When it comes to minor wounds and scratches, the body can start healing within minutes as blood cells clump together to form a barrier in the skin. However, deeper or more serious wounds take more time and energy to heal.
Treating chronic wounds requires a multifaceted and holistic approach. While treatments such as wound debridement and preventing infection strategies are more widely known, evaluating and optimizing nutritional status should also be a part of a comprehensive treatment plan.
While not all wounds are the same, nutrition must be taken into account in the treatment of all types of wounds. But what happens when the body doesn’t receive the nutrition it needs? How does malnutrition impact the healing process? And what can you do to ensure you are giving your body what it needs to recover? This guide has everything you need to know.
Article Contents
- Why is Nutrition Necessary for Wound Healing?
- Malnutrition and Chronic Wounds
- Nutritional Screening and Assessments
- Indicators of Malnutrition in Patients
- Necessary Nutrients for Wound Healing
- Working Together to Optimize Healing
Why is Nutrition Necessary for Wound Healing?
There is a well-established link between nutrition and wound management. Nutrition can be essential throughout each stage of wound healing.
When a person is malnourished the body lacks sufficient nutrients to build, maintain and repair tissue, which can result in issues such as reduced fatty tissue, less resistant skin, oedema, and other potential complications that interfere with healing. Additionally, suboptimal nutrition can impair the healing process by interfering with the immune system, collagen synthesis as well as wound tensile strength.
During the wound healing process, the body works to replace the damaged tissue with new tissue. This response requires increased use of energy and specific nutrients. Most notably protein.
During the catabolic phase which occurs after a wound, the body prioritizes supplying the area with the nutrients it needs to heal by releasing stress hormones and altering metabolism. If the body doesn’t receive enough nutrients or this phase takes too long, a condition known as protein energy malnutrition (PEM) can occur.
Protein energy malnutrition may be directly linked to slow healing wounds. When the body is suffering from PEM, it breaks down the amino acids it needs to heal; resulting in a reduction of lean body mass. As lean body mass goes down, the body breaks down the protein from muscles and is more likely to suppress the immune system and impair healing. This can be especially detrimental for patients with comorbidity such as those suffering from diabetes.
Malnutrition and Chronic Wounds
Unfortunately, nutrition is often neglected in the management of chronic wounds. This is particularly relevant in the older population who are at higher risk of chronic wounds and often suffer from nutritional deficiencies. As referenced above, wounds can increase the metabolic and protein demands of the body.
According to a review published in Advances in Wound Care, “the presence of a chronic wound can increase protein requirements by 250% and calorie requirements by 50%”. The review went on to mention that in some cases, administering more than the usual nutrients may aid in the healing process.
This was further discussed in a later paper on improving clinical outcomes for chronic wounds through proper nutrition published by the Journal of the American Society of Plastic Surgeons.
That’s why many wound care specialists will work with a nutritionist to conduct a nutritional screening and follow up assessment as part of their treatment plan for chronic wounds.
Nutritional Screening and Assessments
Nutritional screening is a strategy utilized by wound specialists to help identify nutritional disorders as well as any signs of malnutrition that could impair wound healing. During the assessment, a specialist will evaluate a patient’s food and medical history and determine whether specific nutritional interventions might be needed.
The Mini Nutritional Assessment (MNA) is a type of tool a specialist may utilize to identify a patient’s potential for malnutrition; especially among older individuals. The MNA evaluates a number of parameters such as body mass index, mobility, and food intake to better understand nutritional risk.
Indicators of Malnutrition in Patients
Being able to spot the most common signs of malnutrition can help a specialist know whether a nutritional assessment might be needed and what actions should be taken moving forward. Here are a few common indicators of malnutrition a specialist might be on the lookout for:
- Greater than 5% of weight loss
- Body mass index less than 18.5 kg
- Eating less than half of their usual daily meals
- Poor appetite or refusal to eat
- Taking just two meals for more than three days in a row
- Low fluid intake
- Slow healing wounds
Because less food intake can cause blood pressure and blood sugar to decrease, some patients might also feel dizzy, tired, or cold for most of the day.
It’s also important to note that malnutrition does not only apply to underweight individuals. Rather, it can also include those who eat too much, eat the wrong things, and/or are overweight.
Necessary Nutrients for Wound Healing
Wound healing is a complex, multi-phase process that relies on specific macro and micronutrients in order to progress through each stage. Additionally, caloric intake should be assessed on an individual basis based on factors such as weight, age, comorbidities, and what type of calories might be needed. The severity of the wound and where in the healing process the patient is should also be evaluated.
