Little in the field of medical aesthetics divides opinion more than collagen supplements. The arguments from both sides are equally convincing when considered on their own, but when measured against the counter claims and held up to scrutiny, the waters become slightly more muddied. Allie Anderson asks the question: are supplements really the silver bullet to youthful-looking skin?
One of the most commonly used methods of increasing collagen levels is hydrolysed collagen supplements. According to the protagonists, what makes this form preferable is its reduced molecular size. “The average molecular size of collagen itself is about 300 kilodaltons (kD), and the average collagen supplement is somewhere between 30 and 90kD, which is still quite large for your body to process,” explains nutritional therapist and supplement supporter Eva Escofet. “In clinic, I have always used a particular type that’s only 3kD, so it’s extremely tiny and it’s truly predigested.” With such a small, lightweight molecule, Escofet adds, the collagen can be passed straight through the gut without having to be broken down by the stomach, meaning it is more readily absorbed into the body. Medical doctor and nutritionist Dr Vidhi Patel also promotes the use of hydrolysed collagen in liquid form, citing its high absorbability as crucial. “Any active ingredient will only be absorbed if it’s digestible,” she comments. “The size of the molecule is imperative – if it’s too large you won’t digest it. In hydrolysed collagen, the molecules are tiny but multiple in number, so you can easily digest and absorb them.” Practitioners have suggested that the amount of collagen that appears to produce optimum skin improvement in their experience is around 10g when ingested as a solid, but Dr Kathryn Taylor-Barnes suggests that due to the increased absorbability rate in a drinkable formulation, this reduces the amount to around 6g.1 According to Escofet, a protein-rich diet contains an insufficient concentration of hydroxyproline, the specific amino acid needed for collagen synthesis. However, Rick Miller, a sports nutritionist and spokesperson for the British Dietetic Association, disagrees. “The synthesis of collagen is unique in that there are about five different forms of collagen in the body and they’re all composed from the same base – amino acids,” he explains. “All proteins start from that base, and lysine and proline [from which hydroxyproline is derived] are the two essential amino acids that are needed for the production of collagen. There are 7g of lysine in a 3oz portion of beef, and 7g of proline in a 3oz portion of turkey. I don’t think that’s outwith a normal diet.”
The message from the sceptics is that the human body is mechanised to process protein in the food we eat, contradicting the idea that dietary protein is insufficient. “We have hydrochloric acid and pepsin in our stomachs; we have the enzymes we need to break down those foods and digest amino acids, to convert them into proteins that benefit the skin,” says nutritionist Kim Pearson. “Protein from food can be quite difficult for the digestive system to process, but that’s ultimately what it’s designed to do.”
Concerns regarding the efficacy of collagen supplements are often centred on the lack of reliable data. Dr Andy Pickett, a microbiologist and expert in botulinum toxin, asks: “What evidence is there that they help people in any way? And is there any basis in fact that an oral collagen supplement ends up effectively depositing collagen in the places it’s needed?” Cosmetic dermatologist Dr Raj Acquilla is concise in response. “There is no credible evidence to suggest that oral collagen is prioritised to the dermis in preference to another part of the body,” he says. “A collagen drink is no more effective at skin rejuvenation than adequate dietary protein intake and forms no part of my clinical practice.” However, there are a handful of studies that have convinced many that hydrolysed collagen works. For example, scientists in Germany conducted a trial among 69 women aged 35 to 55. Those who were given animal-sourced hydrolysed collagen over an eight-week period showed improved skin elasticity compared with that of participants who were given a placebo.2 Hydrolysed collagen was also shown to produce significantly reduced eye wrinkle volume of between 20 and almost 50%, in a group of women aged 45 to 65 who took the supplement once a day for eight weeks as part of another study conducted in Germany.3
Miller argues that such studies are methodologically flawed. “They haven’t taken into account the dietary component [of protein], which is a huge confounding factor in skin viability and the progression of collagen synthesis,” he comments. The inherent problem in using objective markers – such as wrinkle size – in assessing how successful the supplements are in these trials, is that it’s impossible to rule out the effect of other variables. “Participants could have gone away and eaten better in that eight weeks period,” Miller adds, “and that’s quite a long time to make some good nutritional changes to your diet.”
