Joint Health Lesson Transcript

Dan P 00:00 Matt, it is great to see you again. I'm excited to talk about joint health. This has come up before when we talked about yourself. How do I keep my joints healthy? Then with your children, they're athletes what should I do to support their joint health over their journey it's a super important subject from a health span perspective. Think about an older person who moves gingerly. There's discomfort, there's pain they talk about their knees, and the way that I think about it is that joint health is really upstream from the most important health stand factors that we know of, which is movement. But it's hard to move if you're really uncomfortable. So this is important in its own right, but it also then enables another extraordinarily important health span behavior. And that makes intuitive sense to all of us here and nobody wants joint pain anyway why don't we do this? Why don't we start with a primer on joints themselves so we know what we're talking about does that sound good?

Matt O 00:50 That's perfect. Ok, cool.

Dan P 00:52 And like usual, Jenny and I are going to have team and talk about different parts of that and you can ask questions whenever you want. Ok, so what's a joint so there's actually lots of different types of joints in the body. We have fibrous joints this is when you have a fibrous connection between bone you have cartilaginous joints this is when there's cartilage that that is in between bone to bone. You even have cranial sutures so imagine in your skull there's all different plates and nose have joints as those bones come together, The one that we're really interested in, when we talk about joints, we think about it as synovial joints. These are the ones that move and they'll they'll be our focus for the most part. Ok, so these are mobile these are like your knees, your wrists, your fingers, ankles, even parts of your spine like set joints. But enough so I recently started to do some jiu jitsu and in that you grab really hard on on a ghee when you're, if you're doing ghee jiu jitsu and my finger, all the joints in my fingers, I could see all the after for like days and days on end. You have to you take a good healthy joint for granted until you can feel it. Let me describe, like everything yeah so let's think about what like a joint is so imagine these are two bones, and if they if there was nothing really protecting them, you'd experience a lot of grinding. But these bones that come together are encapsulated with a fibrous capsule. And inside that capsule there's a synovial lining and synovial fluid, which is between the bones. And on the end of each bone, there's this articular cartilage test so we'll talk about those different structures, but that's the general sense of all these synovial joints. That is that there's a capsule, there's cartilage, and then there's the synovium and that's going to include the fluid and also the lining. So let's talk about cartilage first this is basically a dilted chocolate shielder and it sits in inside the joints and it's this smooth, thin, looks like a Teflon. Think of it like a Teflon on a pan it's permanently bonded to the bone and it coats those ends. And what it does is it allows for smoother gliding even under very heavy loads so it prevents that grinding that we I was just mentioning. Another thing that it does is it absorbs impact and it cushions the joint when you're walking, jumping, any sort of sudden movement.

Matt O 02:49 Synovial, you said synovial.

Dan P 02:51 There's synovial joint that contains articular carted. So it the articular cartilage is articulating to the bone and it's at the end. And So what is it made of it's made of it's got like this tough polygenic that can withstand these movements for your life. And we think about it as well maybe it's it's like a fingernail where it's not a it grows, but it's not really alive this is actually.

Matt O 03:13 A living structure.

Dan P 03:14 And so it's made-up of specialized cells that are a part of this cartilage tissue called chondrocytes and also this gel like structure, which is the extracellular matrix, so extra outside of the cellular matrix and the chondrocytes sit inside that matrix and that the extracellular matrix give the cartilage its unique mechanical properties so it's strong but flexible, but it's durable but also spring and when it's healthy, these quadrocytes sense the load that is that be placed on them and then responds to the mechanical signals and then adapts, right? So that's how we can think of it. And what is the extracellular matrix made-up of so we understand its properties. It's made-up of type 2 collagen. So we go pretty of lichens and then Alaska. So type 2 collagen. This provides that framework of like tension cables and it keeps the part of a strong and tear resistant, although it can tear the part of lichens the way that I think of it is like there's little water balloons that are spongy molecules that retain water and they absorb shock and they also keep the tissue of springing. And then elastin like elastic adds stretching flexibility, right so it helps the joint rebound when it's stretched and moved. So together this kind of gives the structure, the matrix and the counter sites some pretty unique or their ability to be soft enough to cushion and tough enough to withstand a lifetime of repetitive. Now, one really important point when we talk about joints is that they're a vascular, which means that they don't have direct blood flow to them. So typically blood flow, what is it doing? You eat food, it's digested in your stomach, it goes into the portal vein, goes metabolized in the liver, it's circulated throughout the body it carries oxygen and nutrients and it delivers nutrients to tissues throughout the body so if it if this type of tissue doesn't have its own direct blood supply, where does it get its nutrition from? And the cartilage gets its nutrition from synovial fluid and which we'll discuss a little bit more in a minute jenny will tell you more about some of those properties. But the way that nutrition gets into the cartilage is through diffusion. And that means that the repair process is usually pretty slow and it's also limited. And in fact, damage that occurs is often times permanent. So prevention is crucial. And prevention is really going to be a combination of trying to avoid things that are going to tear it, although when you play sports and you play them aggressively, these things happen, but also keeping it a Southeast. So do you want to say a little more about synovial fluid?

Ginny R 05:44 Yeah, definitely. Yeah your joints are basically high performance hinges, if you think about it they're bending, rotating, absorbing, impact got thousands of times per day. And to keep these joints moving smoothly, your body produces synovial fluid. And this is a slippery liquid that fills the joint cavity, the space between the bones so if you think like these like 2 bones, you've got the joint cap sort of capsule, the space in between the bones and there's a slippery liquid. But the term synovial fluid is a little misleading it's not like a thin watery liquid and that's because it contains hyaluronic acid, which gives the synovial fluid it's a viscosity and shock absorbing properties and.

Matt O 06:23 You said.

Ginny R 06:23 Hyaluronic acid you had the mouthful.

Matt O 06:26 Is that IO?

Ginny R 06:28 It's H Y A L U R O N I. C hyaluronic. You see it a lot in skin care products because it retains water like crazy. Each hyaluronic acid molecule can bind up to a thousand times its weight and water, which makes it good for a lot of skin care products because it like for like serums, stuff you put on your face, it makes it thicker and it does the same thing in your joints it forms like a gel like cushion inside the joint cavity. So it's a very thick fluid, and this is a good thing because it helps distribute loads evenly across the joint, reducing wear on on anyone area. But the role of synovial fluid goes beyond lubrication like Dan said, cartilage is avascular, so synovial fluid is what feeds the cartilage, oxygen, glucose, and amino acids via diffusion. So you could think of synovial fluid as being like WD forty for your, skeleton but honestly, it's even more essential than that. And without it, cartilage would dry out, friction would build, and there would be all kinds of damage.

Dan P 07:29 All right, great. And So what are we, what are we talking about so far for joints so we have this capsule, we have the fluid inside, we have the bones, and then the cartilage is at the ends of the bones. What else does a joint have as ligaments and tendons? And so we'll just quickly review that but a ligament, it offers the twisting force around two different bones. This is bone to bone it holds the bone in alignment it resists excess movement it allows for some, but it doesn't allow for too much. Tendons are interesting they're think of them all look like a sprain they store and release energy and this is muscle to bone so this is the tendon is part of the of the muscle and then it attaches the bone and it helps you transmit force so when you your muscles contract then that pulls against the bone and it is the tendon that is attaching to the bone. Athletes can store and release a massive amount of energy if those tendons are strong, stiff and structurally sound. So these are made mainly from type 1 collagen like bone and skin where artillery just made of type 2. So like cartilage, this also contains an extra cellular matrix, both of both these structures, ligaments and tendons. And so I'll ask them to stretching their coil and then each one of them have the equivalent of a chondrocyte. So pendants and tenocytes and then ligaments have fibroblasts and just like articular cartilage, they don't get much blood flow and they have decreased repair rate. So you need mechanical modes to remodel this tissue, which means that you have to use them and because diffusion is how they get their nutrients and they get better diffusion when you're actually using. So use the ports. No, in terms of ligaments, tendons and cornilage. All right, So they have, they actually have a very good response to training, but at the same time they could be injury prone. So these structures have similarities that give them their unique characteristics they all have some similarities as you can see a vascular similar stretchability diffusion for nutrients. So that's what we that's what we're talking about when we think about a synovial fluid we've got the capsule, the cartilage, the joint, the tendons, the ligaments so that's our primer on this and why don't we talk about the landscape of joint problems in the United States do you want to take this one?

Ginny R 09:35 Yeah, sure thing. So Matt, I'm sure it won't surprise you to hear joint issues affect a large portion of the adult population in the US And there are actually a lot of different types of joint problems like tendinopathies, Bursitis, labral tears, meniscal injuries, ligament sprains. Dan was joking earlier that he he just about has all of these. So we could probably put a picture of Dan's body like outline, make him like the silhouette and just label it.

