Today I’d like to welcome a guest post by my friend and colleague Carla Valmorbida. Carla’s independent consultancy, ‘Life Nutrition’ is in the process of moving from Queensland to Adelaide. She specialises in tailored, individual solutions for her clients and in creating group and corporate presentations – head over to her website for some fabulous resources and contact details.

Collagen is the most abundant protein in the human body and is largely responsible for providing structure and strength to our connective tissues. Most people who are involved in sports will at some time experience injury to such tissues – whether it be to their tendons, ligaments or even to their bones or cartilage. Tendons, fascia and ligaments in particular can be very slow in healing, causing much frustration and subsequent injury when the athlete returns to high training loads without adequate rehab or healing time.

Been there…done that…too many times…

This article looks at the most recent evidence on whether ingesting additional collagen, notably through supplementation with gelatin or hydrolyzed collagen supplements will help with the healing, stabilization and strengthening of these collagen-rich connective tissues with the ultimate aim of preventing injury in the first place.

Before I delve into the nitty gritty, the simple, unavoidable truth first:

There are many micronutrients involved in collagen formation and any additional free amino acids or peptides from supplementation will not be effectively used for collagen production if you are lacking in Vitamin C, E, A, sulphur and lysine in particular. Adequate amounts of these nutrients along with good hydration, sleep, regular exercise and avoidance of alcohol and smoking will do far more for collagen production and creating healthy bodily tissues then popping a few gummies or tablespoons of powdered collagen every day and neglecting these other elements.

SO, WHAT DOES THE RESEARCH SAY?

There are three key amino acids in particular that make up collagen: Proline, glycine and hydroxyproline. Research into supplementing with these amino acids have shown promise in increasing recovery rates on connective tissue(1), reducing muscle loss in the elderly(2) and in the treatment of osteoarthritis(3).

Supplementation is becoming of increasing interest to athletes as it’s recently been shown that taking 15g gelatin with around 48mg of Vitamin C, 30-60mins prior to targeted training such as jumping rope, will double the collagen production after those sessions compared to undertaking the session without such nutritional support.(4) Collagen intake has also been showed to improve function, instability and pain perception in ligament and joint damage – with the most significant and conclusive studies being undertaken on the ankles and knees.(5-8)

Sounds good yes?

Sure, but such studies have to be interpreted with care with substantial weaknesses being:

· Studies in this relatively new area are not common and most are sponsored by the supplement industry. This affects some studies referenced above but they have nonetheless been carefully included in my analysis as the institutions they worked with to undertake their research are so highly regarded in terms of their quality, methodology and ethics. There are plenty of others (all showing positive findings of course) which I omitted for being of questionable quality.

· Most researchers unfortunately compared collagen supplements or gelatin to a non-amino containing placebo only. It would have been far more meaningful to have an additional group taking an equivalent amount of whey protein for example – to identify how much of the positive result was attributed to the specific collagen-related amino acid mix. (Ie – the research doesn’t necessarily answer the question: Are collagen supplements just a tarted up, overpriced protein supplement?)

It’s important to acknowledge that collagen supplementation is still a very new, evolving area of study and there is still insufficient data to be truly conclusive about the efficacy, dosage and application. This includes that most positive studies on improving injury healing rates and injury prevention have very small sample sizes and therefore further, more comprehensive research is needed.

Crucially, the studies that produced positive results combined supplementation with targeted tendon/joint exercises or resistance training.

The theory is that the additional availability of the key amino acids required for collagen production allows the tissues to strengthen in the direction and for the purpose of the targeted activity to which they are being subjected in that active period of uber collagen peptide availability. Popping collagen pills or powers without complementary exercises is unlikely to have any effect on injury healing or the prevention of injury.

So, if you’re tempted to give it a go – based on the reviewed research, a reasonable regimen that you may want to try for the targeting of specific collagen-rich tissues is to:

· Take 10-15g gelatin or collagen peptide supplement 30-60mins prior to 10 minutes of individually-designed targeted connective tissue exercises.

· For injury prevention: 2-3 sessions/week with ideally a 6 hr window between other sessions

· More sessions maybe required if you are addressing a specific acute or chronically occurring injury. Discuss this with your physio.

Gelatin vs Supplements:

So, you might want to ask your Nanna to fire up her repertoire of wobbly gelatin-filled delights (or if you prefer, there are all sorts of recipes that abound on the internet that will contain far less custard, cream, sugar and painful cheek pinching). On the other hand, if you want to get fancier, throw a bit of $$ around but arguably it’ll be more convenient, there are an increasing number and range of new collagen supplements on the shelves these days. Many of these supplements contain the hydrolyzed form of collagen as these are arguably better absorbed by the body and therefore more bio-available after digestion for collagen production.

