What are the signs of weak connective tissue?

Clusters, not singles: the heritable cluster that medicine means by weak connective tissue, and why no supplement addresses it

What are the signs of weak connective tissue is a question that the shelf answers with a list of singles, wrinkles, creaking joints, brittle nails, thinning hair, each presented as a sign that the reader's connective tissue is failing and each pointing toward a tub, and the honest page answers it with the rule that medicine applies to the same question and the shelf never does: the signs come in clusters, and a single sign is a sign of being a person. Connective tissue in the clinical sense is the collagen, elastin and matrix that hold the body together, in skin, joints, vessels, gut wall and the supports of the pelvic organs alike, and when it is weak in the clinical sense it is weak everywhere at once, because the same proteins run through every tissue, so that a real weakness announces itself in several tissues together and never in one. The heritable cluster is the one medicine means by weak connective tissue. Joints that bend past normal, scored on the nine Beighton manoeuvres, the little finger bent back past ninety degrees, the thumb bent to touch the forearm, the elbow and the knee hyperextending beyond straight, and the palms laid flat on the floor with straight knees, with a score of five or more out of nine marking generalised joint hypermobility. Skin that stretches further than usual when pulled at the forearm or neck, that feels soft or velvety, and that bruises at a touch, with bruises appearing where no knock is remembered. Scars that heal wide, thin and papery, spreading from a cut into a stretched pale mark, or that pucker. Recurrent dislocations or subluxations, a shoulder that comes out and goes back, a kneecap that slips, fingers that pop, without the force that would be needed to dislocate an ordinary joint. Hernias, pelvic organ prolapse, varicose veins or haemorrhoids at a young age, because the connective tissue that holds organs and vessels in place is the same tissue. And often a family history of the same, since the cluster is inherited. Together these point to a heritable connective tissue disorder, the Ehlers-Danlos syndromes and their relatives, in which a gene for a collagen or for one of the enzymes that process it is altered from birth, so that the collagen is made wrong or assembled wrong in every tissue; a rheumatologist or a geneticist assesses the cluster, since some forms involve the blood vessels and need to be known about, and since the management, strengthening and protecting the joints, caring for the skin, planning around the hernias and the pregnancies, is lifelong and specific. No supplement addresses this cluster, and collagen least of all, because the problem is in the instruction for the protein and not in the supply of it: a reader whose fibroblasts build a faulty collagen from a faulty gene build the same faulty collagen from the amino acids in a scoop, and the shelf's offer to a person with this cluster is the one offer that cannot possibly help. The three weaknesses of a single ligament, lax, hypermobile and deconditioned, which this cluster's joints are the second of, are on the weak ligaments page.

The acquired cluster and the medication cluster, the singles that are being a person, what to do with each, and the worked example

The acquired cluster is the one historical case in which connective tissue weakens in an otherwise normal body, and it is vitamin C deficiency. The enzymes that stabilise new collagen chains, the hydroxylases that let the triple helix form and the cross-links take, require vitamin C as a cofactor and stop without it, so that a body deprived of vitamin C for months stops making stable collagen everywhere at once and begins to show it in the tissues that turn over fastest: gums that bleed, swell and loosen the teeth, since the gum's connective tissue is replaced quickly; body hairs that grow in a corkscrew because the follicle's collagen is faulty, with bleeding around the follicles; bruising, because the small vessels' collagen fails; wounds that will not heal and, most tellingly, old scars that reopen, because even healed tissue turns over slowly and the turnover cannot be completed; and joint pain with bleeding into joints. This is scurvy, and the cluster together is diagnostic, but it is rare in the United Kingdom, needing months with almost no fruit or vegetables, and it is seen in extreme restrictive diets, severe alcohol dependence, some eating disorders, and elderly people living alone on tea and toast; a reader eating any fruit or vegetables regularly does not have it, and a reader who suspects it has a doctor's blood test and a cure that costs pennies and works within weeks. The medication cluster is the third, and it is iatrogenic: long courses of corticosteroids, oral or potent topical, suppress fibroblast collagen synthesis and produce thin skin that tears at a knock, striae, easy bruising and slow wound healing, a known cost of a necessary medicine that the prescriber monitors, reversible in part on stopping and not a sign of anything in the connective tissue itself. The singles are what the shelf lists, and each has its own ordinary cause. Wrinkles and sagging are the sun's work on the dermis over decades, intrinsic ageing and, in women, the oestrogen loss of menopause, on every face eventually and on sun-exposed faces sooner, and they are a sign of weak connective tissue only in the sense that a grey hair is a sign of weak pigment. Cellulite is the normal architecture of female subcutaneous fat, present in most women from puberty regardless of weight, fitness or diet. Joints that click or creak are tendons moving over bone and gas bubbles in joint fluid, painless clicking being normal at every age. Nails that split are usually wet-dry cycling, detergents and age, and sometimes iron. Thinning hair is iron, thyroid, a shed after illness or a hormonal pattern. None of these is a sign of weak connective tissue in any clinical sense, none clusters with the others in the way a real weakness does, and a reader with one or several of them has a sign of being a person, a sign that the shelf has learned to sell to. What to do with each is simple. A cluster from the first list is a GP appointment with the Beighton score, the skin, the scars and the family history described, and a rheumatologist if the GP agrees, with the reader's joints protected by strength and balance training in the meantime. The second cluster is a GP appointment this week and some oranges today. The third is a conversation with the prescriber. The singles are life, and the thing that would tell a reader whether their connective tissue was deficient in anything does not exist, as the collagen deficiency test page sets out, since there is no collagen blood level and no collagen deficiency, only the vitamin C that makes it and the genes that specify it. The five signs the shelf promises a supplement will fix are audited against the trials on the five signs page. The worked example addresses none of the clusters and is a food protein for the people with none, stated on its true terms: two capsules, 1200mg hydrolysed type 1 marine collagen with 12mg vitamin C at 15% of its reference value plus zinc, 120 for £16.99 at 28p a day, lab tested and UK made, with its 12mg of vitamin C a label threshold rather than a treatment for the second cluster, which needs a doctor's dose, and its collagen irrelevant to the first and third, carrying vitamin C's collagen formation sentence and no connective tissue claim. What are the signs of weak connective tissue: a cluster of hypermobile joints, stretchy bruising skin, thin scars, dislocations and early hernias, for a rheumatologist; a cluster of bleeding gums, corkscrew hairs, bruising and reopening scars, for a GP; and the shelf's singles, which are being a person.

What to check on the label