Matt O 10:03 Yeah, I was talking to the surgeon that did stem cells on one of our actually on both of her boys and he was saying he doesn't. He said if I took if I took Mris of a thousand said nine hundred and ninety of them would have multiple tears in their labrum their their rotator cuffs like the he said the there are, they are there all the time in general and some people have different relationships with them right some are debilitating and some when you look at the image look debilitating and they have 0 effect on their pain at all like they can't even they don't even know they're there.

Dan P 10:45 Yeah, you can see from what we were just.

Matt O 10:47 Talking synovial joints, is, is the labrum in the hip too, right? Is that yeah, a synovial joint, a type synovial?

Dan P 10:54 They have more exactly, they have more movement to them and what you, what we talked about at the beginning, you can see that these are living structures they have cells in them that do get nutrition and they do evolve over time. But because they're slow and then particularly when you get older, you can see that the healing for a variety of reasons will cover some of those. It feels like it is an irreversible issue. And was what Jenny was just saying that there's there's a lot of different types of issues that happened with the joints, right there's pheninopathies, Bursitis there's and as we were joking, which is also why I'm crying. I do have one of each of those and that's just from play sports ARDS grown up, always being active. If you've been an athlete, even if you haven't been, it's likely that some or all of these things are things you can personally relate with. And yeah, and as you get older, you have more time to aggregate the chance of causing some injury. And in fact, arthritis is really the most common, most recognized it's the best study, but it's actually not a single disease how many different conditions Ginny considered as a part of arthritis?

Ginny R 11:56 I think arthritis is an umbrella term for actually 100 different conditions that affect the joints.

Matt O 12:02 Yeah, wild. That's crazy. And how many people have?

Dan P 12:07 Experience this in the United States they're.

Ginny R 12:09 Adults, that's a complicated question if you look at everyone 18 plus, it's the latest CDC data says 20 % of adults but if you break it down by age, it looks different. It's really when you're talking about it's really low up to when you're in your thirties then, like five to forty nine it's ages fifty % four nine %, then 65 to 74 it's 44 % and in people over the age of 75 it's more than half of the population.

Dan P 12:38 Yeah, right so half of the population have joint issues by a certain.

Matt O 12:43 Yeah.

Dan P 12:44 And this is.

Matt O 12:45 Sporting, right, Jenny that's reported stuff.

Dan P 12:47 Right this is diagnosed arthritis, actually. So think about that. If 50 % of the people have diagnosed arthritis, what about that large group of people that are dealing with some sort of joint issue, arthritic like condition just hasn't been diagnosed yet? Yeah, it's a lot of people.

Matt O 13:05 So yet could be discovered thing that we have no idea about because if you have.

Dan P 13:09 100 different types of arthritis now, maybe 20 years from now you have 100 and twenty five a hundred and fifty different types. I thought it was possible you also have people that haven't gotten the doctor they're experiencing it, they just haven't gotten an official diagnosis now, All right, you know why? What happens, what goes wrong over time? And like a lot of things in the body, joint decline is gradual. And so it's often unnoticed only in both the person has pain and discomfort. And there's basically at that point enough structural damage present for it to be causing some issues that you can perceive. And the different drivers are things like repetitive stress, so daily use to intense sports, unhealed injuries, so injuries that you didn't get complete resolution on when you were younger or at some point and they've stuck around. And then of course, aging, right so as you get older and that really the three reasons, the three main processes of deterioration with age is you do have structural breakdowns so even if you don't have some big injury, you do experience structural breakdown. So you see less production of type 2 collagen and elastin, the stretchy stuff. And then the extracellular matrix weakens too so you now have increased surface roughness, which causes more friction, causes more wear. You can't handle loads as well. And so now you're in a situation where you're also going to accelerate the structural damage because the loss of the protective layers between it so it's, it's not a linear curve, it's actually one where you see the situation get worse at an accelerating rate. You have less lubrication and less nutrient delivery so the synovial fluid decreases you have dead less hyaluronic acid, that synovial fluid think of it like a gel that thinned out it goes from a thicker gel to a thinner gel. It's less cushioning, less lubrication, less nutrition, right because remember, where do these structures get their nutrition from the synovial fluid? And then that gives the feeling of dry, stiff, damage prone tissue so you wake up in the morning and you feel stiff and achy until you warm up, right your feet are sore, your knees are sore, whatever it is, wherever you have more damage, you feel that first and then with a little bit of movement, it can loosen up and I'm sure that can relate to that. Get older. Yeah, Yeah, it's a still like a, a, a normal characteristic of getting there and then of course, like anything with aging is chronic inflammation. So as inflammation is a double edged sword, right? And we tend to try to label things that occur in the body as bad inflammation, bad that's not true. If it's acute and short lived, it's super helpful we want inflammation because it recruits immune cells, clears out the debris and it kicks off healing it's a part of that healing process when you do have little micro damage. But what we really are worried about or concerned about is chronic low grade inflammation because that persistent inflammation erodes the joint tissue from within. It's a situation that is toxic to the tissue do we want to shut it down altogether, Matt, or do we want to have a different relationship with? Is that the goal shut down all inflammation?

Matt O 15:55 Just like off the top of my head, like it would be great to have greatly reduced inflammation i'm sure inflammation and I'm not a doctor, but I'm sure it would be something that would be advantageous in some areas i don't know what they are, maybe initially when you get injured, but yeah, you, everything that I've learned, at least with our children with sports, is the quicker you can get inflammation under control with an acute injury, the better off you are and chronic inflammation over time sucks for everybody it's like this. It's like the root of a lot of really bad things parkinson's, cancer, maybe Alzheimer's, heart disease, and also of course, joint health, chronic.

Dan P 16:28 Low grade inflammation being problematic elsewhere, but what we're really trying to do is restore inflammatory homeostasis or balance because it does play an important role. It does play an important role in maintaining the tissue it's the excessive inflammation that's problematic and that chronic inflammation phenotype that state increase as you did. So yeah, you're right, you want to shut down the chronic inflammation, but you also want to keep the function of inflammation strong in fact, that's one of the issues is that when you end up in a place with chronic inflammation, the function of normal healthy inflammation becomes deteriorated. And that's no good no, we don't want to shut down all information, but we do want to get out of that chronic inflammation state. So let's What happens to joints under chronic inflammation why is it bad, Virginia i'll take it to.

Ginny R 17:13 You yeah so we used to think about joint degeneration, like osteoarthritis, as being a simple sort of wear and tear problem, but we now know that's actually only part of the story. New research shows that inflammation plays a central role even in the earliest stages of joint breakdown and the reason why we know this is because researchers have looked at synovial biopsies from people with various stages of osteoarthritis so some people only have a tiny little bit, and other people like they're about to get a joint replacement. And these biopsies consistently show elevated levels of inflammatory cytokines, even in people who are at the very earliest stages so these inflammatory markers are present before there's major structural damage apparent, which suggests that inflammation is not just responding to joint damage, it may actively drive it. And so here's how this works. So ongoing mechanical stress as well as cellular ageing tip the system to chronic inflammation so immune cells get activated in the joint and they release various pro inflammatory cytokines so these are small molecules that signal inflammation. But the problem is that these cytokines don't just increase inflammation, they also act as molecular signals that bind to receptors on other joint cells. So they bind to chondrocytes as well as synovial cells, and these cells shift to a catabolic state, meaning that they start breaking down the extracellular matrix instead of building and maintaining it. And more specifically, they start ramping up production of various what I would call breakdown enzymes and this includes matrix metalloproteinases, which degrade collagen, and agriconases which breakdown agrican and Agrican is the main water retaining molecule in cartilage. So these enzymes aren't inherently bad you actually you need them to remodel damaged tissue but the problem is when they're active all the time, you start seeing accelerated collagen loss, thinning and weakened cartilage and break. Overall breakdown is outpacing the body's ability to repair. So this creates A destructive loop where immune cells are releasing cytokines. The Contra sites respond by producing these breakdown enzymes cartilage starts breaking down, releasing debris, and then in response, more inflammation is triggered. So this propels joint degeneration even in the absence of recent injury. And importantly, these cytokines also trigger another inflammatory pathway, cyclooxygenases, which are better known as Cox enzymes. Matt, are you familiar with Cox enzymes by any chance?

Matt O 19:41 I am not i'm taking notes, strikes. No, I'm not.

