This week, we are talking all about collagen. Collagen has exploded in demand with it seemingly everywhere in supplements, teas and bone broths, so we wanted to speak to someone who’s on the front lines of research. Dr. Steffen Oesser works at the Collagen Research Institute. We cover the impact of collagen in osteoarthritis, tendonitis, skin, all the other areas of health where collagen and collagen peptides have been researched. Also, you’ll hear about some of the misconceptions of collagen and the future of collagen research.

Highlights include:

  • Dr. Oesser’s journey with osteoarthritis and researching collagen
  • The best source of collagen peptides
  • The optimal peptide size for a collagen supplement
  • The biggest misunderstanding about collagen
  • And so much more!

The Latest in Collagen Research

James Maskell: Welcome to the Evolution of Medicine podcast, the place health professionals come to hear from innovators and agitators leading the charge. We cover the latest clinical breakthroughs in health technology, as well as practical tools to help you transform your practice and the health of your community. This podcast is brought to you by the Lifestyle Matrix Resource Center, who provide a range of options to help you deliver successful, effective, functional, and integrative medicine. To find out more and to get started, go to goevomed.com/lmrc. That’s goevomed.com/lmrc.

Hello and welcome to the podcast. This week, we are going to talk all about collagen. Collagen has exploded in demand with seemingly everywhere in supplements and teas and bone broths. And so we wanted to actually speak to someone who’s on the front lines of research. Dr. Steffen Oesser works at the Collagen Research Institute and over the next half an hour, we’re going to talk to him about the impacts of collagen in particularly clinical areas, osteoarthritis, tendonitis, skin, all the areas where collagen and collagen peptides has been researched. We’re going to talk about some of the misconceptions of collagen, and we’re also going to talk about the future of collagen research, where it’s heading, the immune system and just where collagen should fit in the therapeutic order. Very interesting half an hour, enjoy. So a warm welcome to the podcast, Dr. Oesser, welcome, Doc.

Steffen Oesser: Yeah. Thank you for inviting me, James.

James Maskell: I’m excited to talk about collagen, because obviously as people in the functional medicine industry over the last few years, we’ve certainly seen an explosion in the interest in collagen, the delivery systems of collagen in food, in supplements, even in teas. Everyone is trying to get collagen, especially most women trying to get collagen into that body. So I just wanted to try and go to the source and go to a leading expert to really find out what the truth about collagen is and what everyone needs to know about it. So why don’t we just start with a little bit of your story of how you got started in collagen research?

Steffen Oesser: Yeah, thanks for the question. So, yeah, you’re absolutely right. Nowadays, collagen is almost everywhere and I can tell you this was completely different when I started looking into that matter, and that is unbelievable more than 20 years ago. So in these days, we were predominantly interested in resorption processes of macro molecules and also in these days, there were these kind of let’s say anecdotal reports also by the way, coming from my grandma told me so if you have, for example, joint pain, what you need is bone broth or you need collagen intake. And based on these anecdotal reports became interested in this. Is there any scientific background of that? So is this really a true story? And this as I said, more than 20 years ago, we started with the question due to the oral application of the food stuff, with the broth, whatever you take. So the question was, could these collagen fragments, peptides, however you would call it, could that be absorbed in our gastrointestinal tract?

And so we made these key experiments there. And after having seen that, yes, these peptides are absorbed and to some extent also in intact form, then the question is what happened to these peptides? How are they distributed in the body? And reaching the target organs, could they have any efficacy? And then end up with proof of concept models, animal models, and then finally go to the clinics. So a long, long story starting in these days with osteoarthritis, because this was the starting point, osteoarthritis joint problems. Could these collagen peptides have any impact on that?

James Maskell: Yeah. So you’ve been at the Collagen Research Institute there and doing that. And I know that over time you started with osteoarthritis, but I know that you’ve gone into other clinical conditions over time. Why did you start with osteoarthritis and what other clinical areas have you moved into over the two decades?

Steffen Oesser: Yeah, so we looked into osteoarthritis for the simple reason, because what we started with as an experimental model was cartilage tissue. And we used this cartilage tissue because in these days we thought that it is a very simple tissue, because there’s only one type of cells in this tissue, the chondrocytes, and there’s something around the so-called extracellular matrix and these extracellular matrix given the organ function. And so as there was only one type of cell, as said, we thought it was an easy to handle experimental model to see if these collagen peptides could have any impact on these chondrocytes.

