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Collagen peptides supplementation improves function, pain, and physical and mental outcomes in active adults.
Kviatkovsky, SA, Hickner, RC, Cabre, HE, Small, SD, Ormsbee, MJ
Journal of the International Society of Sports Nutrition. 2023;20(1):2243252
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As we age, collagen degrades, which can result in an increased risk for injuries and pain. Pain management largely focuses on drugs to control inflammation, which can result in side effects. Collagen is the predominant component of connective tissues and supplementation has been shown to have beneficial effects on joint pain and inflammation. This randomised control trial aimed to determine the effect of different doses of collagen over 3 different time periods on measures of pain, function, and mental and physical health in 86 active, middle-aged men and women. The results showed that daily activity was improved when individuals were given 10g/day collagen for at least 6 months. Pain was also improved with this dose for at least 6-months, but only in those who exercised more than 3 hours per week. Mental health improved with 10g/day when given for at least 3-9 months. Physical function was also improved with 20g/day collagen for at least 3-9 months, but only amongst women. It was concluded that 10-20g/day collagen supplementation for at least 6 months may improve pain, functionality, and mental health in healthy, middle-aged men and women. Women may particularly benefit from 20g/day collagen and enhanced effects may be seen when in combination with exercise. This study could be used by healthcare professionals to recommend collagen supplementation to improve joint pain and physical and mental health in combination with exercise.
Abstract
INTRODUCTION Chronic pain affects 19% of adults in the United States, with increasing prevalence in active and aging populations. Pain can limit physical activity and activities of daily living (ADLs), resulting in declined mental and social health. Nutritional interventions for pain currently target inflammation or joint health, but few influence both. Collagen, the most abundant protein in the human body and constituent of the extra cellular matrix, is such a nutraceutical. While there have been reports of reductions in pain with short-term collagen peptide (CP) supplementation, there are no long-term studies specifically in healthy middle-aged active adults. PURPOSE To determine the effects of daily CP consumption over 3, 6, and 9 months on survey measures of pain, function, and physical and mental health using The Knee Injury & Osteoarthritis Outcomes Score (KOOS) and Veterans Rand 12 (VR-12) in middle-aged active adults. METHODS This study was a double-blind randomized control trial with three treatment groups (Placebo, 10 g/d CP, and 20 g/d CP). RESULTS Improvements in ADLs (p = .031, ηp2 = .096) and pain (p = .037, ηp2 = .164) were observed with 10 g/d CP over 6 months, although pain only improved in high frequency exercisers (>180 min/week). Additionally, VR-12 mental component scores (MCS) improved with 10 g/d of CP over 3-9 months (p = .017, ηp2 = .309), while physical component scores (PCS) improved with 20 g/d of CP over 3-9 months, but only in females (p = .013, ηp2= .582). CONCLUSION These findings suggest 10 to 20 g/d of CP supplementation over 6 to 9 months may improve ADLs, pain, MCS, and PCS in middle-aged active adults.
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The impact of nutrition on tendon health and tendinopathy: a systematic review.
Hijlkema, A, Roozenboom, C, Mensink, M, Zwerver, J
Journal of the International Society of Sports Nutrition. 2022;19(1):474-504
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Tendinopathy, which involves persistent tendon pain and loss of function related to mechanical loading, is common in athletes as well as in the general population. The aim of this study was to evaluate the impact of nutrition on the prevention and treatment of tendinopathy in a general human population. This study is a systematic review of nineteen studies. The number of people included in these studies ranged from 50 to 80,106. Results show that: - there wasn’t an association between any of the dietary parameters and Achilles tendon thickness. - despite inconsistent findings on the risk and severity of tendinopathy in humans, there is evidence that alcohol may inhibit collagen synthesis through toxic effects. - collagen seems to be beneficial in the treatment of tendinopathy, but conclusions about optimal dosage, timing, duration, and type of collagen supplementation cannot be drawn yet. - many other nutrients may contribute to collagen synthesis or may have anti-inflammatory effects, so most dietary supplements used in the different studies contained multiple substances. Authors conclude it is impossible to draw definitive conclusions and formulate dietary recommendations on the prevention and treatment of tendinopathy.
Abstract
BACKGROUND Tendinopathy is a painful condition that is prevalent in athletes as well as the general human population, and whose management is challenging. OBJECTIVE This systematic review aimed to evaluate the impact of nutrition on the prevention and treatment of tendinopathy. METHODS Searches were conducted in PubMed, EMBASE, Web of Science, and SPORTDiscus without restriction to year of publication. Studies examining the impact of exposure to nutrient intake in an adult human population on 1) prevalence/incidence of tendinopathy, 2) clinical outcomes of tendinopathy, 3) structural changes in the tendon by imaging modalities. Experimental and observational study designs written in English, Dutch, or German were eligible. RESULTS Nineteen studies met the inclusion criteria. The effects of the habitual diet were investigated in one study. Four studies examined the effects of exposure to alcohol. Alcohol consumption can be a potential risk factor associated with Achilles tendinopathy and rotator cuff tears, although findings were inconsistent. The use of dietary supplements was examined in fourteen studies. Among these, collagen-derived peptides were most often part of the supplements evaluated. Combining training and dietary supplements seems to induce better clinical and functional outcomes in tendinopathy. CONCLUSION This review demonstrates the paucity of high-quality studies and a wide variety among studies regarding nutrients, tendon location, study population, and reported outcome measures. Individual studies showed promising clinical implications for the use of dietary supplements, particularly those containing collagen-derived peptides. However, giving any definitive dietary recommendations on the prevention and treatment of tendinopathy remains elusive.
