How to Promote Wound Healing through Nutrition

How to Promote Wound Healing through Nutrition was written by Jenn Zubair of Nutrition by Jenn and reviewed/edited by Jackie Silver MHSc, RD

Medical Disclaimer: The information in this article is meant for educational purposes only. It is not intended to be personalized medical or nutrition advice. For a plan tailored to your needs, please consult with a Registered Dietitian or qualified healthcare professional.

Disclosure: This post may contain affiliate links with which I may earn a small commission but at no additional cost to you. Affiliate links help bloggers like me to provide you with free content. All opinions expressed here are genuine. 

Last updated: October 5, 2022

Join us in this post as we highlight how to promote wound healing through optimal nutrition. We explore 4 major categories, including increasing protein, consuming extra calories, fluids, and vitamin supplementation. We offer you science-backed explanations and tips that will help you understand how to promote wound healing through diet.

Note that there are many names for pressure wounds, such as pressure sores, ulcers, injuries, or bedsores. We will use these names interchangeably throughout the article. 

How Common are Pressure Wounds?

There are many different types of wounds from various causes. Pressure sores are particularly common in people with paralysis, such as spinal cord injury, spina bifida, or multiple sclerosis. 

Before getting into what pressure wounds are, let’s discuss some surprising statistics: 

• According to the National Spina Bifida Patient Registry, 26% of people had a history of pressure sores and 19% had a wound in the past year
  
• Approximately 34% of adults with Spina Bifida vs 26% of the general population experience pressure sores
  
• The prevalence of pressure ulcers in people with spinal cord injuries (SCI) ranges from 25-66%. People with higher levels of SCI are at increased risk compared to individuals with lower level lesions.
  
• Every year roughly 2.5 million people in the US develop pressure sores
  
• The healthcare cost to take care of a pressure sore patient ranges from $20,900 to $151,700 per pressure injury
  
• Pressure wounds can negatively impair one’s quality of life. Potential complications include: cellulitis (skin infection), bone and joint infections (osteomyelitis), and sepsis (a dangerous blood infection). 

Pressure sores are more common than you think. You’ll likely come across friends or family members that will develop one which is why this post will teach you how to promote wound healing with nutrition. 

What are Pressure Wounds?

Pressure wounds  are a skin and tissue injury caused by prolonged pressure on the skin, occurring most often in bony areas of the body, such as the tailbone, buttocks, ankles, heels, hips, and shoulder blades.  

They are often present in individuals with physical disabilities who use a wheelchair but are also present in individuals who are confined to a space for prolonged periods of time. In this case, we are talking about people who are recovering from surgery or are hospitalized with limited mobility. 

Surgical wounds are another type of wound from the incision site. Click here to learn about what to eat after surgery for healing and recovery. 

To give you more of an idea of what a pressure wound might look like, let’s go over the four different stages. 

Stage 1: The skin will be a slightly different colour from your typical skin colour or it could be reddened, and with no open wounds present. There may be pain but no breaks or tears in the skin.

Stage 2: Skin breaks open and forms an ulcer which is tender and painful. The ulcer might look like a blister, scrape, or shallow crater in your skin.

Stage 3: Sore worsens and creates a crater that extends into the tissue underneath your skin. Fat may be visible but not muscle, bone, or tendon.

Stage 4: The pressure sore is very deep, extending into muscle and bone. It may damage the muscle, bone, or tendons. 

Each stage is progressively more severe than the previous.

Risks Factors for Pressure Wounds

• Poor nutritional status 
• Impaired blood flow from conditions such as diabetes or PAD (peripheral arterial disease) 
• Use of wheelchair
• Reduced mobility 
• Excess moisture from sweat, urine, and stool 
• Lack of sensory perception (ie. people with SCI may not be able to feel discomfort or pain when their skin is forming a pressure sore)
• Smoking
• Incontinence (skin is more susceptible to damage when exposed to urine and stool for long periods of time)

So obviously, there are some risk factors that we can’t control. But we do have the ability to promote wound healing through supporting our bodies with adequate nutrition. 

