If we lived ideal lifestyles in a perfect world, none of us would need supplements, and in fact our goal is to get you to the place where you do not need them. However, if you have a non-healing wound, we are certain you need some extra help, and that is where dietary supplementation can be important.
As opposed to pharmaceuticals (medications), which are often patented, specialized synthetic compounds (although some are derived from natural sources), supplements are generally purified natural substances that can usually be bought over-the-counter (OTC). There are various types of supplements including necessary co-factors like vitamins and minerals, metabolic substrates for biochemical reactions, medicinal substances derived from plants, and hormones (such as vitamin D, DHEA, and adrenal extracts, previously discussed). While there are dozens (hundreds?) that have been described and found to have value, we will focus on the ones we have found to be the most helpful for our patients with non-healing wounds.
Purchase only top-quality, pharmaceutical grade supplements directly from reputable suppliers or manufacturers (we trust Pharmanex, Orthomolecular, Metagenics, Pure Encapsulations, and Douglas Labs, among others). In addition, we have created our own special line of supplements designed specifically to help with wound healing. Many supplements purchased in retail stores are counterfeit or have been improperly stored (this can be particularly true with bargain online sources). This may contribute to a lack of potency and efficacy, so if you are not sure what you are getting or cannot get the best ones, don’t bother.
Almost all supplements should be taken with food. We are designed to absorb many of these substances from what we eat, and so it is important that they are absorbed along with many of the other beneficial substances that come in our (hopefully very high quality) diet. Your body was not designed/evolved to take just a single substance at a time in a capsule. Notable exceptions are certain medications and hormones.
DHA—Docosahexaenoic Acid—An Omega-3 Fatty Acid
We discussed DHA previously in the nutrition chapter. The usual source is fish oil. By far, the best source of DHA is wild caught seafood, followed by grass fed meats and wild game. If you are a vegetarian or vegan (a bad idea—get checked for iron-deficiency anemia, B12 deficiency, and have an omega-3 /omega-6 fatty acid ratio test, among others . . .), alphalinolenic acid (found in flax and chia seeds) can be somewhat helpful as a small percentage of it can be converted to DHA in your body—not enough though.
Many studies have correlated high tissue DHA levels with general health, along with decreased cardiovascular and neurodegenerative disease. However, like vitamin D and sunshine, supplementing with fish oil alone has not shown the same results. The literature on fish oil is somewhat contradictory regarding wound healing; it has potent anti-inflammatory properties and can slow the healing of acute wounds; however, all chronic wounds are stuck in an inflammatory phase and it can help move them through it. If you have a non-healing wound (and accompanying chronic illness), we suggest you supplement with quality, mercury-free fish oil. Take at least two grams a day, with meals. Refrigerate or freeze it to decrease problematic oxidation. Most importantly, eat more seafood.
Vitamins and Minerals
Although many studies have questioned the value of multivitamins, our unqualified answer for those with non-healing wounds is yes. A pharmaceutical grade and complete multivitamin provides many of the cofactors necessary for critical chemical reactions in your body.
An optimal multivitamin is not going to be a single tablet, capsule, soft chew, or “gummy chew.” You will need a combination of several capsules with doses well above the US Recommended Daily Amount (RDA—the minimum to keep you alive and without deficiency diseases—not enough to restore your health).
Some of the most important micronutrients implicated in wound healing and worth additional supplementation:
- Zinc is required by over three hundred different enzymes for a variety of functions including DNA synthesis, cell division, protein synthesis, and collagen formation. Most good quality multivitamins will include an adequate amount of zinc. High dose oral zinc sulfate, 220 mg, three times a day, may speed healing time for some wounds by up to 43 percent.
- Vitamin C (ascorbic acid) deficiency famously causes scurvy, a deficiency disease in which connective tissue is weakened because of vitamin C’s importance in collagen formation. Collagen is essential scaffolding for most tissues and thus necessary for wound healing. Humans lack the ability to store vitamin C, so having an adequate dietary amount is important. It is also an important antioxidant that counteracts the potentially harmful reactive oxygen species found in wounds. Suggested dose of vitamin C is 2,000 mg per day until your wound is healed, then 1,000 mg per day thereafter.
- Vitamin A enhances the early inflammatory phase of wound healing. It is required for epithelial (skin) tissue differentiation and immune system function. It improves collagen cross-linking and wound breaking strength. Because vitamin A is fat soluble it is (rarely) possible to build up to toxic levels with prolonged mega-dosing. Safe dosing is 25,000 IU per day for three months to facilitate wound healing.