Additionally, supplementation with non-animal based collagen is of course really the only effective way for vegetarians or vegans to get additional exogenous amounts of these amino acids in any notable amounts without the ingestion of animal tissues. Such vegetarian and vegan collagen supplements (though hard to find!) are usually synthesized from modified yeast and bacteria. If you eat fish marine collagen is an option too.

Of course, you can also generally increase these key amino acids in your diet naturally by slow cooking or making bone broth with animal bones, cartilage and other connective tissues such as ligaments/tendons. It would be hard however to quantify dosage and eat such a dose in the context of the regimen suggested above.

A cautionary note: Concerns with heavy metal contamination have been raised with animal-based collagen supplements and/or high intakes of bone broth/similar dishes. I’d certainly avoid any such collagen-enhanced regimen for children or pregnant women.

Likewise, the outmost care must be taken to select a reputable brand of supplements. I’m far from expert in this area – so after writing this article, I sought advice from Phil (my supplement guru at Fit Empire and Wellness – Townsville). To be clear at this point – there’s no kickbacks for him or me (I just know a lot of you may appreciate a starting point!) He recommended ‘Gelita’ as a brand – both in terms of quality and purity. The Gelita staff are certainly lovely and take a lot of pride in their company, many thanks to Natalie took a lot of time to explain to me the ins and outs of some of their products.

(Side note from Rachel - I’ve been using “thankfully nourished sports collagen” because it was developed by a Sports Dietitian)

TARGETED EXERCISES – AN ESSENTIAL, NOT AN OPTIONAL COMPONENT!

I won’t go into depth with the different sorts of training/exercises that can be done as I’m certainly not a physio by any means and each sport and different injuries and individual athletes need to be professionally treated with a tailored program.

However, targeted exercises are an essential ingredient in the athletic context; so for your interest and consideration:

There are specific types of training that can stimulate collagen production in these connective tissues in different ways. The good news is that compared to muscular and cardiovascular adaptations that can benefit from hours of training, stimulus to strengthen the connective tissues largely turns off after 10 minutes – so no need to worry about how you’re going to fit in any more big blocks of training time into your day!

These mini-sessions are best done minimally 6 hours apart from each other or from other training – so timing is important. Generally 2-3 sessions/week are recommended for injury prevention and up to 2 or even 3 times/day to address and rehab an acute injury.(9)

· Fast, plyometric type of exercises improve strength and speed – the interlinking of collagen proteins within the muscle and at the muscle end of the tendon are built up under this sort of loading.

· Jarring exercises can be used to strength bone which is also a collagen-rich tissue. For example; a useful exercise for runners for the prevention of lower limb stress fractures is 5-10 minutes of skip rope jumping 3-4 times/week.

· Of particular use for tendon injury treatment or prevention is training with slow reps and heavy weights including exercises with eccentric loading or isometric holds.(7) This type of training will still increase the interlinking of the collagen proteins within the muscle but not so much at the muscle end of the tendon, reducing stiffness at those locations, thereby reducing risk of injury.

· Eccentric loading – where your muscle lengthens at the same time it’s being contracted – think of the downwards rather than the upwards part of a bicep curl

· Isometric holds – static holds where a muscle is under load but without lengthening/contracting of that limb – eg a static tricep extension against a solid surface such as a wall all or even the dreaded plank

Again, I stress with emphasis – the types of exercises you need and frequency should be tailored by a physio to suit your sport and to correctly target your area of likely (or current) injury.

CONCLUSION

Research is not yet at the point where we can positively define the dose-response effect of collagen supplementation or to separate out the effects of supplementing with specific collagen peptides vs standard amino acid supplements as unfortunately most of the research was merely comparing collagen vs placebo. Some more truly independent research would also be a valuable addition to this discussion.

However, it’s a promising new area for injury prevention and treatment in the athletic context with few reported side-effects – the most common being slight digestive upset (possibly more due to the ‘eeww’ factor of thinking what collagen is made from rather than any true physiological response).

The key take away points if you are considering jumping on the collagen train for injury treatment or prevention is that:

· Most successful studies used around 10-15g hydrolyzed collagen or gelatin with supplemental 48mg Vitamin C (eg a small 100mL glass of orange juice). If you want to make a “jelly” make sure you are using a source of vitamin C - don’t for example make a chocolate or coffee jelly

· Dosage taken 30-60 mins prior to targeted exercise sessions

· Sessions were short and comprised of specifically-designed, exercises on key target tissues or areas. See your physio for a program that suits your priorities

· Supplementation will be ineffectual if other micronutrients required for collagen synthesis are lacking (namely Vitamin C, E, A, sulphur and lysine)

Again, for emphasis – do not fall into the trap of thinking that you’ve popped a supplement therefore will automatically reap the benefits. Timing, frequency, targeted activity and general overall good health and nutrition is also essential.