Ginny R 19:44 Yeah, they might start ringing a bell as we talk about them. So Cox enzymes make prostaglandins, which there's like local hormones that act over a short distance and there are two different types. One is Cox one and Cox one is always turned on. It maintains protective prostaglandins and the lining of your stomach. Cox 2 is only switched on by injury, inflammation or infection and it drives pain and inflammation and too much Cox 2 leads to joint damage so. What do people usually do when they have joint pain they take NSAIDs, non steroidal anti-inflammatory drugs like ibuprofen, naproxen these drugs work because they block both Cox One and Cox 2, which is great 'cause it it blocks pain and blocks inflammation the problem is that they also block Cox One, which produces GI side effects and that's because Cox one protects the lining of your stomach. The prostaglandins in your stomach promote like mucus production bicarbonate, which neutralizes stomach acid and also promotes like healthy blood flow to the gut. So blocking Cocs 1 disrupts this defense, leading to ulcerous GI bleeding that's why I when if you take ibuprofen or Aleve too much, you're obviously going to feel less pain and less inflammation, but you also will wind up with problems with your stomach. You can develop ulcers and GI bleeding, and this is a problem that pharmaceutical companies have been dying to solve for decades and actually almost did with Vioxx do you remember Vioxx about 20 years ago?

Matt O 21:14 No.

Ginny R 21:15 Yeah dan, do you want to explain Vioxx a little bit?

Dan P 21:18 Yeah, this was, I was working in the Pharmaceutical industry at the time and medical affairs and So what was I remember this because I think through the at one point not that long ago, the Pharmaceutical industry was considered to be.

Matt O 21:33 One of the most prestigious.

Dan P 21:34 Jobs that you could have, these were heroes making life saving drugs that were helping us have more comfortable, longer lives. And the Biox scandal was one of multiple different things that happened in the industry that started to turn the perception of a perception of drugs and pharmaceutical companies from highly prestigious sought after rolls into something where the public was looking a lot more negatively upon them. And Biox had a ton of excitement about and it selectively hit inhibited Cox 2, which is great, right cox 2 is going to drive joint inflammation it causes, it's a habit you get an an up regulation of Cox 2 when you've got pain and swelling. And so inhibiting that people would feel immediate relief. And as a result, it became a blockbuster drug, two billion dollars in sales, everybody was sitting on it. It was great, right it was the best of both worlds. You weren't affecting your gut lining like the NSAIDs and Naproxen. And by the way, the gut lining is not the only system that is affected by Cox. You also have very similar border systems from the blood brain barrier, the orchid or testicular blood barrier as well. So there's some interesting research shows messing with Cox 1A sexy barrier systems, including your gut barrier. Not no bueno, not good. I very rarely take NSAID's only when I really need to and I do more a short period of time and I take it with food, but it's not a rare side effect. People get gut issues and if you take it a lot you will develop an old. So this seemed to be a great thing. What ended up happening is that being on these medications for a long period of time doubled cardiovascular events. And there was a trial called the approved trial that showed that this was a, really showed exactly that if you were on it, you are more than twice as likely to experience some sort of cardiovascular event, like a, like a myocardial infarction. Is it a Yeah. So Merck ended up withdrawing this in September 2004 And even though they made over two billion dollars they had massive litigation and so the lawsuits were closer to five billion dollars in payouts. And there was thinking that they sat on this information for too long. Like, they knew that there was a signal there, but they didn't want to remove it because the drug was doing so well and that right, there's the the incentive is strong enough. They're not going to comfortably take this off the market even when they should. And now pharmaceutical companies are much better about that if there is a signal, they might remove it from the market, do more research, even if they end up putting it back. But this was not a good look for Merck, and it definitely was one of the Seminole moments in the pharmaceutical industry's reputation. But this illustrates a really important point that shutting down inflammation can backfire, right we talked about this before you don't want it it has an important role in the body. And so a simplistic view that inflammation is bad is going to be harmful and here's just one illustration. Bad, right it's playing a role in homeostasis throughout the body including vascular, which is why you saw increased cardiovascular. Yeah, great some key points there is that yes, excessive Cox 2, I'll just drink that. We don't want that. But Cox 2 is helpful when controlled. So we're not trying to eliminate it, but we are trying to keep it in check. And I came up with this acronym curve which is ALM inhibit, reduce and preserve. So you're trying to calm Cox 2 and you throw in foot inflammatory signals dampen those pro inflammatory signals down inhibit certain enzymes so gene wasn't intra name a matrix metallobrotinases. These are these enzymes that can break down the structure really important to clear out debris when overactive, actually break down the structure, not just through debris that makes sense. And then reduce swelling, stiffness and pain we want to get rid of that that's that is our physical experience of what's happening inside the body and then preserve long term structure and as long as we can so calm and Hibbit reduce and preserve, so cool the fire without getting rid of the firefighters. Got it yeah i do want to mention actually one thing about cortisone shots so Jenny said what happens when you develop blood pain you might take up non steroidal anti-inflammatory drugs. And then that is we're not going to make a medical decision or determination about whether that's the right or wrong thing to do for an individual case they have a role we're glad that we have. That's to medications like that. Most things have side effects and consequences and so you think your doctor has to make a medical determination and sometimes it's appropriate, sometimes it's not. Cortisone shots are actually similar. We talked about how many people are affected by osteoarthritis in the United States. It's a lot of people. And another thing that people do if it's bad enough and the NSAIDs aren't working is they'll go get a port assumption. And what recent research has shown is that this actually worsens the condition overtime yeah. And so.

Matt O 26:04 Is that connected to somehow like creating a situation where Cox 2 enzymes then come back?

Dan P 26:11 So what you're doing with a cortisone shot is you are getting temporary relief by suppressing pain signals, but you are breaking down the tissue further. So there was 2 studies that support this ID, that's this ID, recent ones that support this idea that the cortisone cortisol steroid shots are actually not they worsened the condition. One of them was a 210 person study that used magnetic residence imaging, MRI and showed that the disease progression was actually accelerated over a period of time when you had these shots so it made you feel better and worsened the condition over time. The second one has 150 patients in it and it was a radio graphic study, so they were taking imaging and that also confirmed worst outcomes over time too. So what's probably better is getting injected with either on the gas, right, That gel like substance that seemed safer and it also has been shown to decrease disease progression. So that's like an alternative look into getting a hyaluronic acid shot in the same joint you might not get the same similar amount of immediate pain relief, but you're actually going to decrease the disease progression. And I would rather opt for that i would rather slow down the deterioration than feel better for a little bit and accelerate the deterioration because you're basically just pushing off the issue downstream, right? Yeah all right. The aging problem, right we talked about the various things that happened when you do age there's breakdown in structures, there's inflammation, there's variety of those things that we talked about. There's other things that take place though. The cells, the polycytes, tenocytes, etcetera, they actually become less metabolically active when you get old, right and so they're and they're more prone to senescence. And as you are aware with senescence, you have cells that are not functioning, but they're releasing more inflammation into the immediate area. Now typically the release of what are called fast factors, it's over 120 different inflammatory molecules that plays a physiological role. It signals to the immune system hey, there's an issue here, immune system come clean up this damage. But over time, as you're as you get older, you have more senescent cells that's going to raise your inflammatory state and you have a weakened immune system. So now we have a situation of heightened immunity and less clearance. And so no longer as helpful of a situation as before. And they're also less responsive to mechanical stress so before how do we keep these tissues healthy we have to use them, right, because they get their nutrition through diffusion, but they're now less responsive. A good example actually to understand this is skin. A very similar process is taking place in skin those skin fibroblasts also manufacture collagen. And with age, the slower metabolism, the increase in essence decrease collagen production. And you see this as visible evidence in wrinkles and you the same exact process is happening in your joints you can't see it, but you can see it, right?

Matt O 28:48 This supplementation of collagen over the course of your life on a regular, daily basis can have positive effects on all of these things that slowly deplete over time.

Ginny R 29:00 That's where we're going.

Dan P 29:02 Yeah so now we cover exactly, we've covered what a joint is we've covered what happens with aging we understand how these tissues work through their their limitations and their capabilities. We see how certain common drugs like NFED orgasteron shots are not as helpful as you'd want, They're not a solution. So now it asks the question, what does help? And before we get to College in why don't we talk actually about resistance training because this is something that we don't want to overlook as we're talking about before the movement is really important and that remains true here. So let's talk about the movement side first so we can understand the nature of what's helpful so that we can design programs for your movement map that include the stuff that's going to help. Abby, Jenny, do you want to take this?

Ginny R 29:43 One, Yeah, I can jump in here. Yeah, inactivity causes collagen production to decline or stagnate but the good news is that tendons, just like muscles, are highly responsive to mechanical loading. Exercise itself stimulates collagen synthesis to a surprising degree. Even 1 resistance accession can double the rate of collagen synthesis. And overtime, this results in stronger tendons not just in young people, but even in older people there was one study in older adults we're talking like 70 to 80 years old. Fourteen weeks of strength training led to a 70 % increase in tendon stiffness. Remember, stiff tendons aren't good like.

Matt O 30:22 They transmit force, joint stiffness, bad tendon stiffness.

Ginny R 30:28 Good yeah, tendon stiffness is good. I know it's counter intuitive, but yeah.

