Here in the Bay Area of California we are more than two months into our shelter in place and if you are anything like me it has meant that your exercise plan has changed significantly. For me it means daily walks and weekend hikes. While it is great exercise and wonderful for my head, it isn’t so spectacular on my knee.
Three knee surgeries in, I count the years until I am due for a knee replacement and depend on my knowledge of sports medicine and training to manage and preserve my knee as much as possible. Running is an activity that is off the list. I would not even make it a week before I am limping around in constant pain. I do not have access to the elliptical or exercise bike that I otherwise would use in a gym setting so I am resolved to walking and doing resistance circuits to get my cardiovascular work.
As a guy in his late 40s I have switched from being overly focused on how strong I am or how much mass I can pack on and now think about my heart health and various other disease risk factors. I manage my body composition more for those reasons then to look good when I take my shirt off (ok that may be a little bit of a lie but as this lockdown goes on I am slowly slipping towards dad bod and trying to justify it).
So, miles and miles of walking is on the program. And while my legs and energy levels are getting better and better, my knee is starting to feel the strain. I haven’t reached constant pain and disability, yet. Those are familiar friends that have shown up over the years when I’ve foolishly decided to tackle hikes that are more stepping up and down on rocks, like a giant uneven stone staircase, for long distances as opposed to the up and down I experience on smoother trails. Mt Whitney took almost a year for my knee to recover. Camelback took four months. Yet I can climb endlessly if the trail isn’t like a constant rock stairs. And now the mileage of daily walks is starting to build and that leads me to the real purpose of this blog. Discussing cartilage and the impact of collagen supplementation on it.
Now that every journalism major who is reading this has gotten over that is took me four paragraphs and almost 400 words to even tell you what the topic of this article is, lets dive in. Articular cartilage is found on the ends of our bones. It has multiple functions such as shock absorption and force distribution as well as creating a low friction, lubricated surface for movement to take place. It is crucial for healthy, pain free movement. Unfortunately, cartilage is exceptionally poor at healing and when more significant damage occurs, it does not heal at all. This eventually leads to osteoarthritis and eventually, pain and a loss of function. While a tremendous amount of research has been conducted over the past two decades and all sorts of surgical approaches have been developed, they still have mixed and limited outcomes and are certainly not a first line treatment for most injuries.
Most individuals want to maintain an active healthy lifestyle. While that can be broadly defined from the person who just wants to go to the market and walk around pain free to those who are trying to have a daily exercise routine and engage in various sports everyone who is suffering from cartilage damage of any extent could benefit from a simple supplement that supports cartilage healing.
Now anyone who knows me knows that I do not support the magic pill approach towards health and fitness. As of the time of this writing I do not have a single person I work with taking any supplements with the exception of those who have been tested by their physicians and found to be low on vitamin D. If I am going to support anyone taking any supplement, I want to see that there is a broad base of research showing, or at least strongly suggesting that a supplement works. So, let us look at what the research says about collagen supplementation and its effect on cartilage.
The Data
A double-blind, placebo-controlled randomized study by Kumar et al. (2015) found improved pain and function levels in osteoarthritis patients. Another 2016 study by Lugo et al. also found similar improvements.
In a 6-month study (Puigdellivol et al. 2018) of 130 osteoarthritis patients recruited from hospitals a dietary supplement containing a combination of hydrolyzed collagen, chondroitin sulfate and glucosamine showed significant improvement and in pain and function. It should be noted that chondroitin sulfate and glucosamine could be responsible for all or some of the improvement, though this does add to the body of literature that supports collagen supplementation.
Trc and Bohmova (2011) compared hydrolyzed collagen to glucosamine sulphate in osteoarthritis patients. They found clear improvement in pain and other symptoms with collagen supplementation and a significant difference as compared to the glucosamine subjects.
A small MRI study (McAlindon et al. 2011) confirmed the increase in collagen growth in the medial and lateral tibial cartilage regions with a collagen hydrolysate supplement. While this study was small and only looked at subjects with mild osteoarthritis it does show actual cartilage growth as compared to those on a placebo.
A 24-week study (Clark et al. 2008) of 147 college age athletes found significant improvements in pain at rest and across a variety of activities in the group consuming 10g of collagen hydrolysate. This was a double-blind study with a placebo control group.
Zdzieblik et al. (2017) looked at active individuals who had activity-related knee pain but did not have osteoarthritis. At 12 weeks they found significant reductions in pain in subjects taking a collagen supplement.
