Nutrition for Tissue Repair & Pain by Sophie Knapp, MScN, CN

July 03, 2022

Summer is finally in full swing in the PNW! The sun is shining sweetly, and the abundance of light coupled with its warmth is inviting all of us to get outside and play! During this period of abundant energy, none of us want injury or pain to hold us back from participating in the activities we love with the ones we love.

Injury and pain are vast, complex topics. Despite their complexity, these guidelines cover the basics and some supplemental options for holistically nourishing yourself to promote healing for various types of acute injury: minor cuts, scrapes, and burns; bumps & bruises; sore & pulled muscles; & severe, acute injury such as broken bones, torn ligaments, & recovery from surgery. 

Though the recommendations made in this article are generally considered very safe, the nature of your injury & the full picture of your health beyond that injury are incredibly important for determining the best course of healing & pain management for you. It’s always best to consult your healthcare provider(s) before beginning any specific eating plans or supplement/herbal regimes to ensure you’re walking the path of natural, holistic healing safely.

For all acute injury:

Nourishing yourself holistically during healing involves managing inflammation, consuming adequate amounts of necessary nutrients while minimizing less healthful foods, and caring for your mind to keep your mental health strong during recovery.

Inflammation and Injury:

Some inflammation is necessary! 

It’s how your body delivers extra nutrients & immune cells to a wounded area so that it can heal. However, inflammation also brings on pain & oxidative stress, so although it’s healing, it’s helpful to keep a lid on inflammation to bring pain down to a manageable level while your tissues repair. Achieving this comes through managing stress levels, eating colorful, nutrient-dense, whole foods, and perhaps involving some supplements.

Eat whole, fresh, & colorful foods:

While healing, eat a wholesome, diverse diet to ensure you’re getting adequate amounts of all nutrients. For example, if you’re trying to heal a cut, your body needs zinc, vitamin C, biotin, vitamin A, and more to carry out the process of building new skin and to pull the edges of your wound back together.1 Eating habits rich in whole, fresh foods contains these essential micronutrients, making healthy eating a top priority to promote healing.

Prioritize Protein:

Protein is so important while you’re rebuilding tissues. Your daily need for it increases during times of healing. 

Your protein needs also increase when you’re stressed, which is one of the reasons why finding ways to relieve stress while recovering is worth your while. Curious about ways to reduce your stress levels? Check out this blog post I wrote, especially the last section for practical application.  

While mending your tissues, ensure you’re eating adequate protein for your body size, composition, and physical activity level. Unsure what your needs are? A nutritionist can help you figure that out in a precise manner, or at the very least, bump add an extra serving of protein or two to your baseline intake.

Focus on Complex Carbohydrates:

Complex carbohydrates are another nutrient that play an important role in healing by enabling fibroblasts, the cells that produce collagen, to migrate to the injury site.2 You’re definitely going to need those around if you want to heal, so focus on consuming fruits, vegetables, whole grains, and high fiber carbohydrate-based foods while avoiding simple carbs.

Nourish Your Microbiome:

Support your microbiome, especially if your injury breaks the skin. You want a robust, diverse community of microbes symbiotically coexisting in your body to decrease your likelihood of infection and/or allergic reaction. A few basics for how to do this include avoiding alcohol and processed foods. Both tend to kill off beneficial species and set the stage for harmful bacteria to colonize your gut. Stress will throw your microbiome out of whack too–another reason to pay attention to your levels and mindfully address them. 

Eat at least thirty unique plant foods/week, and that includes herbs!3Fiber is food for microbes, and plants are rich in fiber and other constituents like polyphenols that nourish your microbes and allow all kinds of helpful ones to flourish. Getting enough diversity of fiber and other forms of “microbe food” will in turn support the diversity of your community of microscopic friends. Curious to learn more about the microbiome? Give this other article I wrote a read. 

