Nutrition for wound healing.

June 2012

Medlin S.

Source

Torbay Hospital, Torquay, Devon.

Abstract

The importance of the role of nutrition in wound healing is an area that has been widely explored over the last decade. It is well recognised that both macronutrients (protein, fat and carbohydrate) and micronutrients (vitamins, minerals and trace elements) play important parts in the healing of both chronic wounds and acute injuries. The term 'wound' encompasses many different situations from leg ulcers to laparostomy wounds. This article provides an overview of the role of different nutrients in the healing of wounds and guidance to nurses on first-line assessments, which can be used to ensure the patient is receiving adequate nutrition for successful wound healing. It will focus on commonly seen wounds in primary and secondary care but will not cover specialist wound management, such as laparostomy sites and burns, as these must always be cared for by experienced and specialist multidisciplinary teams.

Internurse

Protein

Protein Moving Closer to Center Stage

Harvard School of Public Health

When it comes to nutrients, protein hasn't gotten much attention. Like a quiet child in a classroom of rowdies, it's often been overshadowed by fat, carbohydrates, and vitamins. That's changing.

Surprisingly little is known about protein and health. We know that adults need a minimum of 1 gram of protein for every kilogram of body weight per day to keep from slowly breaking down their own tissues. That's about 9 grams of protein for every 20 pounds. Beyond that, there's relatively little solid information on the ideal amount of protein in the diet, a healthy target for calories contributed by protein, or the best kinds of protein.

Around the world, millions of people don't get enough protein. This protein malnutrition leads to the condition known as kwashiorkor. Lack of protein can cause growth failure, loss of muscle mass, decreased immunity, weakening of the heart and respiratory system, and death.

In the United States and other developed countries, it's easy to get the minimum daily requirement of protein. Cereal with milk for breakfast, a peanut butter and jelly sandwich for lunch, and a piece of fish with a side of beans for dinner adds up to about 70 grams of protein, plenty for the average adult.

Too little protein is clearly a problem. What about too much? The digestion of protein releases acids that the body usually neutralizes with calcium and other buffering agents in the blood. Eating lots of protein, such as the amounts recommended in the so-called no-carb diets, requires lots of calcium. Some of this may be pulled from bone. Following a high-protein diet for a few weeks probably won't have much effect on bone strength. Doing it for a long time, though, could weaken bone. In the Nurses' Health Study, for example, women who ate more than 95 grams of protein a day were 20 percent more likely to have broken a wrist over a 12-year period when compared to those who ate an average amount of protein (less than 68 grams a day).(2) While more research is clearly needed to define the optimal amount of daily protein, these results suggest that high-protein diets should be used with caution, if at all.

All protein isn't alike

Some of the protein you eat contains all the amino acids needed to construct new proteins. This kind is called complete protein. Animal sources of protein tend to be complete. Other protein lacks one or more amino acids that the body can't make from scratch or create by modifying another amino acid. Called incomplete proteins, these usually come from fruits, vegetables, grains, and nuts.

Vegetarians need to be aware of this difference. To get all the amino acids needed to make new protein–and thus to keep the body's systems in good shape–people who don't eat meat, fish, poultry, eggs, or dairy products should eat a variety of protein-containing foods each day.

The protein package

Animal protein and vegetable protein probably have the same effects on health. It's the protein package that is likely to make a difference. A 6-ounce broiled Porterhouse steak is a great source of complete protein–38 grams worth. But it also delivers 44 grams of fat, 16 of them saturated. (3) That's almost three-fourths of the recommended daily intake for saturated fat. The same amount of salmon gives you 34 grams of protein and 18 grams of fat, 4 of them saturated. (3) A cup of cooked lentils has 18 grams of protein, but under 1 gram of fat.(3) The bottom line is that it's important to pay attention to what comes along with the protein in your food choices. If you are partial to beef, stick with the leanest cuts. Fish or poultry are excellent alternatives. Even better options are vegetable sources of protein, such as beans, nuts, and whole grains.

