NATURAL ALTERNATIVES TO v****
v**** - the synthetic potency pill - is giving new life to many men, but at what price? I am not only referring to the $10 a pop cost of the pill, but also the problem of side effects. It is a price many men appear willing to take as prescriptions for v**** are now topping over one million per month and are expected to rise to almost three million per month. This article shall identify the problem of impotency, how v**** works, and natural approaches to promote potency.
Defining the problem
The term impotence has traditionally been used to signify the inability of the male to attain and maintain erection of the penis sufficient to permit satisfactory sexual intercourse. Impotence, in most circumstances, is more precisely referred to as erectile dysfunction, as this term differentiates itself from loss of libido, premature ejaculation, or inability to achieve orgasm.1
An estimated ten to twenty million American men suffer from erectile dysfunction. This number is expected to increase dramatically as the median age of the population increases. Currently, erectile dysfunction is thought to affect over twenty-five percent of men over the age of fifty.1,2
Although the frequency of erectile dysfunction increases with age, it must be stressed that aging itself is not a cause of impotence. Although the amount and force of the ejaculate and the need to ejaculate decrease with age, the capacity for erection is retained. Men are capable of retaining their sexual virility well into their eighties.
Causes of Impotence
Erectile dysfunction may be due to organic or psychological factors. In the overwhelming majority of cases the cause is organic, i.e., it is due to some physiological reason. In fact, organic causes are responsible for erectile dysfunction in over ninety percent of men over the age of fifty.3 In the past, a man with impotence who was able to have nighttime or early morning erections was thought to have psychogenic impotence. However, it is now recognized that this is not a reliable indicator.2
Causes of Impotence
Organic (85%)
Vascular insufficiency
Atherosclerosis
Pelvic surgery
Pelvic trauma
Venous shunting
Drugs
Antihistamines
Antihypertensives
Anticholinergics
Antidepressants
Antipsychotics
Tranquilizers
Others
Alcohol and tobacco
Endocrine disorders
Diabetes
Hypothyroidism
Decreased male sex hormones
Elevated prolactin levels
High serum estrogen levels
Diseases or trauma to male sexual organs
Diseases of the penis
Prostate disorders
Neurological diseases
Pelvic trauma
Pelvic surgery
Multiple sclerosis
Psychological (10%)
Psychiatric illness
Stress Performance anxiety Depression
Unknown (5%)
Since correction of any underlying organic factor is the first step in restoring sexual function, it is critically important that a proper diagnosis be made. A thorough history and physical exam is most often all that is needed. However, there are special noninvasive tests that can be performed to diagnose the cause of erectile dysfunction. These tests are best performed or supervised by a urologist.
How v**** Works
In simple terms, an erection requires that the volume of blood entering the penis exceed the volume leaving it. The erectile tissue of the penis is really nothing more than large, cavernous, blood storage compartments, which are normally relatively empty but which become filled with blood during an erection. The erectile tissue is surrounded by a strong membrane composed of hard fibers which greatly increases the pressure within the ballooning erectile tissue, thus the penis becomes hard and elongated.
v**** works by increasing the amount of blood entering the erectile tissue of the penis by dilating the arteries of the penis. It accomplishes this effect with the help of nitric oxide. This compound made from the amino acid arginine. With sexual stimulation, erectile tissue releases nitric oxide. This effect, in turn, leads to elevations in a substance (cGMP) that v**** increases the effect of nitric oxide by inhibiting its breakdown. It does this by blocking an enzyme (PDE type 5) that normally breaks down cGMP. In men with impotence, low levels of nitric oxide and cGMP appear to lead to insufficient filling of blood in erectile tissue. PDE type 5 quickly breaks down the little cGMP that is produced. In men without impotence, v**** will not produce any additional benefit since these men produce more than enough cGMP (there are a finite number of receptor sites for cGMP in erectile tissue.
The erection produced by v**** is better than nothing, but it is not as strong as a normal erection. v****, despite hope and hype, is not a cure-all for impotence. It is effective in about 7 out of 10 men and is associated with a number of side effects. It is not an aphrodisiac and it will not work in the absence of desire nor will it make a normal erection last longer. The side effects of v**** include:
HEADACHES One out of eight men in the clinical trials developed blinding headaches that grew more severe at higher doses (100 mg).
SEEING BLUE Because the eyes contain an enzyme similar to the one on which v**** works in the penis, about 3% of users develop temporary vision problems, ranging from blurred vision to a blue or green halo effect.