Dan P 30:31 Tendon stiffness here's how I remembered it. Because it is sound intuitive here's how I remembered it so what happens to skin? Also uses collagen when you get older, it becomes faggy, it becomes less stiff, right it actually loses it's it becomes more LAX call Edenver like that too. And in fact, they're about 15 % more compliant than younger ones so they deform more under load and they have a decreased ability to transmit that for So the way to think of it, because it is, it seems like it might sound bad, less stiffness is like saggy skin, right? Resistance training actually helps to keep your tendons stiff and that helps with force transfer so that's it.

Matt O 31:09 Resistance training means lifting weights, using bands, running, walking. Is that true or is it more lifting weights and?

Ginny R 31:18 Yeah, for most people walking and probably running, unless you're like sprinting is not going to be enough of a stimulus for like most healthy individuals I.

Matt O 31:26 Think lifting weights using bands.

Dan P 31:29 Body weight swimming.

Matt O 31:30 Maybe could swimming do that or no is it not weight bearing so it doesn't really have the same?

Dan P 31:35 Effect or it's any more modest?

Matt O 31:37 But like pushed off putting.

Dan P 31:38 Yeah, putting stress on the tendon, so like body weight will do it. Lifting a load certainly will so the canonical form of this is actually weightlifting, but yes, somebody weight stuff as well and you're going to get a modest amount of that with anything that's going to. Yeah, go ahead.

Matt O 31:56 Oh, so no good good. You're going to get a modest amount of that. Sorry finish your thought and then I'll ask.

Dan P 31:59 My question with things like swimming, if you're working hard through the water and the muscle is now going to be contracting and pulling the tendon of the yeah 'cause.

Matt O 32:08 You're almost humorous pulling it's almost.

Dan P 32:09 Pulling yeah, exactly.

Matt O 32:11 Or if you're forcing your leg down through the water, it might be resistance.

Dan P 32:16 A little bit, Yes, a little bit.

Matt O 32:17 But what you're really talking about is body weight like push ups, lunges, squats, step UPS, pull ups and all weight lifting and maybe band like band work like pulling resist training band work. I had so my here's my question for you so we're talking about loading up tendons. Is the same thing true for ligament and cartilage?

Dan P 32:40 Yes, because the loads are what are going to, they're going to facilitate better diffusion of nutrients and oxygen into those particular tissues because just using them in the.

Matt O 32:52 Reason why? So if you use them, yeah, for some reason in the synovial fluid or in this area around tendons or ligaments that are avacular, right? The reason why usage is good is because like just talking about like the synovial joints, you have to get the nutrients into the synovial joints and then by process of osmosis it gets into the cartilage, right? But what what is actually going on when you load it up that helps that process happen faster?

Dan P 33:24 Think of it like a sludge, these tissues like a sponge, right oK. And when they're in use, the sponginess of these tissues is going to increase and you're going to get better exchange of extracellular fluid inside of those particular tissues.

Matt O 33:41 A really important piece of the puzzle, and you were explaining it, You said think of the tendon, that ligament, the cartilage as a sponge.

Dan P 33:49 Yes, that gets more spongy with usage and when it's being.

Ginny R 33:54 Wretched like when it's under tension.

Dan P 33:56 Yes.

Matt O 33:56 So if it's, if it's getting, if it's getting, if it's a synovial joint, it's getting pounded, it's going like that so it's getting moved around if it's a pendant, if it's like your hip flexor, boom, I'm lifting my leg up, I'm stretching this out and I'm using it. If it's a ligament, then some sort of analogy there. But basically if it's being moved, it turns into more spongy because it because it's being moved it's like a if you took a dry sponge, it's brittle, but you pour water on it, it's a little bit more spongy and it can take more water.

Dan P 34:28 That's right, Yes, it can get.

Matt O 34:29 More of it can get into the cartilage through the synovial fluid if it's being used because it's spongier, it's able to bring in more and more OK.

Dan P 34:37 Yeah, and so the synovial fluid is only going to be in that synovial joint capsule. It's not affecting the tendons or the leggings. But very similarly, diffusion is what's going to help all of those tissues get their nutrients that's the main idea I saw i did a podcast with Keith Barr, researcher at UC Davis, really interesting work and he showed that by taking collagen 45 minutes before training, you actually see increase in collagenation of endems over a training period. You it requires some vitamin C as well. But think about that if you consume hydrolyze collagen and you before you go exercise, then it's going to be present while you're then making the tissues more spongy. And if there's no nutrients in the fluid that is moving out of the slunginess that you're not really helping that much but if you are loaded up with collagen and that collagen is now getting into the tissues, those spongy tissues, now you're that's one way in which the supplemental collagen hydrolyze collagen peptides are going to help keep those particular tissues healthier. Got it. So let actually, let's talk about collagen. There's a lot of different types. There's at least 28 different types of collagen in the body and when it comes to joints, a few types do the heavy lifting so Jenny, do you want to talk about type one two and three?

Ginny R 35:57 Absolutely, yeah. So type 1 is found in tendons like a man's bone and skin, and has a high tensile strength. Type 3 is found in skin, blood vessels and connective tissue, and it adds elasticity and support. So types one and three are found in hydrolyzed collagen like that's the typical collagen supplement that you see in the tubs. There's another type, type 2, which is found in articular cartilage so it its main function is shock absorption and load distribution and this is not in most hydrolyzed collagen. So we will have to come back to that one later that's a little bit of a special case, but what we're talking about right now with hydrolyzed collagen peptides, that's types one and three and they are ideal for supporting tendons and ligaments. And the way they work is actually interesting. So most people think that taking collagen is directly providing building blocks for your joints they're like delivering bricks to a construction site. That's not like I.

Dan P 36:58 Just like I.

Ginny R 36:59 Was just talking and that's it's true you do need the amino acid building block, but that's not the primary mechanism. Actually when you're supplying types one and three, it's more like pulling an alarm to mobilize a repair crew in other words, hydrolyzed collagen acts more like a signal. And in order to understand this, you need to think about what happens when tendons are put under stress, either in response to hard training or even in response to an injury. They start to break down and they release these collagen derived dipeptides, meaning pairs of peptides that are bound together like proline and hydroxyproline or hydroproline and glycine. And these pairs of peptides basically serve as a signal to the body that it's time to repair. So when you are supplementing with hydrolyzed collagen peptides, you are mimicking this process you're flooding the bloodstream with the same peptides that are released after tissue stress, which kind of tricks the body into prioritizing collagen synthesis and repair. And when it's repaired, when you pair this with resistance training, this molecular mimicry can accelerate and amplify the body's own tend to remodeling response so it's pretty cool actually.

Matt O 38:03 Ok, so type one and three, basically by supplying hydrolyzed collagen, it sends a signal to your body and the collagen dry dipeptides are released basically, and the body says it's time for me to now repair. And so if you give these peptides to your body, then it tricks your body into starting the remodeling response. Like basically, OK, I got to start fixing something and I'm going to look at tendons, ligaments, bones, skin, blood vessels, depending on what the type is that's what I'm signaling i've wondered.

Dan P 38:34 That that too does exercise, supports skin collagenation through the mechanism that we're talking. So there is a little bit of damage from the use of the tendons or if the dipeptides trigger the rebuilding response and is collagen throughout the body done remodeled. And I wouldn't be surprised if the answer is yes, but I would also not be surprised if there is because of the damage. There's an acceleration that occurs at the areas that were releasing the dipeptides in the 1st place through use.

Ginny R 39:03 So I think the specificity is important and that's suggested by the fact that resistance training seems to be you pairing this with resistance training seems to be important. So it seems like applying stress is a key stimulus combining with the collagen, at least what trials that we've looked at.

Matt O 39:20 Ok, So the trials that you just sorry to just repeat what you just said, 'cause I wanted to make sure I got that so what you were just saying was actually you need to be like very specific when you're talking about this, right so when you're taking type one and three, the trials stated by supplying the hydrolyzed collagen and doing the risk resistance training, those two together send a signal to your body and then the collagen derived dipeptides are released and the signaling to the body that's time to repair and then the peptides body tricks your body into remodeling is that there's.

Dan P 39:53 A There's a little nuance there. Sorry, I didn't mean to cut you off no.

Ginny R 39:56 Go ahead.

Dan P 39:57 It's actually important, and I don't mean to be.

Matt O 39:59 No, I want to get it specific i want to get it yeah, it's fine.

