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Health maintenance

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Related Terms
  • Abrasions, anal fissure, autolytic debridement, bed sore, Clostridium sp., collagen, collagen matrix, cuts, debridement, decubitus ulcer, diabetic ulcers, electrotherapy, epithelial, epithelialization phase, extravasation, gangrene, gas gangrene, human growth factors, hydrocolloid, hyperbaric oxygen, incision wounds, incontinence, infected surgical wounds, infectious arthritis, inflammatory phase, injuries, laceration, macrophages, mechanical debridement, microvascular, minor injuries, myonecrosis, necrotizing fasciitis, pressure ulcers/wound care, proliferative phase, puncture wound, remodeling phase, scrapes, scratches, sepsis, septic arthritis, skin damage caused by incontinence, skin graft healing (split thickness), skin ulcer, surgical skin flap ischemia, skin wounds, squamous, stitches, superficial, suture, vulnerary, wound care, wound healing.

Background
  • A wound is a break in the outer layer of the skin, called the epidermis. Wounds are usually caused by cuts or scrapes. Different kinds of wounds may be treated differently from one another, depending upon how they happened and how serious they are. Other wounds include puncture wounds, lacerations (cuts), pressure sores, anal fissures, extravasations (a drug accidentally going outside of a vein causing tissue damage), skin damage caused by incontinence (lack of bladder control), skin graft healing (split thickness), diabetic ulcers, and surgical skin flap ischemia (lack of blood flow to surgically attached skin).
  • Healing is a response to the injury that sets into motion a sequence of events. With the exception of bone, all tissues heal with some external scarring. The object of proper care is to minimize the possibility of infection and scarring.
  • There are basically four phases to the healing process: the inflammatory phase, proliferative phase, remodeling phase, and epithelialization phase.
  • The inflammatory phase begins with the injury itself. In the inflammatory phase, there is bleeding, immediate narrowing of the blood vessels, clot formation, and release of various chemical substances into the wound that will begin the healing process. Specialized cells (macrophages) clear the wound of debris over the course of several days.
  • Next is the proliferative phase in which a matrix or latticework of cells forms. On this matrix, new skin cells and blood vessels will form. It is the new small blood vessels (known as capillaries) that give a healing wound its pink or purple-red appearance. These new blood vessels will supply the rebuilding cells with oxygen and nutrients to sustain the growth of the new cells and support the production of proteins (primarily collagen). The collagen acts as the framework upon which the new tissues build. Collagen is the dominant substance in the final scar.
  • The remodeling phase begins after 2-3 weeks. The framework (collagen) becomes more organized making the tissue stronger. The blood vessel density becomes less, and the wound begins to lose its pinkish color. Over the course of six months, the area increases in strength, eventually reaching 70% of the strength of uninjured skin.
  • Epithelialization is the process of laying down new skin, or epithelial, cells. The skin forms a protective barrier between the outer environment and the body. Its primary purpose is to protect against excessive water loss and bacteria. Reconstruction of this layer begins within a few hours of the injury and is complete within 24-48 hours in a clean, sutured (stitched) wound. Open wounds may take 7-10 days because the inflammatory process is prolonged, which contributes to scarring. Scarring occurs when the injury extends beyond the deep layer of the skin (into the dermis, which is the second layer of skin).

Integrative therapies
  • Unclear or conflicting scientific evidence:
  • Aloe: Transparent gel from the pulp of the meaty leaves of Aloe vera has been used topically for thousands of years to treat wounds, skin infections, burns, and numerous other dermatologic conditions. Study results of aloe on wound healing are mixed with some studies reporting positive results and others showing no benefit or potential worsening of the condition. Early studies suggest that aloe may help heal skin ulcers. High-quality studies comparing aloe alone with placebo are needed.
  • Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.
  • Alpha-lipoic acid: Alpha-lipoic acid (ALA) may reduce tissue damage that is often caused by long-term exposure to high levels of oxygen. While early studies are promising, more research is needed to fully understand how ALA might work for wound healing in patients undergoing hyperbaric oxygen therapy.
  • Avoid if allergic to alpha-lipoic acid (ALA). Use cautiously with diabetes and thyroid diseases. Avoid with thiamine deficiency or alcoholism. Avoid if pregnant or breastfeeding.
  • Arginine: Arginine, or L-arginine, is considered a semi-essential amino acid, because although it is normally synthesized in sufficient amounts by the body, supplementation is sometimes required (for example, due to inborn errors of urea synthesis, protein malnutrition, excess ammonia production, excessive lysine intake, burns, infection, peritoneal dialysis, rapid growth, or sepsis). Arginine has been suggested to improve the rate of wound healing in elderly individuals. A randomized, controlled clinical trial reported improved wound healing after surgery in head and neck cancer patients, following the use of an enteral diet supplemented with arginine and fiber. Arginine has also been used topically (on the skin) to attempt to improve wound healing. Early studies suggest that arginine may also help treat chronic anal fissures. Additional studies are needed.