The Pressure Wound Management Puzzle

Please note that wound management is complicated and requires an interdisciplinary approach, which means multiple types of healthcare professionals are involved, such as nurses, occupational therapists, physical therapists, dietitians, primary care physicians, dermatologists, and sometimes surgeons. 

I like to think of it as a puzzle with many moving pieces that works best when all the puzzle pieces are involved.

While nutrition plays an important role in pressure wound management, all healthcare practitioners are needed for optimal healing. This blog post focuses on the nutrition piece. 

How To Promote Wound Healing Using Nutrition

Nutrition plays an important role in managing pressure sores by speeding up the healing time and helping your wound grow new tissue. We see the opposite effects if proper nutrition is not present during the healing process, where the wound will be weak and more likely to break down again.

There are 4 important nutrition categories that help promote wound healing:

1. Protein, protein, and more protein. Your wounds need protein to help build and repair skin, muscle, and other tissues. Protein also helps prevent or fight infection and protect your immune system.
   
2. Extra Calories will help to facilitate wound healing and make up for tissue breakdown.
   
3. Fluids help transport nutrients to your wound and are needed to replace any drainage from wounds. Cool, right?
   
4. Vitamins and minerals which can help reduce inflammation, support tissue repair, and boost collagen production

The Role of Protein in Wound Healing 

I know you’ve heard the talk about protein– so let’s cover how it promotes wound healing. 

It boils down to 5 main points, but is not limited to these: 

1. Repairs and grows muscle tissue. When people think about the healing process, this is typically what they picture.
   
2. Plays a role in producing enzymes and hormones involved in wound healing. Without getting too technical, there is an enzyme called protease that is used to break down the proteins ¹. When the proteins are broken down, they are transported by hormones to the wound site². Everything is interconnected to protein in this situation!
   
3. Resists infection and protects the immune system.
   
4. Promotes growth of skin cells.
   
5. Helps rebuild muscle, skin, and cartilage.  

Protein Requirements 

Protein needs are higher when you have a pressure wound compared to when you don’t. To give you some context, the general daily protein recommendations for individuals is to consume about 0.8g (grams) of protein per kilogram (kg) of body weight per day. This number can be more than double when you have a serious wound.

Most importantly, it is crucial to consult with your dietitian or doctor before making dietary changes. However, here are some guidelines to consider. 

• Stage 2 pressure wounds: 1.2g- 1.5g of protein per kg of body weight per day is recommended
  
• Stage 3 or 4 pressure wounds: 1.5g- 2g of protein per kg of body weight per day is recommended

To calculate this, you would multiply your weight in kilograms by the amount of protein per kg you want to consume (such as 1.5). 

Please don’t get hung up on calculating the exact number of grams of protein to consume per day and don’t worry about the number. If you are intentionally consuming adequate amounts of protein at all your meals and snacks throughout the day, then you will likely meet your protein needs to promote wound healing.

Please note that the above info may not be appropriate for individuals on protein-restricted diets for medical reasons such as kidney disease. Please consult your healthcare team for a plan tailored to your needs.

Protein Sources

• Beef 
• Chicken 
• Fish and seafood 
• Eggs
• Dairy products (cottage cheese, greek yogurt, milk) 
• Soy or pea milk 
• tofu and tempeh 
• Edamame 
• Chickpeas or lentils 
• Beans or legumes 
• Nuts, seeds, and nut butters 
• Protein powders 
• Protein bars 

Increasing Protein Intake

Some people have difficulty increasing their protein intake. Replacing their normal meals with high protein meals is what people think you have to do. So, it can be overwhelming. But it doesn’t have to be, there are ways to include protein into your existing diet. 

