The Link Between Proper Nutrition and Wound Healing
As a former nutritionist (in my last life, prior to podiatry school), I worked in a hospital as a dietician and was exposed to the different nutritional needs of patients. Where as I can’t say I was well versed in wound care at that time, (was there even a discipline known as wound care back then??), I did counsel patients on proper dietary goals for the hypertensive patient, the diabetic patient, the renally impaired patient, the cardiac patient, etc. Even then it was challenging to motivate patients to be personally responsible for their dietary needs/ constraints let alone to understand the basics of nutrition. Now as a podiatrist, dealing with wound care day in and day out, and trying to educate people on obesity, effects of diabetes on the foot, the importance of exercise etc, the challenge is even greater.
Why is Proper Nutrition Important?
Without proper nutrition, the intricate process of wound healing can be adversely affected. A poor diet can turn a “normal” type wound into a chronic non healing wound quickly. In one phase of healing (anabolic), new tissue is created by bringing stress hormones, carbohydrates, fats, and mainly protein into the wound. However, if the first phase (catabolic) drags on too long, a phenomenon known as PEM or protein energy malnutrition can occur. This begins a negative cycle whereby the body will send extra protein to the wound site, but as a negative consequence, other important organs do not receive enough protein or further, lean muscle mass begins to break down. This ultimately will cycle back to delayed wound healing.
The Role of Protein, Fats, and Carbohydrates
Protein is by far the most important of the required dietary components for a healing wound because it helps repair damaged tissue and serves as the “building blocks” used to create new tissue. It is important to increase the protein in one’s diet while trying to heal a wound and not allow the loss of any lean body mass as this can be detrimental to one’s general health as well as to the wound healing process. A healthy adult requires .8 g of protein/ kg of body weight /day or about 60-70 g protein to maintain and patients with wounds require almost double that. Losing lean body mass will impair wound healing and substantial loss of lean body mass can lead to the development of spontaneous wounds such as pressure ulcers and even wound ruptures (dehiscences). Nearly all consumed protein is used for synthesis NOT for energy.
Carbohydrates which have gotten a bad “rap” of late in the diet world are actually essential in the diet of someone trying to heal a wound. Carbohydrates fill the role for energy use and have other important functions. They work together with proteins to build structure and communicative properties. Glucose, which has many functions, is interestingly also used for inflammatory cell activity leading to the removal of bacteria and other harmful material.
Fats from dairy products are essential in wound healing. Cell membranes are created with the use of fatty acids and one needs extra fats in order to propel wounds to heal. Lipid components are responsible for tissue growth and wound remodeling including collagen and extracellular matrix production.
The Importance of Vitamins and Minerals
Vitamins and minerals are also key factors in wound healing. There are several vitamins and minerals which contribute positively in wound healing, but the three main ones are Vitamin C, Vitamin A, and Zinc. Vitamin C is an important antioxidant. It increases the strength of the wound as it heals and helps with the creation of collagen in the skin. It is important in the development of new blood vessels and also helps with iron absorption. As little as two hundred mg of Vitamin C daily can be significant in wound healing. Vitamin A is another crucial antioxidant. It helps fight infection and aids in controlling the overall inflammatory response. It should be noted that because Vitamin A is fat soluble and not water soluble, toxicity can actually occur if consuming too much. Red fruits, fish, eggs and dark green vegetables are good sources of Vitamin A. Zinc, a mineral, helps the body synthesize proteins and develop collagen. It is involved with DNA synthesis, protein synthesis, and increases the number of cells. Other minerals such as manganese, arginine and selenium in trace amounts can be helpful with wound healing.
Lab Work as Indicators of Wound Healing
Clinical factors to be on the lookout for, would be checking for albumin (protein) in routine lab work, which if too low is an indicator of poor wound healing. Also a low body weight, less than 85% of ideal is a risk factor as is a 5-10% loss of body mass over 1 month. Lastly when obtaining routine lab work, a decrease in serum transferrin (iron levels) can also be a risk indicator for poor wound healing.
Hopefully by taking a few of these concepts into account, we can become better equipped to deal with the ever so omnipresent foot wound.
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