Impotence, or chronic erectile dysfunction (ED), is no longer a taboo subject and has been recently “brought out in the open” by advertisers on radio and TV.

Research estimates that 20-30 million American men suffer from erectile dysfunction (a medical term for impotence), which can affect over fifty percent of men over the age of 50. Erectile dysfunction is defined as the inability to initiate and/or maintain an erection sufficient for penetration via sexual intercourse. Approximately 75-80% of male sexual problems is related to ED. The remaining 20-25% are related to ejaculatory disorders, the most common being premature ejaculation.

Penile erection requires the relaxation of the cavernous smooth muscle, which is triggered by nitric oxide (NO). Increasing the amounts of endogenous NO seems to be effective finish this sentence.

Consumers are exposed to a huge number of natural products claiming to restore erection and sexual vitality. A review of the evidence shows that most naturally occurring compounds lack adequate clinical trials to support efficacy. It is important to fan out agents that remain moderate-to-uncertain in efficacy, and impartially review the natural products that have been time-tested as having moderate-to-certain efficacy.

Causes

Medications
Alcohol and drug addiction; cigarettes and cigars
Low testosterone levels *
Vascular disease, including diabetes and heart disease that block blood flow
Low zinc levels
High cholesterol
Psychological factors, including mental (low self-esteem) or visual arousal factors that inhibit stimulus
Neurological conditions, such as Parkinson’s disease and multiple sclerosis

* CAUTION: Testosterone replacement therapy may be a bad trade-off for most men. Prostate cancer specialists from the American Urological Association warn that testosterone replacement may increase the risk of developing cancer.

Before treatment options can be determined, it is important to identify some common physical and/or psychological causes of impotence. Some of the most common causes include side effects of prescription drugs and medications (including anti-depressants, beta-blockers, and statin drugs); vascular disease (hardening of the arteries or atherosclerosis); diabetes; prostate disease; alcohol consumption; long-term tobacco use; and other endocrine and hormonal diseases. The most common antidepressant drugs that contribute to erectile dysfunction include fluoxetine, nefazodone, bupropion, sertraline, paroxetine, venlafaxine, and phenelzine.

Much of male sexual dysfunction is caused by the accumulation of toxins from sources such as toxic foods, toxic chemicals, and toxic lifestyles. Toxins in food come from nitrates (bacon, sausage, and shellfish), dyes, and preservatives (phosphoric acid found in soft drinks, packaged lunchmeat, and alcoholic beverages.)

Remember, drugs (like Viagra) do nothing to resolve the factors of impotence due to poor diet, stress, fatigue, or deeper psychological issues such as sexual shyness, performance anxiety, and childhood abuse. Viagra works against impotence because it indirectly enhances the effects of nitric oxide, the molecule that dilates blood vessels and allows greater blood flow to regions that need it. The amino acid arginine is a natural and safer alternative.

Diet

A change in dietary and nutritional support is critical to a supplemental or drug regimen for impotence. The plain truth is that for men over fifty the main reason for ED is cardiovascular in nature. An erection can only occur when the arteries in the penis fill with blood; if the arteries are obstructed by fatty plaque, not enough blood reaches them and the penis remains flaccid. Improving the diet requires “healthy” choices, such as drinking more fresh water and eating whole foods, including vegetables, fruits, whole grains, garlic, and legumes. Adequate protein from high-quality, low-fat sources (soy, whey, cold-water fish, organic eggs, legumes, and free-range chicken) is also important. Highly fatty foods, refined sugar, alcohol, aspartame, and processed foods should be avoided.

