Nutrition And Erectile Dysfunction Public


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Learn how nutrition can both cause and relieve erectile dysfunction. Bernard Rosen's PhD dissertation was on this subject.

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Nutrition And Erectile Dysfunction Public

  1. 1. Nutrition and Erectile Dysfunction Bernard Rosen, PhD
  2. 2. Bernard Rosen <ul><li>PhD in Nutrition (Clayton College) </li></ul><ul><li>MBA (Northwestern University) </li></ul><ul><li>B.S. (University of Pennsylvania) </li></ul><ul><li>Corporate Experience – Norlight Telecommunications, Kohler Company, J.I.Case, United Airlines </li></ul><ul><li>I used to weigh 185 pounds! </li></ul>
  3. 3. Definition <ul><li>The National Institute of Health defines erectile dysfunction (ED) as: </li></ul><ul><li>“The inability to achieve or maintain an erection sufficient for satisfactory sexual performance.” </li></ul><ul><li>What exactly does that mean? How can it be measured? </li></ul>
  4. 4. How is it measured? <ul><li>Somewhat subjective </li></ul><ul><li>Doctor diagnosis </li></ul><ul><li>Validated questionnaires </li></ul><ul><li>IIEF (International Index of Erectile Function) </li></ul>
  5. 5. Statistics <ul><li>The Massachusetts Male Aging Study - 52% of men between the ages of 40 and 70. (1987-1997) </li></ul><ul><ul><li>The combined prevalence of minimal, moderate and complete impotence was 52%. </li></ul></ul><ul><ul><li>The prevalence of complete impotence tripled from 5 to 15% between subject ages 40 and 70. </li></ul></ul><ul><ul><li>Erectile dysfunction is classified as minimal, moderate, or complete. Of the 52% of men who suffer from erectile dysfunction 17% have minimal ED, 25% have moderate ED, and 10% have complete ED. </li></ul></ul>
  6. 6. Statistics <ul><li>Over 30 million men in the United States. </li></ul><ul><li>Cases will more than double over the next 25 years due to population trends. </li></ul><ul><li>The worldwide incidence of erectile dysfunction estimated at over 152 million men, with a forecast of 322 million men by the year 2025. </li></ul>
  7. 7. My Dissertation <ul><li>Starting point – Why so many commercials? </li></ul><ul><li>Test the theory that nutrition is both a cause of and a resolution for erectile dysfunction. </li></ul><ul><li>Nutrition = diet + supplementation. </li></ul><ul><li>Erectile dysfunction = IIEF + medical diagnosis. </li></ul><ul><li>A Variety of lifestyle factors also considered (such as disease prevalence, smoking, alcohol consumption, drug usage, weight management, and exercise). </li></ul>
  8. 8. My Dissertation <ul><li>Present evidence of: </li></ul><ul><ul><li>1) a direct association between poor nutrition and erectile dysfunction </li></ul></ul><ul><ul><li>2) a direct association between improved nutrition and improved erectile function. </li></ul></ul><ul><li>Phase 1 – online survey. </li></ul><ul><ul><li>Nutrition Index </li></ul></ul><ul><ul><li>Lifestyle Index </li></ul></ul><ul><ul><li>Erectile Function Index </li></ul></ul><ul><li>Phase 2 – dietary and supplement intervention. </li></ul>
  9. 9. Questions <ul><li>What exactly is erectile dysfunction and what causes it? </li></ul><ul><li>Is it a physical condition or a psychological condition? </li></ul><ul><li>How is it related to other diseases? </li></ul><ul><li>Is it a symptom of other diseases or a disease on its own? </li></ul><ul><li>Or is it a warning sign of other diseases to come? </li></ul><ul><li>Does a man’s diet have anything to do with whether or not he will have erectile dysfunction? </li></ul>