Minor cuts/scrapes/burns:

Set the Neosporin and triple antibiotic creams aside, and reach for all natural disinfectants. Though sometimes necessary and currently widely used, topical antibiotics could be causing some trouble. There are scientists out there blowing the whistle, encouraging us to slow our use of them because they’re likely contributing to antibiotic resistance. Viruses and bacteria can replicate so quickly that they have been able to adapt to the use of these agents. Additionally, commonly used antibiotics are increasingly causing allergic reactions. 

Natural alternatives you can reach for are usually herbal-, essential oil-, or honey-based. They’re not as strong of microbe killers as antibiotics, which is beneficial for promoting the use of your body’s natural defenses & mitigating the growing issue of antibiotic resistance. Certain herbs used in these formulas often times contain healing-promoting constituents and can be additionally beneficial in that way.

Calendula:

Calendula may be helpful for promoting skin healing from cuts & burns.4 Specifically, one study on rats found that it helped promote angiogenesis, the growth of new blood vessels, in burned areas of the animals.4 With fresh blood vessels, the body is able to deliver nutrients via blood flow to the harmed part of the body & enable healing. Another study analyzing burn healing in rats found that a mixture of calendula, chamomile, rosemary, and dryer’s alkanet in ointment helped decrease skin healing time.5

Vitamin E oil:

Vitamin E oil could be another magic skin healer that helps to maintain the integrity of cell membranes by preventing inflammation from damaging them.6 Two review articles, one from 2013 & another from 2016, indicate that although there’s mixed evidence out there, some studies show promising effects of vitamin E to improve skin healing time & reduce the appearance of scars, including those that appear raised or bubbly & are referred to as hypertrophic scars or keloids.7,6

Bumps & bruises:

Have you ever stubbed your toe or jammed your finger & immediately, gripped or rubbed it with intense pressure? It could be instinct that makes us do that, & it has to do with a fascinating concept called Gate Pain Theory. 

We reflexively reach for our stubbed toes to apply pressure because that pressure actually reduces our perception of pain. We have multiple types of nerve fibers that pick up on different sensory stimuli. In this case, the two of importance are fibers that send pressure signals to the brain and those that send pain signals. Amazingly, the fibers that communicate a sense of pressure are able to send signals significantly faster than the fibers that tell us we’re in pain. By applying pressure to a painful area, we’re able to “close the gate,” or block the pain signal from reaching our brains by overriding it with a pressure signal. Just a fun fact for the next time you find yourself intensely grabbing a jammed finger! You’re actually helping reduce the perceived amount of pain.

Although it’s great that we can reduce the pain from bumps & bruises using this simple action, how can we actually encourage them to heal? 

Arnica:

Arnica is a well-researched herb in its ability to heal bruises & reduce muscle pain. Though a clinical trial from 2003 concluded that arnica exhibits no significant effects,8 subsequent articles argue that the trial & its interpretation weren’t handled responsibly.9  However, beyond those two articles, there remains little open access literature investigating the efficacy of arnica on bruise-healing,10 and one article that seemed promising has since been retracted.11 That being said, it’s an herb that’s very commonly used and seems to have little or no side effects. Stay tuned for more research in the future!

Sore & pulled muscles:

Magnesium:

Magnesium is a wonder-mineral for muscles. Choosing the right form to take can be important for absorption and mitigating its effects on the bowels. 

Certain forms of magnesium can cause water to be pulled into the intestines and induce a bowel movement. Magnesium oxide seems to exert this effect most strongly, while magnesium citrate isn’t far behind in inducing bowel movements, i.e. making you need to go number two, sometimes urgently. Though this seems negative, when used appropriately, these two forms of magnesium can be quite beneficial to keep folks regular if they experience constipation on an ongoing basis.

Magnesium glycinate is the alternative to oxide and citrate and tends to be better absorbed, avoiding the movement-inducing effects. 

Magnesium taurate and magnesium threonate are able to cross the blood brain barrier, which can make them good options for specifically attenuating headaches and other brain-related discomfort.

