You surely know or have heard of someone who has suffered from hard-to-heal wounds. Such wounds often occur in the elderly, and the doctor explains that it is common for wounds to have a harder time healing as one gets older. If the explanation isn’t that bacteria have entered the wound, the doctor usually explains the hard-to-heal wound by saying that blood circulation in the tissues worsens with age – an explanation that most people accept without questioning why the circulation deteriorates. Should anyone happen to ask that question, unfortunately, they should not expect an adequate answer. The explanation often given is that blood vessels harden and become fragile with age, which sounds logical to the patient, who accepts it without further questions.
Let’s go back to the question of why circulation deteriorates and not just accept the explanation that blood vessels harden with age. What then causes the blood vessels to harden? This is the question that the doctor should be able to answer, but unfortunately, they rarely can provide a correct answer. A very simple answer is that insufficient oxygen reaches the area, thus prolonging the healing time. Sometimes, even more time is not enough for healing since adequate oxygen still doesn’t reach the wound.
This is what it says on the Karolinska Institute’s website about why blood vessels harden: ’The vessels become narrower and stiffer as we coat them with blood fats and wear away elastin, the substance that makes them elastic.’ That this explanation is given in 2022 when Furchgott, Ignarro, and Mureno already in 1998 received the Nobel Prize for their explanation of what keeps blood vessels elastic is remarkable. The explanation FIM gave is that blood vessels harden when their muscle layer (tunica media), consisting of so-called smooth muscle, lacks nitric oxide (NO), which happens if the glycocalyx is damaged, i.e., low and sparse instead of high and dense as it is when not damaged. The thing about blood fats and elastin is an old and outdated explanation that should be removed from ki.se.
I search further. The Healthcare Handbook states:
”In all treatment of wounds, the cause of the wound should be investigated. Hard-to-heal wounds, such as leg ulcers and pressure ulcers, are tissue defects that must be filled in order for the wound to heal.”
It further states, ”The goal of wound treatment is to enable healing.” Examples of hard-to-heal wounds include ”leg ulcers, foot ulcers in people with diabetes, or pressure ulcers,” along with a few other examples.
I read on to find out what causes hard-to-heal wounds and find ”hard-to-heal as in leg ulcers, foot ulcers in people with diabetes, or pressure ulcers.” Exactly what I was looking for. Why do such wounds heal so slowly? I search for the reason and find ”The goal of wound treatment is to enable healing, prevent wound infection, reduce suffering, and facilitate daily life.” Sure, but……
It continues with ”the expected time for healing varies according to the patient’s age, general condition, nutritional status, smoking, mobility, and diseases such as diabetes. Therefore, a general prognosis cannot be given. Large wounds and wounds of long duration heal more slowly, as do wounds with a heavy bioburden/biofilm.”
Here it comes again – this time that healing ”varies according to the patient’s age.” Statistically yes, but where is the causality? This lifebuoy that age is a cause of disease or is a cause of slow wound healing, which doctors regularly use to explain patients’ problems, is something patients accept and stop considering any other cause. I am old, after all!
But diabetes, everyone knows that it usually leads to hard-to-heal wounds. So it seems!? Now, the explanation for why diabetes causes hard-to-heal wounds is what I am after. The Healthcare Handbook should be able to provide this, right!? But no, there is no such explanation.
Under the heading ”Factors Inhibiting Healing”, I find ”Anemia is an important factor that can inhibit wound healing through insufficient general oxygenation of the skin and wound area.” and ”Tobacco smoking inhibits wound healing by reducing peripheral circulation (capillary constriction), decreasing the supply of oxygen and nutrients to the skin.” Now we’re getting somewhere, but why is there no explanation for poor oxygenation? A clue is the 1998 Nobel Prize that Furchgott, Ignarro, and Mureno received for their discovery that the supply of nitric oxide (NO) to the muscle layer (tunica media) of blood vessels, which consists of smooth muscle, is dependent on regular supply of NO to maintain its elasticity and allow red blood cells to be pumped through the narrow and thin arteries called arterioles. If arterioles lose their elasticity due to lack of NO, it becomes difficult for the heart to pump red blood cells to deliver oxygen to the cells. This is the explanation for why, for example, leg ulcers are often hard to heal. Lack of oxygen leads to poor healing.
But why would the delivery of NO to the tunica decrease or cease? Well, if the hairy outside of the vessel’s inside, called the glycocalyx, is damaged so that it is no longer high and dense but low and sparse, and maybe partially missing, then its production of NO decreases, which is so crucial for your vessels to maintain their elasticity and deliver oxygen to the cells.
But what can damage the glycocalyx? The literature indicates several possible causes, but the most dominant cause is said to be too much sugar (glucose) in the blood. That’s right – diabetes! Yes, but you could have had too much glucose in your blood for a long time without having been diagnosed with diabetes or prediabetes. During this time, your glycocalyx has slowly but surely become sparser and reduced its NO deliveries, causing your thin vessels (arterioles) to harden and allow fewer red blood cells to reach the cells to deliver oxygen so that your wound can heal without causing long-term care problems.
Unfortunately, your doctor cannot tell you the state of your glycocalyx. But you can easily decide to ensure that your glycocalyx is not further damaged and even begins to grow healthy, i.e., high and dense, by radically reducing your intake of sugar, i.e., sweet drinks, chocolate, ice cream, and candy, flour, i.e., bread and cookies, starch, i.e., freshly cooked potatoes (cooled is fine, such as fried), freshly cooked pasta (cooled is fine and can then be warmed), and the same with rice. Don’t forget to eat plenty of salad primarily based on dark green above-ground vegetables – peppered and salted plus organic virgin olive oil (no cheaper oil). The green above-ground vegetables ensure that you get plenty of nitrogen (N) which in the glycocalyx ’mixes’ with oxygen (O₂) from the red blood cells and becomes NO, i.e., nitric oxide, which prevents your arterioles from hardening and maintains their elasticity. This makes it possible for oxygen to reach the cells’ mitochondria so that wound healing does not drag on but heals normally – even if you are among the elderly who have hard-to-heal leg ulcers.
