The science of better healing
All of the recommendations included in Heal Better Feel Better are based on science.
We’ve reviewed the clinical literature on nutrition, sleep, movement, stress, tobacco, alcohol, and more to understand how everyday health behaviors affect healing, recovery, and long-term outcomes. From wound healing and immune function to pain control and hospital length of stay, these choices matter more than many people realize.
We believe that every patient deserves to have this information.
On this page, you’ll find the key studies and clinical evidence that shaped our recommendations. Click on any topic below to jump directly to citations for the supporting research, along with key quotes from each source.
Nutrition Sources
Evans, D. C., et al. (2014). “Nutrition Optimization Prior to Surgery.”
Key Quote: “Optimization of metabolic state prior to major surgery leads to improved surgical outcomes.”
Key Quote: “Optimization of metabolic state prior to major surgery leads to improved surgical outcomes.”
Cleveland Clinic (2023). “What To Eat When You’re Trying to Heal”
Key Quote: “Wound healing involves the body replacing the damaged tissue with new tissue, and this process requires an increased intake of calories, protein and particular nutrients.”
Nazari, Ahmad (2024). “Nutritional Requirements for Optimal Surgical Recovery.”
Key Quote: “Proteins play a pivotal role in repairing and regenerating tissues and cells. They are integral to the synthesis of collagen, a key component in the extracellular matrix essential for wound healing.”
Temple Health (2024). “Six Post-Surgery Nutrition Tips.”
Key Quote: “Try choosing seafood and fish; lean meats like chicken or turkey and pork; and non-meat proteins like eggs, tofu, beans and other legumes.”
Wang, X., et al. (2022). “The Effect of a Compound Protein on Wound Healing and Nutritional Status.”
Key Quote: “Pathological report showed increased vascularization, collagen deposition, and epithelialization in compound protein-treated groups.”
Wright, J. A., et al. (2014). “The role of iron in the skin and cutaneous wound healing.”
Key Quote:“Iron is a vital co-factor for proteins and enzymes involved in energy metabolism, respiration, DNA synthesis, cell cycle arrest and apoptosis.”
Zhu, L., et al. (2024). “Effects of comprehensive nutrition support on immune function, wound healing, hospital stay, and mental health in gastrointestinal surgery.”
Key Quote: “A comprehensive nutritional support program significantly enhances immune function, promote wound healing, reduces pain… and shortens hospitalization stays.”
Key Quote: “A comprehensive nutritional support program significantly enhances immune function, promote wound healing, reduces pain… and shortens hospitalization stays.”
Movement Sources
Buckwalter, J. A. (1996). EFFECTS OF EARLY MOTION ON HEALING OF MUSCULOSKELETAL TISSUES.
Key Quote: “Modern experimental studies have largely resolved this controversy and provided the basis for clinically effective approaches to accelerating restoration of function following musculoskeletal surgery or injury.“
Dronkers, J. J., et al. (2013). The association of pre-operative physical fitness and physical activity with outcome after scheduled major abdominal surgery.
Key Quote: “In multivariate analysis, adequate activity level (OR 5.5, 95% CI 1.4–21.9) and inspiratory muscle endurance (OR 5.2, 95% CI 1.4–19.1) were independently associated with short-term mortality, whereas conventional factors, such as age and heart disease, were not.“
Gilmore, S. J., et al. (2019). Predictors of substantial improvement in physical function six months after lumbar surgery: is early post-operative walking important? A prospective cohort study.
Key Quote: “For every one hour increase in total walking time, the odds of achieving the ODQ SCB change threshold increased by 18%.”
King, W. C., & Bond, D. S. (2013). The Importance of Pre and Postoperative Physical Activity Counseling in Bariatric Surgery.
Key Quote: “To help patients maximize weight loss and other health benefits following bariatric surgery, patients need more PA encouragement and support before and following surgery.“
Nilsson, H., et al. (2016). Is preoperative physical activity related to post-surgery recovery? A cohort study of patients with breast cancer.
Key Quote: “More active participants (level 3 or 4) had an 85% increased chance of feeling physically recovered at 3 weeks after the operation, RR 1.85 (1.20 to 2.85).“
Oldmeadow, L. B., et al. (2006). NO REST FOR THE WOUNDED: EARLY AMBULATION AFTER HIP SURGERY ACCELERATES RECOVERY.
