Curious about Connective Tissue? Let's Talk About Collagen
Collagen is a critical protein for development, structure and function of tissues and organs throughout the body and is implicated in many diseases. And what's the deal with collagen supplements?
Collagen constitutes a substantial 30% of our body's proteins. It plays a pivotal role in maintaining the structural integrity and strength of various tissues. As we dive into collagen, we'll talk about its diverse roles, its involvement in biological processes, and the “trend” of collagen supplementation.
So, what is collagen?
Collagens are a group of proteins, with 28 different types encoded by 43 genes in the human body. It is a vital component of the extracellular matrix (ECM), functioning as a 'glue' that holds together the dynamic network of proteins outside our cells. This matrix provides structural support and facilitates cell communication. Collagens exhibit a variety of expression patterns and functions but are found virtually everywhere. Highly expressed in connective tissues such as skin, tendons, ligaments, and bone, collagen significantly contributes to skin elasticity, joint flexibility, and bone and tendon strength. Beyond the skin and joints, collagen forms the structural foundation of crucial organs like the heart and lungs. Collagen plays a key various biological processes, making its first appearance early in development. It provides structural support for tissues and organs, aiding in proper wound healing, maintaining tissue integrity, and supporting organ function.
Collagen in health and disease
Due to its broad expression and multifaceted roles, collagen is implicated in diseases spanning from connective tissue disorders like Ehlers-Danlos Syndromes (EDS) to skin-related conditions, autoimmune disorders, fibrosis, and even cancer metastasis.
Scurvy
Scurvy, a disease known for its historical impact on sailors, is another example of collagen in human disease. This condition arises from a deficiency of vitamin C, a key player in collagen synthesis. Vitamin C is essential for the hydroxylation of proline and lysine residues in collagen, a process crucial for the stability of collagen fibers. In the absence of vitamin C, collagen production is disrupted, leading to weakened connective tissues, impaired wound healing, and, the characteristic symptoms of scurvy such as bleeding gums, joint pain, and skin lesions.
Autoimmune Diseases
Diseases like lupus, ankylosing spondylitis, rheumatoid arthritis, and Sjögren syndrome emphasize the relationship between collagen and autoimmune disorders. In these conditions, the immune system turns against the body's own tissues, and collagen is a key player that is affected. Rheumatoid arthritis, for instance, involves an immune attack on the synovium, a connective tissue rich in collagen, leading to joint inflammation and damage. Similarly, lupus, an autoimmune disease affecting multiple organs, manifests with immune-mediated collagen alterations contributing to skin, joint, and organ involvement. Ankylosing spondylitis, primarily impacting the spine and large joints, underscores collagen's role in autoimmune-induced structural changes. Sjögren syndrome, characterized by immune attacks on moisture-producing glands, implicates collagen in the disruption of glandular tissues.
In conditions like scleroderma, aberrations in collagen metabolism result in excessive collagen production. This surplus collagen accumulation causes skin hardening and thickening, significantly impacting the skin's flexibility and overall health. In psoriasis, an inflammatory cascade prompts an accelerated turnover of skin cells, affecting collagen dynamics.
Fibrosis
In some instances, excess collagen accumulation occurs, leading to fibrosis, as a consequence of scarring or tissue repair. As tissues undergo stiffening due to an abnormal buildup of collagen, their functionality becomes compromised. Fibrosis can occur in various tissues and organs. The heart can have impaired contractility and potentially heart failure as a consequence of fibrosis. Similarly, the lungs can face challenges when ensnared by fibrotic changes.
Cancer Metastasis
In cancer, altered collagen and ECM interactions can create a microenvironment conducive to tumor progression. This microenvironmental interplay involves intricate signaling mechanisms that support cancer cell survival, proliferation, and invasion.
Genetic Connective Tissue Disorders
The genetic implications of collagen become apparent in inherited disorders like Osteogenesis Imperfecta and EDS. Direct links to mutations in collagen genes underscore its significance beyond a structural element, portraying it as a fundamental player in the orchestration of our genetic makeup. In other cases, mutations aren’t present in collagen directly, but in other components that interact with collagen.
In cutis laxa, there is a deficiency in elastic fibers, leading to loose and sagging skin. Despite elastin being impacted, underlying biology also involves disruptions in collagen. Similarly, Marfan syndrome is associated with mutations in fibrillin-1, however, changes are also seen in collagen metabolism.
So, what is the deal with collagen supplements?
The collagen supplement market is estimated to hit $1.8B in a few years, yet there is little efficacy to support their use for many of the claims being made. As a health and beauty trend, collagen supplements, serums, and creams are marketed as beneficial for things from skin elasticity, aging, hair growth, and nail strength to joint protection and arthritis. Some data suggests cosmetic benefits of collagen supplementation, but most studies have been relatively small and some have lacked crucial things like a control group or placebo. In the orthopedic space, the data is really limited.
The recent surge in the popularity of collagen supplements also raises questions about their efficacy, especially in the context of genetic connective tissue disorders like EDS. To dive into it, its important to understand what collagen supplements actually are and how your body uses them. These supplements provide hydrolyzed collagen, broken down into smaller peptides and amino acids, which serve as building blocks for various bodily processes. However, it's crucial to understand that collagen consumed through supplements does not equate to collagen in our tissues. Those amino acids from supplementation can be used by your body to produce proteins based on instructions from your DNA (and other biological factors, like epigenetic changes), there is no guarantee they will be assembled back into collagen in your body, or in places where you want/need it. And if you don’t want to take my word for it, another great summary can be found here.
Individuals with genetic connective tissue disorders, such as EDS, harbor mutations affecting collagen synthesis or components interacting with collagen. While collagen supplements offer amino acids, they fall short of addressing the underlying genetic factors responsible for these disorders. The consumption of collagen supplements is not any different than getting protein or amino acids from other sources.
All of that being said, if you want to buy collagen powders as a source of protein, go for it - it can be a great way to get that extra protein in your diet, especially if you struggle with nutrition, malabsorption, GI issues with solid foods, or are working on improving muscle mass. If you see positive changes in your skin or nails, that’s great, but is it really because of those collagen peptides, or just that you are giving your body nutrients it was lacking before? Some of the key things needed to produce collagen include the amino acids proline and glycine, vitamin c, zinc and copper. They can be found in a lot of foods that are easy to incorporate into your diet if you aren’t already - I recommend talking to a registered dietician if you have concerns about your diet and how to best support your health.
And a general disclaimer, remember that the supplement industry as a whole is unregulated. Claims don’t have to be backed by the same rigorous research that pharmaceutical drugs go through because they don’t go through FDA approval. That doesn’t mean all supplements are scams, but as consumers, be skeptical!
With the popularity of collagen supplementation, we will likely more studies and data coming out in this space. I look forward to sharing them with you!