Does Collagen Work?

It’s a $3+ billion industry, projected to be $6+ billion in 2025! Everyone seems to be jumping in, but the question is - should you?

Is it worth the steep price tag?

Are there side effects and downsides? (Possibly! Read on...)

What is collagen? Why do we need it?

As a group of proteins that is most abundant in our body, collagen can be found in our bones, skin, muscles, tendons, and cartilage. They make up the structure of connective tissue that supports our body and is responsible for our joints and skin elasticity. It is basically what is holding us together and gives us 'structure'. 

In fact, one-third of the protein in our body and two-thirds of our skin is made up of collagen. So, no questions about it, collagen IS essential, not just for beauty and youth, but also for our overall health. 

But do we need to be taking it in the form of a supplement? 

Here’s the truth. Our amazing body produces collagen naturally. When we eat protein in our food e.g. tofu, and legumes, our gut breaks down the protein into little building blocks called amino acids, these get absorbed into our bodies, and our bodies then use these to make collagen. To do this, our bodies need proline, glycine, lysine, and hydroxyproline as well as supportive nutrients such as vitamin C, zinc, copper, and manganese.

Collagen is also broken down - particularly by environmental stressors like UV damage (from the sun), smoking, environmental pollutants, stress, and inflammatory foods like refined sugar found in processed foods like snack bars, pastries, and beverages. 

Here's the kicker - many people are throwing money at collagen supplements when they are still doing the things listed above that break it down! 

This is like having a hole in your roof and putting a bucket under it instead of patching up and fixing the hole... get to the root cause and you'll save yourself a lot of money over time.

Collagen production also decreases with age, starting in our 20’s, which leads to wrinkles and dry skin, weakening of muscles, joint pains, and stiffness - and I have some tips below to help you support that production. 

What are collagen supplements?

Currently, most collagen supplements are sold in the form of collagen peptides (also referred to as hydrolyzed collagen or collagen hydrolysate) - these are broken-down collagen, and the idea is that when it’s broken down, it allows for better absorption. 

Most collagen peptides in the market are made from bovine (beef) or porcine (pork) sources. There are also some marine collagen supplements made from fish skin or scales. Currently, there are no vegan collagen supplements, but rather collagen boosters made using genetically modified yeast and bacteria and other nutrients intended to support the natural production of collagen in the body.

But, is there real scientific evidence to support the benefits these collagen supplements claim to offer?

What does science say?

Let's take a closer look: 

1. Skin health:  This is a mixed bag, and up until more recently, the data was conflicting, with some small (mainly collagen company funded) studies showing benefits and others showing none, so I was of the opinion that the data is too weak to support its hefty price tag. Most of the positive data was found using a brand of collagen called Verisol - derived from pork. 

However, 2 systemic reviews (which look at a collection of studies) have shown some promise. 

A 2019 review of 11 studies involving a total of 805 patients on collagen supplementation (hydrolysate) with doses ranging from 2.5g to 10g per day for 8 to 24 weeks found notable improvement in skin elasticity and hydration.

Similarly, a 2021 review of 19 studies involving 1,125 participants between the ages of 20 and 70 years reported that favorable results were noticeable after 90 days, and results were maintained for 30 days in terms of improved hydration, 

Now, if collagen was cheap and harmless, then I would say, why not give it a try? I might even have jumped on the bandwagon, but collagen supplements run a recurring cost of between $30-60+ a month ($720+/year).

The biggest concern I have though, is with contaminants. A Clean Label Project in 2020 tested 30 popular collagen products and found measurable levels of lead and arsenic in many of the products. I personally feel this is probably just the tip of the iceberg. Most of the collagen products made on the market are not from bones, but from animal hide (skin), extracted by soaking it in acid/chemicals. Since many pollutants in our environment are lipophilic (fat-loving) - it is concentrated in fatty tissue like skin (subcutaneous fat), which will probably be extracted WITH the collagen.  

