Shiloah Kviatkovsky PhD CISSN - Delving into the Science of Collagen for Optimal Joint Health
Mar 25, 2024
Jose Antonio PhD
Shiloah Kviatkovsky, PhD CISSN
Collagen - the secret ingredient to joint health?
Dr. Kviatkovsky's talk reviewed the subject of collagen and joint health. I found it interesting that sex differences exist in levels of joint pain. Granted, this work was applicable to athletes, non-athletes, and even older adults, where pain can be an important issue. Essential aspects are if athletes need to address joint pain, both steroids and Non-Steroidal Anti-inflammatory Drugs (NSAIDs) can also cause problems with training or biomarkers associated with performance. Collagen is sometimes overlooked as an essential supplement in an athlete's diet, and this talk highlighted how collagen could be the answer to address problems with joint health – as a study of collagen protein use over six months shows improvements in knee-related functions and decreases in pain, indicating potential benefits for joint health and quality of life.
Dr. Kviatkovsky's talk reviewed the subject of collagen and joint health. I found it interesting that sex differences exist in levels of joint pain. Granted, this work was applicable to athletes, non-athletes, and even older adults, where pain can be an important issue. Essential aspects are if athletes need to address joint pain, both steroids and Non-Steroidal Anti-inflammatory Drugs (NSAIDs) can also cause problems with training or biomarkers associated with performance. Collagen is sometimes overlooked as an essential supplement in an athlete's diet, and this talk highlighted how collagen could be the answer to address problems with joint health – as a study of collagen protein use over six months shows improvements in knee-related functions and decreases in pain, indicating potential benefits for joint health and quality of life.
Speaker 1:
So today we're going to talk about collagen. I've talked about it a lot in a lot of different ways, but today we're going to mainly focus on joint health and collagen. So is it the secret ingredient for joint health? Quick disclosures my research, some of which I will introduce today, was sponsored by SoluJail, which is the collagen supplement that we actually used, and that is a product of PD liner in test and air load group. So really quick, you know, in our field we talk about protein a lot, but one of the things that we don't talk about that much is collagen. So we're always kind of talking about the complete proteins, essential amino acids, but collagen is actually the most abundant protein in the human body, and so it's 70% of our skin, 30% of bone and 80% of tendons and ligaments is actually made up of type one collagen specifically, and that's usually accompanied by a type three collagen. Our cartilage and our bone is also a lot of type one and type three, but also some type two collagen as well. And really quick, I'm going to move this bar over. But if you look over at the right hand side down here, this is what a triple helical collagen strand looks like, and with type one collagen. It's really important to think about glycine, because that is making up about one third of the type one collagen fibers, and then that's usually accompanied by an XY. So two other amino acids, generally proline and hydroxy proline, and that's really important because individually these amino acids make up a lot of the connective tissue in our body, but also they do get absorbed intact as diatri and even longer peptide chains that then are have been shown to act as bioactive peptides, which act as signaling molecules. That are one of the reasons that we're seeing some of the benefits that we're seeing with some of the supplementation.
Speaker 1:
So a little bit about collagen supplements themselves. They are always from animal sources. I think that there are some companies that are trying to develop them from non-animal sources. I don't know if that's ever going to be a possibility. Generally in the United States we do have a lot of bovine collagen, so from cows. Their pig is actually a pretty good source, but it's not as popular in the United States. Chicken. We get a lot of the type two collagen from chicken and a lot of type one and type three from bovine and pig. And then marine collagen is getting very popular. It's especially popular in some of the supplements that are intended for skin and that's generally a one and three type.