Key Quote: “Patients in the EA group were more likely to be discharged directly home from the acute care than those in the DA group (26.3 compared with 2.4%) and less likely to need high-level care (36.8 compared with 56%).“
Onerup, A., et al. (2017). The effect of pre- and post-operative physical activity on recovery after colorectal cancer surgery (PHYSSURG-C): study protocol for a randomised controlled trial. Trials.
Özdemir, İ. A., et al. (2019). Impact of pre-operative walking on post-operative bowel function in patients with gynecologic cancer.
Probst, S., et al. (2022). The impact of patient health and lifestyle factors on wound healing, Part 2: Physical activity and nutrition.
Ruiz-Tovar, J. (2023). Physical Activity Within ERAS. In J. Ruiz-Tovar & A. Marc-Hernandez (Eds.), Physical Activity and Bariatric Surgery. Springer Nature.
Stethen, T. W. (2016). Walking to Recovery – The Effects of Postsurgical Ambulation on Patient Recovery Times.
Valenzano, A. A., et al. (2025). Impact of Exercise Therapy in ERAS Prehabilitation for Major Surgery: A Systematic Review.
Sleep Sources
Christian, L. M., et al. (2006). Stress and Wound Healing.
Key Quote: “Because the majority of GH [growth hormone] release occurs during sleep, stress can substantially affect GH production by altering sleep architecture.”
De Pasquale, C., et al . (2024). Sleep hygiene – What do we mean? A bibliographic review.
Key Quote: “‘Sleep hygiene’ describes modifiable behaviours and environmental adjustments that can be used to promote sleep quality and improve sleep duration.”
Liao, W. C., et al. (2011). A Systematic Review of Sleep Patterns and Factors That Disturb Sleep After Heart Surgery.
Key Quote: “It took 2 months for sleep to recover to preoperational levels.”
Rampes, S., et al. (2020). Postoperative sleep disorders and their potential impacts on surgical outcomes.
Key Quote: “Postoperative sleep disturbance occurs due to the complex interactions of numerous factors, many of which can be attenuated. If not managed, postoperative sleep disturbance can lead to delayed recovery and increased morbidity.”
Rodrigues da Silva, F., et al. (2024). Can Improving Postoperative Sleep Speed Up Surgical Recovery?
Key Quote: “Sleep care in hospitals is intimately correlated with patients’ physiologic function and quality of life needed to achieve fast surgical recovery.”
Sipilä, R. M., et al. (2021). Sleep Well and Recover Faster with Less Pain—A Narrative Review on Sleep in the Perioperative Period.
Key Quote: “The bidirectional nature of sleep and pain is widely acknowledged. A decline in sleep quality adds a risk for the onset of pain and also exacerbates existing pain.”
Stress Management Sources
Esterling, B. A., et al. (1999). Empirical foundations for writing in prevention and psychotherapy: Mental and physical health outcomes.
Key Quote: “Only those people who wrote about both the facts of the trauma and their emotional responses exhibited long-term mental and physical health benefits.”
Key Quote: “Only those people who wrote about both the facts of the trauma and their emotional responses exhibited long-term mental and physical health benefits.”
Hesselink, G., et al. (2020). Environmental Needs, Barriers, and Facilitators for Optimal Healing in the Postoperative Process: A Qualitative Study of Patients’ Lived Experiences and Perceptions. Key Quote: “Participants described the need for positive distractions: personalizing the room, connecting with the external environment, and the ability to undertake activities.”
Hole, J., et al. (2015). Music as an aid for postoperative recovery in adults: a systematic review and meta-analysis.
Key Quote: “Music reduced postoperative pain (SMD –0·77 [95% CI –0·99 to –0·56]), anxiety (–0·68 [–0·95 to –0·41]), and analgesia use (–0·37 [–0·54 to –0·20]).”
Krampe, H., et al.
Key Quote: “Preoperative stress… is associated with peri- and postoperative complications and worse surgical outcomes.”
Li, Q. (2022). Effects of forest environment (Shinrin-yoku/Forest bathing) on health promotion and disease prevention —the Establishment of “Forest Medicine”.
