Dec. 12, 2019 -- In January 2019, Jessica Sansevera looked in the mirror and discovered the holidays had not been kind to her skin. Winter dryness and stress had deepened her fine lines, and overindulgence in caffeine and sugar had left her with welts of rosacea-related acne around her mouth.
“My skin was just not where it should be for a woman my age, and I wanted to do something preventive before those lines got too etched in,” says Sansevera, a 30-something mother of two and schoolteacher from Westchester, NY.
Due to her sensitive skin, fancy treatments and expensive creams were off the table. So, at the advice of her dermatologist, she took a different “inside-out” approach. She began spiking her morning smoothie or coffee with a scoop of ground-up cow or fish parts -- aka collagen.
Within a month, her acne abated, replaced with a rosy glow. And within 3 months, she noticed a host of other unexpected changes. Her nails were thicker. Her hair stopped falling out in the shower. And she could dance without pain from her knee osteoarthritis.
“It is not a miracle pill,” she stresses, noting that she also cleaned up her diet and added a probiotic to her daily routine. “But I absolutely believe the collagen is helping.”
Sansevera’s discovery is hardly a new one.
For centuries, Chinese women have viewed collagen -- a protein that binds tissues in fish and animals -- as a fountain of youth, routinely consuming foods like pig’s feet, shark fins, and donkey skin in hopes of smoothing withered skin and preserving aging joints. In the United States, collagen became best known in the 1980s as an expensive injectable filler to plump lips and soften lines. But only in recent years, as companies have come up with more appetizing ways to take it (including fruity chews, vanilla-flavored-coffee creamers, single-serving sachets, and easy-to-swallow capsules) has edible collagen begun to catch on here.
Instagram endorsements from celebrities like Kourtney Kardashian (who starts her day with a hot collagen beverage) haven’t hurt. And thanks to a small but growing body of evidence suggesting it can improve skin, ease arthritis symptoms, promote wound healing, and fend off muscle wasting, former skeptics in the medical field are also beginning to come around.
In 2020, in the United States alone, consumers are expected to spend $293 million on collagen supplements, up from just $50 million in 2014, according to market research firm Nutrition Business Journal. Globally, as collagen makes its way into more foods and beverages, topicals, and even the operating room, the market is projected to reach $6.5 billion by 2025.
But despite its popularity, questions remain about how well it works and how safe it is.
“It’s definitely among the top three products people ask me about, and I believe it does hold promise in some diverse areas of medicine,” says Mark Moyad, MD, director of the complementary and alternative medicine program at the University of Michigan Medical Center. “It’s also one of the most wacky and controversial.”
The Body's Scaffolding
Collagen is often called the body’s scaffolding.
“It’s the glue that holds the body together,��� says New York dermatologist Whitney Bowe, author of The Beauty of Dirty Skin: The Surprising Science of Looking and Feeling Radiant from the Inside Out.
She says collagen makes up about 75% of the dry weight of your skin, providing volume that keeps skin looking plump and keeps lines at bay. It’s also rich in in the amino acids proline and glycine, which you need to maintain and repair your tendons, bones, and joints.
“As we get older, we break it down faster than we can replace it,” she says, noting that we begin to lose about 1% of our collagen per year in our mid-20s and lose as much as 30% during the first 5 years of menopause.
Injecting collagen has fallen out of favor in many medical skin care practices, since it doesn’t last as long as other fillers and tends to prompt allergic reactions. And when it's put on the skin, it doesn’t absorb well, Bowe says.
When she learned a few years ago that people were eating it instead, she was skeptical. But she has since changed her mind.
“Just in the last few years, there have been some impressive studies showing that ingestible collagen can indeed impact the appearance of skin,” says Bowe.
One 2014 study of 69 women ages 35 to 55 found that those who took 2.5 or 5 grams of collagen daily for 8 weeks showed a lot of improvement in skin elasticity, compared with those who didn’t take it.
Another found that women who took 1 gram per day of a chicken-derived collagen supplement for 12 weeks had 76% less dryness, 12% fewer visible wrinkles, better blood flow in the skin, and a 6% higher collagen content.
