Chronic wounds can be extremely difficult to heal. Particularly in the diabetic patient, where a weakened immune system coupled with a loss of protective sensation, the risk of developing a chronic wound is compounded.
Diabetic foot ulcers have become a massive problem in the United States. Approximately 15% of diabetics are affected by chronic ulceration. They can become infected, and precede almost 90% of non-traumatic amputations. Because of the risks involved with open chronic ulcers in the diabetic patient, aggressive measures are often made at closing the wound. This generally involves at the very minimum a period of offloading the wound as well as strict control of blood sugars, in addition to local wound care.
Another area of concern that is often overlooked is the nutritional status of the patient. Simply managing the blood sugars of a diabetic patient is a good start, but many other nutrients are involved in the process of wound healing.
The single most important nutrient for healing is protein. A deficiency in protein has been linked to longer healing times, due to impaired steps in the healing process. In particular, the formation of new capillaries and the collagen fibers that assist in wound closure depend heavily on adequate supply of protein. Protein levels can be check with a blood test to look for albumin, the most abundant free protein in human blood. This level should be above 3.5g/dL for adequate levels. Protein deficiency can be the result of poor diet, or secondary to kidney disease or other metabolic dysfunction.
Omega-3 fatty acids have long been touted for their anti-inflammatory effects, and recent research suggests that they may play a role in the healing of chronic wounds. They may serve as building blocks for the healing wound, as well as control inflammation and promote the healing process.
Vitamins C, A, and E play an important role as antioxidants in the body, and contribute to wound healing as well. Vitamin C is particularly important in the formation of collagen. Without vitamin C, a crucial step in collagen synthesis is missed, and the resulting collagen is weaker than normal. This results in fragile capillaries, easy bleeding, and weakness of the newly synthesized collagen fibers that help the wound heal. Vitamin C deficiency was first described in Scurvy, a condition associated with poor wound healing. Vitamins A and E act as antioxidants, attacking free radicals in the wound that contribute to its chronicity.
The term micronutrients refers to minerals that are essential in small doses in the diet. This includes zinc, magnesium, copper, selenium, and iron. These nutrients all function as essential co-factors for enzymes that are critical for wound healing.
In summary, nutrition plays an essential and often overlooked role in the healing of chronic wounds. In diabetic patients susceptible to such wounds, or with those that have a chronic wound, their diet should be optimized for healing. Tight glycemic control is crucial to preventing the complications of diabetes, and proper nutrition is extremely important as well.
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