Gather round for a story about wounds and the evil things that prevent proper healing. It’s the same old tale of woe with all the usual suspects. Stress, low thyroid, inflammation, bacteria, serotonin and PUFA have been named. Sugar, the legendary hero, comes to the rescue again.
It’s true that how quickly and how well a wound is able to heal, is impacted upon by a variety of forces. This does not mean however, that there is no rhyme or reason behind why one wound heals easily, and another becomes a problem.
Unfortunately, this also does not mean that the best methods for making wound healing safer and more effective, are well known or commonly applied.
It’s safe to say that most people will not be aware of the fact that the topical application of plain white sugar has a long history in the treatment of serious, chronic, acute, and sometimes even life threatening wounds. But that is the truth.
“…we treated 605 patients for wounds, burns, and ulcers with granulated sugar…Rapid healing ensued…requirements for skin grafting and antibiotics were greatly reduced, as were hospital costs…”
“…critically ill adults…after cardiac surgery were treated with granulated sugar…Packing the mediastinal cavity with granulated sugar…resulted in near-complete debridement of the wound and rapid formation of granulation tissue in all patients and sterilisation of the wound after an average of 7.6 days.”
In fact simple white sugar – if applied to a wound – has been shown to be able to protect against dangerous bacterial infections, to dramatically speed up healing, and to significantly reduce scarring. If not for biology, it would seem like a miracle.
“…treatment of infected wounds…with simple granulated sugar in 120 patients, with a cure rate of 99.2%…ages ranged from 3 months to 94 years old…Six diabetes cases were among the sample group…”
“…sugar…has been reported to accelerate the healing of cutaneous wounds and ulcers by promoting re-epithelialization and granulation tissue formation as well as having an anti-microbial effect.”
“Sugar treatment is a reasonable and effective option in patients with mediastinitis refractory to closed irrigation treatment.”
“…we demonstrate…that sugars (sucrose, glucose) inhibited the production of the main protein toxins…responsible for the onset and progression of gas gangrene.”
But what is probably even less well known, however, is the fact that how well a wound is able to heal has a lot to do with internal circumstances, not just outside influences. The state of things in the body. The degree of exposure to stress and the condition of metabolism.
Considering the kinds of diets being promoted as healthy today, it isn’t surprising that most are probably unaware that dietary changes can improve wound recovery. And one could be forgiven for being shocked to find out that, not only can applying sugar directly to a wound be a miraculous helper, eating sugar in the context of an appropriate diet, can also (for similar reasons) be very helpful.
Even though the position of a wound (as well as many external interfering factors like temperature and moisture for instance) impacts upon how difficult it will be for it to heal, metabolic function is fundamental. If that wasn’t the case there would likely not be a relationship between wound healing capability and metabolic illness, such as diabetes, cancer, heart disease, arthritis, perhaps even depression.
I’m not going to go too much into the mechanisms involved in the wound healing process, partly because I’m not a physiologist or a wound specialist of any sort, and partly because I’m not sure how helpful it always is, as often what’s really important ends up getting lost in the details.
It’s too much biological stress which is I think in general, probably the important thing when it comes to interfering with the wound healing process. The question which I believe needs to be asked is, what is inhibiting the availability of energy required to deal with the stress of an injury to tissue.
So it’s probably no surprise to discover that when thyroid energy metabolism is already being interfered with, any stress will be more difficult to manage effectively.
“…the state of hypothyroidism constitutes an important factor in delaying wound healing.”
“…In the state of hypothyroidism, a decrease was observed in type-IV collagen and hydroxyproline during the proliferative phase of wound healing. This indicated that the state of hypothyroidism constitutes an important factor in delaying wound healing.”
“We conclude that the hormone replacement therapy in hypothyroidism cases was beneficial with regard to wound healing…
“…most recent data suggest that topical thyroid hormone may accelerate wound healing rate.”
“Wound healing disorders affect between 3 and 6 million Americans every year. Treatment options are variable and often unsuccessful, resulting in amputation…a positive role for the topical administration of thyroid hormone has…proven effective.”
“T(3) is necessary for…optimal wound healing. Thus, for hypothyroid patients undergoing surgery…our data support T(3) treatment for the perioperative period.”
