“Sex is: kicking death in the ass while singing at the top of your lungs” – Charles Bukowski

Erectile dysfunction means early death

Up to 30 million men in the United States and about 100 million men worldwide suffer from erectile dysfunction (ED), the repeated or persistent inability to achieve or maintain the erection necessary for satisfactory sexual performance. Wait a minute. Less than 5 percent of the world’s population lives in the United States, but up to 30 percent of all impotent men in the world? We’re number one!

ED is considered a major factor in reduced quality of life in men—in an early theory, a connection between impotence and heart attack was even suspected. Depression is a risk factor for coronary heart disease, and it was thought that men who can’t get an erection become so depressed that they die of a broken heart.

The real reason the United States is the world leader in ED is probably the artery-clogging Standard American Diet. One in five ED cases may have psychological causes, but most are “vasculogenic,” meaning blood flow to the penis is impaired. For any body part to function properly, it needs enough blood. Cholesterol can clog the arteries of internal and external organs and cause aneurysms, heart attacks, strokes, kidney failure, spinal degeneration, and sexual dysfunction. Up to three quarters of men with cholesterol-narrowed coronary arteries suffer to some degree from erectile dysfunction. But Americans have red, white, and blue pills like Viagra. Yet those are only a stopgap to cover up the symptoms of vascular disease; they don’t change the underlying pathology at all—atherosclerosis, which threatens not only one’s love life, but life itself.

For more details, read the section on erectile dysfunction in How Not to Die, but basically, men in their mid-40s with erection problems can have up to a 50-fold risk of a cardiac event such as sudden cardiac death. In the past, ED in men under 40 was attributed to psychological causes; it was thought to be all in the head, but today we know the complaints are more likely early signs of vascular disease. Only a minority of the men over 70 years old who were surveyed felt bothered by their ED, but they may not have been aware of the broader significance for the health of their arteries. Some experts argue that a man with ED should—even if he has no cardiologic symptoms whatsoever—“be considered to have heart disease … until proven otherwise.”

Survival of the hardest

Given the causes of physiological erection problems, it’s not surprising that an artery-healthy diet would make a substantial contribution to prevention. In 2022, researchers wrote in an article in the journal Urology titled “Healthy plant-based diets are associated with a lower risk of erectile dysfunction” that the number of U.S. consumers who eat plant-based, which has increased by 500 percent in recent years, could lead to improved male sexual function. However, this improvement applies only to the consumption of healthy plant foods. Eating fewer animal products but continuing to wash down your fries with soda probably won’t improve anything in the bedroom. Whole plants for the whole man.

This fits with findings from the Harvard Health Professionals Follow-up, in which 20 000 men averaging 62 to 73 years old were followed for a little more than ten years. The researchers found that men who ate a healthier diet were significantly less likely to have erectile dysfunction. A study of Canadian diabetics concluded that each additional serving of fruits or vegetables per day lowered ED risk by 10 percent. This association appears to apply to younger men as well, since among men under 40, too, fruit and vegetable consumption was linked to a lower ED risk.

Erectile function is such a sensitive indicator of cardiovascular health that it could even explain why men no longer have a bone in the penis. I made a video about this, see.nf/baculum. Without the bone, “only really healthy and strong men could present a really stiff penis,” wrote evolutionary biologist Richard Dawkins, and thus “women could freely make a diagnosis.”

Feelings from a can

A recent study found that men who eat organic are less likely to have ED. What role pesticides play in sexual function has attracted interest for more than 50 years; back then, the British Medical Journal published the report “Impotence in agricultural workers exposed to toxic chemicals.” Farmworkers frequently exposed to pesticides are up to eight times more likely not to have nocturnal erections, but it’s still unclear whether pesticide residues on conventionally grown foods have this effect as well. The lower risk among consumers of organic foods could be due to the fact that they usually also eat fewer processed foods and more fresh foods.

The plastic additive BPA (bisphenol A) is associated with reduced male sexual function—lower sexual desire, more erectile difficulties, reduced ejaculatory force, and an overall less satisfying sex life. We do inhale BPA with dust and absorb it through the skin when we touch BPA-containing cash register receipts, but 90 percent of our BPA intake comes through diet. In see.nf/bpa I describe how to limit BPA exposure: use fewer products made of polycarbonate plastics, which are usually marked with recycling codes 3 or 7; choose fresh or frozen foods rather than canned; and be especially cautious with tuna and canned soups. If plastic containers are necessary, don’t put them in the microwave, dishwasher, or sun, and don’t leave them in a hot car. Don’t use them anymore if they are scratched. Ideally, choose containers made of glass, ceramic, or stainless steel, because it is not certain whether BPA-free plastics like Tritan are better.

Be careful when cycling

Other behaviors also affect male sexual function. Smoking can almost double the risk of ED, and secondhand smoke doesn’t help either. In an experiment, five out of six dogs that were in cigarette smoke for about ten minutes could no longer get an erection. Smoking cessation can’t be studied precisely because participants often don’t follow instructions, but men who quit smoking had significantly improved erectile function. Thus, in a six-month study, 54 percent of the men who quit smoking regained their erectile function, compared with 28 percent of the men who continued smoking. Cannabis use is also associated with ED. A meta-analysis using data from thousands of men found that the prevalence of ED among cannabis users (69,1 percent) was about twice as high as among nonusers (34,7 percent).

Obesity can cause severe sexual dysfunction, but with sufficient weight loss through dietary change or surgery, it is reversible. Physical inactivity leads to sexual inactivity, whereas regular aerobic exercise improves erectile function almost as well as the newest generation of Viagra-type drugs. To restore erectile function, at least 40 minutes of moderate to vigorous aerobic exercise four times per week for at least six months is recommended. However, caution is advised with extended bike rides.