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Effect of n-3 PUFA on extracellular matrix protein turnover in patients with psoriatic arthritis: a randomized, double-blind, placebo-controlled trial.
Holm Nielsen, S, Sardar, S, Siebuhr, AS, Schlemmer, A, Schmidt, EB, Bay-Jensen, AC, Karsdal, MA, Christensen, JH, Kristensen, S
Rheumatology international. 2021;41(6):1065-1077
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Psoriatic arthritis is a chronic inflammatory condition that causes joint pain and swelling along with red, flaky, and scaly skin. Inflammation affects the extracellular matrix, which comprises proteins and molecules that support cartilage, bone, and soft tissues in joints. A high level of collagen fragments is released into the bloodstream as a result. Fish oils and fish are good sources of n-3 polyunsaturated fatty acids (n-3 PUFA), including eicosapentaenoic acid and docosahexaenoic acid. Inflammation and joint pain have been shown to be reduced by n-3 PUFA in previous studies. This randomised, double-blinded, placebo-controlled study randomly assigned 142 patients with psoriatic arthritis to receive 3g n-3 PUFA (50% EPA and 50% DHA) or 3g of olive oil as the control for 24 weeks. Taking N-3 PUFA supplementation did not affect extracellular matrix turnover in psoriatic arthritis patients. This may be due to the anti-inflammatory properties of olive oil, which was used as a control, and to the short duration of the study. The benefits of using n-3 PUFA as a therapeutic strategy in patients with psoriatic arthritis need to be evaluated in larger, robust long-term studies. Furthermore, the clinical efficacy of n-3 PUFA cannot be distinguished since 75% of the patients took anti-rheumatic drugs. A study like this can provide healthcare professionals with insights into the potential benefits of n-3 PUFAs, which may aid them in making therapeutic decisions.
Abstract
Psoriatic arthritis (PsA) is a chronic inflammatory disease characterized by involvement of skin, axial and peripheral skeleton. An altered balance between extracellular matrix (ECM) formation and breakdown is a key event in PsA, and changes in ECM protein metabolites may provide insight to tissue changes. Dietary fish oils (n-3 PUFA) might affect the inflammation driven tissue turnover. The aim was to evaluate ECM metabolites in patients with PsA compared to healthy individuals and investigate the effects of n-3 PUFA. The 24-week randomized, double-blind, placebo-controlled trial of PUFA included 142 patients with PsA. Fifty-seven healthy individuals were included for comparison. This study is a sub-study investigating biomarkers of tissue remodelling as secondary outcomes. Serum samples at baseline and 24 weeks and healthy individuals were obtained, while a panel of ECM metabolites reflecting bone and soft tissue turnover were measured by ELISAs: PRO-C1, PRO-C3, PRO-C4, C1M, C3M, C4M, CTX-I and Osteocalcin (OC). C1M, PRO-C3, PRO-C4 and C4M was found to be elevated in PsA patients compared to the healthy individuals (from 56 to 792%, all p < 0.0001), where no differences were found for OC, CTX-I, PRO-C1 and C3M. PRO-C3 was increased by 7% in patients receiving n-3 PUFA after 24 weeks compared to baseline levels (p = 0.002). None of the other biomarkers was changed with n-3 PUFA treatment. This indicates that tissue turnover is increased in PsA patients compared to healthy individuals, while n-3 PUFA treatment for 24 weeks did not have an effect on tissue turnover. Trial registration NCT01818804. Registered 27 March 2013-Completed 18 February 2016. https://clinicaltrials.gov/ct2/show/NCT01818804?term=NCT01818804&rank=1.
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Temporal Change in Biomarkers of Bone Turnover Following Late Evening Ingestion of a Calcium-Fortified, Milk-Based Protein Matrix in Postmenopausal Women with Osteopenia.