Here are a few helpful strategies:

• Add extra nuts and seeds to cereal, yogurt, and salads
  
• Melt cheese into soups, scrambled eggs, or casseroles
  
• Add ½ cup of liquid egg whites to your omelettes
  
• Add skim milk powder to soups, smoothies, milk, or stews
  
• Extra protein servings at meals. For example, 3 eggs instead of two or a larger portion of chicken, fish, meat, tofu, lentils, etc.
  
• Add protein powder and/or Greek yogurt to smoothies 
  
• Drink cow milk, soy beverage or pea milk, instead of cashew, almond or oat (they are higher in protein)
  
• Include a protein source(s) at all meals and snacks so it is spread out throughout the day

If you’re looking for specific recipes, I have plenty of high protein recipes on my blog.

Check them out here: 

• Easy No-Bake Protein Cheesecake Recipe (Greek Yogurt)
  
• Easy High Protein French Toast (2 ways)
  
• Deconstructed High Protein Lasagna (One Pot & Vegetarian)
  
• Greek Yogurt Protein Bark
  
• Protein Chia Pudding 
  
• High Protein Blueberry Pie Smoothie
  
• Protein Overnight Oats
  
• High Protein Chocolate Berry Smoothie

Increasing Caloric Intake to Promote Wound Healing

When you have a wound, your body loses extra fluids and nutrients from the wound(s), so it is critical to increase your energy intake to account for these losses and promote healing. Conversely, consuming too little calories impairs wound healing.  

How many calories should I consume? 

When learning about how to promote wound healing, the general guidelines are to consume 30 kcal-40 kcals (calories) per kg of body weight per day. Stage 3 & 4 wounds require more energy intake than stages 1 & 2, as they are more severe.

To calculate this, you would multiply your weight in kg by 30 (as an example). 

For healthcare professionals, another way to calculate energy needs of people with SCI with pressure wounds is to use the Harris-Benedict times stress factor (1.2 for stage II ulcer, 1.5 for stage III and IV ulcers).

Please note that I am not a proponent of calorie counting and I prefer to follow a more intuitive eating approach to nourishing our bodies for our medical conditions. 

I am sharing the above guidelines as that is based on the current available evidence (which hasn’t been updated since 2009!).

Having said that, you DO NOT need to count calories when you have a wound. As long as you are eating slightly larger quantities than you do when you don’t have a wound, you’ll be golden. 

People with SCI who have a pressure ulcer have higher energy/caloric requirements than people with SCI of a similar injury level who do not have a wound.

Some people may have concerns about eating more than they normally do, but the reality is your body needs the nourishment to heal. 

Consult with your dietitian or doctor to ensure you’re receiving the proper amount of nutrients to promote wound healing for your situation. 

Tips to Increase Energy Intake 

• Add an extra snack per day
  
• Add an extra portion of protein, carbs or health fats with meals and snacks
  
• Limit liquids at meal times. Liquid takes up a lot of volume in your stomach and makes you feel full, but does not offer enough nutrients
  
• Add nut butter, avocado, protein powder or cream to smoothies
  
• Spread food intake evenly throughout the day by eating every 3 hours (3 meals + 2-3 snacks)
  
• Add avocados and nuts to sandwiches or salads
  
• If you have a low appetite, drinking nutrition supplement drinks (such as Boost, Ensure, or adding this powder to milk) is a great way to get more calories and protein. 

The Role of Fluids in Promoting Wound Healing

Fluids play a critical role in wound healing by:

• Keeping wound sites hydrated. Fluids leak out of wounds, so it is critical  to replace it  
• Transporting nutrients
• Maintaining skin integrity 

How Much Fluid Should I Drink?

The general recommendation is 2-3 liters per day, which is equal to 8-12 cups, but it depends on other factors such as wound stage, activity level, and climate.

This means that depending on your wound, you may need an additional ½ – 1 L of water per day. Trust me, I understand that this is a lot of fluid!

My recommendation to you is to spread your intake of fluids throughout the day. If you need 8-12 cups a day, try to drink 1 cup an hour. 