Protein and chronic disease

The most solid connection between proteins and health has to do with a common disorder of the immune system. Proteins in food and the environment are responsible for a variety of allergies. These are basically overreactions of the immune system to what should be harmless proteins. Beyond that, relatively little evidence has been gathered regarding the effect of protein on the development of chronic diseases.

Cardiovascular disease: Cardiovascular disease: To date, only one large, prospective study has investigated the association between dietary protein and heart disease or stroke. In the Nurses' Health Study, women who ate the most protein (about 110 grams per day) were 25 percent less likely to have had a heart attack or to have died of heart disease than the women who ate the least protein (about 68 grams per day) over a 14-year period. (4) Whether the protein came from animals or vegetables–or whether it was part of low-fat or higher-fat diets–didn't seem to matter. These results offer reassurance that eating a lot of protein doesn't harm the heart. In fact, it is possible that eating more protein while cutting back on easily digested carbohydrates may be benefit the heart.

Diabetes: Diabetes Proteins found in cow's milk may play a role in the development of type 1 diabetes (formerly called juvenile or insulin-dependent diabetes). That's one reason why cow's milk isn't recommended for infants.(5) Later in life, the amount of protein in the diet doesn't seem to adversely affect the development of type 2 (adult-onset) diabetes, although research in this area is ongoing.

Weight control: Weight control: In short-term studies, a lower-calorie diet that includes more protein and less carbohydrate is more effective for losing weight or keeping weight steady than a lower-calorie, high-carbohydrate diet.

Eating high-protein foods such as beef, chicken, fish, or beans makes you feel full longer because they slow the movement of food from the stomach to the intestine. This strategy may also delay hunger signals. The digestion of protein, when compared to that of carbohydrates, results in smaller, steadier increases in blood sugar. This helps avoid the steep climbs and drops in blood sugar–which trigger hunger pangs and occur after eating rapidly digested carbohydrates. Unfortunately, few data have been collected on the long-term effects of a high-protein diet on weight control.

Cancer: There's no good evidence that eating a little protein or a lot of it influences cancer risk.

Carbohydrate Addiction

Carbohydrate Addiction

What causes carbohydrate and other food cravings?

We don't really know enough about all the factors that cause specific food cravings. More research is needed to help understand appetite. Many studies suggest that a decrease in blood sugar stimulates hunger. This might help explain a craving for foods high in carbohydrates, which are a quick energy source.

Other studies suggest that the “mind-mood-food connection” may be explained by decreases in the brain chemical serotonin (sair-oh-TO'nin). Serotonin helps you feel less pain, less anxiety and less stress, so it improves mood by increasing relaxation. Some experts think that people who crave carbohydrates have low serotonin levels. Others caution that these cravings may just be a learned response.

What is “carbohydrate craving” or “carbohydrate addiction?”

These terms are used in a theory about the relationship between carbohydrate, insulin and appetite. (The body uses the hormone insulin to convert sugar, starch and other foods into energy.) We know that eating carbohydrate raises insulin, which then lowers blood sugar. This causes a desire (or craving) for more food and, in some people, carbohydrate.

Some people advocate severely reducing carbohydrate intake to reduce the insulin response and cravings. Others suggest that choosing carbohydrate-containing foods with a lower glycemic (gli-SE'mik) index also can lower insulin response and appetite. There isn’t enough research in this area for us to know what’s right. Also, individual responses may vary considerably.

What are the potential problems of severely reducing carbohydrate intake?

Diets low in carbohydrate are likely to lack sufficient amounts of essential nutrients found in plant foods that promote good health. People following these diets may not get enough vitamins, minerals and fiber to avoid blood chemistry imbalances, constipation and other health problems.

What's missing if carbohydrate-containing foods are severely restricted?

The American Heart Association recommends choosing a wide variety of foods low in saturated fat and cholesterol. While people need to watch their calorie intake to prevent obesity, they should consume a diet rich in grains (6 or more servings of breads, cereals, rice, pasta and beans) and at least five servings of fruits and vegetables daily. Combined with 2–4 servings of fat-free or low-fat dairy products, most healthy diets will contain at least 50–55 percent of calories from carbohydrates. Diets severely restricted in carbohydrate may be low in components that we need. For instance,

Diets low in grain products are likely to be low in B vitamins and minerals. Whole grains are also rich sources of potassium and fiber.

