Good nutrition, plenty of sleep, and lots of the right kinds of liquids are prime ingredients for good health.
Pressure ulcers, also known as “bed sores” or “decubitus ulcers,” are an all-too-common health concern for wheelchair users. Anyone who does not regularly change positions is at risk for developing them. They usually form in areas where bones are close to the skin, such as the back, hips, ankles, elbows, and heels.
Wheelchair users should routinely check for evidence of developing pressure ulcers, as there is usually no pain to indicate one may be occurring. If you suspect you have one or are getting one, it is extremely important to see a doctor immediately. If left untreated, it can worsen and become infected, which can be life-threatening.
The Power of Nutrition
If you have a pressure ulcer, proper nutrition is a key to treatment and can help lead to a quicker recovery. Following are several key nutrients important for wound healing.
Protein
Protein is necessary for building and repairing tissues. The Recommended Daily Allowance (RDA) is 0.8 gm/kg times body weight, but more is needed for wound healing. If you have a pressure ulcer, research shows that approximately 1.5–3gm/kg is more appropriate, depending upon the wound’s severity. Insufficient protein intake inhibits collagen and fibroblast production, impairing healing. However, taking in too much increases protein synthesis, which puts a burden on the kidneys and liver and can lead to dehydration.
The best food sources for protein include meat, poultry, and fish; dairy products (milk, cheese, yogurt); and eggs. Others are tofu, soy, whole grains, rice, corn, beans, legumes, oatmeal, peas, and peanut butter. For vegetarians, vegans, and/or those who do not eat meat, fish, eggs, or dairy products, it is important to eat a variety of other foods to get enough protein.
Vitamin A
This fat-soluble vitamin stored in the liver helps in the early inflammatory phase of wound healing and the formation of scar tissue. It helps to speed healing. High doses of vitamin A, however, especially when taken in supplement form, can be toxic. The RDA for vitamin A in adults is 5,000 IU.
The best food sources of vitamin A include carrots, liver, sweet potatoes, red peppers, kale, collard greens, swiss chard, and turnips.
Vitamin C
Vitamin C plays an important role by supporting collagen synthesis. Collagen helps to strengthen wounds and therefore leads to quicker recovery. Vitamin C is water soluble so the body cannot store it. Therefore, it is unlikely that high doses will lead to toxicity. The RDA for vitamin C is 60mg in adults; excessive amounts can lead to gastrointestinal distress.
The best food sources of vitamin C include citrus fruits and juices, cantaloupe, kiwi, strawberries, papaya, tomatoes and tomato products, potatoes, and dark green vegetables.
Zinc
This mineral aids in healing by supporting the development of collagen and helping to synthesize protein. A deficiency can lead to abnormalities in white blood cell function, which increases the risk of infection. Too much zinc, however, can hinder wound healing and cause nausea. The RDA for zinc is 15mg/day.
The best food sources for zinc include beef and lamb, organ meats (such as liver), peanuts and peanut butter, and legumes.
Fluids
It is important to keep your body well hydrated to promote good skin turgor (degree of resistance to deformation), which is essential for preventing skin breakdown. Dehydration is one of the risk factors for developing pressure ulcers. In general, approximately eight eight-ounce glasses of fluid per day are necessary for proper hydration. Less may be required for people with fluid restrictions. More may be needed for very active individuals. The best choices for fluid are water and juices, as beverages that contain caffeine can lead to dehydration (see “The Power of Liquids”).
Remember, while nutrition can aid in wound healing, it is not a substitute for medical treatment. You never want to self-diagnose or self-treat if you have or are developing a pressure ulcer. Always seek medical advice first. Ask your doctor before taking any vitamin or mineral supplements.
The Power of Liquids
Water is one of the most essential components of the human body, yet many people do not understand the importance of being well-hydrated or how much water we can lose during the day.
Water regulates the body’s temperature, cushions and protects vital organs, and aids in digestion. It also acts within each cell to transport nutrients and dispel waste. Water comprises 75% of all muscle tissue and 25% of fatty tissue; it is impossible to sustain life for more than a week without it.
In one hour of exercise, the body can lose more than a quart of water, depending on intensity and air temperature. It is extremely important to pay attention to your body before, during, and after exercise, as dehydration can have negative effects on your health.
In a dehydrated state, the body is unable to cool itself, leading to heat exhaustion and possibly heat stroke. For people with SCI, staying well-hydrated is especially important in order to help regulate body temperature, keep skin in good condition, and maintain proper kidney function.
For regular exercisers, maintaining a constant supply of water in the body is essential to performance. Dehydration leads to muscle fatigue and loss of coordination. To prevent dehydration, you must drink before, during, and after a workout. As a general rule during exercise, drink a half cup of fluid for every 15 minutes of exercise.
Water vs. Sports Drinks
As a general rule water is the best choice for exercise that lasts less than one hour. Sports drinks (like Gatorade®) are most appropriate for workouts of more than an hour. If your energy is low, a sports drink can provide you with added endurance and stamina.
Sports drinks and juices do help keep you hydrated, but they contain excess calories. If you’re watching your weight, be aware of the calories many of these contain.