  • Avoid if allergic to arginine, or with a history of stroke, liver, or kidney disease. Avoid if pregnant or breastfeeding. Use caution if taking blood-thinning drugs (like warfarin or Coumadin®) and blood pressure drugs or herbs or supplements with similar effects. Blood potassium levels should be monitored. L-arginine may worsen symptoms of sickle cell disease. Caution is advised in patients taking prescription drugs to control sugar levels.
  • Aromatherapy: Aromatherapy is a technique in which essential oils from plants are used with the intention of preventing or treating illness, reducing stress, or enhancing well-being. Preliminary data from one small study suggests aromatherapy may contribute to reduced pain intensity during dressing changes in wound care. Data are insufficient for forming any opinion for or against this application.
  • Essential oils should only be used on the skin in areas without irritation. Essential oils should be administered in a carrier oil to avoid toxicity. Avoid with a history of allergic dermatitis. Use cautiously if driving or operating heavy machinery. Avoid consuming essential oils. Avoid direct contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
  • Ayurveda: There is some evidence that a traditional Ayurvedic treatment using specially prepared alkaline threads (ksharasutra or Ayurvedic setons) to achieve gradual cauterization may provide an effective alternative to surgery in patients being treated for anal fissures. Further research is needed to confirm these results.
  • Ayurvedic herbs should be used cautiously. Some herbs imported from India have been reported to contain high levels of toxic metals. Ayurvedic herbs can interact with other herbs, foods and drugs. A qualified healthcare professional should be consulted before taking. Use guggul cautiously with peptic ulcer disease. User should avoid sour food, alcohol and heavy exercise. Mahayograj guggul should not be taken for long periods of time. Pippali (Piper longum) should be taken with milk and avoided with asthma. Avoid sweet flag, and avoid amlaki (Emblica officinalis) at bedtime. Avoid Terminalia hebula (harda) if pregnant. Avoid Ayurveda with traumatic injuries, acute pain, advanced disease stages and medical conditions that require surgery.
  • Bovine cartilage: Reduction in inflammation and edema (swelling) and enhancement of the healing of wounds were effects that appeared in the medical literature of bovine cartilage during the 1950s and 1960s. In a preliminary comparison of potential wound healing effects with a commercially available ointment of 10% powdered bovine cartilage (Catrix® 10 Ointment) or Aquaphor® original formula in post-operative facial skin care with a laser resurfacing agent, Catrix® 10 Ointment was better. However, this study was a pilot study so its results need confirmation by follow-up clinical studies that clearly have the appropriate randomization and are double-blinded, given that such were in absence in this study. Also lacking in this study was a definition of primary outcome that therapeutically differentiated Catrix® 10 Ointment.
  • Avoid if allergic or hypersensitive to bovine cartilage or any of its constituents. Use cautiously with cancer, renal (kidney) failure, or hepatic (liver) failure. Avoid if pregnant or breastfeeding.
  • Calendula: Calendula (Calendula officinalis), also known as pot marigold, has been widely used on the skin to treat minor wounds, skin infections, burns, bee stings, sunburn, warts, and cancer. Calendula is commonly used topically (on the skin) to treat minor skin wounds. Reliable human research is necessary before a firm conclusion can be drawn regarding the use of calendula for wound healing.
  • Avoid if allergic to plants in the Aster/Compositae family, such as ragweed, chrysanthemums, marigolds, and daisies. Use cautiously in patients taking sedatives, blood pressure medications, cholesterol medications, blood sugar-altering agents, and immunomodulators. Use cautiously with diabetes and in children. Avoid if pregnant or breastfeeding.
  • Chamomile: Chamomile (Matricaria recutita, Chamaemelum nobile) has been used medicinally for thousands of years, and is widely used in Europe. There is promising preliminary evidence supporting the topical use of chamomile for wound healing. However, the available literature is not adequate to support the use of chamomile for this indication.
  • Avoid if allergic to chamomile. Anaphylaxis, throat swelling, skin allergic reactions and shortness of breath have been reported. Chamomile eyewash can cause allergic conjunctivitis (pinkeye). Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating machinery. Avoid if pregnant or breastfeeding.
  • Chitosan: There is limited evidence on the effects of chitosan in wound healing. Better studies are needed.
  • Avoid if allergic or sensitive to chitosan or shellfish. Use cautiously with diabetes or bleeding disorders. Use cautiously if taking drugs, herbs, or supplements that lower blood sugar or increase the risk of bleeding. Chitosan may decrease absorption of fat and fat-soluble vitamins from foods. Chitosan is not recommended during pregnancy or breastfeeding.
  • Dimethylsulfoxide (DMSO): Dimethylsulfoxide (DMSO) is a sulfur-containing organic compound. DMSO occurs naturally in vegetables, fruits, grains, and animal products. DMSO applied to the skin may prevent tissue death after extravasation of anticancer agents. It can be applied alone or with steroids. Limited available study also suggests that DSMO improves lack of blood flow in surgical skin flap ischemia. Currently, there is not enough scientific evidence available for the use of topical DMSO for diabetic ulcers.
