Chapter 145
Collagen Supplementation
Orally administered collagen is the anti-aging treatment of the moment, and with pills, powders, and products ranging from bars and gummy bears to fortified coffee and beer, people are trying to counter skin aging. Social media are said to be “flooded with paid advertising for unproven claims.” Are there claims that are true, and if so, which ones?
In my video see.nf/collagen I go through all the studies on collagen supplementation and skin aging. In short, most of these studies were funded by manufacturers of such supplements, and experts have rated the quality of the evidence as “limited, inconsistent” or “not particularly meaningful.” In 2022, an article in the Journal of Cosmetic Dermatology titled “Myths and media surrounding collagen supplementation for skin, nails and hair” concluded: “Dermatologists should be aware that companies are making unproven statements about collagen, … that go beyond the evidence in the existing literature,” and given the inadequate evidence, “collagen cannot be routinely recommended.” The evidence was “particularly unconvincing,” another study states, compared with methods that have been shown to be beneficial for skin collagen, such as using sunscreen, quitting smoking, and eating healthier.
In see.nf/collagendiet I describe how to stimulate your own collagen synthesis, for example with at least 95 milligrams of vitamin C daily, meaning more than the daily allowance currently recommended in the United States.
While there is still no evidence that collagen is superior to other proteins for skin aging, if you still want to try it, you should ask manufacturers about the sources. Most collagen supplements lack this information— and for good reason. Collagen can come from a witch’s brew of duck feet, frog skin, kangaroo and rat tails, alligator bones, and horse tendons. Others come from the sea and consist of fish skin, bones, heads, scales, fins, and intestines.
Recommended questions include: “What steps were taken to prevent contamination and adulteration? If the collagen comes from fish, were fish with low mercury levels used? If it comes from cows, how was it ensured that no material from the brain or nervous system was used, so as not to spread mad cow disease?” In the United States, collagen is exempt from the FDA’s ban on risky tissue, such as brain, intended to protect consumers from bovine spongiform encephalopathy.
For food safety reasons, for religious and ethical reasons, and because of allergies, there are calls not to use any animal material. For example, 2 to 4 percent of the population are allergic to bovine collagen. To solve the mad cow dilemma, there have been calls to produce genetically engineered cattle without prions in order to “be able to offer a safe source of collagen-based materials,” but why not just use plants? There is a method that can be used to produce collagen from plants, but it is not yet cost-effective. Animal feet are simply unbeatable cheap.
Topical Skin Treatment
Over-the-counter “anti-aging” products are a multibillion-dollar industry. “Spending more money affects the psyche,” one study on the myths of anti-aging skin care noted, but also: “Don’t let fancy packaging and high prices seduce you.” Advertising for many products claims they have sensational effects, but this is often exaggerated or misleading and rarely scientifically substantiated. An independent testing institute fundamentally questioned the effectiveness of anti-aging creams, found that any beneficial effects could be measured only with sensitive instruments but were not clinically detectable, and concluded that these products do no more than ordinary moisturizers.
Cross-sectional studies with Chinese and British women found that women who regularly moisturized their faces were estimated to be about two years younger than women of the same age who did not. A third and larger (Dutch) study could not confirm this, however. But snapshot cross-sectional studies cannot demonstrate cause and effect anyway. There are limited studies on moisturizers, but such creams can improve the appearance of dry skin that would otherwise be blotchy, scaly, and rough. Moisturizers can hydrate the skin and reduce fine lines by 15 to 20 percent, which is considered the “oldest trick in the cosmetics industry,” but they do not change the underlying cause.
Daily Skin Cream with Sun Protection Factor 15
Most skin care products—whether makeup, night cream, or anti-aging “serum”—are basically a moisturizer, combined for marketing reasons with supposedly active ingredients. But which ingredients actually have an anti-aging effect? I bet you can guess which is the most effective skin care factor if I give you the tip that up to 90 percent of visible facial skin aging is attributable to sunlight. The most biologically active anti-aging ingredient in skin products is sunscreen.
Applying sunscreen daily and taking other protective measures, such as wearing a hat, is considered the most important step to preserve the skin’s youthful appearance. Everything else pales in comparison, especially in people with lighter skin. UV-A rays are the main culprits for skin aging, whereas UV-B are the rays that cause sunburn. A broad-spectrum sunscreen against both is best, because both increase cancer risk. To prevent skin cancer, the American Academy of Dermatology recommends sunscreen with an SPF of at least 30, but even SPF 15 can prevent skin aging. How do we know? It was tested.
900 adults were randomized to either use sunscreen daily for years or maintain their usual habits. (Giving participants a placebo sunscreen and thereby withholding real sun protection was considered unethical.) In the end, 77 percent of participants in the group assigned to apply it daily used sunscreen at least three or four days a week, whereas in the other group it was only 33 percent. Was that enough to be able to detect a difference? Yes, the skin of those assigned to apply it daily aged significantly less. In fact, their skin did not measurably age over the four and a half years of the study. The scientists concluded: “Regular sunscreen use retards skin ageing in healthy middle-aged men and women.”
Although sunscreen should prevent further facial photoaging rather than reverse existing sun damage, the appearance of the skin of some participants in the group assigned to apply it daily improved. The results are all the more remarkable given that participants in the control group were to continue using sunscreen and hats when they felt it was necessary, which means that people, when left to their own devices, poorly assess or plan when they are exposed to increased UV radiation. Moisturizers with SPF 15 are therefore recommended even for days when it is cloudy or raining. The “gold standard” in anti-aging skin care is considered to be “daily use of sunscreens during the day and retinoids at night.”
Nightly Retinoids?
While sunscreen can prevent further photoaging of the skin, tretinoin can reverse some of the damage already done. Tretinoin, or all-trans-retinoic acid, is sold under various brand names, for example Retin-A. It is a prescription form of vitamin A that can noticeably improve mild to moderate photoaging, such as fine and deep wrinkles, freckles, and other skin discoloration, and after months of regular use it presumably improves the overall appearance of the skin, but it also causes redness, stinging, burning, itching, and peeling of the skin in many patients. There are gentler, less effective, over-the-counter retinoids for topical use: retinaldehyde, retinol, and retinyl esters (retinyl acetate, -palmitate, or -propionate). I compare them in see.nf/retinoids.