Blood sugar regulation issues and thyroid dysfunction often go together, and it is well known that the diabetic state is one in which wound healing is severely compromised. If I didn’t know better, I would say it was ironic that topical application of sugar is so effective when it comes to healing diabetic ulcers.
“…ulcer treatment with granulated sugar…21 patients with ulcers…were evaluated over a 9-month period…Eighteen ulcers had satisfactory results, with 9 ulcers completely healed and 9 ulcers with decrease of wound dimension and decrease of bacterial contamination…next case study…38 wounds, pressure sores, and leg ulcers with granulated sugar over a 9-month period…89.5% satisfactory healing result…”
“Honey is a low-cost topical therapy with important potential for healing. Its use may be considered in diabetic foot ulcers…”
“…sugar is an effective wound cleansing and is safe to use in patients with insulin-dependent diabetes. In vitro studies demonstrate that sugar inhibits bacterial growth.”
One thing that is happening more these days under conditions of stress and low sugar availability, is exposure to the the polyunsaturated fats (PUFAs), which (due to dramatically increased consumption) get released out of storage into the blood stream in far greater amounts than ever before in conceivable history.
The PUFA breakdown products have been shown to be involved in the interference with proper wound healing capabilities, as well as being known to promote the kind of chronic inflammatory energy system impaired state which can prevent effective healing.
“…evidence that lipid peroxidation inhibition restores wound healing to nearly normal levels in experimental diabetes-impaired wounds…”
“…elevated levels of MDA…may be contributory to impaired wound healing..”
“…similarities between the chronic wounds of diverse aetiologies…Unbridled inflammation in particular, has been implicated in playing a pivotal role.”
PUFA breakdown promotes physiological stress in general, and this tends to lead to an increase in exposure to many substances which have been found at the scene of the chronic wound.
Bacterial endotoxin exposure, high cortisol and excessive levels of serotonin, nitric oxide and estrogen – stress substances which are involved in the progression of the diabetic state, cancer and heart disease – have all been implicated in the processes which are involved in preventing proper wound healing.
“…subclinical level of LPS was sufficient to…compromise wound healing process, potentially due to the expansion of monocytes/macrophages with low-grade pro-inflammatory properties.”
“…tumor necrosis factor-alpha (TNF-alpha) induced by endotoxin inhibits the effect of the growth factor(s) in the wound area, which results in decreased collagen production. Subsequently the wound healing process is impaired.”
“The overall results showed a significant negative correlation between speed of wound healing…and…Perceived Stress…a clear elevation in the morning cortisol slope of those whose wounds were slowest to heal.”
“The beneficial effects of serotonin S(2)-receptor blockers on healing skin and muscle ulcers and refractory lesions such as leprosy and diabetic and ischemic ulcers have been reported…”
“Inhibition of NO synthesis might improve wound tensile strength, which suggests a possible role for NO inhibitors in improved wound healing in the presence of endotoxemia.”
“…improves the wound healing of pressure ulcers through decreased expression of iNOS and COX-2, which reduces wound inflammation and promotes dermal reconstruction and scar formation.”
“…findings demonstrate for the first time a female-specific phenotype of delayed corneal epithelial wound healing that can be induced by topical treatment with estradiol.”
A stressed metabolism with rising levels of the thyroid inhibiting substances, endotoxin, nitric oxide, serotonin and estrogen, goes together with increased production of lactic acid and reduced production of carbon dioxide.
High lactate in wounds has been shown to be a marker for chronicity, and CO2 therapy – as with thyroid hormone application – has had success in the treatment of chronic ulcers and other serious wounds.
“Non-infected diabetic foot ulcers that healed within 6 months of treatment showed a significantly lower wound fluid lactate concentration at baseline as opposed to those that did not heal…Non-healing diabetic foot ulcers are characterized by high wound fluid lactate levels…”
“A wound is defined as chronic when it does not heal according to the normal repair times and mechanisms. This particular condition may be principally due to local hypoxia…In the group that underwent subcutaneous treatment with CO(2) therapy, the results highlighted a significant increase in tissue oxygenation values, which was confirmed by greater progress of the lesions in terms of both healing and reduction of the injured area.”
“…hypothyroidism is associated with retarded wound repair…Topical liothyronine [T3] is an effective, inexpensive and probably safe therapeutic option for diabetic ulcers.”
