Oral collagen is hot. It has exploded into a multi-billion-dollar industry. But do these “ingestibles” actually work? And might there be a cheaper way?
Do collagen supplements work? There is no evidence that collagen in skin lotions has any benefit, but numerous studies have suggested oral collagen supplements do work. They make skin more moist or flexible or whatever proxy measure the scientists use for the holy grail – youthful appearance.
But there’s just as much research showing these ingestibles aid injury recovery, improve heart health and fat loss and maybe help the dodgy knee.
All this has launched a global industry in collagen pills and powders that is expected to grow to more than $6.5 billion by 2025 and launched success stories like Australia’s Vida Glow.
So what’s not to love about this wonder nutrient?
The flaw often cited with the studies on collagen’s benefits for the skin is that they have “all” been industry-funded.
Clare Collins, laureate professor of nutrition and dietetics at Newcastle University, is one such critic. On whether collagen supplements create more youthful, more elastic, better-hydrated skin, she says the evidence is “from low-quality studies. So it’s a proceed with caution.”
There have been reviews of the evidence that has not been funded by industry, says Collins, “but if the underlying studies are funded by industry, that doesn’t neutralise the limitations in the studies.”
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What is Collagen?
Collagen is the strong, flexible protein that holds skin, bones, muscles, blood vessels, cartilage and tendons together. It is the most abundant protein in the body. The key amino acids of lysine, proline and hydroxyproline form various complex webs that give different degrees of strength and flexibility. Collagens – like gristle in meat – break down at temperatures over 71 degrees Celsius and form gelatine, which can then be refined into hydrolysed collagen.
The author of one of these reviews mentioned above, dermatologist Natasha Mesinkovska, an associate professor at the University of California, Irvine, is less quick to dismiss the work of her colleagues. Her review of 11 randomised controlled trials found that the studies overwhelmingly showed collagen supplementation “increased skin elasticity, hydration, and dermal collagen density” – all markers for younger-looking skin. And since publishing her findings, she had been inundated with requests to endorse various products but had declined the offers, she said.
But while almost all the published studies had shown benefits, Mesinkovska warned there was a strong publication bias towards positive studies. “It’s very difficult to get negative stuff published,” she said. “I spent years studying vitamin D and hair loss conditions that showed no difference (with supplements). Nobody would publish them because they showed nothing exciting.”
With collagen, she said she’s been accused of having an agenda but retorts: “My agenda is to know what’s going on.” She said it was often hard to know if research had been industry-funded.
“Do we trust our colleagues who wrote the articles? And the magazines that published them? They cannot all be wrong.”
Natasha Mesinkovska
She became interested in collagen after a friend’s daughter with a brain tumour was given bone broth by the hospital for recovery. “Look at all the cultures that use it. I’m from the Balkans. You have the Chinese with the chicken legs. There’s so much gelatine [a less refined form of collagen] throughout the world – it’s part of cuisine and nourishment. That’s what made me think about it: Do collagen supplements work? There must be something to it.”
Mesinkovska uses collagen supplements herself. “But not regularly.” “Even after so many years I still can’t be 100% on, ‘This is how it works, this is who it works for’. Most of the studies are done in women or people who have [skin] ulcers, most of the changes they can notice in skin is in older women who have some benefit to gain.”
Prominent Melbourne dermatologist Dr Shyamalar Gunatheesan agrees about traditional foods having provided sufficient collagen in the past. She points to the diets of her Tamil forebears and the way they prepared curries. “You wouldn’t just have the meat, you’d have it with the whole bone. You’d suck out the marrow. I remember as a kid thinking, ‘This is disgusting.’ When you cook any dish with bones, you get the leaching of the amino acids.”
These days, she boils a whole chicken for six hours with sage parsley and thyme.
When patients ask her: do collagen supplements work? Gunatheesan, a skin, hair and nail specialist and founder of ODE Dermatology in Melbourne, cites a 2020 review published in the Journal of Cosmetic Dermatology. It found “almost all” the 31 papers reviewed reported beneficial effects of collagen supplements with “no inconsistencies” between them.
“Essentially, the message is that there was wrinkle reduction, luminosity improvement, anti-aging benefits [which were] overall quantified to be about a 28% to 30% improvement,” Gunatheesan – AKA Dr Shammi – said.
The wide range of $60-a-bottle supplements available today come primarily from cattle, pigs and fish. Gunatheesan said there was a difference. “It seems to be marine is probably superior for skin. Bovine may be better for joints and bones.” She did not cite research supporting this statement. She recommends Par Olive’s Pearl Marine Collagen Superpowder at $85 for a 150g bottle, made from the skin of wild-caught Norwegian fish.
Do collagen supplements work better for vegans? Gunatheesan says that given the absence of collagen from plants, vegetarians and vegans would likely benefit more from supplementation than omnivores. Other sources of collagen, like chicken skin and bacon rind, have also fallen out of favour within the general population, further decreasing its availability to many.
