There's no doubt that your patients have either asked you about collagen or have started taking it on their own. As their health expert, it can be challenging to keep up with the latest trends and separate marketing hype from the actual efficacy of a product. Many clinicians want to know if there is science that supports collagen for skin health. In this post, we'll start with the basics of collagen and then get below the surface of research to give you the most up-to-date information on this popular supplement.

What is Collagen?

The root word and suffix comes from the Greek "kólla," and "-γέν," which literally translates to "glue-producing." Connective tissue holds the body together on a cellular and tissue level. Collagen comprises about 30% of the body's total protein and is a building block for many structures ranging from the cornea and blood vessels to tendons, ligaments, bone and skin.

In the body, there are 28 types of collagen, but only types I and II comprise the majority of connective tissues. Although it is not a collagen protein, hyaluronic acid is closely involved in the spacing and alignment of collagen fibers and plays a vital role in skin hydration.1-3

  • Type I collagen: This type accounts for 90% of the body's collagen and is made of densely packed fibers. It provides structure to skin, bones, tendons, fibrous cartilage, connective tissue and teeth.
  • Type II collagen: This type is made of more loosely packed fibers and is found in elastic cartilage, which cushions joints.
  • Hyaluronic acid: This glycosaminoglycan pulls water into the skin and contributes to lubrication and decompressive properties in joint cartilage.
What Damages Collagen?

Diet, the aging process, and free radical damage can all damage collagen proteins. As we age, the body produces less and lower-quality collagen, which weakens collagen and skin overall and accelerates damage. Around age 25, collagen production begins to naturally decline,1 and skin begins to lose its natural firmness. Other lifestyle habits that can inhibit collagen production include a pro-inflammatory diet, excessive sun exposure, smoking, and some health conditions. These factors may warrant clinical support to mitigate collagen decline.

  • Sugar and refined carbs: Sugar interferes with collagen's ability to repair itself. Consumption of sugar and refined carbs should be minimal.4
  • Too much sunshine: Ultraviolet radiation (UVA and UVB) can reduce collagen production, and excessive sun exposure should be avoided.5
  • Smoking and environmental toxins: Smoking reduces collagen production. This can impair wound healing and lead to wrinkles. Pollution and environmental toxins can increase reactive oxygen species and cause free radical damage.6
  • Autoimmune disorders: Autoimmune disorders that cause the immune system to attack the body can also damage collagen production.
Choosing the Best Collagen Supplement

When supporting patients with a collagen product, it is pertinent to evaluate the most efficacious form available. Two types of collagen supplements are gaining popularity: collagen peptides (from hydrolyzed collagen) and gelatin. Gelatin contains larger collagen proteins (300+ kDa) that need to be broken down by hydrochloric acid in the stomach and protease enzymes in the intestine to be absorbed as amino acids and peptides. Bone broth is a popular example of this type of collagen protein.

Hydrolyzed collagen begins as gelatin and is typically broken down into smaller peptides by acid hydrolysis and enzymatic degradation. Peptide sizes can range from 200 kDa down to 3.3 kDa. Smaller peptides, with a lower molecular weight, allow much higher absorption in the body compared to whole proteins, gelatin, bone broth and larger peptides. When peptide size gets down to 3.3 kDa on average, peptides are easily absorbed and become biologically active, stimulating connective tissue cells to produce more collagen. Cofactors such as magnesium, vitamin C and mucopolysaccharides also play key roles in supporting connective tissue cells and promoting endogenous collagen synthesis.

Benefits of Collagen Supplementation

Research on collagen and skin health continues to develop. The key areas that collagen peptides and hyaluronic acid show benefit are in skin elasticity, signs of aging, skin strength, cellulite reduction, and skin hydration.

