Welcome back to Summer School. I'm Colleen Sloan, a PA and dietitian, and for this special series of the Exam Room Nutrition Podcast, I'm bringing back a few of my favorite conversations from the archives. And today's lesson is all about nutrition for wound healing. I'm joined by Erin Scherer, a surgical PA and registered dietitian, to talk about why nutrition matters before and after surgery, which nutrients support tissue repair, and the simple moments like a dressing change or wound check when you can naturally bring nutrition into the conversation. Plus, this episode comes with a free post-surgical nutrition guide full of easy meal and snack ideas you can share with patients. So grab your coffee, take your seat, and welcome to class. Erin, I cannot wait to have this conversation with you. Thank you so much for being here. Welcome to the show.

Thank you so much for having me. I'm really excited today to be here and to share some information about nutrition.

I would love to know why nutrition is important for wound healing? Why should clinicians care and why should they educate their patients about this?

Oh my goodness. Nutrition is so important when it comes to wound healing. One of the most common complications that we see associated with poor nutrition is delayed wound healing. And this is where wounds take longer to close or repair. And it actually puts our patients at higher risk of infections. But there's also this chance that you could have wound dehiscence. And this is where the wound actually opens up. And this can be pretty serious for patients. Sometimes, you know, it just leaves a difficult scar, but other times we actually have to take them back into the operating room to try to improve that. So one thing that I really want to bring to the forefront, though, is malnutrition. There is a lot of data that suggests malnourished surgical patients have longer hospitalizations, they have higher medical costs, and they have reduced quality of life. So this really highlights the importance of using a malnutrition screening tool if you have a surgical patient. And ideally, you want to be using that nutrition, malnutrition screening tool before your patient even goes into surgery, because we want to try to optimize the patient's nutritional status throughout the entire surgical process to prevent those complications that I was just talking about.

I love that you mentioned the pre-operative care and how nutrition is important there. Because I'm sure a lot of my listeners, if they're in surgery, they're probably like, eh, nutrition doesn't really matter for my field. And I actually saw a thread on LinkedIn that was talking about my, you know, surgeon didn't even talk about nutrition as part of my post-operative care and my post-operative education. So if a patient does ask, hey, you know, what diet should I go on? Can you direct our clinicians as to some education on like what is that specific post-operative diet and what that looks like?

You've raised an excellent point. There are a lot of clinicians that don't, you know, have time to talk about nutrition during their clinic visits or they just kind of forget about it because it is something that sometimes, you know, we have to really focus on big picture things and nutrition sometimes falls through the cracks. But it's so important to educate our patients. For general surgery, there's no specific post-op diet that everyone would follow. It's highly individuals. So let's say you have a small wound, maybe you have an abrasion, you might not have to change your diet at all. And you might feel fine, especially if you're well-nourished beforehand. However, if you are having a major surgery, this is much more traumatic and this is likely to cause some bigger, you know, changes to your diet to support your recovery. If you remember having surgery in and of itself is a stress to the body and it increases your metabolic needs. So then if you've got a big wound that has to heal, it's definitely going to require additional nutrition to support that tissue repair, the immune function, and the overall recovery.

Now, let's linger here a little bit. So although there isn't a specific post-op diet, I know there are certain nutrients that patients should be focusing on. And there are specific foods that do promote healing. So I would love to hear what some of those are.

