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The politically correct term for impotence these days is “erectile dysfunction,” or ED. Whatever you call it, the lesson we doctors were taught in medical school–that most cases of failure to get or maintain an erection are emotional–turned out to be dead wrong. We now know that ED has a physical cause about 85% of the time. Usually the problem is poor circulation and reduced blood flow to the penis, so that an erection cannot occur. Undeniably, the new prescription drug Viagra works well for many men. But it’s expensive, can have side effects, and may not be right for everyone. Over the years, several supplements and herbs have been used with good results. (In fact, one of these, yohimbine, can be so effective that it’s available only by prescription.) Let’s see how some of our WholeHealth Chicago recommendations can help.

What is Impotence?
Impotence (also known as erectile dysfunction, or ED) is the inability to achieve or maintain an erection that is adequate for sexual performance. The process by which the penis becomes erect involves a complex series of steps. But simply put, sexual arousal causes nerves in the brain and spine to signal arteries in the penis to swell up with blood. This, in turn, allows its spongy tissues to expand. Any interference with this process–whether physical or psychological–can prevent an erection. According to some experts, impotence is the most common sexual problem facing men. Most men experience brief episodes of impotence at one time or another. And persistent impotence may afflict as many as one in four American males over the age of 50. In most cases, impotence is not associated with a lack of sexual desire, nor does it indicate an inability to have an orgasm. Only in one out of ten cases is the cause purely psychological.

The great majority of men with impotence can be helped, but it’s likely that most of these men do not seek help because of embarrassment or a belief that the condition can’t be treated. So it’s important to realize that very often the cause is physical and correctable, often by making a few simple changes.

Key Symptoms

  • A persistent inability to achieve or maintain an erection sufficient for sexual intercourse
  • What Causes Impotence? In most cases, the cause is physical and involves impaired blood flow to the penis. The most common reason for this is atherosclerosis, or hardening of the arteries. Other possible reasons include:
  • Hormone imbalances
  • Prostate disease
  • Diabetes
  • Nerve disorders
  • Vascular disease
  • Certain medications, such as antihistamines, antidepressants, and beta blockers
  • Brain disorders, such a tumor or stroke
  • Smoking
  • Alcohol
  • Fatigue
  • Advancing age
  • Emotional and psychological factors, such as stress, depression, guilt, or anxiety (particularly performance anxiety during sex).

Treatment and Prevention
First try to determine if your erectile dysfunction (ED) is physical or psychological. If you awaken with an erection, or you experience erections at night, then your problem with erection during sex activities is probably psychological. This type of impotence is often stress-related and temporary.

If the problem seems to have a physical component, there are a number of supplements you can try that may improve blood flow to the penis. Certain lifestyle measures, such as regular exercise, may also help address the problem. And you should be sure to check if the occurrence of ED is linked to any medications you are taking, since this is a common side effect of many prescription drugs for heart disease, depression, and allergies.

If your ED persists, you should see your doctor for an evaluation. You can be tested to determine if blood flow into the penis is adequate, and your doctor can ascertain if medications or other physical problems are involved. If the problem is psychological, then counseling for you and possibly your partner may prove helpful.

For impotence that doesn’t respond to self-treatment or counseling, there are medical solutions available. The least invasive is Viagra (sildenafil), an easy-to-use pill that relieves impotence in the majority of men who try it. However, it can have bothersome side effects , some men don’t respond to it, and it’s not safe for some people with heart disease. For these men, there are other more invasive treatments that include penile suppositories or injections and vacuum erection devices that draw blood into the penis. Certainly it’s best to try all non-invasive measures first.

How Supplements Can Help
By keeping blood vessels supple, vitamin C and flavonoids may allow those in the penis to expand and accommodate more blood.

Several types of essential fatty acids–flaxseed, borage, and evening primrose oils–not only improve blood flow, but when taken long-term help prevent blood vessel narrowing.

The herb ginkgo biloba, which has been shown to increase blood flow to the brain, may well have a similar effect on the penis.

If impotence is the result of prostate disease, try the herbs saw palmetto and pygeum africanum. Some prostate combination products contain both herbs.