Let’s explore some of these nutrients essential to wound healing in greater depth:
Macronutrients and Caloric Intake
Proteins
Proteins are the main nutrients needed for repair, tissue regrowth, and cell renewal throughout the healing process. Because protein is directly linked to the body’s ability to produce collagen it plays a major role in how effectively wounds heal.
Protein also plays other roles in the healing process. It has been shown to impact immune function, wound contraction, and fibroblast proliferation. It can also help maintain oncotic pressure which can be valuable in treating venous insufficiency wounds.
Additionally, as discussed above, deficiencies in calories can result in the body utilizing protein for other functions instead of the wound site. Making it all the more important to make sure you’re getting enough protein.
Some of the foods known to be a good supply of protein include whole grains, eggs, cheese, meat, fish, and chicken.
Carbohydrates
If the body doesn’t receive enough energy, it will use the protein it should be using to help the healing process. The bigger and more severe the wound, the more carbohydrates are needed to avoid this from happening.
Carbohydrates provide a major fuel source for the body. They encourage metabolic activity, stimulate insulin production, and facilitate collagen synthesis as well as tissue regeneration. Making sure you get enough carbohydrates can also aid in fibroblast production.
Lipids and essential fatty acids
Many of the benefits of carbohydrates also apply to lipids and fatty acids. They provide energy to the body to support the healing process and aid in wound remodeling.
Getting enough fats in your diet can also help absorb fat soluble nutrients such as Vitamin A, and omega-3 and omega-6 fatty acids that help the body heal.
Water and Fluids
In addition to caloric intake, dehydration is another important factor to consider. Dehydrated skin is more fragile and easier to injure. It can also interfere with the supply of nutrients to the wound site by affecting blood circulation. It’s imperative to regularly monitor hydration levels after a wound for signs of dehydration. It’s also a good idea to make sure you are drinking plenty of water throughout the day.
Micronutrients
Amino Acids
Amino acids such as arginine and glutamine can also contribute to recovery after an injury. Arginine plays a crucial role in the inflammatory stage of wound healing. It can also aid in collagen synthesis as well as lymphocyte mitogenesis.
While similar to arginine, glutamine can also impact how effectively wounds heal. It can serve as an energy source, lower risk of infection, and increase insulin sensitivity.
Vitamins
Ensuring you are getting adequate Vitamins in your diet can also facilitate healing and improve outcomes. For example:
- A deficiency in Vitamin A can delay the synthesis of collagen, impact antibody production, and impair wound closure. Vitamin A can be found in many animal products, eggs, cheese, and certain brightly colored fruits and vegetables.
- A deficiency in Vitamin B can interfere with the production of antibodies and increase risk of infection. Some foods that contain Vitamin B include leafy greens, salmon, meat, eggs, and milk.
- In addition to delaying collagen synthesis, a Vitamin C deficiency can make the skin more fragile and increase the chance of bleeding. Brightly colored vegetables and fruits can be a valuable source of Vitamin C.
- Vitamin K often found in leafy vegetables, meat, and dairy products can modify proteins used for bone metabolism and coagulation.
- Vitamin E is an antioxidant and provides anti-inflammatory properties. Deficiencies in Vitamin E can speed up blood cell death. You can usually find Vitamin E in nuts, seeds, and vegetable oil.
Zinc
Zinc plays a role in how the body metabolizes carbs and proteins and helps maintain cell membrane integrity. A diet too low in zinc can put you at added risk of oxidative damage. In fact, a recent study that explored the effects of zinc on wound healing among patients with diabetic foot ulcers found zinc supplementation helped reduce ulcer size and improve metabolic profiles. If you are looking for diets high in zinc, consider incorporating animal based foods into your diet.
Working Together to Optimize Healing
Your body needs all of the nutrients available to heal chronic wounds. Unfortunately, poor nutrition and an unhealthy diet can prolong the process and are too often neglected until it’s too late. Don’t let this happen to you
Like wound care itself, there are different components to proper nutrition and it can play a number of roles in wound healing. Incorporating a variety of healthy foods into your diet that includes the right macro and micronutrients before and during healing can help. That said, the best way to ensure your body has everything it needs to heal properly after a wound is to consult with a wound care specialist and nutritionist. Working on your nutritional status in conjunction with proper wound care treatments can help you heal.
Unlike most other practices, at West Coast Wound Center, we value the whole patient’s health and not just the wound. We consider the most important extrinsic and intrinsic factors that affect healing including nutritional health. Our team works closely with each patient’s nutritionist to help optimize one’s wound healing.
Book an appointment today and let us help restore your quality of life.