Please note that these guidelines are not appropriate for people on fluid restrictions, such as those with kidney or heart disease. Please consult your healthcare team to learn what’s right for you. Click here to learn about fluids in chronic kidney disease (CKD). 

Personally, I find it easy to keep track of my fluid intake if I use a water bottle that has a time marker. Check out this one and this one. 

What Counts as Fluid?

This is where it gets tricky! There is a misconception that only water counts as fluid intake! Meaning, you have to drink 8-12 cups of water per day. 

However, many liquids count as fluid, such as: 

• Milk or non-dairy substitutes
• Juice
• Caffeinated tea & coffee (not too much)
• Herbal tea
• Flavored seltzer 
• Soup
• Smoothies

Now that being said, I am not suggesting that you consume all fluids in the form of caffeine! Just make sure you are consuming enough fluids and keeping a variety of choices to help meet your daily needs. 

Tips for Increasing Fluid Intake

• Add frozen or fresh fruit, vegetables, herbs, or flavored water enhancers to your water to improve the taste!
  
• Keep a reusable water bottle with you throughout the day as a reminder to drink! Make sure to refill when you run out!
  
• Soups count as liquids! So try to incorporate them into your diet. Check out my butternut squash carrot ginger soup or my tahini chickpea soup!
  
• Pair it with a habit. For example, drink a glass of water after you brush your teeth or after a workout. This really helps me!
  
• If you really can’t remember and need to increase your intake, set an alarm every hour!
  

Vitamins and Minerals that Support Pressure Wounds

Vitamins and minerals help reduce inflammation, fight infections, and support tissue repair of wounds. Low levels of vitamin C, A, E, zinc, selenium, magnesium and iron are associated with impaired wound healing. 

If you have a known nutritional deficiency or your diet is low in certain vitamins and minerals, then a supplement may be appropriate, such as a multivitamin like this or this.  

To make sure you have enough vitamins to support healing, try your best to include lots of fruits and vegetables, and foods rich in A, C, iron, and zinc. 

Here are a few options for you: 

• Sources of vitamin A: milk, mangos, sweet potatoes, carrots, cheese, eggs, leafy greens, and pumpkin
  
• Sources of vitamin C: kiwi, broccoli, cantaloupe, citrus fruits, bell peppers, strawberries 
  
• Sources of iron: meat, liver, oysters, eggs, milk, and whole wheat products
  
• Sources of zinc: red meat, shellfish, eggs, hemp seeds, quinoa, and brown rice

Anti-inflammatory Diets  

There is exciting research showing that anti-inflammatory diets may play a role in reducing symptoms related to inflammation such as improving body tenderness. ³ If this sounds beneficial to you, check out my post: The Ultimate Anti-inflammatory Food List (PDF included). There are lots of healthy options here that can help you increase your micronutrient intake but also your protein and caloric intake! 

Overloading on Vitamins– Yay or Nay?

There are a set of reference values used to plan and assess nutrient intakes of individuals called the dietary reference intake (DRI). ⁴  Within these references, there is a determined level that 97-98% of healthy people require to maintain their health.

There is another reference called the tolerable upper intake level (UL) which is the highest amount of daily average nutrient intakes that will not pose risk of adverse health effects. ⁴

This means that we have a set of values that predetermine the amounts of nutrients that will improve or harm our health.

You may have read that high doses of certain nutrients, such as vitamin C and collagen speed up recovery time. However, the research regarding these newly discussed topics is unclear.

Does Vitamin C Promote Wound Healing?

Vitamin C has a UL of 2,000 mg per day. A study with a large sample size of 11,300 participants concluded that high doses of vitamin C does not treat or speed up the recovery time of colds. ⁵

In fact, consumption of high doses of vitamins caused participants more harm than good. Vitamin C that exceeds the daily recommended value is associated with  diarrhea, vomiting, nausea, and in some cases, kidney stones. ⁵ 

Without getting too technical, our cells can only saturate a certain amount of vitamin C, meaning, once our cells are full of vitamin C, they can not accept anymore.⁶

I like to think of our bodies as a chemistry lab– and trust me, we don’t want to be experimenting with them! That is why there are limits set in place to protect us. 

