Can Dietary Changes Improve Erectile Dysfunction?

Erectile dysfunction is not commonly thought of as a diet-related condition, but rather an unfortunate -- albeit inevitable -- medical phenomenon related to either age or prostate disease. This assumption is bolstered by the fact that most men with the condition are treated with a little blue pill and sent on their merry way without further conversation about the benefit of dietary or lifestyle change. In many cases, however, erectile dysfunction is very much the result of dietary patterns, and can be an early warning signal of more serious health risks such as heart attack or stroke, which are also diet- and lifestyle-related.

When considering how diet and lifestyle choices contribute to erectile dysfunction, it's helpful to understand a few of the condition's underlying causes. For starters, erectile dysfunction results from poor blood flow to the penis that prevents achieving or sustaining an erection. One reason blood flow can be impaired is buildup of plaque in the blood vessels that stiffens (pardon the word choice) their normally flexible walls and prevents them from dilating in response to sexual arousal. (In other words, when your arteries harden, your penis won't.) Plaque buildup results from chronically high cholesterol levels, and a subsequent inflammatory response from the body's white blood cells. If this sounds familiar, it should: This is the same process that occurs in coronary arteries that increases risk of a heart attack. Indeed, erectile dysfunction is often considered an early symptom of cardiovascular disease, and is associated with increased risk of heart attack or stroke within several years. So don't let anyone tell you that the penis isn't connected to the heart.

Another reason that erectile function can be impaired is inadequate production of a compound called nitric oxide by the cells lining the blood vessels in the penis. Nitric oxide is responsible for relaxation of the smooth muscles lining the blood vessels of the penis so they can dilate to accommodate greater blood flow, and is regarded as the main factor responsible for penile blood flow. But production of nitric oxide is impaired when these blood vessel liner cells are inflamed (which can be caused by smoking and obesity) or damaged (which can be caused by smoking and plaque buildup). Better blood vessel function means more nitric oxide, and more nitric oxide means better erections. As luck would have it, dietary choices and exercise can improve nitric oxide levels.

So if you or someone you love is among the 30 million American men affected by erectile dysfunction, consider this diagnosis a wake up call to get your nutritional house in order. Here are some suggestions for both long-term lifestyle changes (and one heat-of-the-moment trick) that may help improve erectile function -- and overall health to boot.

1. Adopt a Mediterranean-style diet (and use it to lose weight and lower cholesterol if needed.)

In my experience, many overweight male patients default to a low-carb, Atkins-style diet when they decide to lose weight. As a result, they pile on artery-clogging foods high in inflammatory omega-6 fats such as red meat, cheese, bacon and butter, while avoiding foods high in naturally cholesterol-lowering soluble fiber and antioxidants such as whole grain oats, barley, fruit and beans. For cardiovascular health in general and erectile dysfunction in particular, the Atkins-style diet is precisely the pattern you want to avoid.

While research into diet and erectile dysfunction is somewhat sparse, the Mediterranean diet is the best-studied dietary patterns to date. Studies have shown that adopting this pattern of eating is associated with an improvement in erectile function among men with erectile dysfunction -- as well as reduced risk of developing erectile dysfunction among men who do not yet suffer from it -- when compared to the typical Western diet. A Mediterranean diet is high in fruits, vegetables, minimally-processed whole grains, beans, nuts and olive oil, and can feature moderate portions of lean animal proteins such as fish, poultry and low-fat or fat-free dairy. Animal foods high in saturated fat such as beef, pork and cheese are used very sparingly, and sugary drinks or foods high in added sugar should be avoided.

The benefit of the Mediterranean diet for erectile dysfunction is likely multifactorial, and results from more than just any weight loss it produces. It's an antioxidant and omega-3 rich (and therefore anti-inflammatory) way of eating that helps keep blood vessels flexible and healthy. It's also loaded with potassium-rich veggies and is sparse on high-sodium processed foods, which helps keep blood pressure low. Its staples are foods with a known cholesterol-lowering effect such as whole grains, nuts, and certain vegetables and fruits. If you won't eat this way for your heart, would you at least consider doing so for your penis?

2. Exercise at least 150 minutes per week (and more if possible).

A sedentary lifestyle is a significant risk factor for erectile dysfunction, but research has shown that initiating regular exercise even in midlife is associated with an improvement in erectile dysfunction symptoms. The benefit likely results from several factors. Exercise helps increase levels of good cholesterol, which, at high levels, is associated with a lower risk of erectile dysfunction. It also increases levels of nitric oxide -- the erectile essential -- by blood vessels throughout the body, including the penis. According to the studies, 30 minutes should help; 45 to 60 minutes per day is even better.

3. If you're not already taking meds for erectile dysfunction or angina, try drinking beet juice two to three hours before "game time."

Beets are one of nature's richest source of nitrates, a dietary compound that can be converted into nitric oxide and therefore improve function of blood vessels throughout the body. Indeed, athletes often use beet juice before competitive events to help maximize blood flow -- and therefore oxygen -- to their extremities in order to improve exercise endurance. Indeed, studies have shown that supplementing 500 milliliters (about 2 cups) of beet juice lowers blood pressure of healthy people within several hours via the blood vessel-widening effect of increased nitric oxide levels. Similarly, in people with peripheral artery disease whose hardened leg arteries produce pain when walking, beet juice consumption was associated with significantly improved exercise tolerance as the result of improved blood flow to the legs.

To date, there have not been controlled studies investigating whether supplementing beet juice before sexual activity improves erectile function compared to placebo. But in theory, it may help a bit and could be worth a try, provided your doctor gives you the green light. Be aware that a 2-cup serving of beet juice will tint your urine a lovely pink and dye your stools a beautiful magenta color for a day or two. Don't panic.

Importantly, beet juice may not be for everyone. Foods high in nitrates may have adverse interactions with certain medications and therefore, high doses of beet juice may not be safe for people who use drugs used to treat angina. Like nitroglycerin, it could produce dangerous drops in blood pressure. If you already use medications for erectile dysfunction, particularly those from the class called PDE-5 inhibitors (sildenafil citrate, tadalafil and vardenafil, marketed as Viagra, Cialis and Levitra), it's also worth checking with your doctor to be sure it's OK to double up on a nitric oxide-promoting intervention like beet juice. Lastly, those with acid reflux may find that nitrate-rich foods like beet juice worsen heartburn, so use with caution.

Tamara Duker Freuman, MS, RD, CDN, is a registered dietitian whose NYC-based clinical practice specializes in digestive disorders, celiac Disease, and food intolerances. Her personal blog, www.tamaraduker.com, focuses on healthy eating and gluten-free living.