  10. 10. Anatomy of the Penis <ul><li>Three structures made of erectile tissue that support an erection. </li></ul><ul><ul><li>Corpus spongiosum </li></ul></ul><ul><ul><li>Corpora cavernosa (2). </li></ul></ul><ul><li>The corpus spongiosum runs the length of the penis, ends at the glans penis, and surrounds the urethra. (It is through the urethra that either urine or semen can exit the penis.) </li></ul><ul><li>There is one corpora cavernosa on each side of the penis. </li></ul>
  11. 11. Anatomy of the Penis
  12. 12. Anatomy of the Penis <ul><li>Tunica albuginea – a fibrous sheath that encompasses the corpora cavernosa. </li></ul><ul><li>The erectile tissue of the corpus spongiosum and the corpora cavernosa contains many tiny blood vessels called cavernous sinuses. </li></ul><ul><li>Smooth muscles surround each of the blood vessels and regulate their activity. </li></ul>
  13. 13. Anatomy of the Penis <ul><li>These vessels are supported by collagen, a fibrous tissue made of protein. </li></ul><ul><li>Blood flows into the penis through the penile arteries and out of the penis through the penile veins. </li></ul><ul><li>Nerves connect the spinal cord to the penis. </li></ul>
  14. 14. Anatomy Summary <ul><li>Erectile tissue </li></ul><ul><li>Tiny blood vessels </li></ul><ul><li>Smooth muscle </li></ul><ul><li>Nerves </li></ul>
  15. 15. Erection Physiology: Blood Flow <ul><li>The penis is either flaccid or erect. </li></ul><ul><li>When the penis is flaccid (not erect), the small arteries leading to the cavernous sinuses are contracted. </li></ul><ul><li>The smooth muscles are also contracted which limits the amount of blood that can enter the penis and reduces the inflow of blood. </li></ul><ul><li>When the male becomes sexually aroused the central nervous system releases a number of chemicals. </li></ul><ul><li>Chief among them is nitric oxide. </li></ul>
  16. 16. Erection Physiology: Blood Flow <ul><li>The enzyme nitric oxide synthase converts L-arginine (an amino acid) into nitric oxide. </li></ul><ul><li>The receptor for nitric oxide in vascular smooth muscle is guanylate cyclase. </li></ul><ul><li>These two chemicals interact, producing cyclic guanosine monophosphate (cGMP). </li></ul>
  17. 17. Erection Physiology: Blood Flow <ul><li>The cGMP causes the smooth muscle to relax and blood flows into the cavernous sinuses and the penis becomes erect. </li></ul><ul><li>At the same time, the veins in the penis are squeezed almost completely shut due to this pressure. Since the veins are shut, blood can not drain from the penis, and it remains erect. </li></ul>
  18. 18. Erection Physiology: Blood Flow <ul><li>Once the arousal has subsided, or the man has ejaculated, the cGMP is broken down and the penis again becomes flaccid. </li></ul><ul><li>The main chemical responsible for this part of the process is an enzyme called phosphodiesterase-5 (PDE-5). </li></ul><ul><li>Prescription drugs such as Viagra, Cialis, and Levitra are PDE-5 inhibitors. They work by preventing the breakdown of cGMP, thus keeping blood in the penis to maintain the erection. </li></ul>
  19. 19. Erection Physiology: Nervous System <ul><li>The nervous system plays a critical role in the process of creating an erection - communicates the state of arousal throughout the body. </li></ul><ul><li>The nerves serving the penis are the dorsal penile and perineal nerves. </li></ul><ul><li>These nerves are a continuation of sympathetic, parasympathetic, and sensory and motor somatic nerves. </li></ul><ul><li>They control the tone of the corpus cavernosum smooth muscle and its related vascular system. </li></ul>
  20. 20. Erection Physiology: Somatic Nerves <ul><li>The somatic nerves begin the initiation of the arousal signal to the brain. </li></ul><ul><li>It is these nerve messages, relayed by neurotransmitters that drive the entire process. </li></ul><ul><li>The pudendal nerve connects the penis with nerve fibers that go to the skin of the penis and the genital area. </li></ul>