Yeah, I'm gonna actually use an analogy here. So when it comes to wound healing, you can think of your body as a construction site. Okay. Protein is one of the major, major components here. It's like the bricks. It's essential for building and repairing the tissue. Now, after an injury, your body is gonna need rebuilding and repairing. Just like you need more bricks for a bigger repair job, your body is gonna need more protein to heal wounds. So depending on how serious that wound actually is, you might actually need to double your protein intake compared to what you usually eat. And that number goes from 1.2 up to two grams of protein per kilogram of body weight per day. Some good sources of protein. You know, if you eat animal products, a lot of these do provide good sources of protein. So our meats, chicken, turkey, beef, pork, seafoods, fish, and shrimp, our dairy products, you know, eggs, milk, cheese, yogurt. However, if you do follow a plant-based diet, there are lots of great options for you as well. You know, you might want to encourage lentils, beans, tofu, quinoa is another great source. So lots of good sources of protein for our patients and for our own bodies to help repair it when we have wounds. Now, another important nutrient is vitamin A. And this acts as the body's tool for constructing new tissue. It's gonna help ensure that all of that repair work is done right. You might think of this as the food that comes from carrots, right? It's in those orange and yellow fruits and vegetables. So we do have a lot of vitamin A in carrots, sweet potatoes, pumpkins, apricots, sort of those yellow-orange colored ones, but it's also in leafy green vegetables, spinach and kale. And then if you're looking for some animal sources of vitamin A, eggs and dairy products and fish oils, those have vitamin A too. We also have vitamin C. This is a helper that brings those necessary materials to the construction site. So it's going to bring in collagen, and then it's going to add that as the scaffolding to sort of support the new tissue. So we can get vitamin C from our citrus fruits. I'm sure that you've heard that before oranges, lemons, limes, but it's also found in berries like strawberries and raspberries. And then my personal favorite is bell peppers. So, you know, vegetables like bell peppers, broccoli, and breathless sprouts are also really good sources of vitamin C. We also have zinc, and this is going to serve as reformin of the construction site because this is going to oversee everything, make sure the immune system is supported, fighting off any infections, and then just ensuring that everything is running smoothly. And good sources of this include beef, pork, lamb. You can also find it in oysters and crab and lobster if you like seafood. And then the plant-based options, we would want to include chickpeas, lentils, beans, and then pumpkin seeds, sesame seeds. So again, those nutrients that I talked about, the protein, the vitamin A, the vitamin C, and the zinc, they're gonna be really important for the healing process. There is one other nutrient that I didn't really talk about, but I kind of wanted to bring up because it does have a role in wound healing as well, and that is omega-3 fatty acids. So these polyunsaturated fats are not just good for heart health, but they also play a pivotal role in controlling inflammation in the body. So during wound healing, inflammation is important and it's necessary for healing. But if you have too much inflammation, that can actually hinder the process and it can actually damage the healthy tissue. So incorporating some omega-3 fatty acids into your diet can help control that inflammation and support wound healing. So good options or sources of those include fatty fish like salmon or mackerel, and then flax seeds, chia seeds, and walnuts. So what I like to do is just ask my patients if they're familiar with sources of these nutrients. For example, you know, I might say, we need to focus on your nutrition a little bit. Do you know any good sources of protein? Like, do you have a favorite protein that you like to eat? And if they are lost, they have no idea what a protein is. I know that this patient is going to benefit from further education. So this is an opportunity to get them in to see a dietitian. It is an opportunity to give them some websites to review with YouTube videos, give them some handouts to take with them. Sometimes a handout is incredibly effective. It is a way for you to give them something to review when they're at home. Their family members might look at it. And it really is helpful for you because you don't have time to explain everything. I would also, again, just encourage providers to collaborate with dietitians, particularly for those complex nutritional patients. If you know somebody is at risk of malnutrition or you know that they're going in for some type of complicated GI procedure, they're going to have nutritional issues for several months. So it's best to get that process started early on.

I can tell you're an educator because I love the analogy that you used. It's such a helpful way to explain things to patients. And I think that will be really helpful for the clinicians listening to literally just use that same analogy to educate your own patients because that was really, really helpful using that construction site analogy. Now I'm curious, how long should patients be focusing on those specific nutrients to optimize their wound healing?

I'm really glad you asked this question because earlier we talked a little bit about optimizing nutrition in the pre-operative period and in the post-operative period. So I would say probably over the last 10 years, there's been a big focus on something called enhanced recovery after surgery. And these enhanced recovery protocols really start to get our patient up and moving a lot faster after surgery. And they really look at optimizing everything before surgery. They call it prehab instead of, you know, like rehabilitating in the post-operative period. And part of the enhanced recovery protocols includes an aspect of nutrition. So we want to get our patients optimized early on. And that includes doing a malnutrition screening. If you catch somebody who's at risk of, you know, potentially developing complications in the postoperative period, you want to start improving their nutrition before surgery. So that might include, you know, increasing their protein or their calorie needs in adding some type of oral nutrition supplement beforehand. And then, of course, in the post-operative period with the enhanced recovery protocols, we're starting to give foods to patients like just a few hours after they've had the surgery. And this is because we want to stimulate gut function, we want to get things moving again. And those patients that can't actually eat, sometimes we actually give them gum to chew, which I know it sounds a little bit weird, but chewing gum stimulates saliva, it gets the gut starting to contract again, which can help prevent ileas, it can get the bowels moving again so you can have your first bowel movement. And then it actually has found to shorten the hospitalization. But as far as, you know, wound healing, that process can take several weeks and months, depending on the type of wounds that you've had.

That's very helpful. And it's so interesting how wound care has kind of changed and progressed over the years. And I love that we are focusing on gut function and gut health now in the surgical world. And I want to bring it back to protein. I think we really honed in on the importance of almost doubling what their initial protein needs were, going all the way almost up to two grams protein per kilogram per day. Now, do patients always need a you know meal replacement shake or a protein shake if they do ask the clinician about that?

