Do collagen supplements really do anything?

This BBC Podcast is supported by ads outside the UK. The Signal Awards recognize the podcasts that define culture, and being honored by the Signal Awards sets your production team apart. With recognition from the industry's top experts, and access proof that your work is a standard bearer for podcasting worldwide. By entering, your work is heard by the Signal Awards Judging Academy, an invitation only.

Professionals from acclaimed organizations which include the BBC. Grow your audience, celebrate your team, and stand out. The final entry deadline to submit is the 26th of June. Enter your podcast. at signalaward dot com for consideration. Hello, you're listening to Health Check from the BBC, where we take a closer look at some of the most important and interesting medical studies and breakthroughs from around the world. I'm Laura Foster.

Today we're looking at whether collagen supplements are the magic elixir of youth they're made out to be. Then we're going to try and solve the problem of the million missing midwives. I'm joined today by the family Doctor Anne Robinson. Anne, how are you? Hello. Thanks for having me on the programme. Oh pleasure to have you with us. What have you brought in for us today?

Well I'm excited about a story about ticks, which are nasty little blood sucking parasites, but could they help us to fight disease? Oh, I'd love it if the ticks that we all hate so much turn out to be really helpful. Um but then we're going to talk about flatulence, in other words, farting, and how often we should be doing it and whether smart underwear tracking it can help us get a better understanding of gut health.

But first Anne, I want to talk to you about collagen supplements, which seem to be having a real moment right now. Like there are adverts all over social media. I see celebrity endorsements. And they all suggest that if we take these supplements, we'll all look younger and be wrinkle free. Before we get into the study about how effective they actually are, and what do we already know about collagen and skin?

Yeah, it's a good question. Like you say, it's a huge and burgeoning global market over two billion dollars. And it's because a lot of us, like me, are really keen to find something that will stop those wrinkles and reverse the signs of aging. Of course they're foodstuffs, they're not licensed as as medical products. And partly because of that we really lack robust um evidence.

But collagen, as a lot of people will know, is a protein. It actually makes up about a third of the protein in our body and it contributes to connective tissue, the kind of scaffolding that holds us together. And the thing is that we start to lose our collagen or we make less of it from our late twenties onwards.

Now I'm just a little bit older than twenty and only a little bit. And I will have already lost about half of the collagen that I had in my twenties. And frankly, when I look in the mirror it's obvious. First of all, can I just before we go into the first time? I'm not looking for you. Can I just tell you that you are beautiful? Yeah, thank you, Laura. I wasn't fishing for that, but it is a fact that connective tissue and collagen does decline with age.

Yes, you mentioned we we naturally produce it. Some people are taking these collagen supplements, be they in powders or pills or or or gummy form. What are the main types of collagen? How popular are they? So the types you can buy can be derived from bovine or marine or there are vegan ones as well, but we don't know anything about which of those is best. and indeed whether they live up to the very extravagant marketing hype that often accompanies them.

Well, has this new research added any clarity to the industry? It definitely has. I mean it's super useful that someone's done it. It's published in a robust journal. And what they did was an umbrella review of all the stuff that's out there. So they whittled it down to one hundred and thirteen Reasonable quality randomized controlled trials, which looked at the experience of about 8,000 patients who'd taken the supplements.

And it showed that there was some consistent association with quite favourable outcomes for joints and for skin, for skin elasticity. But there are a lot of caveats. What do you mean by that actually in terms of what they notice for joints and skin? Well the kind of benefits that would have been reported in these studies were self reported measures of whether joint pain was better, mobility was better.

And in terms of skin elasticity there are various objective ways of measuring that, alongside people's report of looking in the mirror and feeling that they looked more useful. The problem with all these studies is a lot of them are industry funded, a lot of them lacked good controls, like really important factors were often missing, like we know that the most important thing in terms of skin health are things like whether you smoke and how much sun exposure you've had.

And the problem is that in a lot of those studies we just don't have that information. So to be able to say that the improvements that people noted were attributable to the collagen supplements is somet alone is sometimes a bit of a stretch. Overall, what do you think about collagen supplements? So I think the study was useful, suggested an association with good hydration for the skin, which might play out in a positive way, but for myself I'm gonna carry on not smoking.