Skin Elasticity

In one 2014 study, women who took a supplement showed improvements in skin elasticity. Collagen has also been used in studies using topical formulations to improve the appearance of skin by minimizing lines and wrinkles.7,8

Another study published in 2014 found that volunteers who took a daily supplement containing 5 grams hydrolyzed collagen improved dryness, wrinkles, and nasolabial fold depth after 60 days, and collagen density and skin firmness improved after 12 weeks. 9

A study using collagen peptides, run in conjunction with a university, had volunteers take either a daily supplement containing 2.5 grams of collagen peptides or a placebo for eight weeks. There were improvements in eye wrinkles as well as the content of the skin. The same supplement also improved skin elasticity after eight weeks in a separate trial.10,11

A study published in 2014 randomly chose 46 of 69 women, ages 35 to 55, to take a collagen peptide supplement. The rest of the group took a placebo. The women who took the collagen showed an improvement in skin elasticity within four weeks.14 The same collagen peptide formulation was also used in another study in 2014, and showed significant wrinkle reduction after just eight weeks.15

Although it hasn't been tested in people with loose skin related to major weight loss, studies suggest that collagen hydrolysate may have a protective effect on skin elasticity.17,18,13

Skin Strength

A controlled study published in 2015 found that collagen strength increased significantly after four weeks of supplementation with collagen peptides, and this effect remained for the duration of the 12-week study.13

Cellulite Reduction

Collagen may also help improve the appearance of cellulite. Cellulite occurs when the layer of fat under the skin pushes up against the connective tissue, creating a dimpled or lumpy appearance on the skin.

Another study in 2015 investigated the effects of type I collagen on cellulite. They randomly assigned 105 women, ages 24 to 50, to take collagen peptides for six months. Those who did demonstrated a clear improvement in skin texture.16

Skin Hydration

Collagen contains the amino acid hydroxyproline that is unique to youthful skin. Prolyl-hydroxyproline, a collagen fragment that consists of two amino acids, was found to trigger skin cells in vitro to produce more hyaluronic acid, another component that is important for boosting the skin’s water content.19 

Another placebo-controlled trial performed on collagen peptides found that 10 grams of a daily collagen peptide supplement improved skin hydration after eight weeks and decreased fragmentation of collagen in the skin after four weeks.12

Hyaluronic acid (HA) itself also promotes water retention and skin hydration which can help reduce wrinkles, signs of aging, and photo-damage to skin.20 HA must be in the correct size and structure to exhibit the best results. With a very low molecular weight of 5 kDa, HA has the ability to penetrate the skin, which means it can potentially carry other unwanted ingredients, chemicals, and bacteria more deeply into the skin and intestinal cells. Human studies on HA indicate that between 50 to 1,000 kDa is the most beneficial for skin, with about 130 kDa being the best, according to the most recent human studies. Anything lower might cause inflammation and higher ranges show little clinical benefit.3,21

Key Cofactors for Collagen

Key cofactors such as vitamin C, magnesium and mucopolysaccharides also ensure maximum cellular health, collagen protein synthesis and proper collagen fiber alignment. Including vital cofactors and support molecules maximizes the potential of a collagen-based supplement. Here are the top three nutrients to consider:

Vitamin C is essential for skin health and supports skin in a variety of ways. Vitamin C plays a role in collagen production inside the cell, reduces free radical damage (excess sunlight and smoking), and prevents collagen breakdown from the aging process.22

Inside the cell all collagen starts off as procollagen. The body makes procollagen by combining two amino acids, glycine and proline, with other amino acids. This process requires vitamin C. In addition, vitamin C is a cofactor for the hydroxylation process that combines the collagen fibers into the triple helix strand that gives every form of collagen its strength.

Mucopolysaccharides help align collagen fibers and allow them to "stick" together in a specific order in the ground substance of the skin and between skin cells and other connective tissue molecules. Mucopolysaccharides are naturally found alongside collagen structures in the body and play key roles in skin hydration. Mucopolysaccharide metabolism disorders can worsen skin diseases by limiting collagen repair, structure strength, and overall ability to hydrate and retain water.23,24

Magnesium is required for all protein synthesis in the body and most of the US population is deficient in magnesium. Almost every enzyme involved in the collagen synthesis process requires magnesium, which may not be surprising when it is the required cofactor for more than 300 biochemical reactions in the body. Magnesium can also play a role in reducing the stress response. The kidneys are known to release magnesium when cortisol is elevated, suppressing the effects of the hormone. Elevated cortisol has been known to contribute to the increased acne and wrinkles.25 Finally, magnesium is also necessary for the enzymes that manage DNA repair and replication. Without the mineral, the skin would be subject to a variety of harmful free radical damage and inflammation that would ultimately lead to wrinkling and skin damage.26

The Bottom Line 

Collagen has been shown in cell and human studies to benefit the skin. Other nutrients such as mucopolysaccharides and hyaluronic acid support connective tissue and the skin. Vitamin C and magnesium are also essential nutrients. Collagen products are one of the most hypoallergenic forms of protein available and a high-quality product that is backed by research is the best way to ensure benefits for patients.

