Surgery is controlled trauma, causing increased metabolism, tissue damage, inflammation, muscle loss, and hormone disturbances, including increased cortisol.
Increased metabolism requires more calories to maintain weight and more protein to maintain muscle mass and wound healing.
Being well-nourished before surgery supports healing afterward. Adequate protein, vitamins, minerals, antioxidants, and phytonutrients are especially important.
A wholesome, balanced diet provides the nutrients needed to maintain health, repair and rebuild tissues, support immune function, and reduce infection risk:
- Focus on an abundance of greens and colorful vegetables; spices; whole, plant-based carbohydrates, including baked starchy vegetables, whole fruits and berries, legumes, and whole grains; healthy protein sources, including lean meat/fowl, seafood, organic omega-3 eggs, low-fat dairy, and whey protein; and healthy fat sources, including nuts, seeds, olives, olive oil, cocoa, avocado, and organic butter.
- Include high-quality omega-3 sources, such as organic omega-3 eggs, salmon, and sardines.
- A Mediterranean-style diet is ideal
Mediterranean diet
Serra-Majem, Lluís et al., 2020
Nutrition is vital to healing and recovery and should include:
- Protein and amino acids, e.g., high-quality protein, arginine, and glutamine
- Vitamin A, Bs, C, and E
- Minerals, including magnesium, copper, zinc, and selenium
- Healthy fats, including omega-3 fatty acids
- Bone-building nutrients as needed
- Calcium, phosphorus, fluoride, magnesium, sodium, potassium, vitamins A, B6, B12, folate, C, D, and K.
- Immune-supportive nutrients
- Protein, glutamine, omega-3s, vitamins A, Bs, C, D, E, zinc, selenium, iron, and copper
- Hydration is vital to wound healing, and it is important to consume at least 1 mL per Kcal of energy consumed and replace any fluid losses from large wounds, sweating, gastrointestinal losses, etc.
- Fortify meals with protein with a daily goal of at least 1.2-1.5 grams of protein per kg body weight:
- Protein powder with oatmeal, soup, coffee, etc.
- Cheese with salad, soup, sandwiches, eggs, etc.
- Nuts & seeds with oatmeal, salad, baked goods, etc.
- Eggs and other protein sources with salad and soup
- Minimize unhealthy foods
- Minimize highly processed, nutrient-poor foods, including potato chips, French fries, commercial cookies, pastries, fatty lunch meats, instant potatoes, margarine, and white bread.
- Avoid trans-fat in deep-fried foods, hydrogenated oils, margarine, and most snack crackers and commercial baked goods.
- Avoid excess added sugar, soda, sweetened beverages, commercial sweets (except 60% dark chocolate), sweetened cereal, and too many desserts.
Factors that potentially influence wound healing and aesthetic outcomes
Seth et al., 2024
Nutrient Sources
- Vitamin A
- Sweet potato, pumpkin, winter squash, carrots, spinach, greens, kale, cantaloupe, egg yolk, butter
- B vitamins
- Whole grains, nuts, seeds, leafy greens, seafood, nutritional yeast
- Calcium
- Dairy milk, cheese, fish with bone the bones, organic tofu, collards, kale, broccoli, molasses, white beans
- Vitamin C
- Citrus, kiwi, strawberries, cantaloupe, bell peppers, Brussels sprouts, broccoli, baked potato
- Vitamin D
- Egg yolk, fish with bones, fortified foods
- Vitamin E
- Sunflower seeds and oil, almonds, peanuts, pecans, mixed nuts, avocado
- Zinc
- Animal-based foods, whole grains, legumes, nuts, seeds
- Selenium
- Brazil nuts [limit to 1/day], sunflower seeds, seafood, meat
- Magnesium
- Pumpkin and squash seeds, Brazil nuts, almonds, cashews, quinoa, spinach, buckwheat, organic soybeans, lima beans, chickpeas, pine nuts, peanuts, halibut, mackerel, molasses
- Omega-3 fatty acids
- Salmon, herring, trout, tuna, crab, oysters, flaxseeds, chia seeds, English walnuts, organic tofu
Overview of key nutrients and insufficiencies in wound healing
|
Nutrient |
Role in Wound Healing |
Complications from Deficiency |
|
Carbohydrates |
Stimulate insulin production that aids in tissue regeneration. |
Impaired granulocyte function, increased risk of infection, and exacerbated wound formation in patients with diabetes. |
|
Proteins |
Essential for collagen production, immune response activation, and maintenance of skin integrity. |
Compromised fibroblast proliferation and angiogenesis, delayed wound healing, and reduced collagen formation. |
|
Fats |
Necessary for cell membrane integrity and eicosanoid synthesis. |
Poor energy reserve, impaired immune function, and reduced absorption of fat-soluble vitamins. |
|
Vitamin A |
Supports growth of epithelial cells and fibroblasts and enhances inflammatory response. |
Impaired immune function, delayed wound healing, and reduced collagen synthesis. |
|
Vitamin B |
Critical for leukocyte generation, collagen synthesis, and wound healing anabolic processes. |
Impaired immune function and increased risk of infection. |
|
Vitamin C |
Involved in collagen synthesis, antioxidant response, and angiogenesis. |
Delayed wound healing, weakened immune response, and increased risk of scurvy. |
|
Vitamin D |
Regulates immune response and receptor production. |