I'm gonna try and be a bit careful in the sun with my SPF. I might moisturize when I remember. The main thing I should have done was choose parents differently'cause genetics plays a big part. My mum was really wrinkled. So that's the way it is. But I'm actually gonna embrace my wrinkles and I'm gonna see them as a badge of honour and a map of my life, as some people say. Laughter lines, not wrinkles. Thank you, Anne, for that health and financial advice there.

Now, in order to keep all mothers, mums to be and babies in the world safe, the world needs nearly a million more midwives than it currently has. That's according to recent research, which shows almost half the shortage is in Africa. Sara Namyal is a midwife in Uganda. Uganda, as a midwife in private practice, I'm seen not just as a health care provider.

As a valued member of the community One of the most significant challenges I encounter in my profession Is the demanding nature of long working hours Kwa hivyo, kwa hivyo, kwa hivyo, kwa hivyo, kwa hivyo, kwa hivyo, kwa hivyo. Compounding these issues is the lack of support and insufficient funding from the government. I envision a more balanced work life dynamic. with moderate working hours that prioritize our well being.

It would also be wonderful to see an increase in the number of young girls choosing to enter the medieval profession, ensuring a diverse and passionate workforce. So where did this nearly one million figure come from? Well, Daniela Drandich from the International Confederation of Midwives helped calculate this research, and she told me a midwife's job is much more varied than people realise.

In many countries, the focus of the midwife's work is around pregnancy, childbirth, and the postnatal period. But in reality, in the vast majority of countries, that role is much larger, from newborns to adolescents. to women who are seeking sexual and reproductive health services all the way to pregnancy, childbirth, and the postnatal period, and in some countries, even beyond that, with care for sexual and reproductive health.

So you've done this research and it pulls together data from the World Health Organization and then most recently from the United Nations Population Fund, and you found that the world is short of nearly a million midwives. Which places are most affected and which places are least affected? So every single region in the world is affected. And when we look at the country level, it's just over 50% of countries that have a shortage.

What's interesting is that the Africa region has the highest shortage. So it's about 47% of the global shortage. Other regions with high shortages are the Eastern Mediterranean region and the Americas, and the regions with the lowest are Europe and Western Pacific. And what's also important to say is when we did this analysis, we were only talking about essential midwifery services.

When we think about what we were talking about earlier with the full scope of midwifery practice, that shortage would probably be even higher. So at minimum, we still need 1 million more midwives. What problems does this shortage of midwives cause for mothers and expectant mothers?

So in different regions it plays out in different ways. For example, if we look at Africa and the Eastern Mediterranean, women and newborns are more likely to die in those regions because they don't have access to services. If we look at other regions, we don't have enough screenings for sexually transmitted infections, that there are issues with accessing comprehensive abortion services. And we also see there is.

abuse or different forms of of negative behavior when they're trying to reach us and access these services. W you talked there about mothers and newborn babies dying because there aren't enough midwives. How many of those deaths could be avoided if we had enough midwives in the world to cater to them? There are studies that have done an analysis on what would happen if we had perfect coverage of midwife delivered interventions, which are the same ones that we looked at in our study.

And those studies are showing us that about 65% of the preventable maternal deaths could be avoided. How do you think we fill these shortages? How do we get more midwives? Having midwives helps make s um s health systems more sustainable. And they're there whenever there's some sort of a tragedy, when there's emergency. And having that type of an agile, mobile workforce helps make health systems much more responsive and much more sustainable.

So on the one hand, we have to really show the public what the power of investing in midwives is. And once communities and individuals see what's possible, they can start pushing for that type of service on their governments. That then makes it more likely that governments will invest in maternal well-being and in sexual reproductive health services overall that are delivered by midwives. Daniella, you've talked about investing in midwives. Have we got enough people wanting to be midwives?

Midway. It it's different in different parts of the world. I think one of the things that we need to do is first of all work on recruiting, of course, having students in attractive, high quality educational programs. We also really need to work on retention.

