Orthobiologics Digest™ Can diet affect PRP?
Updated: 4 days ago
No. 5 October 5, 2026
Research. Evidence. Perspective.
Curated by Deborah Westergaard, MD | Regen Experts
Orthobiologics continues to evolve at the intersection of biology, biomechanics, technology, and clinical judgment. This week’s five stories range from a question I never expected TikTok to make me investigate, whether what we eat could affect our own PRP, to long term intraosseous BMC data in ankle osteoarthritis, tendon health, robotic blood draws, and the increasingly important question of when medical testing is thoughtful medicine rather than “too much.” The common thread is not that newer is always better, or that more is always better. It is that medicine advances when we remain curious enough to ask better questions, and disciplined enough to follow the evidence wherever it leads.
1. STEAK OR PLANTS? Can Diet Affect Your PRP, Muscle & Longevity?
Every once in a while, something that appears in a social media feed raises a question worth investigating.
Recently, vegan activist and filmmaker Kip Andersen, known for "Cowspiracy" and "What the Health", began appearing in my TikTok feed. Andersen is controversial, and some of the claims in his films and social media content have generated considerable debate. But controversy alone is not a reason to dismiss an idea.
The better question is: What does the evidence actually show?
Andersen raises several issues that are difficult to ignore, particularly animal welfare in industrial food production and potential health effects of diets high in animal products.
Then there is the cancer question. It is too broad to say that “animal products cause cancer.” The World Health Organization’s International Agency for Research on Cancer classifies processed meat as carcinogenic to humans and red meat as probably carcinogenic to humans, with the strongest evidence involving colorectal cancer. In the studies evaluated by WHO, consuming 50 grams of processed meat per day was associated with approximately an 18% increase in relative colorectal cancer risk. That does not mean eating processed meat gives someone an 18% chance of developing cancer, nor does it establish that all animal products cause cancer.
There is another side to the nutrition discussion: muscle.
Loss of muscle mass and strength becomes increasingly important with aging, and adequate dietary protein combined with resistance exercise is one of our major tools for preserving it. Expert recommendations generally suggest approximately 1.0 to 1.2 grams of protein per kilogram of body weight per day for healthy older adults, with at least 1.2 g/kg/day often suggested for active older adults.
Can that protein come from plants? Evidence suggests that it can, provided the diet is deliberately constructed to supply adequate protein. “Plant based” and “adequate protein” are two separate decisions. Can diet affect your PRP?
Then this became an orthobiologics story.
A 2026 study examined leukocyte poor PRP from 75 healthy adults, 25 vegans, 25 vegetarians and 25 omnivores. Platelet enrichment was comparable among the groups. IGF 1, HGF and PDGF BB were not significantly different. But IL 6 concentrations were significantly lower in PRP from vegans than omnivores.
That is intriguing, but lower IL 6 does not automatically mean “better PRP.” The investigators did not study healing or clinical outcomes. The study shows an association between dietary pattern and selected components of PRP. It does not show that becoming vegan improves the effectiveness of PRP.
Dr. Westergaard’s Take
I wrestle with this.
I do not like thinking about the treatment of animals in industrial food production. But I also know that as I age, maintaining muscle is vital. I am very conscious of resistance training and protein intake, and animal protein makes that relatively easy.
After looking at the research, I do not think this has to be an either or decision. A thoughtfully designed plant based diet can provide enough protein, but particularly as we get older, it has to be intentional.
I also do not accept the blanket statement that animal products cause cancer. That goes beyond what the evidence shows. But I do not think we should dismiss the evidence surrounding processed meat and colorectal cancer either.
What interested me most was the PRP study.
PRP and bone marrow concentrate are different from conventional pharmaceuticals. The medicine comes from us.
We talk constantly about platelet concentration, leukocytes, processing methods, aspiration technique and precise image guided placement. But what about the person producing the biologic? What did that person eat? Do they exercise? How is their metabolic health? How well do they sleep?
We do not yet know how much those factors ultimately affect clinical outcomes, and this study certainly is not enough evidence to tell a patient to become vegan before PRP.
