Abby asked for suggestions to accelerate healing of her injuries. What should be done when a wound won’t heal?
More often than not, I think, slow healing wounds reflect nutritional deficiencies. Tissue regeneration is a nutrient-intensive process, and a lack of nutrients can radically slow it down.
Osteoporosis Epidemic Indicates a Widespread Deficiency of Bone Nutrients
Tissues are not static: they are constantly broken down and regenerated. So just maintaining tissues requires a steady supply of nutrients.
Bone is particularly in need of certain nutrients: vitamins C, D, and K2; magnesium; and others. Unfortunately, the nutrients needed by bone are precisely the ones in which Americans are most deficient.
I believe that deficiencies in these nutrients are the main cause of the osteoporosis epidemic. Take vitamin K2. Most Americans are deficient in vitamin K2, which is needed for bone calcification. Non-vertebral fractures are five-fold more common in people with vitamin K2 deficiency. [1] The rise in fracture rate in women after menopause may be due to the fact that estrogen improves vitamin K2 status. [2]
Vitamin D is another nutrient critical for bone health. Bone mineral density peaks in the range 32 to 45 ng/ml. [3]
Vitamin C is a third nutrient necessary for bone health. Vitamin C is needed for collagen to form a meshwork that can then be mineralized by calcium, magnesium and other minerals. In the absence of vitamin C, bone is malformed.
Interestingly, cow’s milk has only one-fifth the vitamin C of human breast milk, and vitamin C is destroyed during pasteurization, so formula-fed babies before the days of vitamin C supplementation were prone to scurvy. Some believe that vitamin C and vitamin D deficiencies, not malicious parents, are responsible for “Shaken Baby Syndrome.” [4,5]
Vitamin Levels Determine the Success of Orthopedic Surgery
Today I read a press release about a study that found that 40% of all patients arriving for orthopedic surgery, and 52% of those coming in for trauma service, were deficient in vitamin D. Deficiency was defined as 25(OH)D levels below 20 ng/ml.
(We recommend keeping 25(OH)D between 35 and 50 ng/ml.)
What happened? Those who had surgery with vitamin D deficiency failed to heal properly, while those who were vitamin D sufficient generally did well. Concluded the doctors:
“In the perfect world, test levels, fix and then operate,” said Joseph Lane, M.D., professor of Orthopedic Surgery and chief of the Metabolic Bone Disease Service at HSS, who led the study. “If you put people on 2,000-4,000 [milligrams] of vitamin D based on what their deficient value was, you can usually get them corrected in four to six weeks, which is when you are really going to need the vitamin D. If you are really aggressive right before surgery, you can correct deficient levels quickly, but you have to correct it, measure it, and then act on it.”
According to Dr. Lane, bone remodeling or bone tissue formation, a part of the healing process, occurs about two to four weeks after surgery. This is the critical stage when your body needs vitamin D….
“With arthroplasty, there is a certain number of patients that when you put in the prothesis, it breaks the bone adjacent to the protheses, which can really debilitate patients.” This could be prevented or minimized by rectifying vitamin D levels. Dr. Lane also explained that they now perform procedures where they grow a bone into a prosthesis without using cement. “In those people, it would be an advantage to have adequate vitamin D, because it matures the bone as it grows in, it is really healing into the prosthesis,” he said.
“The take home message is that low vitamin D has an implication in terms of muscle and fracture healing, it occurs in about 50 percent of people coming in for orthopedic surgery, and it is eminently correctable,” Dr. Lane said. “We recommend that people undergoing a procedure that involves the bone or the muscle should correct their vitamin D if they want to have an earlier faster, better, result. What we are saying is ‘wake up guys, smell the coffee; half of your patients have a problem, measure it, and if they are low, then fix it.'” [6]
Conclusion
If you have any sort of injury, make sure you are well nourished.
If an injury refuses to heal, consider it a red flag: you are probably missing one or more crucial micronutrients. Take steps to identify the deficiencies and remedy them as quickly as possible.
References
[1] Cockayne S et al. Vitamin K and the prevention of fractures: systematic review and meta-analysis of randomized controlled trials. Arch Intern Med. 2006 Jun 26;166(12):1256-61. http://pmid.us/16801507
[2] Shea MK et al. Genetic and non-genetic correlates of vitamins K and D. Eur J Clin Nutr. 2009 Apr;63(4):458-64. http://pmid.us/18030310.