Much later, we learned that that was a very, very complicated model because this one type of cell handling all the building up processes, turn over processes, in the extracellular matrix. So we choose a very complicated model at the end of the day. But nevertheless, that was the starting point where we looked on osteoarthritis research. And there we did the first clinical trials, which supported our ideas that the intake of collagen peptides could have a positive impact on osteoarthritis and is influencing the turnover of these cartilage cells. And based on that, we used that as a kind of roll out model for connective tissue in general, because we thought so if this has a certain efficacy in one type of connective tissue, which was the cartilage tissue. So it was interesting to see if it has also an impact on skin, for example.

And so that was the next thing we were looking in. And so could these bioactive collagen peptides have any impact on skin health, looking for beauty aspects, wrinkles, skin elasticity, and then also switching over to more severe skin diseases and finally go into wound healing. And the interesting thing is that the overall principle is pretty much the same. So the loss of extracellular matrix and what you call when you are in the cartilage area, the loss of extracellular matrix is the reason at the end of the day for osteoarthritis. And when you go into the skin, the loss of extracellular matrix is the reason for wrinkles. So the overall principle is pretty much the same, although of course, the impact is completely different. And after having seen that this also works in skin, then we screened all the other important connective tissues, which is bone, for example, looking on the effect on osteoporosis, switching over to ligaments and tendons, which has also an interesting area for example, in sports.

And finally, and that was the first time when we went one step further above connective, we were looking also at muscle tissue. And interestingly enough, we also saw a positive effect of the intake of the specific bioactive collagen peptides on muscles in terms of increase of fat-free mass, of muscle mass, increased performance, et cetera, et cetera. So that was a very interesting result in these days. And so to bring that all together, sometimes people say, “It’s too good to be true.” Everywhere these collagen peptides sort of thing. Yeah, it looks like a little bit at a first glance, but when you dig a little bit deeper and when you understand what are the differences in terms of efficacy and in terms of the mode of action, then it makes the picture more clearer, I would say.

James Maskell: Yeah, that’s really interesting. So when you were first starting with the research, what was the source of the peptides that you were studying on? And then how has that evolved over time? What’s the best source for collagen peptides and what are the other sources?

Steffen Oesser: Yeah, so as I said before, when we started with the idea of collagen peptide being active in some way, metabolic way, the world was much different. So people were not much interested in collagen research and it was perceived as a structural protein and has almost no turnover and does almost nothing. Cartilage in these days was perceived as a dead tissue with almost no metabolic activity and now we learned that this of course is completely wrong, but in these days that was the case. And we presented our ideas the first time, I can very, very, remember that at scientific congresses, our posters were really hanging in the darkest corner and nobody was interested in anything. But fortunately, this has changed completely over the years. And as you said at the beginning, now it’s big interest in collagen and lots of products put collagen and the market is full of collagen, maybe a little bit too much from my perspective, but that’s a different story.

James Maskell: The Americans want to have good skin so that’s very important to them and they have to put it in everything. I think it really made a big jump when they saw that the skin research was there. Where do you see the future of collagen research now? Where are you aiming at next as far as to understand its impact on other areas of the body?

Steffen Oesser: Yeah. So I think what is very important also with these, let’s say kind of hype of collagen product. When I started, nobody talks about collagen. Now, everybody talks about collagen. And unfortunately, there are some, if not to say a lot of misunderstandings and due to this misunderstandings, this could raise disappointments. And so that’s where we always keep on saying, “Okay, we have to be sharp here and it’s not all about collagen, it’s about collagen peptides and what can collagen peptides do and what they can’t.” So this is very important to-

James Maskell: Would you say that was the biggest misunderstanding about collagen or what would you say is the biggest misunderstanding?

Steffen Oesser: I think that there are at least, let’s say two or three. I don’t know what the biggest is, but what I always hear is the intake of collagen helps to build up new collagen and in terms of a direct process, this sounds good, but in reality, it’s a little bit more complicated. So first of all, collagen could not help at all so you need collagen peptides and out of this collagen peptides, it’s not possible to generate new collagen. What it does it stimulates the connective cells to produce more collagen. So that’s one of the big misunderstandings.

What is also misunderstood is that people think collagen makes collagen. And what it does is it stimulates the entire extracellular matrix because otherwise the stimulation of just the collagen part of the cell, extracellular matrix, which makes no sense, and would not lead to physiological situations. So what these collagen peptides do is they stimulate collagen, yes that’s true, but they also stimulate proteoglycans. They stimulate other macromolecules, which are important in the extracellular matrix. So what they do is they stimulate a complete extracellular matrix.