  • Avoid if allergic or hypersensitive to DMSO. Use caution with urinary tract cancer or liver and kidney dysfunction. Avoid if pregnant or breastfeeding.
  • Eucalyptus oil: Eucalyptus (Eucalyptus globulus) oil contains 70-85% 1,8-cineole (eucalyptol), which is also present in other plant oils. Limited evidence suggests that eucalyptus essential oil may be beneficial for patients with skin ulcers when combined with antibiotics. More studies are needed to confirm these early findings.
  • Case reports describe allergic rash after exposure to eucalyptus oil, either alone or as an ingredient in creams. Avoid if allergic to eucalyptus oil or with a history of seizure, diabetes, asthma, heart disease, abnormal heart rhythms, intestinal disorders, liver disease, kidney disease, or lung disease. Use caution if driving or operating machinery. Avoid with a history of acute intermittent porphyria. Avoid if pregnant or breastfeeding. A strain of bacteria found on eucalyptus may cause infection. Toxicity has been reported with oral and inhaled use.
  • Gotu kola: Gotu kola, Centella asiatica (formerly known as Hydrocotyle asiatica), has a long history of use, dating back to ancient Chinese and Ayurvedic medicine. Preliminary study has demonstrated the ability of Centella asiatica extracts to promote wound healing, possibly through the stimulation of collagen synthesis. However, additional human study is needed in this area.
  • Avoid if allergic to gotu kola, asiaticoside, asiatic acid, or madecassic acid. Avoid with a history of high cholesterol, cancer, or diabetes. Avoid if pregnant or breastfeeding.
  • Honey: Honey is a sweet, viscid fluid produced by honeybees (Apis melliflera) from the nectar of flowers. The primary studied use of honey is for wound management, particularly in promoting rapid wound healing, deodorizing, and debriding necrotic tissue. The types of wounds studied are varied; most are non-healing wounds such as chronic ulcers, postoperative wounds, and burns. Currently, there is insufficient human evidence to support the use of honey for skin graft healing. Although honey has apparent antibacterial effects, more human study is needed in this area.
  • Avoid if allergic or hypersensitive to honey, pollen, celery, or bees. Honey is generally considered safe in recommended doses. Avoid honey from the genus Rhododendron because it may cause a toxic reaction. Avoid in infants younger than 12 months of age. Use cautiously with antibiotics. Potentially harmful contaminants (like C. botulinum or grayanotoxins) can be found in some types of honey and should be used cautiously in pregnant or breastfeeding women.
  • Hydrotherapy: Hydrotherapy is broadly defined as the external application of water in any form or temperature (hot, cold, steam, liquid, ice) for healing purposes. It may include immersion in a bath or body of water (such as the ocean or a pool), use of water jets, douches, application of wet towels to the skin, or water birth. These approaches have been used for the relief of various diseases and injuries, or for general well being. Hydrotherapy has been used in patients with pressure ulcers, and preliminary research suggests that daily whirlpool baths may reduce the time for wound healing. Better research is necessary in this area before a firm conclusion can be drawn.
  • There is a risk of infection from contaminated water if sanitary conditions are not maintained. Avoid sudden or prolonged exposure to extreme temperatures in baths, wraps, saunas, or other forms of hydrotherapy, particularly with heart disease, lung disease, or if pregnant. Avoid with implanted medical devices like pacemakers, defibrillators, or hepatic (liver) infusion pumps. Vigorous use of water jets should be avoided with fractures, known blood clots, bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, and impaired temperature sensitivity, such as neuropathy. Use cautiously if pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis or treatment with more proven techniques or therapies, and should not be used as the sole approach to illnesses. Patients with known illnesses should consult their physician(s) before starting hydrotherapy.
  • Iodine: It is not clear if healing of wounds or skin ulcers is improved with the application of topical iodine solutions. Iodine solutions may assist with sterilization as a part of a larger approach to the wound healing process.
  • Reactions can be severe, and deaths have occurred with exposure to iodine. Avoid iodine-based products if allergic or hypersensitive to iodine. Do no use for more than 14 days. Avoid Lugol solution and saturated solution of potassium iodide (SSKI, PIMA) with hyperkalemia (high amounts of potassium in the blood), pulmonary edema (fluid in the lungs), bronchitis, or tuberculosis. Use cautiously when applying to the skin because it may irritate/burn tissues. Use sodium iodide cautiously with kidney failure. Avoid sodium iodide with gastrointestinal obstruction. Iodine is safe in recommended doses for pregnant or breastfeeding women. Avoid povidone-iodine for perianal preparation during delivery or postpartum antisepsis.
