How does a vegetarian diet affect the healing of wounds?

An estimated 22.8 million Americans follow a largely vegetarian influenced diet, according to the 2008 report “Vegetarianism in America” published by Vegetarian Times. It appears most people make this decision to improve their overall health, with 53 percent of those surveyed stating health as the reason for choosing a vegetarian diet. However, could vegetarians be adversely affecting their health inadvertently by eliminating protein found in meat and chicken? For health care professionals in wound care, the answer is yes.


Understanding the link between wounds and protein


 Collagen is the protein that comprises our skin and some of the underlying tissue layers. When there is a disruption in the tissue, collagen is required to repair the defect. The body relies on protein intake for collagen synthesis. If the protein intake is not sufficient, the body will begin breaking down lean muscle.


Therefore, when treating patients with compromised skin integrity, adding protein in the form of meat, poultry, fish/seafood, eggs, dairy products, and sometimes protein supplements is typically among the treatment plan. However, for vegetarians, this may not be an option, depending on their preference to strictly follow the vegetarian diet. As interest in vegetarianism rises in the US, more health care providers in wound care are facing this conversation with their patients.


Dr. Eugene Dickens with the Wound Care Clinic at Hillcrest Medical Center says they treat vegetarian patients on a regular basis. Dr. Dickens advises his vegetarian patients to seek protein through other non-meat sources. “At the wound clinic, we always try to encourage our patients to choose healthy sources of protein, and when animal protein is not an option, other sources such as beans, green leafy vegetables, soy-based foods, and even protein powders such as pea protein can be beneficial in ensuring adequate intake,” Dr. Dickens says. “We caution patients to ensure they are replacing animal protein with nutrient dense foods, instead of ‘empty’ calories such as heavily processed convenience foods, sugar-laden baked goods, and the like.”


Supplementing a Vegetarian Diet for Wound Care


Not all vegetarians are the same, meaning a vegetarian diet, as Dr. Dickens cautioned, does not always mean a healthy diet. However, according to a recent study, vegetarians have higher intake amounts of fiber, thiamin, riboflavin, folate, calcium, magnesium, potassium, iron, and vitamins A, C, and E than nonvegetarians. Specific to wound care, lower levels of fatty acids, vitamin B-12 and vitamin D need to be addressed to assist with treatment.


Fatty Acids – Because vegetarians do not eat fish and some may not eat eggs, vegetariansas can be low in the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). It is recommended vegetarians incorporate alpha-linolenic acid, an essential omega-3 fatty acid, into their diet. Sources of ALA include walnuts, flaxseed oil and canola oil.


Vitamin B-12 – Found natural only in animal products, vitamin B-12 aids in peripheral nerve function. Vegetarians are encouraged to add fortified foods such as soy and rice milk beverages and fortified breakfast cereals to their diet


Vitamin D – Unlike any other nutrient, our bodies can actually make vitamin D. However, if patients do not have an adequate amount of vitamin D, they will not be able to properly absorb calcium, essential for bone health.  Low levels of vitamin D can also result in a loss of balance, or more falls, according to recent research. There are only a few natural sources of vitamin D in food, including fish and eggs. For vegetarians, it is recommended they add foods fortified with vitamin D to their diet, including soymilk, fortified juice, fortified breakfast cereals, cow's milk, and margarine.


All Wound Care Clinic vegetarian patients are assessed for nutritional needs and recommended adding appropriate protein sources and supplements if necessary. If you have questions regarding the treatment of wounds for vegetarians, please email Wound Care Clinic at Hillcrest Medical Center at woundclinic@hillcrest.com.