To avoid any effects on your bowels, and for a relaxing, stress-relieving experience, you could take an epsom salt bath. Epsom salts are made of magnesium, and by bathing in them, you absorb magnesium through the skin.

How does magnesium actually help your muscles? It’s effective at blocking pain receptors in our muscles, helping us feel less sore.12 That being said, a review article published in Nutrients in 2021 investigated more detailed mechanisms of action of magnesium in more specific cases like rheumatic disease and cancer and found that there is still insufficient evidence to clearly see why it’s effective for some folks and not others.13

Topical Essential Oils:

DoTerra Deep Blue Rub is essential oil based icy hot! As a rock climber, I frequently tweak muscles and find myself sore from strength training. In addition to daily magnesium supplementation, this is my go-to for calming inflammation and turning down the pain signals from my recovering muscles. It’s a product my WILLOWTREE co-workers & I recommend frequently to folks dealing with muscle soreness, and many of them grow a similar affection for the product. Just be sure to wash your hands well after use & don’t touch your eyes until your hands are well-washed! The cayenne, peppermint, and other oils will cause discomfort and could cause damage if they end up in your eyes.

CBD:

CBD is another promising supplement for reducing inflammation and managing acute and chronic pain.

It’s been shown to be a strong antioxidant and have anti-inflammatory properties as summarized in a 2019 study.14 Additionally, a review article from 2020 summarized numerous, well-backed mechanisms of action for CBD improving pain perception for neuropathic pain, inflammatory pain, osteoarthritis, and more.15 Though CBD is convincingly effective for improving inflammation and pain perception, it doesn’t have the same degree of effect for everyone. Further research is needed to better understand why this variation exists.

Turmeric:

Being the most studied herb in the literature, most all of us are familiar with the idea that turmeric is a strong anti-inflammatory agent, but it has other tricks up its sleeve too. According to a 2019 study published in International Journal of Molecular Sciences, turmeric, more specifically its active constituent curcumin, could be a key facilitator of wound healing and may speed up the repair process. In the article, the team of scientists dove into how it may help balance the inflammatory response and reduce the length of time it lasts. In addition, turmeric may aid in collagen synthesis to further accelerate connective tissue repair.2

Inflammation is often an overarching contributing cause to some of your pain. Mitigating it with a natural anti-inflammatory like curcumin, could help to optimally lower the level of inflammation, and therefore also could help reduce how much it hurts.

A couple tips on eating and supplementing turmeric to optimize absorption. Some companies have patented forms of curcumin that can be absorbed on an empty stomach. More commonly though, turmeric, when cooked or supplemented, has a couple of requirements to be absorbed. First, it’s fat soluble, meaning you need fat in your digestive tract in order to absorb it. Second, black pepper is needed for it to be absorbed. 

Severe acute injury like broken bones, torn ligaments, and recovery from surgery:

Collagen:

For injuries like this that involve large volumes of connective tissue in need of repair, bringing collagen peptides on board may help you heal up faster and stronger, especially when combined with movement.16 

The idea behind moving following collagen ingestion to improve its efficacy is that our connective tissues like tendons and ligaments don’t normally have a lot of blood flow. By moving around as in walking, running, or engaging in specific strength training exercises 30-60 minutes after ingesting collagen, when it’s peaking in your blood stream, recruits blood flow to those connective tissues. In that way, it helps those collagen amino acids get to the place they need to be, i.e. the site of injury.

There’s also robust evidence out there that taking vitamin C is necessary for your collagen supplement to actually manifest in more collagen being created in your body.17 It’s a signal for collagen to form, so taking it at the same time as your collagen supplement is recommended.

A Quick Note on Chronic Pain:

A healthy, anti-inflammatory diet is usually helpful to ensure dietary factors aren’t aggravating or causing the pain in the first place. However, there’s still possible ways that eating habits and diet composition can contribute to pain. That’s where working with a specialist like a holistic nutritionist, naturopath, functional medicine doctor, physical therapist, massage therapist, acupuncturist, counterstrain specialist, craniosacral practitioner, and other professionals comes into play to help you identify if other specifics about your dietary intake, environmental exposures, and lifestyle are contributing to your pain. 