  • Magnet therapy: The use of magnets to treat illness has been described historically in many civilizations. In modern times, magnetic fields play an important role in Western medicine, including use for magnetic resonance imaging (MRI), pulsed electromagnetic fields, and experimental magnetic stimulatory techniques. Early scientific evidence suggests that the time to heal wounds, including ulcers, may decrease with the use of static magnets. Better quality studies are needed before a firm recommendation can be made for wound healing.
  • Avoid with implantable medical devices, such as heart pacemakers, defibrillators, insulin pumps, or hepatic artery infusion pumps. Avoid with myasthenia gravis or bleeding disorders. Avoid if pregnant or breastfeeding. Magnet therapy is not advised as the sole treatment for potentially serious medical conditions, and it should not delay the time to diagnosis or treatment with more proven methods. Patients are advised to discuss magnet therapy with a qualified healthcare provider before starting treatment.
  • Pantothenic acid (vitamin B5): Pantothenic acid (vitamin B5) is essential to all life and is a component of Coenzyme A (CoA), a molecule that is necessary for numerous vital chemical reactions to occur in cells. Pantothenic acid is essential to the metabolism of carbohydrates, proteins, and fats, as well as for the synthesis of hormones and cholesterol. In animal research, oral and topical pantothenic acid has been associated with accelerated skin wound healing. However early human study results conflict. Additional evidence is necessary before a clear conclusion can be reached regarding this use of pantothenic acid or dexpanthenol.
  • Avoid if allergic or hypersensitive to pantothenic acid or dexpanthenol. Avoid with gastrointestinal blockage. Pantothenic acid is generally considered safe in pregnant and breastfeeding women when taken at recommended doses.
  • Papain: Papain is an enzyme that breaks protein bonds and has been used in Africa for treating burns. In standard western medical care, papain-containing debridement agents are commonly used to remove necrotic tissue and slough in burns, postoperative wounds, pilonidal cyst wounds, carbuncles, trauma wounds, infected wounds, and chronic lesions, such as pressure ulcers, and varicose and diabetic ulcers. According to reviews and clinical trials, papain may be very useful for wound debridement and for stimulating wound healing. More high-quality research is needed in this area.
  • Use cautiously in patients sensitive to papain. Use cautiously in patients being treated for prostatitis. Use Wobenzym®, which contains papain, cautiously, especially in those with bleeding disorders or taking anticoagulants or antiplatelets. Use cautiously as an adjuvant to radiation therapy. Avoid in patients with gastroesophageal reflux disease. Avoid in patients using immunosuppressive therapy.
  • Physical therapy: Physical therapy techniques, such as laser treatment, have been used to clean and heal wounds. Early evidence also suggests that high voltage stimulation or pulsed electrical stimulation may speed the healing of some types of skin ulcers. More research with similar outcome measures is needed to better understand the role of physical therapy for wound care.
  • Not all physical therapy programs are suited for everyone, and patients should discuss their medical history with a qualified healthcare professional before beginning any treatments. Physical therapy may aggravate pre-existing conditions. Persistent pain and fractures of unknown origin have been reported. Physical therapy may increase the duration of pain or cause limitation of motion. Pain and anxiety may occur during the rehabilitation of patients with burns. Both morning stiffness and bone erosion have been reported in the literature although causality is unclear. Erectile dysfunction has also been reported. Physical therapy has been used in pregnancy and although reports of major adverse effects are lacking in the available literature, caution is advised nonetheless. All therapies during pregnancy and breastfeeding should be discussed with a licensed obstetrician/gynecologist before initiation.
  • Psyllium: Psyllium, also referred to as ispaghula, is derived from the husks of the seeds of Plantago ovata. Psyllium contains a high level of soluble dietary fiber, and is the chief ingredient in many commonly used bulk laxatives. Results from human study suggest that psyllium may reduce the number of surgeries necessary to heal anal fissures. Further evidence is necessary.
  • Avoid if allergic or hypersensitive to psyllium, ispaghula, or English plantains (Plantago lanceolata). Avoid in patients with esophageal disorders, gastrointestinal atony, fecal impaction, gastrointestinal tract narrowing, swallowing difficulties, and previous bowel surgery. Avoid ingestion of psyllium-containing products in individuals with repeated or prolonged psyllium exposure who have not manifested allergic or hypersensitive symptoms. Prescription drugs should be taken one hour before or two hours after psyllium. Adequate fluid intake is required when taking psyllium-containing products. Use cautiously with blood thinners, antidiabetic agents, carbamazepine, lithium, potassium-sparing diuretics, salicylates, tetracyclines, nitrofurantoin, calcium, iron, vitamin B12, other laxatives, tricyclic antidepressants (amitriptyline, doxepin, and imipramine), antigout agents, anti-inflammatory agents, hydrophilic agents, and chitosan. Use cautiously with diabetes and kidney dysfunction. Use cautiously if pregnant or breastfeeding.