If I had a need for a product like this, I might have done the research on a brand that tested but so far I've been able to escape wrinkles with the tools in my toolbox - so I am not jumping on this bandwagon just yet. If you do, make sure you ask for a Certificate of Analysis to make sure you know what is going into your body. 

2. Joint health: A 24-week study reported in 2018 showed improvement in athletes with activity-related joint pain who were treated with collagen hydrolysate. Another 2019 pilot study of 20 runners (again, a small study) with Achilles tendon injuries also showed improvement in those who took 2.5g of collagen twice daily after three months and suggests that oral supplementation of collagen peptides supports well-structured calf-strengthening and return-to-running programs. It is worth noting that both studies were funded by collagen supplement companies. 

3. Arthritis management: There are some small-scale clinical studies on the benefits of collagen supplements in the management of osteoarthritis (OA) and rheumatoid arthritis (RA). A 2021 White Paper review reported that collagen hydrolysates are likely to make a greater impact on patients with early OA as compared to advanced OA. On the contrary, a 2022 review of studies on collagen supplementation on RA and OA concluded neither beneficial nor detrimental effects of collagen supplementation due to the high adverse effects and low efficiency of collagen supplementation when compared to routine treatments. It also highlighted that most of the studies had poor quality and suffered the risk of bias.

4. Hair and nails: There are some small studies like this on collagen supplements for improving the health of hair and nails (growth and brittle nails). However, according to a reputable review in 2021, the data is inconclusive, because there is only one clinical trial on the role of collagen on nails and hair respectively. So, the jury is out. From personal experience, my clients who see a benefit - they either are not consuming enough quality protein in their diet, OR they have an impaired digestive function so cannot break down protein adequately. I usually help them improve their digestive function, so they don't need long-term supplementation. 

5. Healing leaky gut:  There is zero evidence to support this.

What are the RISKS and side effects?

Another reason why collagen supplements are so popular is that they are generally considered safe for most people - there are some reports of GI side effects like diarrhea, loose stools, and if you have high oxalates - beware! Collagen can add to that burden - address the root cause of your high oxalate. 

That said, we don't know the implications of their use in pregnancy, and due to contaminant risks, unless directed by their doctors, I advise my clients against their use in pregnancy or breastfeeding. 

In 2020, the Clean Label Project tested 28 collagen supplements on the market and found:

• 64% had detectable levels of arsenic
• 17% had cadmium
• 33% were positive for lead.

Some of the levels were low, but when you consider the fact that this is a product most people take daily,  it is plausible that these heavy metals start to accumulate, especially in the context of someone with blocked detox pathways. Over time, this may cause health issues. 

If you do take a collagen supplement regularly, here's what to do:

1) Ask the company you buy from for a Certificate of Analysis to make sure they have tested the product for contaminants like pesticides and heavy metals. 

Since it is not a product I am spending my money on (yet), there are no #DrVivapproved brands right now. 

2) Take a look on Page 7 of this white paper to see how the 28 brands tested and read about the various concerns they raised. 

Just like most supplements, collagen supplements are not regulated by the FDA. This means the onus is on you as the consumer to vet these products if you want to keep you/your family safe.

Don't fall for the marketing gimmick "Grass Fed". Grass-fed is a loose term with no federal regulations -  it can mean an animal was out to pasture for just 1-2 months of its life and then sent back into a feedlot to be fed pellets, given antibiotics, etc. (If the product is USDA Organic, then the regulations are stricter and it must have been pastured for at least 120 days per calendar year (4 months out of the 12). The American Grassfed Association also seems to have more strict rules. 

ALSO, Grass-fed also does NOT protect you from environmental toxins - persistent organic pollutants like PCB, dioxins, PFAs (which are powerful endocrine disrupters associated with certain cancers, type 2 diabetes, and fertility issues) are frequently found in our environment and so even if cows fed on JUST grass - the grass may be contaminated because our world is so polluted now. 