While there are products sold as “vegan collagen”, they don’t contain collagen. Edible Beauty Australia’s “Native Collagen”, for example, contains a “blend of superfruits, hibiscus, Kakadu plum, quandong and mountain pepper berry, along with sea buckthorn and maqui berry, [to] unleash a wave of rejuvenating and anti-ageing actions.”
Edible Beauty founder Anna Mitsios says that the research she was reading when she started the product in 2017 was that the most benefit from collagen was being seen in cartilage and joint health. “So my approach then was to take a sustainable plant-based approach to provide your body with the building blocks to create the collagen itself,” she says.
“And we know that protein, vitamin C, silica and antioxidants are all very important in creating the collagen yourself, and if your body is given all the tools and resources it needs to do that, then it will do it through the whole body rather than just to the joints.”
Anna Mitsios, Edible Beauty
While skin health is moving supplement bottles off the shelf and launching dozens of local Australian brands, the best reasons for taking them might lie elsewhere.
So do collagen supplements work on other body parts?
A 2022 Cambridge University review of 12 randomised placebo-controlled trials looking at collagen and heart health found that the supplement “reduces fat mass, LDL [so-called “bad” cholesterol] and [blood pressure] while increasing fat-free mass [muscle]”. Published in the British Journal of Nutrition, the weight and muscle benefits were small, but the cholesterol and blood pressure improvements were “significant”.
A 2015 German study also published in the British Journal of Nutrition found that elderly men suffering muscle loss who took collagen and did weights lost more fat and gained significantly more muscle, bone density and co-ordination than those on a placebo, whereas similar studies using other proteins had mixed results.
There is also evidence that collagen assists in wound healing via several mechanisms and reduces muscle soreness after exercise.
A 2020 review of 41 published studies on collagen’s effects on osteoarthritis and joint pain found: “All in-vivo preclinical studies and clinical trials, regardless of their quality, concluded on beneficial effects of collagen derivatives in osteoarthritis and cartilage repair.” Such results have also been called into question based on industry funding.
Greg Shaw, now the general manager of performance at Swimming Australia, was handling nutrition at the ACT Brumbies rugby franchise when he became interested in collagen. He had a few players with career-threatening knee injuries and the nagging question: “How do we get their careers back?”
The traditional thinking had been that nutrition played virtually no part in building or repairing connective tissue because the three key amino acids involved – lysine, proline and hydroxyproline – were abundant and “non-essential”, meaning that the body could manufacture them from other proteins.
Studies were starting to show, however, that collagen was doing something to fix injuries, but at that stage, there still wasn’t even good evidence that collagen supplements got into the bloodstream as lysine, proline and hydroxyproline.
Shaw, however, led an ingenious study in which eight men skipped three times a day for three days. One hour before each session, they drank either a placebo, 5g of gelatine, or 15g of gelatine. Gelatine is just a less refined version of collagen. Shaw chose to use gelatine because it was cheap and easily available. He chose the maximum dose of 15g (rather than the oft-used 20g dose) simply because it became too difficult to hide any more of the sticky substance from the participants – a requirement in a “blinded” study.
Blood samples were taken before and after each session. The first arm of the study showed that, yes, the larger the dose of gelatine, the more of the relevant amino acids got into the blood, which was an important finding at the time. But the clever part was a collaboration with a famed protein researcher from the University of California, Davis, Keith Baar, who then took those blood samples and fed them to petri dishes in which muscle and ligament were being grown, stimulated by tiny motors that simulated exercise in the dish. The test-tube ligaments fed the most gelatine-laden blood grew significantly stronger and worked better than the ligaments fed the placebo-group’s blood or that from the group fed the smaller dose.
It was groundbreaking research proving that collagen does help injury repair, but Shaw is cautious about the results. “There’s been some overselling of the research we’ve done” to sell supplements, he says.
His PhD student, Rebekah Alcock, now a dietician at the Essendon AFL club, did further research on natural sources of collagen in trying to get more of it into the diet of the ACT Brumbies. But she found store-bought bone broths had insufficient collagen/gelatine to reach the therapeutic dose, and homemade versions were little better. “We were making gummy bears, jellos, [with gelatine], but over time, the practicality side came in,” says Shaw. “The hydrolysed collagen became a more practical solution. But we did have people building broths into their weekly nutrition plans. They liked the taste and could use it as a hydration drink.”
Fun Fact
Aeroplane Jelly contains 2.2 grams of gelatine for every 200-gram serving. 5 gram is the most studied effective dose for skincare.
Alcock’s work also pointed to 20g being the optimal dose for ligament repair, says Shaw. In skin health studies, 5g is the most studied effective dose.
So do collagen supplements work? Shaw stresses that exercise remains crucial for ligament repair. “There are studies showing that the hormones from exercise can be far more beneficial to growth than just the nutrient availability.” But if one of his swimmers pulls up with a ligament injury, nutrition is now an important lever to pull. “It’s not just about the exercise or the surgeon any more,” he says.