  • Rose hip: Rose hips are the fruits that develop from the blossoms of the wild rose (Rosa spp.). They are typically orange to red in color, but some species may be purple or black. When applied topically, the volatile oils of aromatic plants may have physiological effects that will facilitate wound healing. Rose hips contain several vitamins and minerals, including vitamin C, vitamin B1, vitamin E, calcium, zinc, and carotenoids, which could potentially promote wound healing when applied to the skin. Much larger and high quality clinical trials are needed to establish the therapeutic efficacy of rose hip and rose oil preparations in the topical treatment of surgical wounds and ulcers.
  • Use cautiously in patients who are avoiding immune system stimulants. Use cautiously in patients who are taking anticoagulant or anti-platelet aggregating agents, antibiotics, antineoplastics, antiretrovirals, anti-inflammatory agents, "Long-Life CiLi", antilipemics, aluminum-containing antacids, salicylates, or laxatives. Avoid in patients who are allergic to rose hips, rose pollen, its constituents, or members of the Rosaceae family.
  • TENS: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. TENS is often used to treat pain, as an alternative or addition to pain medications. Therapy sessions may last from minutes to hours. TENS is often used in conjunction with acupuncture therapy. TENS has been tested for its effects on blood flow to skin flaps used in plastic surgery procedures such as breast reconstruction. TENS has also been evaluated in patients with skin ulcers, diabetic foot ulcers, and chronic ulcers of various causes. More research is needed in this area.
  • Avoid with implantable devices, like defibrillators, pacemakers, intravenous infusion pumps, or hepatic artery infusion pumps. Use cautiously with decreased sensation, like neuropathy, and with seizure disorders. Avoid if pregnant or breastfeeding.
  • Therapeutic touch: Although some studies report an improvement in wound healing with therapeutic touch, others show no benefits.
  • Therapeutic touch is believed to be safe for most people. Therapeutic touch should not be used for potentially serious conditions in place of more proven therapies. Avoid with fever or inflammation, and on body areas with cancer.
  • Vitamin A: In preliminary study, retinol palmitate significantly reduced rectal symptoms of radiation proctopathy, perhaps because of wound healing effects. Further research is needed to confirm these results.
  • Avoid if allergic or hypersensitive to vitamin A. Vitamin A toxicity can occur if taken at high dosages. Use cautiously with liver disease or alcoholism. Smokers who consume alcohol and beta-carotene may be at an increased risk for lung cancer or heart disease. Vitamin A appears to be safe in pregnant women if taken at recommended doses; however, vitamin A excess, as well as deficiency, has been associated with birth defects. Excessive doses of vitamin A have been associated with central nervous system malformations. Use cautiously if breastfeeding because the benefits or dangers to nursing infants are not clearly established.
  • Zinc: Although zinc is frequently cited as having beneficial effects on healing of incision wounds, few studies have investigated this use. Further research is needed. There are conflicting findings regarding the potential benefit of zinc for healing leg ulcers. Available studies reported no or few adverse effects.
  • Preliminary evidence suggests that topical zinc oxide oil may help manage perianal and buttock skin damage in incontinent patients. Further research is needed to better understand the role of zinc for treatment of skin damage caused by incontinence.
  • Zinc is generally considered to be safe when taken at the recommended dosages. Avoid zinc chloride since studies have not been done on its safety or effectiveness. Avoid with kidney disease. Use cautiously if pregnant or breastfeeding.
  • Fair negative scientific evidence:
  • Aloe: A well-designed human trial found no benefit of topical acemannan hydrogel (a component of aloe gel) in the treatment of pressure ulcers.
  • Avoid if allergic to aloe or other plants of the Liliaceae family (garlic, onions, tulips). Avoid injecting aloe. Do not apply to open skin, surgical wounds or pressure ulcers. Avoid taking by mouth with diarrhea, bowel blockage, intestinal diseases, bloody stools or hepatitis. Avoid with a history of irregular heartbeat (arrhythmia), electrolyte imbalances, diabetes, heart disease or kidney disease. Avoid taking by mouth if pregnant or breastfeeding.

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. American Academy of Family Physicians. .
  2. American Academy of Pediatrics. .
  3. Arnold M, Barbul A. Nutrition and wound healing. Plast Reconstr Surg. 2006;117(7 Suppl):42S-58S.
  4. Centers for Disease Control and Prevention. .
  5. Dini V, Bertone M, Romanelli M. Prevention and management of pressure ulcers. Dermatol Ther. 2006;19(6):356-64.
  6. Langemo D, Anderson J, Hanson D, et al. Nutritional considerations in wound care. Adv Skin Wound Care. 2006;19(6):297-8, 300, 303.
  7. de Laat EH, Schoonhoven L, Pickkers P, et al. Epidemiology, risk and prevention of pressure ulcers in critically ill patients: a literature review. J Wound Care. 2006;15(6):269-75.
  8. Natural Standard: The Authority on Integrative Medicine. .
  9. National Institute of Allergy and Infectious Diseases. .
  10. Pieper B, Sieggreen M, Nordstrom CK, et al. Discharge knowledge and concerns of patients going home with a wound. J Wound Ostomy Continence Nurs. 2007;34(3):245-53; quiz 254-5.