  21. 21. Erection Physiology: Parasympathetic Nerves <ul><li>The parasympathetic nervous system governs the release of the nitric oxide and the subsequent events leading to the erection. </li></ul><ul><li>It tells the smooth muscle in the penis to relax and the muscular walls of the arteries to dilate. </li></ul><ul><li>This allows the blood to rush into the penis and for it to swell with blood. </li></ul>
  22. 22. Erection Physiology: Sympathetic Nerves <ul><li>The sympathetic nervous system governs keeping the penis flaccid. </li></ul><ul><li>It sends the signal for the arteries to contract, less blood comes to the penis, the pressure is relieved, and blood can flow out the veins. </li></ul><ul><li>It is important to note here that events which engage the sympathetic nervous system, such as stress, cause penile artery muscles to contract and blood to leave the penis, making it more difficult to obtain and maintain an erection. </li></ul>
  23. 23. Erection Physiology: Dopamine and Serotonin <ul><li>Two other neurotransmitters that are significant in the erectile process are dopamine and serotonin. </li></ul><ul><li>Dopamine is the chemical messenger that relays pleasure. </li></ul><ul><ul><li>Sends positive signals to the brain to encourage sexual activity. </li></ul></ul><ul><ul><li>Low dopamine levels will decrease libido. </li></ul></ul><ul><li>Serotonin regulates emotions. </li></ul><ul><ul><li>Low levels of serotonin can affect our mood, raise aggression levels, or decrease libido. </li></ul></ul>
  24. 24. Erection Physiology: Summary <ul><li>For the erectile process to function correctly, several systems of the body need to be healthy: </li></ul><ul><ul><li>Blood needs to be flowing smoothly and unobstructed throughout the body </li></ul></ul><ul><ul><li>Nerves need to be firing and sending messages between the brain and the tissues </li></ul></ul><ul><ul><li>Libido needs to be present encouraging sexual interest. </li></ul></ul>
  25. 25. Types of ED <ul><li>Erectile dysfunction is usually caused by one or more of the following pathologies: </li></ul><ul><ul><li>arterial vascular pathology </li></ul></ul><ul><ul><li>neurologic pathology </li></ul></ul><ul><ul><li>endocrine causes </li></ul></ul><ul><ul><li>psychogenic causes </li></ul></ul><ul><li>Physical – 80%. </li></ul>
  26. 26. Arterial Vascular Pathology <ul><li>Endothelial dysfunction </li></ul><ul><li>Atherosclerosis </li></ul><ul><li>Narrowing or blockage of any of the arteries anywhere from the heart to the penis </li></ul><ul><li>Penile venous leakage </li></ul><ul><li>Accounts for 50-75% of ED (depending upon the study) </li></ul>
  27. 27. Neurologic Pathology <ul><li>Nerve damage </li></ul><ul><li>Diabetes </li></ul><ul><li>20-25% of ED (depending upon the study) </li></ul><ul><li>Among diabetic men 40-80% have ED (depending upon the study and their age) </li></ul>
  28. 28. Endocrine Causes <ul><li>Low testosterone levels </li></ul><ul><ul><li>Libido only </li></ul></ul><ul><li>Not proven to impact vascular or neurological channels. </li></ul>
  29. 29. Psychogenic Causes <ul><li>Performance anxiety </li></ul><ul><li>Depression </li></ul><ul><li>Fear of rejection or failure </li></ul><ul><li>Feelings of anger, hostility, and shame </li></ul><ul><li>High levels of stress </li></ul>
  30. 30. Risk Factors: Common Causes <ul><li>Age </li></ul><ul><li>Alcohol consumption </li></ul><ul><li>Diet </li></ul><ul><li>Endothelial dysfunction </li></ul><ul><li>Male hormones </li></ul><ul><li>Inflammation and obesity </li></ul><ul><li>Sedentary lifestyle </li></ul><ul><li>Cholesterol </li></ul><ul><li>Prescription drugs </li></ul><ul><li>Smoking </li></ul><ul><li>Stress </li></ul><ul><li>Motorcycling </li></ul>
