Erectile Dysfunction: Nutritional Considerations

Impotence is often the result of vascular disease. Risk factors for cardiovascular disease are commonly found in patients with erectile dysfunction. These include obesity, elevated cholesterol and triglyceride levels, smoking, inactivity, endothelial dysfunction, elevated C-reactive protein concentration, and metabolic syndrome.^3-6 Moreover, impotence should be viewed as a sign that other cardiovascular problems may manifest in the future, and that diet and lifestyle changes to help prevent these problems are essential.

Although the evidence on nutritional treatment is limited, interventions that reduce cardiovascular risk factors or improve blood vessel reactivity (diet, exercise, and certain botanical agents) may improve impotence symptoms. In one study, a low-fat, low-cholesterol diet combined with exercise resulted in normal sexual function in 31% of impotent men, compared with about 5% in a control group. This combination also significantly reduced several vascular risk factors, including obesity, high blood pressure, elevated serum lipids, and elevated blood glucose and insulin concentrations.⁷ See Coronary Heart Disease chapter for dietary factors to prevent or treat cardiovascular disease.

Dietary supplements are not a substitute for a healthful diet and lifestyle, because they do not address the cause of vascular disorders. Nonetheless, 2 dietary supplements, L-arginine and ginseng, have proven effective in treating erectile dysfunction in clinical trials. These appear to work by enhancing nitric oxide release and increasing cyclic guanosine monophosphate (cGMP), which allows penile arterial relaxation and engorgement.

L-arginine is a precursor to nitric oxide. It was shown to be effective in 30% to 40% of patients taking 3 to 5 grams per day, compared with placebo.^8,9 Combinations of arginine and yohimbine hydrochloride¹⁰ or arginine and flavonoids that stimulate production of nitric oxide synthase (eg, oligomeric proanthocyanidins) increase the percentage of individuals responding to L-arginine to more than 90%.¹¹ However, not all trials of L-arginine have been adequately controlled, and further study is necessary.

Panax ginseng contains active ingredients (ginsenosides) that increase the release of nitric oxide. Controlled clinical studies have found that mean scores on the International Index of Erectile Function were significantly higher in patients treated with ginseng than in those who received placebo.¹² The studies also found that the number of patients treated with ginseng who experienced improvement in erectile parameters was double that of placebo-treated patients.¹³ Additional controlled clinical studies are needed to definitively establish a role for ginseng in ED treatment.

Dietary supplements should be used only under medical supervision, due to the possibility of medication interactions.

Orders

See Basic Diet Orders chapter and nutritional recommendations in Coronary Heart Disease chapter.

Smoking cessation.

Exercise prescription.

Referral for psychiatric evaluation, as appropriate.

What to Tell the Family

Discussion with family members regarding the patient's medical problems should only be done with permission from the patient, particularly in the case of sensitive diagnoses, such as erectile dysfunction. With the patient's permission, however, the sexual partner may be included in discussions of treatment options.

Patients with impotence are commonly at risk for other cardiovascular problems. A low-fat, vegetarian diet, along with smoking cessation and exercise, can be an effective treatment for these risk factors. To the extent that the entire family adopts such a diet, patient adherence is facilitated, and the patient and family are all likely to benefit.