Understanding The Link Between Nutrition And Wound Healing

By John E. Hahn, DPM, ND

In our profession, we do not receive extensive training in medical nutrition and its link to wound healing and the prevention of infections. Most podiatric and medical school curriculums devote only a limited amount of time to nutritional instruction for their students. Granted, podiatrists are aware of the nutritional requirements for the diabetic patients. Preoperatively, we usually work alongside an internist or primary care physician to help these patients balance their insulin and glucose levels during and after the foot surgeries. However, aside from treating patients who are diabetic, morbidly obese or alcoholics, not much thought is given to a patient’s dietary habits as they relate to wound healing. The field of medical nutrition is growing significantly each year and the general public is becoming more aware of the importance of foods and food supplements in maintaining health and preventing disease. There are daily reports in both print and electronic media on health issues and the relationship to foods, beverages and supplements. Podiatrists need to take a proactive role in learning about the field of nutrition as it relates not only to wound healing but to other diseases which affect the lower extremities and feet. Diseases such as osteoporosis, arthritis, peripheral neuropathy, psoriasis and eczema all have nutritional ramifications. In fact, plantar fasciitis has recently been linked to obesity. Patients whose body mass index (BMI) is over 25 have an increased incidence of foot and heel pain.1 Augmenting the traditional podiatric therapies for plantar fasciitis and heel pain with nutritional counseling for obese patients will give a value-added service. Helping these patients reduce their weight can subsequently reduce weightbearing stress and plantar fascia pain. Choosing The Most Nutritious Diet Although there are no magic formulas for dietary recommendation to ensure wound healing in all cases, there are a few general dieting guidelines, which are supported by all major health-related organizations.2 In general, patients should consume a low-fat, high fiber diet, a nutrient dense diet that is adequate in all vitamins and minerals, on a daily basis. Avoidance of simple sugars, carbohydrates and convenience foods should be a top priority along with reducing fat intake. This diet should consist of a wide variety of fresh fruits, fresh or frozen plain vegetables and whole grain breads and cereals, beans and peas. Also on the menu are low-fat or non-fat milk products such as 1% low-fat milk and yogurt. Patients should consume small amounts of extra lean meats, chicken or fish in a ratio of 40 percent protein to 30 to 35 percent complex carbohydrates and 30 percent oils such as olive oil and sunflower oil. These oils could be added to the meal as either part of a salad dressing or a vegetable topping. In addition, daily aerobic exercise acts as an effective method of stress control. Avoidance of tobacco products and toxic elements (e.g., lead, mercury, arsenic) are important for reducing oxidation radicals within the body. Most people can tolerate alcohol in moderation and wine does have antioxidant activity. Your patients must take an active responsibility to make wise food choices or assume the risk for the unnecessary suffering that results from a lifetime of poor dietary choices. The American menu is not the only way to eat. In fact, few people in the world consume the quantity of fats, salt and sugar that Americans do on a yearly basis. It shouldn’t be a surprise that cultures of those who do eat a “Westernized” diet also have higher rates of cardiovascular disease, cancer and other degenerative diseases.3 Since most Americans do not eat a correct balance of the various foods in the aforementioned food groups, there is the possibility of lacking vital nutrients essential to wound healing. Many of these macro- and micronutrients essential for wound healing may be either greatly reduced or missing in the standard American diet. The immune system requires adequate protein, fatty acids, vitamins and minerals for normal function. There is a direct link between a healthy immune system and healthy wound healing.

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