In a randomized, double-blind study Bruyere et al. (2012) found that subjects with upper extremity and spine joint pain had significant pain reductions at 6 months as compared to the placebo group.
Putting it all together
That is just a small subset of the research on collagen supplementation. Those eight studies all showed positive improvements in stiffness, pain and function with collagen intake. I could continue to reference many more studies that I read but I will spare you the boredom of going through them. In study after study clinical improvements were found. To me, the case is clear. If you suffer from osteoarthritis, or just have regular joint pain, you may benefit from adding a collagen supplement to your daily regime.
Now I know you are sitting there saying, I just said the case is clear then used the dreaded “may benefit”. Collagen is not a magic fix it for osteoarthritis. It improved symptoms for enough subjects in enough studies to have clinical significance. And if you or your clients are like me, some improvement is a welcome thing. If I can experience a little less pain and increase my function for $10.00 a week without all the risks that NSAIDS have then sign me up.
As for how much collagen to take, these studies used ranges from 5g to 15g. There is still no strong data concluding what the minimal effective dose is, if there are increasing benefits with higher doses or if there is an upper limit. The best conclusion I can currently make is a 10-12g dose should be a good starting point and there is no harm in using 15g or even higher. Collagen supplementation appeared to be safe and well tolerated at higher doses. The cost is another concern. I have seen products priced as high as $60 though you can obtain a 1-2 week supply at your local Trader Joes for under $10. The products you are buying are essentially processed animal byproducts that are usually turned into gelatin. There is absolutely no reason to purchase the higher priced products.
So, despite my usual reluctance to promote any sort of supplement, this week I am on board with giving collagen a try. It is well worth a six-month experiment to me. We will see in a few months if I am still taking it and experiencing any meaningful improvements.
Bruyere, O., Zegels, B., Leonori, L., Rabenda, V., Janssen, A., Bourges, C. and Reginster, Y. (2012) Effect Of Collagen Hydrolystate In Articular Pain: A 6-Month Randomized, Double-Blind, Placebo Controlled Study. Complementary Therapies In Medicine. 20(3):124-130. Clark, K., Sebastianelli, W., Flechsenhar, K., Aukermann, D., Meza, F., Millard, R., Deitch, J., Sherbondy, P. and Albert. A. (2008) 24-Week Study On The Use Of Collagen Hydrolysate As a Dietary Supplement In Athletes With Activity-Related Joint Pain. Current Medical Research and Opinion. 24:5. Kumar, S., Sugihara, R. Suzuki, K., Inoue, N. and Venkateswarathirukumara, S., (2015) A Double-Blind, Placebo-Controlled, Randomised, Clinical Study On The Effectiveness of Collagen Peptide on Osteoarthritis. Journal of The Science of Food And Agriculture, 95(4):702-707. Lugo, J., Saiyed, Z. and Lane, N. (2016) Efficacy and Tolerability of an Undenatured Type II Collagen Supplement in Modulating Knee Osteoarthritis Symptoms: A Multicenter Randomized, Double-Blind, Placebo-Controlled Study. Nutrition Journal 15:14 https://doi.org/10.1186/s12937-016-0130-8 McAlindon, T.E., Nuite, M., Krishnan, N., Ruthazer, R., Price, L.L., Burstein, D., Griffith, J. and Flechsenhar, K. (2011) Change in Knee Osteoarthritis Cartilage Detected By Delayed Gadolinium Enhanced Magnetic Resonance Imaging Following Treatment With Collagen Hydrolystate: A Pilot Randomized Controlled Trial. Osteoarthritis and Cartilage, 19:4, 399-405. Puigdellivol, J., Berenger, C., Fernandez, M., Millan, J., Vidal, C. and Gil, I. (2018) Effectiveness of a Dietary Supplement Containing Hydrolyzed Collagen, Chondroitin Sulfate and Glucosamine in Pain Reduction and Functional Capacity in Osteoarthritis Patients. Journal of Dietary Supplements, 16:4. Trc, T. and Bohmova, J. (2011) Efficacy and Tolerance Of Enzymatic Hydrolysed Collagen (ECH) vs. Glucosamine Sulphate (GS) In The Treatment Of Knee Osteoarthritis (KOA). International Orthopaedics, 35:341-348 Zdzieblik, D., Oesser, S., Gollhofer, A. and Konig, D. (2017) Improvement Of Activity-Relate Knee Joint Discomfort Following Supplementation Of Specific Collagen Peptides. Applied Physiology, Nutrition, and Metabolism. 42(6):588-595.