Should Your Patient Drink Juven BID for Healing?
No, do not use Juven (or similar protein/amino acid supplements containing HMB, arginine, and glutamine) twice daily for wound healing, as the highest quality evidence shows no benefit for healing outcomes. 1
Guideline-Based Recommendation
The most recent International Working Group on the Diabetic Foot (IWGDF) 2024 guidelines provide a strong recommendation against using pharmacological agents that supplement vitamins, trace elements, and protein supplements to improve wound healing outcomes over standard care. 1 This recommendation is based on systematic review of nutritional interventions including protein drinks containing the exact ingredients found in Juven (arginine, glutamine, and β-hydroxy-β-methylbutyrate/HMB).
Key Evidence Against Juven
A well-conducted, double-blind randomized controlled trial of 270 patients compared twice-daily protein drinks containing arginine, glutamine, and HMB (the active ingredients in Juven) versus control drinks for 16 weeks and found no difference in ulcer closure rates or time to healing. 1
This study was at low risk of bias and directly tested the formulation marketed as Juven for wound healing. 1
The IWGDF guidelines explicitly state that despite some studies showing small desirable effects, the balance of effects favors neither intervention nor control, with low certainty of evidence. 1
Why This Recommendation Matters
Resource Implications
Juven and similar supplements have moderate cost implications without demonstrated clinical benefit. 1
The additional resources required reduce healthcare equity, particularly in lower-income settings, without offsetting benefits. 1
Study Quality Issues
While some smaller studies suggested benefit, they had major methodological inconsistencies including poor definition of standard care, uncertain compliance assessment, and discrepancies in analytical reporting. 1
Studies showing apparent benefits measured only secondary outcomes (ulcer dimensions) rather than complete healing, time to healing, or sustained healing—the outcomes that actually matter for patient morbidity and quality of life. 1
What Actually Works for Healing
Focus resources and efforts on evidence-based standard wound care rather than nutritional supplements:
- Appropriate offloading and pressure relief 1
- Adequate debridement when indicated 1
- Infection control and appropriate antimicrobial therapy 1
- Vascular assessment and revascularization when needed 1
When Nutritional Support IS Indicated
Provide age-appropriate, balanced, nutrient-dense diet for all patients with wounds. 1
Consider continuous enteral nutrition (20-25 kcal/kg daily during catabolic phase, increasing to 25-30 kcal/kg during recovery) only in patients with extensive skin breakdown and compromised oral intake. 2
Use protein-containing supplements (not specifically Juven) only when there is documented malnutrition or inadequate protein intake from diet alone. 2
Common Pitfalls to Avoid
Do not prescribe Juven based on:
- Marketing claims or anecdotal reports 3
- Small exploratory studies without proper controls 3
- Studies in different patient populations (trauma, cancer cachexia) that do not translate to wound healing efficacy 4, 5
The critical distinction: While HMB/arginine/glutamine may improve nitrogen balance in critically ill trauma patients 4, this metabolic effect does not translate to improved wound healing outcomes in the populations where it has been rigorously tested. 1