If you consume animal products, find out the actual practices of the farm where you purchase from - but this is usually not possible with a product like a collagen, where hides/bones are probably amalgamated from a mixture of different farms with different practices. 

What do I do to support my collagen?

Remember, we have an amazing body that can produce collagen naturally. While the ability to do so may decline with age, our diet and lifestyle can totally help this (I am wrinkle-free aged 45, not that I have any issues with wrinkles, they add beautiful wisdom in my opinion).

1. Healthy food choices: There are a variety of animal and plant foods that contain the essential nutrients to form collagen. 

An IMPORTANT NOTE here:  If you have brittle nails or thinning hair, please look for underlying root causes. Could it be you have poor digestive health, and therefore cannot break down protein in your food adequately? Could there be hormonal issues? A supplement is just that - it is often a band-aid, and unless you find the root cause, continually applying bandaids can get expensive. 

My top foods to support collagen production:

Protein - animal foods like chicken, beef, fish, and eggs are rich sources but my preferred source is plant proteins:

• Legumes
• Soy
• Nuts and Seeds - pumpkin, chia, flax, sesame
• Quinoa
• Spirulina 

Minerals and antioxidants:

These foods support collagen synthesis and slow down the breakdown of collagen by fighting free radicals. Here are my favs:

Sulfur-rich foods - sulfur aids collagen production AND helps us detoxify from environmental toxins. Think garlic, onions, leeks, broccoli (and my favorite, broccoli sprouts!)

Leafy greens for vitamin C, and folate - both support skin renewal.

Chia, Flax seeds, and walnuts - for omega 3 - important for skin health

Red foods like berries, bell peppers, all berries, tomatoes, and watermelon - rich in vitamin C and lycopene both protect against UV damage.

Orange foods - sweet potato, and apricots - provide betacarotene, another skin-protecting nutrient. 

I really cannot emphasize enough the importance of Vitamin C - they not only help FORM collagen, they also prevent collagen breakdown - kiwi, bell peppers, and berries are great, easy sources. 

Green tea/matcha - high in antioxidants and has been shown to help mitigate some of the damaging effects of UV. I love this brand, which tests for heavy metals, and also take the electrolyte in the bundle, which contains hyaluronic acid and ceramides (I do notice my skin plumper when I take it). My affiliate link gives you 15% off for life if you subscribe. 

2. Healthy lifestyle choices:

• Direct UV exposure causes oxidative damage, which damages the skin and breaks down collagen. I'm not saying to avoid the sun like the plague - but avoid excessive exposure, and wear sunscreen for protection. Use apps such as D-minder to check out the UV index. 
• Avoid or reduce smoking including secondhand smoke, and excessive consumption of alcohol.
• Maintain good sleep hygiene with adequate sleep each night. For most, this may be 7-8 hours of quality sleep.
• Incorporate mindfulness and mind-body practices to help manage your stress levels. This may include meditation, breathwork, yoga, tai chi, grounding, spending time in nature, or whatever works for you.  

Last but not least,  

3. Red light therapy (RLT)

Another approach to boost collagen production that is emerging, and has helped me personally is the use of RLT. RLT has been shown to stimulate fibroblasts which are skin cells that produce collagen, it also reduces the breakdown of collagen, reduces inflammation, and increases blood circulation. It doesn't just stop at skin health - due to the fact red light therapy can stimulate mitochondria, the part of our cells that produce energy, there are lots of other benefits too like reducing inflammation. 

What science hasn't shown us yet, is what the optimal dose is for each of the benefits.

When I interviewed the world's leading expert in red light therapy, Dr. Hamblin, a professor of dermatology at Harvard, he said that there is currently no one dose that works for everyone.

Just like we tan differently and some of us burn easier than others, the amount of red light we need in order to see a benefit also differs - and that's where we need more research. The good news is that, because it is devoid of UV, it is generally considered to be safe although you should always check with your doctor if you are pregnant, on medications, have tatoos or other medical conditions.

