wake up in the morning?If you're not hungry, do you still have to eat? No. If you're not hungry, why areyou going to eat in the first place? A lot of this is just developing an intuitivesense so that even if you eat the wrong thing, you don't beat yourself up …I'm trying to take this high-tech movement and swing it back to using theinformation to get you to identify when you are ready to do something you're notyet ready to do. A good example would be a heart rate monitor. I train with aheart rate monitor …Now, after years of using one, I know what my heart rate is at different levels. Infact, the only reason I ever used a heart rate monitor after the first couple ofyears was to keep me below a certain level [of exertion], because I knew if Iwent above a certain level, I was in that black hole of [over]training."

How a Heart Monitor Can Improve Your Endurance

Sisson has a counterintuitive recommendation and approach to endurance training. While 220 minus your age is your theoretical max heart rate, Sisson recommends using 180 minus your age. This formula gives you your maximum aerobic function. What this means is that that's the heart rate at which enough oxygen is being put through your body to fuel fat burning, and to not put you into glycogen or sugar burning.

"A lot of people say, 'I'm 40 years old. That means I have a max trainingheartrate of 140. But Mark, I can train at 160 and 165 all day long. I could runsix-minute miles. And when I do what you say, and I train at 140 as a maxheartrate, I'm doing nine-and-a-half- to 10-minute miles. I'm almost walking.That can't be accurate.'My response is, 'It's entirely accurate. Here's the issue. You perform well as asugar burner. You're a great sugar burner. When you are training at 165 or 170heart rate and you feel pretty good about it, you're great at burning sugar. Butyou suck at burning fat. The fact that you suck at burning fat is demonstratedby the fact that you can't do much work at 140 beats a minute.'How Mark Allen became the premiere Ironman in the world is because Dr.[Phil]Maffetone coached him … [to keep] that metric. They go for long periods oftime, never exceeding that heart rate … They don't use speed or miles per hourto dictate how fast they're going.Over time, what they find is they become more and more eficient at thatheartrate. All of a sudden, those nine-and-a-half-minute miles become eight-and-a-half-minute miles, and then eight-minute miles, and then seven-minutemiles.The next thing you know, this guy who's 40 years old complaining about howslow he's going, if he's done it for several weeks, he's all of a sudden going,'Mark, I'm running six-minute miles at 140 beats a minute. Imagine what I cando when I get in a race and then I'm throttling it up at 160 or 165 beats aminute.'At six-minute miles at 140 beats a minute, we know based on how hard theheart is not working, that he's burning fat, because he would not be able tosupply that much oxygen to fuel that amount of work on sugar.You have to understand the science. But when you do, and you realize as longas you're willing to spend time in this zone, you become more and moreeficient. That is what endurance is all about. It's about how eficient you are."

More Information

For more fitness, diet and health tips, check out Sisson's blog on . There you can also find his books, which include "The Primal Blueprint," "The Primal Connection," "Primal Endurance" and "The 21-Day Total Body Transformation." If you subscribe to his newsletter you get a free copy of his fitness e-book. His latest book, " The Keto Reset Diet ," is available on Amazon and . Sisson also sells whey, collagen protein, unsweetened organic ketchup, mayonnaise and salad dressings made with avocado oil on .

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