Man, Oh, Man!
Topics: Just Say "NO", Stay in the Pink With Zinc, Tool Up with Good Health, Increasing Potency Naturally, Understanding Your Erector Set, Yohimbe, Muira Pauama, Stinging Nettle, Tribulus Terrestis, Ginkgo Biloba
Beginning with a worldwide drop in sperm count, men's health issues have recently been at the forefront of the news. Articles have also included reports on enlarged prostate, prostate cancer, and high levels of sexual dysfunction. The real heads up came with the introduction of ViagraTM. Everybody, including the pharmaceutical manufacturer, was surprised by the immediate popularity of the "potency pill."
No one could have predicted that impotency, previously a hush-hush topic, would appear dolefully disguised as "erectile dysfunction." Who would have guessed that a former statesman would be teaching us about ED, not on the q.t., but on primetime TV? Contrary to public opinion, ED is not a politically correct term for impotency. It was coined in 1992 during an NIH Consensus Development Conference on Impotence. The panel defined it specifically as the inability to attain and maintain an erection sufficient to permit satisfactory intercourse at least 75 percent of the time. This distinguishes ED from a range of sexual problems related to impotency and includes the loss of libido, premature ejaculation, and the inability to achieve orgasm.
According to the Massachusetts Male Health Study, over 50 percent of men between 40 and 70 experience some degree of impotence. The National Institutes of Health estimate that about 30 million men are affected. However, many experts believe the problem is even more widespread. Citing a 1993 study published in Postgraduate Medicine, Michael Murray, ND, writes that the overwhelming cause of ED is physiological, accounting for 90 percent of all cases in men 50 and older. This leads people to blame aging per se as the cause of the problem. In fact, men have the physiological capacity for erection well into old age. Speaking with USA Today, Troy Burns, MD, medical director of a nationwide chain of ED clinics, stated, "Impotence is a symptom, not a diagnosis."
And, with few exceptions, it is a symptom of poor health. The list of health concerns related to ED includes vascular disease (such as diabetes and heart disease); medications (especially those for depression and high blood pressure); high cholesterol (for each 10 points above normal, the risk of ED increases by 32 percent); endocrine disorders (particularly under active thyroid or pituitary function); neurological conditions (such as Parkinson's and multiple sclerosis); surgery in the genital area; prolonged stress; low testosterone levels; and zinc deficiency. According to Thomas Kruzel, ND, men with diets high in caffeine, sugar, and alcohol as well as those who smoke and/or use recreational drugs are more likely to experience ED.
Regarding psychologically based ED, in clinical trials with Sildenafil citrate (ViagraTM), the placebo effect was found in 20-30 percent of all participants. This number is highly significant, indicating that the needs of many men are met only indirectly by medication. The most commonly cited psychological cause of ED is said to be performance anxiety, but other emotions can dampen enthusiasm. These include depression, fear of intimacy, guilt, shame, and boredom.
Just Say "NO"
The essential amino acid arginine is imperative to erectile function. It is used by the body to produce nitrous oxide (NO), a neurotransmitter. (See sidebar, "Understanding Your Erector Set.") One effect of NO is the relaxation and dilation of the blood vessels. Sexual stimulation causes the local release of NO, and, in brief, an erection occurs. Arginine is absolutely necessary for the production of NO. No NO, no action. (NO also plays a part in the sexual arousal of women.)
The use of arginine as an aid to erectile response has not been rigorously studied. However, an animal study was published by The Journal of Urology in 1997 which indicates its usefulness. (NO is responsible for erection in both rats and humans.) The researchers found that megadoses of arginine significantly improved erectile response in aging animals. They concluded, "The data support the possible use of dietary supplements for the treatment of erectile dysfunction."
Commenting on this study in the November 1997 issue of the American Journal of Natural Medicine, Ray Sahelian, MD, wrote, "To recommend this amino acid...for erectile dysfunction may be premature. ED is a long term condition and we do not have the lengthy studies needed to affirm whether it is safe for consumption [in megadoses, ed.] for many months and years." Further, a contributor to the urology journal stated, "Neuroscientists consider NO as a brain toxin with deleterious effects on the CNS." On the other hand, no evidence was presented to establish at what point arginine might cause the "toxic" production of NO.
