14
Dietary Factors in Healing and Specific Nutrients
Arginine
• Arginine is a conditional essential amino acid that can be synthesized by
the body from glutamine and is a precursor of nitric oxide and proline. It
plays an essential role in the inflammatory process and collagen synthesis,
regulates pathways required for tissue cell growth, replication and repair
and may be beneficial to enhance wound healing.
▶ Arginine can become essential in malnourished patients with DFUs or those at
risk of DFUs.
• Arginine is beneficial in larger dosages when a diabetic wound is present
since it has been shown to enhance wound strength and collagen deposition.
▶ Supplemental arginine improve markers of wound healing such as greater protein
and hydroxyproline in the wound bed, enhanced T-lymphocyte function, and
promotion of positive nitrogen balance.
• For patients who have existing diabetic wounds with adequate protein
intake, the recommended dose of arginine supplementation is 4.5 g/day.
Glutamine
• Glutamine is also a conditional essential amino acid. It becomes essential
when wounds are present since it helps support the immune system and
helps stimulate collagen synthesis.
• Glutamine is also essential for wound repair. It is used by intestinal cells
within wounds for cell proliferation, and inflammatory cells including
lymphocytes and macrophages.
• When the body's immune system is affected due to illness and or infection,
the demand for glutamine is high since inflammatory cells use glutamine as a
leading source of fuel.
• Recommended glutamine doses range from 20–40 g daily depending on the
condition being treated.