  11. Wu SC, Driver VR, Wrobel JS, et al. Foot ulcers in the diabetic patient, prevention and treatment. Vasc Health Risk Manag. 2007;3(1):65-76.

Safety




Technique
  • Antioxidants:
  • Oxidation is a chemical process in which electrons from a substance are transferred to what is known as an oxidizing agent. Oxidation reactions may produce substances referred to as "free radicals." These molecules may cause chain reactions that can damage many cells in the body. Antioxidants may stop the chain reactions caused by free radicals, and therefore stop the process of this sort of damage occurring in the body. In other cases, antioxidants may stop other kinds of oxidation reactions by becoming oxidized themselves and thus sparing cells and tissues from damage. The potential medical benefit of antioxidants may reside in their ability to prevent or slow the oxidation of molecules in the microscopic parts of the body, such as DNA or proteins.
  • The most common theory of aging is called the free radical theory. Many researchers believe that free radicals may cause extensive damage to the body's tissues. Although free radicals are needed for the body to produce energy, maintain immunity, transmit nerve signals, produce hormones, and contract muscles, they may also contribute to the process of aging. Free radical damage begins at birth and continues through adulthood. However, when individuals are young, the effects are minimal because the body has many different ways to repair and replace cells to maintain proper functioning. As individuals age, the damage caused by free radicals increases.
  • Antioxidants are found in varying amounts in foods such as vegetables, fruits, grain cereals, legumes, and nuts. Some antioxidants such as lycopene and ascorbic acid can be destroyed by long-term storage or prolonged cooking. Other antioxidant compounds are more stable, such as the polyphenolic antioxidants in foods such as whole-wheat cereals and tea. In general, processed foods are thought to contain less antioxidants than fresh and uncooked foods since preparation processes may expose the food to oxygen. In addition to being available in a variety of fruits and vegetables, antioxidants are available as supplements. They are one of the most popular categories of supplements available today. Some of the most popularly used antioxidants are ascorbic acid (vitamin C), glutathione, lipoic acid, carotenes, ?-tocopherol (vitamin E), and ubiquinone (Coenzyme Q10).
  • Experts have suggested that in order for antioxidants to be possibly beneficial, a person must consume them on a regular basis over a period of many years as the proposed benefits of antioxidants may occur by possibly stopping many oxidation reactions over long periods of time. Therefore, consuming a large number of antioxidant supplements over a day, week or month may not reverse the damage that has already been done by free radicals.
  • Diet:
  • Food groups: An appropriate amount of fruits and vegetables should be consumed to stay within one's energy needs. Two cups of fruit and 2 1/2 cups of vegetables per day are recommended to achieve a 2,000-calorie intake. Food portions may need to be adjusted depending on the calorie level. Vegetables should be selected from all five groups (dark green leafy vegetables, orange vegetables, legumes, starchy vegetables, and other vegetables) several times a week.
  • At least three-ounce-equivalents of whole-grain products should be consumed each day. Additionally, the remaining grains should come from enriched or whole-grain products. At least half the grains should come from whole grains. Three cups of fat-free or low-fat milk or equivalent milk products should be consumed daily.
  • Atkins dietT: Despite the common public perception that the Atkins dietT permits an unlimited consumption of greasy foods, it is actually recommended that dieters consume primarily lean meats, such as seafood and poultry. Like many diet plans, the Atkins dietT requires regular consumption of nutritional supplements, such as a multivitamin pill, and adherence to a regular exercise plan. The Atkins dietT does not recommend that individuals adopt the eating plan unless they abide by the nutritional supplements and exercise routine. A qualified healthcare professional should be consulted before beginning any new diet.
  • Under the Atkins dietT, it is recommended that dieters stop any unnecessary medications. Any changes to medications should be discussed with a qualified healthcare professional. When combined with this diet, diuretics, and, to a lesser extent, other cardiovascular medications and diabetes medications, including insulin, may produce a dangerous overdose. Psychotropic drugs, phenothiazines and antidepressants such as Prozac®, tranquilizers, lithium, and similar drugs, may cause metabolic resistance to the diet. Estrogen, prednisone, and other steroids, and antiarthritic drugs, especially NSAIDS, may cause weight gain or prevent weight loss. For persons metabolically resistant, any medications may aggravate the condition.
  • During the induction period (the first two weeks), dieters are permitted to eat no more than 20 grams of carbohydrates per day with a diet consisting of nearly unlimited meats, poultry, seafood, eggs, cheeses, oils, butter, margarine, bacon, and sausages. The 20-gram carbohydrate limit is generally derived from trace amounts of carbohydrates in sauces, dressings, cheeses, and a couple cups of lettuce greens or vegetables daily. During these two weeks, participants are not allowed to have any milk, fruits, grains, cereals, breads, or "high glycemic index" vegetables such as potatoes, peas, corn, and carrots.
