The Facts on Collagen Supplementation

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After covering collagen basics on Tuesday, two questions remain. Are collagen supplements absorbed or are they digested just like any other protein? Second, does research support the use of collagen supplementation to improve skin quality? Let’s take a look.

Collagen Absorption

The data on collagen absorption is sparse. In almost every study, dipeptides or tripeptides are used; then the change in serum peptides over several hours after ingestion is measured. There’s enough data to suggest that the tripeptides are absorbed as a whole without being broken into individual amino acids.

What hasn’t been tested yet is whether protein ingestion from a meal may interfere with the digestion and absorption process.

Is Collagen Supplementation Effective?

Several review articles have summarized the absorption of collagen. Eleven studies with just over 800 subjects were included in the latest review; eight of those studies used collagen hydrolysate, 2.5 to 10 grams per day, for eight to 24 weeks. They tested whether the supplemental collagen benefitted people with pressure ulcers, dry skin, aging skin, and cellulite, with generally positive results. Two studies used collagen tripeptides, three grams per day for four to twelve weeks, with notable improvement in skin elasticity and hydration. Again, positive results.

I was disappointed to find no research on whether collagen may benefit other connective tissue such as tendons and ligaments. That may help the recovery from rotator cuff or Achilles tendon surgery, among many other conditions.

Practical Application

Based on the data, it appears that collagen tripeptides are absorbed intact to some degree, although I’m still concerned about the absorption in relation to meals. I’m already recommending that essential amino acids be taken at least 15 minutes or longer before a meal. But I think to help with absorption, take collagen tripeptides, usually collagen I and III, about 15 minutes before a meal if it contains protein or a couple of hours afterward. Giving the digestive system a head start may increase absorption. I put mine in my second cup of coffee because it has no flavor and the heat doesn’t impact the tripeptides.

The Bottom Line

Although the evidence is not overwhelming, there are positive results using collagen supplements to benefit your skin. Research shows that it will be absorbed in a form that can help the body make structural collagen for the skin. While the studies I cited used differing amounts of collagen for varying amounts of time, I would try 5 to 10 grams per day for at least 90 days to see results. And pay attention to your muscles and joints; you may find they benefit as well.

What are you prepared to do today?

        Dr. Chet

References:
1. Biol Pharm Bull. 2016;39(3):428-34.
2. StatPearls. Biochemistry, Collagen Synthesis. Marlyn Wu; Kelly Cronin; Jonathan S. Crane. 2021. PMID: 29939531
3. J Drugs Dermatol. 2019;18(1):9-16.

Are Collagen Supplements Effective?

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I spent the past weekend with a few thousand of my closest friends, some in person and others via live broadcast; that always means I get some good questions, including one about collagen I couldn’t answer.

A healthcare professional had told one attendee that collagen supplements were broken down into individual amino acids before being absorbed, as proteins are from any source, thus he was wasting his money buying collagen supplements. I decided that the answer could benefit everyone, so this week we’ll cover collagen basics.

Collagen is a protein and therefore is made up of amino acids. We can manufacture it, but just like other characteristics of aging, we make less as we get older. Collagen provides structure to all connective tissue such as skin, tendons, bones, and ligaments. We notice it most in our skin. Crepe skin? Smile lines around the eyes? Those come courtesy of reduced collagen. There are close to 30 types of collagen that have been discovered, but the most prevalent are types I–IV. Of that, over 90% are type I.

Collagen is made of repeating sequences of tripeptides or three amino acid blocks; they form three chains that twist to make a triple helix. The primary amino acid sequence of collagen is glycine-proline-X or glycine-X-hydroxyproline where X can be any of the other 17 amino acids. Glycine is the amino acid with the smallest structure; that allows the collagen triple helix to twist tightly and thus adds strength to the structure wherever it’s used, including the skin.

That’s the structure of collagen. On Saturday, we’ll answer the absorption question and look at how to use collagen most effectively. In tomorrow night’s Insider conference call, I’ll cover collagen more in depth as well as comment on the recent United States Preventive Services Taskforce on vitamin supplementation. If you become an Insider before 8 p.m. Eastern Time tomorrow, you can join me live to get your questions answered.

