Not Just Skin Deep
Chronic Wounds as a Thermometer for Health
Bruce Thomas, MD
If you stumbled across a bunch of nerdy holistic doctors talking about what they do, wound care would not likely be the topic of conversation. On the surface, it does not have the wow factor of other things.
However, according to the NIH, 6.5 million Americans struggle with chronic wounds (1), which is a wound that just will not heal in 3 months. A typical approach, one might be referred to the wound clinic which does a great job of debridement, washing, dressings and other topical treatments and often to an infectious disease doctor for an expert opinion on antibiotics.
But might there be other avenues of healing?
Two approaches to healing this situation are to look at, “What else can I do to heal this wound?” and “What else can I do to heal this person?” As the article noted above points out, chronic non healing wounds don’t usually happen to otherwise perfectly healthy people (1).
Healing the Wound, Addressing the Wound from Within
It is no secret that most of us lean toward being overfed and undernourished. Nevertheless, having a non-healing wound cannot only be partly caused by nutritional deficiencies, but can also make those deficiencies worse because it creates more demand. While weight loss is a desired goal for many of us, the setting of a chronic wound is not the time for calorie restriction. An expert panel of pressure ulcers called for 35 kcal/kg, which would be about 2400 calories for a 150 lb person. For an underweight person, it would be 40 kcal/kg (2).
As with almost everything else, sugar is the enemy (3). Here it reduces the wound’s healing ability by granulation (which helps it to connect back together). But to all the keto devotees, you really do need some carbs because here you want some insulin which actually helps tissue growth. We demonize insulin, of course, but ask any body builder about its uses.
You want good fats, which are a source of energy and help you absorb fat-soluble nutrients like Omega 3 and 6s. Just like insulin, Omega 6s are criticized, but actually you do want the inflammatory prostaglandins they make in wounds as part of the healing process.
Not surprisingly, protein is critical for collagen synthesis and wound repair. A wound can cause a person to need up to 250% more protein to maintain weight (4), at least 1.2-1.5 g/kg of protein, but a wound this is particularly large or multiple needs could be as high as 2.5 g/kg of protein.
Helps deliver nutrients to the wound and carry waste from it. 30 mL/kg of filtered has been proposed.
Arginine and glutamine are particularly helpful. Arginine helps nitric oxide and is especially good for collagen. 4.5 g a day has been proposed. Glutamine is conditionally essential and the amount needed depends in part of the health of the person but 4 g seems like reasonable place to start. 2-5 g twice a day has been propose to speed surgery recovery. Generally, it is one of the most healing amino acids.
The most well supported vitamins include:
- Vitamin A: 10,000-15,000 IU/day (5)
- Vitamin C: 500 mg twice day a day is supported (6) ,but I would tend to suggest twice this.
- Vitamin D: is especially interesting because it induces a class of peptides called Cathelicidin, which promotes wound healing. More on this in a future blog post but you can actually take human cathelicidin as a commercially available peptide called LL-37.
- Zinc: is well known for wound healing and helps both topically (7) and orally. In zinc deficient individuals, short-term high doses can be used up to 220 mg a day for 2 weeks, but here after 40 mg a day.
- Iron: can help but only if deficiency exists, but can actually make the situation worse otherwise
- Curcumin can help as it helps cell migrate during wound healing (8). It can also help collagen be stronger.
- Calendula has been used traditionally by naturopaths (9).
By giving these, you are giving extra building blocks to help the body make what it wants to make (10, 11).
The thing above are more foundational, but peptides are one of the most exciting area of wound care to be discussed in a future blog post.
Healing the Wound, Addressing the Person.
When a wound occurs, all the things above can help, but the wound itself should be a call to assess what else might be going on that allowed this to happen? We know that steroids can inhibit wound healing, but so can the natural steroid cortisol which can be high from stress and other reasons. Sometimes sleep can hurt the immunes system, which will block the healing process.
Sometimes healing the wound involves looking beyond the wound, but to the whole person.
A natural medicine clinic can help with that!
- Chandan , K. Sen, et al . Human Skin Wounds: A Major and Snowballing Threat to
Public Health and the EconomyWound Repair Regen. 2009 Nov–Dec; 17(6): 763–771.
- Dorner P et al; National Pressure Ulcer Advisory Panel. The role of nutrition in pressure ulcer prevention and treatment: National Pressure Ulcer Advisory Panel white paper. Adv Skin Wound Care. 2012;22(5):212-221.
- Doley J. Nutrtion management of pressure ulcers. Nutr Clin Pract. 2010;25(1):50-60.
- Breslow RA, Hallfrisch J, Guy DG, Crawley B, Goldberg AP. The importance of dietary protein in healing pressure ulcers. J Am Geriatr Soc. 1993;41(4):357-362.
- Stechmiller JK. Understanding the role of nutrition and wound healing. Nutr Clin Pract. 2010;25(1):61-68
- Ellinger S, Stehle P. Efficacy of vitamin supplementation in situations with wound healing disorders: results from clinical intervention studies. Curr Opin Nutr Metab Care. 2009;12(6):588-595.
- Lansdown AB, Mirastschijski U, Stubbs N, Scanlon E, Agren MS. Zinc in wound healing: theoretical, experimental, and clinical aspects. Wound Repair Regen. 2007;15(1):2-16.
- Madhyastha R, et al,. Curcumin Facilitates Fibrinolysis and Cellular Migration during Wound Healing by Modulating Urokinase Plasminogen Activator Expression. Pathophysiol Haemost Thromb. 2009;37:59‐66
- Preethi KC, et al. Wound healing activity of flower extract of Calendula officinalis. J
Basic Clin Physiol Pharmacol. 2009;20(1):73
- Jorgensen LN, et al. Reduced collagen accumulation after major surgery. Br J Surg.
Johnson LB. Dis Colon Rectum. 2005;48(8):1573‐80.