Dan P 40:02 Think of it this way training releases the dipeptides normally. Ok, supplemental hydrolysologen mimics that process, but exercise with peptides does have evidence for it being particularly useful. There was a study that was looking at Achilles tendon thickness it was 14 weeks it was young people are around 26 average in the study, five grams daily greater than two time increase in Achilles tendon size. There was twice to grow in the Achilles tendon by taking 5 grams a day over 14 weeks. That's awesome. And that essentially has been replicated in other ways looking at patellar tendon stiffness. This was a study that was in 2023 Also young people, elite female soccer players, oh, 17 years old, even younger, 10 weeks, 30 grams of collagen with some vitamin C you'll see that vitamin C is often taken its part. It's necessary to have on board for the metabolic benefit of the anabolic process that takes the collagen and helps make a tissue. But this was only taken three times a week and this was taken post workout. That's everything so we take it before and take it after. This was taken post workout. In this case, there was a three times greater increase in tendon stiffness. So the last study I was mentioning about Achilles tendon, there was over twice the growth and in this case there's over three times the stiffness there we're seeing anatomical changes we're also seeing function changes that you want to see, right?

Matt O 41:25 So it has to be paired with vitamin C.

Dan P 41:27 Yes, that is important and you'll notice that most supplements now they're designed well, include some amount of vitamin C in the formulation.

Matt O 41:35 It's easy to.

Dan P 41:36 It doesn't have to be in that particular formulation, but you should know that fact if you wanted to try. Your vitamin CC status is good and you're eating a healthy diet you don't have to take it supplementally, but a lot of supplements do include that because the Co consumption of those two is has direct research on it has been beneficial.

Ginny R 41:53 Got it. Yeah, vitamin C is important for is an important cofactor for collagen synthesis that's why in people with scurvy, some of the earliest symptoms of scurvy, which is severe vitamin C deficiency, is that they'll have bleeding gums and they'll have joint issues. That's the earliest sign that you've got a serious problem, simply because vitamin C is so critical for collagen.

Dan P 42:16 Wow, Jenny, how much do we need? How much do we need? One study was 5 grams a day, then there was 30 both had an effect.

Ginny R 42:23 Oh, collagen you mean? Sorry yeah, sorry i thought you were asking about vitamin CI. Don't know the RDI off the top of my head. Yeah and so you're touching on an important point here there have been a ton of studies that have tested collagen peptides and it's hard to interpret because they use a really wide range of doses.

Dan P 42:39 So it's.

Ginny R 42:40 The question is how much do we need specifically for promoting these tendon adaptations i think and so one very recent short term dose response study where they basically they take these resistance treatment and they give them different doses as well as placebo, meaning like 0 grams they found that 30 grams of collagen boosted collagen synthesis beyond the effects of exercise alone because exercise by itself also boosts collagen synthesis. And they found that 15 grams, which was the next high highest dose had the same effect as placebo in other words, it didn't work animal. So they concluded that specifically for spurring these tendon adaptations that that we're talking about here, 30 grams is the minimum effective dose for stimulating collagen synthesis and that actually mirrors that soccer study that Dan was talking about where the teenage soccer players, they were taking 30 grams of collagen and vitamin C after after training only after training three times per week.

Matt O 43:35 They were taking 30 grams of collagen and how much vitamin C i'm sorry.

Ginny R 43:39 I don't remember the exact dose of.

Dan P 43:41 Vitamin C, if it was 50 milligrams, I can't.

Ginny R 43:43 Remember, I think so it's.

Dan P 43:44 Really something 75.

Ginny R 43:45 Milligrams, yeah yeah, it really doesn't take that much honestly most people really don't need to worry about it at all if you're eating like fresh food, 'cause if you're eating like fresh fruits and vegetables, you really don't need to worry about it that much.

Dan P 43:57 Ok i was offline we were mentioning 500 milligrams of vitamin C, not 50 yeah.

Ginny R 44:02 You don't need that much.

Dan P 44:03 But that's a lot, actually.

Ginny R 44:04 I actually wouldn't recommend taking that much.

Dan P 44:06 I agree you might be blunting some of the signals that lead to adaptation so a smaller amount, probably 50 milligrams would be adequate that's what Keith argues 50 to 75 milligrams. 500 is a lot, and that might be too much.

Matt O 44:18 Could they? So it's interesting, they took 30 milligrams of collagen grams, I'm sorry, 30 grams of collagen along with say 50 to 75 milligrams of vitamin C. And did they take it all in one dose or did they split it up like what can your body take in terms of collagen?

Dan P 44:38 Yeah, that's a good question.

Ginny R 44:39 Yeah, they took it in one fell swoop.

Dan P 44:41 The study that I mentioned earlier with the podcast with Keith Barr, they took it 45 minutes before training and the idea was get it into your circulation while these sponges are being used. In this case, it was taken afterwards, but it is possible and I don't know how long the altered sponginess of these tissues is going to occur after exercise. But I think without that knowledge immediately presence in my mind or in my life and be known, there is some biological possibility around taking it 45 minutes before or right away.

Matt O 45:13 If you took it right before and then you worked out for say an hour and a half, yeah, I would think that it's still diffusing through your bloodstream, like from that 45 say an hour before a hour, it's got to be in your bloodstream for at least like 3-4-5 hours.

Dan P 45:29 It might not be in the bloodstream that long, but it'll be, yeah, but it's going to diffuse into the tissues. But if you want to play around with what if you did 15 grams before and fifteen grams immediately, after just to, from a practical perspective, reduce the load of collagen that you're taking, I have no reason to believe that would be useful.

Ginny R 45:50 So I'd like to talk. We're talking about timing the study that I was just about to describe, they took it immediately post training the 30 grams of hydrolyzed collagen and the effects were pretty impressive. So the previous study established that 30 grams is the they said it was the minimum effective dose for stimulating collagen synthesis in this specific context.

Matt O 46:11 What does midly post training mean? Like within 30 minutes.

Ginny R 46:15 Yeah, probably. But the question is that's previous study was looking at short term effectively biomarkers of collagen synthesis like surrogate markers but the question is, does that translate to long term tendon remodeling and does it work in aging tendons? So there was a new trial that was published this year, like a couple months ago, and the researchers recruited 20 men aged 40 to 60 and put them through 12 weeks of progressive resistance training just twice per week. So twice per week, right after working out, the men took 30 grams of hydrolyzed collagen plus 50 milligrams of vitamin C so as you'd expect, both groups gained a similar muscle size and strength collagen didn't enhance muscle growth beyond that collagen's not really good at that, but what did happen is collagen enhanced tendon thickness almost sixfold and tendon stiffness about threefold compared to placebo.

Dan P 47:13 And.

Matt O 47:14 With the, I'm sorry, OK, go ahead, finish that and then I'm going to ask for clarification on dosing.

Ginny R 47:17 Yeah and one thing that's important is the growth was concentrated at the attachment sites, which.

Matt O 47:24 Which is important.

Ginny R 47:25 Of the tendon, which is important because because attachment sites endure the most stress during movement and that's commonly where you see tendinopathy.

Matt O 47:35 Thickness and you said how much strength tensile strength.

Ginny R 47:39 I said the tendon thickness increased almost sixfold compared to placebo.

Matt O 47:44 Ok. And you didn't say anything about?

Ginny R 47:46 Like the stiffness increased about of threefold compared to the effects of the placebo. You do see a little bit of increase with placebo simply because resistance training itself boosts tendon thickness and stiffness cause your tendons respond to mechanical stress.

Matt O 48:00 And what was the timing on that again, it was 45 minutes before or immediately post training? Immediately post training.

Dan P 48:06 Ok i was thinking about this so this is interesting. A minute ago I was talking about the study in the young people, the Achilles tendon size grams a day for 14 weeks. So that doubled in terms of compared to placebo it was, it was more than twice the thickness increase. This is 30 grams. Dot five and you see close to a six fold improvement over placebo in terms of thickness and at least in terms of the growth now different studies, different populations, but what it shows to me is that there was more benefit to be had with a higher dose. The set of 5 grams probably wasn't using enough to maximize the benefits.

Matt O 48:41 Yeah, I, one of our children is was instructed to take 50 grams daily in two different three different doses two different doses throughout the day yeah recovery from tendon. So interesting yeah, yeah.

Dan P 48:55 Yeah, that's great. That's great.

Ginny R 48:58 Yeah, like, on the one hand it sounds crazy taking 30 grams, but when you consider that in the study they were only taking it twice per week, that's actually not that crazy like 60 gram 60 grams per week of collagen is not that insane of a dose honestly.

Matt O 49:11 Yeah, it's crazy.