In the meantime, maybe you should just be proud of those smile lines—you’ve earned them, after all.

What are you prepared to do today?

        Dr. Chet

Reference: StatPearls. Biochemistry, Collagen Synthesis. Marlyn Wu; Kelly Cronin; Jonathan S. Crane. 2021. PMID: 29939531

It’s Still All About the Calories

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The keto vs. Mediterranean diet study was interesting for a variety of reasons. The researchers deserve a lot of credit for even attempting to try a study of this magnitude; 40 subjects may not seem like a lot, but to provide food via delivery together with instructions on preparation is very expensive and labor intensive. It should be noted that a portion of the study took place during the lockdown phase of COVID-19; that delayed some testing, but to their credit, the subjects affected continued the particular diet they were on for the two weeks until testing could be scheduled. Here are my thoughts on the results.

Blood Lipids

  • Subjects on the keto diet showed a greater decrease in triglycerides (TG) than those on the Mediterranean diet.
  • On the other hand, those on the Mediterranean showed a greater decrease in LDL-cholesterol than did the keto diet subjects.

While the researchers discussed it at length, I don’t think it was relevant. All subjects began with average fasting TG in the normal range. While both diets decreased TG, that the keto diet reduced it slightly more isn’t earth shattering when you start at a normal reading.

The same holds true for the LDL-cholesterol. Yes, the Mediterranean diet reduced it while the keto diet increased it, but the net was 6 mg/dl over the initial readings. What could have been concluded was that neither diet reduced LDL-cholesterol by an amount that was clinically meaningful.

The Microbiome

There were no tests of the changes in the microbiome under each diet reported—at least not yet. Subjects had a definite decline in fiber intake, especially when they provided their own food in the keto diet. The Mediterranean diet saw an increase in fiber intake when subjects provided their own food.

Why mention this at all? The microbiome controls the initial processing of nutrients. In addition, the immune function begins in the gut. While the keto diet may have provided some benefit related to HbA1c, at what cost? We simply don’t know. What we do know based on other research is that the lack of fiber changes the probiotic content of the microbiome.

The Bottom Line

The data showed that the subjects averaged 200 to 300 fewer calories per day regardless of diet and maintained the reduction over both diets. They ate better, they ate less, and they lost weight.

I think this study was important because it leaves us with better questions to ask in the future, such as: how would health measures be affected if subjects reduced calories another way? It also proves what I’ve been saying for years. The average weight loss after the study was 13 to 17 pounds, and that was maintained during the follow-up period. This was not a weight loss study, yet regardless of the initial diet, the subjects lost weight. I’ve said it before and I’ll say it again: regardless of the type of diet, it’s still all about the calories.

What are you prepared to do today?

        Dr. Chet

Reference: AJCN doi.org/10.1093/ajcn/nqac154

Face-Off: Mediterranean vs. Keto

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Last week ended with the publication of an interesting study on two popular diets, Mediterranean and ketogenic, and their potential benefits for people with elevated HbA1c levels; HbA1c is a blood test that measures your average blood sugar levels over the past three months. I use the word “diet” as a description of the type of foods eaten, not as a weight loss program.

The researchers constructed what they termed the Well-Formulated Ketogenic Diet plan to compare with a Mediterranean diet. Both approaches reduced sugar, refined carbohydrates, and starchy vegetables; the Mediterranean diet added unprocessed whole grains, beans, and fruit. The subjects had either prediabetes or type 2 diabetes. The primary goal of the 36-week program was to monitor changes in HbA1c along with a variety of secondary measures including blood lipids.

The 40 subjects were randomly assigned to using the keto diet for 12 weeks and then switching to the Mediterranean diet for 12 weeks or vice versa. Food was delivered to all subjects for the first four weeks of both phases, which I think is brilliant—one of the hardest parts of learning a new way of eating is discovering how the foods can be combined and prepared, along with getting used to the different tastes. After those four weeks, they provided their own food that fit within the particular diet they were on at the time. The final 12 weeks were left up to the subjects.

