The above image, A, shows collagen deposition (fluorescent green) in tendon tissue after stimulation by hyaluronic acid. Image B shows almost no collagen when hyaluronic acid is not added. (From Oliva 2021 via Creative Commons License.)

Many people are familiar with hyaluronic acid (HA) as a topical agent, used by many ladies to improve skin hydration and smooth wrinkles, given HA’s ability to bind considerable quantities of water molecules. HA is also injected into joints to increase joint lubrication (knees, hips, shoulders), into skin as a temporary filler to reduce wrinkles, administered into the colon via enema to reduce the inflammation of ulcerative colitis, and applied topically in the vagina as a lubricant. But the real power of hyaluronic acid comes with oral ingestion, just as it was supposed to occur if we added back lost dietary sources.

Organ meats, especially brain, kidney, heart, intestines, and skin, are rich in HA. The modern aversion to organ meats has therefore caused a widespread lack of HA intake that, I believe, is causing accelerated aging of skin, joints, and other organs, perhaps including the brain. Lack of HA compromises the intestinal barrier to microbial byproducts and allows greater intestinal and body-wide inflammation.

HA content of organs drops as we age. Age-related reduction is especially marked in skin, with older people having up to 90% less dermal HA compared to young people. HA is abundant in joints, found both in cartilage and in the joint lubricant, also reduced in quantity as we age. HA is also found in generous quantities in human breast milk, crucial for gastrointestinal maturation of the breastfeeding infant (and yet another deficiency of synthetic infant formulas).

It is clear that orally-ingested HA makes its way to the dermal layer of skin, the joint lubricating fluid in knees, hips and other joints, tendons and ligaments, the eyes, and other organs. After ingestion, HA is metabolized by gut microbes into smaller fragments that are absorbed and distributed throughout the body. As the photo above demonstrates, HA stimulates collagen deposition (as does collagen supplementation, also).

HA also has prebiotic properties and has been shown to markedly increase the population of Akkermansia muciniphila, the keystone species that exerts numerous beneficial metabolic effects including reduced insulin resistance, reduced blood sugar, and increased production of intestinal mucus. Another keystone species, Faecalibacterium prausnitzii, produces increased quantities of beneficial fatty acids such as butyrate when “fed” HA. Applied orally, HA also reduces oral pathogens.

HA ingestion therefore can be expected to:

    • Increase skin moisture and reduce wrinkle depth
    • Increase joint lubrication (glycosaminoglycan and proteoglycans) and reduce arthritis pain

By the way, if the evidence demonstrating that HA, especially when combined with collagen hydrolysates also absent from the modern diet, reduces arthritis pain, increases joint lubrication, and can increase cartilage volume, why are doctors so keen on injecting HA directly into joints, but not on oral supplementation? Ah, well, you can charge money for injections, but not for advocating an oral supplement.

  • Yield metabolic health improvements—at least partly due to the prebiotic fiber properties of HA
  • Reduce intestinal inflammation by increasing the intestinal immune response
  • Reduce penetrability of the gastrointestinal lining (thereby likely reducing endotoxemia and body-wide inflammation)
  • Improved wound healing

Consistent with the consumption of something that should be a natural component of diet, no adverse effects of HA have ever been reported across dozens of human clinical trials.

You can indeed obtain HA by bringing organ meats back into your diet. Most modern people, however, find this objectionable. At the very least, you could increase HA intake by eating the skin on poultry (NEVER boneless, skinless chicken breast, the epitome of low-fat blunders!) and fish, consume sausages encased in natural casings, make soups from the carcass of animals you’ve consumed, but the total quantity ingested will be modest. Supplementation can therefore be the solution.

If we were to consume the brain of an animal, we would obtain around 7.4 grams of HA from a 4-ounce serving. A range of HA doses have been explored but typically 40-240 mg per day. But is that the ideal intake? This is an unanswered question, but would be worth exploring. Because HA is so water-absorbent, small quantities generate substantial hydrating effects.

Image source: Oliva F, Marsilio E, Asparago G, Frizziero A, Berardi AC, Maffulli N. The Impact of Hyaluronic Acid on Tendon Physiology and Its Clinical Application in Tendinopathies. Cells. 2021 Nov 9;10(11):3081.