I've been using red light therapy for a couple of years now. Through trial and error, I have found the right protocol for myself (linked here) and have seen AMAZING results in my own skin. 

Key takeaway

As discussed above, while there have been some studies showing possible benefits from the use of collagen supplements, more research is needed to confirm this. 

While collagen supplements may be considered safe for most, some may contain heavy metals and if you are including them in your daily routine, my advice would be to request a heavy metal testing report from the brand.

Check out the Clean Label Project white paper to see how the 28 brands they tested fared.

Eating foods, incorporating lifestyle habits, and red light therapy to support my collagen and joints are what I prefer until there is clearer data on collagen. 

References:

Albornoz, C.A., Shah, S., Murgia, R.D., Wang, J.V., & Saedi, N. (2021). Understanding aesthetic interest in oral collagen peptides: A 5-year national assessment. Journal of Cosmetic Dermatology; 20:566–568. https://doi.org/10.1111/jocd.13555

Avci, P., Gupta, A., Sadasivam, M., Vecchio, D., Pam, Z., Pam, N., & Hamblin, M. R. (2013). Low-level laser (light) therapy (LLLT) in skin: Stimulating, healing, restoring. Seminars in Cutaneous Medicine and Surgery, 32(1), 41–52.

Choi, F.D., Sung, C.T., Juhasz, M.L., Mesinkovsk, N.A. (2019). Oral Collagen Supplementation: A systematic review of dermatological applications. Journal of Drugs in Dermatology, Jan 1;18(1):9-16. PMID: 30681787.

Clark, K.L., Sebastianelli, W., Flechsenhar, K.R., Aukermann, D.F., Meza, F., Millard, R.L., Deitch, J.R., Sherbondy, P.S., & Albert, A.. (2008). 24-Week study on the use of collagen hydrolysate as a dietary supplement in athletes with activity-related joint pain. Current Medical Research Opinion May; 24(5):1485-96. doi: 10.1185/030079908x291967.  

de Miranda, R.B., Weimer, P., & Rossi, R.C.. (2021). Effects of hydrolyzed collagen supplementation on skin aging: A systematic review and meta-analysis. International Journal of Dermatology Dec;60(12):1449-1461. doi: 10.1111/ijd.15518.

Hsu, D.- jen, Lee, C.- wei, Tsai, W.- choung, & Chien Y.- chung. (2017). Essential and toxic metals in animal bone broths. Food & Nutrition Research, 61. Retrieved from https://foodandnutritionresearch.net/index.php/fnr/article/view/1245

Jabbari, M., Barati, M., Khodaei, M., Babashahi, M., Kalhori, A., Tahmassian, A.H., Mosharkesh, E., Arzhang, P., & Eini-Zinab, H. (2022). Is collagen supplementation friend or foe in rheumatoid arthritis and osteoarthritis? A comprehensive systematic review. International Journal of Rheumatic Diseases, Jul 5. doi: 10.1111/1756-185X.14382.

Jhawar, N., Wang, J.V., & Saedi, N. (2019). Oral collagen supplementation for skin aging: A fad or the future? Journal of Cosmetic Dermatology;00:1–3. https://doi.org/10.1111/ jocd.13096

Kerley, C. (2018). Drinking bone broth – Is it beneficial or just a fad? Retrieved from https://nutritionstudies.org/drinking-bone-broth-is-it-beneficial-or-just-a-fad/

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Mobasheri, A., Mahmoudian, A., Kalvaityte, U., Uzieliene, I., Larder, C.E., Iskandar, M.M., Kubow, S., Hamdan, P.C., de Almeida, C.S Jr., Favazzo, L.J., van Loon, L.J.C, Emans, P.J., Plapler, P.G., & Zuscik, M.J.. (2021). A white paper on collagen hydrolyzates and ultrahydrolyzates: potential supplements to support joint health in osteoarthritis? Current Rheumatology Reports, Oct 30;23(11):78. doi: 10.1007/s11926-021-01042-6.

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