The results demonstrated both dietary approaches reduced HbA1c about the same amount, and the decrease was maintained regardless of which diet they began with. However, there were some differences as well. I’ll give you those on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: AJCN doi.org/10.1093/ajcn/nqac154

Citric Acid: Stone Killer?

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Increasing fluid intake can reduce the risk of developing stones of all types: kidney stones, gall stones, bladder stones, or uric acid crystals. But there’s one more thing you could do to reduce the risk—add some citric acid to the fluids you drink. While the research on using a form of pharmaceutical is not clear yet, this is one thing we can do with diet.

We expect electrolytes such as sodium, potassium, magnesium, and calcium in sport drinks, but adding citric acid can help your blood’s pH as well as reduce the formation of stones. The simplest approach would be to drink limeade or lemonade; fresh squeezed or a manufactured drink, citric acid makes the drink tart and sour. The food with the highest amount of citric acid is lime, with lemon a close second. I typically use sugar-free lemonade and add the juice from one lime in a 16-ounce container. It’s very tart but not inedible.

Avoid the mentality of “if some is good, more must be better.” Research hasn’t shown that to be true, so let’s stick to what we know. And while citric acid is a weak acid, it may still give you an upset stomach if you have too much. One lime or lemon per day seems to reduce stone formation.

What are you prepared to do today?

        Dr. Chet

Reference: Korean J Urol. 2014 Dec; 55(12): 775–779.

Don’t Forget Fluids

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With the unseasonably warm weather many of us are experiencing, I thought it was time to remind you that it’s not all about water: the emphasis should be on fluids. Coffee, tea, milk, soda, sports drinks, soup—all of those count toward your daily fluid intake.

It’s true that some drinks are better than others. Sugary drinks take extra fluid to keep your blood osmotically balanced or to store the sugar as glycogen, but all drinks count as fluid. The only drinks that don’t count are alcoholic drinks because alcohol is a diuretic; caffeine isn’t a true diuretic, so worry about the caffeine only as it affects your sleep. But the rest? All good. Don’t forget that most vegetables and fruit are mostly water, so they count as fluid as well.

How much fluid do you need? One-half your body weight in ounces (if you weigh 200 pounds, make sure you’re getting at least 100 ounces of water every day), and more if you’re in the humid heat.

There’s one more thing you could add; I’ll let you know what on Saturday.

What are you prepared to do today?

        Dr. Chet

Taking Biotin? Tell Your Doctor

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Biotin is a B vitamin often used for skin health among other benefits; it’s involved in many metabolic processes in the body. Due to its chemical nature, it’s used as a coenzyme in several tests. One of those tests is for troponin, a protein released from the heart into the bloodstream during a heart attack. There are no large trials that have tested the effects of biotin on troponin testing, but a physician or lab tech needs to know if you’re taking extra biotin.

The amounts in multi-vitamins appear to cause no issues, but adding the biotin in products to improve hair, skin, and nails could be enough to impact the test. Did it in our subject’s case? Maybe. We don’t know for sure.

As we approach this long holiday weekend, take a minute to add up all the biotin you’re taking in supplements. If it’s more than one gram, and if you end up in the ER because of a suspected heart attack or stroke, tell the lab tech. It doesn’t impact your having a heart attack; it impacts the test as to whether you may have damage to your heart as a result of a heart attack. You don’t want that test to be inaccurate because it’s important to arriving at the correct diagnosis.

Enjoy the July Fourth holiday, check out the audios on sale for men and women, and I’ll be back next week.

What are you prepared to do today?

        Dr. Chet

Still in Doubt? Check It Out Again

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In the last Memo, I said we weren’t done with the person who had waited three days. We spoke again after a couple of days, and she still had the same pain profile: back and chest, not as intense. She’d had a heart catheterization that came back clear: no blockages in any of her coronary arteries. Still the discomfort bothered her.