Side note to this article that some of my clients have been asking about:

Much of the hype within the general population around collagen supplementation at the moment is as it’s role in the ‘beauty’ connective tissues such as in your nails,(10) skin and hair.(5) It’s important to note that from that many of the positive studies in this area were found to have substantial conflicts of interest (ie funded by the supplement makers) and the outcomes were self-reported – sooo….not exactly top science! Additionally, most beauty collagen supplements contain really small amounts of collagen so are unlikely to be effective to any great degree.

However, despite this – there is a small amount of genuine positive evidence to support supplementation for the improvement of these tissues, but the findings have been insufficiently consistent to ascertain effective dosage-response levels(11). Extrapolating from what we’ve learned in the athletic context, the lack of obvious, measurable and consistent response in these aesthetic tissues to supplementation, could be due to the absence of a particular, specific stimulus in those specific tissues. Ie – the additional amino acids in the blood stream may well be used to form other bodily proteins or used for other functions entirely.

So, if you want to grasp onto your youthful looks for as long as possible (don’t we all?!), you really should get your head out of the Jelly Jar and focus on establishing well-balanced dietary and healthy lifestyle habits – no groundbreaking news here!

Have you set yourself a big sporting goal this year? Need some support? My 8 week endurance nutrition program focuses on supporting your training with making nutritious food choices a priority so that you can get to the start line feeling great. On race day you will be armed with well trialled strategies that work for you and will help you run your best fuelled marathon, half marathon or triathlon.

REFERENCES

1. Lopez HL, Ziegenfuss TN, Park J. Evaluation of the Effects of BioCell Collagen, a Novel Cartilage Extract, on Connective Tissue Support and Functional Recovery From Exercise. Integr Med (Encinitas). 2015;14(3):30-8.

2. Hays NP, Kim H, Wells AM, Kajkenova O, Evans WJ. Effects of whey and fortified collagen hydrolysate protein supplements on nitrogen balance and body composition in older women. J Am Diet Assoc. 2009;109(6):1082-7.

3. Garcia-Coronado JM, Martinez-Olvera L, Elizondo-Omana RE, Acosta-Olivo CA, Vilchez-Cavazos F, Simental-Mendia LE, et al. Effect of collagen supplementation on osteoarthritis symptoms: a meta-analysis of randomized placebo-controlled trials. Int Orthop. 2019;43(3):531-8.

4. Shaw G, Lee-Barthel A, Ross ML, Wang B, Baar K. Vitamin C-enriched gelatin supplementation before intermittent activity augments collagen synthesis. Am J Clin Nutr. 2017;105(1):136-43.

5. Czajka A, Kania EM, Genovese L, Corbo A, Merone G, Luci C, et al. Daily oral supplementation with collagen peptides combined with vitamins and other bioactive compounds improves skin elasticity and has a beneficial effect on joint and general wellbeing. Nutr Res. 2018;57:97-108.

6. Dressler P, Gehring D, Zdzieblik D, Oesser S, Gollhofer A, Konig D. Improvement of Functional Ankle Properties Following Supplementation with Specific Collagen Peptides in Athletes with Chronic Ankle Instability. J Sports Sci Med. 2018;17(2):298-304.

7. Praet SFE, Purdam CR, Welvaert M, Vlahovich N, Lovell G, Burke LM, et al. Oral Supplementation of Specific Collagen Peptides Combined with Calf-Strengthening Exercises Enhances Function and Reduces Pain in Achilles Tendinopathy Patients. Nutrients. 2019;11(1).

8. Zdzieblik D, Oesser S, Gollhofer A, Konig D. Improvement of activity-related knee joint discomfort following supplementation of specific collagen peptides. Appl Physiol Nutr Metab. 2017;42(6):588-95.

9. Jeukendrup A. Using gelatin to improve performance prevent injury and accelerate return to play 2017. Available from: http://www.mysportscience.com/single-post/2017/03/15/Using-gelatin-to-improve-performance-prevent-injury-and-accelerate-return-to-play.

10.Hexsel D, Zague V, Schunck M, Siega C, Camozzato FO, Oesser S. Oral supplementation with specific bioactive collagen peptides improves nail growth and reduces symptoms of brittle nails. J Cosmet Dermatol. 2017;16(4):520-6.

11.Choi FD, Sung CT, Juhasz ML, Mesinkovsk NA. Oral Collagen Supplementation: A Systematic Review of Dermatological Applications. J Drugs Dermatol. 2019;18(1):9-16.