Slow healing wounds? Consider nutrition!
If you have a client with a Grade 3 or Grade 4 pressure sore and/or other wound which is slow to heal, have they ever been reviewed by a dietitian?
This may sound like an unusual or surprising suggestion, but there is a massive link between someone’s nutritional status and their body’s ability to heal wounds. This connection is frequently overlooked, in spite of nutritional assessments and nutritional care plans being recommended in the 2014 and 2019 International Guidelines on the Prevention and Treatment of Pressure Ulcers/Injuries produced by the European Pressure Ulcer Advisory Panel, the National Pressure Ulcer Advisory Panel and the Pan Pacific Pressure Injury Alliance.1
You can’t build skin out of thin air. The food you eat provides the building blocks necessary to form new, healthy skin. In fact, malnutrition is a massive contributing factor to wounds developing in the first place.2
So while you can have the most amazing district nursing and tissue viability teams on the planet offering the most amazing dressings, a wound simply cannot heal without the appropriate protein and nutrient “building blocks” in place. I’ve met so many clients who have struggled with slow wound healing for YEARS, but after we got the nutrition right, their wounds started to heal beautifully.
How can a dietitian help with wound healing?
There are four main areas that a dietitian will look at when it comes to wound healing:
1. Blood tests
There are two main blood tests which need to be done any time a wound is slow to heal – HbA1C (to check for diabetes/prediabetes) and full blood count (to check for iron deficiency anaemia). Elevated blood sugar levels can make a wound much slower to heal and much more prone to infection. Low haemoglobin levels will reduce the amount of oxygen that the red blood cells can deliver to the wound and this can slow wound healing as well.
2. Protein intake
Wound healing requires extra protein — and while some clients are aware they need to eat “more” protein, many are a bit lost as to exactly how much protein they need to eat. Protein requirements are based on body weight and a pressure sore or wound typically needs about 1.2 – 1.5 grams protein per kg body weight(1) (subtract 25% if the client is obese). Nutrition supplements are one option for getting more protein into clients who are underweight. The situation is much more tricky in overweight or obese clients where they have extremely high protein requirements but extremely low calorie needs. Some clients hear the “more protein” message and are happy to load up on more meat/chicken/fish, only to realise that they are starting to gain significant amounts of weight because they didn’t reduce their intake of other foods to offset this. Weight monitoring is critical during this period to prevent unwanted weight gain.
3. Micronutrients (vitamins & minerals)
Certain vitamins and minerals are absolutely critical for wound healing and skin repair, such as vitamin A, vitamin C, vitamin E, zinc, copper, selenium and magnesium.2, 3 Additional supplements are often required to ensure that these needs are being met. As a minimum, I often start clients on either a nutritionally complete multivitamin and mineral supplement or if they are underweight, an oral nutrition supplement.
Over-the-counter multivitamin and mineral supplements are not all the same, and some have excessive amounts of some nutrients while missing out on other key vitamins and minerals. The best supplements I’ve found so far which have a nice balance of all nutrients include: Sainsburys A-Z, Tesco A-Z or Asda A-Z multivitamin and mineral supplements. Most wounds require an additional vitamin C supplement on top of this as well.
4. Hydration and other lifestyle factors
Dehydration causes the skin to lose elasticity and makes it more fragile.2 It also slows the transport of oxygen and nutrients to the wound.4 A dietitian can work with clients to increase their fluid intake if required.
Other lifestyle factors which can contribute to slow wound healing include: a client being overweight, smoking and high alcohol intake.3 A dietitian can certainly help clients with managing their weight and can also direct clients to resources that support them to stop smoking or reduce their alcohol intake.
For a more detailed explanation of nutrition and wound healing, check out: Nutrition….healing wounds from the inside out.
To refer a client with a pressure sore or slow healing wound, contact Sheri Taylor, Specialist Rehab Dietitian at firstname.lastname@example.org or 0121 384 7087.
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