FRANK BODNAR, DC, MS

Frank Bodnar, DC, MS Headshot

Dr. Frank Bodnar is a licensed chiropractor in the states of Wisconsin and Illinois. He holds a doctorate of chiropractic from Palmer College of Chiropractic, and Master of Science degree (magna cum laude) in human nutrition from the University of Bridgeport. He is certified in sports nutrition from the International Society of Sports Nutrition (CISSN), and is a certified CrossFit Trainer (CF-L1).

 

References:
  1. Lodish, H., Berk, A., S Lawrence Zipursky, Matsudaira, P., Baltimore, D., & Darnell, J. (2017). Collagen: The Fibrous Proteins of the Matrix. Retrieved July 1, 2019, from Nih.gov website
  2. Papakonstantinou, E., Roth, M., & Karakiulakis, G. (2012). Hyaluronic acid: A key molecule in skin aging. Dermato-Endocrinology, 4(3), 253–258. 
  3. Cyphert, J. M., Trempus, C. S., & Garantziotis, S. (2015, September 10). Size Matters: Molecular Weight Specificity of Hyaluronan Effects in Cell Biology. Retrieved April 9, 2021, from International Journal of Cell Biology website
  4. ‌Danby, F. W. (2010). Nutrition and aging skin: sugar and glycation. Clinics in Dermatology, 28(4), 409–411.
  5. Bosch, R., Philips, N., Suárez-Pérez, J., Juarranz, A., Devmurari, A., Chalensouk-Khaosaat, J., & González, S. (2015). Mechanisms of Photoaging and Cutaneous Photocarcinogenesis, and Photoprotective Strategies with Phytochemicals. Antioxidants, 4(2), 248–268.
  6. ‌Knuutinen, A., Kokkonen, N., Risteli, J., Vähäkangas, K., Kallioinen, M., Salo, T., … Oikarinen, A. (2002). Smoking affects collagen synthesis and extracellular matrix turnover in human skin. The British Journal of Dermatology, 146(4), 588–594.
  7. Proksch, E., Segger, D., Degwert, J., Schunck, M., Zague, V., & Oesser, S. (2014). Oral Supplementation of Specific Collagen Peptides Has Beneficial Effects on Human Skin Physiology: A Double-Blind, Placebo-Controlled Study. Skin Pharmacology and Physiology, 27(1), 47–55. 
  8. ‌Trookman, N. S., Rizer, R. L., Ford, R., Ho, E., & Gotz, V. (2009). Immediate and Long-term Clinical Benefits of a Topical Treatment for Facial Lines and Wrinkles. The Journal of Clinical and Aesthetic Dermatology, 2(3), 38–43. 
  9. Sibilla, S., & Borumand, M. (2014). Daily consumption of the collagen supplement Pure Gold Collagen® reduces visible signs of aging. Clinical Interventions in Aging, 1747. 
  10. ‌Proksch, E., Schunck, M., Zague, V., Segger, D., Degwert, J., & Oesser, S. (2014). Oral Intake of Specific Bioactive Collagen Peptides Reduces Skin Wrinkles and Increases Dermal Matrix Synthesis. Skin Pharmacology and Physiology, 27(3), 113–119. 
  11. Proksch, E., Segger, D., Degwert, J., Schunck, M., Zague, V., & Oesser, S. (2014). Oral Supplementation of Specific Collagen Peptides Has Beneficial Effects on Human Skin Physiology: A Double-Blind, Placebo-Controlled Study. Skin Pharmacology and Physiology, 27(1), 47–55. 
  12. ‌Asserin, J., Lati, E., Shioya, T., & Prawitt, J. (2015). The effect of oral collagen peptide supplementation on skin moisture and the dermal collagen network: evidence from anex vivomodel and randomized, placebo-controlled clinical trials. Journal of Cosmetic Dermatology, 14(4), 291–301. 
