Arizona Advanced Medicine Clinic

Erectile Dysfunction

If you’ve ever told a doctor you had erectile dysfunction, did the doctor talk to you about cardiovascular disease or diabetes?

Erectile dysfunction, ED, is more than just a bedroom frustration. ED is often a warning bell of the onset of heart disease or undiagnosed diabetes.

Men with erectile dysfunction are 80 percent more likely to develop heart disease compared to men who do not have ED. Men ages 40 to 49 with erectile dysfunction are twice as likely to get heart disease.[1]

Diabetics with erectile dysfunction are perhaps twice as likely as non-diabetic men with diabetes to develop heart disease.[2]

The cause of erectile dysfunction is typically the lack of adequate penile blood supply as a result of damage to inner walls of blood vessels. Sounds like the arterial damage we see in heart disease and diabetes? Yes, because it’s the same physiology, the same underlying problem.

• A buildup of plaque blocks arteries around the heart and can also plug the smaller penile arteries, even before we see the effect on heart performance
• Inflammation causes the blood to become more viscous (thick, sticky) and the red blood cells membranes to become more rigid. These rigid red blood cells then nick the lining of the arteries.
• Arteries may lose elasticity over time, affecting the penis first and the heart later

corpora cavernosa

The endothelium or inner lining of blood vessels regulates how the heart relaxes and contracts. When there is a problem with blood vessel relaxation, you have bad blood flow and develop heart disease. Endothelial malfunction in the penis causes erectile dysfunction.

When the brain gets aroused, it sends a signal to the penis. Nerve cells in the penis’ corpora cavernosa start producing nitric oxide, which creates cGMP, an enzyme which tells smooth muscles that line the arteries to relax. Next, blood flow increases and small arteries at the base of the penis dilate. Blood rushing into the penis is shunted into the expandable tissues of the corpora cavernosa and corpus spongiosum. These fill under high pressure to compress outlet veins so blood cannot drain back out again. So those small capillaries are the first element that must operate correctly for a successful erection.

If the arteries in the penis do not dilate enough, the amount of cGMP produced is not enough to maintain an erection.

More than half of American men age 40 to 70 suffer from erectile dysfunction, so that’s a lot of men who may be at risk of vascular disease - and may not realize it.

Other diseases - kidney disease, chronic alcoholism, and multiple sclerosis - can impact vascular health; such diseases account for about 70 percent of cases of impotence. What if it’s not damage to blood vessels which provide blood flow to the penis? Then we look for damage to nerves, medications, chronic inflammation, and environmental toxicity. In late 2009, it was found that Bisphenol-A (BPA), a chemical found in hard, clear plastic used to make everything from baby bottles to food packaging, caused erectile dysfunction in male factory workers exposed to large amounts of the substance. The men handling BPA were four times as likely to suffer from erectile dysfunction and seven times as likely to have difficulty with ejaculation.[2a]

And finally, don't discount psychological factors such as stress. Psychological impotence occurs when erection or penetration fails due to thoughts or feelings.

Erections are triggered by emotional, physical and hormonal signals. The hormone testosterone is important overall but it has no direct impact on blood vessels. Most men who are low on testosterone can blame low adrenal function because of stress.

STATINS - THE ANTI-VIAGRA

Heart disease is often the result of chronic inflammation. Inflammation causes the blood to thicken. The red blood cells get stiff and nick the walls of the arteries. The body uses cholesterol patches to cover the nicks. Although cholesterol does not cause heart disease - it is merely a marker of inflammation - statin drugs were created to reduce the body’s production of cholesterol.

Mother Nature knew what she was doing when she made cholesterol. It is a super anti-oxidant, the building block for manufacture of our sex hormones, and a good Band-aid that can be transported to tissues to repair damage. When you artificially reduce your body’s ability to make cholesterol, you also reduce your body’s ability to make a whole family of intermediary substances which have important biochemical functions in their own right. Let’s highlight Coenzyme Q10 depletion.

Inside each of the 5 trillion or so cells in your body are energy factories called mitochondria. They need CoQ10 as much as a car needs gas. Cardiologist and researcher Dr. Peter Langsjoen says:

“The depletion of the essential nutrient CoQ10 by the increasingly popular cholesterol lowering drugs, HMG CoA reductase inhibitors (statins), has grown from a level of concern to one of alarm. With ever higher statin potencies and dosages and with a steadily shrinking target LDL cholesterol, the prevalence and severity of CoQ10 deficiency is increasingly noticeable.”[3]

Deaths attributed to heart failure more than doubled from 1989 to 1997.[3] Statins were first given pre-market approval in 1987. Interference with production of CoQ10 by statin drugs is the most likely explanation because the heart is a muscle which requires high levels of CoQ10 for healthy functioning.

