Beyond the little blue pill: The real causes behind erectile dysfunction… and how to cure it at any age

Here’s a sad fact I’ve learned over my years as a practicing physician: Getting men to go to the doctor willingly is hard to do. Which means that insidious medical problems—like heart disease and diabetes—often go undiagnosed until the symptoms are too serious to keep dismissing.

There is, however, one major exception to this rule. Maybe the only issue that men usually don’t need convincing to address swiftly. And that’s erectile dysfunction (ED). ED is a problem that most men will race to the doctor to solve. But these visits usually result in little more than a prescription for Viagra and a pat on the back. And that, unfortunately, is the biggest tragedy of all.

Why? Not because Viagra doesn’t work. (It undoubtedly does.) But because for as common as ED is, it’s not a “normal” part of aging. It’s a major warning sign that something else in your body is going very wrong.

And when you ignore this big red flag in favor of little blue pills, that quick fix comes at a higher cost than most men would ever imagine.

True virility starts with your blood vessels

There are two main requirements for reliable erections—strong microcirculation and endothelial cell health. Both ensure ample blood flow to the penis, which you need in order to perform.

Microcirculation refers to the small blood vessels that supply blood and oxygen to our varying body parts. These are the first blood vessels to suffer damage and trigger “age-related” issues. That’s because, as collagen and elastin break down, these smallest vessels lose their ability to stay open altogether.

Endothelial cells, on the other hand, comprise the lining of your blood vessels. One of their roles is to release the enzyme necessary for generating nitric oxide (NO)—a chemical that relaxes smooth muscle in the arteries of your penis, increasing blood flow and facilitating engorgement.

Plaque buildup will impair your endothelium—but it’s also extremely sensitive to dietary influences. The typical American puts away 155 pounds of sugar per year. And this is a prime blood vessel killer, plain and simple.

If you eat foods rich in sugar—even one bowl of ice cream—this causes damage to the endothelial lining of your blood vessels. And there’s no lag time. It’s an immediate response. So when I say sugar kills, I mean it in more ways than one. Consume it often enough and you will soon lose your ability to achieve erection for good.

The damage snowballs with continuous exposure. And that’s also why all of these problems get worse as we age. And when I say all, I really do mean all.

Problems achieving and maintaining an erection are often the very first sign that something is awry in this department. But ultimately, ED is a harbinger of much more lethal issues. Every part of the body that has small blood vessels is affected—from your heart and your kidneys, to your eyes, fingers, and toes.

You name it, and you’re damaging it by neglecting your microcirculation. But there are a lot of other very specific factors that contribute to ED, too. So let’s take a moment to review those right now.

Common culprits that sabotage your sex life

Some of these sex-sabotaging culprits are obvious—some not-so-obvious. But if you want to perform well at any age, you need to have them all on your radar.

For starters, consider your weight. Just being overweight or obese will skyrocket your chances of suffering from ED. Not least of all because it throws off your body’s hormonal balance. When you’re overweight, your body naturally converts testosterone into estrogen, which is then stored in fat.

And I doubt I need to explain why that’s a problem when you’re trying to achieve an erection. Low testosterone is a very common cause of ED by itself.

Toxins—both in food and from other environmental sources—play into this as well. If you eat processed foods or commercially raised meats, touch cash register receipts, use certain shampoos or deodorants, even buy a new car, you can pretty much guarantee exposure to xenoestrogens and xenobiotics. All of which will (among other nasty side effects) decrease your testosterone level and leave you vulnerable to an insufficient erection.

Of course, you can’t ignore the more obvious smoking guns. Like prescription and OTC drugs, for example.

While many medications can contribute to this problem, beta blockers for high blood pressure—along with most anxiety drugs and other psychotropic meds—are notorious culprits in causing ED.  Alcohol, nicotine, antihistamines and even non-steroidal anti-inflammatory meds—most of which American men take routinely—can also contribute to erectile dysfunction.

Excuse the pun, but it’s a rock and a hard place men are stuck between here. Because let’s not forget that your state of mind has a direct impact on the state of your penis. When you’re stressed or suffering from adrenal fatigue in particular, you may just not feel like having sex. And this can absolutely play a role in ED.

The biggest erection killers are hiding in your kitchen

I already mentioned sugar, but it bears repeating: Increased blood sugar destroys your microcirculation, resulting in a shortage of blood to areas of the body that are critical for everyday functioning—including nerves. And as the nervous system is directly involved in stimulating erections, it’s not hard to see how damage to these sensitive nerve endings is a problem.

And that’s not all it does. Studies show that testosterone levels can drop by as much as 25% after a high glycemic meal (That is, one that’s loaded with sugar or carbs, which turn into sugar in your body.) And researchers have also found that soda can interfere with both erectile function and sperm count—a risk they associate with its high fructose corn syrup content in particular.