So it's not just enough to educate midwives. We also have to make sure that the systems that they're working in are providing them workplaces that are safe, that provide them with fair pay, that are giving them the tools that they need to do their jobs. And to do their jobs well. The most recent figures I've seen from the UN show that ninety three per cent of the world's midwives are women. How much of a issue do you think that is when it comes to attracting people into the profession?

It really varies from region to region. So if we look at the African region, for example, thirteen percent of midwives in Africa, the highest percentage uh of all the regions are men. And part of the reason is because midwifery is a very sought after respected career. In many countries in the north of Europe, it's also a very, very competitive career in the sense that it's very difficult to get into the educational program.

So it's really important for us as societies to really decide what we value. And if we value women's health, if we value newborn health. If we value sexual and reproductive health, then we invest in in midwives and in the care that those people need and the midwives to deliver. So celebrate midwives, make it even more attractive as a career and that g shortage m could be eliminated.

Absolutely. And I think it's it's also really interesting to think that midwives are health workers that everybody need at some point in their life. Um, you know, while we do need other health workers as well and everybody has their role, the midwife is usually the first one that helps you out, literally, when you're a newborn and does continue to provide that care.

So midwives are the first health professionals that provide that provide care to the the smallest, frailest and um newest of us and really investing in that I think is is one of the keys to improving all the other outcomes that then ripple through communities and generations. Daniella Drandich The Signal Awards recognize the podcasts that define culture, and being honored by the Signal Awards sets your production team apart with recognition.

The industry's top experts and access proof that your work is a standard bearer for podcasting worldwide. By entering your work is heard by the Signal Awards Judging Academy, an invitation-only body of podcasting. Podcast professionals from acclaimed organizations to Which include the BBC. Grow your audience, celebrate your team, and stand out. The final entry deadline to submit is the twenty sixth of June. Enter your podcast at signalaward.com for consideration.

You're listening to Health Check from the BBC, and with me today is Dr. Anne Robinson, I'm Laura Foster.

Now blood sucking, clingy, bitey parasites all words used to describe tick. Now, just thinking about the viruses and bacteria these small creatures carry makes my skin crawl. But Anne, you mentioned earlier that rather than being the bringers of disease, That ticks may actually be able to help us treat things like cancer and multiple sclerosis? Yeah, I mean ticks are having a bit of a a moment. They're these little parasites and we tend to pick them up if we're walking in grassy or wooded areas.

and they cling to our skin and they suck our blood. They're usually quite harmless except you need to look out to make sure you haven't got fever or aches or a rash, which could mean that you'd picked up something like Lyme disease. But it turns out that the secret of their success as parasites is something that has now interested scientists. What is that something?

So it's really clever. I mean you could ask the question, how come they attach themselves to us and our defence system doesn't get rid of them? And it turns out that they make a group of proteins called evasins because it helps them to evade. our natural immune system. And the thing that alerts our immune system that some nasty little foreign tick is attaching itself to us is that we we have these chemicals called chemokines.

And the parasites evasins attach themselves to our chemokines and basically they deactivate them. So they can't then alert our defence system. So the ticks can just sort of carry on, you know, having their feast on our blood. And and so these uh Australian scientists in Monash University have studied these evasin proteins that the ticks made. And they thought, well, if they deactivate our immune system, maybe they'll be really helpful in autoimmune conditions.

Conditions that we humans have where our m immune systems are too active, where we turn on our own cells, conditions like multiple sclerosis or rheumatoid arthritis. So it's just a really, really clever idea. And how does cancer connect to all of that? Well anything which allows our immune system to not overreact and to produce too much inflammation and potentially cancerous change as well. That's the hope. But previously we thought evasins only

deactivate one bit of our immune system. There are two big groups of chemokines. We thought they were specific for one group or another. But what these scientists did was they found evasins which actually deactivate Both sex. of chemokines and that's what makes them so useful potentially. It's a really versatile evasion we're talking about here from the ticks. Exactly.