And the third one and it’s a very big misunderstanding that people think that collagen is collagen and all collagen peptides have the same efficacy. And this is definitely not the case. So you can produce collagen peptides which have no efficacy at all. And this is also a big problem when you’re going into the literature and people saying, “Okay, so here’s a new study saying that collagen peptides have this and this effect.” And when they use this information to promote a different kind of collagen peptide and it’s simply incorrect because it’s not like that.

So collagen peptides are not a clearly defined molecule. So for example, let’s say glucosamine. So if you do a study with glucosamine then glucosamine is glucosamine is glucosamine, that’s pretty simple. But when you do a study with collagen peptides, you have to be very careful to look on so what kind of peptides have you, what size have you, how they are produced, what preparation is it? What’s the mean molecular weight? What’s the distribution? So it becomes very soon, very complicated, but unfortunately, this is the truth.

James Maskell: Yeah.

Steffen Oesser: So it’s not about collagen not at all. It’s also not about collagen peptides, it’s about specific bioactive collagen peptides, which do the job.

James Maskell: So is there an optimal peptide size for determining bio-activity and bioavailability?

Steffen Oesser: Yes. So first of all, what is very important due to the oral application, it must be resolvable in intact form at least to some extent. So that tells us so up to 10 kilodalton size, this could work. If the peptides are larger than that, they will not be absorbed in the GI tract in intact form and this makes a big difference. What is also, well, let’s say what seems to be of importance are, of course, the amino acid sequence of these peptides, the N standing amino acids. And there are also some more criteria which I won’t tell you, because this is our secret. But it’s definitely the truth that you can produce highly active collagen peptides and this is why we call them specific bioactive collagen peptides, but you can also produce collagen peptides which have no effect at all. And to separate that in terms of what is marketed and what is advertised, that’s very complicated. And just to say, “Okay, here’s collagen and there are studies with collagen.” That’s unfortunately too simple and that’s not the truth.

James Maskell: Interesting. Because I’m sure everyone jumps on the band wagon. They have their own source of it and they could just sort of say whatever they want in the marketing of it. When you get down into it, what’s going on the very basic level to make these peptides effective at dealing with some of the things you talked about, let’s say osteoarthritis and skin issues? What are the features of effective products with collagen?

Steffen Oesser: Yeah. So as I said before, size plays a role. So if these peptides are too large to be resolved in an intake form then of course they are losing bioavailability and at the end of the day, also bio-activity. To produce any efficacy in terms of helping the connective tissue, they have to bind to a receptor, which means it’s also a special size of amino acids and chain and also the order plays a role. By the way, we have identified interactions with certain receptors and this is how we define bio-activity. And if these peptides do not bind to receptors, for example, then they have a different or no bio-activity at all.

The problem is that you can’t see that. You can tell so when people producing collagen peptides, it’s not the data sheet that tells you if they have any bio-activity or not. So what is necessary to give it proof is at the end of the day, a clinical trial. And if people have a certain product with collagen peptides, and they have a positive clinical trial, then I would say, “Okay, then I’m convinced that you have a good working product and congratulations to that.” But what is not possible in this area is to say, “I have a collagen product and there are studies out there, which are made with a completely different product.” This is not okay, but unfortunately hard to explain to the people for sure.

James Maskell: Yeah, exactly. Well, I know this last year, obviously there’s been a lot of interest in the immune system and optimal function of the immune system. Is there any research to show how collagen peptides interact with the immune system or have any effect on the immune system, either positive or negative?

Steffen Oesser: Yes. So this is a very new and interesting topic. Especially in the current situation where everybody is interested in a strong and properly working immune system. So what is known is that there is an interaction between the immune system and the extracellular matrix, and this is where collagen peptides might come into the picture. The question is how exactly and how this is regulated. So who is sitting in the driver’s seat? So is this the immune system that has an impact on the extracellular matrix or is it just vice versa that the extracellular matrix is influencing the immune system? So right now we are working on this and right now we believe that it is the immune system which plays a role and has an impact on the extracellular matrix. But this is still, let’s say under investigation and a very interesting topic for the future for sure and we have to look deeper on that.

James Maskell: Yeah, super interesting. And I think that’s…the extracellular matrix is something that I’ve been aware of because I’ve sat in the back of hundreds of conferences and it certainly seems like what’s happening between the cells and the communication between the cells has a lot of upstream and downstream consequences.

Steffen Oesser: Yes, absolutely. The cell is sitting in the middle of this extracellular matrix, but the cell of course have to understand what’s going on outside. So if the extracellular matrix get lost due to wear-and-tear processes, the cell has to react in terms of producing more and counteract against this wear and tear process. So that’s why there is an intense communication between the cell and the extracellular matrix so this is very well-known.

