Food for Thought: Applying the Principles of Good Nutrition for Intervention and Healing

As rehabilitation professionals, we regularly work with individuals recovering from surgery, acute injuries, or chronic conditions. In all cases, we frequently are asked if there’s anything a patient can do at home to quicken their recovery time. One intervention that is easily adaptable but often overlooked is nutrition. Good nutrition habits have been demonstrated to have life-changing benefits, particularly when it comes to healing. Eating is a natural part of daily life that we all do, and with proper attention, our diet can work to help our bodies recover.

Basic Nutritional Needs for Recovery

The human body requires a baseline number of calories and nutrition to maintain basic processes. This baseline is called the basal metabolic rate (BMR). This required amount increases with physical demands, like exercise or and when the body is recovering from an injury or surgery.¹

The body’s needs for calories and protein increase by:

• 10 percent following elective surgeries
• 10-30 percent following trauma
• 50-80 percent during sepsis
• 100-200 percent following burns

Higher amounts of high quality proteins are needed for wound healing as they contribute to the immune response and tissue repair.²

Inflammation-Reducing Dietary Recommendations

For more common presentations such as chronic pain, overuse, or tissue injury, a diet that promotes health and reduces inflammation will be beneficial.⁴ In addition to their long-term health benefits, certain foods are known to reduce immediate plasma inflammatory biomarkers.³ One study looked closely at patients with rheumatoid arthritis (RA), comparing participants who followed a diet similar to the Mediterranean diet. Participants following a Mediterranean diet reported reduced joint pain and swelling, as well as lower VAS scores.

The Mediterranean diet is rich in:

• Fruits and vegetables
• Whole grains
• Fish
• Omega-3 fats

It minimizes consumption of:

• Processed and ultra-processed foods
• Red and processed meat

When to Implement Nutritional Guidance into Clinical Practice

One opportunity for implementing nutritional advice into clinical practice is during your initial evaluation. This is a time when healthcare providers typically make recommendations for home care, including pain control measures, safety precautions, or ergonomic setup. At this juncture, we can also discuss the immediate and long-term effects of the food we eat as it relates to inflammation and pain.

The topic of nutrition is often avoided in healthcare for several reasons, such as:

• We may assume the patient already knows the important role of food in their well-being.
• Nutrition information is easily accessible online.
• Diet can be a sensitive subject and we don’t want to alienate those whom we are trying to help.

However, if we do not address the very real relationship between nutrition and healing, patients may assume that it must not be a big deal. Likewise, it is important to consider that many patients would benefit from receiving guidance that is beyond that which you may be able to provide.

This guidance can be found through the aid of a registered dietitian (RD), who can provide knowledge and specific instruction based on the needs unique to the patient’s injury or diagnosis. Providing a referral to an RD may very well serve as the key to creating the dietary and behavioral adjustments necessary for nutrition to contribute to meaningful change.

Strategies for Addressing Nutritional Change

Most Americans do not build their meal plate based on recommended servings of the main food groups. When looking to help patients incorporate healthier foods into their diet to promote healing, it may be helpful to start with understanding how they normally approach nutrition. Here are some strategies for starting that conversation:

Ask Questions

Determining what changes need to be made to patients’ daily eating habits can be difficult if you don’t know what they regularly eat. Asking questions is one easy way to get this information.

Some simple questions to start with include:

• What does a typical day of eating look like for you?
• How many times a day do you eat?
• What types of food do you usually eat?
• What do you drink in a day?
• Do you take supplements?

The answers to these questions provide the perfect opportunity to recommend modifications and to ensure you’re talking to the person in the household who can implement them.

Use Empathy and Keep It Simple

Many people find dietary changes overwhelming. You can ask your patient directly if eating healthier or differently feels difficult or overwhelming to them. If so, try to find out why. Understanding the barriers your patient faces will help you effectively address their concerns. You can start by acknowledging their apprehensions and validating that change can be difficult.

Creating the foundation for change also means meeting a patient where they are at and respecting their food choices with regards to socioeconomic status, culinary ability, cultural identity, etc. By recognizing these factors you are creating a relationship in which the patient feels respected and acknowledged, and will be more open as you move on to discussing the benefits that the suggested dietary changes will make their recovery, and ultimately, their life.

It may also be beneficial to remind them that, in most cases, nutritional changes don’t have to be drastic. It can be as simple as substituting whole-grain bread for white bread or opting for apple slices instead of a bag of chips with their sandwich. In many cases they don’t have to reinvent the wheel to see the benefits of improved nutrition; they need only to tweak it.

The Office of Disease Prevention and Health Promotion (ODPHP) guide for health professionals features tips for addressing patient reluctance to healthier eating, as well as clinician guidance for avoiding a critical tone that may feel judgmental to your patient and result in further resistance to change.

Good Nutrition Is a Journey

With so many patients facing multiple chronic diseases or recalcitrant pathologies, we may be prone to focusing on more clinician-led interventions. But it is important to remember that nutrition is a very easily adaptable component of health that we can empower our patients to utilize. Overlooking this component of the recovery process not only hinders more acute healing, but is a disservice to the overall well-being of our patients.

For most people, improved nutrition doesn’t happen overnight. However, with our guidance and the partnership of an RD, our patients can begin incorporating transformative dietary choices into their lives little by little. So, the next time a patient asks if there is anything else they can do at home to aid in their recovery, your answer will be, “Actually, there is!”

To learn more about how specific nutritional requirements can help support the healing process, and how others hinder it, MedBridge instructor Leslie Bonci offers a three-part course on Inflammation and Its Impact on Performance and Chronic Disease.