Approximately 40 percent of the general population, including most of our wound patients, has a mutation in genes coding for enzymes for “methylation.” Methylation is critical to a variety of processes including activating and deactivating hormones, neurotransmitters, and gene transcription. It is also necessary for detoxifying some substances.
Those with methylation defects benefit from methylated B vitamins including methylcobalamin (B12), methyltetrahydrofolate (B6), and tri-methyl glycine (TMG, also known as betaine). These are usually sold in combination “methylation supplements.” Ask your doctor about being tested for methylation defects. If you have not been (or cannot be) tested and are not sure if you have a methylation defect, you should take a methylation supplement at least until your wound heals. When possible, get tested and if you do have a methylation problem, then you should plan on taking a methylation supplement for life. This makes a huge difference in your current and future health and decreases your risk for numerous problems including migraines, allergies, asthma, cardiovascular disease, cancer, and others.
The Mitochondrial Prescription
Mitochondria are tiny organelles in your cells that are essentially power plants. Without the right mitochondrial substrates, you cannot heal. One of the primary functions of mitochondria is to produce adenosine triphosphate (ATP), known as the energy currency of the cell. A cell with abundant ATP and energy is healthy and vital, but a cell without energy is … dead! Effective mitochondrial function is at the root of all health.
The following supplements, taken together, constitute a “mitochondrial prescription” and are important for at least a six-month period if you have a chronic wound.
- Magnesium has three different magnesium formulations. Magnesium threonate (2,000 mg twice per day) is most helpful to the brain and spinal cord. Magnesium maleate (1,250 mg twice per day) is preferred by skeletal muscles, and magnesium orotate (300-500 mg twice per day) is best for cardiac muscle. Magnesium is critical for optimal mitochondrial function. Magnesium deficiency is widespread, especially in diabetics. It also plays an important role in sugar metabolism. High magnesium diets and supplementation significantly decrease the risks of developing type 2 diabetes. Magnesium supplementation is safe unless you have end stage renal disease and are on dialysis. If so, discuss with your physician.
- Taurine is naturally found in seafood and meat, and it helps maintain the pH gradient across the mitochondrial membrane. Take 2,000 mg per day. Vegans/ vegetarians are particularly likely to have taurine deficiency.
- D-ribose is a five-carbon sugar that serves as a (recyclable) building block of ATP. D-ribose is important for cellular energy production and is particularly helpful in heart failure. Take fifteen grams (yes, grams not milligrams) of D-ribose per day. Don’t worry about the “sugar” content; it is not metabolized the same as dietary sugars like glucose and fructose and will not affect your blood sugar (glucose) levels.
- Co-Q10 (coenzyme-Q10) is necessary for mitochondrial energy production and a critical part of electron chain transport. Of the available formulations, the “ubiquinol” form is preferred over “ubiquinone.” Take 300 mg per day.
- Acetyl L-carnitine transfers carbon fragments from long-chain fatty acids across the inner mitochondrial membrane. L-carnitine improves lipid profiles by lowering LDL and raising HDL cholesterol, and the acetyl variety gets into the central nervous system. It is found in meats and seafood. Vegans, vegetarians, and those with kidney disease, B-vitamin deficiencies, and iron deficiency anemia are usually very deficient in L-carnitine. Acetyl L-carnitine promotes fatty acid metabolism in the hypoxic cellular environment typical of chronic wounds. Take 1,000 mg three times a day.
Proteins are made of chains of amino acids. Although we have discussed the importance of adequate protein intake (from whole food) for wound healing, sometimes specific amino acid supplementation for wounds can be very helpful.
- Glutamine. L-glutamine has been shown to be beneficial for both surgical and chronic wound healing. Ten grams a day is the suggested dose if you suffer from a chronic wound. It is prescribed to help heal “leaky gut” syndrome; it is quite effective at healing the intestinal lining.
- Arginine. L-arginine is important for nitric oxide synthesis in the body. Nitric oxide is an important vasodilator and stimulator of angiogenesis. It lowers blood pressure, improves tissue oxygenation, and helps heal wounds. The dose is five grams twice per day. If you have a history of herpes or shingles, it should be taken combined with two grams per day of L-lysine (another amino acid), which decreases the risk of an outbreak.
Other Valuable Supplements
Scientific studies are beginning to validate the efficacy and explore mechanisms of action for these botanical medicines.
