Consuming collagen is not proven to reduce wrinkles
Q: Several months ago, I started adding 25 grams of whey protein to an afternoon smoothie each day. I was worried about muscle loss after reading an article. I have seen the sagging muscles and skin in my arms and thighs. I am a 71-yearold woman who plays tennis twice a week and goes to the gym about once a week. I have friends my age who have started adding collagen powders to their smoothies to improve their skin and prevent further facial wrinkles. After researching collagen supplements, I learned that they contain collagen peptides and protein. The dosage and ingredients vary by vendor. What is the correct collagen dosage and ingredients I should be looking for? Is the protein in collagen the same as the protein in whey?
A: All proteins, such as whey and collagen, are long strands of amino acids. A “peptide” is two or more amino acids connected, while a “polypeptide” is 20 or more amino acids. A protein is a polypeptide that has a function in the organism. Proteins are broken down by acid and enzymes in your stomach back into their component amino acids, to be used anyplace the body has need for them.
Part of the reason that skin wrinkles is loss of collagen, but it is not at all clear that consuming more collagen, or any protein, will increase the collagen in the skin and therefore reduce wrinkles. You can save a great deal of money by consuming collagen, if you decide you want to, from timehonored sources like chicken broth. Or have a vegetable broth; although it does not contain collagen, it still contains proteins that your body breaks down, like it does collagen, into its component amino acids. Some collagen supplements are made from parts of animal carcasses that contain heavy metals and other toxins, so I would be wary of supplements.
Medicated creams, like vitamin A derivatives (such as retinol or tretinoin), work by increasing collagen production in the skin. Vitamin C creams help prevent the breakdown of the existing collagen in the skin. Vitamin C breaks down quickly, so these creams need to be handled sparingly. Moisturizing the skin makes it appear fuller and helps prevent further damage, especially when a daily sunscreen is included. Sunlight is a major cause of skin damage.
Q: I have been diagnosed with acid reflex for 20 years but have never been on any antacid medication until recently, when my doctor prescribed Prilosec. My concern is whether it’s safe for long-term use. Is there an ingredient in Prilosec that causes cancer?
A: No medicine is completely safe, but omeprazole (Prilosec) has been safely used for decades by many people. Longterm risks include an increased propensity to bacterial pneumonia; gastrointestinal infections, such as C. diff; and poor absorption of vitamin B12 and calcium.
When this class of medications was first introduced, there was concern about an increase in a type of tumor called gastric carcinoid, based on laboratory animal studies. This has not been shown to be of concern in humans.
Some antacid medicines (such as ranitidine) have been contaminated by a carcinogen called NDMA. Omeprazole (Prilosec) has not been implicated by this contaminant.
Many people who have been on omeprazole and similar powerful anti-ulcer drugs for years or decades do just fine if they are slowly tapered off the drug. Some people really need them to keep their symptoms under control. I usually try to taper them off, but if a person needs them, it’s safe to continue them long term.
Q: I am a 60-year-old woman at the end of a fiveyear regimen of hormone therapy. My doctor has advised me to eventually stop use of estrogen and progesterone by this summer, as she says women have an advanced risk of breast cancer at this stage. Another friend a few years younger than me was told by her doctor that she could continue with hormone-replacement therapy until she is 70.
Which doctor is correct? I am experiencing constant hot flashes again and am able to snatch only little bits of sleep each night, along with all of the other issues with loss of estrogen (inability to regulate temperature, hair falling out, flaccid skin, vaginal dryness, etc.). My other question is: Am I able to use other herbal compounds, specifically saw palmetto and/or St. John’s wort, without any risk of breast cancer? Or are these and other estrogen-mimicking compounds also a contributor to breast cancer?
A: There is no one-size-fitsall answer to the first question — about how long to continue hormone treatment for symptoms of menopause. I disagree with any absolute rule, such as stopping at five years or waiting until 70, because any woman may place a different value on her well-being and a woman’s individual risk for breast cancer also needs to be considered.
You haven’t told me about any particular risk, but my answer would be very different for a woman with average risk compared with a woman with increased risk due to family history, for example.
About 40 percent of women will have symptomatic hot flashes until age 65, and continuing estrogen is reasonable in women who are willing to accept the increase in risk. The risk is not just breast cancer. Women taking combined estrogens and progestins have a small increase in the risk of heart disease, stroke and pulmonary embolism (blood clot to the lung), but a decreased risk of colon cancer and hip fracture. That all sounds scary, but the increase in risk of any of these is less than 0.5 percent. Many women choose to continue taking their hormones when their symptoms are significantly affecting their quality of life. I feel very strongly it’s the physician’s job to advise so a woman can make the best decision for herself.
Saw palmetto is not commonly used for menopausal symptoms (it’s used very frequently by men with prostate issues), and there is inconsistent evidence on its contribution for breast cancer. Similarly, there is no consensus on the risk of St. John’s wort for breast cancer and only limited evidence that it helps menopausal symptoms. St. John’s wort can interact with many medicines, so it’s wise to discuss its use with a pharmacist if you are taking other medication.
Many women ask about phytoestrogens (such as in soy protein or red clover) and other herbs with estrogenic activity (such as black cohosh). There is a theoretical risk, and although there are some studies suggesting they may be safe, many experts advise against these for women at high risk. That group would include women with a history of an estrogen-sensitive tumor.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Drive, Orlando, FL 32803.