Vitamins, Supplements and Wound healing

Having a non healing wound may seem like a powerless situation, but there are ways that the patient can take control and improved their wound healing.  Supplementing the diet with certain elements can help in multiple steps of the wound healing process. 

1. Protein: Protein’s most important use is production of collagen that serves as scaffolding for scar in healed wounds. The proteins area also necessary for forming new blood vessels and encouraging healing cells to migrate to the wound surface.  During the stress of wound healing, protein requirements increase by 250%! My protein recommendation is 100grams of protein per day
   1. Amino acids: Protein is made of amnio acids. Among amino-acids, those that play an important role in wound healing, are arginine and glutamine. Arginine is essential for the inflammatory process and synthesis of collagen. Arginine also stimulates the immune system to begin the healing process. Glutamine plays several roles via its metabolic, enzymatic, antioxidant, and immune properties. In wounds, it protects against the risk of infections by stimulating production of immune fighting proteins. Glutamine is also a precursor of glutathione—an antioxidant and an essential cofactor in stabilizing cells.  The recommendation is have some arginine and glutamine included in the protein supplements, like Juven.
2. Vitamin C: Vitamin Creduces oxidative damage from the sun and/or toxin exposures, like smoking. It also stimulates collagen and elastin formation. It essential for stabilizing the structure of collagen with strong bonds and crosslinks to strengthen the healing tissue. Without this stabilization, the structure becomes fragile. Vitamin C also provides tensile strength to newly built collagen; otherwise, new tissue could not stretch without tearing. Tensile strength is important in pressure ulcer healing because healed pressure ulcers are susceptible to future skin breakdown. Vitamin C also is required for proper immune system function, a consideration in patients with open wounds. My recommendation is for 500 mg of Vitamins C twice a day.
3. Zinc: Zinc plays a major role in regulating every phase of the wound healing process; ranging from membrane repair, oxidative stress, coagulation, inflammation and immune defence, tissue re-epithelialization, angiogenesis, to fibrosis/scar formation. This means from the time the ulcer begins until it is healed, the body needs adequate Zinc stores. My recommendation for Zinc is Zinc sulfate 220mg twice a day.
4. Vitamin A: Vitamin A is known for its ability to stimulate epithelial growth, fibroblasts, granulation tissue, angiogenesis, collagen synthesis, epithelialization, and fibroplasia.  Vitamin A also has the unique ability to reverse the inhibitory effects of steroids on wound healing. Steroids reduce the ability of healing cells to migrate to the wound and build strong collagen bonds. Vitamin A can reverse this effect! In addition to its role in the inflammatory phase of wound healing, Vitamin A will also strengthen the collagen bonds and reduce the ability of wound inhibitory enzymes to counteract the healing process. Good sources of Vitamin A include “Squash, Eggs, Kale, carrot and Sweet Potato”. My recommendation for Vitamin A supplementation is 8-10,000 units once daily.
5. Blood sugars: Though not a nutritional supplement, blood sugar control is essential for healing. Though glucose is the fuel for cells, when the blood stream is saturated with sugar, the healing cells become sluggish and stop healing.  They also block the path for important nutrients and oxygen to pass into the wound.  Unfortunately, bacteria use this excess sugar to wreak havoc on wounds.  This leads to an infection with no healing cells able to fight the bacteria.  We often see normally benign bacteria cause severe wounds due to elevated blood sugar.
6. Smoking: Though not a nutritional supplement either, smoking is a daily choice that can have life altering consequences. The nicotine in cigarettes narrows blood vessels and reduces healing cells, oxygen, and nutrients from traveling to the wound surface.  It also Vitamin C stores reducing the ability of Vitamin C to aid in healing and reverse the noxious effects of nicotine. The other components in cigarettes reduce oxygen transport, cell adhesions, and undermine wound repair.

If you have had a wound for greater than 6 weeks, a wound increasing in size or becoming deeper, seek out a wound specialist outside of your primary care doctor.  Adding these lifestyle modifications will give you a jump start on healing even before you see the specialist!

Author

Jenna Wishnew Dr. Jenna Wishnew is a board-certified general surgeon with over a decade of experience serving the North Dallas community. Known for her compassionate, patient-centered care, she specializes in wound care and hyperbaric oxygen therapy (HBOT), currently serving as Medical Director at the Wound Care and Hyperbaric Center at Methodist Richardson Medical Center. Dr. Wishnew is a recognized leader in her field, earning two international awards for excellence in wound care. She also has extensive experience managing gastroparesis and Enterra Gastric Stimulators.