Key Quote: “The increased NK activity, number of NK cells, and percentages of GRN-, perforin-, and GrA/B-expressing cells lasted more than 7 days and even for 30 days.”
Lindsay, E. K., et al.
Key Quote: “Loneliness has been associated with lower LPS-stimulated IL-1β and TNF-α production… as well as slower wound healing.”
Mavros, M. N., et al.
Key Quote: “Trait and state anxiety, state anger, active coping, subclinical depression, and intramarital hostility appeared to complicate recovery, while dispositional optimism… and low pain expectations… seemed to promote healing.”
8. Schakel, L., et al.
Key Quote: “This is also relevant for clinical practice, as psychological interventions can possibly supplement, or at least partially replace, current drug treatments in various somatic conditions to reduce side effects.”
Stuckey, H. L., et al.
Key Quote: “Engaging in different types of visual art… helped them focus on positive life experiences, relieving their ongoing preoccupation with cancer.”
Walburn, J., et al.
Key Quote: “The relationship between stress and wound healing estimated by the meta-analysis was r=−0.42… categorized as a medium effect size, showing that greater levels of psychological stress are associated with impaired wound healing.”
Yeung, S. C., et al.
Key Quote: “Apart from enrolling patients into ERAS programs, postoperative pain and distress may be reduced by introducing music, sensory arts, social opportunities, and recreational resources to create an enriched recovery environment.”
Alochol Cessation Sources
Chapman, L., et al. (2023). Reducing Alcohol Use Before and After Surgery: Qualitative Study of Two Treatment Approaches.
Key Quote: “Short-term abstinence from alcohol use (2 to 4 weeks) prior to surgery is linked to a lower likelihood of postoperative complications.”
Fernandez, A. C., et al. (2015). A systematic review of behavioural interventions to reduce preoperative alcohol use.
Key Quote: “As an individual’s alcohol consumption increases, so does postoperative risk; every additional point scored on the consumption questions of the Alcohol Use Disorder Identification Test (AUDIT-C) is associated with a 29% increase in the expected number of postsurgical complications.”
Gethin, G., et al. (2022). The impact of patient health and lifestyle factors on wound healing, Part 1: Stress, sleep, smoking, alcohol, common medications and illicit drug use.
Key Quote: “Clinicians should be aware of and communicate to patients that alcohol can increase the incidence of infection and decrease collagen production.”
Jung, M. K., et al. (2011). Alcohol Exposure and Mechanisms of Tissue Injury and Repair.
Key Quote: “The metabolism of alcohol results in the generation of acetaldehyde and reactive oxygen (and other) species, biochemical moieties that damage healthy tissue.”
Substance Abuse and Mental Health Services Administration (SAMHSA). Alcohol Use Disorder – Causes, Symptoms, Treatment & Help.
Key Quote: “The Dietary Guidelines for Americans recommends that if adults (age 21 and older) choose to drink alcohol, drinking less is better for health than drinking more.”
Shabanzadeh, D. M., et al. (2015). Alcohol Consumption Increases Post-Operative Infection but Not Mortality: A Systematic Review and Meta-Analysis.
Key Quote: “Consumption of more than two units of alcohol per day increases post-operative non-surgical site infections.”
Trevejo-Nunez, G., et al. (2015). Alcohol Use As a Risk Factor in Infections and Healing: A Clinician’s Perspective. Alcohol Research: Current Reviews.
Key Quote: “Clear evidence now indicates that alcohol has a systemic effect on every organ.”
Tønnesen, H., et al. (2009). Smoking and alcohol intervention before surgery: evidence for best practice.
Key Quote: “Abstinence starting 3–8 weeks before surgery will significantly reduce the incidence of several serious postoperative complications, such as wound and cardiopulmonary complications and infections.”
U.S. Department of Veterans Affairs (VA). Alcohol & Drug Addiction Treatment for Veterans.
Yoshimoto, H., et al. (2023). Effect of provision of non-alcoholic beverages on alcohol consumption: a randomized controlled study. BMC Medicine.
Key Quote: “Providing non-alcoholic beverages significantly reduced alcohol consumption, an effect that persisted for 8 weeks after the intervention.”
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