The Importance of Nutrition in Wound Healing

The human body’s wound-healing process is a complicated process. Much of the body’s molecular functions play vital roles in healing a wound. Therefore, ensuring that you have the proper nutrition to support all these functions is paramount to ensuring your body heals properly. To complete the four-part wound healing cycle, your body needs several different proteins, carbohydrates, fats, fluids, amino acids, vitamins, and minerals. Read on to learn exactly how important nutrition is to wound healing.

The Four Stages of Wound Healing

There are four phases to wound healing. It’s essential to understand these, to know just how each nutrient we’re going to talk about is effective.

1. Hemostasis Phase – this first step in the wound healing process begins when blood starts to exit the wound. The wound is closed by clotting. This clotting keeps the platelets and blood cells trapped in the wound area.
2. Inflammatory Phase – beginning right after the injury occurs; in this phase, injured blood vessels leak transudate (water, salt, and protein), causing localized swelling. This inflammation is good, as it controls bleeding and prevents infection. Inflammation only becomes problematic if it becomes prolonged or excessive.
3. Proliferation Phase – in this phase, the wound is rebuilt with new tissue. This tissue is made from collagen and the extracellular matrix. The wound will contract as new tissues are built. Angiogenesis (the creation of new blood vessels) must occur so that the new tissues receive enough oxygen and nutrients to be healthy. In healthy phases of wound healing, the new tissues are pink or red, have an uneven texture, and do not bleed easily.
4. Maturation Phase – also known as the remodeling phase, generally begins 21 days after an injury occurs and can continue for a year or more. In this phase, collagen III (typically found in reticular fibers) is remodeled to collagen I (the most prevalent form of collagen in the body; prevalent in connective tissue), and the wound fully closes. Programmed cell death removes cells used to heal the wound that are no longer needed. Collagen aligns along tension lines, and water reabsorbs so the collagen fibers can lie closer together and cross-link (this will reduce visible scarring).

If your body cannot correctly follow these four stages of wound healing, it can lead to chronic wounds. Chronic wounds are wounds that refuse to heal for prolonged periods. Factors that can cause them are venous disease, diabetes, metabolic deficiencies of the elderly, and infection. However, other risk factors can lead to impaired wound healing.

Nutritional Risk Factors

Malnutrition and different forms of malnutrition, like protein-calorie malnutrition (PCM), can lead to impaired wound healing and even chronic wounds. Malnutrition includes inadequate intake of other nutrients, overconsumption of certain nutrients, and specific nutrient deficits. PCM is defined by the low to non-existent calories and protein consumption in a diet that leads to low lean body mass (LBM). It’s essential to know that when your body is trying to heal a wound, the body’s protein demand increases up to 250%, and caloric demand increases up to 50% to maintain a healthy LBM. In wound healing, inadequate protein stores increase skin fragility, decrease immune function with poor healing, and reduce the patient’s ability to carry out daily activities with longer recovery after illness.

The Importance of Protein

As mentioned above, the lack of protein in a diet can severely impact the wound healing process. Different proteins are essential to collagen synthesis, angiogenesis, fibroblast proliferation (an increase in the number of cells resulting from natural cell growth and cell division), immune function, wound construction, tissue remodeling, and skin structural proteins. Overall, PCM may cause protein reserves to be used for other vital bodily functions rather than wound healing. So, when trying to heal certain wounds, it may be beneficial to supplement with specific proteins.

The liver creates a protein, albumin, to keep fluids contained in the bloodstream, rather than permitting them to leak into other tissues. Without albumin, the body would not receive proper distributions of hormones, enzymes, and medications. Appropriate levels can help promote wound healing (helps resolve inflammation). If there isn’t enough albumin available for the body to use, it could prolong inflammation. Thus, extending the healing process. This is why some malnourished patients, particularly the elderly, develop bedsores and need to be monitored for proper levels of albumin. If your body is not producing enough, it could point to a problem with your liver or kidneys.

Collagen is another vital protein component of connective tissues, meaning it’s essential to helping to close the wound and minimizing visible scarring. It is mainly composed of proline, hydroxyproline, and glycine. Collagen synthesis requires hydroxylation of glycine and proline and co-factors such as ferrous iron and vitamin C. Impaired wound healing can result from deficiencies in any of these co-factors.