Dan P 49:12 I wanted to mention something there's actually something pretty interesting about rest so we're talking about hairy activity right right before or right after, but there's some interesting stuff about Ologen that you should know about, and this has to do with days when you're not exercising. Should you take it? This was a little surprising to me, but inactive tissue turns over all the time. So we did talk about how the slunginess of tissues does increase, but it actually is turning over a good amount and has a naturally higher turnover rate than even muscle, which might be surprising. So repair is going on even when you're not trained. And so there's a study that basically showed that 5 grams of hydrolysologen. This was also done by Keith Barr, who I mentioned earlier, but I don't want to confuse things that study, it was a different study, but he studies this a lot. And 5 grams of hydrolysologen supports this ongoing repair process of connective tissue. And it's especially useful for maintenance, recovery, deloading periods. And it supports this rationale that if you combined frequent small doses within a larger doser around training, so like you have a daily five gram dose five ten gram dose which is easy to add to your coffee, we can talk about practically how to do stuff like this. Then in addition to that you have some either before either or before or after your training and that you're going to probably have optimal benefit in terms, I don't know, type 1 and 2 ologen affecting the tissues that particular type of collagen effects.

Matt O 50:35 Can we talk about type 2?

Dan P 50:37 Yeah, go ahead, Jen.

Ginny R 50:39 Yeah let me just quickly recap what we're talking about we're talking a dual dosing strategy for collagen the idea is that you are taking 5 grams of hydrolyzed collagen daily as a sort of maintenance dose, which supports baseline connective tissue repair and remodeling even on rest days. And then you would take maybe two or three targeted mega doses around training, which would be 30 grams of hydrolyzed collagen, ideally taken within one hour of resistance training and it's not clear if it's important, if it's before or after, just whatever's convenient. But yeah, UC 2 is really different. Just to recap, hydrolyzed collagen peptides, types one and three stimulate stimulate your body's natural collagen production they mimic repair signals released during tissue breakdown. Undenatured type 2 collagen works totally differently. It's not hydrolyzed, it's not broken down into peptides it is a structurally intact protein fragment that sends a message not to your joint tissue, but to your immune system. So oddly enough, there's so many diseases where the origin basically is your immune system making a mistake, and osteoarthritis is no exception. In osteoarthritis, one of the problems is that your immune system misidentifies cartilage as a threat, and this triggers chronic inflammation and progressive tissue breakdown. C2 basically acts as a reverse vaccine. It trains the immune system to stop overreacting to type 2 collagen in your joints. This is a process known as oral tolerance, and it's actually how your body normally prevents overactive immune responses to harmless proteins. So important.

Dan P 52:16 It's not unique just to UC two.

Ginny R 52:18 Right yeah, this is a Yeah this is a very normal process for which your immune system is trained. So the idea is that undenatured type 2 collagen does not suppress your immune system, it educates it.

Matt O 52:31 The type 2, so the Chorbach multi collagen protein, it has 1-2-3-5 and 10 yeah. Is the type 2 in that one two three five ten OK to take for?

Ginny R 52:44 It's OK to take, but it won't work the way that we're describing because it's been broken down into into.

Matt O 52:50 Won't work to help your.

Ginny R 52:53 Yeah, it won't work.

Matt O 52:54 With the cartilage.

Ginny R 52:55 It it won't have a special effect to protect cartilage by modulating your immune system, or it shouldn't anyway. You need it to be a structurally intact protein fragment, but the good news is you don't need very much.

Matt O 53:08 Yeah how do you get that structurally intact fragment? Where do you get?

Ginny R 53:13 If you look at your Qualia joint health it contains, is it 66 milligrams of it?

Dan P 53:19 Yeah, yeah.

Ginny R 53:21 Which is more than enough because.

Matt O 53:23 6 milligrams of type 2 don't see it on here you.

Ginny R 53:28 Don't see use use. It should be listed as UC two under the the ova mat.

Matt O 53:32 Ova mat OK. Eggshell membrane, OK. Uc OK. On, on denatured collagen, 66 milligrams that's right yeah and then it has hyaluronic acid, 9 milligrams yeah OK. And then. Ok, cool. All right. Got it so that's what supports cartilage growth or cartilage health, I should say.

Dan P 53:54 Yeah, and Matt, I know well, Quizia, what is it doing to?

Matt O 53:57 Support cartilage health? Is this an open book can I open book look?

Ginny R 54:02 We will look at you.

Matt O 54:04 All right, so I'm looking back at my notes here. Let's see and I'll try and do this quickly so that you can just give me the answer so I don't bore everybody. But so the hyaluronic acid in the synovial fluid can retain about a thousand times of its weight and water like a big gel like fluid. So it helps reduce load across the joints and bio diffusion occurs inside that fluid. So the type 2 if you have hyaluronic acid at least that's what's helping 1 aspect.

Dan P 54:36 Yeah, that's right yeah.

Matt O 54:38 The undenitured collagen, again, we didn't talk about it much we were talking about one in three collagen types, but under Nature 2 it is found in. It's good for cartilage somehow i don't really know why.

Dan P 54:51 It's telling the immune system don't attack me.

Matt O 54:53 Ok so under nature 2 says hey immune system leave me alone.

Dan P 54:58 Yeah, Yep. So getting on a really nice analogy, he says you have like a reverse vaccine so a vaccine is something that you put in your body that's got a fragment of the outer membrane of a virus and then it says, oh, recognize this immune system attack this when you see it again. So if you get a, if you get a vaccination, then you are after that, if you are get exposed to the actual pathogenic virus, then the body knows how to attack it. And so if you didn't have that virus, your, your immune system wouldn't have any of the adaptive response built in. You'd have to get really sick 1st and then the next time you were exposed to that virus, you would handle it that. So vaccine helped you essentially have some. They train your system so that they can confront any exposure more effectively. This is the opposite.

Matt O 55:42 Udq goes in there and it says, hey, by the way, don't send a lot of things like the Cox 2 enzyme.

Dan P 55:51 I wouldn't put it that way, but I would say immune system. This tissue is OK it's not foreign. Don't attack it. And because these tissues are a part of our actual body and our articular cartilage, we don't want the immune system attacking yet. And because when it does, it breaks it down.

Matt O 56:08 And then that finding, that's what we're finding with joint health over long periods of time. It's one of the but one of the reasons why we have stiffness, why we have joint issues and pain and whatnot over time is because they are worn down over time by the body either attacking or usage or it's one of the reasons why.

Dan P 56:27 It's exactly that's the best way to think of it it's not the reason, it's one of the reasons and.

Matt O 56:31 Ok, so on denatured collagen way different than.

Dan P 56:35 Yeah.

Matt O 56:36 Way different than hydrolyzed is that what you said?

Dan P 56:38 Hydrolyzed type so.

Matt O 56:39 Type 1 is similar.

Dan P 56:41 Type 2 quite different.

Matt O 56:43 So the hydrolyzed 1 and 3 is much different than the on denatured 2.

Dan P 56:50 Yeah and some research supports this so even just 40 milligrams a day of the undernatured head, 2 decreased joint pain, decreased stiffness, improved mobility and walking distance. And in fact, it actually outperforms glucosamine and chondroitin, which are the top supplements that are taken. And this is actually in head to head trials. Yeah, yeah so it outperforms those and that's what.

Matt O 57:12 Is it bad to take in addition or no?

Ginny R 57:16 It's not bad, but glucosamine chondroitin is no longer considered to be the best supplement. I don't think it's actively harmful, but it's no long it's been left in the dust by the substances that we're covering here.

Matt O 57:28 But unnatured collagen and the hydrolonic acid?

Dan P 57:31 And some other ones too.

Matt O 57:32 So can we talk about the other things that are on there or no?

Dan P 57:35 Definitely but I want to make a really important point here is that this, so all those benefits that I just mentioned, decreased joint pain, decreased stiffness, improved mobility, like all the stuff you want better in head to head trials it takes time so you see results like objective results in about three three months so It's not something that you take and you have an immediate benefit remember these tissues do take some time to remodel because they're a little slower than muscle etcetera it's actually one of the challenges of any joint supplement is that some of the things that have a real powerful benefit, they take a while and that requires knowledge about, OK, I'm going to take some time, I better stick with it. And also is going to require a little bit of patience because if your expectation is I took it for a week, I didn't feel anything. You might have given up something that significantly would improve your quality of life in terms of your mobility and your joint health. Don't give up too soon. Set expectations that at least some of these compounds that we're talking about, they take a little while to show up. And you know what? You acclimate to that feeling. You might, you might experience real benefit and forget where you came from. You're like, oh, I'm no longer feeling. And that's another problem with supplements or medications once the problem is on, you're like, oh, I'm good. And you stop taking it. And then the problem goes back. So what you want to do is understand the science, understand the time frames. And then if you believe in it and you want to support your system in that way, you stick with it for a while and you stick with it in perpetuity. Yeah, exactly.

Matt O 59:02 Can we talk?

Dan P 59:02 About the other.

Matt O 59:04 Let's see on this label and what they do.

