Collagen and Cancer with Dr Nina Fuller-Shavel

 

 

Introduction

Collagen is an important structural component of all our tissues, comprising around 30% of the whole protein mass in the body, regardless of supplementation [1]. The cells in our tissues are enclosed in a supportive environment called the ECM (extracellular matrix), and collagens are a family of proteins that are a major normal component of this matrix. Different collagen family members play different roles in the body, and there are 28 known collagen types [1].

 

What happens in cancer is that the ECM, the cell-surrounding matrix, is completely changed by the tumour locally (think of this as a house remodel). Cancer cells subvert our normal cells, such as macrophages (immune cells) and fibroblasts (connective tissue cells), to secrete enzymes that chew up normal collagen (these enzymes are MMPs or matrix metalloproteinases) [2]. The resulting collagen fragments are then taken up and degraded, and new dense pro-cancer collagen is laid down by the subverted cells in a way that can support cancer progression [2]. In this scenario, macrophages and fibroblasts are like the decorators that cancer cells persuade to change the environment to their liking. Studies that link collagen to cancer focus on local tumour-promoted collagen changes, with higher density specific collagen types laid down in the local environment through the interactions between cancer cells and subverted neighbouring cells being linked to cancer outcomes [3].

 

There is currently no available evidence that links oral hydrolysed collagen supplementation to this specific collagen remodelling in cancer. It is a process driven by the cancer cells and involves subversion of immune and connective tissue cells [2].

 

 

Collagen supplementation – is there a link to cancer development and progression?

Collagen changes that occur in cancer are complex, with local collagen production regulated by cancer cells through mutated genes and various signalling pathways - messages within cancer cells and those directed to cells surrounding them [4]. To address collagen remodelling, researchers are looking at multiple potential target points within the process. This includes inhibition or modulation of enzymes that participate in normal collagen breakdown (MMPs or matrix metalloproteinases), inhibiting signalling from cancer cells and targeting the function of specific cells, e.g. cancer-associated fibroblasts, in the tumour microenvironment (TME – a local ecosystem around the tumour) [4].

 

There is a world of difference between the complex multi-cell local process described above and oral collagen intake. We currently have no clinical evidence that hydrolysed collagen supplementation is associated with excess risk for people with cancer or is involved in cancer development, recurrence or progression. However, more research is needed throughout the cancer care spectrum to quantify potential risks and potential benefits, e.g. supporting quality of life and skin or joint-related symptoms. For example, joint stiffness and pain and skin-related symptoms are problems commonly associated with treatment-induced menopause and endocrine (hormone) therapy received for oestrogen-positive breast cancer, particularly aromatase inhibitors, such as letrozole, anastrozole, and exemestane [5, 6]. We know that research studies involving people who do not have cancer but have joint and skin-related symptoms, including those related to ageing, show benefit from collagen supplementation in terms of symptom improvement and quality of life [7-9]. Therefore, we need to study these effects in people during and after cancer treatment to see if these improvements can be seen in this context without carrying excess risk.   

 

People diagnosed with hormone-related cancers and taking endocrine (hormone) therapy may be concerned about effects of various supplements on their hormone levels. While specific research in different cancer types is needed, oral hydrolysed collagen has not been seen to have oestrogenic effects or to raise testosterone levels inappropriately. Current available evidence does not show collagen to have any hormone disrupting properties.

 

It is important to be aware that when people are diagnosed with cancer, all supplements should be checked with the medical team, including the oncology team, and where possible, integrative medicine doctor specialising in cancer support (integrative oncology/integrative cancer care). This is because some supplements may interact with both cancer treatment and general medications or may not be appropriate in view of the person’s overall clinical history, including their medical conditions and current symptoms.   

 

 

 

Different collagen supplementation options

Bovine and marine collagen are the two main choices in hydrolysed collagen supplementation. Unfortunately, we don’t have any comparative evidence on different collagen types for people with cancer. If you choose to supplement with collagen, choice of collagen type is completely up to your personal preference and what you agree with your medical team. You should always follow your medical doctor’s advice.

 

Vegan alternatives to collagen supplementation do not contain actual collagen peptides, as collagens are not found in plants. Instead, most vegan collagen support supplements contain co-factors that may support normal collagen metabolism, and there is currently no comparative clinical evidence to suggest which products may be more or less beneficial in people with cancer. As with any supplement, it is important that your doctor, cancer nutrition professional, or pharmacist checks interactions of these ingredients with any current medications or medical conditions you may have.

