Chapter 141
Lifestyle
One of the most popular substances in dietary supplements for boosting sexual function—and one of the most thoroughly studied—is ginseng. The meta-analysis of six randomized controlled trials found that taking 1800 to 3000 milligrams of Korean red ginseng per day for four to twelve weeks, compared with a placebo, significantly improved erectile function. Of course, that assumes there’s actually ginseng in the “ginseng.” In an analysis of more than 500 commercial ginseng products in a dozen countries across six continents, 24 percent were adulterated.
Some natural “aphrodisiacs” are considered too risky. These include yohimbine, Spanish fly, mad honey (Himalayan honey), and bufotenin, which was banned by the FDA because it can kill you. Yohimbine can kill you, too—though it was purchased online, so it may have been contaminated with other substances.
Lifestyle
The treatments currently recommended for ED don’t address the root cause of the problem—neither oral medications, surgical penile implants, vacuum pumps, intraurethral suppositories (for the pee-hole), nor intracavernosal injections (shots into the penile shaft). At least the American Urological Association encourages physicians to inform patients about the importance of changing lifestyle, but the guidelines of the European Association of Urology go a step further and state that lifestyle changes “must precede or accompany every ED treatment.” And for good reason. At see.nf/edlifestyle I discuss in detail intervention studies showing how effective exercise and healthier eating can be at improving erectile function.
The Atkins diet: Hard, firm to stick with
Erectile dysfunction and heart disease may be two manifestations of the same underlying problem: diseased arteries—inflamed, oxidized, clogged with cholesterol. Fortunately, atherosclerosis in both organs can be reversed through lifestyle changes that include anti-inflammatory, antioxidant, and cholesterol-lowering foods. In my video see.nf/atkins I present a vivid case report. The man started out as a fairly healthy 51-year-old with decent cholesterol values, no measurable plaque in the coronary arteries, and a functioning penis. He started the Atkins diet, lost a few pounds—and his erectile function. Then he nearly died from a 99-percent blockage of the coronary arteries, returned to a healthier diet, and the blood could flow through his body again.
Almost 20 years ago I wrote a book about the diet. The Atkins Corporation threatened to sue me at the time, but I sort of won, because the company filed for bankruptcy six months later. You can find the entire book and the rather funny correspondence between me and the Atkins lawyers at atkinsfacts.org.
More Nuts
In a short-term cross-sectional study, eating at least one serving of vegetables a day and more than two servings of nuts a week was associated with more than a 50-percent lower likelihood of ED. The first intervention study on nuts and ED was published in 2011. As I explain in see.nf/pistachios, men who ate three to four handfuls of pistachios a day for three weeks had significantly improved penile blood flow and significantly harder erections.
A 14-week randomized controlled trial using a mixed-nut blend found higher sperm count, a marginally increased orgasm function, and increased sexual desire, but no change in erectile function. As I note in see.nf/mixednuts, this discrepancy is likely due to differences in the populations studied. In the pistachio study, the men were between 40 and 60 and already had chronic ED, whereas participants in the mixed-nut study averaged 24 years old, so the younger men may have already had near-maximal blood flow at baseline, leaving the nuts little room for improvement.
Vegetables
Would vegetables help? As discussed, the body can make the nitric oxide needed to dilate blood vessels from the nitrates in leafy and root vegetables. There were attempts to apply nitrates directly to the penis (as nitroglycerin gel, which is normally used for chest pain), but it caused headaches in users and, if no condom was used, in their female partners as well. The benefit of vegetable nitrates could explain why eating leafy greens is associated not only with reduced heart disease risk but also with a longer life span—not to mention a potential “vegetable Viagra” effect. Compare that with the Top Ten nitrate sources. That could also explain the link between vegetable intake and improved sexual function, as well as improved blood flow to our most important organ, the brain. The only side effect of giving your brain an extra serving of beets might be a bit more color in life—in the form of red stool and pink urine.
With fruit, pomegranate juice flopped (see.nf/pomegranate), but watermelon held up well (see.nf/watermelon). Watermelon contains citrulline, which is converted in the body into arginine. Direct arginine intake can improve erectile function, but can also cause gastrointestinal discomfort. The amount of citrulline from five servings of red watermelon a day, or a single wedge of yellow watermelon (one-sixteenth of an average-size melon), can lead to a harder erection. If this is news to you, it may be because the advertising budget of companies like Pfizer, which rake in billions of dollars annually from the sale of ED drugs, is about 1000 times higher than the entire budget of the National Watermelon Promotion Board.
The Spice of Life
Half a dozen studies found that saffron was better than placebos for treating depression and could hold its own against drugs like Prozac. That was probably due to the red pigment crocin, because crocin alone (at a dose equivalent to about half a teaspoon of saffron per day) beat placebos as an adjunctive treatment and significantly reduced symptoms of depression, anxiety disorders, and general psychological distress.
If the spice works as well as the drugs, one could argue it’s better because, unlike most prescribed antidepressants, it doesn’t cause sexual dysfunction in most men and women. Common SSRIs like Prozac, Paxil, and Zoloft cause unwanted sexual side effects in about 70 percent of users, which can persist even after stopping the drug. (That’s really depressing!) Saffron doesn’t have that effect; on the contrary, as I lay out in see.nf/crocin, it may even help men and women with the sexual problems that the antidepressants caused in the first place.
What can saffron do for normal ED? In fact, a saffron study inspired me to suggest using the RigiScan device to measure erections for the documentary The Game Changers. There was suggestive benefit both with oral use and with topical application (rubbing it on the penis) of saffron, with the caveats I summarize in my video see.nf/saffroned.
Cost-benefit comparison
A review of diet and sexual health laid out the pros and cons of different dietary patterns. The standard American diet had the advantage of being “relatively inexpensive and easy to obtain,” but its downside showed “increased risk of all-cause mortality, cardiovascular disease, obesity, metabolic syndrome, stroke, chronic kidney disease, and breast, colon, and prostate cancers.” Fortunately, it’s getting easier and easier to eat healthfully, and it’s cheap, too. A consumer, for example, would save an estimated 750 US dollars (about 700 euros) per year by eating meat-free.