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Based on the extensive biological and metabolic changes that occur after trauma, nutritional supplementation is often required. The following nutritional factors have been shown to support the body's enhanced metabolic demands:
Calories: Wound healing consumes energy. Ordinarily, carbohydrates and fats are the main sources of energy. During the stress response, proteins are also broken down to provide energy. To prevent the loss of lean body mass, sufficient energy supply has to be maintained. After trauma, caloric requirements may be increased up to 25 to 30 calories per kilogram of body weight daily (Leininger S 2002).
Carbohydrates: Carbohydrates are a rich source of cellular energy during wound healing. Carbohydrates serve a number of purposes after a wound:
Help meet the body's heightened energy requirements.
Aid in fibroblast movement, which is vital in wound healing.
Enhance white blood cell activity to strengthen immune response.
Protein: Proteins are a vital component of collagen synthesis. Therefore, insufficient protein can affect the rate and quality of wound healing. It is well known that trauma increases the demand for protein. This requirement is further increased in the event of sepsis or stress. Wound healing requires 1.5 to 3 g per kilogram (of body weight) per day of protein, but this requirement may vary depending on the type of wound (Leininger S 2002).
Fats: Fats are a concentrated source of calories. Supplementation with 2 fatty acids is essential. They play the chief role in cell membrane structure and function and help wound healing. It is recommended that 20 percent of calories should be obtained from fats, especially monounsaturated fats. Fats are also implicated in the synthesis of new cells; therefore, low fat levels would delay wound healing.
Vitamin A: Vitamin A is indispensable for normal growth and differentiation of the skin, making it significant in wound healing . The presence of vitamin A increases the strength of scar tissue. Vitamin A is required for an adequate inflammatory response and has been used to counteract the catabolic effect that glucocorticosteroids exert on wound healing (Ehrlich HP et al 1973). The improvement in wound healing from vitamin A supplementation is also attributed to an increase in collagen cross-linking, which results in higher tensile strength (Seifter E et al 1975).
Vitamin C: It is well documented that wound healing requires more vitamin C than the diet alone can easily provide (MacKay D et al 2003) . As vitamin C is water soluble, it has to be taken daily. Vitamin C is important for the proper function of the enzyme protocollagen hydroxylase, which generates collagen. Vitamin C forms bonds between the strands of collagen fibers and helps to provide extra strength and stability. It is also essential for the synthesis of the intracellular matrix of tissues such as bone, skin, blood vessel walls, and connective tissue. Finally, vitamin C is a potent antioxidant, and studies have shown elevated levels of reactive oxygen species (a kind of free radical) in wounds (Gupta A et al 2002; Sen CK et al 2002).
Zinc: Zinc is a trace mineral present in the body in only a small quantity. However, it is found in many tissues, including bone, skin, muscle, and organs, and it is required in as many as 300 enzymatic reactions. Zinc is used in DNA synthesis, cell division, and protein synthesis and mediates the maturation of T-lymphocytes ( Prasad AS 1995).The body's need for zinc increases during cell proliferation and protein secretion.
Water: Meeting hypermetabolic needs may leave the body dehydrated. Not only is it essential to maintain hydration, but the need for hydration increases if a wound is draining or if a person is on an air-fluidized therapy bed. Trauma patients' daily requirement of water may range from 1500 to 2000 mL/day (Leininger S 2002).
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Life Extension Foundation Recommendations
After an injury, it is very important to maintain an adequate supply of calories to support the increased metabolic state. The following guidelines are suggested:
55 percent of calories should come from carbohydrates, mainly complex carbohydrates that can be found in whole-grain foods.
20 percent of calories should come from fats. The addition of EPA/DHA omega-3 fatty acids can help supply these essential fatty acids.
25 percent of calories should come from protein. The addition of whey protein to the diet can help guarantee that adequate protein is ingested.
It is also very important that trauma patients stay properly hydrated. They should drink plenty of water throughout the day.
In severe wound conditions, physicians sometimes use hyperbaric oxygen therapy.
In addition, the following vitamins and nutrients may aid the healing process:
Vitamin A—5000 to 10,000 international units (IU) daily
Vitamin C—1000 milligrams (mg) daily
Zinc—50 mg daily
L-arginine—9000 to 18,000 mg daily
L-ornithine—1000 mg daily
Glutamine—1000 to 3000 mg daily
Bromelain—500 mg daily
Glucosamine —1500 mg daily
Curcumin—800 to 1600 mg daily
Omega-3 fatty acids—1400 mg EPA and 1000 mg DHA daily
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