  • During the maintenance period, dieters consume no more than 90 grams of carbohydrates daily.
  • DASH diet: The DASH diet is based on the U.S. Department of Agriculture (USDA) food pyramid. It has been evaluated in medical trials conducted in the late 1990s and early 2000s and has been shown to reduce blood pressure. The National Heart, Lung, and Blood institute updated the diet specifications after the USDA released an updated food pyramid in 2005.
  • Unlike other diets designed for individuals with high blood pressure, the DASH diet does not make the levels of sodium in the diet the primary focus. However, salt reduction is an important component of the diet. According to the DASH diet, an individual should consume a maximum of 2,400 milligrams of sodium daily. Individuals are encouraged to pay attention to all of the salt in one's diet, including table salt and salt used in cooking, as well as so-called "hidden salts" in fast foods, processed foods, and foods eaten at restaurants.
  • Avoiding or reducing consumption of foods such as canned soups, lunchmeats, and junk foods may significantly decrease a person's sodium intake. As a reference, one teaspoon of salt contains 2,000 milligrams of salt.
  • Ornish diet: The Ornish diet is a low-fat vegetarian way of eating, with less than 10% of daily calories from fat (an average of 15 to 25 grams of fat per day), 70-75% from carbohydrates, and 15-20% from protein. This diet encourages consumption of beans, fruits, vegetables, and whole grains, and it limits intake of processed foods, high-fat dairy products, simple sugars, and alcohol.
  • Dr. Dean Ornish, a physician who has directed clinical research for the past 25 years, created this diet as a lifestyle modification to reverse existing heart disease by emphasizing foods that are very low in fat yet filling, such as high-fiber grains and legumes (i.e., beans and peas). In addition to the proposed heart-healthy effects of the Ornish diet, patients may also lose weight. Based on Ornish's research, patients lost an average of 25 pounds over the course of a year.
  • The Ornish diet is completely vegetarian. Cholesterol and saturated fat are excluded; no animal products (except egg whites and nonfat dairy products) are allowed. All nuts, seeds, avocados, chocolate, olives, coconuts, and oils are eliminated, except for a small amount of canola oil for cooking and oil that supplies omega-3 essential fatty acids. The Ornish diet also prohibits caffeine but allows a moderate intake of alcohol and salt. There is no restriction on calorie intake. Several small meals a day rather than three large meals is also recommended.
  • South Beach DietT: The South Beach DietT is a low-carbohydrate diet. Low carbohydrate diets aim to avoid carbohydrates that may spike insulin levels in the body. When a carbohydrate is high in what is considered by some as "bad" carbohydrates, a large burst of insulin is released from the pancreas in response to a drastic elevation in glucose in the blood.
  • The high insulin levels do not allow glucose to be converted into glucagon, the form of sugar that allows for fat to be used as energy. Instead, these high insulin levels promote the storage of fat in the body. Proponents believe that by avoiding these carbohydrates, individuals could avoid the storage of additional fat, as well as allow for current fat stores to be used as energy.
  • The South Beach DietT consists of three phases: 1. "kick-starting" weight loss, 2. reintroducing the "right" carbohydrates, and 3. "a diet for life." Phase 1 is intended to be followed for 2 weeks. Phase 2 is intended to last for as long as necessary to lose the desired amount of weight. Phase 3 is focused on maintaining a healthy weight.
  • Exercise:
  • Aerobic activity: The American Heart Association states that all healthy adults aged 18-65 years need moderate-intensity aerobic physical activity for a minimum of 30 minutes five days each week. Vigorous-intensity aerobic activity may be substituted instead, for a minimum of 20 minutes three days each week. Additionally, exercise combinations such as walking briskly for 30 minutes twice during the week and then jogging for 20 minutes on two other days is sufficient.
  • Muscle-strengthening activity: It is recommended that 8-10 exercises be performed on two or more nonconsecutive days each week using the major muscle groups. Muscle-strengthening activities include a progressive weight-training program, stair climbing, and similar resistance exercises that use the major muscle groups.

Theory / Evidence
  • Antioxidants:
  • It is currently unclear if oxidants cause disease, or if oxidants are produced as a result of the disease. Regardless, the stress caused by oxidants over long periods of time is thought to play a role in the development of many types of diseases, including heart disease, rheumatoid arthritis, Alzheimer's disease, Parkinson's disease, some conditions associated with diabetes, and some types of diseases where the brain loses its ability to function properly. The role of free radicals in heart disease is better understood than in other types of diseases. The arteries may harden due to oxidation of cholesterol, and over time, this process may result in heart disease.
  • The first large randomized trial on antioxidants and cancer risk was the Chinese Cancer Prevention Study, which was published in 1993. This trial investigated the effect of a combination of beta-carotene, vitamin E, and selenium on cancer in healthy Chinese men and women at high risk for gastric cancer. The study showed that the combination significantly reduced incidence of both gastric cancer and cancer overall.