- Curcumin is the active ingredient of turmeric, the main spice in curry dishes. There are over six thousand publications detailing beneficial effects. It is anti-inflammatory, anti-coagulant, anti-depressant, anti-cancer, and analgesic. It reverses insulin resistance, lowers blood sugar, and improves lipids. If you are going to take just one medicinal herb, this is it. We suggest using copious quantities in cooking and making turmeric tea. A small amount of black pepper increases the bioavailability. Suggested dose as a supplement is 2,000 mg per day.
- Boswellia is a potent anti-inflammatory used in traditional Ayurvedic medicine and promotes angiogenesis, the formation of new blood vessels, which is critical to wound healing. Supplement dose of 300 mg of the standardized extract two to three times per day.
- Devil’s claw is an anti-inflammatory derived from a South African fruit, which has been shown to reduce the pain and inflammation of arthritis and has potent wound healing effects, both applied topically and taken internally. Supplement dose of 200–2,500 mg per day.
- Berberine is an alkaloid derived from a variety of plant sources (including goldenseal, Oregon grape, and barberry) that has been used in traditional medicine for hundreds of years. It improves immune function, glucose metabolism, insulin sensitivity, lipid metabolism, gastrointestinal function, and overall health. It is very beneficial to the cardiovascular system and has been shown to be as effective as the pharmaceutical metformin at decreasing blood sugar in diabetics. Additionally, it has been shown to have beneficial effects on wound healing. Take 500 mg two to three times per day.
- Olive leaf extract (oleopein) has been extensively studied and found to have anti-inflammatory, anti-infective and anti-neoplastic (anti-cancer) properties in addition to beneficial cardiovascular effects such as lowering blood pressure and improving arterial health. It is also a particularly effective natural broad-spectrum antibiotic that destroys both bacteria and viruses—great for helping infected wounds. Dose is 500 mg per day.
- Bromelains are a family of enzymes derived from the pineapple plant. Bromelain reduces edema, bruising, pain, and healing times following injuries and surgical procedures, and in chronic wounds. Bromelain has significant anti-inflammatory activity and increases the re-absorption of hematomas (collections of blood under the skin). Dose is 800–1,000 mg twice per day.
- Alpha lipoic acid is an important antioxidant that plays a significant role in glucose control. Taking 600 mg twice a day, an hour prior to eating, will be helpful for both wound healing and diabetes.
- Chlorella are algae from Japan and Taiwan which have numerous benefits including detoxifying heavy metals, improving immune function, decreasing blood sugar, and increasing cellular growth rates, which are a major factor in the natural repair of wounds. Chlorella helps heal ulcers and promotes bone and muscle growth. Buy “cracked cell wall” chlorella and take five to ten grams per day.
- Gotu kola (centella asiatica) has been used as a natural medicine for the treatment of scars and wounds across Asia for many centuries. Topical creams for your wounds are available. The oral dose is 250–500 mg three times per day.
- Aloe vera has been used for centuries, both topically and internally, to enhance wound repair (and a multitude of skin conditions).
As you have seen, there are many supplements that have been shown to be helpful in wound healing. We have given you a list of more than a dozen possibilities here—so where should you start? You could potentially take all of them at once but that is a lot of capsules or pills to take daily, which is a huge nuisance, and frankly gets very expensive.
Here’s how we recommend sequencing things:
- Make as many of the lifestyle changes as you can to optimize vitamin D and DHA. Have your vitamin D levels measured and supplement as needed. Commit to taking an excellent quality fish oil for at least a year or until your wound is healed. Of course, eat well, too.
- Take a good quality multivitamin as described earlier and a methylation supplement unless you are certain you do not have a methylation defect.
- Follow the “mitochondrial prescription” for at least six months.
- Choose two of the remaining compounds listed and take for at least three months. Rotate and choose another two and keep doing that.
- Look for combination products that contain more than one of the ingredients listed; for example, there is an excellent anti-inflammatory product available which contains turmeric, devil’s claw, and Boswellia in appropriate doses.
The goal with appropriate lifestyle changes is to eventually get you off all but a few supplements (multivitamin and maybe a methylation supplement). However, in the short term it may be necessary to aggressively use supplements to heal your wound and regain your health.
Finally, there is a lot of fraud and poor products being sold in the supplement markets. If you are not getting some effects from your supplements, you either have some serious digestion and malabsorption issues or you are taking a poor-quality product. Make sure to buy pharmaceutical grade supplements from reputable suppliers, consider seeing an appropriate functional medicine physician for gut healing, and follow some of our prior guidelines to get your digestive tract working as optimally as possible.