Why You Need Healthy Fats

Appropriate fat intake can help provide additional energy to the wound healing process, especially in patients with chronic wounds. Healthy fats also play an essential role in absorbing fat-soluble micronutrients like vitamin A, omega-3 fatty acids, and omega-6 fatty acids. Omega-6 fatty acids are vital to the wound healing process, as they are an essential precursor to important lipids that help control inflammation. Omega-3 fatty acids are also crucial because they dampen the inflammatory response and cause vasodilation through cytokine release. Vasodilation is when the walls of the blood vessels relax, allowing more oxygen and nutrients to the wound site. Studies suggest that supplementation of omega-6 and omega-3 fatty acids, in a ratio of 1:1, during the inflammatory phase can be beneficial to wound healing.  However, perhaps one of the most significant benefits of fatty acids comes with the specific supplementation of omega-3 fatty acids. These acids include DHA and EPA, which can improve immune function, thus reducing the risk of infectious complications and improving survival.

Necessary Amino Acids

Amino acids are micronutrients that are considered the building blocks of protein. We’ve already discussed how important protein is to wound healing. Without the proper amino acids, your body would not develop the necessary amounts of different proteins needed to stay healthy. Arginine and glutamine are two amino acids that play significant roles in wound healing. Arginine is the precursor to nitric oxide and is used to produce collagen.

Along with helping to reduce inflammation, nitric oxides also have antimicrobial properties, which means they decrease bacteria levels at wound sites. They also promote the creation of new blood vessels, which help carry more nutrients to the healing wound. Studies have shown that abnormal production of nitric oxides (common with diabetes) is linked to impaired wound healing and the development of chronic wounds. Scientists have also found decreased nitric oxides in extracellular wound fluid directly correspond with a decrease in collagen content. Arginine is also a precursor to proline, which is necessary for collagen production. Arginine supplementation was found to increase collagen deposition in wounds.

Glutamine is the most abundant amino acid in plasma and acts as a significant energy source for rapidly proliferating cells (cells that are growing and dividing rapidly). Along with stimulating the inflammatory immune response, glutamine is an antioxidant needed in many stages of the wound healing process. Oral glutamine supplementation has been shown to improve wound breaking strength and increase collagen levels. Doctors use glutamine supplementation in critical situations, like burns, sepsis, and trauma.  However, research is still ongoing regarding glutamine supplementation and its ability to help promote wound healing in chronic wounds. Overall, scientists agree that glutamine and arginine supplementation should never be used to substitute for protein-calorie malnutrition corrections. Without adequate protein intake, the supplementation of these two amino acids is of no value.

Vitamins & Minerals

Vitamin A (retinol) has been shown to benefit wound healing regardless of deficiency status; however, deficiency does prove to cause impairment in wound closure. It has been used topically to help stimulate epithelial growth, fibroblasts, and ground substance. Vitamin A also seems to have anti-inflammatory effects on open wounds. Deficiency in vitamin A results in altered antibody production during the inflammatory phase and impaired collagen synthesis in the maturation phase. It can manage chronic wounds in patients on corticosteroids for inflammatory disease (e.g., Rheumatoid Arthritis). The recommended supplement dosage for wound healing ranges from 10,000 to 15,000 IU per day and up to 25,000 IU per day. However, treatment must be short (about 10 to 14 days) to prevent toxicity.

Vitamin C (ascorbic acid) and its role in wound healing is believed to be based on its influence on collagen formation and its antioxidant properties. Vitamin C deficiency during wound healing correlates with an impaired immune response during the inflammatory phase and increased capillary fragility and collagen tensile strength and synthesis during the maturation phase. The recommended dosages for wound healing are 500 to 1,000 mg per day, divided into two doses. However, some doctors may prescribe up to one to two grams per day in the presence of severe wounds.

There are more than 200 zinc-containing enzymes involved in the wound healing process. Zinc deficiency affects all phases of the wound healing process because this mineral functions as an antioxidant and modulates cell replication, nucleic acid metabolism, tissue repair, and growth. A review by Lansdown et al. found topical zinc application to surgical wounds consistently increased the wound healing rate. The recommended dose for zinc supplementation ranges from 40 to 220mg twice a day for 10 to 14 days.

The grape-seed extract can help skin wounds heal faster with less scarring. The oral supplement acts as a powerful antioxidant, which helps with inflammation and fighting off pathogens.

Protect Yourself with WellRabbit

When you think of wound care, the first thing you think of probably isn’t nutritional therapy. However, what you eat and how you supplement your body plays a major role in how your body heals itself from injury. Purchase your wound healing supplements from WellRabbit to know that you’re buying the best the market can offer. With the MDRC badge of approval, our supplements will have you feeling like your best self in no time.