[3] Bischoff-Ferrari HA et al. Positive association between 25-hydroxy vitamin D levels and bone mineral density: a population-based study of younger and older adults. Am J Med. 2004 May 1;116(9):634-9. http://pmid.us/15093761.
[4] http://legaljustice4john.com/scurvySigns.htm.
[6] Hospital for Special Surgery (2010, October 7). Vitamin D deficiency rampant in patients undergoing orthopedic surgery, damaging patient recovery. ScienceDaily. October 7, 2010, http://www.sciencedaily.com/releases/2010/10/101006141556.htm. Journal citation: L. Bogunovic, A. D. Kim, B. S. Beamer, J. Nguyen, J. M. Lane. Hypovitaminosis D in Patients Scheduled to Undergo Orthopaedic Surgery: A Single-Center Analysis. The Journal of Bone and Joint Surgery, 2010; 92 (13): 2300 DOI: 10.2106/JBJS.I.01231.
via this link:
Interesting post, as usual. Any thoughts about skin that doesn’t heal, for instance after burns and cuts? Or rather, wounds do slowly close, but marks remain on the skin for a very long time.
Thanks!
Several grams of arginine a day can help with wound healing.
I had that happen to me when I was C-deficient. It could be collagen-related, i.e. vitamin C, or amino acids like glycine and proline. Eat gelatin and take vitamin C to relieve those deficiencies.
Some papers list nutrients that help with wound healing:
http://www.ncbi.nlm.nih.gov/pubmed/14653765 (vitamin C, vitamin A, glucosamine).
http://www.ncbi.nlm.nih.gov/pubmed/20598855 and http://www.ncbi.nlm.nih.gov/pubmed/19427218 (arginine, vitamin C, and zinc).
How would collagen containing foods help to heal?
And would either glucosamine or chrondroitin be recommended?
Three years ago I was diagnosed with osteopenia. Two years ago I started the paleo diet and did the following to help my bone loss:
1. upped my protein intake.
2. stopped eating grains
3. Started lifting heavy weights
4. optimized my Vitamin D level from 10 to 70
5. Started taking Vitamin K2
6 Continued to take 2000 units of Vitamin C
I will get a Dexascan in two weeks and I will report back the results to you. Hopefully all of the above will work.
Hi Jake,
Cut out omega-6 fats and eat some salmon, take magnesium, and you should have your bases covered.
Hi Abby,
Gelatin provides the raw amino acids needed to form collagen, which is the major protein component of bone, connective tissue, fascia, and extracellular matrix.
Some people recommend supplementing glucosamine, but if you eat enough starch you should be able to make the glucosamine you need. You might benefit from sulfur containing foods.
“Cut out omega-6 fats and eat some salmon, take magnesium, and you should have your bases covered.”
I have done all that too. I am a perfect lab rat for your theories.
Jake – Great!
Yes, please let us know your Dexascan results!
i had a bit of a different injury but i cannot not prclaim enough the healing ‘mentally’ powers of organ meat and bone marrow along with good starchy veggies with butter/tallow/coconut oil. really, it is amazing.
also i ‘have’ osteoporosis and was told by the surgeon in february i would never be able to walk again without pain after falling down steps. i had 2 torn miniscus’ (sp?) and sprained MCL’s. both knees. i was in 2 straight casts for 6 weeks.
i stuck to the suggested HIGGGHHHH fat promoted here(before even finding this site) and after 6 weeks i said screw surgery an started easy when i got the casts off, taking walks and making sure to eat the most NON inflammatory diet i could while gaining weight(needed). i moved to kettle bells, lunges, wall squats, front squats after 8 months.
i have NO knee pain now, so no surgery 🙂 i dont even know if i could still be consider as one with osteoporsis as i have no bone pain any longer and you can literally SEE in my arms and shoulders and hips that my bones have broadened.
it i crazy. so, no medicine, no surgery, hopefully no more osteo. the only factor i have is damn good nutrition and rest.
true story i swear haha i reread and it sounds like a promotion lol
Hi Mallory – Great news! it’s wonderful what a healthy diet can do. The body has amazing recuperative powers when you treat it well.
