When your shoulder aches and it is hard to move your arm, everything becomes more difficult. Stretches and strengthening exercises are often helpful and an essential aspect for shoulder health, but there is more to the story. Cutting-edge research shows that certain nutrients impact the health of your rotator cuff and aging well more than previously known. Learn what nutrients impact structural and functional integrity of your rotator cuff and shoulder.

Rotator Cuff

The shoulder is a ball and socket joint. The ball of the upper arm bone, or the head of the humerus, fits into the “socket” of your shoulder blade. Muscles and tendons around the ball and socket form the “rotator cuff” which holds the shoulder joint complex together and allows you to move your arm in all directions.

The tendons and their attachment sites on the head of the humerus undergo wear-and-tear, or oxidative stress, with use of the shoulder and other lifestyle factors. As excessive oxidative stress occurs, it causes tendons to swell. Over time, the tendons remodel with less healthy connective tissue. They become thin and develop micro-tears. As the degenerative process continues, larger tears develop which cause significant pain and loss of function with moving your arm and shoulder.

Factors that Affect Joint Integrity

Trauma, overuse, poor posture with rounded shoulders, and sleeping positions all affect the mechanical integrity of the rotator cuff tendons and muscles. In addition, smoking, elevated cholesterol, and excessive alcohol intake are significant risk factors for rotator cuff breakdown. Poor bone density in the shoulder joint also affects tendon strength and stability.

Age is a significant factor as adults 55 and older are more likely to experience rotator cuff tears. More than 50 percent of individuals over the age of 80 have rotator cuff tears. Various therapies including surgical repair maybe utilized to help your shoulder heal. Rotator cuff surgery however has an astonishing, dismal failure rate of 13% - 94% due to poor tendon-to-bone healing.

Nutrition and Rotator Cuff Health

In an effort to understand rotator cuff tissue health, researchers have evaluated a handful of nutrients and found that vitamin B12 and vitamin D are involved with rotator cuff tendon health. Cutting-edge research demonstrates that these nutrients are essential to manage oxidative stress levels within your rotator cuff tendons and the bone attachment sites.

Vitamin B12

One recent study demonstrated that vitamin B12 inadequacy was an independent risk factor for degenerative changes of the rotator cuff tendons. Individuals with a low-normal vitamin B12 level were more likely to experience tissue tears and breakdown compared to individuals with more optimal levels.

A “low-normal” result refers to levels that are considered adequate and in the normal range and not “deficient.” Other risk factors identified in this study included age (55 + years), diabetes, low vitamin D, and high cholesterol levels.

Vitamin B12 and Homocysteine

Vitamin B12 metabolism affects many things in human health like your red blood cells, nerves, cholesterol metabolism, heart health, and homocysteine. Vitamin B12 is required to metabolize homocysteine, otherwise a build-up of this compound occurs in your blood.

High levels of homocysteine cause production of pro-inflammatory matrix metalloproteinase compounds (MMPs). When this happens in your circulatory system, it irritates and damages the inner blood vessel lining causing cholesterol deposition.

The Homocysteine-B12 Connection to the Rotator Cuff

Scientists delved deeper into homocysteine metabolism, vitamin B12, and how it affected connective tissue health. Research results showed that increased homocysteine levels and low vitamin B12 caused elevated MMP levels in collagen. MMPs are pro-inflammatory compounds that create tissue stress.

Because of high homocysteine and increased presence of MMPs, oxidative tissue stress occurred in the rotator cuff muscles, tendons, and bone. It led to the development of poor quality collagen, increased risk of tendon tears, and diminished bone density.

Homocysteine metabolism requires vitamin B12 as well as vitamin B6 and folate to recycle the compound back into a beneficial metabolite. The latter nutrients were not evaluated in this study.

Other Benefits of Vitamin B12

In addition to its essential role for homocysteine metabolism, vitamin B12 acts as a potent antioxidant. It quenches reactive oxygen species (ROS) free radicals. It protects and supports the master antioxidant glutathione. Vitamin B12 helps modulate cytokines and other pro-inflammatory immune compounds and reduces stress from advanced glycation end products (AGE) in your musculoskeletal system.

