About 450,000 burns in the US every year require medical attention, with about 40,000 requiring hospitalization.[i] A large body of evidence demonstrates the essential role of nutrition in wound healing. Without adequate nutrition, healing may be impaired and prolonged.[ii] Wound healing is the complex process of replacing injured tissue with new tissue produced by the body, which demands an increased consumption of energy and specific nutrients, particularly protein and calories.[iii] [iv]
Appropriate nutritional management of the severely burned patient is necessary to ensure an optimal outcome. Initiation of early enteral feeding, within 6 to 18 hours post burn injury, is recognized as beneficial, and has been shown to be safe in children as well as adults. The advantages of utilizing the enteral route, as opposed to the parenteral route, include improved nitrogen balance, reduced hyper metabolic response, reduced immunological complications and mortality.[v]
Nutritional support is a key component of burn care. Increases in metabolic rates in burn patients are very marked. For instance, adults with burns covering 25% surface area often experience increases in metabolic rates between 118% and 210%, and caloric needs can exceed 5,000 KCal/Day. Patients with a surface burn of 40% can lose 25% of their pre-admission weight in only 3 weeks unless they receive adequate nutritional support. Protein needs increase dramatically as well, often increasing to 2gm/Kg[vi]
It is customary to give meat and eggs in maximum tolerable quantities to patients recovering from any type of injury, and whenever a diet rich in calories with high protein is advised. The magnitude of nutritional demand in burn patients is virtually unsurpassed by any other disease process.[vii]
Given the advantage of beginning enteral nutrition early in treatment, and the greatly increased need for caloric intake, protein, and a variety of critical vitamins and minerals, the question becomes: can a vegetarian diet give wound healing outcomes as effective as the usual meat-centered approach?
To answer this question, a study was conducted on 42 consecutive patients suffering from 10% to 50% surface area of 2nd and 3rd degree thermal burns, with the aim of comparing nutritional status, clinical outcome, of vegetarian and non-vegetarian diets. The patients were divided into two groups depending upon their pre-burn food habits. Both groups were compared by various biochemical parameters, microbiological investigations, weight, status of wound healing, graft take, and hospital stay, and they were followed for at least 60 days post burn. The results were comparable in both groups.[viii]
With the increasing popularity of vegetarian diets, the physician should expect to receive vegetarian patients in their burn practice. Well-meaning physicians who prescribe animal-product intensive diets to their vegetarian patients will likely encounter strong resistance.[ix] The finding that vegetarian diets promote wound healing in burn patients just as well as meat-centered ones should encourage their acceptance by physicians.
Eugene Dickens MD at the Wound Care Clinic at Hillcrest Medical Center in Tulsa Oklahoma says they treat vegetarian patients on a regular basis. He says “At the wound clinic, we always try to encourage our patients to choose healthy sources of protein, and when animal protein is not an option, other sources such as beans, soy-based foods, and even protein powders such as pea protein can be beneficial in ensuring adequate intake. We caution patients to ensure they are replacing animal protein with nutrient dense foods, instead of ‘empty’ calories such as heavily processed convenience foods, sugar-laden baked goods, and the like.” His clinic makes sure the patients receive any necessary supplementations such as Vitamin D, essential fatty acids and vitamin B12.
[ii] Williams JZ. Surg Clin North Am 2003 Jun;83(3):571-96
[iii] Hurd TA. Wound Care 2004
[iv] Demling RH. Wounds 2000;12(1). Health Management Publications, Inc.
[vi] Herndon RN, Tompkins RG. Support of the metabolic response to burn injury. The Lancet, Volume 363, Issue 9424, 1895 – 1902
[vii] Rodriguez DJ. Nutrition in patients with severe burns: State of the art. J Burn Care Rehabil 1996;17:62-70.
[viii] Sharma S, Sharma RK, Parashar A. Comparison of the nutritional status and outcome in thermal burn patients receiving vegetarian and non-vegetarian diets. Indian J Plast Surg. 2014 May;47(2):236-41.
[ix] Collins N., Cristen Harr. Are vegetarian diets adequate for wound healing? Wound Care and Ostomy Management April 2012 14-18