Healing Phases and Nutrition No matter what part of the body is undergoing surgery, the internal process for healing is pretty much the same! Surgically "traumatized tissue" (skin, muscle, bones, cartilage, tendons, etc.) does not just magically heal; rather, the body has to rebuild and repair tissue on the cellular level. This involves energy and the nutritional building blocks to support the healing process. Our nutritional demands are increased following joint replacements as our bodies move into the 'repair and recovery' phases. Healing starts the very moment our surgeon begins and involves a series of orchestrated biochemical reactions, involving the activity of an intricate network of blood cells, tissue types etc. It is important to first explain the composition of connective tissue, which is found in nearly every structure in the body and performs a myriad of physiological functions. The two main fibrous components of connective tissue are collagen and elastin. The majority of this connective tissue is collagen, which is comprised of the amino acids lysine, proline, and glycine assembled together in molecular cables and sheets. These collagen cables and sheets are the structural beams, walls, and scaffolding of the body's cells. Even the seemingly inorganic bones of the body are comprised of a finely organized structure of collagen cables between which minerals are laid down. The structure and function of these fibers are greatly impacted by the healing process. Immobilized; these components will heal in a haphazard fashion, laying down in a variety of directions, causing a phenomenon known as cross-linking. That is one of the reasons we are encouraged to undertake gentle movement in the first six weeks. It is often the connective tissue which causes longer term issues. Medically, there are four phases of healing, the first phase commences in the OR, whilst we are snoozing away. I will explain the following three phases as we are now awake. Each phase is distinct, although the healing process is continuous with each phase overlapping the next. Inflammatory phase (up to 5 days): The body's first response involves forming a localized blood clot to stop bleeding. Inside the clot our immune system is kicking into gear with infection fighting cells called Neutrophils and Macrophages. These Neutrophils and debris cleaning cells (Phagocytes and Macrophages) are recruited to the traumatized area, where they begin cleaning up the debris and providing our first line of defense against infection. Neutrophil migration ceases after the first few days post-injury if the wound is not contaminated. By the way, in Greek the word phagocytes means 'cells that eat'... This inflammatory phase often presents itself as reddening of the skin due to inflammation which is usually a result of accumulation of the immune cells and chemicals these cells release, swelling, and warmth (hence we often find our temperature rises) and is often associated with pain. Remembering that all phases of healing are overlapping, this explains why some of us experience these symptoms for much longer timeframes and to differing degrees. Proliferative phase (2 days - 3 weeks): The body now starts building tissue with specialized collagen-forming cells called Fibroblasts. This new tissue is called granulation tissue and special growth factors to stimulate skin formation called epithelialization. Our incision is now healing, this is also the phase where the cross-linking (as explained earlier) occurs. Remodeling phase (3 weeks - years): The body transforms and replaces the collagen that was placed down during the proliferative phase into a stronger collagen to support the structure and function over the long term. This newly formed collagen is strong, very strong with high tensile strength; however improperly formed collagen at this stage may have the potential to present as issues later as we start to become more mobile, exercising, stretching etc. as the original cross-linkage connective tissue has to realign in the parallel formation. The remodeling is a very slow process which can take anywhere from 3 to 9 years to complete, not that I am trying to discourage you as this is happening whilst you are mostly unaware and getting on with living! However, it is important to understand this, as I often mention recovering from a joint replacement is a marathon, not a sprint! Now you have a glimpse into how our bodies are going about the magical process of repairing and healing, so how can we help with nutrition, what vitamins and minerals do we need? I am not encouraging anyone to take supplements, that is an individual choice, I am a firm believer that 'we are what we eat' and my favorite quote from the Greek physician... “Let food be thy medicine and medicine be thy food” ― Hippocrates Vitamin C: Necessary to build and rebuild collagen throughout the body. Vitamin C is also a