But it leaves me with a question I suspect we will be hearing much more about: If the medicine comes from our own bodies, how much does the way we care for those bodies affect the medicine we ultimately produce?
Read More Cowspiracy: https://www.cowspiracy.com/
WHO, Red Meat, Processed Meat and Cancer: https://www.who.int/news-room/questions-and-answers/item/cancer-carcinogenicity-of-the-consumption-of-red-meat-and-processed-meat/ Dietary Patterns and PRP Composition: https://pubmed.ncbi.nlm.nih.gov/41515279/
2. ANOTHER JOINT ENTERS THE JOINT PRESERVATION CONVERSATION
Long Term Intraosseous BMC Data for Ankle Osteoarthritis Published September 3, 2026 in Medicina, Philippe Hernigou, Christopher J. Centeno, Dustin R. Berger, Ehren Dodson and Matthew B. Murphy examined long term outcomes after intraosseous bone marrow concentrate treatment in 88 patients with bilateral nontraumatic ankle osteoarthritis.
The more symptomatic ankle received intraosseous BMC, while the contralateral ankle was managed nonoperatively.
The endpoint was consequential: did the ankle eventually progress to fusion or total ankle replacement?
Over follow up extending as long as 15 years, 16 of 88 BMC treated ankles underwent fusion or replacement, compared with 44 of 88 contralateral ankles. That means 81.8% of treated ankles had not reached that endpoint, compared with 50% of the comparison ankles. Procedure free survival also favored the treated ankles.
The study is retrospective and nonrandomized, so it demonstrates an association rather than proving that BMC caused the difference. Several of the authors are affiliated with Regenexx, an organization with a long history of orthobiologics research, physician education and development of standardized treatment protocols. That depth of experience is relevant context when considering a study involving a technically demanding orthobiologic procedure.
Dr. Westergaard’s Take
This is amazing news. I love intraosseous treatments because they allow us to think beyond simply treating the surface of a joint. We already have encouraging research involving other joints, including the knee and hip, and I use intraosseous orthobiologic treatments involving the knee, hip and shoulder as part of my joint preservation practice.
Now we have long term research examining this approach in the ankle as well.
To me, this represents the continuing evolution of medicine toward preserving the native joint whenever we reasonably can.
For decades, musculoskeletal medicine has often treated damaged tissue by cutting, burning, removing, fusing or replacing it. Sometimes those treatments are absolutely necessary. But orthobiologics gives us another question to ask first:
Can we nourish and support the tissues that are already there and potentially help the patient keep their own joint longer?
This study does not mean every patient with ankle arthritis is a candidate for intraosseous BMC, and it does not eliminate the need for ankle fusion or replacement. Patient selection remains critical.
But it adds another joint, and long term data, to the growing joint preservation conversation.
I am also proud of the work being done by Philippe Hernigou, MD; Christopher J. Centeno, MD; Matthew B. Murphy, PhD; and their colleagues. Research like this helps medicine continue to evolve from asking only, “When do we replace the joint?” to also asking, “What can we do to help preserve it?”
Read the Study PubMed: https://pubmed.ncbi.nlm.nih.gov/42796300/
3. YOUR MUSCLES MAY BE READY BEFORE YOUR TENDONS ARE
Why Tendons Need Their Own Training Strategy A recent Runner’s World article, “Training Tendons Differently Than Muscles Better Prepares You to Handle Running’s Repetitive Impact. Here’s How,” highlights something easy to overlook: muscles and tendons do not adapt to training at the same rate.
Muscles can become stronger relatively quickly. Tendons remodel more slowly. That means someone may feel stronger and more capable of increasing mileage or resistance before the tendon is prepared for the additional load.
The experts interviewed recommend progressive tendon loading, including heavy slow resistance and, when appropriate, plyometric training to improve elastic energy storage and return.
Dr. Westergaard’s Take
When we strength train, we tend to think about muscle. Are we getting stronger? Are we maintaining muscle mass? Can we lift more?
But muscle is only one part of the system.
A tendon transmits force generated by muscle to bone. Where tendon meets bone, the enthesis, there is a complex transition from soft collagenous tissue through fibrocartilage into mineralized bone.
