Monday, February 6, 2012

Drugs from Strangers and the Collagen Controversy

I am a skeptic.  I question and analyze everything.  I am especially hard on the supplement industry because in a country that does not rigorously regulate supplements it is all too easy to market an ineffective, bogus product.  On Wednesday, I am posting about a glucosamine chondroitin study that found no improvement in joint health from taking any version of this once glorified supplement cocktail.  With glucosamine falling from favor, collagen is now receiving more attention.

I had never intended to try or discuss collagen until NeoCell, a supplement company that sponsors the likes of Frankie Edgar and Igor Gracie, offered to send me some samples to review.  After some searching the web and after talking to a few other jiu-jitsu bloggers, I found that this is a common marketing tactic for NeoCell (nothing wrong with that by the way), but this should make you a bit more critical of NeoCell reviews because the gift of a free product could potentially create bias (this is why it is illegal for a blogger to review a product without disclosing that he was given the product for free).

A suspect promotion might look like this post from the Fair Field North Jersey MMA blog:
Collagen is a very important protein for your body, and were not talking about getting rid of wrinkles here either! lol NeoCell’s Collagen Sport is an excellent source of Collagen protein which actually aids in joint, and tissue repair. MMA Legend’s Renzo Gracie, andFrankie Edgar swear by it! It also has the amino acid L-Glutamine it which helps the body naturally produce Collagen.  Brazilian Jiu Jitsu training will increase your chances for later life arthritis, but all these therapies I suggest will minimize and enhance your post recuperative process and make it a most enjoyable one without great pain.
Meg from MegJitsu, however, is a bit more realistic about her ability to gauge the effectiveness of a collagen supplement (she too is blogging about recovering from knee surgery, so check out her blog if you have time):
While taking the Collagen+C supplements my knee did feel stronger. It is impossible for me to determine how much this is to do with the normal healing process, consistent rehab work or collagen supplements. The jury is still out on the effectiveness of collagen supplements in meeting a range of health claims such as improved hair and skin and help with strong muscles and ligaments and there are those who would suggest that taking supplements outside of doctor’s orders could do harm. Making those informed decisions has to be down to the individual and her health care provider. All I can report is that in the 2 weeks that I took the supplements at the recommended dosage, I noticed no ill-effects.
William from Powering Through addressed some of the positive research on collagen (though I am unsure of the scientific merit of these studies):
A study by Ruiz Benito et al in (2009) saw subjects a randomized trial report a decrease in joint discomfort and another Meta analysis by Moskowitz (2000) reported “Collagen hydrolysate is of interest as a therapeutic agent of potential utility in the treatment of osteoarthritis and osteoporosis. Its high level of safety makes it attractive as an agent for long-term use in these chronic disorders.” Other studies have pointed to collagen supplementation improving the activity of chondrocytes into producing more collagen. Other studies point to increased bone density but thus far these have been conducted on rats. Most of the other studies on this supplement have been conduction on patients with arthritis so applicability to a (fairly) healthy athlete might be a little strained.
And to round out the debate, Scott Gavura, a pharmacist and writer for Science Based Medicine, offers a highly critical perspective on collagen supplementation for joint health:
When we consume collagen, usually in the form of food, the long chain proteins are broken down during digestion to their original amino acids. Only then can they be absorbed. Once absorbed, these amino acids are available as building blocks to support collagen synthesis throughout the body. So from a dietary perspective, your body doesn’t care (and can’t tell) if you ate a collagen supplement, cheese, quinoa, beef, or chick peas — they’re all sources of protein, and indistinguishable by the time they hit the bloodstream. The body doesn’t treat amino acids derived from collagen any differently than any other protein source. For this reason, the idea that collagen supplementation can be an effective treatment for joint pain, osteoarthritis, or any other condition, is highly implausible, if not impossible in principle.
This point made by Gavura, the idea that collagen is the foundation for almost everything in our bodies and that our body basically breaks down any collagen supplement into basic amino acids, is the crux of the collagen-skeptic camp.  As one of my friends put it, eating collagen to improve cartilage health would be like eating bones to improve bone health, and that's just not how it works.  As far as I can tell, there is no definitive study linking collagen to improved joint health that matches the scale and rigor of the glucosamine chondroitin article recently published in the British Journal of Medicine (I planned on discussing this today, but I wanted to address collagen as soon as possible since many other bloggers are talking about it).

For my end, I am still waiting on the science.  For me to take a collagen supplement and to report to you that my knees felt better would be meaningless.  Anecdotal evidence is unreliable because it lacks scientific rigor.  Did my knees feel better because of the collagen supplement or because of physical therapy, the natural healing process, the warming weather, or another of my dietary changes?  It's impossible for me to say; thus it is completely unethical for me to pass along a recommendation to you.  NeoCell could very well be producing an effective collagen supplement (and frankly, I hope that it works), but the controversy needs to be addressed.

I have contacted the resident biochemist at NeoCell and asked her to address the same points that I brought up in this article.  She has been polite and professional and has far more expertise than I and is best equipped to discuss the science of collagen.  As soon as I hear from her, I will post her answers here.

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