Yeah, so that's a great question. Again, it's gonna depend on the individual patient. If it's a minor wound, small something small again, they're not gonna need extra protein or supplements or anything. But if a patient has had surgery, then yes, the answer is definitely yes. Patients are probably going to need a little bit of extra protein to support tissue repair and recovery. And again, the exact amount is gonna vary on the individual's weight, his type of surgery, and their overall health condition before surgery and kind of in that postoperative period. Do you recommend patients take a multivitamin? So multivitamins can absolutely play a supportive role in the wound healing process. And especially in cases where nutritional intake is not really sufficient to meet those increased demands that we've already been talking about. So it is important to note that supplements can support wound healing, but they should not replace a balanced diet. So ideally, nutrients should come from food sources because your body absorbs them better this way. That being said, I realize that not everyone has a perfectly balanced diet. And, you know, we all have days where our diet could use some improvement. So there absolutely is a role for multivitamins and nutritional supplements to support wound healing. In my experience, the patients that benefit the most from nutritional supplements are those that are malnourished or who have undergone a surgical procedure or who may have a more complex wound or some type of, you know, comorbidity. I think as a healthcare provider, it's really important to ask your patients if they're taking any supplements. Patients oftentimes will start taking a product without telling us, and they may not actually realize that the product they've chosen could cause potential harm. Maybe it could interact with the medication they're taking, or maybe the dose is just too high. I have had patients take way too much vitamin C and then they experience GI issues and they're not sure why that's happening. I've also had some that have taken far too much zinc and then it ends up interfering with copper absorption. So this is, you know, an opportunity for you to educate your patients. If, you know, you bring up the idea of supplements, it can start that conversation and you can, you know, educate them.

Erin, I'm really glad that you brought that up because it is so common for our patients to be taking an excessive amount of supplements and sometimes not even know that they're quote supplements because they maybe bought them as a vitamin or greens powder. So if you want to dig deeper into this topic and kind of learn the nuance of how to have this conversation with your patient, I actually did a full episode. It's titled, Are your patients taking too many supplements and don't even know it? It's episode 75. And I'll link down to it in the show notes if you wanted to continue this conversation about excessive supplement use with your patients. I'm actually going to ask you a question that I think a lot of patients might be asking their clinicians. And that's about like specific amino acid supplementation and other things like collagen that they might be seeing on social media or on the internet that, you know, promote wound healing. And I would love to know if this is actually true and if our clinicians should be recommending these things.

When we talk about the importance of protein and wound healing, we're really zooming in again on the role of those amino acids, like you mentioned. And these are the building blocks of protein. So we're going back to that construction site analogy with our protein blocks here. There are several amino acids that are especially important for wound healing. So arginine is a good example of an amino acid that is known to enhance collagen production. And we know that collagen is crucial for helping to repair the damaged tissue. Arginine also helps support immune function. So it makes it easier to kind of fight off infections that might be brewing during that healing process. Another amino acid that's important in wound healing is halutamine. And this serves as the fuel for cells in the immune system. And it just sort of supports the healing process. Now, getting amino acids is actually pretty easy to do through your diet. You don't necessarily need to get a supplement that has these added amino acids in order to fulfill your needs for wound healing. So our bodies produce some amino acids on their own without any support at all, but we do need to eat some through our diet. And those are called the essential amino acids. Now, foods that are already high quality proteins like lean meats, dairy, eggs, and you know, plant-based options like quinoa, nuts, soy products, those provide those essential amino acids. So I would say that unless you are suffering from, you know, a very complex wound, you probably don't need to purchase any very expensive supplements to support this. You can actually get these nutrients from your diet. Now, that being said, there is evidence that supports the use of immunonutrition supplements in certain populations. And those populations are high-risk surgical patients who are malnourished or patients who have cancer and again are at high risk for developing malnutrition. You also asked about collagen. I just want to briefly touch on this. So there are a lot of collagen supplements available that you can add to your foods to get a little collagen boost. And while these do help improve your skin, they might improve your joint function, there's not a ton of evidence indicating that they are useful for wound healing.

Now, how important is hydration for wound healing?

So water is essential for like all body functions, right? But it's especially important for healing. It helps transport nutrients and oxygens to wound sites and it helps wash out the toxins. The general recommendation for drinking water is like eight to ten glasses of water a day. So about two liters. If you've had surgery, those needs might go up a little bit higher. Again, depending on what's going on. If you have a wound that's oozing liquid, you're definitely going to need to add more fluid to your intake because you're putting out a lot of fluid. Same with sweating, or if you develop a fever, you know, you have an infection, your body's gonna need a little bit more fluid on board. You don't need to just drink water. There are other beverages that can support you, you know, in hydration. Sometimes it's really hard for people to just drink straight water. So a good choice I would say is milk. If you do drink dairy products, because that has protein in it and calcium, and it's a good option. I would just stay away from some of those higher sugar beverages.

Now you did mention some complications, but I'm curious about some of those complications that we can treat with nutrition, specifically like constipation or nausea. Are there any foods that can help with those? And what other complications should clinicians be looking out for?