Muscle, tendon, enthesis and bone are not independent structures. They function as a unit.
That becomes particularly important as we age. Aging changes tendon biology and collagen organization and can alter the tendon’s mechanical properties and ability to accommodate load.
That is one reason progressive resistance is so important. We want stronger muscles, but we also need to give the tendon time to adapt to the forces those stronger muscles can generate.
And the relationship works in both directions. If muscle becomes weak or atrophied, the mechanics of the entire muscle tendon unit change. If the tendon is injured, force transmission changes as well.
It is all connected.
That is also how I think about tendon injuries in my orthobiologics practice.
PRP can be considered in selected tendinopathies and tendon injuries. Bone marrow based approaches are also being studied for more substantial tears. But I do not believe in reducing every tendon injury to one percentage cutoff. Severity, location, retraction, tendon quality, muscle atrophy, fatty infiltration, chronicity and mechanical demands all matter.
A partially torn supraspinatus is not the same problem as a completely disrupted Achilles or quadriceps tendon carrying enormous loads.
And I do not look only at the tendon.
With a significant tendon injury, particularly a rotator cuff tear, I also look carefully at the bone beneath the tendon insertion. MRI can show bone marrow changes around the greater tuberosity in association with rotator cuff tears, reminding us that what we call a “tendon tear” may involve the entire tendon bone unit.
In selected patients, that may influence how I think about treating the entire region rather than focusing exclusively on the torn tendon. Whether intraosseous treatment of the underlying bone directly improves tendon healing remains a research question.
The larger point is simple: Do not train only the muscle you can see.
Think about the tendon carrying the force, the enthesis, and the bone it attaches to. Give the entire system enough time to adapt. The body rarely behaves as a collection of isolated parts. It is a connected system, and that is how I believe we should treat it.
Read More Runner’s World, Training Tendons Differently Than Muscles: https://www.runnersworld.com/training/a73691747/how-to-train-tendons/
4. WOULD YOU LET A ROBOT DRAW YOUR BLOOD?
The First Autonomous Blood Draw Device Reaches the U.S. In August, the FDA authorized Aletta, the first standalone robotic device in the United States capable of performing an adult outpatient blood draw without hands on operator intervention during the procedure. The patient places an arm into the system. Near infrared imaging helps locate vessels; ultrasound maps the vein; Doppler helps distinguish venous from arterial flow; and the robotic system performs the venipuncture and blood collection. A trained phlebotomy supervisor is still required, and one supervisor may oversee up to three devices.
In the multicenter performance data, among patients the system determined had suitable venous access, first stick success was approximately 94.5%.
So the question is no longer simply, “Can a robot draw blood?” It can.
The more interesting questions are: when does it improve on a skilled human, what happens when it cannot obtain access, does it improve efficiency, and what clinical skills do humans need to preserve as automation becomes routine?
Dr. Westergaard’s Take
This is a subject I have been debating with other physicians for several years. I think we are much closer than many people realize to robots performing tasks that today we assume require a doctor or nurse.
Look at what is already happening on our roads. Driverless vehicles are no longer science fiction. People are willing to trust autonomous technology with their lives. Allowing a robot to draw blood may not seem like such a dramatic leap, particularly if the technology eventually demonstrates results equal to or better than humans.
But there is another side to this.
I am a board certified anesthesiologist, and I first learned to start IVs as a medical student in the 1980s. Through years of anesthesiology, starting an IV became a manual skill developed through repetition and experience. You learn to look at an arm, feel the vein, understand the anatomy and adjust.
We also have another remarkable tool: ultrasound. For difficult access, ultrasound can help identify and access a deeper vessel. Interestingly, that is essentially what this robot is learning to do technologically, use imaging to identify the vessel and then precisely target it.
That raises one of the most important questions about medical automation:
If robots routinely perform these procedures, who maintains the human skills necessary when the robot cannot do them?
We should not allow valuable clinical skills to disappear simply because technology can handle the majority of cases. We still need experienced people who can step in when technology fails or when the patient does not fit the algorithm.