As you've been talking about this study, you have been smiling and most of the time we talk about tics, people are not smiling. How do you see this being used to help develop a safe, realistic treatment for humans in the future? Yeah, I've been smiling I think because I always marvel at human ingenuity to look around us, whether it's a annoying parasites or perhaps plants which can be poisonous to us.

and derive some sort of way of helping us as a species. I think it is part of what makes humans a very successful species. And although we have such good novel ranges of treatments for autoimmune conditions now, I mean the whole face of the treatment say of multiple sclerosis has been revolutionized. Ond mae'n ymwneud â'r newydd o'r newydd o'r newydd o'r newydd o'r newydd o'r newydd o'r newydd o'r newydd o'r newydd o'r newydd o'r newydd o'r newydd.

Really positive, optimistic words there, and thank you so much.

And I want to talk to you now about something completely different. In your experience, have you had a lot of patients come to you concerned about gap? Yeah, I mean gout is more common than people think. They think unless you're kind of stomping around like Henry the Eighth, it's not going to affect you. But actually it can affect anybody. And it's on the rise globally. Um, as we get older and obesity is more prevalent, we're definitely seeing more of it than we used to.

In fact, the latest figures I have about the problem globally is it's shown to affect more than fifty five million people and it's this type of arthritis, it causes sudden, severe joint pain, swelling. And one of the people who have it is actually one of our reporters, Tony Vinya, who lives in Cameroon. I was travelling from Dwala and we just had uh pork and uh before I got to Bamenda it was difficult for me to come out of the car because my ankle was swelling and painful.

Gideon describes his first gout flay as a I live with a stigma because they will laugh. The things that we used to do together, we could no longer do them because I am just alone. At times I feel like I don't belong here. My friends reacted the same way when I was diagnosed with gout. Thank you. Many Cameroonians socialise by hanging out in bars on weekdays after work and on weekends. Alcohol is often accompanied by remote. like meat and fish. Some of these habits fuel the rice in gout cases.

I'm Timothy Panfon. I am a physiotherapist. Gout is related to lifestyle and uh maybe because uh people are eating a lot of purine rich foods now. Beer is one of it and young people you know they drink a lot of beer. You you smile. Yeah. I take a lot of beer and you hear people saying that no, they eat intestines and all of those inner organs because they think they want to escape from red meat. But organ meat. also are very rich in purines. Things like liver, kidney, even gizzard you know.

The body produces purines when it breaks down proteins and alcohol. Purines are further broken down into uric acid. doctor Epien Jumet, a medical doctor and non communicable diseases researcher, draws the link. Gout occurs when uric acid crystals get deposited. in the joints and bones these crystals now trigger an inflammatory reaction such that the area that joints becomes red, hot, tender Eating habits across Cameroon have also changed.

Meat is now available to more people and in greater amounts, making it harder for those who are predisposed to avoid gout. Black Africans would probably have similar risk factors, similar genetic makeup would contribute to. how purines are metabolized and so d different from say Caucasians in the West. And I would imagine that um these statistics would also mirror

trends that we see in other non-communicable diseases and cardiovascular diseases. Black Africans tended to develop some of these conditions. Gao cause much more in men, but how does it impact women? women tend to start to have high levels of uric acid after menopause. So that introduces the fact that hormones may be playing a role in the metabolism of purines which which lead to the formation of uric acid. So so women before menopause shouldn't be so concerned.

I hadn't been to a hospital for years before my diagnosis. I had no visible signs till my first crisis. Strong. And you didn't have the other were typical. In fact, they were classic for gouty arthritis. Jume and Fanfonsey the government lacks data. And no dedicated program to fight what they believe is a public health concern given its connection with other non communicable diseases. Jesus.

Gout is underdiagnosed. There are a lot of people who have it who are suffering from it but they don't seem to understand what is going on and they keep getting maybe over the counter drugs to help themselves. Increasingly I am seeing a lot of uh young people. I'm surprised about it myself because the literature says that it is more common in older people.

Extreme buildup of uric acid in the joints can lead to the growth of lumps called TOFOS. Tofu further impairs movement and heightens pain. Gout-related complications in some cases can lead to death. But it's policy improving education. I haven't seen any indication that that's happening, perhaps since we don't have any national program.

uh that's addressing that. I but I want to believe that uh healthcare professionals try to educate patients and hopefully their families discussing about the costs, the risk factors and the best ways uh to approach it. Because gout can be that wake up call for people to pay attention to their health. When young men are diagnosed with high levels of egg acid or gouty arthritis, they may want to scream more.

if they are overweight or obese they may want to take steps to try to attain a healthy weight or they may want to reduce the consumption of or purine rich foods that we mentioned earlier. Gideon is making the most of that opportunity. I was put on medication for some time. I disciplined myself to be able to take my medications. No alcohol, no meat. Stop that out. after that treatment I got well, I got better. What hasn't improved is the teasing.

