Nutritional support for wound healing

Alternative Medicine Review, Nov, 2003 by Douglas J. MacKay, Alan L. Miller

Perioperative zinc supplementation is recommended for zinc-depleted patients. (23) Data is lacking to show zinc supplementation improves healing in non-deficient individuals; however, zinc deficiency in humans is widespread, and injured and stressed individuals are more prone to developing deficiencies. Ehrlich et al suggest zinc is lost in significant amounts after surgery because of fistulas, stress, and diarrhea. (50) Zinc deficiencies have also been identified in individuals with deep partial- or full-thickness burns and chronic venous leg ulceration. (51,52)

Further research is needed on the efficacy of zinc supplements for wound healing. Justification for perioperative zinc supplementation includes the absence of adverse effects at moderate doses (15-30 mg daily) and evidence that zinc deficiency impairs wound healing. Zinc supplementation of 15-30 mg daily is recommended perioperatively to prevent unmasking of marginal deficiencies. Higher levels of zinc supplementation may be necessary in patients with malnutrition, malabsorption, chronic diarrhea, or other risk factors of zinc deficiency.

Vitamin E

Vitamin E is popular among consumers for skin care and to prevent scar formation. It functions as the major lipophilic antioxidant, preventing peroxidation of lipids and resulting in more stable cell membranes. The antioxidant-membrane stabilizing effect of vitamin E also includes stabilization of the lysomal membrane, a function shared by glucocorticoids. (53) Systemic vitamin E and glucocorticoids inhibit the inflammatory response and collagen synthesis, thereby possibly impeding the healing process. The effect of vitamin E on wound healing is complex; it may have alternate effects in different types of wounds and in the presence of other nutrients, as well as different functions for water soluble versus lipid soluble preparations of vitamin E.

Animal studies of vitamin E supplementation on surgical wounds show conflicting results. Greenwald et al showed flexor tendon repair in chickens treated with vitamin E had breaking strength less than half that of controls measured after days 7 and 45 from surgical repair. (12) Another animal study showed impaired collagen synthesis in rats treated with vitamin E after wounding. (54) The researchers cite the glucocorticoid-like effect of vitamin E as the cause of the negative results. However, these effects are mitigated by vitamin A, as vitamin A is a lysomal destabilizer that reverses several of the deleterious effects of glucocorticoids. (8)

Paradoxical results found by Galeano et al showed a hydrophilic vitamin E preparation positively impacted delayed wound healing in diabetic mice. Increased breaking strength and collagen content of the wound was found in treated animals. These authors speculate inhibition of lipid peroxidation accounted for the positive results. (55) In addition, prophylactic administration of vitamin E has been shown to increase breaking strength and normalize healing of wounds exposed to preoperative irradiation (56) and to decrease the development of intraperitoneal adhesions in animals. (57)