Ask the Experts: Nutrition

Ask the Experts...

Dear Burn Community, 

Welcome to "Ask the Experts," Journey Magazine's advice column. In this edition, we received common questions about returning to work, how therapy can help your recovery, and the importance of nutrition. As we respond to submitted questions from the community, we draw on our personal and professional experience to offer guidance and do our best to make it good advice.

Want your question featured in the magazine? Email resources@phoenix-society.org with "Ask the Experts" in the subject line. No question is off limits! Odds are, someone else is facing a similar challenge.

Sincerely,

Lise, Felicia, Sam

Question: Nutrition

Dear Experts,

I’m helping to care for my mom after she sustained a major burn injury. She’s recovering at home now, but getting her to eat is an ongoing problem. She says she’s “not in the mood” or “not hungry”, but I know diet and nutrition is important for healing. What are the most important foods she should be eating? And are there vitamins or supplements she should be taking?

Drew

RESPONSE FROM Dr. Felicia Williams

Dear Drew,

This is a very good question, as one of the most challenging aspects of care after a major burn is getting the appropriate amount and type of calories to maintain lean body muscle mass, wound healing, and keep up energy requirements to not only live but thrive.

People have difficulty reaching, achieving, and maintaining caloric requirements for multiple reasons. Depending upon the size of the burn, the amount of calories required may be unrealistic for people to achieve by normal means (eating or drinking), and some may require temporary feeding access (gastric tubes, nasogastric tubes, etc). In the hospital, the calories needed to survive, heal, and thrive after major burns are calculated and adjusted based on one's burn size, activity level, and presence or absence of infection. There are healthcare providers available to adjust and monitor progress and assess changes in activity and healing that would allow adjustments in caloric needs. Any changes in mood, environment, emotional health, well-being, physical health, and taste can also affect our ability to eat. Healthcare providers assess those changes as well.

Any sudden changes in diet or hunger may be a reflection of more than just being hungry. Reaching out to your mother’s healthcare team may be helpful to prevent any wound breakdown or significant weight loss. Consider several smaller meals versus three large meals if she is less interested in eating or feels full quickly.

Caloric quality is a separate issue. One of the hallmarks of major burns is full-body catabolism, or the breakdown of molecules, specifically proteins, for energy. Energy is required to live, move, breathe, and heal. There are three main food categories: carbohydrates, protein, and fat. All three provide energy. Carbohydrates are the primary source of energy for people after major burns. While carbohydrates and fats are relatively easy to eat when we are hungry, eating those can only prevent a small amount of protein breakdown after major burns. Thus, a significant amount of protein is needed to provide the building blocks for healing, building muscle, stopping ongoing muscle breakdown, and supporting the immune system.

Eat foods high in protein first during meal and snack times. These include meats, fish, chicken, eggs, dairy, soy, other beans, and meat alternatives. Smoothies, shakes, protein powder, and prepackaged protein drinks are good options for someone who is not in the mood to eat. They can provide much-needed protein, energy, and other nutrients without being as filling. They can also be consumed in between mealtimes as a snack or as a beverage with meals if she is hungry enough to consume both. While higher calorie recipes and options are preferable when the goal is to thrive after a burn, she is most likely to be consistent with her needs and intake when she finds something that tastes good to her!

Having readily available snacks around can make it easier to meet nutrition needs. Consider nuts, seeds, and dairy such as yogurt, cheese, cottage cheese, and granola are a few examples of easy-to-reach nutrient-rich snacks.

Depending upon the size of injury your mother had, the caloric needs outlined by her medical team, and her ability to consume those calories, she may need supplements to help meet her daily caloric and nutritional needs. A multivitamin is a good option if it is difficult to consume many fruits and vegetables to meet vitamin and mineral needs. Supplement manufacturers are not required to verify their products with the FDA [Food and Drug Administration] before they hit the market. Products with the "USP" (United States Pharmacopeia) label have been independently tested to show they contain what the label says they contain. However, balanced meals often supply key macro and micronutrients, making further vitamins and supplements unnecessary.

It is reasonable to ask for a reassessment of her caloric needs. If it is an appetite issue, this can also be addressed by her healthcare team while they also try to get at the root of why this may have changed. Her team can help guide her to the right amount of carbohydrate, fat, and protein calories she needs to continue to be successful.

Dr. Felicia Williams is a Burn Surgeon at the University of North Carolina - Chapel Hill. She is an Assistant Professor in the Department of Surgery and is the Associate Division Chief for the Burn Division. She completed her General Surgery Residency at ECU and her training in Galveston under Dr. Herndon, dedicating her life to burns. She has many publications, with a current research focus on health disparities in burn care.