by Nancy Collins, PhD, RDN
One of the most common questions I hear from wound care professionals is whether or not patients should take daily vitamin and mineral supplements to help wounds heal more quickly. On the surface, it seems like a very simple question but, in actuality, it’s a complex issue. The research supporting it is scant, at best, and the industry is not regulated by the FDA. Despite this, it’s big business in the U.S., with nearly $31 billion spent on dietary supplements last year.1
A typical “healthy” consumer uses the Recommended Dietary Allowance (RDA) printed on labels as a guide, but wound care patients often suffer from chronic health issues, i.e., diabetes, heart disease, vascular insufficiency, or lymphedema, that stress the metabolic system. In addition, many do not follow proper diets, or they don’t get enough of the right nutrients from diet alone.
Micronutrient Deficiencies in the Wound Care Patient
The first step to help your patient decide whether supplements might help is to identify any deficiencies. The best way to do this is to gather biochemical data, discuss the patient’s dietary history, and conduct a nutrition-focused physical exam. For healthcare professionals, three common dietary assessment methods are as follows: 1) the 24 Hour Recall, 2) the Food Diary, and 3) a Food Frequency Questionnaire (FFQ). You can find more details here, from the National Institutes of Health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4154347/
There are often tell-tale signs or clinical symptoms of deficiencies, and the nutrition-focused exam is designed to help you hone in on those signs. For example, when there’s a riboflavin deficiency, patients often have scaly red patches, or seborrhea of the skin, in the nasolabial folds. A smooth, red, thickened tongue sometimes signals a B12 deficiency. Mouth ulcers, commonly referred to as canker sores, are often the result of iron or B vitamin deficiency. Blood tests can be used to diagnose certain deficiencies, like iron or Vitamin D.
Wound care clinicians should become familiar with common deficiencies and their signs, and really “tune in” with the patient during a nutrition-focused exam to help determine whether supplementation may help.
The Importance of Being Proactive: Diet First
As any healthcare professional knows, patients should be encouraged to consume a healthy diet of whole grains, quality proteins, and low-fat dairy, as well as plenty of fruits and vegetables. Supplements cannot replace a poor diet. It should also be noted that foods rich in Vitamin C are important because ascorbic acid is associated with hydroxylation and secretion of procollagen, which is essential for normal collagen formation.
Total Daily Intakes
There are several excellent pre-packaged drinks or powders on the market that contain vitamins and/or minerals that help with wound healing, and they are marketed as such. These may offer enough support, without additional supplements. It’s important to look at the total cumulative daily intake to determine whether anything else is needed.
For instance, many patients receive targeted amino acids by using Juven (Abbott Nutrition, Columbus, OH). Juven has been reformulated and now contains vitamins B12, C, and E, as well as zinc. If a patient includes Juven as part of their treatment regimen, it is usually not necessary to add additional supplements. Doing so may raise the total cumulative daily intake of certain vitamins or minerals beyond the targeted level. For example, the RDA upper limit for zinc is 40 mg. per day. If the patient combines a multivitamin, a zinc supplement, Juven, and an oral diet, this can easily exceed 40 mg., and higher doses of Zinc can cause side effects like nausea and vomiting. Practitioners should look at the overall meal intake plus all supplements in order to get a more accurate view.
Some supplements can interfere with medications, so be sure to review the medication list on the label and consult with a pharmacist, if needed. Heavily draining wounds may increase the need for supplements, particularly zinc, so also evaluate wound drainage. Patients on dialysis are metabolically challenged in the dialysis process, so you should coordinate with the dialysis center before making any recommendations.
In addition, keep in mind that many patients are unaware that there is no regulation for dietary supplements, or they believe they are safe because they are “natural.” They also may not remember what they are taking, so it’s good to ask for photos of the labels or have them bring the bottles to the office.
In conclusion, the evidence isn’t clear on whether or not supplements can help patients hasten the healing process because there are so many other factors involved: the patient’s health, lifestyle, diet, compliance to treatment, etc. However, it’s safe to say that it’s always a good idea to encourage healthy eating habits, evaluate nutritional intake, and review and collaborate with the wound care physician to determine if certain supplements may be helpful.
About the Author: Nancy Collins, PhD, RDN, LD, NWCC, FAND, is a wound care-certified, registered dietitian nutritionist with expertise in wound care, malnutrition, and medico-legal issues. Dr. Collins strives to improve patient outcomes and patient satisfaction through better communication. To contact her, visit her website, http://www.drnancycollins.com/.