 

 

Disclaimers:

All content in this post is created and published online for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personalised advice. Always seek the guidance of your doctor or other qualified health professional with any questions you may have regarding your health or a medical condition. Never disregard the advice of a medical professional, or delay in seeking it because of something you have read in this blog or on the website.

 

Dr Nina Fuller-Shavel has not received any direct remuneration for the work completed in compiling this article. However, a donation has been provided to Oncio CIC (Community Interest Company), co-founded by Dr Nina Fuller-Shavel for the purpose of providing free digital health resources to people affected by cancer through the Oncio app.

 

 

About the author

Dr Nina Fuller-Shavel

MB BChir and MA Hons Natural Sciences (Cantab) 

MSc Precision Cancer Medicine (Oxon)

FBANT FRSA DipIM DipAc DipCHM PGCert IFMCP DipION RYT200

 

Dr Nina Fuller-Shavel is an award-winning Oxbridge-trained integrative medicine doctor, scientist and educator with over a decade’s experience in integrative healthcare. Dr Fuller-Shavel is a Fellow of the College of Medicine, the British Association for Nutrition and Lifestyle Medicine (BANT) and the Royal Society of Arts (RSA). Alongside three Oxbridge degrees in medicine and science, Dr Nina Fuller-Shavel holds multiple qualifications in nutrition, integrative medicine, functional medicine (IFMCP), health coaching, herbal medicine, Traditional Chinese Medicine (TCM), acupuncture, yoga, mindfulness and other therapeutic approaches.

 

Dr Nina Fuller-Shavel is the founder and Director of Synthesis Clinic, an innovative multidisciplinary practice in Hampshire, specialising in women’s health and integrative cancer care. Alongside her clinical work, Dr Fuller-Shavel delivers educational programmes for medical and nutrition professionals (including her Systems Approach to Cancer Programme), as well as participating in research and contributing to journal editorial boards and guideline development panels nationally and internationally. Finally, Dr Fuller-Shavel is the Co-Founder and Director of Oncio CIC, an innovative non-profit aimed at providing high quality app-based resources for people with cancer.

 

Find out more about Dr Fuller-Shavel’s work at:

https://www.drninafullershavel.com/ 

https://www.synthesisclinic.co.uk/

https://www.oncio.org/

 

 

References

1. Ricard-Blum S. The collagen family. Cold Spring Harb Perspect Biol. 2011;3(1):a004978. doi: 10.1101/cshperspect.a004978.
2. Rømer AMA, Thorseth ML, Madsen DH. Immune Modulatory Properties of Collagen in Cancer. Front Immunol. 2021;12:791453. doi: 10.3389/fimmu.2021.791453.
3. Necula L, Matei L, Dragu D, Pitica I, Neagu A, Bleotu C, et al. Collagen Family as Promising Biomarkers and Therapeutic Targets in Cancer. Int J Mol Sci. 2022;23(20). doi: 10.3390/ijms232012415.
4. Xu S, Xu H, Wang W, Li S, Li H, Li T, et al. The role of collagen in cancer: from bench to bedside. J Transl Med. 2019;17(1):309. doi: 10.1186/s12967-019-2058-1.
5. Tenti S, Correale P, Cheleschi S, Fioravanti A, Pirtoli L. Aromatase Inhibitors-Induced Musculoskeletal Disorders: Current Knowledge on Clinical and Molecular Aspects. Int J Mol Sci. 2020;21(16). doi: 10.3390/ijms21165625.
6. Behbahani S, Geisler A, Kolla A, Dreker MR, Kaunitz G, Pomeranz MK. Art of prevention: The importance of dermatologic care when using aromatase inhibitors. Int J Womens Dermatol. 2021;7(5Part B):769-73. doi: 10.1016/j.ijwd.2021.07.002.
7. Lin CR, Tsai SHL, Huang KY, Tsai PA, Chou H, Chang SH. Analgesic efficacy of collagen peptide in knee osteoarthritis: a meta-analysis of randomized controlled trials. J Orthop Surg Res. 2023;18(1):694. doi: 10.1186/s13018-023-04182-w.
8. de Miranda RB, Weimer P, Rossi RC. Effects of hydrolyzed collagen supplementation on skin aging: a systematic review and meta-analysis. Int J Dermatol. 2021;60(12):1449-61. doi: 10.1111/ijd.15518.
9. Campos LD, Santos Junior VA, Pimentel JD, Carregã GLF, Cazarin CBB. Collagen supplementation in skin and orthopedic diseases: A review of the literature. Heliyon. 2023;9(4):e14961. doi: 10.1016/j.heliyon.2023.e14961.