As far as osteoporosis, in the last 2 years I have gained 12 pounds and half an inch in height with no change in body dimensions / waist size and only rare exercise. I think my bone density must have increased substantially. Teeth definitely seem harder and whiter, maybe bigger.
UPDATE: Shou-Ching wants me to note that the increased height was due to improved posture. True, but I think better nutrition caused the improved posture.
dunno if its applicable but i also wanted to add i did IF, ate 8 hours a day
Another thing to consider when trying to heal bone and cartilage is that NSAIDS interfere with healing. http://www.arthritis.org/nsaids-fracture-healing.php
Thanks, Anne, great point. NSAIDs damage the intestine, too, which is the first step toward many illnesses.
This post got me thinking about those Emergen-C packets. The dose of Vit C in those things is 1000 mg. Additionally, they contain a pretty high dose of Magnesium and B12. However, in the “other ingredients” section, fructose is listed as the first ingredient. Subsequently they have 6g of carbs and 6g of sugar if I recall correctly. Are they worth taking the risk with the fructose content for the high availability of essential vitamins? I only ask because I got a box for free and they’re sitting in my cabinet staring at me. Should I just toss them?
Hi Lindsay,
You can take them. I try to keep my daily fructose intake below 10 g / 40 calories. Most of it comes from fruit and berries. So, one Emergen-C a day wouldn’t be a large dose of fructose.
Hi, I love your blog, research, insight, and willingness to share the science – I will buy your book.
Can you clarify this statement and the reference (I can only see the abstract, but it doesn’t seem to match)?:
The rise in fracture rate in women after menopause may be due to the fact that estrogen improves vitamin K2 status. [2]
Thank you!
PS…Ray Peat talks about estrogen increasing after menopause, but I don’t think is what you are saying…
Hi Kriss,
If you look in the upper right of the Pubmed abstract you’ll see that free full text is available for this paper. The link is: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681093/
The key passage in the full text is here:
Postmenopausal women had higher %ucOC (that is, indicative of lower vitamin K status) than premenopausal women in our sample, while in the post-menopausal women, the use of HRT was associated with a reduction in %ucOC, as has been reported elsewhere (Lukacs et al., 2006). This may suggest estrogen status to be an important determinant of vitamin K status, independent of diet.
Me again:
Estradiol, the main human estrogen, decreases after menopause. Hormone replacement therapy (HRT) restores estradiol and progesterone.
So it looks like estradiol improves vitamin K2 status, and menopause with its loss of estradiol will exacerbate any K2 deficiency.
Ah…Thank you so much for writing out the specifics and showing me the ‘free full text’ hyperlink, next time I will check that out first.
I have a close relative doing the ketogenic diet (with success for a strange neurological problem) who injured her leg and it is taking more than 3 months to heal. She is also post-menopausal, so I think it would be worth adding the vit k2 supplements, specifically.
Thanks again!
Hi Kriss,
Make sure she takes lots of vitamin C – to bowel tolerance one day, then 2 g/day thereafter – as on very low-carb diets this is a common deficiency. Bone cannot form unless collagen is cross-linked by vitamin C. She should take D and K2 and magnesium as well, but I would expect that C deficiency is the most likely cause on a ketogenic diet.
Hi Paul,
reporting from the front. I have started taking NAC (which comes with glutamine and cinnamon) increased the vit C to at least 2 grams per day, increased my potato consumption and the skin near to the inner corner of my eye where it was scaly and reddish has improved. I will continue hoping that my gum disease will at last start improving. (after taking vit K2, D, Mg for a while now)
Thank you.
Hi Simona,
That’s great!
For those following at home, simona’s history is here: http://perfecthealthdiet.com/?p=600&cpage=1#comment-3021
Unusual problem here: I have the Factor V Leiden gene (heterozygous) which makes me somewhat prone to blood clotting. I did have a deep vein thrombosis three years ago, due to being stupid on several fronts, but my doc took me off warfarin a year ago. Have any studies been done on the safety of supplementing K2 in the 5% of the population with this gene considering that vitamin K is a pro-clotting substance? And isn’t this something folks should be aware of when considering taking a K vitamin?
