Wednesday, June 8, 2011

Understanding The Ups And Downs Of Erectile Dysfunction

Erectile dysfunction (ED) or impotence is a growing problem for many men in today's world and has inevitably found its way into the punch line of many jokes as we've found ways to make light of what those little blue pills can do for you.  But joking aside, this condition can cause of lot of anxiety and psychological stress for men as fear of failure and inadequacy with their sexual health takes hold.  Not only does this cause problems for a man's sexual health and the ensuing intimate relationships with their respective partners but it also leads to a decline in their overall health as well.

As it turns out, ED can be just as much of a predictor of developing chronic diseases as high cholesterol or smoking or family history can be.  As a matter of fact, ED has been linked to coronary artery disease, diabetes, hypertension, heart disease, hyperlipidemia, peripheral arterial disease, diabetic retinopathy, and chronic kidney disease [1-5,8].   One shocking statistic is that two thirds of all men with clinically evident coronary artery disease also have ED [1].  What's more, the signs and symptoms of ED frequently show up in these men approximately 2-3 years before the consequences of coronary atherosclerosis.  Atherosclerosis and coronary artery disease, as you may know, increase your risk of heart attacks and strokes.

The Journal of the American Medical Association (JAMA) published a study in 2005 looking at ED and the resulting incidence of cardiovascular events over a 5 year period that included 8,063 men [6]. What they found was eye opening indeed.  Of the men who already had ED or developed it during the study there was a 45% increased risk of experiencing a cardiovascular event (angina, heart attack, stroke, etc.).  These same sort of increased risks were seen in another study published in the Journal of the American College of Cardiology in 2010.  They looked at 6,304 diabetic men who had inquired about ED and followed them for 5 years [7].  For those men who had ED at the start of the trial, there was a 35% increased risk of developing coronary heart disease which leads to angina and heart attacks.  There was also a 36% increased risk in strokes in these same men.  I think it's fair to say that ED is more than just about being a disappointment in the bedroom and has far greater overall health implications than first meets the eye.

So how does all this happen?  And what causes erectile dysfunction?  More importantly, what can men do about it?  Is there anything that can restore men's sexual health and improve their overall health all at the same time?  Well, you're in luck today because we're going to get to the crux of the matter as we find out the answers to all of these questions.

What Causes Erectile Dysfunction In The First Place?

The development of ED has many different contributers such as benign prostatic hyperplasia (BPH), smoking, prescription drugs, injuries, surgeries, hormonal imbalances, and even psychological stressors [9-11].  But the most predominant factor, when it comes to the cause of ED, is the problem of endothelial  dysfunction.  So what's endothelial dysfunction?

In order to get an erection, the penis needs adequate blood flow to make this happen.  The arteries that supply your penis with this blood flow contain a very thin lining of cells on their inner most walls called endothelial cells.  In fact, your entire circulatory system, from your heart to all the arteries and capillaries contained therein, have this same lining of endothelial cells.  These endothelial cells play an absolutely critical role in maintaining healthy blood flow.  Their role is to produce a gas called nitric oxide [12].  And one of nitric oxide's most important functions is to relax the smooth muscle around your arteries to enable them to dilate, which, subsequently causes an increase in blood flow [13].  And that's exactly what every man with ED wants.

Nitric oxide also leads to an increase in blood flow to organs all throughout your body including your heart and the coronary arteries that supply them [14].  Furthermore, it plays a crucial role in preventing the formation of plaque buildup and blood clots within these arteries and your heart [15].  By doing this, it helps your endothelial system continue to make and release nitric oxide.  You can get an idea of this concept by picturing a race, let's say a marathon, where spectators are lining both sides of the route handing out bottles of water to the participants who run by.  The spectators (aka endothelial lining) are handing out water (aka nitric oxide) to the runners (aka blood flow) so that everything keeps chugging along like a well oiled machine.  Now what happens if you put barricades in place to separate the spectators from the runners?  That's right - they can't give out the water "nitric oxide" as easily.  The barricades symbolize plaque buildup in your arteries.  Now what happens if you put several layers of barricades in between the spectators and the runners and these barricades overflow into the race route making less room for the runners to get by?  Now you have spectators "endothelial lining" that's giving out very little water "nitric oxide" and on top of this the runners "blood flow" are being squished together which slows down the whole process.

Hopefully you're gaining an understanding of just how important healthy endothelial function is not only for your sexual health but also for your overall health.  Without it, impotence is bound to come knocking at your door eventually [16].

Erectile Dysfunction - What Can I Do About It?