Bottled vs. Tap
Bottled water is not necessarily cleaner or safer than most tap water. Although some people prefer the taste, bottled is more expensive than what comes from the tap. Also, bottled typically does not contain fluoride, which promotes strong teeth and prevents tooth decay.
Tap water is safe for human and animal consumption, unless it’s labeled non-potable. It contains fluoride, and it’s free! If you don’t mind drinking tap water and want to repeatedly use a water container, sports bottles made of heavier plastic that have wider mouths can be washed and re-used, which helps the environment.
What About Caffeine?
Drinks with caffeine do not help keep you hydrated. In fact, they cause you to lose water and become dehydrated. Caffeine is a diuretic, meaning it elevates the rate of urination, causing water loss. If you drink caffeinated beverages, also increase your water intake. Caffeine is in coffee, tea, colas, and some other soft drinks.
Not all your fluid intake has to come from pure water. Other suitable choices for hydration include fruits, juices, soups, and vegetables.
Water, however, is still the best choice for getting and staying well-hydrated. It is important to drink even before signs of thirst appear. Thirst is a signal that your body is already on the way to dehydration.
The Power of Sleep
In the fast-paced world in which we live, we keep ourselves busy from morning to night. Some people sacrifice sleep for work and other obligations. With the many products all around us aimed at increasing alertness, it can be tempting to depend on that coffee or energy drink to get you through the day.
Other people try to get adequate rest but are plagued with sleep problems and disturbances. Sleep disorders are a common secondary condition for many people with disabilities. There are many reasons for having trouble sleeping, including leg spasms, pain, immobility, medications, depression, anxiety, and frequent urination.
Regardless of the cause, interrupted or inadequate sleep over time can have detrimental effects, including less energy, decreased reaction time, impaired judgment, lack of motivation and patience, and impaired memory. Conversely, the proper amount of sleep can increase energy levels, boost concentration, improve mood, enhance the immune system, and increase motivation.
Dietary Differences
Many dietary factors can make a difference when it comes to sleep patterns. Following are some things to avoid.
Caffeine is a stimulant, which means it can help keep us awake and alert. While some people are more affected by caffeine than others, it is a good idea to avoid it late in the day. Items high in caffeine include coffee, soda, many energy drinks, and chocolate.
Alcohol can also interfere with sleep. While it is a relaxant and may initially help us fall asleep, it will not promote a good night’s sleep. It affects sleep patterns by interfering with the monoamine neurotransmitters, which control the body’s ability to sleep deeply and peacefully. Research has shown that even a small amount of alcohol can disrupt the second half of a person’s sleep cycle, leading to waking in the middle of the night and an inability to fall back to sleep.
Avoid spicy foods just before bed because they can interfere with sleep by causing heartburn and indigestion. Some research has also noted that when we eat a spicy meal, body temperature rises, which can also account for a poorer quality of sleep.
Especially for people who have issues with frequent urination, drinking liquids too close to bedtime can significantly exacerbate this problem. To promote better sleep, limit liquids at least 90 minutes before bed. If you take medications with water just before bed, try to take them one to two hours earlier.
If you go to bed hungry, you will inevitably wake up in the middle of the night. While you should avoid large amounts of food right before bed, it’s a good idea to have a light snack. Avoid foods high in sugar, as these will cause excitability and can interfere with sleep. Also, foods high in fat take longer to digest and can affect sleep quality. Good bedtime snack choices are a small bowl of cereal with milk, yogurt, or crackers with low-fat cheese.
Tryptophan has long been known as something that helps us sleep. It has also been linked to the reason why we feel tired after a Thanksgiving dinner full of turkey. It is an essential amino acid, meaning the body cannot manufacture it. The body has to get tryptophan and other essential amino acids from food.
Tryptophan helps the body produce niacin (vitamin B3), which, in turn, helps the body produce serotonin, a calming agent in the brain that plays a key role in sleep. Research, however, is not completely clear. There is some evidence that the effects of tryptophan can only be seen on an empty stomach. Food sources of tryptophan include turkey, red meat, dairy products, nuts, seeds, bananas, soybeans and soy products, tuna, and shellfish. The tolerable upper limit for tryptophan is 300–600mg in humans. Avoid supplements, as there is inconclusive evidence on the side effects of too much tryptophan.
Increased Activity Level
In addition to nutrition, regular physical activity has been shown to lead to better, higher-quality sleep. While exercise is an important part of a healthy lifestyle, avoid it close to bedtime. It can hinder sleep by making us more alert and increasing our body temperature.
It’s important to remember that what you eat affects not only your weight and general health but also how well you sleep and your energy level throughout the day. Some foods improve sleep, while others can make it difficult or even impossible. While certain nutrition factors can improve sleep, they cannot cure problems. Talk to your doctor if you experience sleep disturbances on a regular basis.
SOURCES
Leininger SM. “How to Help Wounds Heal.” RN. 2004; 67:26.
Fleishman A. Adult Wound Care: “Management of Pressure Ulcers. 2005.” Today’s Dietitian. 7:38.