  31. 31. Risk Factors: Medically Diagnosed Diseases <ul><li>Atherosclerosis </li></ul><ul><li>Depression </li></ul><ul><li>Diabetes </li></ul><ul><li>Cardiovascular disease </li></ul><ul><li>Coronary artery disease </li></ul><ul><li>High blood pressure </li></ul><ul><li>Metabolic syndrome </li></ul><ul><li>Lower urinary tract symptoms </li></ul>
  32. 32. Nitric Oxide <ul><li>Penile erection requires up to 80% dilation of penile arteries. Not enough NO, no erection. </li></ul><ul><li>Nitric oxide lost by: </li></ul><ul><ul><li>Oxidative stress/free radicals </li></ul></ul><ul><ul><li>Excess arginase II (enzyme that breaks down L-arginine) </li></ul></ul><ul><ul><li>Reduction of androgen hormones reduces nitric oxide synthesis </li></ul></ul><ul><ul><li>Increase in Rho/Rho kinase which reduces nitric oxide and smooth muscle dilation </li></ul></ul>
  33. 33. Approaches to Treatment <ul><li>Medical – devices, surgeries </li></ul><ul><li>Medical – pharmaceuticals </li></ul><ul><li>Alternative </li></ul><ul><ul><li>Supplements </li></ul></ul><ul><ul><li>Herbal </li></ul></ul><ul><ul><li>Diet </li></ul></ul><ul><ul><li>Lifestyle </li></ul></ul>
  34. 34. Pharmaceuticals <ul><li>Pfizer reports $1.7 billion of Viagra sales in 2006. An increase of $100 million over 2005’s sales. </li></ul><ul><li>Eli Lilly reports $747 million worldwide sales of Cialis in 2005. An increase from $131 million in 2004. </li></ul><ul><li>Eli Lilly introduced Cialis into the U.S. market in December 2003. In 2004, the first full year of sales in the U.S., Eli Lilly reports $206.6 million of sales. In 2005 Eli Lilly reports $272.9 million of sales in the U.S., an increase of 32% in just one year. </li></ul><ul><li>Bayer reports an increase in worldwide sales of Levitra from €260 million in 2005 to €314 million in 2006, a 20.8% increase. </li></ul>
  35. 35. Supplements <ul><li>L-arginine </li></ul><ul><li>Omega-3 EFAs </li></ul><ul><li>Anti-oxidants (Pycnogenol, grape seed extract, red wine extract, Vitamin C, Vitamin E </li></ul><ul><li>Niacin </li></ul>
  36. 36. L-arginine <ul><li>Precursor to nitric oxide </li></ul><ul><li>Anywhere from 1-15 g per day </li></ul>
  37. 37. Pycnogenol <ul><li>Enhances production of nitric oxide. </li></ul><ul><li>Increases the strength and elasticity of the blood vessels. </li></ul><ul><ul><li>Reinforces collagen fibers </li></ul></ul><ul><ul><li>Strengthening tiny capillaries </li></ul></ul>
  38. 38. Omega 3’s <ul><li>EPA and DHA to benefit cardiovascular and nervous systems. </li></ul><ul><ul><li>Reduce arterial plaque </li></ul></ul><ul><ul><li>Decrease blood clotting </li></ul></ul><ul><ul><li>Lower triglyceride levels </li></ul></ul><ul><ul><li>Decrease blood pressure </li></ul></ul><ul><ul><li>Decrease blood vessel inflammation </li></ul></ul>
  39. 39. Red Wine and Grape Seed Extracts <ul><li>Nitric oxide is quickly oxidized in the blood stream. </li></ul><ul><li>Antioxidants can prolong its bioavailability. </li></ul><ul><li>Prevents build up of oxidized cholesterol on artery walls. </li></ul><ul><li>Increases strength and elasticity of blood vessels. </li></ul><ul><li>Enhances ability of collagen to repair itself. </li></ul><ul><li>Inhibits inflammation. </li></ul>
  40. 40. Niacin <ul><li>Studies show niacin to lower cholesterol and raise levels of HDL. </li></ul><ul><li>Promotes regression of hardened arteries. </li></ul><ul><li>Rejuvenates blood vessels. </li></ul>
  41. 41. Herbs (Most Common) <ul><li>Ashwagandha </li></ul><ul><li>Ginkgo </li></ul><ul><li>Ginseng </li></ul><ul><li>Horny Goat Weed ( Epimedium ) </li></ul><ul><li>Maca </li></ul><ul><li>Rhodiola rosea </li></ul><ul><li>Saw palmetto </li></ul><ul><li>Tongkat Ali </li></ul><ul><li>Tribulus </li></ul><ul><li>Yohimbine/Yohimbe </li></ul>
  42. 42. Tongkat Ali <ul><li>Boosts sex drive, sexual function and performance by increasing testosterone production. </li></ul><ul><li>Inhibits sex hormone agent binding globulin, allowing free testosterone to remain in the blood. </li></ul><ul><li>Antiviral, antimalarial, anticarcinogenic. </li></ul><ul><li>Animal testing shows increased copulation and increased testosterone. </li></ul>