I do take estradiol in patch form (doc says oral HRT not a good idea but transdermal OK because the liver is less involved), so maybe I don’t need to supplement K2 given my ketogenic diet and numerous other supplements (B, C, D, E, magnesium, and EPA/DHA).
Hi Lacie,
Yes, it’s a concern, but it’s unclear how much a concern. In your case, with a genetic issue, more of a concern than for others.
Let me start by addressing the general issue. My brother has been on coumarin because of a stroke, so I have some personal experience thinking about this.
First, the K2 form, which is taken up throughout the body, is much safer than K1, which can be taken up only by the liver and is primarily used to make clotting factors.
Second, K2 is a source for anti-clotting factors as well as pro-clotting factors, so although it may speed up clotting time it’s not clear that it changes the probability of a clot. Studies of high-dose K2 supplementation in Japan have found no increased risk of clotting.
This is where your genetic issue comes into play. If K2 increases your clotting factors but, due to the Factor V mutation, the anti-clotting factors aren’t working as well, it might increase clotting risk. I would have to look into the pathways to evaluate this, which I haven’t done.
However, I would keep in mind in thinking about this that K2 is essential for health and life! So you definitely don’t want your intake to be zero.
My belief is (a) K2 should be supplemented in everyone, with the possible exception of people with genetic mutations like Factor V Leiden, (b) K2 dosage should be increased slowly in those at risk of clotting, to give the liver and body time to adapt. So, start with 100 mcg per day or less, and wait before increasing dose further.
Although estradiol helps make a little K2 go farther, it doesn’t substitute for it.
If you are afraid of supplemental K2, eat lots of pastured butter, cheese, liver, fermented vegetables, etc.
So, tricky situation, Lacie. If it were me I’d first try to understand the pathways to see if Factor V and activated protein C are factors that K2 promotes. Then, I’d probably self-experiment, have my doctor monitor clotting factors as I start 100 mcg K2 supplements and see what happens. But there are risks both ways, low K2 is risky too.
PS – I might add that K2 heals many conditions that cause clots, and K2 deficiency causes vascular injuries which are clotted as part of the healing process. So I feel strongly that in the long run, K2 deficiency is a much more likely cause of clots than K2 excess. However, the benefit is greatest from the first 50 mcg K2 (maybe 70%), next most from the second 50 mcg K2 (maybe 20%), then maybe another 10% benefit from going much higher. So you judge where the optimum lies.
Paul,
“fermented vegetables” <- which ones and in which form do you recommend?
Thanks!
Hi Winalot,
We eat some kimchi because my wife grew up in Korea.
But any fermented vegetables should work. I haven’t seen measurements of K2 content of different fermented foods, so I can’t really make recommendations. I would go by personal taste.
Hi Paul,
are some threads closed? I tried to post on a more relevant one but couldn’t see the ‘leave a reply’ window.
I understand that my situation is probably a good example of glucose deficiency on low carb diets due to chronic infection and that some people might learn from it. I wish there was another way to get answers without making my complaints public. Sometimes I think that I must be annoying or that the owner of the blog couldn’t care less, or not wanting to give private advice. Fortunately, you have been helpful and I am very grateful for your replies. One doesn’t know who to turn to when facing continuous health problems that invariably get overlooked or are not solved by the usual carers. I’ve totally lost my confidence in the medical establishment as it seems that finding a good doctor is like finding gold.
I’m writing again to ask what would be the best way to deal with a gum disease infection from your point of view? Would a ketogenic fast (36 hours) with CO and some cream, 2 grams omega 3 or more and some antibiotic to the area help? Or I need to get some carbs? I don’t know why this happened as I don’t get acute inflammation like this but I suppose I should focus on the how to deal with it first. I had a 16 hours fast yesterday and two normal meals that I could hardly chew and tried to apply some Chlorhexidine in the pockets.
I just called the hygienist and she said that sometimes after cleaning in deep pockets there is a subsequent infection. Hmm. She also said I should rinse with hot salty water a few times a day and if it gets worse I should go back so they can have a look and give me antibiotics, orally I suppose.
I don’t feel great after the CO and vit C this morning, a bit queasy.
Hi simona,
Yes, saline water works great. I had good success with that back in the days when I got gum infections (used to be frequent, no longer the case). Hold the salt water in your mouth for as long as you can. I would definitely start with that.
