Hip pain, knee pain, back pain, hand pain, foot pain, torn ligaments, surgeries. Lately conversations with friends always veer off into a discussion of various orthopedic problems. The common denominator: arthritis. It’s a seemingly inevitable part of aging. The person who comes up with a sure-fire cure will be a billionaire. Meanwhile, is there anything we can do to alleviate the pain?
Some people are taking collagen supplements, hoping to improve the collagen in their joints. Does it work? I recently came across some articles on collagen, and I wanted to share some of that information. First, a brief summary of what collagen is.
Collagen 101
- Collagen is a structural protein, the primary component of connective tissue, found throughout the body. As part of connective tissue, it creates structural support and facilitates resistance and stretching in skin and joints.
- There are many different types of collagen, identified as Types 1, 2, 3 and 4. Skin is mostly Type 1. Cartilage is mostly Types 2 and 4.
- Like all proteins, collagen is made of amino acids. Collagen is uniquely high in the amino acid hydroxyproline, which is critical for strength and stability of connective tissue.
- In the body, hydroxyproline is made in an enzymatic reaction that adds a hydroxyl unit to the amino acid proline (science nerd alert!). Vitamin C is required for this reaction, which is why vitamin C deficiency leads to deteriorating connective tissue. One well known symptom is bleeding gums, as skin becomes more fragile.
- Since all animals and fish have connective tissue, we consume some collagen from meat and fish. Some cuts of meat have higher collagen content, such as chuck and brisket. Bone broth, made by simmering bones and connective tissue, is also high in collagen. Well-made bone broth will gel up when it’s chilled, a sign of collagen content.
- Like any other protein, collagen consumed in food must be digested. It’s not as if collagen you eat is absorbed intact and floats through your blood stream to your aching joints. No, that does not happen. The amino acids are broken off the collagen protein during digestion and absorbed individually. Protein digestion requires stomach acid. As we age stomach acid decreases naturally. And many people take anti-acid medications, further impacting protein digestion and absorption.
Osteoarthritis
Osteoarthritis, the degradation of cartilage in joints, is a disease of aging. It worsens over time, likely starting years before pain and symptoms occur. The pain and immobility linked to osteoarthritis can be debilitating, reducing quality of life. Joint replacement surgery can help, but costs and recovery are significant considerations.
Many factors contribute to the development of osteoarthritis, including genetic tendencies, age, inflammation, joint damage and muscle loss. Does nutrition have an impact? Probably, since collagen and the metabolic systems that control collagen synthesis, all depend on nutrients. Vitamin C, mentioned above, is just one nutrient that clearly impacts collagen status. But it’s unlikely that nutrition intervention alone could reverse degradation caused by all of those non-nutrition contributing factors.
Note that rheumatoid arthritis is a different issue, and not part of this discussion.
Collagen Supplements
Collagen supplements are composed of collagen hydrolysate: the collagen molecules have been pre-digested, so to speak, into small fragments. Collagen hydrolysate powder dissolves more readily in liquid. The hydrolysate fragments, whether pill or powder, may be more easily broken down and absorbed. This could benefit people with less stomach acid and poor protein digestion. Many supplements are labeled as to the type of collagen. For joints, Type 2 (or “Type II”) is preferable.
A theoretical (emphasis on theoretical) benefit of collagen supplements is this: the amino acid profile of collagen is unique, and different from the more diverse amino acid profile of meat. A collagen supplement would (theoretically) supply your body with the specific and unique set of building blocks for the collagen in your joints. Consider this analogy: if you were trying to build a wall designed for rectangular bricks, and you bought a truckload of mixed bricks — square, rectangular, triangular, etc. — you’d have to pick through that truckload to find the bricks you need. If you bought a truckload of only rectangular bricks, your project would be easier. Likewise, if you deliver the amino acids specific to collagen to your joints, maybe collagen synthesis is promoted. Maybe. Again, this is all theoretical.
Is there evidence that consuming collagen supplements will help the collagen in your joints? There are numerous animal studies that suggest a positive impact, but animal studies don’t always translate to humans. Supplement studies on humans have their own issues. Many of the studies are short term, done with small numbers of subjects. Adding to the complication, many studies are funded by the companies that make the collagen supplements used in the study. Not all supplements are created equal, so comparing study results is difficult.
Sarcopenia is a factor
There’s evidence that joints deteriorate more rapidly as muscles lose mass. This loss of muscle, or sarcopenia, is part of aging. Sarcopenia can cause balance issues, which negatively impact joints. While you probably can’t prevent sarcopenia, you can minimize it. Maintain and support muscle mass by eating sufficient protein and staying active.
Food Sources
As noted above, some foods contain collagen. However, there is no good data on how much collagen might be in your serving of beef brisket or turkey soup. Bone broth is one good source, but not everyone makes their own. Commercial products labeled as “bone broth” that do not gel up when chilled aren’t likely to contain much collagen.
As noted, collagen comes from meat or fish. Plants do not have connective tissue. Neither do dairy foods. You can’t make collagen-rich bone broth from vegetables. This leads to a dilemma for vegetarians and vegans. If you avoid meat and foods made with animal ingredients, you will not be consuming any collagen, and likely will not take collagen supplements, which are made from animal byproducts. The best you could do would be to maximize protein intake from food, and hope that your body uses some of the amino acids from that protein to synthesize collagen.
Supplements?
Taking a collagen supplement is entirely up to you. People I know who have used them expressed confusion about whether they helped or not. They may not have taken them for very long, or taken very much. Or maybe they didn’t help. Studies that found any benefit went on for 6 months or more; doses of 5-15 grams/day seemed to be most common.
It’s likely that supplemental collagen would have to be a long term commitment, since connective tissue is continuously renewed and repaired. And remember, there are several other contributing factors to osteoarthritis. Collagen supplements are not likely to fix those.
ConsumerLab (subscription required) has an evaluation of collagen supplements, focused on cost, dose and sources.
Given that the world’s population is aging, and that osteoarthritis is a disease of aging, expect more research on interventions. In my opinion, the jury is still out on the benefit of collagen supplements. Taking them is an individual choice. Meanwhile, you can choose a diet and lifestyle that supports muscle mass. Here’s my video on making real turkey stock (bone broth):