powerful antioxidant that supports our immune response. We lack the ability to store vitamin C, so we must replenish it daily. Strawberries, one of the tastiest and healthiest berries on the planet, strawberries are extremely high in vitamin C. Strawberries aren’t just a Vitamin c food, however, they’re also high in fiber and the antioxidants. Just one serving holds about half of your daily Vitamin C needs. But don't just think strawberries, all berries are rich in Vitamin C and antioxidants. Acerola Cherry, is a small red fruit that is packed with Vitamin C! It holds about 65 times the amount of Vitamin C than an orange! You may have to hunt around for these cherries, but they are such power packed vitamin C and antioxidants treats! Citrus Fruits, oranges, grapefruits, lemon and limes! Citrus fruits pop a powerful vitamin C punch. Peel one medium orange for a whopping 70mg. A small glass of fresh OJ has up to 93mg of Vitamin C, and a small glass of grapefruit juice has up to 70 mg of Vitamin C. Papayas, are another food high in Vitamin C, with one serving holding 100% of your daily needs. Try throwing some in your next smoothie or yogurt. This bright fruit it also high in vitamin A, more about that later! Black Currant, with its deep dark purple hue, its easy to imagine that this fruit would be high in Vitamin C. Black currants hold around 180mg per serving, as well as plenty of potassium, iron, vitamin B5 and phytochemicals. Kiwi, it may surprise you to learn that this small bright green fruit mainly from New Zealand has more Vitamin C than an orange! They are also high in flavonoids and have as much potassium as a banana. Bell Peppers (called capsicum in OZ), are another food high in Vitamin C, as well as beta carotene. These colorful veggies have been studied for the blood clot formation benefits. One half cup of raw red pepper holds over 140 mg of vitamin C. All bell peppers are high in vitamin C, but yellow are the highest and red come in second. Guava, this exotic fruit is another great Vitamin C food, with one Guava containing over 250 mg. They are also rich in dietary fiber, folic acid, potassium and manganese, making guavas one of the best super foods to add to your diet. Many supermarkets are now importing these fruits from the tropics, so they are easier to find. Brussels Sprouts, while not everyone’s favorite food, Brussels sprouts have a great Vitamin C reputation. One serving of cooked Brussels sprouts has almost 50 mg of vitamin C. Brussels sprouts are also high in Vitamin K, Folate, Vitamin A, Manganese, Potassium and dietary fiber. Melons (sometimes referred to as cantelopes) have Vitamin C. Just one cup of melon will provide you with approximately 67 mg of vitamin c, plus plenty of vitamin A and Potassium. Additionally, watermelon is another great source of Vitamin C. Dark leafy greens, kale, mustard greens, turnip greens, watercress, chard and spinach (as well as most other leafy greens) are all great Vitamin C foods to add to your diet. While they all provide different amounts of this essential nutrient, they are all very healthy for you. Kale would be the best choice, as it may have up to 130 mg of Vitamin C in one serving. That is one day’s Vitamin C needs in a single serving! Broccoli, you can never go wrong with broccoli. One serving of this little green tree has over 90 mg of Vitamin C. Broccoli is also one of the best detox foods to add to your diet. Another addition to your green smoothie! Cauliflower, while not as colorful as some of our other foods high in Vitamin C, Cauliflower holds its own with this essential nutrient. Just one cup of Cauliflower will give you approximately 46 mg, not to mention plenty of Vitamin K, folate and dietary fiber. Go slowly with kale and the crucifers vegetables while you're on on blood thinning meds though! Other nutrient-dense veg are: carrots, beets, asparagus, tomatoes, sweet potatoes, artichokes. A special nutrient-dense fruit is avocado - an excellent source of vit B6, but also vit C, zinc, magnesium, manganese and those healthy monounsaturated fatty acids. Tomatoes, bright red tomatoes are another common Vitamin C food. Try using sun-dried tomatoes as they are particularly concentrated in this essential nutrient. Just one serving of 100 grams holds over 100 mg of vitamin C. Many fresh herbs such as cilantro (coriander here in OZ), chives, thyme, basil and parsley are high in Vitamin C. Buy some fresh herbs and sprinkle on most meals. In fact, just one cup of fresh parsley has over 130 mg of Vitamin C, so don't forget to include parsley in your green smoothie! Vitamin A: Supports immune system functioning and aids collagen strength and is also required for bone development. The term "vitamin A" makes it sound like there is one particular nutrient called "vitamin A," but that is not quite true. Vitamin A is a broad group of related nutrients. Vitamin A: retinoids (found