In a previous article, I wrote about the importance of protein and how much one should consume on a daily basis. Now I’m going to be a bit more specific.

The most abundant protein in the body is collagen. Also, collagen makes up about ninety-percent of connective tissue. This is important for a number of reasons, not the least, musculoskeletal health. If “musculoskeletal health” seems vague, think: degenerative joint disease, degenerative (spinal) disc disease, disc herniations (or “slipped” discs), tendonitis/osis, osteoporosis, sprains and strains, etc.. Collagen essentially provides the tensile strength of tissues. If you don’t have enough collagen or your collagen is “weak” or poorly formed, you’ll be susceptible to injuries and all types of musculoskeletal disorders; among other problems that I’ll touch on briefly as well.

There are twenty-nine types of collagen throughout the human body. Collagen is a major component in many tissues, especially bone, cartilage (including intervertebral discs), tendons, ligaments, muscles, skin, blood vessels, lung tissue, and even the cornea of the eye. Now you can see how the integrity of your collagen is so vital to the functioning of your body. Remember, structure determines function, and collagen is a major part of your structure. So now let’s discuss how to make and maintain strong collagen.

First, you need (to digest and absorb) adequate amounts of protein in order to supply the raw materials. Remember, the building blocks of protein are amino acids. Any amino acids can be used in some areas on the collagen molecule, but the key ones are proline, lysine, and glycine. You shouldn’t have to be concerned with eating large quantities of food that contain these specific amino acids in high levels. Focus on getting an adequate amount of protein from a variety of sources and that should cover your bases. Although, vegetarians and vegans may want to seek out foods high in these amino acids to be sure. And, those with injuries and/or chronic musculoskeletal conditions may want to ensure higher than typical amounts of these amino acids.

Now I’ll discuss the synthesis of collagen. First, in order for your DNA to begin the process (I’ll keep it simple), you need zinc. There is an important zinc-dependent enzyme, DNA polymerase, that allows for the proper function of DNA. This is why zinc is an extremely important mineral in general. The proper function of DNA is an absolute necessity for every cell in your body; especially cell growth.

As mentioned above, the amino acids lysine and proline are necessary. These amino acids then need to be hydroxylated (which means adding an -OH group). For this reaction to occur, you need iron, vitamin C, and alpha-ketoglutarate. Focus on the iron, vitamin C, getting enough protein and you shouldn’t have to worry about the alpha-ketoglutarate (for the most part).

The next step in forming collagen is known as glycosylation (adding glucose basically). This requires available glucose (or galactose) along with vitamin A and manganese. Now don’t go out consuming pure glucose in order make sure this step happens. But do make sure you have good blood sugar metabolism in order to have it available for the cells to use. I have written several articles related to blood sugar. Click here to read my article on “what” to eat, and here to read about “how” to eat.

After glycosylation, pro-collagen is eventually formed which is/are basically chains that are linked with the help of sulfur. So sulfur is essential for collagen formation, but it does have other roles in the body as well. In supplement form, sulfur can be obtained from “MSM” (or methylsulfonylmethane). Additionally, there are “sulfur-amino acids” that can be taken as supplements or gotten from food. These amino acids are cysteine and methionine. Foods that are especially high in sulfur include kale, cabbage, cauliflower, onions, garlic and eggs.

Pro-collagen then requires transport outside of the cells which again requires vitamin A and zinc.

At this point pro-collagen is converted to collagen and then strengthened by cross-linking the fibers (or fibrils) with the help of copper-dependent enzymes. Please note that this enzyme can be inhibited by high levels of the amino acid homocysteine. If you’re not familiar with homocysteine, I have written about it in another article linked here. If homocysteine inhibits this enzyme, the strength of the collagen fibers may be compromised resulting in weak or dysfunctional collagen. This is extremely problematic and may thwart the whole effort. See my article linked above for the “antidotes” to homocysteine. It will “save” more than just your musculoskeletal health.

That essentially covers the formation of collagen. To recap, here is a list of the most important nutrients: protein (esp. the amino acids: proline, lysine, and glycine), zinc, vitamin C, iron, vitamin A, manganese, sulfur, and copper. Don’t forget healthy blood sugar metabolism. And you can also include the nutrients that are necessary to metabolize homocysteine.

Before I finish, I want to touch on another point. Collagen can form adhesions, so to speak. This is the result of excessive cross-linking of collagen. Essentially, when this happens, the fibers don’t glide along one another smoothly. Adhesions can result in decreased range of motion in a joint; and it can be caused by decreased range of motion (usually post-injury or post-surgery). Adhesions in other structures that require collagen (such as blood vessels) may affect their function as well. The key nutrients for preventing this excessive cross-linking (thus aiding in normal cross-linking) are bioflavanoids. In nature, bioflavanoids are found in the white, pithy part of citrus fruits under the rind. They’re also contained in most fruits and vegetables as well as green tea. So in addition to structural treatments designed to increase range of motion, bioflavanoids may be particularly helpful. These can be obtained from supplements as well as food.

I’ll give you an example of how helpful bioflavanoids can be, as well as collagen formation in general. A 42-year-old patient who had undergone a double-mastectomy was referred to me for herniated discs in her neck as well as shoulder and rib pain (in addition to hip and knee pain). I surmised that most of her symptoms were a result of scarring and adhesion formation from the surgery (in addition to a lack of regeneration or degeneration of collagen in her neck/discs, hip and knee). The reason I felt this was because she had never injured any of those areas and there was no history of “overuse” as in repetitive sports. The surgery can be considered an injury, but regardless, she didn’t recover well if pain and decreased range of motion persisted.

I treated her structurally to get her muscles, ligaments, joints, and even skin functioning optimally. In thinking about the nutritional component of her pain and realizing this concept of adhesion formation and collagen; I instructed her to take a bioflavanoid supplement containing dried fruits and vegetables; and she also began juicing fresh fruits and vegetables (even better!). I also had her take a specific mineral related to sulfur metabolism. After about one month of treatment she reported “I feel better”, “I finally feel good”. After about two months, she was doing great and reported a “75%” improvement in her neck, shoulder, and rib pain and was able to walk long distances without pain in her hip or knee. This is a significant improvement, especially after undergoing surgery, in addition to chemotherapy and radiation. I recently saw her after a three-to four-week hiatus and she reported that a fair amount of the pain and discomfort had come back. Sure enough, the holiday season and her busy schedule interfered with her juicing and taking the supplements which allowed the adhesions to reform and decrease her range of motion, while increasing her pain. It may be unfortunate that she’s currently relying on supplements to remain pain-free, but it sure beats pain medication. With more time and consistency, she should be fine on a well-rounded, whole-food diet.

In conclusion, the array of nutrients necessary for collagen formation and maintenance helps explain why a well-rounded diet is so important. And remember, collagen is important for more than your musculoskeltal health. It’s absolutely vital for your (cardio)vascular system. Oh right, and something as simple as anemia (iron or folic acid/B12 deficiency) and hypochlorhydia can (and most certainly will) affect your musculoskeletal and cardiovascular health. You see, it does all fit together if you can find the missing pieces.

Also, remember that skin is dependent on collagen (among other things), and without sufficient amounts, wrinkles will result. I wonder if those collagen injections people get could be used for more than just vanity. And when the visual effects wear off, does the body “steal” it from (say) the lips to put it where it’s more important for survival? I hope so.


Dr. Robert D’Aquila – NYC Chiropractor – Applied Kinesiology

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