And a 2019 review of eight studies including 805 patients concluded that “preliminary results are promising for the short and long-term use of oral collagen supplements for wound healing and skin aging.”
Moyad, author of The Supplement Handbook: A Trusted Expert's Guide to What Works and What’s Worthless for More Than 100 Conditions, cautions that many of the studies done so far on collagen are small and at least partially funded by industry.
“The science is truly in its infancy,” he says. “There’s a lot of conflict of interest, and not enough quality control.”
But he, too, believes collagen holds promise.
As a protein source alone, collagen is an excellent one, packing in more protein per calorie than other sources while containing less sodium and sugar. And Moyad finds the evidence suggesting it may improve body composition, joint health, and healing rates intriguing.
One recent study of 53 elderly men with sarcopenia, a loss of muscle caused by aging, found that those who took 15 grams of collagen daily, in addition to lifting weights three times per week for 3 months, gained significantly more muscle and lost more fat than those who only lifted weights.
Collagen has also been shown to act as a powerful wound healer, able to stop bleeding, recruit immune and skin cells, and stimulate new blood vessel formation. One study of 89 long-term care residents with pressure ulcers found that those who took collagen supplements three times daily for 8 weeks saw their wounds heal twice as fast. Another, of eight patients who had a small surgical skin biopsy, found that daily topical collagen healed their wounds at least as well as sutures.
While research is mixed, a few studies have also shown that collagen supplements help with arthritis pain and sports-related joint pain. If this benefit plays out in a large, long-term clinical trial, it could be a game-changer, says Moyad.
“We are desperate for more low-cost, nonaddictive, and safe pain-modifying products,” he says.
Not Everyone's Convinced
All that said, some health professionals remain skeptical.
Augusta, GA-based dermatologist Lauren Eckert Ploch says stomach acids break down collagen proteins you eat before they reach the skin intact, so she’s not convinced it helps at all. “The jury is still out.”
Then, there is the ick factor.
“I think the elephant in the room here is safety,” says Moyad. “We are talking about ground-up fish, chicken, pig, and cow parts, and these parts tend to act as sponges for contaminants and heavy metals.”
In one recent test of 14 popular collagen supplements, by the supplement testing company consumerlab.com, all products contained the levels of collagen they said they did, but one also contained high levels of cadmium, a toxic heavy metal.
Meanwhile, dermatologists and consumer groups have also expressed concerns that those ground-up hooves, hides, bones, and nerve tissues -- particularly if they come from cows -- could carry diseases like bovine spongiform encephalopathy (BSE), or mad cow disease.
Andrea Wong, senior vice president for scientific and regulatory affairs for the industry trade group the Council for Responsible Nutrition, says that as ingredients go, collagen has an excellent track record.
“It has been around for ages, and there is a large body of evidence supporting its safe use,” she says. She notes that studies that see how well it works also look at side effects. In general, collagen has been shown to be safe, Wong said.
She notes that supplement companies are required to comply with federal “good manufacturing practices,” which prohibit unsafe levels of contaminants like heavy metals.
In 2016, the FDA prohibited the use of some cow parts in dietary supplements to “address the potential risk” of the presence of BSE. (Human consumption of BSE-infected meat has been linked to neurological disorders.) The FDA exempted gelatin -- a key collagen source -- from the ban, “as long as it is manufactured using specified industry practices.”
Because dietary supplements vary widely in quality and are generally not regulated as rigorously as drugs, Valori Treloar, a Massachusetts dermatologist and nutritionist, prefers that her patients get their collagen from homemade stock using bones from chicken, fish, or beef.
“I think collagen is interesting and there is some data out there suggesting benefit, but I prefer for my patients to eat food,” she says.
How to Choose
Moyad says many of the concerns expressed about collagen supplements can be addressed by choosing wisely.
Look for companies that get their bones and tissues from cage-free, free-range, and antibiotic-free sources. Look for a trusted brand with a third-party label like NSF or USP. And check out the company’s website to see what it’s doing to keep heavy metals and other contaminants out of their products.
“Consumers need to have the attitude of ‘just prove to me that it’s clean and I’ll try it,’” he says, noting that it can take up to 12 weeks for results to show. “It might help, and it probably won’t harm, unless you are not being diligent about quality control.”