One of the most devastating complications of diabetes is chronic nonhealing foot wounds. I’ve had many patients in the hospital for chronic wounds that become infected. Unfortunately many of them are unable to heal their wounds and wind up with partial or complete amputations of their foot and lower leg.
Diabetics and other chronically ill older patients often have diets that aren’t healthy. They don’t get enough healthy fats, protein and micronutrients from the food they eat. These problems contribute to ill health and complications like poor wound healing.
Vitamin deficiencies are more common in older adults, especially those who don’t have a varied, healthy diet. Inadequate intake, decreased absorption and use of medications are among the causes of nutrient deficiencies. Protein, vitamin D, folic acid, vitamin B12 and water are examples of nutrients that older adults may not get in adequate amounts.
In the case of diabetics, elevated levels of blood sugar over time result in the formation of advanced glycation end products (AGEs) which damage proteins and increase levels of inflammation in the cells and tissues. This is one of the main ways diabetes contributes to end organ damage in just about every organ in the body. AGEs are thought to contribute to a number of diseases, from Alzheimer’s disease to end stage kidney failure to cataracts to atherosclerotic cardiovascular disease.
If someone develops a chronic wound, what nutrients are needed to help in healing? Protein, carbohydrate, fat, vitamins and minerals are all needed. The best sources of these nutrients come from a healthy balanced diet of course. However, studies have shown that 95% of Americans are not getting enough of one or more vitamins or minerals in their diet. Especially if someone is trying to heal a wound, getting enough nutrients is critical and the patient likely will benefit from a supplement.
People who are sick or have a wound to heal need extra protein. Estimates are that such people need about 1.5 grams per kilogram of body weight. So a woman who weighs 70 kg (155 pounds) would need about 105 grams of protein per day. One ounce of animal flesh (beef, poultry, pork or fish), one cup of dairy milk or one ounce of cheese contains about 8 grams protein. One egg contains 6 grams, 8 ounces of Greek yogurt contains 23 grams, one cup of navy beans contains 20 grams and 4 ounces of tofu contain 16 grams of protein.
Getting extra fat in the diet helps provide energy and calories for healing and also provides building blocks for making new cells. Omega 3 fats help mute inflammation and encourage healing, and omega 6 fats balance things out. Fish oil has been shown to be helpful in patients with pressure ulcers in the ICU setting.
Complex carbohydrates provide fiber which feeds the healthy bacteria in the gut, as well as calories for energy. Our gut bacteria help support a healthy immune system. Healing wounds and getting well is hard work! Depends on how malnourished someone is (and how sick they are) a patient may need up to 40 calories per kilogram of body weight. That 70-kilogram woman above would need up to 2800 calories per day, plus more if she is doing more than just lying in bed.
It’s important that these carbohydrates should be whole-food complex carbohydrates like fresh fruits and vegetables, beans and whole grains like oatmeal. Refined carbohydrates like white bread, bagels, bakery and the like are NOT helpful and increase the production of AGEs.
Vitamins and Minerals
Vitamin A, vitamin C, vitamin D, zinc, selenium and antioxidants have been investigated as being helpful in wound healing. While supplementation with high doses of single nutrients has not been shown to help, using a good quality well-balanced multivitamin is smart. After all, if only 5% of Americans get all the nutrients they need from their diet, who doesn’t need a multivitamin? And if deficiencies slow down wound healing, those with slow-healing wounds would benefit even more!
Unfortunately many Americans are badly malnourished. Those with very low or very high body mass index (BMI) are most at risk of significant malnutrition.
How do you know if someone is malnourished? They may or may not lose a lot of weight, especially if they were obese to start with. Low blood albumin levels are a clue, as is swelling (edema). The edema may be mostly in the legs, but the arms and abdomen may be puffy and swollen too. They are weak, and there may be a big change in their strength and ability to take care of themselves.
People who are malnourished will have loss of muscle and fat tissue. A good place to look is at the temples. If the temples look bony and it’s easy to feel the skull bones and see the bones of the eye sockets, it is suggestive of malnutrition.
If you know anyone with a chronic wound, especially if they are diabetic, encourage them to see their doctor and work hard to get their blood sugar under control. Good blood sugar control slows the production of AGEs and decreases inflammation.
Also, make sure they are getting plenty of protein and taking a high-quality multivitamin. Antioxidants and fish oil may be helpful as well. If your doctor isn’t able to make recommendations about specific supplements, you’re welcome to reach out to me or get a quick assessment at jenniferwurstmd.com/healthprint.
Chronic wounds are tough to heal. In addition to careful wound care and avoiding pressure on the wound, attention to a healthy diet and smart supplementation are practical steps you can take to speed up the healing process.
QUESTION: Have you known anyone with a chronic wound? What did it take to heal it?