Other Important Dietary Approaches

Decrease alcohol consumption since it can contribute to male-reproductive-tract toxicity.
Consider supplementation with vitamin B12. Vitamin B12 deficiency can lead to pernicious anemia, which can cause low libido in both men and women.
Quit smoking cigarettes.
Limit consumption of refined sugar (carbohydrates), aspartame, fast food, and saturated fats.
If possible, follow the Dean Ornish Program for Reversing Heart Disease

Supplement Protocol

L-ARGININE
L-arginine, a non-essential amino acid, is an oxidative precursor to nitric acid, which is required for achieving and maintaining penile erection. L-arginine is a safe, natural alternative to Viagra because it is the direct precursor of nitric acid in the body. Dosage: 1,000-3,000 mg a day. When L-arginine is supplemented with PYCNOGENOL (which is also known to increase nitric oxide), there is sometimes a significant improvement in sexual function and erectile dysfunction, without any side effects. Dosage of pycnogenol: 40 mg daily.
GINKGO BILOBA
This Chinese herb acts as a vasodilator (increasing free blood flow) to the micro-capillaries of the penis. Ginkgo appears to be remarkably effective in reversing antidepressant-induced erectile dysfunction. Ginkgo may be effective even if the erectile dysfunction is secondary to taking prescription antidepressant medication. Dosage: Take 60 mg 2-3 times a day.
DHEA (DEHYDROEPIANDROSTERONE)
DHEA is a steroid hormone that shows promise as an alternative to Viagra. It is a hormone precursor to testosterone that peaks in concentration in early adulthood; thereafter, levels may decrease 2% a year. There is a reverse relationship between erectile dysfunction and DHEA levels in older males. Dosage: 25-50mg daily for 1-2 months. Testosterone replacement therapy can be very effective, but can only be done by a licensed physician (a prescription is required).
TRIBULUS
Tribulus is an Indian fruit used as a premium Ayurvedic herbal support for healthy male sexual function, vitality, and stamina. In men, tribulus increases testosterone and decreases estradiol; it also has significant tonic properties. Clinical trials have shown that tribulus diminishes impotence and improves libido in men, including those with chronic prostatitis of less than 5 years of duration. Dosage: As directed on package, 1 tablet 3-4 times a day.
YOHIMBE
An extract of the inner bark of the yohimbe tree, yohimbe was the mainstay herb for treating ED before Viagra hit the market. There is little doubt that it has at least a moderate effect on restoring libido and diminishing erectile dysfunction in some men. Although generally safe to use, it may increase blood pressure and urinary frequency. Dosage: Approximately 250 mg a day, but may also cause nausea, headaches, and sweating.
GINSENG (PANAX OR KOREAN RED)
Ginseng is a natural herb that can enhance desire and arousal by increasing the body ‘heat.” Panax ginseng has a long medicinal history in China where practitioners have used it as a tonic for restoration to promote health and longevity. Asian ginseng increases nitric oxide, increases testosterone, and acts as a general rejuvenator and sexual stimulant. It may possess the ability to improve erectile function in both younger and elderly men. Korean red ginseng has been shown to be safe and effective in assisting men with erectile problems. Dosage: As directed on package or with professional intervention.
SAW PALMETTO (SERENOA REPENS)
Saw palmetto is an herb that helps to increase blood supply to the sexual organs. It also contributes to the integrity of the prostate gland. Dosage: 100-500 mg daily, or as directed on package.
VITAMIN E and VITAMIN C
These are two antioxidants that boost testosterone levels. Vitamin E is a vasodilator that keeps blood platelets flowing smoothly and increases circulation. Dosage: 400-1,000 IU daily is vital for circulation-related difficulties. Use d-alpha-tocopherol form or mixed tocopherols. Vitamin C helps boost testosterone levels. Dosage: 500-1,500 mg daily.
B-COMPLEX VITAMINS
B vitamins are especially important for a healthy nervous system (since stress can be a factor contributing to impotence). They are also important in all cell activities, including energy rejuvenation. Extra VITAMIN B5, VITAMIN B6, and CHOLINE may be helpful. Dosage: 50 mg 2-3 times a day.
ANDROGEN REPLACEMENT (TESTOSTERONE)
Supplementing with androgens may be necessary in certain instances. Doctors may prescribe this hormone in various dosage forms, including topical cream, a patch, or an oral capsule. It is best to do a saliva or blood hormone-function test before initiating androgen replacement. Dosage: See a qualified practitioner before beginning therapy.
ROYAL MACA ROOT
Royal maca root is an adaptogenic herb (like ginseng) from the Peruvian Andes that is believed to support normal hormonal imbalances you probably mean balances, not imbalances (sexual function) in middle-aged and older men. Maca is actually a root vegetable that is a rich source of amino acids, iodine, iron, and magnesium. It has been traditionally used for thousands of years as an aphrodisiac. Dosage: Approximately 4,000 mg daily.
GARLIC
Garlic is a natural antibiotic and has been a time-honored remedy for sexual dysfunction in ancient Egypt, China, Greece and Rome. Garlic works by increasing blood flow and hormone production. Garlic also increases nitric oxide, an enzyme responsible for the mechanism of erection. Dosage: 2-6 capsules, or 1 or 2 cloves daily.
OMEGA-3 ESSENTIAL FATTY ACIDS
These essential fats are the basic building blocks for testosterone and aid in the formation of sperm and seminal fluid in the prostate gland. Men are often deficient in them. Take flaxseed oil or fish oil daily with meals. Dosage: 1,000- 4,000 mg daily.
ZINC and SELENIUM
Zinc indirectly stimulates testosterone production and is present in low levels in men with impotence. It is important to prostate gland function and reproductive organ growth. Dosage: 40-80 mg. It has been found that a deficiency of this important mineral (are you talking about zinc or selenium here–be clear) is associated with decreased sperm motility. Selenium is found in high concentrations in the testicles. Dosage: 100-200 mcg daily.
ASHWAGANDHA
This ancient herbal tonic is sometimes called “Indian ginseng” and appears to improve sexual performance and adrenal function (which controls sex hormones). Dosage: As directed by a qualified practitioner.
DAMIANA and MUIRA PUAMA
These two herbs are used to increase sexual arousal. Muira puama is also known as “potency wood” and has been used for decreasing impotence and possibly elevating testosterone levels. Dosage: As directed on package.
HOMEOPATHIC MEDICINES
Homeopathic practitioners have reported impressive results from utilizing the following homeopathic products: Nux vomica, Lycopodium, Conium, China and Argenium nitrium.