  • The 1999 Women's Health Study (WHS) tested effects of vitamin E and beta-carotene in the prevention of cancer and cardiovascular disease among women age 45 years or older. Among apparently healthy women, there was no benefit or harm observed from beta-carotene supplementation. The Selenium and Vitamin E Cancer Prevention Trial (SELECT) is currently investigating whether taking selenium and/or vitamin E supplements may prevent prostate cancer in men age 50 or older. The Physicians' Health Study II (PHS II) is a follow-up of the earlier clinical trial by the same name and is currently investigating the effects of vitamin E, vitamin C, and multivitamins on prostate cancer and total cancer incidence.
  • Diet:
  • Atkins dietT: The Atkins dietT is based on the theory that overweight people eat too many carbohydrates. Bodies burn both fat and carbohydrates for energy, but carbohydrates are used first. By drastically reducing carbohydrate intake and increasing protein and fat intake, the body will, in theory, naturally lose weight by burning stored body fat more efficiently. Some experts have attributed the success of the Atkins dietT to a significantly reduced intake of calories, rather than changes in the body's metabolism. However, the specific way that the Atkins dietT changes the body's metabolism is unknown.
  • DASH diet: The DASH diet was based in part from data about the lower incidence of certain health problems experienced by vegetarians. It has been found that vegetarians tend to have a lower risk of suffering a stroke, heart attack, or kidney failure due to high blood pressure because individuals who follow a vegetarian diet tend to have lower than average blood pressure. A vegetarian diet also tends to be higher in unsaturated fat, fiber, calcium, potassium, and magnesium than other diets. A 2006 trial by Elmer et al. evaluated several behavioral interventions to lower blood pressure and improve lifestyle behaviors of patients with high blood pressure. The length of the trial was six months. Patients who followed the DASH diet showed a statistically significant reduction in weight and sodium and fat intake. In addition, these individuals also statistically increased their intakes of minerals, fiber, dairy, fruits, and vegetables. The authors concluded that patients who undergo and sustain multiple lifestyle modifications, such as those required by the DASH diet, improve their blood pressure readings and may reduce their risk for chronic disease.
  • Ornish diet: The Lifestyle Heart Trial studied the effects of the Ornish diet. On average, Dr. Dean Ornish's patients lost 24 pounds in a year and had a 37% reduction in low-density lipoprotein (LDL) cholesterol levels; high-density lipoprotein (HDL) cholesterol levels were unchanged. Additionally, there was a 91% reduction in angina frequency (chest pain) and a significant degree of angiographically measured coronary stenosis regression. It was unclear to what degree other lifestyle modifications such as exercise and stress reduction, which are integral parts of the Ornish program, played in these results. Another study compared the Atkins, Ornish, Weight Watchers, and Zone diets. The study set out to assess adherence rates and the effectiveness of the four popular diets for weight loss and cardiac risk factor reduction. Each diet was shown to significantly reduce the LDL/HDL cholesterol ratio by approximately 10% with no significant effects on blood pressure or glucose after one year. For each diet, decreasing levels of total and HDL cholesterol, C-reactive protein, and insulin were significantly associated with weight loss, with no significant difference between diets.
  • Overall, there are mixed findings about the Ornish diet's efficacy (low carbohydrate, calorie restriction, etc.) compared with other diets. However, most results seem promising, and the Ornish diet and lifestyle modification may be effective in reducing cardiac disease risks and aiding in weight loss.
  • South Beach DietT: Recent studies have shown that patients placed on low-carbohydrate diets such as the South Beach DietT lost more weight than similar patients placed on low-fat diets, such as the National Cholesterol Education Program (NCEP) diet or the American Heart Association diet. Additionally, these patients also had greater decreases in triglyceride levels at the end of the studies. Other studies have duplicated these results and suggested that these low-carbohydrate diets not only increase weight loss but also decrease markers for cardiovascular disease, for example LDL cholesterol levels. Experts suggest that even though this diet may be healthier than other low-carbohydrate diets because it includes most of the major food groups, most of the weight lost in the first phase has been found to be water weight.
  • Exercise:
  • Exercise helps to promote overall health and may decrease the risk of developing illnesses, such as heart disease. There is extensive scientific evidence suggesting that regular exercise offers major health benefits. According to the U.S. Centers for Disease Control and Prevention (CDC), the failure to exercise regularly is a significant precursor to heart disease, stroke, diabetes, and cancer. According to the U.S. Department of Health and Human Services and the U.S. Department of Agriculture (USDA), poor diet and physical inactivity may be associated with a variety of conditions, including cardiovascular disease, type 2 diabetes, hypertension, osteoporosis, and certain cancers. Current opinion finds that regular exercise boosts energy, encourages healthy sleep patterns, and helps individuals maintain a regular weight. All major medical organizations recommend exercise as one of the most important ways to stay healthy and recover after illness.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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