Other practitioners, including Dr Patel, suggest that trials conducted in rats can be used to demonstrate that marine collagen peptides, administered orally, improve the deposition of collagen fibres.4 But there is difficulty in extrapolating those findings to humans, says Miller, as rats are known to have very different enzymatic activity and typically, much faster metabolisms than humans. “Often, you see results a lot quicker, but if you try to transpose that data to a human model you aren’t going to see the same effects.”
Among the supplement enthusiasts, opinion on the best source of collagen differs.
Some practitioners, Escofet included, prefer bovine collagen. “The big difference is that animal-sourced proteins resemble human collagen in molecular structure, so the body recognises it and the bioavailability is better,” she says. “In addition, fish is a prevalent allergen, whereas bovine collagen is hypoallergenic.” Dr Martin Godfrey, a GP and medical writer and broadcaster, argues that marine collagen is better. “Made from skin and scales, it seems to contain good antioxidant activity and improves the water-absorbing and water-holding capacity of the skin,” he says. “There is also less potential risk from pathogens such as BSE.”
Supporters and opponents seem to agree that in order to boost collagen in the body, additional nutrients are necessary. Miller says these nutrients are abundant in a balanced diet. “Amino acids are the bricks to build your health – so how do you start building it?” he asks. “You need vitamin C and iron. If you eat red meat you’re going to get a very good bioavailable, highly absorbable source of iron. Vitamin C is plentiful in a high intake of fruit – in citrus fruits, kiwi fruits, berries, and even vegetables.”
Dr Godfrey suggests that a hydrolysed marine collagen supplement that’s packed with additional ingredients produces optimum results in the skin. “Hyaluronic acid is particularly beneficial to the skin because it slows down water evaporation and provides something of a barrier to water loss,” he comments. “There are other additional elements such as borage oil and other vitamins, which individually have a variety of effects and seem to work well together to support the action of the collagen.” However Dr Taylor-Barnes points to a study demonstrating that HA shows poor absorption when taken orally and suggests that it is not expressed in the skin.5 Vitamins C, A, E and B1, zinc and copper are important in a supplement, says Dr Patel, who also suggests that lysine and threonine – amino acids that are not produced by the body – alongside BioPerine, a patented black pepper extract, should be included as well.
“The skin is the last organ to be prioritised for any nutrient because it’s at the extremity”
Supplementary collagen has been shown to be absorbed in the intestine and accumulate in cartilage, producing beneficial effects in people with osteoarthritis.6 Escofet points out that this hydrolysed collagen is also used to treat gut permeability, or leaky gut, which is the root cause of many allergies and digestive complaints.
For medical aesthetic practitioner Dr Toni Philips, this is evidence enough that such supplements could also increase dermal collagen, but admits that the added ingredients could be playing a role. “You could argue that the vitamins and hyaluronic acid are what’s making the difference, but anecdotal evidence is good and clients see a positive result,” she says. And clients in search of an elixir to improved skin are often happy with a trial-and-error approach – as long as don’t believe that they are spending over the odds. “There isn’t a great deal of published science behind it, but at around the £1 a day price bracket, many people are willing to at least give it a try to see if it works,” Dr Philips adds. “There are some supplements at around triple that price, and that’s a lot of money if a client finds three months down the track that it doesn’t work.”
The anti-supplements camp stands firm, though, claiming that money is better spent elsewhere. “The skin is the last organ to be prioritised for any nutrient because it’s at the extremity, so yes, people will see results by boosting protein from the inside,” says Pearson. “In the UK we don’t eat enough protein so whether you give someone a form of protein supplement or feed them chicken, then you’ll see an improvement in their skin. I would suggest the latter.” Focusing on diet means more than simply increasing protein foods, according to Miller. Equally important is avoiding activity that inhibits protein synthesis – notably chronic dieting and stress, which stimulate the production of cortisol and disrupt the hormonal milieu of the body.
Are collagen supplements the panacea for smoother, wrinkle-free skin? Perhaps greater investment in scientific research that rules out the interplay of dietary protein and other variables will convince even the most sceptical in the future. But for now, it seems the jury is still out.
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