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Vitamins and Healing: Vitamin A, E, & C

Posted: January 12, 2010 > breast cancer > interesting & new > Skin / Nonsurgical > Uncategorized > Blog Home

Vitamins.

They are good for you.  Is more better? What happens when you take more? Do you pee it out? Or does it help you heal better?

When looking into this, I went to the scientific articles, not the press.  I do take things with a grain of salt: all scientific papers are not equal.  Was it a good study with adequate numbers and controls? etc etc.

So. What did I find?

Wounds are harder to heal for some people:

  • Age
  • Steroids
  • Radiation
  • Chemotherapy
  • Diabetes
  • Smoking
  • Poor nutrition

As a surgeon, I see the effect of poor blood flow causing wound  healing issues.  Diabetes, smoking, high cholesterol, exposure to cold.  These are not important for small cuts.  But when we do “flap” surgeries like breast lifts, facelifts, and tummy tucks, blood supply is critical.

One good study I saw stated the most important factor was not a vitamin level, but your protein level.  They found if your serum protein was less than 6g/dl, you would not heal well.  They did not see a correlation with Vitamin C, Vitamin E, or anemia. (I was suprised by the anemia part- you need blood to bring the oxygen and nutrients to the wound to heal.)

Vitamin A:

Vitamin A stimulates the early inflammatory resonse to healing (which is good- it’s like the paramedics have arrived).  A deficiency causes impaired collagen synthesis.  In normal people, taking extra Vitamin A likely does little.  The place Vitamin A is well documented to help is in those on steroids.  Steroids, like Vitamin E, inhibit healing.  They measure this by looking at the tensile strength of the wound, ie how easy is it to break open?

A normal dose is 2000-3000 IU/day. When trying to do a supplement to help with healing, the dose is 25000 units.  This should be done for a short period of time 1-2 weeks.  High doses of Vitamin A are not good if trying to have a child, or if you have a history of liver disease.

Vitamin C:

We all know about those scurvy pirates AAARRRH.

One of the original papers I found supporting Vitamin C and wound healing was a 1937 paper, so this is not news.  Vitamin C is needed to make collagen.  It is also an antioxidant and thought to strengthen the connective tissue in skin, muscle, and blood vessels.  When you don’t have Vitamin C, you get scurvy.  Scurvy presents with skin lesions and bleeding from mucous membranes.  People look pale, can lose their teeth, and are depressed.  We humans lack long term storage for Vitamin C.

What dose? Normal daily recommendation is 60 mg/day.  If you lack Vitamin C, they can recommend up to 1-2 grams a day.  A typical wound healing dose though is likely around 500mg.

Vitamin E:

Aaaaah.  This is such a tricky one.  Vitamin E is a strong antioxidant and helps your macrophages work (fighters who eat up bacteria and invaders and call in more troops to fight infection).

BUT I make all my patients stop Vitamin E before surgery.  Why?  1.  Because it makes you bleed.  The normal amount in your multivitamin is okay.  The 400 IU is not.  2.  At higher doses  it can inhibit collagen synthesis and decrease tensile strength of wounds, just like being on steroids.

I get a lot of push back on vitamin E.  “I hear it makes scars better.”  It weakens scars.  The only scars it “makes better” are those which are hypertrophic or keloid.  For a normal scar, you don’t want to weaken it.  It has just the right amount of scar and strength.  If you weaken a normal scar, it will indent or widen.  So for “good healing” I don’t recommend more than what is in a typical multivitamin.

SO to sum it all up, for normal patients you likely don’t need any supplements.  You will heal just fine.  If you have any issues on the list of healing issues, then consider supplements (after you clear it with your doctor of course).

Yes, Protein.  Yes, Vitamin A. Yes, Vitamin C.

No Vitamin E.

Please keep in mind: subjects covered in this blog and certain tips and advice are not substitutes for professional medical advice. This blog is for general informational purposes only. If you are considering plastic surgery, reconstructive surgery, or cosmetic enhancement, you should always consult with a board-certified plastic surgeon and/or your general practitioner in-person for professional medical advice.

If you think you may have a medical emergency, call your doctor or (in the United States) 911 immediately. Always seek the advice of your doctor before starting or changing treatment.

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