I’ve talked to many people over the years who were going through the same thing. I always recommend they go to the ER immediately. She had done that, albeit a couple of days later, and the diagnosis was indeterminate. She did have extremely high blood pressure which had come down with treatment in the hospital, but like most people, she disliked some of the side effects and didn’t want to take the meds. As we talked, she mentioned that she also had dizziness going up a flight of stairs and her vision was blurry. That was it—that’s a symptom of a stroke, so I recommended she go back to the ER if someone was there to drive her.

They ran more tests including and MRI of her head. No blockages or evidence of a stroke; her blood pressure was still way too high, but that could be managed at home. Still there was a diagnosis of a heart attack based on enzyme levels even though the ECG didn’t show it. She is working on lifestyle changes to get off blood pressure medications if possible.

But the enzyme level triggered something in my memory, and I’ll tell you about that on Thursday. Make sure you read it before the holiday weekend begins. Remember, the audios Dr. Chet’s Health Tips for Women with Dr. Pam and Health Tips for Men are still on sale through the Fourth of July.

What are you prepared to do today?

        Dr. Chet

Three Freaking Days!

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When it comes to health, my experience has shown that women tend to take a little better care of their health than men do. I checked back to when I began to use the phrases, “Never, never, ever, ignore chest pain” and “When in doubt, check it out!” It was about 20 years ago. And yet I’m still surprised when people don’t do it.

In fact, it happened within the past two weeks. A reader called me about some health issues. She wasn’t a stranger; we had talked before about her issues. This time it was an inquiry about discomfort in the chest and back—not really pain, but not nothing either. Doing some yoga and deep breathing seemed to help. I always tell people that the safest, most conservative approach is to go check it out at the emergency room. That’s the only way you know for sure. We left it at that.

Finally, a couple of days later, the discomfort got worse and moved toward her left arm. She finally went to the ER—three freaking days after the symptoms began. At least she didn’t wait ten days like my friend Jim.

I understand the hesitation; I’ve faced it myself. No one wants to seem alarmist or silly, and not everyone has health insurance to cover the costs. Still it’s better to be alive with a hospital bill than with a damaged heart or worse for delaying.

The Bottom Line

Let me be very clear about this: when it comes to your heart or your head, when in doubt, check it out. Delaying may make things worse.

Or the problem may turn out to be nothing. You thought we were done with this person? Nope, but I’ll save it for next week.

Women’s hearts are different and the symptoms related to heart disease may be different. This may be a great time to pick up Dr. Chet’s Health Tips for Women with Dr. Pam. As an incentive, I’m lowering the price on the MP3s to $4.95 for Health Tips for Men and Health Tips for Women through the Fourth of July.

What are you prepared to do today?

        Dr. Chet

When In Doubt, Check It Out

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Father’s Day reminded me of some of the wonderful men I’ve known who’ve passed on. The one I miss the most is my best friend Jim even though he’s been gone over 20 years. I can’t help but believe he might still be with us if had done just one thing: check it out.

Jim started having chest pain at Thanksgiving Dinner; he told his wife that he was just tired and stressed from the holidays. He actually went to work on the following Monday, but as the week went on, he felt worse and worse. He was having a heart attack for nine days! By the time his family insisted on calling an ambulance on the following Saturday, it was too late. He died in the ER.

When in doubt, check it out. That’s where the phrase came from, although the symptoms in Jim’s case were clear. It doesn’t apply only to chest pain or other symptoms of a heart attack. If you have blurry vision, a sudden headache, or your face is drooping, that could be a sign of a stroke. Even if the symptoms subside, you have to get them checked out. Better a trip in an ambulance than a hearse.

Jim left behind a family. His wife, three kids, and grandkids needed him desperately at times over the following years; I needed him, too. I want you to be safe and healthy, not the gaping hole left in the family photo. So when in doubt, check it out.

If you haven’t heard my Health Tips for Men, now might be a good time to purchase a copy. There’s more to Jim’s story and nine other health issues that impact men. But what about women? I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet