Most people overestimate their health and overlook how critical nutrition is for surgical recovery.

Surgery puts significant stress on the body, increasing its nutritional demands. Optimizing your nutrition before surgery can help improve healing and reduce complications.

The data is clear:

• Nearly 50% of patients undergoing elective (planned) surgery have a nutritional deficiency.
• That number jumps to 90% for those having bariatric (stomach) surgery.
• Even 67% of young athletes (ages 8-18) show risk factors for poor nutrition.

Broadly speaking, nutrition optimization (the core being protein supplementation and a pre-surgical carbohydrate drink) has been shown to improve speed of recovery, reduce complications, lower pain, and lower length of hospital stay. Conversely, studies do not find a detriment to protein supplementation or a carbohydrate drink. Even people with diabetes have been shown to benefit from a pre-surgical carbohydrate drink for instance. Said another way, there are no apparent downsides of nutritional optimization which is why we advocate it for all surgeries.

This is a very common problem! There are several reasons. First, surgeons get only very basic education about nutrition in medical school. They do not receive any education on nutrition in residency. They are taught to think about surgery alone. Second, most surgeons are under significant time pressures with decreased reimbursement and thus don't take the time to discuss nutrition.

At a high-level data has shown the following with nutritional optimization:

Spine surgery - less pain and high rate of fusion

Joint replacement - quicker recovery and better outcomes 2 years after surgery

Trauma - lower complications and faster recovery

Shoulder - nutrition is more important than tear size and age in healing

Foot and ankle - Vitamin D has been associated with lower union

Several studies have shown that nutrition plays a role in outcomes after gastrointestinal surgery. One of the issues with surgery on the gastrointestinal tract is limited caloric intake after surgery. Therefore, there is a larger need to offset with high quality protein. Data has shown the importance on nutrition on stomach surgery, pancreas surgery, and colorectal surgery.

Gastric surgery references:

https://pubmed.ncbi.nlm.nih.gov/39706719/

https://pubmed.ncbi.nlm.nih.gov/39501291/

https://pubmed.ncbi.nlm.nih.gov/36867644/

https://pubmed.ncbi.nlm.nih.gov/33158590/

https://pubmed.ncbi.nlm.nih.gov/27885532/

Colorectal surgery references:

https://www.nature.com/articles/s41430-024-01509-6

https://www.dovepress.com/impact-of-glutamine-enhanced-parenteral-nutrition-on-postoperative-out-peer-reviewed-fulltext-article-CMAR

https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-024-03510-6

https://onlinelibrary.wiley.com/doi/10.1111/codi.17261?af=R

In a study from Korea, patients with nutritional risk factors had increased mortality over a follow-up period of an average of 4.5 years. Specifically, mortality rates of 10.2% (220/2,158), 22.7% (543/2,395), and 35.3% (273/774) were observed in the low-, intermediate, and high-risk groups, respectively. Interestingly, 59% of patients were intermediate or high risk of nutritional deficiency which shows that nutritional deficiency is common in patients undergoing heart surgery. Reference

Enhanced recovery protocols for cardiac surgery recommend optimizing nutrition and consuming a carbohydrate drink the night prior to surgery. Reference

Eating well after oral surgery can be difficult. Data indicates that protein supplementation leads to lower weight loss after oral surgery. Reference

The association between nutrition and outcomes after plastic surgery has not been well-studied. However, at a basic science level it would make sense that nutritional optimization can improve outcomes. Protein and vitamins are the building blocks for wound healing.Additionally, studies in other fields have shown that nutritional optimization improves wound healing.

Surgery places increased demands on the body. This stress response leads to protein breakdown or catabolism. Additionally, inactivity leads to loss of muscle tissue within 48 hours. This breakdown is higher in older adults.

Protein intake is thus important for decreasing stress on the body, improving healing, and lowering muscle wasting. It is estimated that people undergoing surgery only consume about 22 to 36% of estimated requirements after surgery.Protein supplementation can help lower the muscle breakdown that occurs from inactivity after surgery. Post-surgery supplementation with protein lowers protein breakdown by approximately 20%.

Protein supplementation has also been shown to reduce length of stay in the hospital and infection after colorectal surgery.

Generally speaking it is advised to begin protein supplementation 7-14 days prior to surgery. This provides a loading effect that can help prevent muscle breakdown after surgery.

The answer likely varies by the type of surgery and overall health. Data suggests that the most important period is the first couple of weeks after surgery.However, some data shows that up to 3 months of supplementation can be beneficial.

Total protein intake should be 1.2-2.0 grams per kilogram of body weight per day. For a person of 70 kg, or 154 lbs, this equates to 84 to 154 grams of protein per day. Typically this should occur with 20 to 40 grams of protein in one sitting.Our packs contain 25 grams of protein per day. Alone they do not meet all of your protein needs. We recommend people are consuming an additional 60 to 130 grams of protein per day via breakfast, lunch, and dinner.

Total protein intake should be 1.6-3.0 grams per kilogram of body weight per day. For a person of 70 kg, or 154 Ibs, this equates to 112 to 210 grams of protein per day. Typically this should occur with 20 to 40 grams of protein in one sitting.Our packs contain 25 grams of protein per day. Alone they do not meet all of your protein needs. We recommend people are consuming an additional 90 to 180 grams of protein per day via breakfast, lunch, and dinner. One challenge is hat appetite is often suppressed after surgery. Thus, protein shakes can be good way to obtain needed protein despite a low appetite.

If you are doing physical therapy it is recommended to consume your protein shake 15-45 mins prior to physical therapy if possible.

Animal sources of protein have higher bioavailability. Whey protein is considered one of the highest quality sources because it is over 50% essential amino acids.Particularly important amino acids are Leucine and Glutamine which have been shown to be very important to prevent muscle breakdown.

Leucine is an essential amino acid that is a key mediator of muscle synthesis.

Maintenance of muscle hinges on the balance between protein synthesis and breakdown. To increase muscle, synthesis must exceed breakdown. Several studies have shown the Leucine protects muscle from breakdown during rest (such as that required after surgery) by acting as a trigger for protein synthesis.Consumption of Leucine increases muscle synthesis by 2.5x.

Leucine can improve recovery from surgery. For instance, one study evaluated patient mobility after hip surgery. 81% of those who took Leucine after surgery were mobile 2 weeks after surgery, compared to only 27% in those patients who did not have Leucine supplementation. 1 In other words, those who took Leucine were nearly 3x more likely to be mobile after hip surgery.

Leucine has also been shown to decrease surgical incision healing time and decrease inflammation.

OptiFuel contains 3g of Leucine, the amount that is recommended in scientific studies. Some protocols have evaluated taking this amount twice per day between breakfast and lunch, then again between lunch and dinner. Thus it is possible to actually "double-up" on OptiFuel and take it twice per day.

This depends on the severity of surgery and age. The most critical period is the first couple of weeks after surgery. For young individuals undergoing minor surgery, we recommend Leucine for 1-2 weeks prior to surgery for loading followed by 2-3 weeks after surgery. However, for older individuals and with more significant surgery, the scientific evidence supports up to 3 months of Leucine. In a study of elderly women, for instance, supplementation with Leucine increased improved strength as well as activity by 20%. In another study, 13 weeks of supplementation reduced inflammatory markers in older adults.

Glutamine is the most abundant free amino acid in the body.

When the body is under stress, muscle is broken down to provide energy and essential functions. Glutamine is a key component that is broken down.Supplementation with Glutamine can thus help prevent muscle breakdown. In elective surgical patients the addition of Glutamine has been shown to reduce length of stay in the hospital. In other words, Glutamine supplementation improved speed of recovery.

Glutamine supplementation has also been shown to improve immune function.In one study, people who took 7 grams of Glutamine a day for 30 days prior to surgery had reduced inflammatory levels. These patients also had quicker recoveries after heart surgery. Additionally, glutamine supplementation has been shown to reduce the risk of infection after surgery.

OptiFuel contains 10g of Glutamine. We believe that this amount is ideal for most people. In studies the amount supplemented daily varies from 7 g to approximately 19 grams. Additionally it is safe to supplement up to 45 grams per day.

This depends on the severity of surgery and age. The most critical period is the first couple of weeks after surgery. For young individuals undergoing minor surgery, we recommend Glutamine for 1-2 weeks prior to surgery for loading followed by 2-3 weeks after surgery. However, for older individuals and with more significant surgery, up to 3 months may be ideal based on studies.

Surgery places increased demands on the body. Traditionally people have been told to eat nothing for 8 to 12 hours prior to surgery. With long periods of not eating before surgery (fasting) the body goes into a catabolic or breakdown state that results in increased insulin resistance and stress. This insulin resistance leads to higher levels of glucose in the blood (hyperglycemia) which increases infection and other problems after surgery. This resistance can persist for 3 to 4 weeks after surgery.

Think about this from other life examples... Would athletes perform in a game without eating or drinking for 8 to 12 hours prior? Would you go run a marathon without consuming any energy for 12 hours? The answer is a definite no.

A carbohydrate rich drink the night prior to surgery helps reduce these problems. Interestingly, this is even the case for people with type 2 diabetes.

Studies have shown carbohydrate loading the day prior to surgery decreases length of stay by 20%, meaning speed of recovery is improved.

Other studies have shown that a carbohydrate drink prior to surgery helps preserve muscle function and strength after surgery.

This is a difficult question to completely answer. There is increased evidence that loading should occur the night before surgery and can also occur 2 hours prior to surgery. However, at this time not all medical facilities and physicians are comfortable with intake 2 to 3 hours before surgery. It is standard practice to allow clear liquids to be consumed 6 hours prior to to surgery. Thus, we advise doing the carbohydrate loading just prior to bed the night prior to surgery or approximately 6 hours prior to surgery depending on your scheduled surgery time.

Studies show that 100 grams of a complex carbohydrate that is 12.5% hypo-osmolar should be consumed the night prior to surgery and that an additional 50 grams can be consumed 2 hours prior to surgery.

Vitamin B12, also known as "cobalamin", is a critical vitamin for the body that is made from absorbed from foods and dietary supplements.

Vitamin B12 is a critical vitamin for the normal development and function of our nervous system. It is also required by our body's enzymes that make many proteins as well as genetic material, including DNA and RNA. It is also critical for normal red blood cell formation. Vitamin B12 deficiency is associated with neuropathy, depression, and anemia.

Vitamin B12 is usually attached to proteins in foods, and must be released during digestion from natural foods. Dietary supplements are already in free form and ready for absorption from a specific region of the gut (terminal ilium). Intrinsic factor, a protein secreted by the stomach, is required for B12 absorption by the small intestine.

The Food and Nutrition Board at the National Academy of Sciences, Engineering, and Medicine (NASEM) has a recommended daily dietary intake of 2.4mcg for adult males and females.

Vitamin B12 is usually obtained naturally from meat, fish, eggs, dairy products, as well as fortified breads or cereals. Most people consume sufficient amounts of Vitamin B12, but older patients, women, vegetarians, and those with stomach ("pernicious anemia) and intestinal disorders (disease of the terminal ilium) have been shown to be at increased risk for deficiency. Fortunately, the body can store Vitamin B12.

OptiFuel contains XX amounts of Vitamin B12. We believe that this amount is ideal for most people to safely support healing after surgery. Vitamin B12 is critical during recovery to maintain energy, endurance, and normal neurologicalfunction.

Sufficient Vitamin B12 levels are critically important for healing and recovery after surgery. While the surgical recovery is different for every patient, the healing phase of surgery, including tissue repair and remodeling, extends a minimum of 3 months after most surgical procedures. Fortunately, the body can store 1 to 5mg of vitamin B12, providing sufficient stores for several days before the symptoms and challenges of deficiency impact healing and recovery.

Vitamin D, also known as calciferol, is a critical vitamin for the body that is made from exposure to sunlight and absorbed from foods and dietary supplements.Vitamin D must be activated in the body the kidneys and the liver to be converted into is active form.

Vitamin D has many critical functions in the body. It is critical for calcium and phosphate absorption from our gut, which are critical to maintain bone and muscle health. A lack of Vitamin D and calcium are well-known causes of brittle bones and abnormal muscle contractions. Vitamin D also plays critical roles in many critical anti-inflammatory, immune, and metabolic pathways throughout the body.

Sufficient Vitamin D levels are critically important for bone and muscle health and healing after surgery. Deficiency of Vitamin D due to inadequate dietary intake and/or sunlight exposure is associated with rickets in young patients and poor bone health and osteoporosis in older patients. Lower time and length of sunlight exposure and darker skin are risk factors for reduced Vitamin D production.

The Food and Nutrition Board at the National Academy of Sciences, Engineering, and Medicine (NASEM) has a recommended daily dietary intake of 15mcg for adult males and females under the age of 70, and 20mcg for adult males and females over the age of 70. However, because Vitamin D must be converted to an active form by the patient's own body, the necessary dietary intake to achieve ideal serum levels in the blood may be different for every patient.

Few foods, such as fish, naturally contain Vitamin D. The vast majority of dietary Vitamin D is obtained from the fortified dairy foods like milk and cheese in the U.S. Unfortunately, most people still consume less than the recommended amounts of Vitamin D in their diet.

Sufficient levels of Vitamin D are very important for healing after surgery, particularly with orthopedic procedures. Elderly patients with darker skin, gut absorption disorders, and smokers are at greater risk and may need even greater dietary supplementation.

OptiFuel contains 12.6 mcg of Vitamin D. We believe that this amount is ideal for most people to safely support healing after surgery. Excess dietary Vitamin D can be toxic secondary to excessive calcium, increasing the risk of calcification, kidney stones, and other problems. In fact, 100mcg daily for adult males and females has been defined as a safe and tolerable upper limit of intake.

Sufficient Vitamin D levels are critical important for healing and recovery after surgery, particularly orthopedic procedures that affect muscle and bone. While the surgical recovery is different for every patient, the healing phase of surgery, including tissue repair and remodeling, extends a minimum of 3 months after most surgical procedures. Accordingly, having sufficient levels of Vitamin D for one month before surgery and 3 months after surgery, if not longer, is highly recommended.

Calcium is the most abundant mineral in the body that is obtained from food and dietary supplements.

Calcium is a critical mineral for muscle contraction, nerve function, and the structures of bone and teeth. Calcium ions are required by many critical enzymes in the body for growth, healing, and tissue function. With the critical assistance of Vitamin D, calcium is absorbed by the gut and stored in our bones as a reservoir. The turnover of bone with growth, remodeling, and repair has a complex interplay with circulating levels of calcium in the bloodstream.

The Food and Nutrition Board at the National Academy of Sciences, Engineering, and Medicine (NASEM) has a recommended daily dietary intake of 1000mg for adult males and females age 19-50 years, 1000mg for males and 1200mg for females age 51-70 years, and 1200 mg for both males and females 71 years and older.

Calcium is most commonly obtained from milk, cheese, yogurt and other dairy products. It is present in some plants like spinach as well, but harder to absorb from these sources compared to fortified foods. Despite these readily available sources, survey suggest that as many as 40% of adults consume less than the recommended amounts of calcium. Deficiency is associated with osteoporosis in adults, rickets in children, and neurological dysfunction in extreme cases.

OptiFuel contains 410mg of Calcium. We believe that this amount is ideal for most people after surgery, particularly with fractures and tendon-to-bone repairs in which bone healing is critical. The tolerable upper daily limits of intake are 2000-2500mg for adults. Excess calcium should be avoided, as it has been associated with increased risk of cardiovascular disease, muscle disorders, and other symptoms.

Sufficient calcium levels are critical for healing and recovery after surgery, particularly with orthopedic procedures. While the surgical recovery is different for every patient, the healing phase of surgery, including tissue repair and remodeling, extends a minimum of 3 months after most surgical procedures.

Magnesium is an abundant mineral in the body found in food and dietary supplements.

The Food and Nutrition Board at the National Academy of Sciences has a recommended daily dietary intake of approximately 420mg for adult males and 320mg for adult females.

Magnesium is mostly commonly obtained from green leafy vegetables, seeds, and grains in our diet. It is also often added to bread, cereals, and other fortified foods such as bottled water. Unfortunately, studies suggest that approximately 50% of Americans consume less magnesium than the advised daily intake.Patients with chronic alcoholism as well as elderly patients, diabetics, and patients with celiac or inflammatory bowel disease are at greater risk for magnesium deficiency.

OptiFuel contains 505mg of Magnesium. We believe that this amount is ideal for most people after surgery, given the ubiquitous importance of magnesium for enzymes in almost every tissue in the body. The tolerable upper daily limit of intake is 350mg for adults.

Sufficient magnesium levels are critically important for healing and recovery after any surgical procedure. While the surgical recovery is different for every patient, the healing phase of surgery, including tissue repair and remodeling, extends a minimum of 3 months after most surgical procedures.

Surgery places increased demands on the body. It has been shown that measures to reduce the stress of surgery can minimize loss of muscle mass and allow patients to recover substantially better and faster so they can get back to normal life as quickly as possible.

Often after surgery hunger is reduced or absent, one of the main objectives is in fact to re-establish eating healthy as early as possible after surgery. Just like an athlete has to recover after a big event by eating well, your recovery will be improved by eating well. It is therefore very important to eat a well-balanced and healthy diet after surgery. A "Mediterranean" diet, is also recognized as a diet that modulates inflammation and correlates with optimal health. It is also a good idea to increase protein and fiber intake, and make sure you are getting antioxidants.

It is always best to avoid sugary foods. But especially for at least 2 weeks after surgery it is advisable to avoid high sugar foods such as soda, candy, and desserts.

It is advised to limited alcohol consumption after surgery. In addition to the negative effects on the body, alcohol increases protein catabolism and reduces sleep, which are very important in the recovery phase.

Water intake is important. Frequent hydration helps support the body during rehabilitation. After surgery is NOT a time to restrict calories, be on a ketogenic diet, intermittently fast. The latter has been shown to decrease athletic performance for instance.

The Mediterranean diet has shown many health benefits such as decrease in the risk of cardiovascular disease, cancer, and improved cognitive health.

The Mediterranean diet is a plant-based diet. it encompasses consumption of abundant seasonal vegetables, olive oil for cooking or seasoning (main fat source); fresh seasonal fruit consumed as a desert; regular consumption of nuts and seeds (either as art of the recipes or as healthy snacks); consumption of legumes several times weekly; whole cereals daily; consumption of moderate portions of fish two to three times weekly; dairy (yogurt, milk, cheese) only in limited amounts; spices and herbs to flavor recipes; infrequent consumption of sweets (a few times weekly); moderation of red processed meat; three to four eggs weekly; use plenty of water as a beverage; and drinking wine in moderation.

A hallmark of Mediterranean Diet is the inclusion of unprocessed foods, which are full of healthy nutrients, as opposed to Western dietary patterns, which are rich in processed and ultra-processed foods and full of calories, but very poor in nutrients ("empty calories"). The common Western diet is linked to a high risk of obesity, inflammatory disease, and worsening of cognitive function.

The stress response of surgery leads to protein breakdown or catabolism.Additionally, inactivity leads to loss of muscle tissue within 48 hours. This breakdown is higher in adults over the age of 45. Thus, of the most important things after surgery is to increase protein intake. However, appetite is often reduced after surgery, making it difficult to reach protein needs. Thus, a dietary strategy after surgery is to increase protein intake via the use of protein shakes, or smoothies with fruit, milk and yogurt.

Normally, total protein intake should be 1.2-2.0 grams per kilogram of body weight per day. For a person of 70kg, or 154 pounds, this equates to 84 to 154 grams of protein per day. After surgery, protein requirements increase by up to 50%. Thus, a person weighing 70kg should consume 112 to 210 grams of protein per day.

Useful nutritional advice to achieve this goal is as follows:

• Consume balanced meals starting from breakfast with protein sources at each point such as Greek yogurt, low fat milk, white eggs, scrambled eggs, turkey and chicken breast, or hummus.
• Consume a protein snack before and after the rehabilitation sessions.
• Have two snacks a day to increase your eating windows such as between breakfast and lunch and between lunch and dinner.

Fiber helps improve digestion and can prevent constipation, which is a common problem after surgery. Constipation is caused by anesthesia and by taking narcotics.

Foods that are high in fiber include fruits, vegetables, whole grains, and legumes. Fiber also helps support the intestinal microbia, the bacterial populations that live in our gut and which regulate health, immunity, physical and mental well-being and even muscle growth. An excellent strategy to "feed" our good bacteria is not only to always consume a portion of fiber at all meals, but to vary the color of fruit and vegetables. Seasonal vegetables are preferred as they are rich in the minerals and vitamins they receive from natural cultivation.

Antioxidants help lower inflammation and help protect your cells from damage.

Foods high in antioxidants include fruits and vegetables. Among these, those of red, blue, or purple color such as red peppers, blueberries, blackberries, berries, or strawberries, are ideal. Berries are also a great source of Vitamin C which has been shown to help with pain after surgery. Dark chocolate, consumed in moderation, is also an excellent source of antioxidants! Another optimal source of substances that modulate inflammation are foods rich in omegas. Omegas are found in almonds, nuts, seeds, avocado, and fresh salmon.

Need some new go to recipes to aid health, recovery and well being?

View our recipes page to get some inspiration.

RECIPES

Wound healing involves a series of events. Notable requires include cell proliferation and alignment of collagen. While a variety of factors are important to wound healing, nutrition plays an important role. Protein deficiency affects the immune system anddelays wound healing. Several amino acids (arginine and glutamine most prominently), Vitamin C and Vitamin D have been shown to play an important role in wound healing. Faster more reliable healing can lead to improved recovery and lower risk of infection.

Several amino acids play a role in wound healing. Arginine is involved in pathways producing ornithine (important for cell proliferation), proline (important for collagen production), and nitric oxide (important for wound contraction).Glutamine is the most abundant amino acid in human blood plasma. It is used as a source of energy for cells to proliferate including fibroblasts and epithelial cells. Glutamine is also converted to ornithine and then arginine at the cell level.Several studies show that wound healing is related to amino acids.

Wound Healing

Arribas-Lopez E, Zand N, Ojo O, Snowden MJ, Kochhar T. The Effect of Amino Acids on Wound Healing: A Systematic Review and Meta-Analysis on Arginine and Glutamine. Nutrients. 2021;13.

• Meta-analysis of 5 studies on Arginine and 39 studies on Glutamine and wound healing
• Arginine significantly increased hydroxyproline levels
• Glutamine was associated with improved nitrogen balance, reduced mortality, and decreased length of stay.
• 2 studies reported decreased wound healing time
• 1 study report decreased infection

Diabetic Foot Ulcers

Armstrong DG, Hanft JR, Driver VR, Smith AP, Lazaro-Martinez JL, ReyzelmanAM, et al. Effect of oral nutritional supplementation on wound healing in diabetic foot ulcers: a prospective randomized controlled trial. Diabet Med. 2014;31:1069-77.

• RCT of 270 patients with diabetic foot ulcers who received twice daily amino acid complex (arginine, glutamine, HMB) or a control drink for 16 weeks.
• Those with low albumin or decreased ankle-brachial indexes were 1.7 times and 1.67 times more likely, respectively, to heal in the amino acid group.

Vitamin C plays a critical role in collagen synthesis. Vitamin C is also an antioxidant which can be important for neutralizing oxidants in the epidermis.Notably, Vitamin C levels decrease in response to stress (surgery or wound healing), and Vitamin C deficiency is known to impair wound healing.

Bechara N, Flood VM, Gunton JE. A Systematic Review on the Role of Vitamin C in Tissue Healing. Antioxidants (Basel). 2022;11.

• Systematic review of 18 studies examining Vitamin C and would healing
• Summary of findings:

 - Improved healing of pressure ulcers

- Faster healing time for dental extractions

Taylor TV, Rimmer S, Day B, Butcher J, Dymock IW. Ascorbic acid supplementation in the treatment of pressure-sores. Lancet. 1974;2:544-6.

