Burns, We’ve All Been There and Burned That!  

Whether in the kitchen, bathroom, or garage, almost everyone has suffered from a burn at one point or another. While most of us bear a scar or two from a small mishap, others are not so lucky and require a great deal of intensive care in order to recover from their burns.

I wanted to write a little on this topic since where I live we have experienced a large number of wildfires. As a physician, my heart goes out to the victims and to  the heroic fire fighters that have suffered burn injuries.

Currently, urgent care clinics in affected areas, have had a considerable uptick in the number of burn cases treated each day. I write this to reiterate the need for information we can use to help our friends and neighbors who are recovering from burns.

Not All Burns Are Created Equally

 In order to  treat burns properly, one must know just how “skin deep”  burns can be. A burn can come from a few sources that can cause damage to skin or tissues, and even bone and fat, depending on the depth of the burn. Burns can be caused by the obvious fires, hot liquids, and steam.

Burns can also be caused by chemicals  and the gasses they emit. Chemicals can cause acidic or basic burns, and will need different  treatment approaches. Another very serious type of burn that causes blood vessel, muscle and nerve damage, as well as cardiac and kidney damage  is an electrical burn.

Ok, now that I’ve gotten your attention, let’s carry on: Burns are further differentiated  based on the depth or level of the tissues damaged, namely,1st. , 2nd, 3rd, and 4th degree burns.

1st degree burns invade the superficial layer of the skin called epidermis. In these burns, the skin appears red and is sore to the touch. These sorts of burns typically heal in about a week.

2nd degree burns include the epidermis and varying layers of skin tissue underneath it called the dermis. These burns cause pain and present with blisters.

3rd degree burns will include the whole dermis. This is why they are sometimes referred to as full thickness burns. 3rd degree burns will be painless and will look dry and leathery and will have areas of charred skin.

4th degree burns invade the epidermis, the entire depth of the dermis and include muscle, fat, and bone. These burns require intensive medical and surgical care. Recovery from these burns requires extra calories as well as other macro and micro nutrients.

I promise we’re almost done!! I assure you we need this part to figure out the protein/carb/calories which will be needed to heal optimally.

Moving on, we also need to figure in the total body surface area that has been damaged. To determine this, each part of the body is assigned a certain percentile. Let me demonstrate; for example, your head counts for 9%.

Let’s assume you have a burn on your head, 9% will be used in a formula, called the Parkland formula to help calculate treatment and diet plans required to heel your burn. For those of you who are interested, here is  a list of percentiles assigned to corresponding body parts:

a. Neck and head: 9%.

b. Upper limb: 9% each.

c.  Torso, front and back: 18%.

d. Each lower limb: 18%.

e. Genital area: 1%.

Armed with all of this information, doctors can determine the right types and amounts of fluids and medicines needed to treat an individual patient and know where the patient needs to be in a hospital; for example, the surgical intensive care unit, burn unit, etc. This brings us to the all-important, yet sadly overlooked nutritional needs of the burn victim.

Even when dealing with a sun burn, which is the most common type of burn, we can see burns from 1st  to 2nd degree types that often cover a large  body surface area. In this regard, nutritional requirements are too often overlooked and patients are not given any nutrition counseling from the urgent care and emergency department clinician, resulting in suboptimal, or even poor healing.

Aside from following medical advice closely, attending to wound care meticulously, and keeping all necessary follow up appointments with your doctor, there is a whole lot you can do to ensure you heal from burns optimally. In fact, the proper diet can definitely nudge the tissue healing process in the right direction. It has been shown that correct diet therapy cannot harm and actually helps patients a great deal.

All this to say, you absolutely have control over your recovery.

Diet is key and in this blog post, I will give you all the key nutrition information you will need to successfully recovery and as stated previously,  burns need extra attention because they increase oxygen consumption and put the body into a hypermetabolic state as it tries to respond to  the huge increase in physiologic stress.

Furthermore,  during recovery, the body will shift metabolism and in so doing  increase its requirements for micro and macro nutrients. This translates into more carbohydrates, fats, and protein, but just exactly how much? Below is a usual breakdown in a typical diet plan based on weight and without other medical conditions.

Carbohydrate needs  are calculated by using 7 grams/KG/day and protein needs are calculated by using 1.5-2.0 grams/KG/Day for adults  and 2.5-4.0 grams/KG/day in children. Fats are crucial as well. Keep in mind Omega 3 fats  are hugely important as they do not cause a pro-inflammatory effect on already stressed tissues. As for calories, when recovering at home, aim for 5% to 10% more per day  than your usual intake. Moreover, micronutrients play a huge role in optimal and timely burn recovery.

Below is a list of the key micronutrients  and a how much should suffice . Remember, this applies to a typical adult patient without any other complications or medical conditions:

a. B-complex vitamins.

b. Thiamine or B1.

c. Riboflavin or B2.

d. Niacin or B3.

e. Pyridoxine or B6.

f. Folic Acid or B9 .

g. Cyanocobalamin or B12.

Consider that Vitamin C is also crucial for wound healing and that Vitamin D is essential in full thickness burns affecting bone tissue. It doesn’t end here though.

Minerals such as  Selenium, Copper, Zinc, Manganese, Calcium, and Iron will help meet the increased nutritional  demands  of the burn patient. Follow the links to  know more about mineral listed in this paragraph. I highly recommend you read the blog posts  that further explain all of the aforementioned vitamins and minerals. Look to your right in “The Vitamin Channel’s Library” and click on the “Minerals Blog”.

I will add that if I could wave a magic wand and make the best foods needed during the burn recovery period  they would include high quality, plant-based protein foods such as nut butters, beans, peas, lentils, Tofu, Edamame, plant-based milk, cheese, and yogurt.

To this list, I would add good quality fats  from avocados and coconuts added to potatoes, pasta, and whole grains to meet increased calorie requirements. Vegetables such as dark leafy greens, carrots, green beans, cauliflower, broccoli, and asparagus.

For fruits, I’d include citrus fruits, berries, kiwi, and tomatoes. 

I am also recommending granola mixed with raisins for B vitamins and Iron and calories and carbohydrates.

The stress of healing from a burn can affect our fight or flight hormones, our metabolic needs, and even our emotional well being, but consider that the most important thing is to focus on prevention whenever possible, such as applying sun screen and making sure  the space you live in is well maintained and needed repairs are addressed  as soon as possible. Do not delay treatment by any means and see a doctor as soon as the burn occurs.

Be patient and kind with yourself during recovery and eat great plant-based foods as you recover.