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Fitness Q & A With Dr. David Greuner

David Greuner, MD, is a lifelong competitive athlete who now competes in triathlons for charity causes. He shares with us a range of information about exercise and diet, from dispelling myths to letting us in on the science behind diet and exercise advice.

He is a founding member and the director of NYC Surgical Associates, a multi-specialty practice with seven locations in the tri-state area, each with its own on-site surgical facility. Since its founding in 2008, NYC Surgical Associates has become one of the fastest growing practices in New York. It’s also one of the safest. NYC Surgical Associates brings together highly skilled physicians who work together as a team for their patients.

A gifted and professionally renowned cardio-thoracic surgeon,  Dr. Greuner is the inventor of No Knife EVLT, a procedure that solves vein problems without even the smallest of incisions. You can see Dr. Greuner perform this procedure on The Doctors show, which is available on YouTube. He has also pioneered the novel procedure known as The Slim Line Hernia Repair, a cutting-edge way to repair hernias — a topic he covers below. Dr. Greuner has appeared on The Doctor Oz Show, ABC, and CBS.

Tell us about your background and what you do.

I am asked this question often, as NYC Surgical Associates is unique, and I’m not aware of another practice like it in the country. I am a general and cardiovascular surgeon by training, and I am double board certified. When I was in training I loved the anatomy and physiology of my field, but was disappointed about the stage at which we were treating patients. We were treating end-stage disease in patients who had damaged their bodies for decades. I began to study techniques for treating people at earlier stages, with less invasive approaches, what is called “endovascular” surgery. As I progressed in this skill set, I began to teach others about new techniques, and how to prevent the need for surgery. I educated via seminars, articles such as this, and other media. I became a media correspondent for health concerns for a nationwide TV network and wrote for publications such as Muscle & Fitness magazine.

I began to see younger patients, with other problems. I ventured into a world that was unknown at the time, the world of deep venous intervention, or the treatment of the large deep veins in the body that return blood from the abdomen, pelvis, and chest to the heart. My medical practice started to take a different shape, as people with these issues tended to be more athletic, largely because deep venous disease is often only manifest in very active people.

As I treated this more athletic crowd, I began to see the types of problems that are more prevalent in this population, including hernias. Hernias happen often in individuals who are constantly challenging their bodies. As I had significant experience in this arena as part of my surgical training, I began to treat my patients for this as well. I began to search for ways to do these operations with less scarring, and better results, and over time I developed some excellent techniques not practiced widely. Now NYC Surgical Associates specializes in the most high-risk cases that have been turned down by all other surgeons. Well, we appreciate the easy ones too!

Currently, our practice is one of the busiest in the country for hernia surgery, from simple to extremely complex, as well as deep venous endovascular surgery as a result, and we have an active fellowship program that has trained several top-notch graduates.

I love speaking about health, fitness, and preventative issues and how to keep in shape — not just for ideal form, but for function as well.

Let’s start on the lighter side. What are some of the most common misconceptions about diet and weight loss? 

Well, there are so many of them out there, I don’t know where to start! Let me give a few of my favorites.

If you work out more, you can ease up on your diet. False. This is one of the most common false statements I hear routinely. In general, diet and working out should be looked at as affecting two completely different aspects of your physique. In general, the way you look is 80 percent dependent on diet. Of course diet affects a lot of other things as well, including how you feel. Working out affects mostly how your body functions. If you want to increase strength, cardiovascular fitness, flexibility, etc., the only way to do so is through workouts engineered to achieve that goal. However, if you exercise routinely and with maximum effort, and you do not have a very well-structured diet, you likely will not look how you want to look. The converse is also true. If you have a diet that is completely on point, and work out very little, you will likely still look superb, but may not function very well, and you may not have any endurance, strength, or muscle mass.

You must do cardio to lose weight. False. Cardio is a catch-all term for aerobic exercise, but did you know that you can get your heart pumping in many other ways? Rapid fire circuit training, for example.

Lifting lighter weights for more repetitions is the way to get ripped. False. The only way to get that ripped, lean look is by having a low percentage of body fat, which is achieved mostly by a low-calorie diet. That is the only way to show your hard-earned muscle in its true glory.

If I lift weights, I’ll get too bulky. False. Just like fat, muscle needs excess calories in order to enlarge. If you lift heavy weights, and eat excess calories and protein, yes, you will get bulkier. If you eat a low-caloric diet, massive muscle growth is impossible.

OK, so what is the ideal workout regimen? 

That depends on what you are trying to accomplish. In general, I group objectives into three separate categories.

•  Flexibility

•  Endurance

•  Strength/Muscle Mass

All three goals are achieved using different techniques, and all are important. If you noted, I didn’t include weight loss as a category because, in general, weight loss has very little to do with your workout regimen, as I stated prior. Men tend to focus more on endurance and strength/mass, while women tend to focus on flexibility and endurance. Ideally, all should be addressed for a healthy body. If you look at workouts as a way to improve your functional status, and diet as the path to weight management, you will likely have far greater success in achieving your fitness goals.

What are some ways you recommend to help stick to your workout routine?

Personally, I try to adapt to the seasons. In summer, I spend as much time as I can outdoors, doing activities like running, cycling, swimming, and hiking. During the winter, I mix it up. When the weather confines me to an indoor environment, I start taking more group classes at places like Barry’s Bootcamp, Soul Cycle, and other group fitness classes.