AGE occurs with elevated blood sugar or dietary sources of AGE-rich foods and makes collagen tissues, like muscles and tendons, stiff and inflamed. AGE-rich foods include foods that are charbroiled, fried and deep fried, burnt, Cajun, red meats, dairy, margarine, and foods cooked at high temperatures for longer periods of time.

A low vitamin B12 level is associated with higher production of pro-inflammatory cytokines and gene expression changes that affect connective tissue quality and collagen strength.

The optimal range for homocysteine is
The optimal range for vitamin B12 is proposed as 500–1300 pg/mL. According to the Mayo Clinic Proceedings journal, vitamin B12 lab markers however may not be completely reliable in identifying an insufficient status. Strive for the higher optimal range.

Vitamin B12 – Further Considerations

Vitamin B12 requires adequate stomach acid and intrinsic factor protein and other proteins in the digestive tract for its absorption. With age, stress, autoimmune disorders, and other factors, stomach acid production declines and tissues that produce intrinsic factor, etc can atrophy. This diminishes your ability to absorb vitamin B12 from your diet.

Changes in methylation genes which affect vitamin B12 metabolism are also common factors for greater dietary and supplemental needs. Other factors like the use of acid blocking medications, Metformin, birth control pills and other medications, impact your vitamin B12 status. You may learn more in the article Vitamin B12 Essential for Energy, Mood, and Overall Health.

Vitamin B12 is found in animal proteins such as beef, pork, fish, eggs, and poultry. Individuals on a plant-based diet commonly lack vitamin B12. As more individuals choose to consume a plant-based diet for heart health, have impaired vitamin B12 absorption with age, and/or have methylation gene SNPs that greatly increase need, it is crucial to ensure optimal vitamin B12 supplementation and support.

The type of B12 supplement you take makes a difference for health benefits. Coenzyme B12 as methylcobalamin or adenosylcobalamin has superior bioavailability and absorption. Low quality B12 as cyanocobalamin has poor cellular usage and bioavailability. Coenzyme B12, coenzyme B6, and natural folate are found in Daily Energy Multiple Vitamin, Super Coenzyme B Complex, and Blood Booster.

The Connection between the Rotator Cuff, Bones, and Vitamin D

On head of the humerus, there are bone bumps or attachment sites where the rotator cuff tendons attach. These bony prominences are affected by changes in bone density. Vitamin D is required for bone density and remodeling of these tissues. It stimulates growth of new bone and strengthens muscles affecting rotator cuff tendon attachments. Vitamin D also offsets factors like MMPs which cause collagen breakdown.

Studies showed that optimal vitamin D status improved bone formation and healthier rebuilding of collagen fibers in the rotator cuff. Research also shows that decreased bone density with low vitamin D status is an independent risk factor for tendon attachment tears and contributes to the high failure rates of rotator cuff surgery.

Optimal levels for vitamin D are between 50-80 ng/mL. Levels at or below 20 ng/mL are considered vitamin D deficient. An estimated 1 billion people worldwide are vitamin D deficient. Even more individuals lack optimal vitamin D status.

More information about vitamin D may be found at:

Vitamin D and Your Immune System – Are You Getting Enough?

New Discoveries Highlight the Importance of Vitamin D

Additional Nutrients for Connective Tissues

In addition to vitamin B12 and vitamin D, a comprehensive systematic review and meta-analysis study found several nutrients helpful for other aspects of rotator cuff tendon health and recovery.

These include omega-3 EPA/DHA, collagen peptides, MSM sulfur, hyaluronic acid, chondroitin, glucosamine, arginine, vitamin C, curcumin, bromelain, and boswellia. These nutrients support tissue comfort and help nourish, protect, and enhance recovery due to their effects on collagen and modulation of inflammatory markers.

Aging well later in life requires that you be proactive today. Your vitamin D and vitamin B12 status along with others like essential omega-3 fish oil intake affects not only your immune system, brain and memory, energy levels, and heart, but also impacts your joints and connective tissue. Ensuring optimal nutritional status for vitamin B12, vitamin D and other nutrients is critical for aging well.

Being able to put your shirt on or lift your arm to comb your hair is something you may take for granted. For someone with a failed rotator cuff surgery, these basic activities are difficult at best. Optimize your nutrient status today so you can keep up with your self-cares for tomorrow.