“The cure for pain is in your food.”
Just a few days ago, I went for a whole body checkup. I got an ‘A’ on my health card, but at the same time discovered that there was a minor tear in my knee ligament. Immediately, I started to plan how to manage it nutritionally and physically nip it in the bud. Surgery is required sometimes, and at other times, you need to build surrounding muscle tissue to compensate for the damage. So I would like to share with you my secrets on the importance of nutrition in wound healing or injury-rehabilitation process.
Phases of Normal Wound Healing
Wound healing consists of a coordinated sequence of collagen synthesis. It is the key element of the extracellular matrix of your body’s ligaments, tendons and the skeletal system, and the most abundant protein in the human body. The healing process is divided into three distinct phases: inflammation, proliferation, and remodelling or maturation.
The inflammatory phase occurs immediately after a wound is inflicted and thromboxane A2 and prostaglandin 2a are released by cell membranes. These potent vasoconstrictors cause a small reflex vasoconstriction and reduction in bleeding.
Within seconds, the clotting cascade is stimulated by the damaged endothelium and the presence of platelets, leading to the formation of a clot. The clot consists of collagen, platelets, thrombin, and fibronectin; the cytokines and growth factors attract neutrophils to the wound site which successively initiate the inflammatory response.
Tip: It is very crucial to act fast by consuming collagen-rich and anti-inflammatory foods like bone broth, turmeric, etc.
The proliferative phase of wound healing usually occurs on the fourth day after the injury is sustained. It is characterised by the early appearance of fibroblasts in the wound region.
There are four major steps in this phase:
(3) granulation, and
(4) tissue formation and collagen deposition.
Tip: Do not wait for two-three weeks to consult a sports dietitian. Do so immediately within the next one-two days on injury so that the dietitian can utilise the wound-healing phase to give you the proper nutrition required.
Most athletes gain weight when recovering from injury. The calorie expenditure is lower but the appetite to eat large does not lessen. Also, athletes tend to binge eat due to stress; it results in bad nutrition, weight gain, and slow recovery.
Remodelling or Maturation Phase
The remodelling or maturation phase normally begins a week after the wound is inflicted. It may continue for a year or longer.
Tip: For collagen synthesis, include foods like bone broth, chicken, omega-3 rich foods like walnut, mackerel, chia seed, and Vitamin C rich foods like lemon, orange, watermelon, pomegranate, amla and ginger+turmeric as part of your daily diet.
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Nutrient Requirements for Wound Healing Energy
Energy is necessary for collagen formation and wound healing. Glucose is the major and the most efficient fuel source for collagen synthesis. Individual energy needs depend on age, gender, nutrition status, basal metabolic rate, body mass index (BMI), activity level, stress of illness, severity and number of wounds, size of the wound(s), and stage in the healing process.
The amount and type of food/liquid ingested daily should be assessed frequently to ensure that each individual meets his/her estimated nutrient needs. Oral nutrition supplements can be used to help achieve these needs, combat weight loss and undernutrition, and enhance wound healing.
Protein is necessary for the synthesis of enzymes involved in wound healing, proliferation of cells and collagen, and formation of connective tissue.
All stages of wound healing require protein; provision of adequate protein is also necessary for positive nitrogen balance. Severe protein depletion results in decreased skin and facial-wound-breaking strength, and increased wound-infection rates. Increased protein intake is associated with enhanced wound healing rates. The recommended range of protein associated with healing is between 1.25 and 1.5 g/kg/d for individuals with chronic wounds. Finally, adequate calories must be provided to prevent protein from being used as an energy fuel.
Glutamine is the most abundant amino acid in the plasma.
Glutamine is a nitrogen donor for the synthesis of other amino acids. It is essential for gluconeogenesis, providing fuel during wound healing. After injury, glutamine levels in the plasma and muscle fall rapidly. The suggested dose of supplemental glutamine for wound healing in adults is 0.57 g/kg/d. Which means that an average 70kg man needs to consume eight teaspoons of glutamine powder to meet the suggested dose.
The role of fat in wound healing has not been studied sufficiently. However, it is well-known that with injury there is an increased need for essential fatty acids. Omega-3 fatty acids have anti-inflammatory actions.
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Ensuring adequate water intake is necessary for perfusion and oxygenation of healthy and healing tissues. Furthermore, prevention and treatment of skin breakdown requires optimal fluid intake. Studies indicate that if hypoxia is present, healing of acute wounds may be compromised. Recommendations for daily fluid intake are 30 mL/kg or 1 to 1.5 mL/kcal consumed. Increased fluid demands exist in patients receiving a high protein intake.
Standard multivitamins with minerals are recommended for patients with wounds and if deficiencies are confirmed or suspected. Two vitamins — A and C — are particularly important in wound healing.
Vitamin A plays an important role in wound healing during the inflammatory phase. Vitamin A stimulates the immune system by increasing the number of macrophages and monocytes in the wound during inflammation.
Vitamin A has also been shown to enhance wound healing by stimulating epithelialisation and increasing collagen deposition by fibroblasts. The DRI for daily Vitamin A consumption is 700 mg/d for females and 900 mg/d for males (2,310 and 3,333 IU, respectively). To enhance wound healing in injured patients, documented recommendations include a range from 10,000 to 50,000 IU/d orally or 10,000 IU intramuscularly for 10 days.
Vitamin C functions in the synthesis of collagen connective tissue protein. Vitamin C supplementation at 100 to 200 mg/d is recommended for patients who have Vitamin C deficiency or wounds, including Stage I or II pressure ulcers.
Micronutrients are critical to cellular metabolism, especially during wound healing. Specifically, trace elements and minerals act as cofactors or participate in enzymes necessary for wound repair.
Magnesium interacts with adenosine triphosphate to support the processes for collagen synthesis during wound healing.
Zinc is required for the catalytic activity of approximately 100 enzymes, including metalloproteinases, and plays a role in immune function, DNA synthesis, protein and collagen synthesis, cellular proliferation, and wound healing.
Zinc supplementation is recommended only in the presence of zinc deficiency. The recommendation for zinc supplementation to enhance wound healing is up to 40 mg (176 mg zinc sulfate) for 10 days. Zinc sulfate 220 mg twice daily (25-50 mg elemental zinc) has been used as a standard adult oral replacement dose. Excess zinc interferes with iron and copper absorption, and can lead to deficiency of these important minerals.
It is obvious that nutrition plays a crucial role in wound healing. All patients with wounds should be nutritionally assessed and have their treatment managed by a multidisciplinary team.