And this is by the way, the mode of action where collagen peptides came into the picture because they’re using this physiological pathway, which our cells are familiar with. So if the cell sees collagen peptides outside, the cell thinks, “Okay, this is a broke down process and I have to react in producing more.” And by adding these collagen peptides from outside, it’s a bit like mimicking this process and the connective tissue cells, they produce more extracellular matrix. And if they produce more extracellular matrix, this is exactly what helps in osteoarthritis, what helps in osteoporosis, what helps in ligament and tendon problems, skin issues. So, so this is, I would say, the overall principle, how we see it, but of course, for every connective tissue and every cell are a little bit different.

James Maskell: So what would you say if there’s obviously clinicians that listen to this who may or may not be already using collagen and collagen peptides. There’s obviously a range of clinicians who are dealing with some autoimmunity, but also some people helping with skin, more generalists, but there’s obviously a lot of people who are just working on a whole range of chronic illnesses with their patients. What do you think is the best clinical application of collagen peptides in medicine?

Steffen Oesser: That’s a hard question. So I, of course, and I think that’s not a big surprise for you, so I’m very much into the asked again, in all the topics I’ve shared with you in the last minutes. My personal opinion is that where…so collagen peptides have a big impact, as I told you before, on different areas. But I think where it really comes into a clinical situation where people are really suffering from a kind of disease. So let’s talk about these badly healing wounds, talk about osteoarthritis. People have to leave their home because they can’t go upstairs any longer. So atopic dermatitis, we haven’t talked about that, but this is also a loss of quality of life for these people. And these diseases, and when you see that there’s a positive impact when the people use these specific bio-active collagen peptides, that’s really the fun part of the research I can tell you.

James Maskell: Yeah, I can imagine that. I can imagine that given the building block nature of what you’re talking about, it seems to me that this should be a little bit further up the therapeutic order before a lot of medications where those medications just don’t have the potential to rebuild tissue in the way that you’re talking about. I mean, that’s really what you’re talking about with these collagen peptides is rebuilding tissue in the way that they’re meant to operate in the body. And ultimately I think a lot of people in our community are always looking for ways to just bring the body back to homeostasis. And if you compare collagen peptides to osteoarthritic drugs, one is going to take you in one direction and one is going to take you in a different direction, even though the symptoms may be the same in the first couple of months.

Steffen Oesser: Yes. You’re absolutely right. And this is another aspect we haven’t talked about yet, so besides the, I would say, great efficacy of collagen peptides in different areas, when you look on the side effects, there’s almost none. And this is why when people call me sometimes and say, “Okay, I’m suffering from what have, osteoarthritis, and I’m looking for a surgical intervention in the next month so is there anything I can do?” Then I say, “Okay, give collagen peptides a try, because the worst thing that could happen for you is that nothing happens.” And of course you lose maybe a little bit of money. So you’re definitely giving no harm to your body and if it works, great. If not, you’re unfortunately one of the few non-responders, but it will not worsen your situation. So that’s why this is also a very important aspect, I think, of the story.

James Maskell: Yeah. And it might have some positive impact on an area where you’re not considering. Given that it’s just like a fundamental building block, you may have a condition and even if you’re a non-responder there, you may have other beneficial effects other parts of the body. Yeah look, I think it’s very interesting. Look, I appreciate you coming to share, and I appreciate all the work that’s happening at the Collagen Research Institute. And yeah, I think many of the practitioners in our community are already recommending it. And so I think that there’s a lot more that we could be doing to be using these fundamental, low-cost, low-invasive therapies as a frontline for healing. And I wish you all the luck in the future of your research and if you get some big breakthroughs on the immune system and collagen and the extracellular matrix, we’d love to have you back to talk about it.

Steffen Oesser: Yeah. Thanks a lot, exciting story. And it was a big pleasure talking to you.

James Maskell: Wonderful. Well look, we’ve been with Dr. Steffen Oesser. He is from the Collagen Research Institute, and if you have questions about collagen, feel free to reach out. This is part of our series in looking at some of the big topics and clinical topics in medicine and speaking with the researchers on the front lines. And so thanks so much for tuning in. This has been the Evolution of Medicine podcast. I’m your host, James Maskell, and we’ll see you next time.

Thanks for listening to the evolution of medicine podcast. Please share this with colleagues who need to hear it. Thanks so much to our sponsors, the Lifestyle Matrix Resource Center. This podcast is really possible because of them. Please visit goevomed.com/lmrc to find out more about their clinical tools like the group visit toolkit. That’s goevomed.com/lmrc. Thanks so much for listening and we’ll see you next time.

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