Even though it would be a stretch to assume that a well functioning system will be able to effectively deal with any wound regardless of where on the body it is, or the kind of environment it is exposed to, it makes little sense to ignore evidence showing the enormous impact metabolic health has upon wound repair capability.
And it makes even less sense to disregard the positive impact a pro-metabolic diet can have with regards to protection against stress, at a general and local level. Regardless, when assistance is required, you want to know that the help you are receiving is actually helping, and you also want to know if there is something out there that has been shown to help even more.
The pro-thyroid, pro-CO2 influence of both the consumption and the topical application of sugar, is relevant to safe and effective wound healing, and to me, anti-sugar propaganda is symbolic of everything that is wrong with the scientific/medical establishment.
A pro-metabolic, thyroid enhancing diet, that avoids PUFA and includes sufficient protein from good quality, highly assimilable protein sources like milk and cheese and gelatin, and plenty of sugar from sweet ripe fruit, fruit juice and white sugar, helps to protect against stress and the symptoms and complications of metabolic dysfunction, including sub-optimal wound healing.
Some other things (apart from topical sugar, honey, thyroid hormone and CO2) which have been used (in some cases both topically and internally) to improve wound healing and protect against infection, include red light, methylene blue, aspirin, coconut oil, taurine, activated charcoal, minocycline and possibly even cyproheptadine and some other stress reducing substances.
I have used sugar on my own wounds over the years with very positive results, and having read through many studies, I find the evidence to be convincing. We already have so many miraculous ways to protect against metabolic illness, and to deal with life threatening wounds, so let us not pretend that what we are waiting for, is for the scientists to figure out what is going on.
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Perceived stress and cortisol levels predict speed of wound healing in healthy male adults.
A role for thyroid hormone in wound healing through keratin gene expression.
Use of granulated sugar in treatment of open mediastinitis after cardiac surgery
Use of sugar and povidone-iodine to enhance wound healing: five year’s experience
Treatment of recurrent postoperative mediastinitis with granulated sugar.
Use of Sugar on the Healing of Diabetic Ulcers: A Review
Why do some cavity wounds treated with honey or sugar paste heal without scarring?
Use of granulated sugar therapy in the management of sloughy or necrotic wounds: a pilot study.
Sugar inhibits the production of the toxins that trigger clostridial gas gangrene.
Mild hypoglycemia is strongly associated with increased intensive care unit length of stay
Mixture of sugar and povidone–iodine stimulates wound healing by activating keratinocytes and fibroblast functions.
Topical Minocycline Effectively Decontaminates and Reduces Inflammation in Infected Porcine Wounds.
Metabolite-enabled eradication of bacterial persisters by aminoglycosides
Role of endotoxin in wound healing impairment.
Proinflammatory Effects of Hypoglycemia in Humans With or Without Diabetes
Low grade endotoxemia delays wound healing associated with inflammatory monocytes/macrophages expansion (INC7P.405)
Wounds and malignancy.
Inflammation in Chronic Wounds
Practical considerations of using topical honey for neuropathic diabetic foot ulcers: a review.
Effect of topical honey on limitation of radiation-induced oral mucositis: an intervention study.
Effect of Honey and Eugenol on Ehrlich Ascites and Solid Carcinoma
Effects of low-power light therapy on wound healing: LASER x LED*
Photodynamic therapy mediated by methylene blue dye in wound healing.
The effect of cyproheptadine hydrochloride (Periactin®) and megestrol acetate (Megace®) on weight in children with cancer/treatment-related cachexia
The Histopathological Investigation of Red and Blue Light Emitting Diode on Treating Skin Wounds in Japanese Big-Ear White Rabbit
Selective inhibition of COX-2 improves cutaneous wound healing of pressure ulcers in mice through reduction of iNOS expression.
Bacterial toxins and wound healing.
The wound healing, chronic fibrosis, and cancer progression triad
Shedding Light on a New Treatment for Diabetic Wound Healing: A Review on Phototherapy
Case series of lower-extremity chronic wounds managed with an antibacterial foam dressing bound with gentian violet and methylene blue.
Aspirin treatment for chronic wounds: Potential beneficial and inhibitory effects.
Effect of topical application of virgin coconut oil on skin components and antioxidant status during dermal wound healing in young rats.
