Is collagen really the silver bullet for ageing?

Everyone, it seems — including older journalists — is exploring collagen supplements to erase the ravages of the past and delay the effects of ageing.

It’s a fast-growing market globally: according to a Future Market Insights report, the current global demand for collagen supplements is $1.5bn, and is forecast to grow at 6.4% annually and reach $2.8bn in 2032.

According to Google Trends, online searches for collagen have steadily increased since 2014, reads a report by Harvard’s TH Chan School of Public Health. “Despite its abundance in our bodies, collagen has become a top-selling supplement purported to improve hair, skin, and nails — key components of the fountain of youth. The idea of popping a pill that doesn’t have side effects and may reverse the signs of ageing is attractive to many.”

My own search began at my local chain pharmacy, in the bodybuilding section where they stock things like creatine and body mass builder, and where the assistant can be counted on to try to sell me the latest wonder potion. Last month it was whey protein powder. He shows me a fine array of collagen powders, some with added benefits such as glutathione, vitamin C, glucosamine, probiotics and coenzyme Q10. You can add the powder to your morning coffee, juice or yoghurt, or put it in a smoothie. The market is becoming evermore specialised and sophisticated.

Collagen supplements are said to help improve skin elasticity as well as joint health, helping prevent inflammation and conditions like osteoarthritis. But how do I find out what taking collagen does apart from taking a salesperson’s word for it, or doing my own six-month trial?

Solid testimonial

I speak to a friend of a friend, who is an agent for Honey products, which sells a powdered collagen supplement. She raves about the wonders of the product, but I want proof. She asks some of her customers to give short reviews and these are very positive. Winny says: “My nails grew fast n strong n my skin is glowing”. Tandi says: “I use the collagen once a week hence I haven’t needed more yet. Using every day made my hair grow like crazy!” Kerry Lee says: “I’ve been tracking my new hair growth … all these new hairs on the TOP of my head … are since I’m taking collagen for 10 months now, not to mention my skin and my nails are just getting better and better!” Kerry Lee sent a picture showing the new tufts of hair growing out since using the collagen supplement.

These appear to be solid testimonials for the product, unless the agent is bribing them with a year’s supply.

What about taking a collagen pill then? Solgar makes Collagen Hyaluronic Acid Complex, and Amazon.com supplies it. I look on the website for testimonials, which range from positive (“I have been taking this product for four months now. What a difference on how I feel. My skin is softer, and my joints have no pain”) and ambivalent (“very good product, my skin is plumped in a week. But the tablets are really big. I noticed some constipation during use”) to negative (“gives me huge bloating in my stomach and all over my body, I have sausage fingers, and get socks marks on my ankles, my face looks like I had partied hard the night before.”)

These remarks don’t inspire me to rush out and buy collagen capsules.

Meanwhile, I have been emailing a Johannesburg dermatologist, asking for information on collagen supplementation. “I am sceptical and do not use collagen,” is Dr Hilary Carman’s first response. She directs me to some studies and agrees to revert with more information.

I’m back to square one. Whereas I had felt quite prepared to go out and buy a tub of collagen — they range in price from about R250 to R1,000 — I am now hesitant, and wonder if there is a snake-oil business behind this industry. Is it just another scam?

I go back to the pharmacy, to the beauty section, where the assistant is an old friend who once, about five years ago, entreated me to take collagen ampoules. I was a bit put off by the price and declined, but I do wonder how fine my skin would be looking now and how strong my bones would be if I had taken her advice.

I feel I can trust Helena’s word, but she directs me to the beautician, a Payot representative. It’s difficult to get a truly independent opinion on collagen; there’s a lot of buzz and hype but I need evidence. The Payot product does not actually contain collagen, but stimulates the growth of collagen in the skin, she explains. This range, the Rose Lift, cost about R995 for the 50mg day cream but there are cheaper ranges like Dermactin and NutriWoman Laserlift, from about R300 to R450.

There is no proper researched evidence that collagen supplements remove wrinkles or improve damaged joint cartilage

The criticism of collagen skin products has been that they cannot penetrate the deeper layers of the skin, where collagen is found. This is the reason many dermatologists have not accepted the topical treatments available. “The problem is that collagen is a large molecule and not absorbed through the skin,” says Carman. 

When Carman comes back to me, she concludes that “there is not to date proper researched evidence that collagen taken by mouth or applied to the skin actually has the desired effect of removing wrinkles or improving damaged joint cartilage. According to the Harvard report, some of the studies have been supported by the manufacturing company.” 

I look closer at a study, “A collagen supplement improves skin hydration, Eelasticity, roughness and density: results of a randomised, placebo-controlled, blind study”, undertaken by Liane Bolke and others and published in the journal Nutrients. The purpose of the study was to “investigate the effects of the drinkable nutraceutical Elasten® (Quiris Healthcare, Gütersloh, Germany) on skin ageing and skin health”, it says in the abstract. Further down, however, the report clearly reads: “This research was funded by Quiris Healthcare, Germany.” And yet the authors found no conflict of interest.

A subsequent review of studies on collagen supplementation cites the German study, without mentioning that it was industry funded. Another one, “Oral intake of low-molecular-weight collagen peptide improves hydration, elasticity, and wrinkling in human skin”, led by Do-Un Kim and published in 2018 in Nutrients, tests a Newtree product and is funded by Newtree, Seongnam, Korea. Again, no conflict of interest is declared.

Seems counterintuitive

I begin to see what Carman is saying: “There is a lack of research to show that eating collagen can directly benefit skin or joint health. Also, physiologically it seems counterintuitive. Collagen, even broken-down collagen, is not absorbed into the gut and then transported preferentially to the wrinkled skin and the painful joints. It is broken right down into amino acids which are then reconstituted into the proteins the body needs at the various sites of metabolism. And as the Harvard article points out, these proteins are found in fish, chicken, milk, meat and all the well-known protein foods — not just collagen.”

Many of these foods would be unacceptable to vegetarians or vegans, as would most collagen supplements as they have a bovine and porcine provenance. The Korean study, Newtree, tested a collagen hydrolysate obtained from the sutchi catfish’s skin. Some users prefer the marine variety for religious or dietary reasons. In a review of collagen treatment in clinical studies, Hsiuying Wang says despite the risk of bovine spongiform encephalopathy (BSE), bovine collagen is widely used in collagen-based products. Cow and pig skins and bones are the main sources of collagen.

At least part of the reason for collagen’s ascent is surely that in a fast-paced world, many people don’t want to pause to eat a balanced meal or go for a walk in nature. A huge industry has arisen because we want instant gratification in a tin. There is evidence that our collagen levels decline with age, and supplementation is recommended. But as always, real health comes back to basics.

“The Harvard article recommends a good diet using high-protein foods, which contain the amino acids that make collagen: fish, poultry, meat, eggs dairy products, legumes. Zinc and vitamin C are required for collagen production. It also recommends sun avoidance, avoidance of smoking, use of sunblocks and possibly exercise,” says Carman. 

It could be that, when people decide to do something about their health, and start by wandering into a shop looking for a collagen supplement, after buying it they improve their diet and clean up their act in various ways. That one step prompts them to start taking care of their diet, exercise, stress management and so forth, with the resulting boost to general health and a better outlook on life.

Or else collagen is the silver bullet it is purported to be.

Carman’s final words: “It will be most interesting [to see the outcome of more studies] and hopefully it does make us all look younger and better, and joint cartilage is healed to stop the necessity for joint replacements! Let me know.”