At the same time, I do not think we should be afraid of this technology. Patients will increasingly trust it if robotic systems demonstrate excellent safety and success rates. Whether robotic blood drawing ultimately saves money or improves efficiency remains another question worth answering.
And I suspect blood drawing is only the beginning.
I believe robotics will eventually perform increasingly sophisticated medical procedures, including some of the work surgeons and procedural physicians like me do today. If humans someday establish communities far from Earth, we cannot realistically assume every small settlement will have every type of surgeon and specialist available. Highly capable robotic systems that can be continually trained and updated could become part of the solution.
Medicine is changing extraordinarily quickly. We probably cannot stop that transformation, and I am not sure we should try.
The challenge is to embrace what technology does better without losing the human skills, judgment and connection that still matter when technology reaches its limits.
It is happening fast. My inclination is to keep asking the hard questions, but also to look for the good.
Read More IEEE Spectrum, This Robot Will Draw Your Blood Now: https://spectrum.ieee.org/blood-draw-robot-vitestro-aletta
FDA, First of Its Kind Robotic Blood Draw Device: https://www.fda.gov/news-events/press-announcements/fda-authorizes-first-its-kind-robotic-blood-draw-device
5. WHEN IS MORE MEDICAL TESTING TOO MUCH?
Algorithms, Clinical Judgment, and the Patient We Cannot Afford to Miss In “More Medical Testing, More Problems,” physician Fred Pelzman describes a growing problem: patients arriving with pages of laboratory results ordered through online services, standalone laboratories or wellness practices, sometimes without a clinician who has taken responsibility for interpreting why the tests were ordered or what should happen next.
His central concern is legitimate. The more tests we order, the more likely we are to find an abnormal result by chance. That can lead to anxiety, repeat testing, downstream procedures and potentially unnecessary treatment.
His argument is not simply “never test.” It is that testing should have a clinical purpose and someone should take responsibility for interpreting the result.
But there is another side to the question. A 2021 JAMA Health Forum study of 171,625 hospitalized general medicine patients found that female physicians ordered more CT, MRI and ultrasound imaging. Their patients had an unadjusted in hospital mortality rate of 4.8% compared with 5.2% for patients treated by male physicians. The mortality difference persisted after adjustment for patient characteristics but was no longer statistically significant after adjustment for physician characteristics. Importantly, the additional imaging did not explain the mortality difference.
A 2026 JAMA Internal Medicine study also examined practice pattern differences between female and male emergency physicians, adding to the broader discussion about variation in diagnostic testing and whether different styles of practice necessarily translate into different outcomes. These studies do not establish that ordering more tests saves lives. They also do not establish that additional testing is automatically unnecessary.
Dr. Westergaard’s Take
Most medical testing should be ordered for a plausible clinical reason. I agree with that.
But a plausible clinical reason is not always the same thing as having a specific diagnosis in mind.
Sometimes I examine a patient, listen to the history, look at the pattern of symptoms and recognize that something is not fitting together. Physicians sometimes call that clinical gestalt. It is not magic. It is pattern recognition built over years of seeing patients.
Sometimes the reason for ordering a test is very specific. I may be looking for a fracture, infection, tumor, nerve compression or another defined diagnosis. Other times, I may not yet know what the diagnosis is.
What I do know is that the patient's symptoms, examination, history or clinical course tell me there is more to investigate. That uncertainty can itself be a legitimate clinical reason to test. We absolutely need to understand the consequences of testing. False positives are real. Incidental findings are real. Cost matters. Every test has the potential to start another cascade.
But there is also a consequence to failing to investigate when clinical judgment tells us something may be wrong. The JAMA study is interesting because female physicians ordered more advanced imaging and their patients had a small observed mortality difference before adjustment for physician characteristics. The study does not prove that the additional imaging saved those patients. We should not claim that it did.
But it reminds me why percentages can sometimes feel very different at the bedside than they do in a statistical table. A difference of a few tenths of a percentage point may look small when we are discussing 171,625 people. But if the person whose diagnosis was found because someone kept looking is you, or someone you love, it is not small.
One life is not a rounding error.