Good nutrition is important for immune function. You can add NAC to our supplement list, for glutathione support.
You can also use anti-biofilm techniques. Get some cranberries, chew them and hold them in your mouth as long as you can. You can also hold the coconut oil in your mouth, it has a mild antimicrobial action.
No, I wouldn’t recommend a ketogenic fast for gum infections. These are extracellular, biofilm based. Fasts promote autophagy, they’re good against internal infections, e.g. viruses. Some carbs should be helpful, but not sugars – starches only.
Queasiness is normal when taking coconut oil by itself, I get that too. If you mix it with food it will be comfortable. Mashing the coconut oil with sweet potatoes works well.
Good luck!
Simona:
I find even the smell of coconut distasteful and can’t imagine cooking with CO. Pouring it down my throat followed by a full glass of water in the morning was an ordeal, but now I switched to bedtime and that works much better. I brush my teeth (with a toothbrush dedicated to this task) immediately following the CO and then rinse with Listerine for quite a long time — no queasiness and no lingering oily taste.
You’re right about finding a good doctor. If anyone knows of a physician who’s willing to listen to patients in the Jacksonville – St Augustine – Daytona Beach area, I’d love to know his or her name.
Paul:
I’ve been using L-Lysine for a long time to combat sores in my mouth and tongue. I saw it mentioned in the “Ask the Doctor” column in the paper, tried it and found it works great.
Do you have any thoughts on my adding to your list of suggested supplements?
Hi erp,
That’s interesting about the lysine.
I don’t want to add disease treatments, or amino acids, to the supplement list. It could easily grow very long and be a turn-off to many people. But maybe we’ll try to come up with a log of supplements people have found helpful for various conditions. That would be a useful resource.
Paul, I didn’t mean for you to add to your list, but whether you thought it was okay for me to take it myself.
Oh! Sorry. Yes, it’s fine to take it. A benign supplement. I assume you’re taking less than 10 g/day which might induce diarrhea.
“Mashing the coconut oil with sweet potatoes works well.”
Great idea. What are your thoughts on coconut cream? It still contains, I believe, a good array of medium chained saturated fatty acids, of which lauric acid is the main component. Just like the oil.
The brand I have access to generates 91% of calories from fat (75% of those saturated) and provides only 5% of calories from CHO and 4% from proteins. Can this be substituted for ketogenic purposes by folks who find the oil nauseating?
Thanks as always.
Hi Poisonguy – Coconut cream / milk is great. You just have to eat more of it for the same dose of oils.
Erp,
I don’t think using Listerine is a good idea. It has alcohol, it is too acidic, it might disturb the balance of the oral flora. You might try green tea. See this f.ex.
http://www.webmd.com/balance/news/20030520/tea-fights-bad-breath-mouth-bacteria
I don’t mind eating CO after a meal. Yesterday I took it on its own and it seems Paul is right, it might cause queasiness. I drank more water and it went away.
I did a 24 hours fast yesterday with cream at lunch, I see now it’s not necessary. (I’m in Ireland so I had to take a decision on my own) After rinsing with hot saline water it’s better but not gone yet and was bleeding more when I cleaned my teeth last night.
Simona, Thanks for the tip, but I’m using Listerine to counteract the taste of the CO, not for oral health and I don’t know that green tea would do that.
I’ll switch to warm water and salt. That might do the trick.
Paul,
Thanks, I’m only taking 500 mg/daily of L-Lisine.
I received the results of my Dexascan and they were disappointing.
The deterioration in my spine has been halted
1/28/08 T score was -1.25, today it is -1.2
However my femur necks continue to decline.
1/28/08 T score was -1.5, today it is -1.7
It is not that I am not doing the weight bearing exercises as I can leg press 370 lbs. The only explanation I can come up with is that 4 years ago doctors beamed proton radiation through my hips to my prostate to cure my cancer. They warned me that it would cause temporary bone loss in my hips. Maybe it is not so temporary.
Since I do not do dairy, I plan to up my calcium supplementation from 400 mg to 800. And increase my magnesium from 400 mg to 800.
Hi Jake,
Hmmm … So is the only osteopenia near the hips? Are your arm bones good?