Balach, PA, Balch, JF. Prescription for Nutritional Healing, Third edition. Penguin-Putman, NY. 2000.

Block, W. Take Arginine to Heart. Life Enhancement, Feb. 2004. Pp. 4-7.

Blumenthal, M. Korean Red Ginseng Helps Men with Erection Problems in Clinical Study. Herbalgram, No. 58. 2005. P. 25.

Downey, M. Safe Alternatives to Viagra. Alive #240, October 2002. Pp. 40-42.

Duke, JA. The Green Pharmacy. Emmaus, PA: Rodale Press, 1997.

English, J, Dean, W. Viagra: Performance, Side Effects and Safe Alternatives. Vitamin Research News, Nov 1998. 12(9): 1, 3-6.

Gebhart, F. Testosterone Therapy Should be Used with Caution, Drug Topics, June 7, 2004, 148(11): 26.

Goldman, EL. Ginkgo Eases Medication-Induced Sex Dysfunction. OB-GYN News, July 15, 1997. 19.

Ivker, R. Viagra Fever. Natural Health, Sept-Oct 1998, p. 38-39.

MacKay, D. Nutrients and Botanicals for Erectile Dysfunction: Examining the Evidence. Alternative Medicine Review, March 2004. 9(1): 4-15.

Mann, D. Natural Alternatives to Viagra. Better Nutrition, December, 1998.. P.16.

Nutrient Profile: DHEA- The new Viagra Competitor. Herb & Dietary Supplement Report, Sept. P. 7.

Ryan, L. Herbs for Impotence. Herb Egram, 2001. MediHerb Company brochure.

Saul, D. Latest Research on Erectile Dysfunction. Am. Journal.of Natural Medicine, Dec. 1998. 5(10): 15.

Stanislavov, R, Nikolova, V. Treatment of Erectile Dysfunction with Pycnogenol and L-arginine. Alternative Medicine Review, Nov 2003. 8(4): 465.

Thompson, B. A Man’s Worst Nightmare. Natural Health, July-Aug 1997. P. 40.

Tribulus. Medi-Herb Solutions, www.mediherb.com

Wright, JV, Lenard, I. Maximize Your Vitality and Potency for Men Over 40. Smart Publications, Petaluma, CA, 1999.