In the opposite camp, those stalwart pioneers on the nutritional supplement frontier — Dirk Pearson and Sandy Shaw, John Morgenthaler and colleagues at Life Enhancement, and William Faloon and the other professionals from Life Extension — are very enthusiastic about arginine. The average dose they recommend is 6-12 grams per day. (Opinions about timing vary from divided doses during the day to all at once several hours before the planned activity.) Sahelian suggests 2-5 grams per day. One could consider that as a starting point. He also suggests following a couple weeks on, couple off dosage pattern as a prudent measure.
One known side effect is that large quantities of arginine may cause diarrhea. Also diets high in foods containing arginine and lacking in those containing lysine have been associated with chronic herpes outbreaks. If you have this concern, you will need to experiment with the effects of supplemental arginine. If the arginine proves to be a problem, it can be balanced with lysine supplements. Incidentally, foods with high arginine levels can't duplicate the effects of the synthesized free arginine used in the scientific trials.1
Stay in the Pink With Zinc
Often called "the man's mineral," adequate zinc is essential for hormone activity and reproductive health. It is the most important nutrient of the prostate gland and is a major component of seminal fluid. Insufficient zinc is associated with decreased testosterone levels. In a study cited by Faloon, young men (27-28) were put on a zinc restricted diet. After 20 weeks, their levels had decreased by over 70 percent. In the same study, older men (55-73) with marginal zinc deficiency were given zinc supplements. Their testosterone levels increased by an average of 92.8 percent.
Besides decreased testosterone, insufficient zinc negatively affects wound healing, energy levels, immune response, and prostate health. It has been linked with the development of benign prostatic hyperplasia (BPH or enlarged prostate gland). Getting enough zinc reverses these symptoms, relieves BPH, and may protect against prostate cancer. Zinc supplementation (as picolinate or citrate) has been recommended in the amounts of 15-60 mg per day. Foods high in zinc include oysters, lean meat, poultry and organ meats.
1 One more thing, The Journal of Urology also featured an article about interstitial cystitis in which 1.5 grams of arginine daily for six months resulted in a significant decrease in symptoms. Read Nutrition News, "Living Without Cystitis" for more information on this insidious bladder disease.
Tool Up with Good Health!
Vigor and stamina cannot be obtained or maintained without utilizing the rudiments of good health. Most readers could fill-in-the-blanks on this. However, intellectual acumen only counts on "Jeopardy," not between the sheets. It may help to think of a positive attitude, fresh wholesome food, regular exercise, sufficient rest, and a nutritional supplement program as the tools needed to get the job done.
Currently, over 350,000 men die of heart attacks each year. Physiologically, vascular integrity is not only important to your heart. In other words, the same program which keeps your ticker pumping can keep your plumbing humming. As an added bonus, a lifestyle which improves your physical vitality and increases circulation, also supports the flow of well-oxygenated blood to the brain.
A minimal supplement program consists of a multivitamin-mineral formula containing all the B complex vitamins as well as 200 mcg of selenium, 200 mcg of chromium, and 15-20 mg of zinc. (Vanadyl sulfate which helps the body to utilize carbohydrates is also a good idea, 50-100 mcg.) Your daily intake of supplemental vitamin C needs to total at least 1000 mg, and vitamin E, 400 IU. Calcium (1000 mg if you don't drink milk or eat cheese daily) and magnesium (500-1000 mg in any case) are recommended for bone density, heart health, and sexual function. Eat fish 2-3 times weekly or take a tablespoon of flaxseed oil daily to insure a higher intake of omega-3 fatty acids.2
2 Never cook with flax oil; it is highly vulnerable to oxidation. The omega-3 oils support hormone production and heart health. If you would like to understand the why behind these recommendations, individual Nutrition News issues covering each of these supplements are available.)
Increasing Potency, Naturally
Supplements which most directly affect "potency" include the herbs yohimbe, muira pauama, stinging nettle, and tribulus terrestis, the amino acid arginine, and the mineral zinc. Adjunctive supplements for sexual support include the herbs ginkgo biloba, ginseng, and saw palmetto, the hormone DHEA, plus a variety of antioxidants.
Yohimbe
In his must-have reference The Green Pharmacy (Rodale Press, 1997), world renowned herbalist James Duke, PhD, writes, "For at least 10 years, I have maintained that if there is a real herbal erection enhancer, yohimbe is it." Although yohimbe may not be familiar to you, for many years yohimbine, the active ingredient of this herb, was the only treatment for impotency approved by the FDA. Centuries of African folklore support this bark as an aphrodisiac, plus it has been used in Europe for over 75 years. Even the editors of the usually conservative Environmental Nutrition write that it is "one of the best studied herbs for relief of impotence and may be a treatment option for some men...."
