Are there any vitamins that help with tendonitis?

Help is conditional on a measurement: why the only vitamins that help a tendon are the ones you are short of

Are there any vitamins that help with tendonitis is a question that the shelf answers with a bottle and the honest page answers with a rule, because the rule is what decides whether any bottle is worth buying: the only vitamins that help a tendon are the ones a reader is short of. A vitamin is a cofactor, a molecule that an enzyme needs in order to do its job, and the enzymes that build and maintain a tendon's collagen need their cofactors present in sufficient amounts and are not made faster, better or more numerous by amounts above sufficiency; a reader whose vitamin C is sufficient has collagen-stabilising enzymes that are working at the rate the cell sets, and a tablet that raises blood vitamin C does not change that rate, while a reader who is deficient has enzymes that are stalling for want of their cofactor and a tablet that restores sufficiency restarts them. Help, in other words, is conditional on a measurement, and the measurement comes before the tablet rather than after it. That rule turns the shelf of tendon vitamins into two tests and a protocol. The first test is for vitamin D, and it is worth doing. Vitamin D is made in the skin from sunlight, and in the United Kingdom the sun is too low from October to March for the skin to make any, so a low level is common by late winter in people who do not supplement, and the national advice is for everyone to consider 10 micrograms a day through the winter for bones and muscle. The tendon literature on vitamin D is observational and inconsistent: some cohorts find lower levels in people with rotator cuff tears or tendinopathy, others find no difference, and the association is confounded by age, season and activity, since older, less active people measured in winter have both lower vitamin D and more tendon problems for reasons that run through neither; there is no randomised trial showing that correcting a low level prevents or treats a tendon problem. So the honest reading is that a reader who tests low corrects it, because the bones and the muscle around the tendon are reason enough, and expects nothing measurable for the tendon itself, while a reader whose level is fine gains nothing for the tendon from more. The second test is for vitamin C, and it is a diet history rather than a blood test, because the question it answers is binary. Vitamin C deficiency is scurvy, a failure of connective tissue everywhere, with bleeding gums, bruising, poor wound healing and bleeding into joints, which takes months of near-total absence of fruit and vegetables to produce and is rare in the United Kingdom outside of extreme diets, severe alcohol dependence and some elderly people living alone; anyone eating any fruit or vegetables regularly is sufficient, and no trial has shown that vitamin C above sufficiency does anything to a tendon. The reader who eats no fruit or vegetables at all has a diet to fix rather than a tablet to buy, and the reader who eats some has a sufficient cofactor and a tendon that will not notice more. The kernel of truth that keeps vitamin C on the tendon shelf is on the best vitamin for tendonitis page.

The one vitamin in a tendon trial and what it is doing there, the register's silence, where the money and the hours belong, and the adjunct

One vitamin does appear in a tendon trial, and the honest page explains what it is doing there, because its presence is what the shelf points to when it sells vitamin C for tendons. In the pre-loading protocol, healthy young men were given 15g of gelatin with around 50mg of vitamin C about an hour before a short bout of jump rope loading, and a blood marker of collagen synthesis rose more than with placebo; the vitamin C was there as the cofactor the collagen enzymes need to stabilise the new chains that the gelatin's amino acids might be built into, present at a dose that any sufficient diet already supplies, and the trial was a trial of the protocol, gelatin plus loading with the cofactor along for the ride, not a trial of vitamin C for tendonitis, with the methods sections read closely on the vitamin for healing tendonitis page. The one outcome trial that followed, 2.5g of collagen beside six months of calf strengthening for Achilles tendinopathy, did not add vitamin C as a variable at all. So the one vitamin in a tendon trial is doing a cofactor's job at a sufficient dose inside a protocol whose active parts are the gelatin and the loading, and a reader who buys vitamin C for tendonitis on the strength of that trial has bought the passenger. The register's silence confirms the picture from the regulatory side: the authorised health claims, searched for the word tendon, return nothing for any nutrient, and vitamin C's collagen formation claim names cartilage, bones, skin, gums, teeth and blood vessels and stops there, so no product may say that any vitamin helps a tendon, and a label that implies it has stepped outside the register. The other vitamins the shelf offers for tendons, the B vitamins, vitamin E, vitamin K, have neither a tendon trial nor a deficiency state that produces tendon symptoms in a fed adult, and their place on the shelf is by association with connective tissue in general rather than by any evidence about tendons. Where the money and the hours belong is the treatment, and the treatment for tendinopathy is a progressive loading programme: isometric holds for pain, heavy slow resistance every second or third day through the months that remodelling takes, energy storage loading when the heavy work is tolerated, a return gated by tests and a maintenance dose afterwards, with the floor of protein at 1.6 to 2 grams per kilogram, sleep, not smoking and enough food under it, and the three deficiencies that do cause tendonitis, of capacity, recovery and energy or oestrogen, on the deficiency and tendonitis page. Collagen's place is beside the heavy session, as the protocol's substrate rather than as a vitamin: the worked example pairs the protocol's two ingredients at habit scale, 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, below the 15g protocol dose, carrying vitamin C's collagen formation sentence for cartilage and bones and no tendon claim, with the 12mg a label threshold rather than a dose and any fruit supplying more. Are there any vitamins that help with tendonitis: only the ones a reader is short of, which is a test and not a tablet, and the loading programme is where the help is.

What to check on the label