So there are definitely complications that occur in the postoperative period. Postoperative nausea is a really big one. So if you're inpatient, you know, we can throw some medications on board to try to help support you. But foods that support nausea, we might want to encourage smaller meals. So if you're used to having three big meals throughout the day, you might want to break it up into five or six small meals or just eat snacks throughout the day and keep sometimes keeping your liquids separate from your meals can also help modify that nausea or improve it for some people. And then of course, avoiding trigger foods. If something smells, you know, weird and it's giving you some nausea, then stay away from that. Avoid greasy, spicy foods. Sometimes those can cause reflux. And ginger tea can sometimes help alleviate nausea in patients. Another complication associated with postoperative period is constipation. And you know, sometimes during the anesthesia period, we give medications that put your whole body to sleep. And, you know, that has an impact on your GI tract as well. So sometimes your GI tract has to kind of wake up again and get moving. And when you do have constipation in the postoperative period, you can try to combat that by increasing your fluid intake. So drinking more water that can sort of push things through a little bit. And then, of course, increasing your fiber intake. So fruits and vegetables, whole grain foods are going to be, you know, really effective. There are supplements you can take like metamucil is the cilium-based fiber, and that helps kind of support moving things through your GI tract as well.

So I would love to open up the conversation to you. If you have any final thoughts or anything you think that my clinicians and the listeners would really benefit from knowing.

I think the last thing I would say is that those follow-up visits, when you're doing maybe a wounds check, if you work in urgent care, you work in the ER, the, you know, even surgery, this is a great opportunity for you to talk about nutrition too. You might be, you know, changing the dressings. You can bring it up. So, how is your nutrition doing? Have you been, you know, improving your protein at all? Okay, well, the wound is looking good, but I want you to take a little bit of time this week and just think more about improving your diet. So there are lots of opportunities for us to educate our patients and to share knowledge with them, but it's difficult because we always, you know, have a time crunch and it may not always be in the forefront of our minds. But just remember that there are lots of resources available for you. If you do forget, you can always send your patient a link to a video, send them a PDF that they can review at home.

If you could provide my listeners with some of those resources that they can be suggesting to their patients, I think that would be really helpful.

Yeah. One of the resources that I go to frequently is through the Physician Assistant Foundation. They actually have some really great videos that you can direct your patients to. They're short YouTube videos, just a few minutes in length, but they discuss wound healing, nutrition for it. And they also have some handouts that you can print off for your patients. So I'll share those links with you.

Awesome. We're gonna go ahead and link those down in the description below. So if you wanted to pull those up, definitely feel free to use those so you don't have to go searching for those items. Erin, thank you so much for the gift of your time. This has been so helpful. So thanks so much for being here. Absolutely. It's such a pleasure. Thank you again. All right, guys, now it's time for my nutrition notes. So now that you know about the key nutrients that you should be discussing with your patients, let's get really practical here. So, what do you say when your patient asks you, okay, well, what should I eat? Or what if they don't feel well enough to cook? How are they gonna get their protein? Now, of course, you can suggest nutrition shakes and other supplements. However, answering these questions can be really tough. So, for my nutrition notes today, I am going to share a few really simple meals that are high in protein and in the micronutrients vitamin A, C, and zinc. But not only that, because I think nutrition is so vital to a patient's wound healing journey, I have created a post-surgical nutrition guide that has 10 easy meal and snack ideas that you can suggest to your patient. This is my gift to you as just a way of saying thank you for listening to my podcast. You can download the nutrition guide for free at examroomnutrition.com slash meals, or just go to the show notes and click on the link. But I will leave you with two of my favorite recipes that you can find in that nutrition guide. The first one is a spinach and mushroom scrambled eggs with a twist. Now you're gonna have your patient add one half cup of cottage cheese into their eggs, then whisk those together. Now, this not only makes the eggs extremely fluffy, but adding a half cup of cottage cheese brings the three egg omelet from 18 grams of protein to almost 32 grams. Now they can add in their favorite veggies and maybe have an orange on the side for that extra boost of vitamin C. And that, my friend, is a well-balanced wound-healing breakfast. My next favorite recipe in this nutrition guide is a simple sheet pan dinner with salmon, sweet potato, and broccoli. All your patient has to do is place everything on a baking sheet, drizzle it with olive oil, a little bit of lemon, and some seasonings, and bake it at 400 degrees for 20 to 25 minutes. That's a super simple dinner. You can make it for one person or as many people as you need, and it is full of protein and vitamin A. Now, all of these things can be found in my post surgical nutrition guide, full of easy meals. Like I said, it is my gift to you, so go to examroomnutrition.comslash meals and download it for free. Well, that's all I've got for you today. So, as always, let's continue to make our patients healthier one exam room at a time. I'll see you next time.