I would assume that the trouble with the proton radiation is dead osteoclasts/osteoblasts, maybe bone marrow. Perhaps a stem cell therapy might be helpful? (Not that those are available.) Can they do small-quantity bone marrow transplants with needles?
This is way outside my expertise. I would be curious to hear what your doctors tell you.
The one thing I would suggest now is supplements to promote osteoblast proliferation. These would include:
– vitamin B12, 5,000 mcg/day
– vitamin C, see http://www.ncbi.nlm.nih.gov/pubmed/15777530
– vitamin A
I don’t think anyone has the answers on the radiation problem. Since I am 68, all I have to do is stop the deterioration or just slow it down. In the meantime my bones are protected by a lot of muscle.
I will do everything you suggested-thanks. In the meantime I will wait for the next test in two years and hope for the best.
Hi Jake,
Be careful about the A, it has risks for bone degradation. A short-term trial of that, much less than 2 years, would be better.
Vitamin C is safe, and vitamin B12 is non-toxic but it makes things grow — your hair, your nails will grow faster. I don’t routinely recommend it because it can make cancer grow too. Hopefully it will make your bones grow.
Be aware of the risks and judge potential benefit vs risk in light of your experience.
I am loving your blog and I am devouring your posts. I did want to comment on “Shaken Baby Syndrome.” I am an OB RN, and my wife works as an RN in a peds ICU that gets all the shaken babies in our state (b/c of the peds neurologists there. This is about physical abuse, surprisingly often premeditated. “You cheat on me, I’ll destroy our child” is a reasoning we have heard more than once. So I got a cold chill when I read about it in the context of diet… Now the argument that adults are more likely to abuse their children because their brain chemistry is off, that does make sense to me…
Pinon
Hello,
In addition to my myriad of stomach issues, I also have osteoporosis and enjoying these blog posts. I was wondering about supplementing with Vitamin K2–is it safe to take Nattokkinase 2000 FU (Natto Max-Jarrow) supplements with a leaky gut/yeast issues? I’ve tried it and felt like it had good effect on my digestion yet as always have lots of concerns about making things worse…
Thanks,
Devi
Hi Devi,
I think nattokinase is safe in low doses but I would definitely take vitamins K2 and C with it, the danger is bleeding. Any benefits will be in the gut.
Best, Paul
In regards to vitamin C: Is Ester C more effective than ascorbic acid….less or doesn’t matter?
I’ve heard good things about taking Strontium for bone repair. Have you considered it?
I’m keeping this brief since I don’t know if you still answer this thread.
thank you
Hi rhc,
C: I think they’re the same.
Yes, I think the case for strontium makes sense and it’s likely to help, but it’s a bit esoteric and with insufficient data to judge optimal dose or toxicity we can’t really recommend it.
We’ll answer any thread that’s open.
Best, Paul
I know this is an older post, but I have been looking into injury healing for the past few days. On Monday, I woke up with terrible back pain and it got worse and worse. I finally went to a chiropractor yesterday, because it felt like my back needed to “pop.” He said I have some serious inflammation from misalignment going on.
Aside from the nutrients listed, do you have any suggestions on ANTIinflammatory foods to reduce the tension? The chiro is doing small adjustments each day, and every time the radius of the pain gets a little smaller (although the overall QUANTITY of pain is still the same). I already avoid inflammatory foods, but am wondering if you know of anything that actually reduces inflammation. I’d really like to speed up this healing.
Hi Becky,
Niacinamide and vitamin C are often suggested for wound healing. Also gelatin or other collagen sources, like bone broth soups.
We don’t recommend niacin for routine supplementation, as it feeds bacteria, but for temporary wound healing it’s not a problem. Try 300 mg/day niacinamide (not niacin) to see if there’s an effect. If you feel worse, discontinue it.
B-complex vitamins may also help. Zinc and copper are probably more important than usual. N-acetylcysteine helps a lot of wound healing conditions.
Get well soon!
Best, Paul
No wound healing discussion is complete with out zinc. Heck, that could be an entire post on it’s own. 🙂
Paul, as skeptical as I was at first regarding your stance on starches, I have to say that I absolutely love your blog. You’ve enriched my perspective in more ways than I’d have expected from a blog focused on nutrition. A heartfelt thanks to both you and Sou-Ching.
Thanks, Katherine!