So you've been diagnosed with ED or perhaps you never want to be diagnosed with ED, what do you do now?  This can be a frightening disease because it effects more than just what goes on in the bedroom, it's often accompanied with heart disease and other chronic illnesses that can have severe health consequences including death.  So it's important that you take this condition seriously and take action to put it to rest.

Mainstream treatments approach ED from the back end and do nothing to foil the cause which is endothelial dysfunction.  Viagra, Levitra, and Cialis are the three blockbuster drugs prescribed to treat ED.  They are the most commonly used conventional approaches and work by inhibiting an enzyme called cGMP specific-phosphodiesterase type 5 (PDE-5) [17].  Why is this important?  Because PDE-5 is responsible for causing erections to subside [18].  So, if you inhibit PDE-5 and keep it from carrying out its work then you lengthen the time that an erection can occur.  And voila!  The little blue pill has just worked its magic.

But there's a problem with this approach because you need to have a healthy endothelial system in the first place to have an erection.  And in many cases, a number of men have compromised endothelial systems due to years of fatty streaks and plaques building up inside their blood vessels causing hyperlipidemia and the beginning stages of heart disease.  But they can't "feel" these fatty streaks and plaques until they become so bad that either chest pain develops or even worse a heart attack or stroke occurs.  That's why heart disease is often referred to as the silent killer.  Now you understand why erectile dysfunction precedes cardiovascular disease because it's literally the calm before the storm.  So how can a person improve the health of their endothelial system?

One way to do this is to include some moderate exercise in your daily routine.  Daily moderate exercise such as walking, swimming, or biking has been shown to increase the production of nitric oxide which, as you know, helps to improve blood flow [19].  Cessation of smoking and avoiding excess alcohol have also been shown to increase nitric oxide production [19].

But the most successful way to restore a healthy endothelial system resides in adopting a plant-based diet.  Studies have shown that individuals who eat more plant-based foods (vegetables, fruits, whole grains, legumes, nuts) have a much lower incidence of ED and metabolic syndrome unlike those who consume a standard diet [20,21].  In contrast, high-fat diets showed just the opposite and were associated with a greater incidence of ED due to impaired endothelial function [22].  To get a better idea of which foods are high in fat and which are low in fat take a look at the chart below.

There are a couple of reasons for the success of a plant-based diet in terms of improving and/or reversing ED.  They have to do with putting back into place a healthy, viable endothelial system and this is done in the following ways.

First off, a plant-based diet that is low in fat and high in complex carbohydrates has been shown to lead to far less arterial plaque formation than either a high-fat western diet or a high-fat, high protein diet which is what most people have come to know as the Atkin's diet [23].  Refer to the illustration below to better visualize this point.

As you can see, when you have less plaque formation your endothelial cells are able to do their job of producing nitric oxide much more efficiently than if your arteries were lined with harmful plaques on their innermost walls.  This is why heart disease and ED go hand in hand.

Another method in which plant-based diets lead to a healthier endothelial system is due to the fact that they supply a portion of the raw materials needed for the formation of nitric oxide.  This can be summed up best by Dr. Caldwell Esselstyn in his book titled "Prevent And Reverse Heart Disease" [24].

"The essential building block for nitric oxide production is
a substance called L-arginine, an amino acid that is in rich
supply in a variety of plant foods, especially legumes,
beans, soy, and nuts."   ̴ Dr. Caldwell Esselstyn 

Your endothelial cells use L-arginine in addition to oxygen to produce nitric oxide.  As you already know, the production of this nitric oxide is vital to helping your blood vessels dilate efficiently leading to an increase in blood flow and providing for an overall healthier vascular system.


Erectile dysfunction is something that no man wants to get.  It's embarrassing, disheartening, and worse yet can lead to serious health consequences.  But there is hope, and it comes in the form of what many might have overlooked because it's so simple.  When you get back to the basics of taking care of yourself through proper nutrition and lifestyle choices you arm your body with the tools not only to defeat ED but also to regain control of your health in its entirety.  There will always be other choices like prescription medications but too often those choices come with side effects, fail to live up to expectations, and certainly don't get to the root cause of your problems when it comes to ED.  So I challenge you to eat healthier, stay active, and feel better if you're not already doing so and if you need more information on how to accomplish this then there are plenty of resources on my website to help you succeed.  Be happy, be healthy, and live life to the fullest!

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by Dustin Rudolph, PharmD
Clinical Pharmacist

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1 comment:

  1. Great blog! It makes perfect sense, and I like the marathon scenario to get the point across. Very creative!


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