Appropriately balanced nutrition is a cornerstone of high-quality wound care, and this isn’t a new revelation. Nearly all modern wound centers include some version of nutritional screening, along with ever-expanding recommendations regarding overall protein intake, complex carbohydrate needs, and micronutrient supplementation as clinical evidence for these is presented. But what is a provider to do when high-quality food isn’t accessible? Acting on the recommendation of several colleagues and nutritionists with whom I regularly interact, I spent time researching food prices in my neighborhood to ascertain exactly what the financial demands of these recommendations would be.

Idealized Menu

For my own calculation, as a 6 ft, 172 lb person, my recommended protein intake in the setting of a chronic wound would be between 117 and 156 grams daily. The following idealized menu roughly meets this requirement, supplying 149 grams:

• Salmon fillet – 4 oz (23 grams protein)
• 1 cup spinach (1 gram protein)
• 2 boiled eggs (12 grams protein)
• 2 cups cooked oatmeal (12 grams protein)
• 1 grilled chicken breast – 172 grams (54 grams protein)
• 1 orange
• 4 oz coffee with cream
• 1 cup almonds (3.5 grams arginine, 30 grams protein)
• 1 cup Greek yogurt (17 grams protein)

To maintain this diet for one week for one person, the price in my home city of Portland, Oregon would be approximately $250.00. Fairly understandably, this idealized diet would have been far from attainable for a large number of our patients, even before the economic hardships of the last year and a half. Taking this into account, what nutrient-rich foods can we offer as an alternative? And what alternatives exist for individuals who are unable to prepare their own meals, such as those who lack housing security? A relatively important disclaimer: fast food is not a first-line recommendation for nutritional supplementation, which all but goes without saying.

There are substantial health risks with frequent consumption, but the stark reality is that for patients in certain socioeconomic groups or those located within “food deserts,” there can be few other viable choices. In these cases, the best possible recommendation (lean protein sources, fresh fruits and vegetables) is out of range for a variety of factors, leaving the provider to look for the “next” best possible alternative. This is perhaps best compared with smoking cessation in the sense that quitting is best, but if cutting back on cigarette use is the only acceptable alternative, it’s far preferable to no change in behavior at all. If this is what’s available to the patients in our care, it’s important to work within those boundaries and steer them toward the most approachably reasonable option.

Alternative Menu

To that end, also within my home neighborhood, I was able to price an alternative menu accordingly:

• McDouble™ (at McDonald’s) costs $1.35 on average and delivers 22 grams of protein. Compared with other menu offerings, it’s relatively low in fat and sodium.
• 1 can of tuna costs $1.00 on average and contains 22 grams protein.
• 1 banana costs roughly 50 cents and supplies 1 gram protein and 28 grams complex carbohydrates.
• 1 cup small curd cottage cheese carries 25 grams protein at an average price of $1.00 per serving.
• 1 can (2 cups) pre-cooked black beans costs around $1.00 and contains roughly 30 grams protein.

There are numerous other options available, and this article isn’t intended to be an exhaustive list, but with these selections, it’s very possible to meet minimum protein requirements for under $35.00 over a week. If your patients are generally able to even minimally prepare their own meals, an even greater variety of protein-rich foods is available at low cost; sardines, edamame, lentils, oats, and ground turkey all provide high protein content at relatively low cost, and they are worth mentioning during the course of nutritional education.

Conclusion

Depending on your locality, prices may differ from what is listed here, but I strongly recommend researching what options exist within your community. And when in doubt, local dietitians are generally very willing to discuss lower-cost nutritional options to help your patients maximize their intake. At the end of the day, concordance with care is much easier to achieve if the patient believes their clinicians share a willingness to help them address their barriers and work within their means.

References

1. Kubala J. 17 cheap and healthy protein sources. Healthline.com. 2017. https://www.healthline.com/nutrition/cheap-protein-sources#TOC_TITLE_HD…. Accessed June 9, 2021.
2. Molnar JA, Underdown MJ, Clark WA. Nutrition and Chronic Wounds. Adv Wound Care (New Rochelle). 2014;3(11):663-681. doi:10.1089/wound.2014.0530
3. The role of protein in wound healing. Advanced Tissue. 2014. https://advancedtissue.com/2014/09/role-protein-wound-healing/ Accessed on July 14, 2021.
4. Healthwise Staff. High-protein foods for wound healing. 2020. https://www.uofmhealth.org/health-library/abs1199 Accessed on July 14, 2020.

About the Author

Ryan Cummings is a family nurse practitioner and certified wound specialist with a ten-year history of wound care experience, including home health, hyperbaric medicine, inpatient and outpatient wound management. He has also worked extensively as a wound educator and clinic manager, and most recently became involved in the international society of pediatric wounds as one of very few dedicated outpatient pediatric wound specialists. He possesses an intense passion for patient care and the advancement of wound science to both enhance the practice of wound healing and to improve patient outcome and quality of life.