BLACKOUTS v**** can trigger sudden drops in blood pressure, and there is a risk that men who take it in combination with nitroglycerin or other antihypertensive drugs could faint or go into shock.
There are a number of natural compounds that appear to promote nitric oxide synthesis and may also impact cGMP levels including supplemental L-arginine, antioxidants like vitamin C and E, allicin-yielding garlic preparations, Panax ginseng, and Ginkgo biloba extract. Although not likely to produce the immediate benefit noted with v****, taking these nutritional and herbal supplements on a regular basis may help restore potency. Of these items, only Ginkgo biloba extract has been studied as a natural "potency pill."
Atherosclerosis - The Major Cause of Impotence
Effective natural treatment always involves addressing the underling cause. In impotency, the most common cause by far is atherosclerosis - the process of hardening in the artery walls due to a buildup of plaque containing cholesterol, fatty material, and cellular debris. Erectile dysfunction due to atherosclerosis has been shown to be a strong predictor of a heart attack or stroke.3 The process of atherosclerosis occurs systemically throughout the body, not just the arteries supplying the heart or penis. Patients with diseased coronary arteries are much more likely to have erectile dysfunction than individuals without coronary disease. If erectile dysfunction is due to vascular insufficiency, it is imperative to reduce cardiovascular risk factors such as elevated cholesterol and triglyceride levels, high blood pressure, obesity, lack of exercise, and smoking.
Since atherosclerosis is the primary cause of erectile dysfunction, it is especially important to follow dietary recommendations that will prevent or reverse atherosclerosis. A diet rich in whole foods—particularly plant foods like vegetables, fruits, whole grains, and legumes—is extremely important. Adequate protein is also a must; but it is better to get high-quality protein from legumes, fish, chicken, turkey, and lean cuts of beef (preferably hormone-free) than from fat-filled sources such as hamburgers, roasts, and pork.
If additional support for lowering cholesterol levels is required, niacin is particularly helpful.5,6 The best for of niacin is inositol hexaniacinate—a safer form of niacin composed of one molecule of inositol (an unofficial B vitamin) and six molecules of niacin. Inositol hexaniacinate has been used in Europe for over thirty years to lower cholesterol levels. It yields slightly better results than standard niacin, but it is much better tolerated—in terms of both flushing and long-term side effects, including effects on blood sugar control.7-9 Inositol hexaniacinate is available at health food stores. The best dosage for lowering cholesterol levels is 1,000 to 3,000 mg per day.
In the case of erectile dysfunction, inositol hexaniacinate may offer an additional benefit: improving blood flow. In fact, it is used in Europe more for its ability to improve circulation than for its cholesterol-lowering effects.
In addition, if cholesterol levels are high (greater than 200 mg/dl) I would recommend using garlic – either 4 grams (roughly one to two cloves) of fresh garlic or a commercial garlic product that guarantees to deliver at least 4,000 mcg of allicin. Since allicin is the component in garlic that is responsible for increasing nitric oxide levels10 as well as for its easily identifiable odor, some manufacturers have developed highly sophisticated methods in an effort to provide the full benefits of fresh garlic in a more socially acceptable" form. These "odorless" garlic products are concentrated for alliin – the storage form of allicin - because alliin is relatively "odorless" until it is converted to allicin in the body. The pills are then enteric-coated to prevent breakdown in the stomach. They are designed to breakdown in the small and large intestine instead to reduce the chances of having "garlic breath."
Exercise
Physical exercise is a vital component of health, including sexual health. Regular exercise improves a man’s sexual performance. In one study, the effects of nine months of regular exercise on aerobic work capacity (physical fitness), coronary heart disease risk factors, and sexuality were studied in seventy-eight sedentary but healthy men (mean age: forty-eight years).11 As with many other studies, beneficial effects of regular exercise on fitness and coronary heart disease risk factors were demonstrated. Analysis of diary entries revealed significantly greater sexuality in the exercise group (frequency of various intimate activities, reliability of adequate functioning during sex, percentage of satisfying orgasms, etc.). Moreover, the degree of sexuality enhancement among exercisers was correlated with the degree of their individual improvement in fitness. In other words, the better physical fitness the men were able to attain, the better their sexuality.
Nutrition and Sexual Function
Although potency is largely dependent on adequate male sex hormones, adequate sensory stimulation, and adequate blood supply to the erectile tissues, all of these factors are dependent on adequate nutrition. Therefore, it can be concluded that nutrition plays a major role in determining virility. For optimal sexual function, we need optimal nutrition. A diet rich in whole foods—particularly vegetables, fruits, whole grains, and legumes—is extremely important. Adequate protein is also a must; it is better to get high-quality protein from fish, chicken, turkey, and lean cuts of beef (preferably hormone-free) than from fat-filled sources such as hamburgers, roasts, and pork.