Consider consulting any one of those types of practitioners to get starting on finding the root cause of your pain, especially if you’ve exhausted your options in the Western medical system, or are wanting to avoid taking medications or having surgery. You can also start by trying on some of the guidelines for “all acute injury” outlined early in this article.

References:

1. Quain AM, Khardori NM. Nutrition in Wound Care Management: A Comprehensive Overview. Wounds. 2015;27(12):327-335.
2. Barchitta M, Maugeri A, Favara G, et al. Nutrition and Wound Healing: An Overview Focusing on the Beneficial Effects of Curcumin. Int J Mol Sci. 2019;20(5).
3. McDonald D, Hyde E, Debelius JW, et al. American Gut: an Open Platform for Citizen Science Microbiome Research. mSystems. 2018;3(3).
4. Parente LML, Andrade MA, Brito LAB, et al. Angiogenic activity of Calendula officinalis flowers L. in rats. Acta Cir Bras. 2011;26(1):19-24.
5. Farhan A, Alsuwayt B, Alanazi F, Yaseen A, Ashour MA. Evaluation and HPLC characterisation of a new herbal ointment for the treatment of full-thickness burns in rats. J Taibah Univ Med Sci. 2021;16(2):152-161.
6. Tanaydin V, Conings J, Malyar M, van der Hulst R, van der Lei B. The Role of Topical Vitamin E in Scar Management: A Systematic Review. Aesthet Surg J. 2016;36(8):959-965.
7. Rahmani N, Hashemi SA, Ehteshami S. Vitamin E and its clinical challenges in cosmetic and reconstructive medicine with focus on scars; a review. J Pak Med Assoc. 2013;63(3):380-382.
8. Stevinson C, Devaraj VS, Fountain-Barber A, Hawkins S, Ernst E. Homeopathic arnica for prevention of pain and bruising: randomized placebo-controlled trial in hand surgery. J R Soc Med. 2003;96(2):60-65.
9. Richardson J. Homeopathic arnica. J R Soc Med. 2003;96(4):204; author reply 206-207.
10. Harris L, Darby P. Enhanced Recovery after Abdominoplasty Using Perisurgical Nutritional Supplementation. Plast Reconstr Surg Glob Open. 2020;8(12):e3314.
11. Marzotto M, Bonafini C, Olioso D, et al. Arnica montana Stimulates Extracellular Matrix Gene Expression in a Macrophage Cell Line Differentiated to Wound-Healing Phenotype. PLoS One. 2016;11(11):e0166340.
12. Shin HJ, Na HS, Do SH. Magnesium and Pain. Nutrients. 2020;12(8).
13. Morel V, Pickering ME, Goubayon J, Djobo M, Macian N, Pickering G. Magnesium for Pain Treatment in 2021? State of the Art. Nutrients. 2021;13(5).
14. Atalay S, Jarocka-Karpowicz I, Skrzydlewska E. Antioxidative and Anti-Inflammatory Properties of Cannabidiol. Antioxidants (Basel). 2019;9(1).
15. Mlost J, Bryk M, Starowicz K. Cannabidiol for Pain Treatment: Focus on Pharmacology and Mechanism of Action. Int J Mol Sci. 2020;21(22).
16. Praet SFE, Purdam CR, Welvaert M, et al. Oral Supplementation of Specific Collagen Peptides Combined with Calf-Strengthening Exercises Enhances Function and Reduces Pain in Achilles Tendinopathy Patients. Nutrients. 2019;11(1).
17. DePhillipo NN, Aman ZS, Kennedy MI, Begley JP, Moatshe G, LaPrade RF. Efficacy of Vitamin C Supplementation on Collagen Synthesis and Oxidative Stress After Musculoskeletal Injuries: A Systematic Review. Orthop J Sports Med. 2018;6(10):2325967118804544.

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