• Debbie Safra, MS, RDN, LD/N

Fuel your Body for Wound Healing


When an individual is undergoing elective or emergency surgery, the last thought on a persons’ mind is nutrition. Their thoughts are focused on the procedure, outcome, and recovery period as well as time away from work and activities. Post-surgery the patient feels pain, sees bruising, and swelling. The body, on the other hand, does not distinguish healing from an emergency or an elective procedure.1 Surgery can cause catabolic stress on the body, and surgical stress can include hyperglycemia, protein catabolism, and depletion of nutrients.2 After a physical injury, the body’s immune-inflammatory response begins the wound healing process. For new, healthy tissue to form, the body requires an increase in macro and micronutrients for collagen building and to promote healing.2


It’s a wonderful process to imagine how our bodies can heal. But why do some heal faster than others? Why do some individuals have wounds that refuse to improve and become chronic wounds? It all comes down to what’s going on inside the body, not only if that person has a condition such as diabetes, but also their nutritional intake plays a huge role.


What are some steps an individual can do before a procedure? In one sentence—eat nutrient-dense healthy foods! Other factors include stop smoking, limit alcohol, get your HgA1C under control, and exercise. But what if my wound is not from an elective procedure? Am I doomed? No, the body can rebound by giving it what it needs to heal through nutrition and added supplementation.


During the healing process, the body requires additional energy (calories from nutrient-dense foods) to heal not only the wound but to help prevent unintended weight loss and nutrient deficiencies that could cause other health-related issues. Below are just some of the major nutrients and their functions and food sources that are necessary to help facilitate wound healing along with non-food sources, sometimes recommended pre and post-surgical procedures.


Nutrient

Protein (amino acids, particularly arginine). The recommended amount per day 0.8 - 1.0 g/kg of body weight.

Function

Building blocks for muscle, skin, ligaments. Involved in the synthesis of enzymes for wound healing

Food Source

Meat, eggs, fish, cheese, yogurt, dairy foods, nuts, seeds. Protein drinks


Nutrient

Vitamin A. The recommended intake 900mcg/day for men and 700 mcg/day for women

Function

Protein synthesis, immune function, maintenance of epithelial tissues

Food Source

Dark green and yellow fruits and vegetables, beef liver, fortified milk, egg yolk.


Nutrient

Vitamin C (Ascorbic acid). The recommended intake 90mg/day for men, 75mg/day for women. Higher amounts may be needed post-surgery. 2

Function

Anti-oxidant. Responsible for the biosynthesis of collagen, L- carnitine, and certain neurotransmitters. Improves the absorption of non-heme iron. It improves the stability of folic acid and helps recycle oxidized vitamin E for reuse in the cells.

Food Source

Citrus fruits, tomatoes, strawberries, potatoes, peppers, broccoli, mangos, collard greens, cabbage.


Nutrient

Zinc. The recommended intake 11 mg/day for men and 8 mg/day for women

Function

Co-factor for collagen formation and cell metabolism, immune function

Food Source

Nuts, dried fruits, whole-grain cereals, organ meats


Nutrient

Copper. The recommended intake 900mcg /day for both men and women

Function

Plays a role in enzymatic reactions in the body, Preserves strength of skin, blood vessels, connective tissues

Food Source

Liver and kidney meats, fish, nuts, seeds, shellfish (oysters/clams), chocolate, brewers yeast, leafy green vegetables, molasses.


Nutrient

Iron. The recommended intake 19.3 - 20.5mg/day for men, 17.0 - 18.9mg/day for women

Function

Formation of red blood cells supports a healthy immune system

Food Source

Liver, meat, fish, poultry, fortified bread/cereals,

You’ll notice there’s one vitamin missing from this chart, and that is vitamin E, an anti-oxidant. This fat-soluble vitamin is often not recommended before and during the wound healing process due to its anti-clotting activity and may prolong bleeding. A couple of things worth mentioning is Bromelain and Arnica. Bromelain found in pineapple helps the body absorb proteins and to reduce inflammation of muscle and soft tissues. Arnica is a plant, not a food source used to help with bruising, pain, and swelling.


As with any type of surgery, it is recommended to consume higher calories of nutrient-dense foods to help with unintended weight loss and collagen formation, along with plenty of hydration (water), which helps to maintain body temperature and transports nutrients.

References:

1. Gillis C, Wischmeyer P.E., Pre-operative nutrition and the elective surgical patient: why, how, and what? Anesthesia, 2019;(1): 27-35.

2. Nguyen B, Tao M, Yu P, et al. Pre-operative diet impacts the adipose tissue response to surgical trauma. Surgery. 2012: 584-591.

3. Muller S, Marz R, Schmolz M, et al. Placebo-controlled Randomized Clinical Trial on the Immunomodulating Activities of Low and High Dose Bromelain after Oral Administration – New Evidence on the Anti-inflammatory Mode of Action of Bromelain. Phytother Res.2013. 27:199-204