  13. Aula, G., España, M., Juher, F., & Basés Pérez, T. (2015). An overview of the beneficial effects of hydrolysed collagen intake on joint and bone health and on skin ageing. Nutr. Hosp., 32(1:62-6). 
  14. ‌Proksch, E., Segger, D., Degwert, J., Schunck, M., Zague, V., & Oesser, S. (2014). Oral Supplementation of Specific Collagen Peptides Has Beneficial Effects on Human Skin Physiology: A Double-Blind, Placebo-Controlled Study. Skin Pharmacology and Physiology, 27(1), 47–55. 
  15. Proksch, E., Schunck, M., Zague, V., Segger, D., Degwert, J., & Oesser, S. (2014). Oral Intake of Specific Bioactive Collagen Peptides Reduces Skin Wrinkles and Increases Dermal Matrix Synthesis. Skin Pharmacology and Physiology, 27(3), 113–119. 
  16. ‌Schunck, M., Zague, V., Oesser, S., & Proksch, E. (2015). Dietary Supplementation with Specific Collagen Peptides Has a Body Mass Index-Dependent Beneficial Effect on Cellulite Morphology. Journal of Medicinal Food, 18(12), 1340–1348. 
  17. Asserin, J., Lati, E., Shioya, T., & Prawitt, J. (2015). The effect of oral collagen peptide supplementation on skin moisture and the dermal collagen network: evidence from anex vivomodel and randomized, placebo-controlled clinical trials.  Journal of Cosmetic Dermatology, 14(4), 291–301. 
  18. ‌Asserin, J., Lati, E., Shioya, T., & Prawitt, J. (2015). The effect of oral collagen peptide supplementation on skin moisture and the dermal collagen network: evidence from anex vivomodel and randomized, placebo-controlled clinical trials. Journal of Cosmetic Dermatology, 14(4), 291–301. 
  19. Ohara, H., Ichikawa, S., Matsumoto, H., Akiyama, M., Fujimoto, N., Kobayashi, T., & Tajima, S. (2010). Collagen-derived dipeptide, proline-hydroxyproline, stimulates cell proliferation and hyaluronic acid synthesis in cultured human dermal fibroblasts. The Journal of Dermatology, 37(4), 330–338. 
  20. ‌Oe, M., Sakai, S., Yoshida, H., Okado, N., Kaneda, H., Masuda, Y., & Urushibata, O. (2017). Oral hyaluronan relieves wrinkles: a double-blinded, placebo-controlled study over a 12-week period. Clinical, Cosmetic and Investigational Dermatology, 10(10), 267–273.
  21. Pavicic, T., Gauglitz, G. G., Lersch, P., Schwach-Abdellaoui, K., Malle, B., Korting, H. C., & Farwick, M. (2011). Efficacy of cream-based novel formulations of hyaluronic acid of different molecular weights in anti-wrinkle treatment. Journal of Drugs in Dermatology: JDD, 10(9), 990–1000.
  22. ‌Catani, M. V., Savini, I., Rossi, A., Melino, G., & Avigliano, L. (2005). Biological Role of Vitamin C in Keratinocytes. Nutrition Reviews, 63(3), 81–90. 
  23. Wanitphakdeedecha, R., Eimpunth, S., & Manuskiatti, W. (2011, June 30). The Effects of Mucopolysaccharide Polysulphate on Hydration and Elasticity of Human Skin. Retrieved April 9, 2021, from Dermatology Research and Practice website
  24. ‌Braun-Falco, O., Plewig, G., Wolff, H. H., & Winkelmann, R. K. (1991). Skin Diseases Caused by Disorders in Mucopolysaccharide Metabolism. Dermatology, 888–898. 
  25. Lee, W. J., Kim, S. L., Choe, Y. S., Jang, Y. H., Lee, S.-J., & Kim, D. W. (2015). Magnesium Ascorbyl Phosphate Regulates the Expression of Inflammatory Biomarkers in Cultured Sebocytes. Annals of Dermatology, 27(4), 376–382. 
  26. ‌Zheltova, A. A., Kharitonova, M. V., Iezhitsa, I. N., & Spasov, A. A. (2016). Magnesium deficiency and oxidative stress: an update. BioMedicine, 6(4).