Kruzel reports that yohimbe increases libido and shortens the latency period between ejaculations. He cites improvement in erectile function in men with diabetes.3 In 1987, a Canadian study resulted in a 44 percent success in treating men with ED who were also heart disease and diabetes patients. (See below for cautions.) A double-blind study published by the Archives of Sexual Behavior in 1997 compared yohimbe to a placebo. The study used 30 mg of the herb and found "strong positive effects" for about one quarter of the men with sexual problems. In addition, a 1999 review of seven well-controlled clinical trials found yohimbe more effective than a placebo in treating both psychological and physical ED.
Except for the end result, the action of yohimbe has nothing in common with ViagraTM. The mechanism of action is different from that of any other potency remedy. It works by increasing the production of the excitatory adrenal hormone norepinephrine. And therein lies the rub. Although it is a useful and less costly treatment for ED than ViagraTM, many men who would appreciate its effects are just the individuals who shouldn't use it except under the supervision of a physician. The FDA lists it as unsafe, and it is definitely not a good candidate for recreational pharmacology.
CAUTION: Older men and those with heart disease, hypertension, liver or kidney disease, prostate problems or psychiatric illness should not take it. It should not be taken with mood-altering drugs such as antidepressants, including St. John's wort. With both the herb and the medication, drugs containing phenylpropanolamine (used to counter allergic responses) and foods containing the amino acid tyramine need to be avoided. (Those foods include aged cheeses, red wine, and liver.) It is important to have your blood pressure taken regularly.
In a recent article for Let's Live, nutrition reporter Jack Challem suggests 40 mg per day. To be sure you're getting you money's worth, purchase only standardized extracts or see your doctor and get a prescription. Both of these forms are thought to cause fewer side effects.
3 Vascular breakdown is a symptom of this disease which commonly leads to both heart disease and impotence.
Muira Pauama
In answer to Shakespeare's famous "What's in a name?" sometimes there is plenty, especially when the name means "potent wood." In a 1994 issue of the American Journal of Natural Medicine, Michael Murray compared the Brazilian shrub muira pauama with yohimbe. Although he declared muira pauama the winner, this decision is based more on promise than proof. Unlike the well-studied yohimbe, clinical studies are wanting on muira pauama and its action is not known. On the plus side, in the two existing studies (both conducted by Jacques Waynberg, MD, Institute of Sexology, Paris) over 60 percent of the 356 participants related satisfactory results. Further, and amazingly, there are no known side effects.
Life Extension's William Faloon reported on the findings from the second study. Of the 94 men completing the study, 66 percent experienced significantly increased frequency of intercourse. Stability of erection during intercourse was reported by 55 percent. Other beneficial effects included more morning erections, reduction of fatigue, and improvement in sleep.
Muira pauama has a tonic action, meaning that it doesn't produce results overnight...at least not for a while. Faloon commented that some men report increased vitality within two weeks with full effects building over several weeks. A daily dose of 1-1.5 grams of standardized extract was used in the studies. Muira pauama is available in health food stores.
Stinging Nettle
Although you may see it referred to by its Latin name Urtica dioca, don't be fooled. There's nothing mysterious about it. But there is something surprising. After years in the herbal pharmacopeia, this humble (and annoying) weed is proving to be a real boon for men. Nettle root is effective for the treatment of both ED and enlarged prostate.
The action of nettle root in the relief of ED is unique. Highly concentrated nettle root extract increases levels of free testosterone. It is free testosterone which has the aphrodisiac effect on the libido. Usually, these levels are controlled by sex hormone binding globulin (SHBG). When it binds to SHBG, testosterone loses its biological activity. With age, men do not produce appreciably lower amounts of testosterone. However, they do nearly double the amount of SHBG produced by younger men. This results in less free testosterone to maintain an interest in sex. Nettle has constituents which fool SHBG, causing it to bind with the nettle. This leaves more free testosterone, ergo, more desire.