Dan P 59:06 Yeah, definitely this, this is we talked about eggshell membrane and that's a really interesting one it does contain these under natured type 2 collagen peptides and there's three things that are part of it that make it special. So it has hydronic acid. We talked about that as being important to keep that gel between your synopial joints thicker, better shock absorption, healthier, better nutrient delivery so that's all good, right. In fact, we also mentioned hydronic acid earlier. In comparison to injections of Corticosteroject without getting hyaluronic acid injected into your joints actually is better and decreases the disease process awesome egg shell membrane has hyaluronic acid. It has some Droid and sulfate, which is one of the things that we're talking about as the most commonly used for joint health there's some benefit there. And then it has this under nature type 2 collagen it's got three things that we are really interested in for joint now they do different things that are complementary and what.

Matt O 59:59 A study do. I'm sorry go ahead.

Dan P 1:00:01 Oh yeah. So I can, I'll go through some of that. But the so those ones are definitely of interest. As you asked earlier, are they no longer, are they valid do they conflict? And no, they're still actually useful. So the Droidan helps by inhibiting the enzymatic breakdown. You can't say that certain enzymes around joint tissue are all good or bad, but it's supporting homeostasis. It has shown to decrease pain and improved mobility. So that's good, particularly around like the knees and the hands. Some studies show that it can actually decrease the joint space narrowing so that's like a double negative. It prevents the reduction in joint space by taking quadroitin. So it actually keeping the distance that's good. But the effect, the effects are pretty slow like we were talking about, but they're more durable. So when take non steroidal steroidal anti-inflammatory drugs, you feel right away and under nature type 2 collagen, this is going to be something that's going to take a while for it to work. So what are the three things that eggshell membrane has that we care? There's three ingredients that are that we care about that are useful.

Matt O 1:01:02 Ok. What I heard you guys say is that the three ingredients are under nature collagen, hydro, hydrolonic acid i don't know if I said correctly good enough and then you can and then control it in.

Dan P 1:01:14 The Gulf it. Yeah, Nice. Nailed it yeah and so there's actually direct work research in in HL membrane that's it so there's a 12 week study that is looking at HL membrane daily and you did see decreased pain and decreased sickness and it led to meaningful improvements in physical function so you wouldn't be surprised because we can, we've now seen how the individual ingredients can support joint health. And so this one substance that has these three in interesting relevant amounts at a positive effect.

Matt O 1:01:42 That's awesome, I'm taking this one.

Dan P 1:01:44 Like everything in the body, there's usually not a single ingredient that is going to fix a complicated but affecting it with a systems approach saying, OK, what are all these various? What are all the various ways in which something could be supported, including all the various ways that it could that the detractions have or the breakdown occurs and can we look to support that system from multiple angles? I prefer that approach. In fact, the first product by Qualia was a brain divorce, a nootropic, and that's exactly the methodology that they were considering, which is instead of like caffeine, right? If you just take caffeine, you realize that if you get a bit of a boost up to a certain point, if you take more than that, it doesn't make you perform better, it makes you anxious. So what if you added theanine, which is naturally found in teas, and that actually takes some of the edge off of the caffeine? What if you added neurotransmitter recursors, so amino acids that lend to the development of certain neurotransmitters in the brain. What if you had other natural plant substances that affect the enzymatic breakdown of neuro transmitters, keeping them present in the synapse longer? That was the whole idea of how can we support that whole system. And generally that is the methodology that is used across all their products and including this one too, which is what I like that as instead of that opening 10 different bottles, you have fewer to have to engage with. And that I think it's something that can lend itself to long term usage and compliance.

Matt O 1:03:10 Can we talk about what the other things are in this like tamiflux, apreflat, ginger, T3L corn, corneti, hirotaki and up in boron like what are all these things doing to support?

Dan P 1:03:25 Joint health, yeah, Yeah so the Tamiflex is two different countdowns. It's tamarind and turmeric. And tamarind is this tropical tree fruit that it's told that it's been used in traditional medicine for a long time and it's thought to help joint health and inflammation. Turmeric, powerful anti-inflammatory or lots of research backing its effects on joint health. The combo of the two shows that again, decrease in joint pain and stiffness, improved walking distance and physical function so you're seeing real world outcomes from taking it and it this can actually work faster than the undernatured collagen. But this actually can work in as level as around 2 weeks. Again, if you take it and the next morning you wake up and you I feel the same. You haven't given it a long enough time for it to work. This is like a two weeks saying where you are before you even begin to possibly notice an effect. So the mechanisms is that as we talked about earlier with the Biox, Biox shut down Cox 2, not good. This is going to down regulate Cox 2 so it's working on that pathway that people feel, but it's not doing it as powerfully. And that's that is good because again, you don't want the cardiovascular events and it also inhibits something called TNF alpha, which is a key inflammatory cytokine. So it's the nature of this UMBO ingredient is that it's working on the inflammatory systems. So it's basically tackling pathways of non steroidal anti-inflammatory drugs, but without affecting Cox 1. So it's protecting your gut and without affecting Cox 2 as powerfully, thereby bypassing the two strong suppression of Cox 2, which leads to the cardiovascular events over the period of time. Yeah, so that's great. Then another, the next one is Boswellia. This is again similar ancient herb. And so it's been used in ancient medicine for a long time. It's derived from frankincense and it has pretty powerful.

Matt O 1:05:07 That's that's the apreflex in Indian frankincense oK, sorry go ahead.

Dan P 1:05:11 No, that's good. This one is faster acting. So this can be where the Camelflex you're going to feel it essentially after two weeks does have significant benefits within that period of time. Again, as we discussed, whether you perceive it or not that there's a lot going on there, you can acclimate to that feeling and be like, oh, I forgot where I was. But so 14 days for that, for that one to be working, five to seven days for blood Whalia. So yeah, again, you're not going to wake up the next day and look at anti-inflammatory and feel that blunted pain, but it is going to be healthier for the system. And so this one is working a little bit differently this is inhibiting something called sidewalks. And this is an enzyme that is produced by leukotrienes. And what are those oK, so leukotrienes are produced by white blood cells and remember your immune system including white blood cells are key in helping to maintain arm eustasis of inflammatory response to damaged tissues to get in there, clear it away and allow the rebuilding process of nutrition to occur. What these leukotrienes do is they promote inflammation and that then is going to attract of your molecules to the area. Not a bad day, OK, But if it's overactive, it's going to make the inflammatory situation worse, right so this is going to promote swelling if you get a little bit of an injury, you can twist your ankle and it swells up. This is going to be through leukotriene synthesis and it can definitely can contribute to the chronic pain. And it's also not targeted by the pathways that non steroid or anti-inflammatory drugs target. So this is a different pathway it's complementary. It's basically a complementary mechanism of action to turmeric based strategies, the chemicals. And then the ginger is the third anti-inflammatory compound it's again used traditionally for a long time for pain. Now we have science to back it up and this is going to shut down the inflammatory prostaglandins. Jimmy mentioned this earlier. Prostaglandins are these local hormones, if you will, that are affecting an immediate area where hormones are going to be longer acting over the entire body. This is acting more locally and this is going to affect both your cock system like camouflage, but also something called nuclear factor Kappa beta, which is a major pathway for inflammation. Typically this nuclear factor Kappa beta complex is locked up in a Sinosol and then when you deal with some forms of stress like like reactive oxygen species, your usage, some damage, it unlocks that pathway and that's going to then drive inflammation and that could be overactive and ginger shuts that down it blocks that pathway from becoming overactive like the other products we mentioned in directly just looking at this one ingredient in human clinical trials decreased during pain, decreased swelling and it actually compares like it's compares to a lower dose of non steroidal anti-inflammatory drugs. So it's pretty sometimes we can dismiss a power of natural ingredients, sometimes people overemphasize them, but they are having a powerful effect. And you know, I also have better tolerance too so you're not going to get the ulcers and that gastrointestinal issues. Yeah so you can see these three ingredients are really working together to reduce inflammation and pain and swelling.

Matt O 1:08:10 And we talk about Hirotaki and also the cucumber and the boron glycinate.

Dan P 1:08:17 Yeah so a couple of these there without getting, I don't want to overwhelm you with information, but the Kiritaki is also an anti-inflammatory It has anti oxidant effects which can counter the breakdown of cartilage from excessive oxidative stress and it actually adds a little digestive support which can help with nutrient absorption. So that's like an indirect benefit, but that's pretty interesting in that front and then the cucumber extract, this is we use a standardized formulation for it called Q Actin and similarly to the other ones, only in putting ingredients that actually have evidence for them in having an impact on what we're looking at here so decreased joint pain and stiffness in humans also anti-inflammatory and then can also seemingly improve range of motion. There's been some studies that show that it actually improves range of motion.

Matt O 1:09:06 Do you know how that mechanically works to like? Yeah, it's probably.

Dan P 1:09:10 Yeah, it's probably true. Reducing swelling and anti inflammation so inflammation is going to cause dry pain and then extra swelling is going to limit range of motion. And so by supporting the being an anti-inflammatory and reducing swelling, you're going to now shouldn't get more range of motion and.