You may have read some research completed on animals that suggests high doses of vitamin C does speed up wound healing. If you would like to review the research for yourself, here is a study completed on guinea pigs.⁷

I encourage you to remember that humans differ from animals. This research allows us to explore the effects, but it does not conclude solid evidence that works on humans. In other words, take animal research with a grain of salt.

Do Collagen Supplements Promote Wound Healing?

Collagen plays an important role in skin integrity. Basically, it is a protein that helps keep your skin strong by building and maintaining it. ⁹ It would be logical to think that taking a collagen supplement could help heal your wound, but the reality is that our bodies have limits. 

There is a lot of misinformation suggesting that collagen consumption improves wound healing. Objectively speaking, it is not practiced in a medical environment because there is no statistical significance in the current findings. 

If you’re interested in the role of collagen in wound management, this is a great review.⁸  

I know you’re probably wondering is it safe to consume collagen supplements? The answer is yes. There have been no reported adverse effects.⁹ And, it has been shown that it can improve elasticity and hydration, but again, not practiced in medical settings. 

In other words, collagen is a buzzword in the wellness world but we don’t have enough scientific evidence to recommend taking collagen supplements for wound healing.

Conclusion 

Thank you for joining us with our discussion on how to promote wound healing through nutrition. We hope you learned some valuable information suitable to you!

Have you ever had a pressure wound? Did you use nutrition to help your recovery? Please share below!

References 

1. https://www.woundchek.com/uploads/downloads/consensus_documents/Role-of-proteases-in-wound-diagnostics-International.pdf
2. Pardridge WM. Transport of protein-bound hormones into tissues in vivo. Endocr Rev. 1981 Winter;2(1):103-23. doi: 10.1210/edrv-2-1-103. PMID: 7028469. https://doi.org/10.1210/edrv-2-1-103
3. Haß, U., Herpich, C., & Norman, K. (2019). Anti-inflammatory diets and fatigue. Nutrients, 11(10), 2315. https://doi.org/10.3390/nu11102315 
4. Otten, J. J., Hellwig, J. P., & Meyers, L. D. (2006). DRI, dietary reference intakes: The essential guide to nutrient requirements. National Academies Press. https://doi.org/10.17226/11537
5. Hemilä H, Chalker E. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev. 2013 Jan 31;2013(1):CD000980. doi: 10.1002/14651858.CD000980.pub4. PMID: 23440782; PMCID: PMC8078152. https://doi.org/10.1002/14651858.CD000980.pub4
6. U.S. Department of Health and Human Services. (n.d.). Office of dietary supplements – vitamin C. NIH Office of Dietary Supplements. Retrieved August 22, 2022, from https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/ 
7. Silverstein, R. J., & Landsman, A. S. (1999). The effects of a moderate and high dose of vitamin C on wound healing in a controlled guinea pig model. The Journal of Foot and Ankle Surgery, 38(5), 333-338. https://doi.org/10.1016/S1067-2516(99)80004-0
8. Rangaraj A, Harding K, Leaper, D. (n.d.) Clinician review: Role of collagen in wound management. https://www.woundsinternational.com/uploads/resources/content_10039.pdf
9. Reports on extracellular matrix proteins findings from university of california provide new insights (oral collagen supplementation: A systematic review of dermatological applications) (2019). NewsRX LLC. https://pubmed.ncbi.nlm.nih.gov/30681787/

About Jackie

Jackie is a Toronto-based Registered Dietitian with a Masters of Health Science (MHSc) in Nutrition Communications. Her mission is to empower and support neurodivergent and physically disabled communities through a weight-inclusive lens to manage their condition, prevent complications, and live active lifestyles through nutrition. Jackie runs a virtual private practice and consulting business and runs her blog which has simple recipes and health information for the disability and autism/ADHD communities.

Check out her full bio here →