In Germany, the root has been used for decades as a treatment for enlarged prostate. It is so effective in this capacity that its reputation is becoming known in this country. You will see nettle root (sometimes as Urtica dioca) on the labels of prostate nostrums along with the African pygeum. They may be combined with saw palmetto.4
Tribulus Terrestis
This herb, commonly known as puncture vine, has long been used among Ayurvedic practitioners for the treatment of genito-urinary tract disorders. In the early 80s, it began to be used in Europe to treat both impotence and infertility. The action of this herb is based on an increase in testosterone levels. Tribulus appears to raise testosterone production by stimulating the pituitary gland. (A nettle-tribulus combination might make for a good thing.) No serious side effects have been reported.
Ginkgo Biloba
Because ginkgo improves circulation, it is a surprising but logical remedy for ED. Although it is known for its effects on the brain, it is also helpful when there is arterial blockage. This is the case with heart disease and is a possibility with high blood pressure, high cholesterol, and diabetes. In a German study, half of the men (30) regained potency within six months of taking 60 mg of standardized ginkgo extract daily. This finding is especially important since the subjects were chosen because they had not responded to papaverine injections.5
4 In a future issue, we will discuss new and natural discoveries for enlarged prostate (benign prostatic hyperplasia, BPH). Besides saw palmetto, pygeum, and nettle root, flower pollen is showing good results.
5 Papaverine is an erectile stimulator injected directly into the penis, o-o-o-ow.
Understanding Your Erector Set
Paradoxically, erection involves the relaxing of muscles. When a stimulus is sexually arousing (a function of free testosterone), the brain sends signals down the spinal cord, along the prostate gland, and into the penis. This causes the release of a neuro- transmitter called nitrous oxide (NO).
The presence of NO activates an enzyme cascade resulting in the metabolite cyclic GMP. The cGMP relaxes muscles in the corpora cavernosa. This consists of two spongy bundles of nerves and blood vessels in the penis. (There are equivalent structures in the clitoris.) The relaxation allows the bundles to engorge with blood, resulting in an erection. Once these tissues are expanded, veins that normally carry blood away from the penis are squeezed shut, trapping the blood inside, maintaining the erection.
According to Pfizer's Product Prescribing Information, ViagraTM enhances the effect of NO by inhibiting an enzyme which would normally cause the breakdown of cCMP. Arginine (see "Just Say NO") is a precursor for the production of NO. Through differing mechanisms, both of these substances support erectile function by keeping cGMP in circulation.
Bookshelf
Here are some good reads of special interest to men:
Maximize Your Vitality & Potency (For Men Over 40), Jonathan V. Wright, MD and Lane Lenard, PhD (Smart Publications, 1999, $14.95). This terrific book tells you all about natural testosterone replacement. Both the book and the use of natural testosterone are highly recommended by Julian Whitaker, MD. There are many bug-a-boos about testosterone therapy but like estrogen therapy, the difference is in the word natural. Natural testosterone is a substance which is identical to that produced by the human body, not a patented imposter. The book also includes natural alternatives to ViagraTM and ProscarTM.
The Smart GuideTM to Andro, Lane Lenard, PhD (Smart Publications, 1999, $6.95). Here is everything you ever wanted to know about Mark McGwire's miracle "medicine," androstenedione. This book gives a complete discussion of the safe and natural testosterone precursor now famous for sex and athletic enhancement.
Better Sex Through Chemistry, John Morgenthaler and Dan Joy (Smart Publications, 1994, $14.95). Subtitled "a guide to the new prosexual drugs and nutrients," this book brings extensive coverage and detail to a wide range of sex enhancing substances. (Predates ViagraTM.)
FYI: Smart Publications are available at PO Box 4667, Petaluma, CA 94955 fax: 707-763-3944, www.smart-publications.com or amazon.com.
Men's Health for Dummies, Charles B. Inlander and The People's Medical Society (IDG Books, 1999, $19.99). At last, an Our Bodies, Ourselves for men. If you always wanted an operator's manual, this is it. Attractive, direct, and filled with meaningful information (like a good man), this excellent reference book gives you the low down on high health. In fact, the only boring aspect is the title. (I'm beginning to tire of the "for Dummies" bit.)
QUOTABLES
True potency is not only defined by the ability to perform the sexual act. It encompasses the way a man exists in the world: the ability to be influential in his environment, to take risks with confidence and persistence, and to adapt to changing circumstances.
-- K. Rosenblatt, acupuncturist