PREVENTION & TREATMENT

Nutritional intervention: 3 important nutrients essential to helping patients improve skin health.

We know chronic wounds can be difficult, sometimes taking years or decades to fully heal. Individuals experiencing these wounds can be in severe pain, emotional stress, and have limited mobility. We also know that non-healing chronic wounds can impact the quality of life of those affected and can lead to something more serious like an amputation or even premature death. Infections, amputations and possible death as consequences of a wound are unfortunately all too common and may be avoidable with accurate diagnosis and early appropriate treatment, such as nutritional intervention.1

For more than 100 years, nutrition has been recognized as a very important factor that affects wound healing. Likewise, malnutrition or specific nutrient deficiencies can have a profound negative impact on wound healing after trauma and surgery. Patients with chronic or non-healing wounds and experiencing nutrition deficiency often require special nutrients. Both macro and micronutrients can all affect the healing process. (Arnold and Barbul, 2006).2

Protein

Protein is one of the most important nutrient factors affecting wound healing. Adequate protein is essential for maintaining and repairing tissue, as well as facilitating wound healing. Increased protein levels have been linked to improved healing rates.3 Collagen is the major protein component of connective tissue and is composed primarily of glycine, proline, and hydroxyproline. Collagen synthesis requires lysine and proline, and co-factors such as ferrous iron and vitamin C. Impaired wound healing results from deficiencies in any of these co-factors.4

Amino acids Arginine and Glutamine

Amino acids are the building blocks of protein. They also play an essential role in cell function and tissue repair. There are essential and non-essential amino acids. Since the body cannot produce essential amino acids, they must be acquired by eating meat, grain, and vegetables. Two critical amino acids help with both prevention of pressure ulcers and wound healing:

  • Arginine can have significant beneficial effects on the wound repair processes. Not only does it help prevent wounds but it also has been shown to promote healing in at-risk populations, such as elderly individuals and/or those with limited mobility. Arginine is essential during stress, growth or illness. We get arginine from both plants (wheat germ, granola, nuts and seeds) and animals (dairy, beef, pork, and chicken). Arginine improves immune function, and stimulates wound healing in healthy and ill individuals.5 Under psychological stress situations, the metabolic demand of arginine increases, and its supplementation has been shown to be an effective adjuvant therapy in wound healing.6
  • Glutamine may be the most abundant amino acid in the body, but it must be replenished in times of need. Glutamine in the body is often reduced after major surgery or trauma, and supplementation has been shown to improve healing. It influences wound repair and immune function. It is obtained from both plants (wheat, cabbage, beets, beans, and spinach) and animals (beef, chicken, fish, and dairy products). Oral glutamine supplementation has been shown to improve wound breaking strength and to increase levels of mature collagen.7

Vitamin C

Vitamin C has many roles in wound healing, and a deficiency in this vitamin has multiple effects on tissue repair. Vitamin C deficiencies result in impaired healing, and have been linked to decreased collagen synthesis.8 Also, vitamin C deficiency leads to an impaired immune response and increased susceptibility to wound infection.9,10

While healing wounds is a complicated and multi-step process, utilizing nutrition during wound care, or improving nutritional intake prior to surgeries, patients will experience improved outcomes. By utilizing the targeted nutrients listed above, we can expect speedier recovery of wounds, and improved quality of life in patients, and decreased associated consequences of wounds.

The Phases of Wound Healing 11,12,13,14
PHASE Timeframe What to Expect Nutrients Involved Nutritional Needs
Inflammatory First few days Decreased bleeding; Clot formation; Wound is cleared of bacteria and other debris Protein; Amino acids: arginine, glutamine; Vitamins: A and C Adequate calories from any combination of enteral nutrition, oral nutritional supplementation or oral diet; Adequate protein intake; Adequate hydration
Proliferative Few days to few weeks Increase in blood flow; New blood vessel formation; Collagen formation and deposition Protein; Amino acids: arginine, glutamine; Vitamin C; Minerals: iron, copper, zinc Adequate calories from any combination of enteral nutrition, oral nutritional supplementation or oral diet; Adequate protein intake; Adequate hydration
Maturation Few weeks to several years Collagen assists with cellular growth and increased tensile strength— Wound size decreases, Ultimately wound heals Protein; Vitamin C; Copper Adequate calories from any combination of enteral nutrition, oral nutritional supplementation or oral diet; Adequate protein intake; Adequate hydration
Routsi Lee

Bushra Hassan, MBA, RD, LDN, is an expert in supplement development, nutrition education, wellness coaching, and product brand management. Her work focuses on diet and nutrition, digestive health, and integrative and functional medicine.

References:

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5259833/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903966/
  3. National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: clinical practice guideline. Washington DC: NPUAP; 2009
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903966/#bibr12-0022034509359125
  5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903966/#bibr96-0022034509359125
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903966/#bibr12-0022034509359125
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903966/#bibr16-0022034509359125
  8. National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: clinical practice guideline. Washington DC: NPUAP; 2009
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903966/#bibr3-0022034509359125
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2903966/#bibr12-0022034509359125
  11. Stechmiller J. Understanding the Role of Nutrition and Wound Healing. Nutrition in Clinical Practice. 2010, February;25(1):61-68. Available at: http://ncp.sagepub.com/content/25/1/61.full.pdf+html. Accessed September 7, 2012.
  12. Harris CL, Fraser C. Malnutrition In The Institutionalized Elderly: The Effects On Wound Healing. Ostomy Wound Manage. 2004 Nov;50(11):10.
  13. Johnston E. The Role Of Nutrition In Tissue Viability. Wound Essentials. 2007;2:10-21.
  14. Thompson C, Fuhrman MP. Nutrients and Wound Healing: Still Searching for the Magic Bullet. Nutrition in Clinical Practice. June 2005;20(3):331-347.