Passion Play
By Tom Jenkins

It's a delicate subject, to be sure. Sexual function, or the lack of it, can impact a man's deepest personal needs. It is an important factor in the bonding between couples and has deeply rooted implications for the health of the male psyche.

As many as 30-40 million American men have experienced varying degrees of sexual dysfunction, according to the National Institutes of Health. "Half of all men ages 42-70 have some degree of erectile dysfunction," says Irwin Goldstein, M.D., of Boston University Medical Center. "About 50 percent are under the age of 65, with erectile dysfunction affecting 1 in 20 after age 40 and 1 in 4 after age 65."

Despite its prevalence, erectile dysfunction (ED) is a condition that is difficult for many men to talk about, so sufferers often do not seek treatment. As a result, experts are only just beginning to understand the root causes of erectile dysfunction, but more and more are coming to a consensus about treatment—a long-term solution for the condition can only be achieved with a holistic approach that takes into account a man's physical symptoms as well as his lifestyle choices and psychological issues. It may sound complicated, but there are some simple actions that can have great effect.

What Is Erectile Dysfunction?
Erectile dysfunction—the inability to attain or maintain a penile erection for satisfactory sexual intercourse—can be caused by organic, psychogenic or mixed-origin factors. Although experts are divided as to the most common causes, there is increasing evidence that both psychogenic and organic issues often play a role in a single individual. And certainly as the population ages, more cases can be attributed to physiological problems.

"Organic causes are responsible for erectile dysfunction in 90 percent of men over age 50," says Michael T. Murray, N.D., of Bastyr University in Kenmore, Wash. That is not to say, however, that erectile dysfunction is part of a normal aging process. Although it can be associated with diseases and life events more common in older men—such as pelvic vascular disease, diabetes mellitus, neurodegenerative disorders and side effects from medications, surgery or trauma—erectile dysfunction also can be initiated or influenced by lifestyle choices including a nutritionally inadequate diet, excessive use of alcohol, any use of tobacco or harmful drugs and a lack of exercise.

Seeking Solutions
In treating erectile dysfunction, the first decision is whether to focus on the dysfunction or the health of the entire body. Historically, mainstream Western medicine has emphasized the former. At the other end of the spectrum, various enthusiasts passionately tout innumerable "male potency enhancers" and aphrodisiacs claiming to heal impotence and increase sexual passion, virility and endurance, but the staggering number of palliatives and "cure-alls" calls into question the efficacy of any of them. The Greeks and Romans swore by artichokes; the Chinese, apricots; the Egyptians, onions; and other cultures over the centuries have sworn by an assortment of edible aphrodisiacs such as oysters, animal testicles, deer antlers, raw fish, ginkgo, ginseng, arginine, damiana and ashwagandha.

Today, mainstream medical practitioners tend to prescribe hormones, such as testosterone injections, and neurotransmitters including yohimbe (often used with trazodone), phentolamine and apomorphine, taken orally. Practitioners may also suggest a number of invasive treatments involving injections, pumps and prosthesis implantations. It's no wonder men welcomed the arrival of a prescription drug called Viagra, which, after its FDA approval in March 1998, dominated these treatment strategies.

A Natural Regimen
The recent short-term success of Viagra does not mean it is a panacea for men with ED, because, says Goldstein, "in most cases erectile dysfunction is a multifactorial problem." Viagra attacks the symptoms, not the cause of the impotence.

For a man seeking to reverse this condition, there is no magic bullet, concurs Othniel J. Seiden, M.D., of Doctors to the World in Denver, Colo. "Heart disease, cancer and stroke, as well as erectile dysfunction, are not normal at any age," he adds. "They are the result of unhealthy living...contaminating the body and the bloodstream with poor food, tranquilizers, alcohol, tobacco and/or illicit drugs." Accordingly, to restore health, Seiden says, a man should consider a composite health program: low-fat, high-antioxidant diet; vitamin/mineral/phytochemical supplemental mixture with a nutritionist's advice; reduction of stress; an appropriately tailored aerobic exercise schedule; the avoidance or moderate use of alcohol; and abstinence from tobacco. This regimen can enhance total blood flow, cardiovascular fitness, digestion and nutrient absorption.

