Magazine Articles and recipes Magazine Feature | Erectile dysfunction Published on 17th December 2014 It happens to every man once in a while. The spirit may be willing but the flesh somehow doesn’t respond. While we can usually laugh it off as ‘just one of those things’, frequent occurrences of this kind may merit the medical label of erectile dysfunction (ED). This embarrassing problem is, understandably, something that few men want to talk about, even to their doctor. Yet in many cases it can be helped or totally resolved by nutrition and lifestyle. Mike Murphy writes ED is defined as “the consistent inability to achieve or maintain an erection sufficient for satisfactory sexual intercourse”.1 Also referred to as impotence, this very common condition may affect around 50 per cent of men aged 40 to 70 to some degree.2 But while a man’s sexual function normally declines with age, ED is not necessarily a normal aspect of aging.3 The causes of ED are varied and can be physical, physiological or psychological. Men who suffer from ED may experience low self-esteem,4 and the condition can also impact their intimate relationships and quality of life. While it is estimated that only one-third of men with ED seek help,5 various therapeutic options are available and nutrition and lifestyle choices can also play an important role in restoring normal erectile function. Five hundred years ago Leonardo da Vinci discovered that the penis fills with blood during an erection. The penis contains three cylindrical columns of erectile tissue that are supplied with blood by arteries deep within the penis. When a man is sexually aroused, the brain sends excitatory signals directly to parasympathetic nerve endings in his penis, which in turn release nitric oxide (NO) gas.6 NO is a potent vasodilator (it opens up blood vessels) and sets off a chain reaction of chemicals that allows more blood to flow into the spongy tissue, causing an erection. At the same time, the pressure from the expanded tissue compresses the veins that otherwise would drain blood from the penis, so keeping it firm. Cardiovascular disease is one of the major risk factors associated with ED7 and around half of the cases in men over 50 are caused by atherosclerosis (hardening) of the penile artery,2 so ED can be an early warning sign of a more serious cardiovascular condition. Other risk factors for ED include diabetes, obesity, a sedentary lifestyle and smoking, all of which can be associated with coronary artery disease (CAD).8 Low testosterone levels can also be a factor in ED9 and many medications are known to cause ED as a side-effect, including diuretics, antihypertensives (blood pressure drugs) and antidepressants.10 Psychological factors contribute to approximately 15 per cent of ED cases11 and are more likely to be the cause in younger men. The fear of not being able to attain or sustain an erection can cause ‘performance anxiety’. Depression, past abuse and relationship problems can also be a factor, and psychotherapy may sometimes be an appropriate treatment option.4 Conventional drug treatments for ED include phosphodiesterase type 5 (PDE5) inhibitors, such as sildenafil (Viagra), which enhance NO production. These drugs can cause side-effects and are not suitable for everyone. Neither do they address the root cause of ED. Natural solutions Taking steps to improve cardiovascular health can play a major role in restoring healthy erectile function. Optimising your diet, increasing physical activity and eliminating smoking provide the best natural first-line defence against ED. The Mediterranean diet has long been associated with good health and longevity, and there is evidence that it could improve erectile function, too.12 This diet is largely plant-based with an emphasis on fresh fruits and vegetables, whole grains, legumes, olive oil and fish. It typically features less red meat and dairy products than the usual western diet and can include moderate (red) wine consumption. There are several effective solutions to ED, including nutritional therapy, so sufferers do not have to endure the condition. Adopting a healthy lifestyle, which includes not smoking, taking regular exercise, maintaining a healthy weight and eating a Mediterranean diet, can be an effective first step. In fact, doing anything that is good for your heart is likely to be good for your sex life, too. And embracing a healthier lifestyle may also bring increased energy levels, better self-esteem, improved overall health, and a better quality of life. Foods to focus on for improving ED Eat a wide variety of colourful vegetables and fruits, particularly those that are dark red and blue in colour, which are high in resveratrol. This potent antioxidant has been shown to reduce vascular inflammation and improve erectile function in animal studies13 Whole grains and legumes reduce the risk of vascular disease and may prevent ED through the same mechanism.14 Oily fish like salmon, mackerel and trout provide complete protein as well as omega-3 fatty acids that benefit circulation and protect the heart15 Mono-unsaturated fatty acids found in avocados, olive oil and rapeseed oil are also heart-healthy and can help lower blood pressure16 Nuts and seeds are also rich in mono-unsaturated fats and are good sources of arginine, an amino acid that your body needs to produce nitric oxide, a critical precursor to normal erectile function Some specific nutrients have also been shown to be of benefit for ED L-arginine is an amino acid that plays a significant role in erectile function by contributing to the formation of NO.17 and supplementation with L-arginine has been shown to restore erectile quality and increase sexual satisfaction.18 Acetyl-L-carnitine and propionyl-L-carnitine are natural amino acid compounds that have testosterone-like effects in the body. A combination of these two nutrients has been found to restore erections more effectively than testosterone therapy and to relieve depression and fatigue19 Vitamin D is needed for healthy blood vessels and is also involved in the production of NO. Vitamin D deficiency has been identified as a risk factor for erectile dysfunction20 Vitamin E has long been associated with sexual function and animal studies suggest it may be useful in preventing or treating erectile dysfunction21 Pycnogenol is not strictly speaking a nutrient but is a proprietary extract of French maritime pine bark. A combination of Pycnogenol and L-arginine has been shown to improve male sexual function and reverse ED22 Please note: Supplements should be taken under the supervision of a qualified health professional Download Read more articles and recipes References NIH Consensus development panel on impotence (1993). Impotence. NIH Consensus Conference; 270(1):83-90. Morley JE (1993). Management of impotence. 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