Speaker 1:
So how is collagen made? You take some of the tissue from these animals, generally any of the non-meat containing tissues, so we would think of that as scrap, but it's actually very beneficial and our ancestors, a long long time ago, used to actually eat collagen containing foods, and we don't actually eat those, at least in Western culture, that often. So we're actually lacking something that we used to eat a long long time ago, which is one of the arguments as to why we would want to supplement with this. So they use hot water extraction basically to create a gelatin which is available on the food market. But what these companies are doing further is they're using enzymatic hydrolysis with very specific enzymes to create this collagen hydrolysis. And these are just summarizing some of the benefits that have been reported in the literature. So we have this intact alpha triple helical structure here, that's a collagen fiber, and then what happens is that it gets denatured with that hot water extraction into its individual collagen alpha chains, and then, with the enzymatic cleavage, we're creating these peptides that are acting as signaling molecules in our body, and then we have those amino acids then as amino acids available for building blocks.
Speaker 1:
So there are three hypotheses as to the mechanisms of action for why collagen peptide supplements are beneficial. One is that we're supplying the amino acids themselves, which are the building blocks for the connective tissue that we are trying to regenerate, synthesize, repair Glycine. We need that it's, you know, conditionally, essential, basically, that's you know something that a lot of people are arguing, that it should be considered that, especially when we're in increased needs. So if we have injuries or we're growing, then proline and hydroxy proline they're not altogether that abundant in our diets and especially hydroxy proline needs to be made in our body and we need vitamin C for that. Then I just talked a little bit about acting as biological messengers. So when we have those dye and tripeptides of glycine, proline and hydroxy proline, they're going to different areas of the body and they're actually acting as signaling molecules to initiate pathways, specifically in fibroblasts, tenocytes, condrocytes and osteoblasts. So those are the cells that are going to produce more skin collagen, more tendon collagen, more cartilage collagen and then also more bone. And then there's a third hypothesis which is really kind of just specific to joint health, which is inducers of oral tolerance and that has to do with inflammation and the joints, especially with osteoarthritis, so we won't go there too much.
Speaker 1:
But basically having these kind of peptides available is kind of desensitizing the body to an autoimmune response to the collagen fragments there. So how do oral collagen peptides get absorbed, and do they get absorbed and how are they absorbed? So it used to be thought that only amino acids were absorbed intact in the gut, and what they're finding is that these amino acids are in fact actually getting into the bloodstream intact and so when we're consuming anything with protein they are going through the enterocytes and there's actually preferential absorption of peptides over amino acids. And there have been an abundant number of studies that have actually published the presence of these peptides that are intact, as you know, for instance here glycine, proline and hydroxypoline in the blood after consumption and generally they're peaking around 60 to 90 minutes. This study was done and it actually compared a placebo to native collagen, which is more of like a gelatin versus an enzymatically hydrolyzed collagen, and so in the purple we have, you know, the more refined form which has those bioactive peptides, and then we have the gelatin and then we have the placebo, and so this was total area under the curve of this tripeptide. And they saw that the native collagen was still significantly, had significantly more of this tripeptide in the blood compared to the placebo, but ultimately the hydrolyzed collagen had significantly more. Kind of just proving the point that these peptides do pass into circulation intact.
Speaker 1:
So common contributors to mobility problems and I have a female here, because joint pain is actually more prevalent in females and males. So you know a little bit appropriate that this is following Hannah's talk just before mine but aging is a huge contributor to joint pain, inflammation, overuse, injuries, and actually the more active we are, the more pain we tend to suffer, and a majority of the pain is usually caused by musculoskeletal injuries. So just to give you guys a couple of stats here, so showing you that pain does increase with age, and those over the age of 45 to 64 suffer about 30%, and then anybody over 65 is about 33% chronic pain, and then females suffer from pain more than males, as I said. And then here's a comparison of males versus females with osteoarthritis and, just to show you guys, knee pain scores. So this is actually from the COOS, something that I will talk about a little bit later and a lower score actually indicates a worse score. So you know, this is showing that they have almost 6% greater pain than males in the knee, and then the prevalence is also, you know, about 5% higher in the knee and the hip. So this is definitely something that there are some sex differences that need to be explored a little bit more. It's thought that these are potentially due to decline in estrogen with age.