in animal foods) and carotenoids (found in plant foods). These two forms aren't just chemically different - they also provide us with different types of health benefits and may be provided in different ways. There are some specific immune, inflammatory benefits of vitamin A that can only be obtained from the retinoid forms of the vitamin. These retinoid forms can be especially important with respect to red blood cell production, and resistance to infectious disease. Like the retinoid forms of vitamin A, the carotenoid forms also provide us with unique health benefits. Most carotenoid forms of vitamin A also function as antioxidant and anti-inflammatory nutrients. So what foods provide vitamin A ... Sweet potato, Carrots, Spinach, Kale, Collard greens, Turnip greens, Swiss chard, Mustard greens, Romaine lettuce, Cantaloupe, Papaya, Bell peppers, Tomatoes, Cayenne pepper, Leeks, Grapefruit (pink/red), Green peas, Asparagus, Watermelon, Green beans, Apricot, Brussels sprouts, Parsley, Broccoli, Oatmeal. Cows milk, Shrimp, Eggs, Salmon, Halibut, Cheese, Yogurt, Sardines, Scallops, Tuna, Cod, Chicken Tuna. Zinc: An essential micromineral used in enzymatic reactions involved in tissue and wound healing, regeneration and repair, needed every day, but only in very small amounts. Many types of immune cells appear to depend upon zinc for optimal function. Foods which provide zinc.... including asparagus, chard, scallops, lamb, beef, maple syrup, shrimp, green peas, yogurt, oats, pumpkin seeds, sesame seeds, turkey, miso, and spelt. Vitamin K: Aids the natural blood clotting response and is important for bone health. Excellent sources of vitamin K include parsley, kale, spinach, brussels sprouts, swiss chard, green beans, asparagus, broccoli, kale, mustard greens, turnip greens, collard greens, thyme, romaine lettuce, sage, oregano, cabbage, celery, sea vegetables, cucumber, leeks, cauliflower, tomatoes, and blueberries. B-Vitamins: Cellular metabolism, tissue repair and immune support, B6, B12, folic acid. There are eight B-group vitamins, which are essential for bodily functions such as energy production and making red blood cells. In addition as the B Bitamins are crucial for energy I am writing a separate article for these. Vitamin D & Calcium: Important for bone health and don't forget Silica (precursor to Calcium). As mentioned earlier to keep bones strong, your body is constantly breaking down old bone cells and growing new ones as part of the remodeling phase. To fuel bone growth, keep bone density strong, and prevent osteoporosis, you need a good supply of calcium from dairy products and other foods. But you also need enough vitamin D. Without it, you could drink milk all day and may not in fact absorb the calcium. Vitamin D is key in absorbing calcium! Our body doesn't make calcium on its own. The best way to get more calcium is to improve your diet. You already know that dairy products, such as milk, cheese, and yogurt are good sources of calcium for those who don't have lactose or other dairy intolerance there are other foods that are high in calcium which include, Spinach, Kale, Okra, Collards, Soy beans, White beans, some fish such as sardines, salmon, perch, and rainbow trout. http://bonesmart.org/forum/threads/vitamin-d.20806/ Magnesium: Mineral involved in approximately 300 biochemical reactions. Check out my article... http://bonesmart.org/forum/threads/magnesium-is-a-star.20301/ Protein is an essential component of the diet, because it provides the amino acids that the body needs to synthesize its own proteins. Proteins are critical for wound repair and immune function. There are essential (our body cannot synthesize on its own) amino acids and therefore must be obtained from our diet, and non-essential amino acids. As the topic of proteins is complex, I plan to write a separate article however, for this article, I am sure you have awareness of good protein.. Other minerals that you need in small amounts such as boron, copper, manganese. As these as micro-minerals are quite interesting, I also plan to write a separate article for these... Well, if you have read through this, I applaud you! As this is a joint replacement forum, I concentrate my remarks regarding nutritional vitamins and minerals specific to joint replacements. It is important to note that balanced and varied nutrition is very important to other health issues. Cheers, Poppet. Disclaimer: The information on dietary factors, foods, and beverages contained in this article does not cover all possible uses, actions, precautions, side effects, and interactions. It is not intended as medical advice for individual problems. Liability for individual actions or omissions based upon the contents of this article is expressly disclaimed. Consult a doctor or other health care professional for diagnosis and treatment of all medical conditions including the taking of supplements.