  43. 43. Rhodiola Rosea <ul><li>Increases energy, stamina, sexual desire and performance. </li></ul><ul><li>Fights stress and fatigue. </li></ul><ul><li>Lowers corticotrophin releasing factor (CRF) a substance that builds up in the body due to stress and has been found to impair sexual function. </li></ul><ul><li>Useful where function and desire have been reduced due to stress. </li></ul>
  44. 44. Yohimbine <ul><li>Has been used as drug for ED for over 70 years. </li></ul><ul><li>Blocks the presynaptic alpha-2-adrenergic receptors in the brain. </li></ul><ul><li>Reduces the levels of norepinephrine which blocks the normal sympathetic inhibitory reaction. </li></ul><ul><li>Enhances nitric oxide release from penile nerves. </li></ul>
  45. 45. Maca <ul><li>Root vegetable, member of cruciferous family. </li></ul><ul><li>Rich in amino acids, fatty acids, and sterols. </li></ul><ul><li>Primarily increases libido. </li></ul><ul><li>Some improvement in function reported. </li></ul>
  46. 46. Horny Goat Weed <ul><li>Increases sexual desire, arousal, and activity. </li></ul><ul><li>Contains flavonoids = antioxidant. </li></ul><ul><li>Improves sperm production. </li></ul><ul><li>Has androgen-like influence on testes, prostate gland, and anal muscles. </li></ul>
  47. 47. Horny Goat Weed <ul><li>Inhibitor of acetyl cholinesterase (AChE) which stops neurotransmissions at cholinergic synapses which are associated with sexual arousal. This keeps the nerves stimulated. </li></ul><ul><li>Inhibitor of monoamineoxidase (MAO) which may elevate levels of norepinephrine, adrenaline, serotonin and dopamine. </li></ul><ul><ul><li>High dopamine -> release of LH -> produces testosterone. </li></ul></ul>
  48. 48. Ashwagandha and Ginseng <ul><li>Alkaloids – increase production of nitric oxide and improve vascular endothelial abnormalities. </li></ul><ul><li>Sterols – stimulate sexual and adrenal functions. </li></ul><ul><li>Flavonoids – aid cardiovascular system. </li></ul>
  49. 49. Ginkgo, Tribulus, Saw Palmetto <ul><li>Ginkgo – increases blood flow to the penis through peripheral arteries. </li></ul><ul><li>Tribulus – increases testosterone levels. </li></ul><ul><li>Saw Palmetto – reduces prostate enlargement. </li></ul>
  50. 50. Dr. Lamm (The Hardness Factor) <ul><li>Pycnogenol – 80 mg </li></ul><ul><li>L-arginine – 3 g </li></ul><ul><li>Horny Goat Weed – 2 x 500 mg capsules </li></ul><ul><li>Omega-3 fatty acids – minimum 800 mg of EPA and 300 mg of DHA </li></ul><ul><li>Red wine extract – 200 mg </li></ul><ul><li>Grape seed extract – 100 mg </li></ul><ul><li>Niacin – 2 x 400 mg capsules </li></ul><ul><li>Vitamin C – 500 mg </li></ul><ul><li>Vitamin E – 400 IU </li></ul>
  51. 51. Dietary Therapies <ul><li>One study that put diabetic men with ED on Mediterranean diet. </li></ul><ul><li>Standard American Diet (SAD) – many studies linking it with all the risk factors previously mentioned. </li></ul><ul><ul><li>Obesity, Metabolic Syndrome </li></ul></ul><ul><ul><li>Inflammation </li></ul></ul><ul><ul><li>Cardiovascular disease </li></ul></ul><ul><ul><li>Diabetes </li></ul></ul>
  52. 52. Lifestyle Therapies <ul><li>Exercise increases nitric oxide production. </li></ul><ul><li>Best results when combine dietary and lifestyle therapies. </li></ul>
  53. 53. Bernie Rosen Nutrition Consultant and Educator <ul><li>Bernie Rosen, PhD, Clayton College of Natural Health </li></ul><ul><ul><li>Phone (262) 389-9907 </li></ul></ul><ul><ul><li>E-mail – </li></ul></ul><ul><li>Services </li></ul><ul><ul><li>Nutrition consultation and education </li></ul></ul><ul><ul><li>Individualized wellness programs </li></ul></ul><ul><ul><li>Nutrient testing </li></ul></ul>