Good medical judgment includes knowing when a test is unlikely to add useful information. It also includes recognizing when the clinical picture does not make sense and having the curiosity to keep investigating.
Sometimes good medicine means knowing exactly what you are looking for.
And sometimes good medicine means recognizing that you do not yet know, but that there is enough reason to keep looking until the pieces make sense.
Read More JAMA Health Forum, Variations in Processes of Care and Outcomes for Hospitalized General Medicine Patients Treated by Female vs Male Physicians: https://jamanetwork.com/journals/jama-health-forum/fullarticle/2782058
JAMA Internal Medicine, Practice Pattern and Outcome Differences in the Emergency Department by Physician Sex: https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2851436
This Week’s Perspective
This issue began with a question about what we put into our bodies and ended with a question about what physicians choose to investigate. In between, we looked at preserving an arthritic joint rather than immediately replacing it, training the tendon rather than focusing only on muscle, and allowing a robot to perform one of medicine’s oldest manual procedures. Those stories may appear unrelated, but I think they share something important. Medicine advances when we resist false choices. It does not have to be plants or protein. Technology or human skill. Testing or judgment. Orthobiologics or surgery.
The more useful question is often: What does this particular patient need, at this particular moment, based on the best evidence we have? That is precision medicine in its most practical form. Research will continue to evolve. Technology certainly will. My goal is to keep evaluating both without losing sight of the patient in front of me. Know your options while you still have options.
Deborah Westergaard, MD Regen Experts | Dallas & Plano Double board certified in Anesthesiology and Pain Medicine Three decades of image guided experience
Frequently Asked Questions About Nutrition, PRP and Joint Preservation
Can what I eat affect my PRP?
Diet may influence certain components of platelet-rich plasma, or PRP. A 2026 study found differences in selected inflammatory proteins among people following different dietary patterns. However, it did not test whether those differences improved pain relief or healing after PRP treatment. Diet’s effect on clinical outcomes remains uncertain. PubMed
Should I become vegan before a PRP injection?
There is currently insufficient evidence to recommend becoming vegan specifically to improve PRP results. The study discussed in this issue examined established dietary patterns, not a short-term diet before an injection. It does not establish a preferred preprocedure diet or show that vegan PRP produces better treatment outcomes. PubMed
What is the difference between PRP and bone marrow concentrate?
PRP is prepared from your blood and concentrates platelets. Bone marrow concentrate, or BMC, is prepared from bone marrow and contains a mixture of cells and other biologic components. They are different preparations, and neither is universally better. Their potential usefulness depends on the diagnosis, tissue being treated and available evidence. AAOS
What is intraosseous BMC treatment for osteoarthritis?
Intraosseous treatment places bone marrow concentrate into bone. In joint-preservation procedures, this may involve the subchondral bone beneath the cartilage. The ankle study discussed in this issue examines this approach. Its findings should not be interpreted as proof that the treatment rebuilds cartilage or reliably prevents surgery.
Can PRP help tendon pain?
PRP may help selected chronic tendon conditions, but results vary by the tendon, diagnosis and treatment approach. Evidence for one tendon condition does not establish effectiveness for every tendon injury. A careful evaluation is necessary before deciding whether PRP belongs in the treatment plan. AAOS
Can orthobiologic treatment help me avoid joint replacement?
Some patients may obtain symptom relief with nonsurgical care, including selected orthobiologic treatments. However, symptom improvement does not prove that arthritis has reversed or that joint replacement will never be necessary. The purpose of an evaluation is to determine which options are reasonable for your particular condition. AAOS
Where can I receive an orthobiologic evaluation in Dallas or Plano?
Dr. Deborah Westergaard evaluates patients at Regen Experts in Dallas and Plano. She is double board-certified in Anesthesiology and Pain Medicine, with thirty plus years of image-guided experience. An evaluation considers your symptoms, examination, imaging and goals to determine whether PRP, bone marrow concentrate or another treatment may be appropriate.
Considering your options before joint surgery? Schedule a physician-led evaluation at Regen Experts in Dallas or Plano to discuss your diagnosis and whether orthobiologic treatment belongs in your care plan.
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