Panax ginseng and Siberian ginseng may be beneficial because they help boost testosterone levels.

A tea made with the herb muira puama (also known as potency wood) may actually serve as an aphrodisiac.

Self-Care Remedies
Exercise regularly to increase blood flow throughout the body, increase energy, and reduce stress.

Avoid alcohol and nicotine, both of which can aggravate the problem.

Deal with stress, anxiety, or depression, if any of them is a contributing factor. Take concrete steps to reduce them, including counseling.

When to Call a Doctor

  • If you are consistently unable to attain or maintain an erection for over a month of various nonstressful sexual situations
  • If a new medication or stress is affecting your sexual performance
  • If you are over age 55 and think you might have any of the medical conditions listed above that contribute to erectile dysfunction

Supplement Recommendations

From David Edelberg, M.D. at WholeHealth Chicago: Since most impotence is due to an inadequate blood supply to the penis, one important goal is to get your circulation in tip-top shape. Make sure you’re already taking a high-potency multivitamin plus a quality antioxidant complex daily.
The B vitamins in the multiple are helpful in part because they appear to lower blood levels of homocysteine. Researchers recently discovered that elevated levels of this amino acid can cause premature hardening of the arteries, which affects circulation to the genitals. The antioxidant vitamins C and E prevent free radicals from causing cholesterol to collect along your arteries.

Everything recommended can be used with any prescription drugs for this condition.

How to Take the Supplements
For healthy arteries, start with the vitamin C and flavonoids. Then add one of the essential fatty acids–flaxseed oil or evening primrose oil–and ginkgo biloba (GBE) to improve your circulation; and finally one of the ginsengs, either Panax or Siberian, to improve both energy and libido. If you haven’t been taking these supplements regularly, it may take three months to get a full effect from their use.

If you don’t notice improvement after four to six weeks and you still want to try dealing with impotence on your own, add muira puama, an herb long used in Brazil as an aphrodisiac but little researched here. However, one French study did show that more than half of 262 men with ED responded positively to the herb.

If you can’t find muira, your next step should be a visit to your primary-care physician. He can perform a medical evaluation to help determine why you might be experiencing erectile problems. Prescription medications for the well-known drug Viagra or the herb yohimbine, which is FDA approved for ED, are often very helpful. In addition, ask your doctor to measure your blood levels of total testosterone. Increasingly prescribed, hormone replacement can be very effective in the right circumstances.

If you think a prostate problem is present (symptoms include slow urine flow or getting up at night to urinate), also add either (or both) the saw palmetto or the pygeum africanum.

Of special interest
If you have access to a qualified practitioner of traditional Chinese or Japanese herbal medicine, ask about the East Asian herbal combinations for augmenting libido and improving sexual function and longevity.

If your ED is accompanied by declining sexual interest, ask your doctor to test the DHEA levels in your blood. The body needs the steroid hormone DHEA (dehydroepiandrosterone) to make some of its testosterone (most of it comes from your testes). If DHEA levels are low, a supplement may help. DHEA is available over the counter, and an eight-week course of 25 mg a day will likely bring your levels into normal range (you should stop taking it at this point). One caution: Because DHEA does partially convert to testosterone (a hormone), supplements should not be used by anyone with prostate cancer or at high risk for it. Always get checked by your doctor before beginning to take this supplement. Important:

We at WholeHealth Chicago strongly recommend that everyone take a high-potency multivitamin/mineral and well-balanced antioxidant complex every day. It may be necessary to adjust the dosages outlined below to account for your own daily vitamin regimen. All of our supplement recommendations also assume you are eating a healthful diet.

Be aware that certain cautions are associated with taking individual supplements, especially if you have other medical conditions and/or you’re taking medications. Key cautions are given in the listing below, but you need to see the WholeHealth Chicago Reference Library for a comprehensive discussion of each supplement’s cautions and drug/nutrient interactions.

For product recommendations and orders click here for the Natural Apothecary or call 773-296-6700 ext. 2001.

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Here’s a special invitation for patients of Dr. Kelley who are currently being treated for Lyme disease. Dr. Kelley’s new, four-week Lyme Academy starts on October 4, continuing over the following three Tuesdays.


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