By Nancy Collins, PhD, RDN, LD, NWCC, FAND
Protein plays a critical role in wound healing by supplying nitrogen and amino acids, which are needed to build new tissue. Nutritional interventions for wound healing often include a recommendation to increase the amount of protein consumed daily to 1.25 – 1.5 grams per kilogram of body weight.1 For comparison, the Dietary Reference Intake for protein, which is based on the nutritional needs of healthy people, is 0.8 g/kg.2 Patients with wounds must consume sufficient protein each and every day to meet their increased needs. Typically, this means eating increased amounts of meat, poultry, fish/seafood, eggs, and dairy products. Since more and more people are following a plant-based diet or vegetarian lifestyle, they may be concerned if their diet is adequate for wound healing.
Types of Vegetarians
There are many different interpretations of the term vegetarianism. If your patient remarks that he is a vegetarian, ask questions to determine what foods he consumes and which ones he avoids. For example, a patient recently told me she was vegetarian. When I asked more questions, she revealed that she ate plant-based meals at home, but not when she eats at restaurants. I told her that was more a flexitarian than a vegetarian, but she was unfamiliar with that term. So, let’s get the terminology straight first.
The term complete protein refers to amino acids, which are the building blocks of protein.
Protein is formed by 20 different amino acids. Out of the 20, 9 fall into the category of essential or indispensable because the body cannot produce them on its own. They must come from food. A complete protein must contain all 9 of these essential amino acids in roughly equal amounts. Meat and eggs are complete proteins, while beans and nuts are not.
But don’t worry. We do not need all 9 essential amino acids at every single meal and snack. Most vegetarians will consume a variety of foods over the course of the day that will meet their daily requirements for all of the amino acids. The challenge is that most wound-care patients have increased nutritional needs and often have decreased appetites. On top of this, wound healing increases the need for some of the nonessential amino acids as well, such as arginine. Consuming sufficient calories each day also is key to wound healing.
Making a Plan
If your patient will eat eggs and dairy foods, he will be getting a variety of amino acids. If not, you should recommend vegetarian proteins that are complete.
The best choices are:
Hempseed and chia, which are both very close to complete, also are good choices.
Other simple suggestions are food combinations where one food makes up for what the other lacks, thereby creating a complete protein. The best examples are rice and beans, peanut butter sandwiches, and hummus and pita bread. For example, most beans are low in methionine and high in lysine, while rice is low in lysine and high in methionine. When eaten together, they create a protein as complete as meat.
Protein supplements are another good option as a concentrated source of protein. Many supplements come from whey or casein, both derived from milk. If your patient prefers to avoid milk, look for a protein supplement derived from soy, rice, pea, or hemp, or a combination of these. The evidence on soy is divided, particularly in patients with certain estrogenic and thyroid diseases, so make sure to know your patient’s medical history when recommending soy. Protein shakes are an easy way to provide both protein and calories.
Vegan diets may fall short on some vitamins and minerals. This is especially true for vitamin B12, vitamin D, and long-chain omega-3s. Supplements can fill the gaps. If you are concerned about the adequacy of your wound patient’s diet, a registered dietitian nutritionist (RDN) can provide a detailed analysis and make appropriate recommendations.
The Bottom Line
Patients with wounds require increased amounts of dietary protein, typically meaning meats, poultry, dairy products, and eggs. With the current popularity of plant-based and vegetarian lifestyles, some patients will need alternate sources of protein. This should not be a problem. With a little planning and knowledge, these patients can meet their needs for wound healing by consuming a varied diet with adequate calories each day.
For Further Reading
The Vegetarian Resource Group. Health, environment, ethics. The Vegetarian Resource Group website. https://www.vrg.org/
Nancy Collins, PhD, RDN, LD, NWCC, FAND, is a wound care certified registered dietitian based in Las Vegas, NV. Dr. Collins is well-known for her expertise in the complex relationship between malnutrition, body composition, and tissue regeneration. She can be reached through her web site, www.drnancycollins.com
- European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel and Pan Pacific Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline. Emily Haesler (Ed.). EPUAP/NPIAP/PPPIA; 2019.
- Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, D.C: National Academies Press, 2006. doi:10.17226/10490