A prospective evaluation of methylene blue and gentian violet dressing for management of chronic wounds with local infection
Wound-healing factors can prime head and neck cancer cells to increase their tumor-forming capacity.
The wound inflammatory response exacerbates growth of pre-neoplastic cells and progression to cancer
Effects of honey and sugar dressings on wound healing.
Granulated sugar treatment for leg ulcers: a case report
The use of granulated sugar to treat two pressure ulcers
Taurine improves the wound healing process in cutaneous leishmaniasis in mice model, based on stereological parameters
The influence of hypothyroidism on wound healing. An experimental study.
Thyroid Hormone and Wound Healing
Relationship of hyperglycemia and surgical-site infection in orthopaedic surgery.
The effects of thyroid hormone on wound healing
Effects of L-thyroxine and zinc therapy on wound healing in hypothyroid rats.
Tracheal suture in rats with hypothyroidism: wound healing study.
Wound Healing in Colonic Anastomosis in Hypothyroidism
The role of carbon dioxide therapy in the treatment of chronic wounds.
The Effects of Topical Application of Thyroid Hormone (Liothyronine, T3) on Skin Wounds in Diabetic Wistar Rats
Stimulating healthy tissue regeneration by targeting the 5-HT2B receptor in chronic liver disease
A concomitant review of the effects of diabetes mellitus and hypothyroidism in wound healing
Transdermal CO2 Application in Chronic Wounds
Differential cytokine activity and morphology during wound healing in the neonatal and adult rat skin
The Impact of Psychological Stress on Wound Healing: Methods and Mechanisms
Nitric oxide synthase inhibitors appear to improve wound healing in endotoxemic rats: An investigator-blinded, controlled, experimental study
Topical Humidified Carbon Dioxide to Keep the Open Surgical Wound Warm: The Greenhouse Effect Revisited
Oxidative stress in normal and impaired wound repair.
Local photodynamic action of methylene blue favorably modulates the postinterventional vascular wound healing response.
Effect of taurine on wound healing.
CO2 Delivery To Accelerate Incisional Wound Healing Following Single Irradiation of Near-Infrared Lamp on the Coordinated Colloids.
Inhibition of lipid peroxidation restores impaired vascular endothelial growth factor expression and stimulates wound healing and angiogenesis in the genetically diabetic mouse.
Wound fluid lactate concentration: a helpful marker for diagnosing soft-tissue infection in diabetic foot ulcers? Preliminary findings.
Healing effect of ketanserin on chronic leg ulcers in patients with diabetes.
Effect of Carbon Dioxide Therapy on Diabetic Foot Ulcer
Effects of a serotonin S2-receptor blocker on healing of acute and chronic tendon injuries.
Role of Serotonin in Angiogenesis in Diabetes
A Novel Model of Chronic Wounds: Importance of Redox Imbalance and Biofilm-Forming Bacteria for Establishment of Chronicity
The lactate conundrum in wound healing: clinical and experimental findings indicate the requirement for a rapid point-of-care diagnostic.
Wound healing and diabetes mellitus.
Congestive heart failure presence predicts delayed healing of foot ulcers in diabetes: An audit from a multidisciplinary high-risk foot clinic.
Heart failure in hospitalized patients with diabetic foot ulcers: clinical characteristics and their relationship with prognosis.
Congestive heart failure presence predicts delayed healing of foot ulcers in diabetes: An audit from a multidisciplinary high-risk foot clinic.
Psychological factors and delayed healing in chronic wounds.
[Heart failure and stasis ulcer: A significant association (prospective study of 100 cases)].
Rheumatoid arthritis-associated inflammatory leg ulcers: a new treatment for recalcitrant wounds.
Lipid peroxidation inhibition by raxofelast improves angiogenesis and wound healing in experimental burn wounds.
Promotion of cutaneous wound healing by famotidine in Wistar rats.
Antioxidant status during cutaneous wound healing in immunocompromised rats.
Reactive carbonyl compounds impair wound healing by vimentin collapse and loss of the primary cilium.
Estrogen negatively regulates epithelial wound healing and protective lipid mediator circuits in the cornea
In vivo Assessment of Antioxidant and Wound Healing Improvement of a New Schiff Base Derived Co (II) Complex in Rats
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