Innumerable processes are involved in healing—from the production of platelets and macrophages to the rebuilding of extracellular matrix and the formation of new blood vessels. But these healing processes can’t happen if the body doesn’t have the right vitamins and nutrients. Unfortunately, many Americans (the elderly in particular) fail to receive the appropriate amounts of vitamins and minerals from their diet. Consequently, their ability to heal suffers.
To maintain normal health, the human body needs a minimum of 20 vitamins and 16 minerals/trace elements. The following 10 play a role in recovery and healing at various physiological levels—from the skin and bones all the way down to cell membranes and energy metabolism. These vitamins and minerals are usually obtained from a healthy diet, but are also found in various over-the-counter multivitamins and supplements. They may benefit those who are deficient in these compounds and are healing from skin wounds or internal injuries—such as those often sustained during surgery, childbirth, contact sports, and motor vehicle accidents.
Calcium represents about 99% of the body’s total mineral content. It is a cofactor and regulator of the skin and other soft tissues. Calcium gradients in the epidermis modulate basal cell proliferation. Following skin injury, calcium concentrations in the epidermis increase and are maintained through the duration of wound healing. Calcium ions in exudates help with hemostasis.
The trace element copper is found in all living cells, and is a cofactor in various enzyme systems, such as cross-linking reactions that strengthen scars. Increased concentration of copper and zinc are related to improved wound elasticity and resistance.
Iron plays pivotal roles in oxygen transport, formation of hemoglobin, break-down of free radicals, oxidation-reduction processes, hydroxylation of collagen precursors, and mitochondrial respiration. Iron deficiency compromises wound healing via hypoxia and decreased bactericidal effects of leukocytes. For these reasons, iron supplementation is especially recommended for patients with pressure ulcers.
Selenium is an important component of glutathione peroxidase. As such, it is a free radical scavenger that protects biologic membranes. Inadequate levels of selenium have been associated with immunosuppression.
A minimum of 70 major wound-healing enzyme systems—including DNA polymerase, RNA polymerase, protease, and carbonic anhydrase—rely on zinc as a cofactor. Zinc is also important in cell membrane stabilization, carbohydrate metabolism, and mobilization of vitamins A and C, among others. Because lower zinc levels have been associated with impaired wound healing, some researchers have suggested that zinc replenishment may increase healing rates. Furthermore, many topical agents include zinc due to its antiseptic and anti-inflammatory properties, which may be especially beneficial for skin wounds.
Vitamin A is a fat-soluble essential micronutrient that is found naturally in carotenoids, or plant pigments. It is necessary for epidermal proliferation and reepithelialization via the binding of retinol (ie, the active form of vitamin A) to cell surface receptors. Vitamin A can reverse the inhibition of wound healing caused by corticosteroids, and it plays an integral role in the inflammatory phase of wound healing.
Vitamin A also moderates prostaglandin production, glycoprotein/glycolipid synthesis, and cell membrane metabolism. Furthermore, it blocks collagenase, thus promoting dermal proliferation.
Vitamin B complex
The vitamin B complex comprises all essential water-soluble vitamins, with the exception of vitamin C, and includes:thiamine (vitamin B1), riboflavin (vitamin B2), niacin (vitamin B3), pantothenic acid (vitamin B5), pyridoxine (vitamin B6), biotin, folic acid, and the cobalamins (vitamin B12). These B vitamins are found naturally in beer (brewer’s yeast), cereals, dairy, fish, and meats.
The vitamin B complex aids with cell proliferation and the maintenance of muscle tone and healthy skin. It also increases metabolic rate and improves the function of the immune and nervous systems..
In one study of the effects of vitamin B complex on periodontal wound healing, supplementation with vitamin B complex significantly increased wound repair compared with placebo.
As with the B complex vitamins, vitamin C is an essential water-soluble vitamin. It is an electron donor for various enzymes, a mighty antioxidant, and a cofactor in collagen synthesis. Vitamin C contributes to enzyme processes important in lysine and proline hydroxylation necessary for the formation of the triple helix present in collagen.
It also contributes to enzyme processes necessary for carnitine synthesis, which is required to transport fatty acids into mitochondria that are used in ATP generation. Vitamin C also plays a role in immune response, iron uptake and metabolism, trace metal metabolism, and calcium metabolism for the homeostasis of epidermal gradients.
Smokers, in particular, often present with more wounds and depleted vitamin C levels compared with non-smokers. Thus, vitamin C supplementation (along with smoking cessation) may increase these deficient levels and improve wound healing.
Vitamin D is a fat-soluble vitamin. Although it is largely generated from skin exposure to sunlight, it can also be found in eggs, fatty fish, beef liver, mushrooms, and fortified foods. Vitamin D contributes to calcium absorption and metabolism by inhibiting calcitonin and parathyroid hormone, which play important roles in bone/cartilage remodeling, immune function, and neuromuscular function.
Vitamin K represents a collection of fat-soluble vitamins that are found naturally in plant-sourced foods—particularly dark, leafy greens—as well as eggs and dairy. Vitamin K is necessary in the modification of proteins required for coagulation and bone metabolism. Consequently, it plays an important role in the hemostasis of wound healing.
Of note, people taking anticoagulants should ensure they get enough vitamin K. “Prothrombin (clotting factor II) is a vitamin K-dependent protein in plasma that is directly involved in blood clotting. Warfarin (Coumadin®) and some anticoagulants used primarily in Europe antagonize the activity of vitamin K and, in turn, prothrombin. For this reason, individuals who are taking these anticoagulants need to maintain consistent vitamin K intakes,” notes the NIH.
A word to the wise
Finally, one important word of caution: Although excess levels of water-soluble vitamins (vitamin B complex and vitamin C) are excreted via the kidney, excess levels of fat-soluble vitamins (vitamins A, D, E, and K) can be toxic.
For health professionals, the NIH offers a comprehensive database of recommended intakes and other important data on micronutrients. Supplementation beyond these intakes is not recommended.