Nutrition is one of the most important factors of healing. Healing can be in the aspect of surgery, disease, or injury. Regardless of how tissue damage occurs, the body treats all of it the same. When a surgeon makes a cut, diabetes is damaging blood capillaries, or plantar fascia is being
strained, the body reacts in the same way. The body’s job during the healing process is to promote new tissue growth and repair through the inflammatory and immune system processes.
During the inflammatory process, your body promotes blood flow to the area of concern. Your blood contains the substances that we need to heal: red blood cells, platelets, oxygen, nutrients, and white blood cells. The body then activates the autonomic nervous system sympathetic division. When the sympathetic division is more excited, your body reacts as what we refer to
as “fight or flight.” During this time, the body goes through a series of events to increase metabolism, blood pressure, water retention, sodium retention, blood glucose, and also in response the opposite parasympathetic division is decreased. The parasympathetic division is responsible for “rest and digest.” That being said, the body has increased difficulty with digestion during times of stress.
The increase of the stress response causes the body to have cortisol levels rise. This response is to help with energy promotion and inflammatory regulation. Cortisol will increase blood glucose levels, sodium levels, and decrease the inflammatory response. So while are bodies are in this stress response, we are increasing blood sugar. Cortisol also depresses the immune system response as a way to keep inflammation lower. Too much of this immune compensation can cause a lower immune response and therefore, increased chance of illness. If cortisol remains high, this also damages our tissues, which are the very things trying to be healed. Tissues are compromised to allow the body to dispense more blood glucose into the blood. This means that the body breaks down its own tissues in order to produce more blood glucose. The body puts this glucose into the blood in order to ensure energy is readily accessible during this stress on the body. So the higher the cortisol, the more tissues are being damaged when in fact the opposite is supposed to be being achieved, healing.
This cycle can be overwhelming to an individual and so it is important to make sure the body is getting everything it needs to replenish its supplies that are being depleted. Remember, these are things happening to the average individual during times of healing and doesn’t account for any added illnesses, conditions, or diseases. In surgery for example, patients are usually given anesthesia and pain medicine for recovery. Anesthesia and pain medicine is known to interfere with digestive health and causes symptoms like constipation. If your gut is compromised, then absorption of nutrients will be affected. If proper nutrition is not handled through dietary intake, then the body cannot preplace what is needed. Both also block the stress response by decreasing ACTH (adrenocorticotropin hormone) which is the main stimulus for cortisol. Cortisol is something the body releases to help reduce the amount of inflammation going on initially from the injury, damage, condition, surgery, etc. Since cortisol is blocked by these things, when they finally wear off, the patient has more inflammation to deal with as the body wasn’t able to naturally handle it.
This becomes a rather complicated set of events, as one thing feeds into the next. The most important thing is to just have an understanding that events that happen to the body are not just local. It’s not just a cut on the toe, a broken ankle, or aggravated plantar fascia. It is the increased sugar, stress, sodium, water retention, cortisol, and inflammation the body is manipulating that becomes the bigger picture. Injury cannot be predicted, but if it is known, that a patient is going to be having surgery, then necessary preparations can be made to ensure the patient has a good diet going in, during recovery, and after surgery.
Diabetes is a very common complication of healing. Patients suffering with diabetes already have an issue with blood glucose and inflammation on a day-to-day basis. The tiny blood vessels of the body are compromised in diabetes which makes it very difficult to help with oxygen saturation and nutrient delivery to tissues and cells. Taking all of these things into consideration, there are some small ways in which care can be handled to ensure that dietary requirements are met. Below there are different requirements and suggestions for different examples of patients and categories. Bottom line is that patients should have a healthy reserve and consciously be aware of sugar, water, and sodium intake.
Dietary Considerations for Surgical patients and wound healing:
Introduce these recommendations 6 weeks before surgery
Increase calories 300-600 cal/day
Protein 1.5-2.0g/kg (increased from 0.8g/kg)
Arginine 30g/day continuing for 2 weeks post-surgery
Omega 3 fatty acids
Vitamin C 2g/day
Increase H20 by 10%
Anti-inflammatory diet (dark veggies, blue and blackberries, cherries, cold water fish, avoid sugar gluten, excessive sodium, excessive carbs)
Aloe to help with digestive health from likely use of medication
Diabetic Dietary Considerations for Diabetics:
American Diabetes Association
1/2 your plate in non-starchy vegetables (tomato/spinach/carrots)
1/4 your plate protein
1/4 whole grain
add a serving of fruit a day
Low glycemic carbohydrates 130 g/carbs/day
40g fiber (lentils, beans)
40-60g of protein/day
Increase omega 3 fatty acids
Avoid trans fats
Magnesium 400-1000 mg/day
Chromium 800-1000 micrograms/day
Dr. Zachary Stelmack
Stelmack Pinpoint Health Care
600 Hillgrove Avenue, Suite 3
Western Springs, IL 60558
“18, 36.” Food and Nutrients in Disease Management, by Ingrid Kohlstadt, Taylor & Francis, 2009.
Desborough, J.P. “The Stress Response to Trauma and Surgery.” British Journal of Anaesthesia, vol. 85, no. 1, 2000, pp. 109–117., doi:10.1093/bja/85.1.109.