The most common reported side effect of statins is muscle pain and weakness. So on one hand, statins help heart disease patients by lessening inflammation, but on the other hand, statin drugs can predispose patients to congestive heart failure by lessening heart function and antioxidant activity. Statins are now proven to activate a gene called atrogin-1, a gene that is activated in order to break down skeletal muscle, when the muscle protein is needed for calories (as in diabetes, starvation, and… when taking statin drugs). This explains why patients on statin drugs so often experience muscle pain.[4]

Anecdotal reports have been surfacing for years of impotence, loss of libido and erectile dysfunction associated with statin drug use. Researchers continue to find a strong relationship between statin drugs and erectile dysfunction.[5] In 2010, an Italian study of 3,484 men found that statin drugs lower testosterone levels and contribute to ED. The authors called upon doctors to be better aware of the association. “Our data suggest that statin therapy, even at low dosage, might induce an overt primary hypogonadism [decreased production of testosterone] and should be considered a possible confounding factor for the evaluation of testosterone levels in patients with erectile dysfunction.”[6] Other studies show ED is reversible when men stop taking statins.

Chronic inflammation also can cause prostate enlargement, by the way. That tends to go hand-in-hand with erectile dysfunction, but prostate enlargement does not directly impact the ability to achieve an erection.

THE ED SOLUTION

ViagraViagra® can enable an erection to be attained and maintained long enough for intercourse, but drugs do not permanently improve the underlying condition.

A healthy artery is a clean, smooth, slick one with flexible walls that can expand to let more blood through when the heart needs to work harder. And what maintains that youthful vigor? Nitric oxide. It is essential for healthy circulation. It helps dilate blood vessels, prevent blood clots, and regulate blood pressure. It also inhibits the accumulation of dangerous arterial plaque.

Drugs can increase the efficacy of nitric oxide temporarily. But drugs come with side effects. The most common side effects of Viagra are headache, facial flushing, and upset stomach. Less commonly, bluish vision, blurred vision, or sensitivity to light may briefly occur. People taking nitroglycerin need to be especially careful because nitroglycerin works by increasing nitric oxide. The combination of nitroglycerin and Viagra can lead to major problems maintaining any blood pressure at all. Viagra can cause a heart attack. As the television commercials say, if you get a painful, long-lasting erection, you have to see a doctor to solve the problem. Treatment involves removal of blood from the corpora cavernosa by needle decompression. Sound painful? You betcha. But so is priapism (painful long-lasting erections). And priapism can cause death of penile tissue - also pretty painful.

Herbal preparations: Many are offered, but effectiveness is questionable. A few have been tested - ginseng, DHEA, propionyl-l-carnitine - but very little research has actually been done with them. Yohimbe, a popular remedy, can cause significant high blood pressure and heart failure.

Yin YangAcupuncture can be helpful with ED. The placement of acupuncture needles in the back and lower legs support the bladder-kidney meridian. The penis is part of that system. In Chinese medicine, impotence is chiefly due to the deficiency of the kidney’s energy, or kidney qi. At the Arizona Center for Advanced Medicine, we use acupuncture to improve the function of the kidney meridian to relieve stagnation, calm the mind, and invigorate the heart and spleen. Relieving stagnation helps to move blood out of the body into the penis. Calming the mind relieves stress, which is a major factor in erectile dysfunction. Invigorating the heart and the spleen gets the blood moving, gets the emotions in a good place, and enhances the entire sexual experience for both men and women.

In the long run, the best way to address ED is not with a pill. Sure, the pill works - but at some considerable cost to the health of the body. If the other health issues are not addressed, you stand the chance of dying in the saddle - not a very nice experience for anyone involved. If emotional issues are addressed, then look at the underlying state of health of the body - clean up the filters (the liver), make sure the fuel pump is working well (the heart), make sure the fuel lines are clear (the arteries) and make sure that the computer is loaded with the right software (the brain).


[1] Martin Miner, MD; Erectile Dysfunction and the “Window of Curability”: A Harbinger of Cardiovascular Events; Mayo Clinic Proceeding, February 2009, vol. 84 no. 2 102-104 [2] Dr Peter Chun-Yip Tong, Journal of the American College of Cardiology, May 2008 [2a] Lyndsey Layton, High BPA levels linked to male sexual problems – Study in China is likely to bring further scrutiny of the common chemical; Washington Post, November 11, 2009 [3] Langsjoen PH, Langsjoen AM. The clinical use of HMG CoA-reductase inhibitors and the associated depletion of coenzyme Q10. A review of animal and human publications; Biofactors. 2003;18(1-4):101-11. http://www.fda.gov/ohrms/dockets/dailys/02/May02/052902/02p-0244-cp00001-02-Exhibit_A-vol1.pdf [4] Jun-ichi Hanai, Peirang Cao, et al; The muscle-specific ubiquitin ligase atrogin-1/MAFbx mediates statin-induced muscle toxicity, Journal of Clinical Investigation, Volume 117, Issue 12 (December 3, 2007) [5] Rizvi K, Rizvi K, Hampson JP, Harvey JN; Do lipid lowering drugs cause erectile dysfunction? A systematic review. Family Practice 19 (1):95-8, 2002 [6] Corona G, Boddi V, et al. The Effect of Statin Therapy on Testosterone Levels in Subjects Consulting for Erectile Dysfunction. J Sex Med. February 5, 2010.)
Erectile Dysfunction
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