Special foods often recommended to enhance virility include liver, oysters, nuts, seeds, and legumes. All of these foods are good sources of zinc. Zinc is perhaps the most important nutrient for sexual function. Zinc is concentrated in semen. Frequent ejaculation can greatly diminish body zinc stores. If a zinc deficiency exists, the body appears to respond by reducing sexual drive as a mechanism by which to hold on to this important trace mineral.
Others key nutrients for sexual function include essential fatty acids, vitamin A, vitamin B6, and vitamin E. A high-potency multiple-vitamin-and-mineral formula insures adequate intake of these nutrients as well as others important in health and sexual function.
In addition to nutrition, the natural approach to erectile dysfunction utilizes exercise and herbal medicines.
Yohimbe
The first FDA-approved medicine for treating impotence is yohimbine - an alkaloid isolated from the bark of the yohimbe tree (Pausinystalia johimbe), native to tropical West Africa. Yohimbine hydrochloride increases libido, but its primary action is to increase blood flow to erectile tissue. Contrary to a popular misconception, yohimbine has no effects on testosterone levels.
When used alone, yohimbine is successful in thirty-four to forty-three percent of cases.12,13 If combined with strychnine and testosterone, it is much more effective. However, side effects often make yohimbine very difficult to utilize. Yohimbine can induce anxiety, panic attacks, and hallucinations in some individuals. Other side effects include elevations in blood pressure and heart rate, dizziness, headache, and skin flushing. Yohimbine should not be used by women, individuals who have kidney disease, and individuals with psychological disturbances.
Because of the yohimbine content of yohimbe bark, the FDA classifies yohimbe as an unsafe herb.14 In addition to the problem of side effects with the use of commercial yohimbe preparations, consumers should be very suspicious of the quality of yohimbe products that exist in health food stores. A 1995 analysis showed that, while crude yohimbe bark typically contains six percent yohimbine, most commercial products contained virtually no yohimbine.14 Compared to authentic yohimbine bark, which contained yohimbine in concentrations of 7,089 parts per million (ppm), concentrations in the commercial products ranged from <0.1 to 489 ppm. Of the twenty-six samples, nine were found to contain absolutely no yohimbine, and seven contained only trace amounts (0.1 to 1ppm). The remaining ten products contained negligible amounts of yohimbine. In other words, there were no legitimate products tested. If you elect to use yohimbine, use products marketed by reputable companies that clearly state the level of yohimbine per dosage. Without knowing the content of yohimbine, it is virtually impossible to prescribe an effective and consistent dosage or to attain any consistent benefit.
Potency Wood (Muira puama)
One of the best herbs to use for treating erectile dysfunction or lack of libido is potency wood, which is also known as Muira puama (Ptychopetalum olacoides). This shrub is native to Brazil and has long been used as a powerful aphrodisiac and nerve-stimulant in South American folk medicine. A recent clinical study has validated its safety and effectiveness in improving libido and sexual function in some patients.15
In 1990, a clinical study was conducted at the Institute of Sexology in Paris, France, under the supervision of one of the world’s foremost authorities on sexual function, Dr. Jacques Waynberg. The 262 subjects, who initially complained of lack of sexual desire and the inability to attain or maintain an erection, demonstrated Muira puama extract (6:1) to be effective in many cases. Within two weeks, at a daily dose of 1 to 1.5 grams of the extract, sixty-two percent of patients with loss of libido claimed that the treatment had a dynamic effect, while fifty-one percent of patients with "erection failures" felt that Muira puama was of benefit.
Presently, the mechanism of action of Muira puama is unknown. From the preliminary information, it appears that it works on enhancing both psychological and physical aspects of sexual function. Future research will undoubtedly shed additional light on this extremely promising herb.
Ginkgo biloba Extract
In addition to its use in increasing blood and oxygen flow to the brain, recent evidence indicates that Ginkgo biloba extract (standardized to contain 24% ginkgo flavonglycosides) may be extremely beneficial in the treatment of erectile dysfunction due to lack of blood flow. In one study, 50 patients with erectile dysfunction were divided into two groups.16 Group 1 (twenty subjects) were able to attain an erection after injection of papaverine - a drug that improves blood flow to erectile tissue. Group 2 (thirty subjects) did not respond to high-dosage injection therapy. After six months of treatment, all twenty patients in the first group responded by regaining the ability to attain and maintain a rigid erection without injection of papaverine. In Group 2, nineteen patients responded positively to ginkgo in that they were able to attain and maintain an erection with the help of papaverine.