• Randomized controlled trial of 20 patients with pressure ulcers who received placebo of Vitamin C 500 mg bid for 4 weeks
• Pressure ulcer size reduced by 43% in placebo group compared to 84% in the Vitamin C group

Gunton JE, Girgis CM, Lau T, Vicaretti M, Begg L, Flood V. Vitamin C improves healing of foot ulcers: a randomized, double-blind, placebo-controlled trial. Br J Nutr. 2021;126:1451-8.

• Randomized controlled trial of 16 patients with foot ulcers

- 9 randomized to placebo

- 7 randomized to Vitamin C

50% of patients in a high-risk foot population were Vitamin C deficient

• Ulcer healing at 8 weeks was improved in the Vitamin C groupAmputations by 8 weeks:

- 0/7 Vitamin C

- 4/9 Control group

Vitamin D can impact several processes involved in wound healing including differentiation of fibroblasts, signaling of the epidermis in wound healing, and improved glucose control. Notably, Vitamin D deficiency has been associated with delayed wound healing.

Bikle DD. Role of vitamin D and calcium signaling in epidermal wound healing. JEndocrinol Invest. 2023:46:205-12.7

• Review article which outlines the mechanisms by which Vitamin D helps signal the epidermis to heal wounds.

Ghadimi E, Rahbar R, Jafarzade E, Mansoori A. Effects of vitamin D3 supplementation on the recovery of hospitalized burn patients: a randomized double-blind controlled trial. BMC Nutr. 2025;11:37 8

• Randomized controlled trial of 54 burn patients.

- 18 placebo

- 18 Vitamin D 1000 IU/Day

- 18 Vitamin D 3000 IU/Day

• Supplementation of at least 1000 IU/Day improved wound healing time, decreased scar thickness, and reduced insulin requirements.

Wu X, Zeng J, Ye X, Peng M, Lan Y, Zhang S, et al. Effects of vitamin D supplementation on diabetic foot ulcer healing: a meta-analysis. Postgrad MedJ. 2025;101:100-7 9

• Meta-analysis of 7 trials including 580 patients with diabetic foot ulcers.
• In combined analysis Vitamin D supplementation improved wound healing time and reduced insulin levels.

In addition to the evidence above, some studies have looked at multimodal approaches to wound healing. Simply put this is combining many nutritional ingredients in one delivery (vitamins and amino acids) as is down with the complete surgical nutrition kit.

Smith TJ, Wilson M, Whitney C, Fagnant H, Neumeier WH, Smith C, et al.Supplemental Protein and a Multinutrient Beverage Speed Wound Healing after Acute Sleep Restriction in Healthy Adults. J Nutr. 2022;152:1560-73.

• Wound healing trial of 20 healthy young adults (mean age 20 years) using a wound model

- Participants were sleep restricted per the model to simulate stress

- Half of the participants received supplementation with arginine, glutamine, omegas, Vitamin C, and Vitamin D

• Wound healing time was 3.9 days in the supplementation group, compared to 5.3 days in the placebo group (p = .0001).

Cereda E, Klersy C, Serioli M, Crespi A, D'Andrea F, OligoElement Sore Trial Study G. A nutritional formula enriched with arginine, zinc, and antioxidants for the healing of pressure ulcers: a randomized trial. Ann Intern Med. 2015;162:167-74.

• RCT of 28 patients with pressure ulcers followed for 12 weeks who received placebo versus nutritional supplementation including 34 g of protein, 6 gArginine, and 500 mg of Vitamin C

- Faster healing time was observed in the supplementation group

van Anholt RD, Sobotka L, Meijer EP, Heyman H, Groen HW, Topinkova E, et al.Specific nutritional support accelerates pressure ulcer healing and reduces wound care intensity in non-malnourished patients. Nutrition. 2010;26:867-72.

• RCT of 43 patients followed for 8 weeks
• Treatment group received 20 g protein, 3 g Arginine, and 250 mg of Vitamin C
• Ulcer healing was improved in the treatment group