Working out with a friend or partner is often an excellent way to stick to a routine. On days when you might not feel like pushing forward, your partner can give you that extra nudge and vice versa.

What are the critical hormones that affect your overall physique and health? 

There are four key players: testosterone, growth hormone (GH), insulin, and cortisol.

1) Contrary to popular belief, testosterone is actually important for females as well, but they need it in significantly lower levels than males. Testosterone functions to stimulate our libido, increase stamina, help maintain muscle mass, and also affect other things such as skin health. Lack of testosterone causes lack of libido and fatigue. The decrease in this hormone is largely responsible for the loss of muscle mass and increase in fat as we age, for both males and females. Appropriate testosterone levels are necessary for an overall toned physique. Weight-bearing exercises and a diet higher in protein can result in higher amounts of testosterone being released.

2) GH promotes lean muscle growth, but also causes fat loss. It improves the overall health of skin, hair, and connective tissue. Increasing growth hormone levels clearly helps promote a leaner physique and healthier appearance. You can help increase the levels of GH by more frequent, higher-intensity workouts, and taking a power nap. It is also released in longer intervals when insulin levels are lower, so low-sugar diets will help increase GH.

3)  Insulin is your body’s only completely anabolic hormone, meaning it is entirely pro-growth. It causes accumulation of muscle, fat, and promotes rebuilding of any damaged tissue in the body. It is released in response to a meal. Insulin is great, but in excess, it will cause a significant amount of weight gain. In general, a high-sugar diet will cause an over release of insulin.

4) Cortisol triggers the body to break down muscle to raise blood sugar as well as blood pressure levels, which in short-term stressful situations works towards our benefit. When stress is prolonged, however, and cortisol levels are elevated for longer periods of time, a situation that mimics diabetes is the result. Excessive cortisol exposure over the long-term can cause a huge variety of issues, ranging from premature aging of the skin to heart disease and atherosclerosis to a flabby, non-muscular physique.

How can we help mitigate the effects of cortisol and stress?

In short, anything that makes you calmer and more relaxed helps to lower your cortisol levels, which is clearly beneficial over the long-term. This can range from meditation to hard-core workouts. If you wanted to take things a step further, and actually stimulate certain hormones, such as GH, testosterone, and other hormones that promote a lean, toned physique, weight-bearing workouts such as circuit training or weight lifting are an excellent way to do so.

How does sleep affect your physique and overall health? 

Believe it or not, getting enough sleep is beneficial on multiple levels.

I’ve heard a lot about how instituting cheat meals into your diet can be beneficial to actually maintaining a leaner physique. It sounds confusing. Can you explain? 

Think of your body as a creature of habit. It wants to maintain the status quo, whatever that is, at any cost. It also is pre-programmed to always be in a storage mode to accumulate fuel for when it is needed. In short, we are programmed to be fat.

When we diet, our body wants to preserve the status quo. It senses that our caloric intake is dropping, and tries to operate in a more efficient way in order to accommodate the new, more restrictive “fuel budget,” so to speak. This takes several days to happen. When you have a cheat meal, your body’s detection mechanism is thrown off, and it thinks that it can once again operate on a frivolous energy budget again, meaning less efficiently. This way, you are always able to trick your metabolism into temporarily speeding up.

Of course, this only works if the majority of your time is spent in a caloric deficit. You can’t have cheat meals every other day and expect to lose weight.

What are some injuries that you see in very active people, and how can they be treated? 

Deep vein problems and hernias are problems I see commonly in my practice, and I see them in two patient populations: those who have had a significant weight loss and competitive athletes.

Let’s start with hernias. Hernias are essentially an over-widening of a normally existing space between muscle layers. This widening creates a gap large enough to allow normally contained contents to slide through, something that wouldn’t normally be possible in a person without a hernia. They can also be due to tears in muscular structures that are inherently weak. They often happen in patients who perform repetitive weight-bearing activity, because increased pressure within the abdomen, chest, and pelvis, strains these areas. When pressure overwhelms the structural integrity of your body, a hernia results.

Hernias can be fixed in many ways. Most commonly, a prosthetic device called a “mesh” is used to close the gap. I am not a fan of these meshes, as up to 40 percent of these patients have issues like chronic pain related to the mesh. In fact, a large part of our practice is removing previously placed meshes.

NYC Surgical Associates uses mesh-free repairs, utilizing natural tissues to close the gaps, which is more technically challenging, but yields far better results, in my opinion.

The second issue we see with regularity is what is called deep vein disease. Deep veins are the drains of your body, and work to return blood to your heart from your arms and legs. I like to use the analogy of a shower with a poorly functioning drain. We can all relate to that. When you exercise lightly (taking a short shower), the drain works fine. It’s when you perform strenuous activity, causing your heart to pump a large amount of blood to your legs (taking a long shower), that the drain starts to become a problem. Blood becomes trapped in your legs, because the veins that are not functioning well cannot return blood as fast as it is being pumped in (the shower floods). The legs then become numb, painful, crampy, and swollen. This can range from mildly uncomfortable to completely debilitating. I know, because I myself had a severe case. This can now be fixed with excellent durability, through nothing more than an IV catheter, no incision, and local anesthesia. Isn’t modern medicine awesome?

Is it ever too late to become fitness-centric? 

It’s never too late to make a change, especially when it comes to your health and fitness. Clearly, as you age, criteria, activity tolerance, and goals may change somewhat, but you are the master of your own domain when it comes to your health. A little discipline and dedication can help you transform yourself at any age.

NYC Surgical Associates