How to Prepare Your Body for Surgery: Protein, Prehab and the 5 Days That Change Your Recovery | Dr. Rebecca Knackstedt

September 29, 2026

AI Summary

5 min read

In 2017, a young woman arrived at Duke for breast reconstruction. She had just finished chemotherapy, was upbeat, and had a clear surgical plan with her plastic surgeon, Dr. Rebecca Knackstedt. Between that consult and her surgery date, she developed metabolic syndrome, lost her hair, got divorced, lost her job, became homeless, and her mother died of breast cancer. Knackstedt performed what she considered good surgery. The patient did not heal. That case forced Knackstedt to confront a blind spot in surgical training: the weeks before an operation are not a waiting period. They are a window of intervention where the patient has far more influence over their outcome than they have been told.

The Case for Prehabilitation

Prehabilitation, or "prehab," is the practice of preparing the body for the stress of surgery before the incision is made. It mirrors rehab but happens before the trauma. Knackstedt argues that surgery is a catabolic event—it triggers protein breakdown, inflammation, and often immobility. The body draws on its protein reserves to heal, fight infection, and regulate blood sugar. If those reserves are low going in, the post-surgical dip is steeper and complications more likely.

Continue reading the full summary in the app — free to try.

Read Full Summary →

Free • No credit card required

Listen to Audio Summary Open in App

Never miss an episode of The Dr. Gabrielle Lyon Show

Get every new episode summarized in your inbox — free, ~5 minutes to read.

No spam. Unsubscribe anytime.

What you'll learn

1 (00:00) **Why Prehabilitation Matters** - Dr. Knackstedt introduces the concept of preparing the body before surgery, arguing it is a shift from reactive to preventative healthcare.
2 (01:07) **Guest Introduction: A Surgeon Focused on Prehab** - Dr. Rebecca Knackstedt, a plastic and reconstructive micro-surgeon at Duke, explains her unique focus on surgical prehabilitation with nutrition, supplementation, and exercise.
3 (02:30) **The Holistic View: Why Traditional Training Falls Short** - Dr. Knackstedt describes how a single patient experience shifted her perspective from believing "good surgery" was enough to understanding the need for a holistic approach.
4 (04:53) **The Patient That Changed Everything** - Dr. Knackstedt shares the story of a young breast cancer patient whose life unraveled before surgery, leading to a poor outcome that forced her to look beyond the operating table.
5 (07:12) **Protein: The Missing Pre-Surgical Standard** - The current lack of a standard protein recommendation for surgical patients is addressed, with the host stating that "no less than 100 grams a day" is critical.
6 (09:08) **Practical Prehab: Exercise and Muscle Targeting** - Dr. Knackstedt explains how she evolved her exercise recommendations from a general "increase lean mass" to specific, functional movements that aid post-surgical recovery.
7 (11:20) **Hormones, Breast Cancer, and Vaginal Estrogen** - The conversation covers the role of hormones in treatment outcomes, specifically the safety and importance of vaginal estrogen for quality of life and preventing UTIs in patients with hormone-receptor-positive breast cancer.

+ Full timestamped outline available in the app

Show Notes

Most patients are told one thing before surgery: stop all supplements. Duke surgeon Dr. Rebecca Knackstedt says that advice is often wrong – and that what you do in the days before surgery changes how you heal. In this episode: how much protein to eat (no standard exists, and most women get half of what they need), why surgery is catabolic and muscle is your reserve, the night-before carb loading trick that reduces pain, and the 5 day window that lowers complications and even mortality.

Dr. Knackstedt is a plastic and reconstructive microsurgeon on faculty at Duke, an MD-PhD researcher and a certified functional medicine provider whose research focuses on surgical prehabilitation, preparing the body, mind and home before surgery the way we already do rehab after it. She and Dr. Lyon cover what prehab looks like for any operation, the labs she checks, which supplements to keep and which to stop (omega-3s do not increase bleeding), why bed rest is over, hormones after breast cancer, why mammograms still beat thermography, what chemo does to metabolism, and the questions to ask before you consent.

Connect with Dr. Knackstedt

Instagram → https://www.instagram.com/surgical_recovery/

Website → https://www.clararecovery.com/

Join the Menopause Challenge →

https://drgabriellelyon.com/menopause-challenge/

(Use Code: 25OFF for 25% off)

Sponsors

- Perfect Amino by BodyHealth, https://bit.ly/4wZgg6N, code LYON20 for 20% off your first order

- Timeline Mitopure → https://bit.ly/4x18cm5, for an extra 20% off

- Lola Blankets → lolablankets.com, code: DRLYON for 40% off select blankets (limited time)

Find Dr. Gabrielle Lyon at:

- Instagram: https://www.instagram.com/drgabriellelyon/

- TikTok: @drgabriellelyon

- Facebook: facebook.com/doctorgabriellelyon

- X: x.com/drgabriellelyon

- Apply to become a patient – https://drgabriellelyon.com/new-patient-inquiry/

- Weekly newsletter – https://institute-for-muscle-centric-medicine.ck.page

- Order my book – https://www.amazon.com/exec/obidos/ASIN/1668085623

Mentioned

- Dr. Jocelyn Wittstein on estrogen, joints and injury → https://youtu.be/ILyzNTjZTGI

- Menopause Is a Muscle Problem (solocast) → https://www.youtube.com/watch?v=OvK21cHM_RE

- 5 Protein Myths Your Doctor Is Still Repeating → https://youtu.be/cYtTRTwUzcs

Chapters:

00:00 Prehab saves lives and money — so why isn't it standard of care?

01:05 Meet Dr. Rebecca Knackstedt: Duke microsurgeon and functional medicine provider

05:35 The patient who changed everything — good surgery isn't enough

08:34 What prehab is, and the exercises to do before any surgery

12:14 Hormones after breast cancer, rising rates in young women, and real risk factors

18:42 Chemo,