Low-fat or fat-free milk and yogurt are excellent sources of calcium, protein and riboflavin.

Vegetables and fruits are rich sources of vitamins, minerals and fiber. They may also have other components with health benefits that are still being discovered.

Some experts stress the importance of eating breakfast and at least two other meals a day to help control hunger. People with insulin resistance or diabetes may need to spread their calories out over a whole day by having small meals and 2–3 small snacks. (This can also help reduce hunger.) Related AHA publications:

An Eating Plan for Healthy Americans

Easy Food Tips for Heart-Healthy Eating

Reading Food Labels: A Handbook for People with Diabetes, order from American Diabetes Association (1-800-232-3472) Detailed Research

AHA Scientific Statement: AHA Dietary Guidelines: Revision 2000, #71-0193 Circulation. 2000;102:2284-2299; Stroke. 2000;31:2751-2766

See also:

Carbohydrates and Sugars Whole Grains and Fiber American Heart Assoc. - Nutrition Center Healthier Kids Fiber and Children's DietPhytochemicals and Cardiovascular Disease Triglycerides Vegetables and Fruits Vegetarian Diets Carbohydrate Addiction

Diet and Lifestyle Recommendations

A Diet for Lymphedema

There is no “special” diet that lymphedema patients must follow, just because they have lymphedema. If you have no other medical conditions involved, your diet will be fairly normal (healthy diet of course).

The rules on foods to avoid or consume in moderation are much like the guidelines given for non-lymphedema people.

1. Restrict high fat foods or high cholesterol foods.

2. Limit sodium intake as it causes fluid retention.

3. Limit or avoid caffeine as it is a natural diuretic

4. Limit or avoid alcohol

Having said that however, I have always been a proponent of vitamins, supplements, good nutrition an, exercise and weight control. It just makes sense whether or not you have lymphedema.

It becomes even more important if you do.

It is well established that stress depletes your body of vitamins and nutrients as it tries to cope with whatever threat you are under, physically and mentally. Once these reserves are depleted, it becomes even more difficult for your “system” to take care of and rejuvenate itself.

These supplements will help give it that extra boost.

I am also a proponent of the concept that it is up to the patient to take the responsibility for taking care of themselves. This is especially true in lymphedema.

You can not expect doctors too, most of them have no clue anyway about this condition. Therapists are our best friends and do more for lymphedema patients that anyone else in the medical world, but you shouldn't expect this from them either.

At some point, you must care enough about yourself and your life to step forward. You must understand no one else can take care of you, but you.

Special Dietary Considerations

It is essential to understand as well, that if you other medical conditions that require a special diet, you must follow that dietary regime.

For example If you have a diabetes and lymphedema, then you must ad here to the special dietary rules for diabetes. The same is true should you have coronary problems and lymphedema.

The Importance of Weight in the Management of Lymphedema

The importance of weight control in the management of lymphedema cannot be stressed enough. Obesity or morbid obesity can actually cause a secondary form of lymphedema. While it may start as a “temporary” lymphedema the lymphatics can be so damaged that if the weight were lost, the lymphedema would remain. The weight actually crushes and overloads the lymphatics. When this occurs you will also begin experiencing further damaged caused by lymphedema complications, such as infections, weeping wounds and fibrosis.

Also, some of the complications involved in obesity lead to edema.

These edema causing complications are congestive heart failure, diabetes, hypertension, kidney disease, stroke and liver disease.

Other reasons for weight control when you have lymphedema is simple mobility and the ability to continue to function and do activities you really enjoy. It is difficult enough with just lymphedema and is profoundly affected by morbid obesity.

For information on obesity and lymphedema. Our following articles that will help in understanding what a healhy diet is and the basic foods groups that contribute to that diet and help in managing lymhpedema.