Impaired wound healing, increased risk of infection, and weakened adaptive immune system. |
|
Vitamin E |
Antioxidant, involved in collagen synthesis and inflammatory response (though evidence of impact on wound healing is mixed). |
Potential worsening of scar appearance and impaired collagen synthesis. |
|
Zinc |
Promotes re-epithelialization, tissue generation, and immune function. |
Delayed wound healing and weakened immune response. |
|
Copper |
Involved in all stages of wound healing, modulating cytokines, and growth factors. |
Impaired wound healing owing to disrupted enzymatic functions and cytokine modulation. |
|
Magnesium |
Reduces serum CRP levels and increases plasma antioxidant capacity. |
Delayed wound healing, increased risk of diabetic foot ulcers, and impaired immune function. |
|
Iron |
Essential for oxygen transport in red blood cells, facilitates tissue perfusion and collagen synthesis. |
Tissue hypoxia, impaired collagen synthesis, and increased risk of inflammatory diseases. |
|
Omega-3 PUFAs |
Modulate inflammatory response and critical in cell membrane integration for tissue regeneration. |
Altered wound healing dynamics, potentially slower or less robust healing, and reduced anti-inflammatory effects. |
|
Resveratrol |
Anti-inflammatory and modulates cytokine activity. |
Increased inflammation and potentially delayed wound healing. |
|
Curcumin |
Exhibits anti-inflammatory properties by inhibiting NF-κB. |
Increased inflammation and delayed wound healing. |
|
Naringenin |
Mitigates inflammation and aids in nitric oxide production. |
Increased inflammation and potential impairment in wound healing processes. |
|
Apigenin |
Reduces apoptosis in endothelial cells and aids in wound healing. |
Increased endothelial cell apoptosis and potential delays in wound healing. |
Seth et al., 2024
Nutrition support
If key nutrient intake is insufficient, targeted nutrition support, including supplements, may be needed. A functional blood chemistry analysis can help identify nutrient insufficiencies.
A balanced, well-formulated multivitamin-mineral supplement can help meet needs and should provide supportive doses of vitamins A, B, C, E, zinc, and selenium. Additional micronutrients can be supplied as needed. Glutamine, arginine, and other specialty nutrients can also support healing.
Role of nutrients in the wound healing process
Ju et al., 2023
Optimal Takeaways
- Nutrition is vital to healing, including that required after surgery
- A balanced, Mediterranean-style diet containing an abundance of fruits, vegetables, whole plant-based foods, and omega-3s is ideal
- Extra protein is needed to support healing and tissue regeneration
- Micronutrients are vital to healing, including vitamins A, B, C, and E, and minerals copper, zinc, iron, magnesium, and copper
- Amino acids glutamine and arginine support healing
References
Appendix B Foods Sources of Selected Nutrients. https://odphp.health.gov/sites/default/files/2020-01/DGA2005.pdf
Arribas-López, Elena et al. “The Effect of Amino Acids on Wound Healing: A Systematic Review and Meta-Analysis on Arginine and Glutamine.” Nutrients vol. 13,8 2498. 22 Jul. 2021, doi:10.3390/nu13082498
Chan, D. (2017, April). The role of nutrition in wound healing. In BSAVA Congress Proceedings 2017 (pp. 272-273). BSAVA Library.
Cruzat, Vinicius et al. “Glutamine: Metabolism and Immune Function, Supplementation and Clinical Translation.” Nutrients vol. 10,11 1564. 23 Oct. 2018, doi:10.3390/nu10111564 This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license
Demling, R. H. (2009). Nutrition, anabolism, and the wound healing process: an overview. Eplasty, 9, e9.
Ju, Myoungjean, Yoonhong Kim, and Kyung Won Seo. "Role of nutrition in wound healing and nutritional recommendations for promotion of wound healing: A narrative review." Annals of Clinical Nutrition and Metabolism 15.3 (2023): 67-71. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0),
Linus Pauling Micronutrient Center. https://lpi.oregonstate.edu/mic
Raymond, Janice L., et al. Krause and Mahan's Food & the Nutrition Care Process. Elsevier, 2021.
Medlin, Sophie. “Nutrition for wound healing.” British journal of nursing (Mark Allen Publishing) vol. 21,12 (2012): S11-2, S14-5. doi:10.12968/bjon.2012.21.Sup12.S11
Serra-Majem, Lluís et al. “Updating the Mediterranean Diet Pyramid towards Sustainability: Focus on Environmental Concerns.” International journal of environmental research and public health vol. 17,23 8758. 25 Nov. 2020, doi:10.3390/ijerph17238758 This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license
Seth, Ishith et al. “Impact of nutrition on skin wound healing and aesthetic outcomes: A comprehensive narrative review.” JPRAS open vol. 39 291-302. 23 Jan. 2024, doi:10.1016/j.jpra.2024.01.006 This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Stechmiller, J. K. (2010). Understanding the role of nutrition and wound healing. Nutrition in clinical practice, 25(1), 61-68.
Yu, Y. M., & Fischman, A. J. (2017). 6. Nutrition, Metabolism, and Wound Healing Process. Bioengineering In Wound Healing: A Systems Approach, 8, 141.