Nutrition For Potency Diet is perhaps the most significant single factor in good health. Although sexual potency is dependent on male sex hormones, sensory stimulation and adequate blood supply to the erectile tissues, all of these factors are contingent upon adequate nutrition. It plays a major role in generating virility. A diet rich in whole foods—particularly vegetables, fruits, whole grains and legumes—is extremely important. Likewise, adequate protein from tofu, legumes, fish, chicken, turkey and lean beef is crucial.

Foods that contain zinc, such as liver, nuts, seeds and legumes, also are vital. In particular, a zinc supplement is also recommended because zinc is perhaps the most essential nutrient for male sexual function. Because zinc is concentrated in the semen, frequent ejaculation can diminish the body's zinc stores; if a zinc deficiency exists, the body seems to respond by reducing sexual desire, which, in effect, conserves this important trace mineral.

Other key nutrients for enhancing sexual function include omega-3 essential fatty acids, sarsaparilla, which increases testosterone, and vitamins A, B6 and E. Upon the advice of a nutritionist or health care practitioner, a high-potency multiple vitamin-mineral formula can provide adequate intake of these nutrients.

"Poor eating habits with excessive animal fats and saturated fats can result in obesity, heart disease, hypertension and erectile dysfunction brought about by atherosclerosis," says Seiden. Neal Barnard, M.D., president of the Physicians Committee for Responsible Medicine in Washington, D.C., agrees: "The same high-cholesterol and low-density lipoprotein diet that causes atherosclerosis of the coronary arteries can cause blockage in the arteries that feed blood to the erectile tissues of the penis," he says.

Other Lifestyle Choices
In addition to nutritional issues, other poor lifestyle habits are among the causes of ED. Correcting them can improve or even reverse overall deterioration of the body. For example, says Seiden, "No chemical abuse is more harmful to your sexual life than tobacco."

Similarly, explains Steven Lamm, M.D., of the NYC School of Medicine, "steady drinking can inhibit both erections and orgasms by inhibiting the blood flow to the penis." He also cites the negative impact on oxygen flow from hypertension, stress and the lack of exercise. "Without sufficient oxygen to the penis, an erection won't happen," Lamm says.

Exercise is essential. "Inactivity is deadly," says James Rippe, M.D., a cardiologist in Shrewsbury, Mass. In fact, lack of exercise increases heart disease risk "as much as smoking a pack of cigarettes a day," he says.

"Regular exercise has an impact on vasocongestion, raising blood supply to the penis and helping to get and keep an erection, with walking, stretching, swimming and resistance exercise also raising testoterone levels," adds Seiden.

In the end, poor lifestyle choices may lead to erectile dysfunction; however, relieving circulatory problems may help solve the disorder. And, Barnard reiterates, the right natural lifestyle choices: "Lining up for broccoli could be more important than lining up for Viagra," he says.

"Before men roll the dice on pharmaceuticals," adds Earl Mindell, R.Ph., Ph.D., a Beverly Hills, Calif.-based nutritionist, "they should investigate the natural choices that control impotence and restore sexual performance, including more whole food meals, taking supplements and relaxation. I would try anything before using synthetic drugs."

It's too early to evaluate the long-term effects of Viagra on the future health of men now experiencing success with the drug. Based on what we do know, the predictions are more positive for long-term efficacy of the natural choice. And whereas restoring sexual function depends not only on improving the overall vascular health of the man with ED, it also depends on the devotion of the couple affected by the dysfunction. Impotence involves two people, not just the man. The answer seems to be less the chemistry of a pill than the alchemy of love.

Tom Jenkins is a freelance writer who specializes in health, nutrition, the environment and several outdoor activities.