I feel like some of my friends have it and they're hiding it. I agree. When guys turn up in sandals, walk with a slight limp, ignore the tray of meat, and order water. Everyone suspects gout. That report there from Tony Vinya in Cameroon, ending with some music that Tony himself created. A very talented bunch of people we were.

And Tony talked a lot about the stigma around gout. And then the next thing we're gonna talk about now also causes a lot of people to feel embarrassed. I'm talking about flatulence, so farting.

Anne, had you ever heard of smart underwear before this week? No, I really hadn't. I thought smart underwear was the sort that you kind of wear when you don't want your tummy to show under a tight dress or something like that. I had no idea that there's a new gadget that can measure your gas. So before we talk about what the smart underwear has found, can you tell me a little bit about how it works?

So I mean it's an absolutely ingenious device. It will be used primarily as a research tool. They want to form an atlas of farting throughout the US. But the thing is it sounds like a joke, um, but it's really, really important because there's a lot of interest in our gut health. We know now that our microbiome, the little microbes, usually bacteria that are part of our digestive system, play a really important part not just in gut health,

but all sorts of health, including our mental health, incidents of depression, etc. But the thing is that it's very difficult to measure gut health in real time. The sort of ways we can sample what's going on in the gut often don't represent what's happening in that moment and the gut microbiome can change very rapidly. So we don't have good ways of assessing that.

And the ways that we have of directly accessing what's going on in the gut involve putting a tube up people's backside and sampling, you know, what's going on. And you can't do that too often. So this device seems like a very good step forward comfort wise,'cause it's just something you just put in your pants and you can remove at the end of the day and wash your pants, and then you can put it in the fresh pair of pants the next day. What exactly is it measuring?

So I think it is a game changer, as you say, and uh it communicates the information via Bluetooth to your phone and that data can be uh centrally collected. So it's measuring your gas content. Uh so the gas that we expel contains mainly hydrogen gas, carbon dioxide gas, then non-smelly, and then a little bit of hydrogen sulfide, that's the smelly one. Hydrogen sulfide's the one that we give off.

when we're digesting certain sulfur containing foods like broccoli and cabbage and onions. But most of the gas that we pass actually doesn't smell at all. But it can still be embarrassing'cause people stand up and then there's that sound of passing wind and people feel really embarrassed about it. So it's measuring hydrogen, isn't it? Do we know what is a good amount of hydrogen to be releasing in our

Well no, we don't know what's a good amount, we don't know how much gas in total is a good amount. There's huge variation between individuals and also within ourselves. I mean we all know we can have days when we think we're not farting at all, although we are, at least kind of

probably about ten to twenty times minimum. But then there are other days when you're just kind of farting all the time, you can't stop. So we need to understand more about this because it is a direct association with what's going on in our gut. which we want to understand better.

Thank you so much to Dr. Anne Robinson for joining us for Health Check today, and thank you to the producers Hannah Robbins, Georgia Christie, and Anna Sharalambu, and our studio engineers today were Sir Whitney and Andrew Garrett. Do contact us with your health questions at HealthCheck, that's one word, at bbc.co.uk. I'm Laura Foster, and in the next episode of Health Check, our reporter is in Finland discussing health at the Winter Swimming World Championship. Until then take care.

Пока. The Signal Awards recognize the podcasts that define culture, and being honored by the Signal Awards sets your production team apart with recognition. The industry's top experts and access proof that your work is a standard bearer for podcasting worldwide. By entering your work is heard by the Signal Awards Judging Academy, an invitation-only body of podcasting. Podcast professionals from acclaimed organizations to

Which include the BBC. Grow your audience, celebrate your team, and stand out. The final entry deadline to submit is the 26th of June. Enter your podcast at signalaward.com. them for consideration.