New Guidelines Emphasize Nutrition for Foot Ulcer Healing

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New Guidelines Emphasize Nutrition for Foot Ulcer Healing

New guidelines from the American Limb Preservation Society emphasize the role of nutrition in the healing of foot ulcers in people with diabetes — including the importance of getting enough total calories, water, protein, and micronutrients like vitamin C.

Diabetic foot ulcers — wounds on the feet that don’t heal properly — are a common complication of diabetes, and can lead to severe complications if steps aren’t taken to make sure that they heal. Potential complications include infection, which can require amputation of toes, a foot, or a leg if it grows widespread enough. The last couple of years have seen some advances in care for foot ulcers, including a new topical drug shown to be much more effective for healing than the standard treatment of absorbent dressings. A stem cell-based therapy has also been shown to help persistent foot ulcers heal and potentially prevent amputations.

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Nutrition for foot ulcer healing

The latest guidelines, though, focus not an any cutting-edge treatments, but on how your diet can affect wound healing — for the better or for the worse. In addition to blood glucose control and physical activity, nutrition is an area where people with diabetic foot ulcers can take steps on their own to help promote healing and avoid serious complications. The guidelines note that foot ulcers in people with diabetes tend to be linked to diabetic peripheral neuropathy (nerve damage in the limbs due to high glucose exposure) and peripheral arterial disease (PAD, restricted blood flow to the limbs). A many as 34% of people with diabetes are expected to develop a foot ulcer at some point in time, and about 15% to 25% of foot ulcers in people with diabetes end up requiring amputation.

At the same time, the report notes that as many as half of people with diabetic foot ulcers experience moderate to severe malnutrition — and that malnutrition is tied to a higher risk for amputation in people with foot ulcers. This means that nutrition interventions could potentially dramatically reduce the risk for amputation, although a lack of rigorous studies on this subject — or even any standard definition of malnutrition — means that it would be difficult to create widely followed recommendations on screening for and treating nutrition deficiencies in people with foot ulcers.

The guidelines note a few important nutritional factors in wound healing, though — while encouraging health care providers to create a specific plan to address each person’s nutritional deficiencies. The three most important steps, according to the guidelines, are making sure that people get enough total calories, protein, and fluids. When it comes to total calories, people should consume at least 30-35 calories per kilogram of body weight each day. That means someone who weighs 150 pounds (68 kilograms) should consume at least 2,040-2,380 calories each day. For protein, the recommendation is 1.25-1.5 grams per kilogram of body weight each day, or 85-102 grams for someone who weighs 150 pounds. For fluid intake, the recommendation is at least 1 milliliter each day for every calorie consumed — so if you consume 2,040-2,380 calories, that means drinking at least 8.5-9.9 cups of fluids.

Other important nutritional factors for ulcer healing, the guidelines note, include consuming more healthy unsaturated fats and less saturated fat, consuming less than 3,400 milligrams of sodium each day, and consuming nutrient-dense foods. If needed, people can take oral nutritional supplements — such as vitamin pills or prepared shakes or drinks — to ensure an adequate intake of any dietary component they may be missing.

While monitoring and working to address any nutritional deficiencies in people with foot ulcers takes time and money, the guidelines note that these costs are likely to be far lower than for advanced treatment options or amputations. If future studies show that nutrition interventions can help prevent amputations, insurance providers may take a more proactive role in promoting and paying for them.

Want to learn more about foot ulcers? Read “Diabetic Foot Ulcers: What Are They and How Can You Avoid Them?”

Quinn Phillips

Quinn Phillips

Quinn Phillips on social media

A freelance health writer and editor based in Wisconsin, Phillips has a degree from Harvard University. He is a former Editorial Assistant for Diabetes Self-Management and has years of experience covering diabetes and related health conditions. Phillips writes on a variety of topics, but is especially interested in the intersection of health and public policy.

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