Matt O 1:09:26 Then what about boron glycinate and L carnatine HCI?

Dan P 1:09:32 Boron is an interesting one. It we know that there's some synergy with vitamin D, so it's both of those are really crucial for joint health and cartilage health. It it not only modulates vitamin D, but also pathways and it supports, it's part of the, it's like a cofactor that is supporting calcium and magnesium activity for stronger bones and joints so I would say this is more of a supportive rule, but there are actually studies that show that there's a decreased symptoms with arthritis when people take borons limitation. But there are some that are working more directly and powerfully and some of these are going to be a little bit more supportive and the O carnity is going to be a little bit more supportive as well maybe indirect. But this course is something that is an end effects mitochondrial energy production. And everything that the body is doing requires energy. As you get older, the body makes less energy. And so the body needs has trade-offs and it needs to make decisions. What should I give this limited re energy resource to? And so by facilitating our currency helps make it easier for mitochondria to make energy through food substances it's delivering it to the mitochondria so they more easily substrate to create energy and then you can use that energy for tissue repair. Though there is actually direct evidence showing that there's a decrease in inflammation in people with osteoarthritis. That's why it's included because there is direct evidence in humans with arthritis just like boron and all the ingredients have some animal or human research that is directly looking at joint and so that's why this formulation was put together. Does this product contain everything that we talked about today? No, you still have to take the hydrolyzed type 1 collagen, but it does do a lot of things. The egg shell membrane with hyalurmic acid, the under natured collagen peptides and then a variety of anti inflammation, complementary mount bounds with the addition of some supporting molecules. It's a really nicely designed formula.

Matt O 1:11:25 That's cool. Yeah and there's curcumin in here it's just in the form of the Merrick.

Dan P 1:11:31 Yeah, curcumin is a phytochemical that is in turmeric.

Ginny R 1:11:36 It's the primary active compound in turmeric.

Matt O 1:11:38 Ok. And I've read a lot about bio pepperin or bio pepperin and or pepperin and it's combination of helping you to absorb curcumin.

Ginny R 1:11:49 Yeah so the problem is that natural curcumin is very poorly absorbed when it's taken orally by itself, partly because it's not, it's poorly, It's not very water soluble, so it doesn't dissolve well in your gut and it thus it gets quickly metabolized and eliminated from the body. So you just take standard turmeric powder like if you just went to an Indian grocery and bought turmeric powder, very little of the free curcumin would actually reach your bloodstream. But this this black pepper extract inhibits an enzyme that normally tags curcumin for rapid elimination in the gut, and by blocking this enzyme, the black pepper extract drastically slows down curcumin's breakdown and enhances its absorption like I remember one study showed that adding the black pepper extract increased curcumin bioavailability by 2000 %.

Matt O 1:12:38 That's amazing.

Dan P 1:12:39 Yeah.

Ginny R 1:12:40 And this supplement uses a specific form of turmeric extract that is water dispersible, so it's designed to overcome the absorption issues that associated with turmeric extract by itself.

Dan P 1:12:53 That's cool. Yeah a lot of those phytonutrients have incredibly powerful effects in the body. And you look at them in vitro so you put them into a Petri dish and you see this, the effects and they're incredible, but they your body, they can't get into the body very easily. So sensible formulations like in this case using piperin, there's a black pepper extract it does actually help quite a bit, and you could be wasting your money if you don't have something that's getting into the body, even though the content itself is efficacious once it reaches the tissue.

Ginny R 1:13:22 Another thing worth noting, curcumin is very highly fat soluble so that is another way to get around it is if you consume it with a little bit of fat, like a little bit of oil or like nuts or something like that, that would also be a way to get around the problem of absorption.

Matt O 1:13:38 Is qualia best taken at a certain point do you take it one in the morning and one at night or you take two in the morning or two at night? And do you take it with food could you take it with a fat like a like nuts or olive oil or something like that?

Dan P 1:13:52 Yeah i'm always very interested in the timing because I think that's it's underappreciated. We don't have that information on many different compounds. Got it but I take it in the morning and I take it with.

Matt O 1:14:03 Food got it.

Dan P 1:14:05 Yeah.

Ginny R 1:14:05 Yeah, you don't need to because this particular version of curcumin is water dispersible. It's designed to enhance absorption without needing to rely on either black, the black pepper extract or fat.

Dan P 1:14:18 So we've covered a ton i have other stuff that we can discuss we don't have to discuss it now but icing an injury, icing a joint, aside from taking non steroidal anti-inflammatory drugs or getting a cortisone shot, icing an injury is something that we do a lot. Stenolytics, products that breakdown senescence cells, peptides so things like BPC one fifty seven bimosine beta four or TP five, hundred that's his nickname bimosine alpha one aod nine six O four, even one that's not really a peptide, but you can include it in the discussion is something called pentosine polysulfate, sodium Stauna, red light H FOT, hyperbaric oxygen radiation like from a radio oncologist. Now low dose radiation therapy or LDRT is being used on joints so you might do let's say 6 different sessions, three one week and three the next. And this is having pain relief on tendinopathies, on osteoarthritis that lasts for months to years.

Matt O 1:15:18 I'd, I'd love to have more conversations when we've talked about SO and I'd love to talk more about peptides and the red light and also stem cells and PRF.

Dan P 1:15:27 Why don't we make time again in the next week or two we'll cover some of these other other topics because they're interesting. And what we're also going to do is create a how to died for you that has less on the education as to the why, but condenses the down into the how. Like remind me of the dosage, remind me of the time under exposure, right, so that it's easier to reference and putting that together that should be ready soon.

Matt O 1:15:49 Thank you.

Ginny R 1:15:50 Maybe we should quickly recap what our recommendations are i feel like we covered a lot of stuff, but actually the joint health maintenance plan that has emerged from all of these notes is actually not that complicated.

Matt O 1:16:02 Yeah, it seems pretty, pretty straightforward yeah, go ahead.

Ginny R 1:16:05 I think so. So with the collagen peptides, we're suggesting A2 pronged approach where you're daily, you're taking at least five grams daily to support connective tissue maintenance and then after resistance training, you're taking a mega dose of 30 grams to help promote tendon adaptations and then.

Dan P 1:16:24 You're OK with before wrap but hairy exercise?

Ginny R 1:16:27 Peri exercise, yeah, I guess that's the correct term for it. And then obviously the quality of joint health, it just really covers all three pillars of joint resilience that we talked about. It provides structural support through the egg shell membrane, which contains undenatured type 2 collagen, promoting immune tolerance to joint cartilage, as well as the elastin, which supports tissue flexibility, resilience. Then the hyaluronic acid in the egg shell membrane promotes both lubrication and nutrient delivery because it improves that synovial fluid viscosity, promoting exchange of nutrients and base, which is important for cartilage health because cartilage is a vascular And then inflammation balance through all of the different compounds that Dan explained, like the Tamiflex, the tamarind plus the turmeric, the Boswellia through the Op reflex and the ginger. And then all of those additional ingredients that we talked about like boron, elk, carnitine, haritaki, and the cucumber extract all contribute a little bit on all three of those pillars. So yeah, it's actually not that much like.

Matt O 1:17:33 Collagen 5 grams a day when 30 grams after exercise and then take two joint health pills in the morning.

Ginny R 1:17:38 Yeah, it's actually not that much.

Matt O 1:17:40 To keep moving.

Dan P 1:17:42 Yes, Matt, great summary perfect that's a great summary. And I'll conclude with what I said in the very beginning is that there's a couple of challenges here. The ideal time to start this is before you feel the issues, but it's also great to start it when joint health becomes more important to you, which is usually when you start to feel some of the effects of joint breakup. Yeah, for those who are bought in, starting to take this in their thirties even earlier is great. And then being patient so if you do have some joint health.

Matt O 1:18:12 Issues take as like a teenager.

Dan P 1:18:15 Yeah i mean it's providing structural support and then you do want to be careful around antioxidant anti-inflammatory But what I like about natural compounds taken in reasonable doses is that Jenny said nicely, they're supporting inflammatory balance and that's what we want. We want to be able to keep your inflammatory processes healthy so that they can clear debris and work functionally, but you're also then preventing chronic inflammation and that is going to be a good strategy throughout life.

Matt O 1:18:43 Yeah, cool. Thank you, guys. Really appreciate you guys taking the time.

Dan P 1:18:48 Love chatting with you, Matt. I'll follow up two things we'll talk about the other stuff we'll find time and then we'll let you know when that how to guide for joint health is done so that you have that as a reference.

Matt O 1:18:57 Perfect that sounds great.

Dan P 1:18:59 Have a great weekend.

Matt O 1:19:00 Ok, bye. Have a great weekend bye.