Speaker 1:
So pain and injuries are pretty bad because they lead to more pain and injuries. So, generally, when you have some pain, you start to decrease your activities of daily living and you also stop, you know, participating in sports and you know, other activities, and so, as you stop doing the things that you normally do, this tends to cause a decline in your mental health, your social health. It can even negatively impact employment, which will then feedback and negatively impact economic health, and that all negatively kind of feeds back onto your activities of daily living and sport and activity and it's called the cycle of restriction, and this then feeds back into other things that will cause more disability, such as gaining weight, becoming overweight, becoming obese, and then that also negatively feeds back on itself. So there's a lot of issues with pain and injuries aside from just being able to be an athlete or be physically active. It impacts every aspect of your life and unfortunately, when you suffer from chronic pain, you know a lot of the treatments are going to be corticosteroids or NSAIDs and inflammatory drugs, which then lead to other chronic additional issues. So GI damage to the GI, increased nerve dysfunction and then even, especially with corticosteroids now you're actually causing more destruction to that connective tissue that is already damaged and causing that pain. So that kind of leaves a wide open door for alternative treatments other than pharmaceutical remedies, so something natural like a collagen peptide supplement.
Speaker 1:
So in a recent review that I published with Robert Hickner and Mike Ormsby, my PhD in Mike Ormsby's lab, we just kind of outlined some of the recent findings in the literature, just talking about how the literature is actually really growing and expanding in collagen peptides for activity, for physical function, for pain, for skin health, and so what we found is, you know, in the last, you know, 12 to 18 months we found an abundance of papers and even since this paper was published we've seen a lot more come out and another review basically stating that there have been a lot of improvements in body composition, strength, muscle recovery with collagen supplementation. But they do acknowledge that you know, they, that anything with strength related outcomes is not superior when taken collagen compared to another complete form of protein. So I always like to, kind of, you know, deliver the message that protein is collagen. Protein is not to be taken in lieu of another protein like a way or essential amino acids, but something that should be taken in conjunction with and something that should be taken to support the connective tissue that supports the muscles and the bones, so kind of like a whole body system wide approach to nutrition and supplementation. So just to talk about some of the studies out there in the literature that kind of support the use of collagen peptides for the reduction in joint pain, this was in an older population. They had a pretty robust sample size 207 people 59 years old. They took six months of 10 grams a day, compared to placebo, and they use the visual analog scale to look at changes in pain and the knee, and so they only counted people that saw an improvement of at least 30 millimeters or greater in the visual analog scale and what they found was 75% of the population that took collagen, compared to 53% in the placebo group, saw at least a 30 millimeter improvement in knee pain according to the visual analog scale. Similarly, this study actually looked at pain in the most painful joint. So anybody that was suffering from chronic pain and any joint, approximately 65 year olds another robust sample size of 200. They took 12 milligrams a day for six months and they also had something called responders versus non responders and so they looked at how many people saw improvements of greater than 20% and they found that that a little over 50% which was still significant in the collagen hydrolysate group at least saw 20% or greater improvement in joint pain in their most painful joint. A study just done in women looked at collagen supplementation 100 women 40 to 7 years old with the Neosteoarthritis and they did. They took either 8 grams a day or of collagen or 8 grams a day of placebo and what they found was, when measured with WOMAC at 3 months and then at 6 months, they saw significant improvements in knee pain, knee joint pain and stiffness. So if anybody's ever used a WOMAC, it kind of has a couple different scales that they look at. So those were the two specific sub-scales that they saw improvements in.
Speaker 1:
So for athletes, really important female athletes actually suffer from higher incidence of especially knee related injuries. Acl tears are pretty prevalent in females compared to males. This was a young group of really high level soccer players. Their average age was 17 years old and they looked at patella tendon properties with 30 grams of collagen plus 500 milligrams of vitamin C per day compared to placebo, and they took this over a 10 week training period where they were training 3 days a week for the entire duration of that 10 weeks and what they found were significant improvements in stiffness and something called Young's Modulus, and so that has to do with kind of like strength, with elasticity, so something that would potentially be beneficial to minimize the you know, minimize patella tendon injuries. And so these are the kinds of studies that I'm really interested in looking at now, because we want to kind of look at ligaments and tendons and how they respond specifically to these collagen supplements and so really important for athletes, especially female athletes.
