Chronic stress is a contributor in many injuries. What does chronic stress look like? As I mentioned in part 1 of this article, chronic stress looks like a lack of sleep, too much caffeine or sugar, an emotionally unstable job or relationship,1 lack of exercise or overtraining.2 These factors result in increased cortisol, which affects your rate of healing3 as well as your hormone levels and sense of well-being.
Patients sometimes ask if they should take ‘joint juice’ or some other joint related supplement to help their injury heal. While some research supports the idea that joint-health supplements can reduce joint pain, the jury is still out as to how effective they are.4, 5, 6 Not to mention that while taking them can be beneficial, they may have to be taken for at least a month to have an impact on cartilage formation.6
My primary concern is making sure my body is able to make its own new tissue rather than having to supply expensive joint repair building blocks.
So what do I need for injury healing?
The connective tissues of our bodies (muscle, cartilage, bone, etc) differ somewhat in building blocks, but there are a few components that are consistent across the board. All these tissues have lots of collagen and proteoglycans (proteins with water-holding GAG molecules attached). Injury healing requires that your body make more of each of these.
How do I crank out more collagen and proteoglycans?
1. Move it.
We know from Part 1 that our bodies respond really well to the forces placed on them. In order to get better, stronger, less injury prone bodies, your body has to be moving. Even if you’re already injured, you should still be moving, albeit it might mean moving less than usual. Even in injuries of cartilage, regular moderate exercise results in more healing than kicking your feet up and resting.7 You don’t want to overdo it, but don’t think that sitting makes it magically better long-term.
2. Feed it.
Part two of injury healing is making sure your body has the building blocks to make proteoglycans and collagen. Proteoglycans get made out of proteins and GAGs. The proteins get made in your body and require that you are eating enough protein. Recommended amounts for how much protein you should eat differs, but I recommend 0.7 grams per pound of body weight per day.8 That’s 105 grams protein if you weigh 150 lbs or 140 grams if you’re 200 lbs.
What about GAGs (aka glycosaminoglycans)?
One type of GAG is chondroitin sulfate—one of the two most asked about natural joint supplements in my office. The other commonly asked about natural joint healing supplement is glucosamine. Glucosamine is one of the building blocks for chondroitin sulfate. So these supplements or foods like bone broth can be used after an injury to skip the steps of making your own, but you should also have no problems making your own.
These GAG molecules start as a sugar molecule and undergo sulfation—the addition of sulfur. These natural forms of sulfur come from veggies like garlic, onions, broccoli, cauliflower, arugula, cabbage, and mustard. Cysteine, which comes from protein, can also provide sulfate groups. Things that will use up these sulfate groups? NSAIDs9 and any kind of stress (cortisol).10 Know that if either of these sulfate-thieves increase in your life, healing will slow down.
Other things needed for GAG production in injury healing are B vitamins (B1, B2, B3, B5, B6 and B9), vitamin C, magnesium, lipoic acid, potassium, copper, iron, manganese and molybdenum. These should come from your diet, but know that a majority of adults don’t come near meeting the daily recommendations for vitamins, especially vitamins A, D, E, K, C and magnesium, calcium and choline.11, 12, 13 Healing requires getting good nutrients and may require working with a healthcare practitioner to figure out if there are specific nutrients you’re missing for healing.
3. Don’t sugar coat it.
So yes GAG molecules start with sugar, but don’t think that means you need to eat more sugar. Your body is great at keeping blood sugar levels stable, so the big challenge here is getting sugar in the cells.
Cortisol (back to that stress again) causes your cells to take in less sugar, which we call insulin resistance.14, 15. Insulin resistance is a common stepping stone for those who are type 2 diabetic or working themselves that way. If sugar can’t get into the cells, the cells can’t make glucosamine (GAGs) and joints can’t repair.
Wanting to make sure that injury heals?
The joint damage has to stop, and the chronic stress needs to go with it. Fixing biomechanics is important because crappy biomechanics results in abnormal cartilage wear and tear, less activity, more stress, worse dietary habits and more NSAID use. Chronic stress—lack of sleep, too much caffeine or sugar, emotionally unstable jobs or relationships, and lack of exercise or overtraining—needs addressed so your body can actually produce GAGs.
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