Panax ginseng
Although Panax ginseng is claimed to be a "sexual rejuvenator," human studies supporting this belief do not exist. Ginseng has, however, been shown to promote the growth of the testes, increase sperm formation and testosterone levels, and increase sexual activity and mating behavior in studies with animals. In addition, Panax ginseng has also been shown to increase nitric oxide synthesis.18 These results seem to support ginseng's use as a fertility and virility aid.
Summary
Impotence (erectile dysfunction) is an extremely common condition that affects over 10 million American men. Restoring potency requires addressing the underlying cause. The chief cause is decreased blood flow (vascular insufficiency) due to atherosclerosis. The natural approach to erectile dysfunction involves the use of diet, exercise, nutritional supplements, and herbs. This combined approach is designed to restore potency by restoring normal physiology.
Supplements:
A high-potency multiple vitamin and mineral formula
Vitamin C: 500 to 1,000 mg three times daily
Vitamin E: 400 to 800 IU daily
L-arginine: 2-3,000 mg daily
If cholesterol levels are elevated:
Inositol hexaniacinate: 1,000 mg three times daily with meals.
Garlic: One to two cloves of raw garlic per day or use commercial preparations that deliver a minimum of 4,000 mcg of allicin daily
Herbal Medicines: (can be taken individually or combined)
For impotence with decreased libido:
Panax ginseng extract (5% ginsenosides): 100 mg. three times per day.
Muira puama (Ptychopetalum olacoides) extract (6:1): 250 mg three times per day.
For impotence due to lack of blood flow:
Ginkgo biloba extract (24% ginkgo flavonglycosides): 80 mg three times per day
References:
NIH Consensus Conference Panel on Impotence: Impotence. JAMA 270:83-90, 1993
Lerner SE, Melman A and Christ GJ: A review of erectile dysfunction: New insights and more questions. Journal of Urology 149:1246-55, 1993
Morley JE: Management of impotence. Postgraduate Medicine 93:65-72, 1993
Ornish D, et al: Can lifestyle changes reverse coronary heart disease. Lancet 336:129-33, 1990
The Expert Panel: Report of the National Cholesterol Education Program Expert Panel on detection, evaluation, and treatment of high cholesterol in adults. Arch Intern Med 148:136-69, 1988
Canner PL and the Coronary Drug Project Group: Mortality in Coronary Drug Project patients during a nine-year post-treatment period. J Am Coll Cardiol 8:1245-55, 1986
Welsh AL and Ede M: Inositol hexanicotinate for improved nicotinic acid therapy. Int Record Med 174:9-15, 1961
El-Enein AMA, Hafez YS, Salem H and Abdel M: The role of nicotinic acid and inositol hexaniacinate as anticholesterolemic and antilipemic agents. Nutr Rep Intl 28:899-911, 1983
Sunderland GT, Belch JJF, Sturrock RD, et al: A double blind randomised placebo controlled trial of hexopal in primary Raynaud's disease. Clin Rheumatol 7:46-9, 1988
Das I, Khan NS and Sooranna SR: Nitric oxide synthase activation is a unique mechanism of garlic action. Biochemical Society Transactions 23:136S, 1995.
White JR, et al: Enhanced sexual behavior in exercising men. Arch Sex Behav 19:193-209, 1990
Susset JG, et al: Effect of yohimbine hydrochloride on erectile impotence: A double-blind study. J Urology 141:1360-3, 1989
Morales A, et al: Is yohimbine effective in the treatment of organic impotence? Results of a controlled trial. J Urology 137:1168-72, 1987
Betz J, White KD and der Marderosian AH: Chemical analysis of 26 commercial yohimbe products. 78:1189-94, 1995
Waynberg J: Aphrodisiacs: Contribution to the clinical validation of the traditional use of Ptychopetalum guyanna. Presented at The First International Congress on Ethnopharmacology, Strasbourg, France June 5-9, 1990
Sohn M and Sikora R: Ginkgo biloba extract in the therapy of erectile dysfunction. J Sex Educ Ther 17:53-61, 1991
Kang SY, et al. Dietary ginsenosides improve endothelium-dependent relaxation in the thoracic aorta of hypercholesterolemic rabbit. Gen Pharmac 26:483-7, 1995.19-21
