Nutrition for Wound Healing

Nutrition for Wound Healing

Wound healing is something I’m often asked about in clinic, most often for upcoming surgical wounds, but the science on wound healing equally applies to traumatic wounds, infective wounds and ulcers. In my time working as a registered nurse in the community I dressed hundreds of wounds, most often chronic vascular ulcers which were painful and debilitating for my clients. Unfortunately, some of these vascular ulcers never fully healed before breaking down again. In these clinical situations, I was limited in how much I could advise patients on nutritional factors influencing their wound healing as it was outside the scope of practice for an RN, but if I was ever asked by the client, I offered simple dietary suggestions that could support their wounds to heal, but in truth I knew a lot more about wound healing than I could offer in that context.

Vitamin C deficiency causing scurvy

We first learnt of the influence of Vitamin C on wound healing when during the age of discovery sailors noticed old wounds breaking down during long voyages with poor rations. Scurvy threatened the continuation of such voyages until Captain James Cook started carrying lemons on board to prevent further crew losses. Since these early days our knowledge of the nutritional and dietary influences on wound healing has grown exponentially, so let’s examine what we know from the body of evidence. 

The Phases of Normal Wound Healing

A wound is recognised as the disruption in the physical continuity of functional tissues, with normal wound healing beginning immediately after injury. The process consists of four sequential and overlapping phases: haemostasis, inflammation, proliferative and remodelling. The process is often not linear and can persist for years depending on a diverse array of both intrinsic and extrinsic factors. In the first stage haemostasis, the wound is being closed by clotting, followed closely by the inflammatory response which further controls bleeding and prevents infection with immune fluid engorgement at the wound site. On day 3 the proliferative phase begins with the rebuilding of new tissue made up of collagen and extracellular matrix. Revascularisation takes place to oxygenate the new tissue, then epithelial cells resurface. Then the final stage is the maturation or remodelling stage beginning 21 days after injury, where collagen is remodelled to fully close the wound. Left over cells are removed or programmed for cell death, with cross linking of collagen in this phase strengthened the wound and reducing scar thickness. As I said earlier, this process is not linear in complex wounds and can and does take much longer for complete healing.

wound healing phases

Generally, it is important to eat a wide variety of foods from each food group, ensuring you get at least 7 to 10 vegetables per day and a couple of pieces of fruit. Choose your fruit and vegetables according to the seasons, which generally means the ones that are cheaper at the supermarket, or alternatively buy from local growers at markets, so you know you are eating fresh and foods in season. Along with seasonal fruits and vegetables, add in at least 5 serves of fish per week, vegetarian proteins such at tofu, tempeh, legumes, nuts and seeds, and some lean meats if you like. To wash this all down we need at least 2 litres of filtered water per day to keep our bodies hydrated. But let’s drill down into the nutritional specifics for wound healing, which can be applied across a broad range of wounds.

Energy – Carbohydrates

During wound healing we need more energy for collagen production for the structural integrity of the wound. Carbohydrates and good fats are the best way to provide this energy source. Eat whole grain cereals like muesli, grainy breads, legumes, nuts and seeds, good oils like olive oil and avocado. This will boost your supply of energy and prevent fatigue during the healing process.

Protein

The protein requirements during wound healing almost doubles to 2.0 gms/Kg/day, which for an average person of 75 kg, means a protein intake of 150 gms of protein in a day. Refer to table for protein content of foods to help you work out how much you need to eat to supply your protein content during wound healing.

The specific amino acids arginine and cysteine play an important role in synthesising connective tissue, whilst arginine has a significant influence on collagen accumulation and immune response in healing. Glutamine has long been thought to play an important role in healing wounds, yet the specific mode of action needs further clarification. What we do know absolutely is that patients with inadequate protein intake will have slow wound healing and poorer wound outcomes.

Protein for wound healing
omega-3 for wound healing

Vitamins A and C

Vitamin A stimulates the inflammatory response, epithelialisation and is a co-factor for collagen synthesis. Whilst Vitamin C promotes collagen and the synthesis of new blood vessels in wound healing.
Vitamin A food sources: green leafy vegetables, egg yolk, dairy, fish, orange and yellow fruit and vegetables, beef liver, fish oils.

Vitamin C food sources: fruit – citrus, kiwi, strawberry, tomato, capsicum, cruciferous vegetables, white potato

Minerals

Copper plays an important role by regulating activity of proteins involved in the wound repair process. Food sources of copper – Been liver, oysters, crab, salmon, dark chocolate, cashes, sunflower seeds, sesame seeds, chickpeas, millet, whole what pasta, potatoes, and spinach.

Zinc promotes collagen production, immune function and is a factor in over 100 catalytic reactions involved in tissue regeneration. Food sources of zinc – shellfish, oysters, crab, lobster, beef, poultry, pork, legumes, nuts and seeds, whole grains.

Vitamin C deficiency causing scurvy

Iron is essential for red blood cell production, hence delivery of oxygen to the wound, for regeneration. Food sources of iron are divided into heme iron (from animals) and non-hem iron (plant based). Heme-iron – oysters, clams, mussels, beef or chicken liver, organ meats, canned sardines, beef, poultry, canned tune. Non-heme iron – fortified cereals, beans, dark chocolate, lentils, spinach, potatoes with skin on, nuts and seeds, and enriched rice or bread.

In conclusion, I’ll draw your attention to suggestions I made up front about eating a healthy diet. If you focus on eating a broad range of fruit and vegetables every day, whilst including legumes, nuts and seeds, whole grains and good oils and plenty of good quality protein you’ll be well on the way to giving yourself the best chance to heal any wound you may have. Wounds of the heart may take some extra support, but these guidelines would also help. Look out for the wounds of the heart blog coming soon.

Check out my blog post on Healthy smoothie recipes to support wound healing.