Hettiarachchi, M, Cooke, R, Norton, C, Jakeman, P
Nutrients. 2019;11(6)
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Low bone mineral density (bone mineral content) and a diminution in bone quality (bone microarchitecture) are attributes of risk of fracture in people with osteopenia. The aim of this study was to investigate the effect of feeding a milk protein-based matrix (MBPM) fortified with calcium and vitamin D prior to bedtime on the biomarkers of bone remodelling in postmenopausal women with osteopenia. The study is a block-randomised cross-over design which recruited a sample of 41 postmenopausal women aged 50 to 70 years. Out of the 24 participants classified as osteopenic, 16 volunteers progressed to the RCT and randomly assigned to receive either a milk-based protein supplement (MBPM) or an isoenergetic, control. Results indicate that a dairy-based protein supplement fortified with calcium (MBPM) fed at bedtime has a potent effect on nocturnal rates of bone resorption in healthy osteopenic postmenopausal women. Furthermore, the synergistic, pluripotent quality of a milk-based protein matrix and timing of ingestion to the nocturnal, peak rate of bone remodelling transiently depressed bone turnover. Authors conclude that a late-evening supplement of calcium-fortified milk protein affects a beneficial decrease in the homeostatic rate of bone remodelling in persons at risk of degenerative bone disease.
Abstract
The diurnal rhythm of bone remodeling suggests nocturnal dietary intervention to be most effective. This study investigated the effect of bedtime ingestion of a calcium-fortified, milk-derived protein matrix (MBPM) or maltodextrin (CON) on acute (0-4 h) blood and 24-h urinary change in biomarkers of bone remodeling in postmenopausal women with osteopenia. In CON, participants received 804 ± 52 mg calcium, 8.2 ± 3.2 µg vitamin D and 1.3 ± 0.2 g/kg BM protein per day. MBPM increased calcium intake to 1679 ± 196 mg, vitamin D to 9.2 ± 3.1 µg and protein to 1.6 ± 0.2 g/kg BM. Serum C-terminal cross-linked telopeptide of type I collagen (CTX) and procollagen type 1 amino-terminal propeptide (P1NP), and urinary N-telopeptide cross-links of type I collagen (NTX), pyridinoline (PYD) and deoxypyridinoline (DPD) was measured. Analyzed by AUC and compared to CON, a -32% lower CTX (p = 0.011, d = 0.83) and 24% (p = 0.52, d = 0.2) increase in P1NP was observed for MBPM. Mean total 24 h NTX excreted in MBPM was -10% (p = 0.035) lower than CON. Urinary PYD and DPD were unaffected by treatment. This study demonstrates the acute effects of bedtime ingestion of a calcium-fortified, milk-based protein matrix on bone remodeling.
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Specific Collagen Peptides Improve Bone Mineral Density and Bone Markers in Postmenopausal Women-A Randomized Controlled Study.
König, D, Oesser, S, Scharla, S, Zdzieblik, D, Gollhofer, A
Nutrients. 2018;10(1)
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Osteoporosis is a complex disease involving aspects of ageing, gender, malnutrition, and genetics. Once diagnosed, therapies such as exercise and dietary changes may slow disease progression, however improvements are unlikely. Collagen is a protein in bones that naturally decreases with age. Animal studies on collagen supplementation have shown improved bone density. This randomised control trial aimed to determine the effects of 12 months of collagen supplementation on bone density in 130 postmenopausal women with reduced bone density. The results showed that bone density in the hip significantly increased after supplementation with collagen whereas individuals who did not take collagen reported worsening bone density. Markers for bone formation were significantly increased and those which show bone breakdown were decreased following collagen supplementation. It was concluded that collagen supplementation significantly increases bone mineral density through increased bone building markers. This study could be used by healthcare professionals to recommend collagen supplementation to increase bone mineral density in individuals at high risk of developing osteoporosis.
Abstract
Introduction: Investigations in rodents as well as in vitro experiments have suggested an anabolic influence of specific collagen peptides (SCP) on bone formation and bone mineral density (BMD). The goal of the study was to investigate the effect of 12-month daily oral administration of 5 g SCP vs. placebo (CG: control group) on BMD in postmenopausal women with primary, age-related reduction in BMD. Methods: 131 women were enrolled in this randomized, placebo-controlled double-blinded investigation. The primary endpoint was the change in BMD of the femoral neck and the spine after 12 months. In addition, plasma levels of bone markers-amino-terminal propeptide of type I collagen (P1NP) and C-telopeptide of type I collagen (CTX 1)-were analysed. Results: A total of 102 women completed the study, but all subjects were included in the intention-to-treat (ITT) analysis (age 64.3 ± 7.2 years; Body Mass Index, BMI 23.6 ± 3.6 kg/m²; T-score spine -2.4 ± 0.6; T-score femoral neck -1.4 ± 0.5). In the SCP group (n = 66), BMD of the spine and of the femoral neck increased significantly compared to the control group (n = 65) (T-score spine: SCP +0.1 ± 0.26; CG -0.03 ± 0.18; ANCOVA p = 0.030; T-score femoral neck: SCP +0.09 ± 0.24; CG -0.01 ± 0.19; ANCOVA p = 0.003). P1NP increased significantly in the SCP group (p = 0.007), whereas CTX 1 increased significantly in the control group (p = 0.011). Conclusions: These data demonstrate that the intake of SCP increased BMD in postmenopausal women with primary, age-related reduction of BMD. In addition, SCP supplementation was associated with a favorable shift in bone markers, indicating increased bone formation and reduced bone degradation.