Speaker 1:
My study that I did for my dissertation work with my Gormspeys lab at Florida State University, we looked at 40 to 65 year old lifelong active males and females and they weren't allowed to have any kind of diagnosed injury or osteoarthritis in any joint but they had to suffer from chronic pain. So something that would be intermittent, but it has to be pretty persistent on a regular basis, and so we actually looked at two different dosages of collagen. We looked at 20 grams a day and 10 grams a day versus a placebo and we looked at a number of different metrics. But what we found was, with the COOS, which is actually their score, anything that's increasing and is improvement versus the WOMAC, which is the opposite. What we found was that actually with 10 grams a day, that there was superior benefits compared to 20 grams a day, compared to placebo in activities of daily living. And then we also found that when we dichotomize our group by minutes per week of activity moderate to low intensity activity those people that were doing more than 180 minutes per week actually they're pain improved in the COOS In both of the groups with supplementation, but specifically in that 10 gram a day group. And I'm not going to go into some of the other findings here because it's not related to joints, but it was that same 10 gram a day group that we actually saw like all of the benefits across the board, and so pretty interesting stuff there.
Speaker 1:
So, looking at dose response, it's not always more is better, all right, so but why? Why are we seeing these benefits? What are the mechanisms of action here? Well, a lot of that really isn't understood. So we do know that a lot of joint pain is caused to the fact that the connective tissue isn't healing. There is increased inflammation. But what is it that collagen peptides are doing that is potentially helping with this? So one of the hypotheses is that glycine, especially, is related to decreased inflammation. So there's that there's also a stimulation of more collagen synthesis in these joints and in this connective tissue. But we don't really know that yet.
Speaker 1:
And also one of the things that I'm really focusing on is how are you going to repair the joint if you're going to leave the deteriorated collagen there and then just rebuild on top of that? So, looking at some of the enzymes that are actually responsible for clearing out some of that damaged connective tissue so that the new tissue can heal, so just kind of some of the mechanisms of action that you know we're looking at is some of the hydrolyzed collagen gets through the enterocyte. These bioactive peptides then are stimulating some of the chondrocytes to produce more collagen in that tissue. We know that the TGF beta pathway is mainly responsible for collagen synthesis, but it's also responsible for fibrosis, and so if we continue to just synthesize and not, you know kind of break down some of that tissue and clear it out. Then we end up with scar tissue and fibrotic tissue. So we want to look and see, make sure that this tissue is actually turning over, so not just synthesizing the tissue but also repairing it by getting rid of the damaged tissue. So from what? From our study that I described to you guys, we did see that with some of the biomarkers CTX and P1NP these are markers of, you know, synthesis and degradation we saw that there was increased what we would call remodeling or turnover, also in that tenogrammetate group, both at 6 and at 9 months. So that's something that we're, you know, going to be exploring a lot more and you guys will be hearing a lot more about that.
Speaker 1:
So some of the recommendations according to the literature out there, just so that you guys can come home and you know how much you should be taking.
Speaker 1:
If you decide that you want some performance recovery 10 to 15 grams a day you should be seeing some benefits after about three months. Bone health that has not really been studied enough, but there is one study that showed that 12 months actually improved bone mineral density in postmenopausal women with osteopenia or osteoporosis. 10 grams a day for three to six months is what we've seen in the literature so far and what we saw in our own studies Pain and function 10 grams a day for three to six months. And then what I didn't discuss was mood. But in our study we also found improvements in mood as soon as three months, but also it lasted all the way out to nine months, and I'd like to thank Florida State University the ISSN, obviously for having me. I'm currently at University of Arkansas for medical sciences and then also PB liner that supported all my college and research up to now and are continuing to support me.