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



Read more articles and recipes  



  1. NIH Consensus development panel on impotence (1993). Impotence. NIH Consensus Conference; 270(1):83-90.
  2. Morley JE (1993). Management of impotence. Diagnostic considerations and therapeutic options. Postgrad Med; 93(3):65-72.
  3. University of Maryland Medical Center. Sexual dysfunction.
  4. Melnik T et al (2008). The effectiveness of psychological interventions for the treatment of erectile dysfunction: Systematic review and meta-analysis, including comparisons to sildenafil treatment, intracavernosal injection, and vacuum devices. J Sex Med; 5(11):2562–2574. (5) UKHC - Statistics on erectile dysfunction
  6. Goldstein I, (2000) Working group for the study of central mechanisms in erectile dysfunction, Male sexual circuitry. Sci Am; 283(2):70-75.
  7. Vrentzos GE et al (2007). Erectile dysfunction: a marker for early coronary heart disease. Hellenic J Cardiol. 2007; 48(4):185-191.
  8. Heidelbaugh JJ (2010). Management of erectile dysfunction. Am Fam Physician; 81(3):305-212.
  9. Shabsigh R (2005). Testosterone therapy in erectile dysfunction and hypogonadism. J Sex Med; 2(6):785-792.
  10. NHS Choices. Erectile dysfunction (impotence) – causes.
  11. McCabe MP (2005). The role of performance anxiety in the development and maintenance of sexual dysfunction in men and women. Int J Stress Mgt; 12(4):379-388.
  12. Esposito K et al (2006).. Mediterranean diet improves erectile function in subjects with the metabolic syndrome. Int J Impot Res; 18(4):405-410.
  13. Yu W et al (2013). Resveratrol, an activator of SIRT1, restores erectile function in streptozotocin-induced diabetic rats. Asian J Androl; 15(5):646-651.
  14. Flight I & Clifton P (2006). Cereal grains and legumes in the prevention of coronary heart disease and stroke: a review of the literature. Eur J Clin Nutr; 60(10):1145-1159. 
  15. Holub DJ & Holub BJ (2004). Omega-3 fatty acids from fish oils and cardiovascular disease. Mol Cell Biol; 263(1-2):217-225.
  16. Appel LJ et al (2005). Effects of protein, monounsaturated fat, and carbohydrate Intake on blood pressure and serum lipids: results of the Omni heart randomized trial. JAMA; 294(19):2455-2464.
  17. Paroni R et al (2012). Asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA) and L-arginine in patients with arteriogenic and non-arteriogenic erectile dysfunction. Int J Androl; 35(5):660-667.
  18. Gianfrilli D et al (2012). Propionyl-L-carnitine, L-arginine and niacin in sexual medicine: a nutraceutical approach to erectile dysfunction. Andrologia; 44(Suppl 1):600-604.
  19. Cavallini G et al (2004). Carnitine versus androgen administration in the treatment of sexual dysfunction, depressed mood, and fatigue associated with male aging. Urology; 63(4):641-646.
  20. Sorenson M & Grant WB (2012). Does vitamin D deficiency contribute to erectile dysfunction? Dermatoendocrinol; 4(2):128-136. 
  21. Helmy MM & Senbel AM (2012). Evaluation of vitamin E in the treatment of erectile dysfunction in aged rats. Life Sci; 90(13-14):489-494. 
  22. Aoki H et al (2012). Clinical assessment of a supplement of Pycnogenol® and L-arginine in Japanese patients with mild to moderate erectile dysfunction. Phytother Res; 26(2):204-207.