Soy poses another dietary danger to your androgen levels. Even organic, non-GMO forms of this food have documented estrogen-like properties—though in small quantities, it’s not likely to pose a problem.

What is a problem is the glut of soy products currently saturating the modern food industry. Even if you avoid tofu and other processed soy products—and I certainly advise that you do—if you regularly eat processed and packaged food of any kind, you’re likely consuming more soy than you think. And that can suppress testosterone. And, in turn, your sex drive and erectile function.

Speaking of the hidden dangers of processed foods, let me remind you that canned foods and plastic bottles and packaging contain BPA. As I briefly touched on earlier, studies have shown that men who are exposed to this chemical are four times more likely to experience erectile dysfunction and seven times more likely to report problems with ejaculation.

But if you recall our discussion in the August issue, then you’ll remember that recent “BPA-free” alternatives have not proven to be any safer in this department.

There are, of course, plenty of other erection killers that may be hiding in your kitchen. Trans fats, for one, which (alongside sugar) are among the most lethal enemies your cardiovascular system—and by association, your sex life. But even something as simple and innocuous as salt could potentially trigger erectile problems.

As you know, I’m not nearly as salt-phobic as most physicians. However, if you eat a lot of processed foods, canned beverages (diet or regular), or fast foods, you’re undoubtedly consuming way too much sodium. And while sugar is by far the more problematic culprit here, too much salt absolutely can increase blood pressure in some people—which in turn decreases your ability to achieve and maintain erections.

Now that we’ve covered some of the most common causes, let’s start talking solutions. And I’ll begin by dealing with the little blue elephant in the room first…

Think twice before you shell out for Viagra

Look, there are at least four prescription medications for ED. I am not going to pretend they don’t exist—or that they won’t give you an erection quickly and effectively.

But I will point out that they are merely Band-Aid solutions. They fix a single symptom in the moment—but they do nothing to address the larger problem causing your erectile dysfunction. And they also don’t come without their own fair share of side effects.

This list includes, but is not limited to: low blood pressure, dizziness, headache, back pain, muscle pain, nausea, visual disturbances, sudden vision or hearing loss, and cardiovascular events (like heart attack). And let’s not forget the very painful condition called priapism, where you can have an erection that lasts four hours or longer.

I realize that may sound like fun on paper. But let me assure you that it’s actually excruciatingly painful.

There’s also the fact that ED drugs directly contraindicate a lot of medications, one of which you may already be taking, especially if you have diagnosed cardiovascular issues—which leaves you with little choice but to explore drug-free alternatives. So it’s a good thing that, as usual, there are plenty available.

As you’ve probably guessed by now, what’s good for your heart is also good for your penis. That’s why two out of the three main cornerstones of lasting, natural virility focus on the exact same strategies you’d use to keep you cardiovascular health locked down.

The three cornerstones of stalwart sexual health

I always start any of my recommendations with a focus on food, so first I’d like to direct your attention to the results of one recent study.

It showed that eating a Mediterranean diet led to an improvement in cardiovascular performance in patients with erectile dysfunction. Conversely, those who didn’t adhere well (or at all) to this diet had more cardiac and vascular damage.

The researchers concluded that: “Erectile dysfunction is not a symptom of aging, it is a bad sign from the body that something is wrong with the vasculature. In 80% of cases erectile dysfunction is caused by vascular problems and is a warning that patients are at increased risk of a heart attack or stroke.”1

What more is there to say? This is just one more reason why a Mediterranean-style diet, with a strong focus on high quality protein, fresh veggies, and a lot of healthy fat is really the only “diet” worth following.

Of course, given the strong connection between your heart and your penis, it also won’t surprise you that exercise is essential for maintaining sexual function.

A 2015 study featured in the Journal of Sexual Medicine showed that men who exercise more—in this case, a total of 18 metabolic equivalents, or METS—also have stronger sexual and erectile function.2

Just for context, 18 METS is the equivalent of about two hours of high intensity exercise, such as running, weekly. It adds up to about 3.5 hours of moderate exercise, like brisk walking—or alternatively, six hours of light exercise, like housework—per week.

I realize that this may seem like a lot of exercise if you’ve been off the saddle for a while. But everyone starts somewhere. There really is no “one-size-fits-all” exercise regimen. And any exercise, even if it isn’t at these levels, is better than no exercise at all where erections are concerned.

Finally, I must mention the obvious role of testosterone replacement when you’re struggling with sexual issues. Many studies indicate that men with low libido and low testosterone levels show more interest in sex and engage in more sexual activity when they undergo testosterone therapy. And this clearly makes sense, as testosterone levels continuously nosedive in men as we age.

You can get the full scoop on T replacement by going back and reviewing the November 2012 issue, where I covered the subject in detail. But needless to say, if you have ED, you definitely want to talk to your doctor about it.

Six supplements that restore lost virility, once and for all

Of course, suppelements also play a role in my protocol for reversing erectile dysfunction. But I’ll clarify right now that I’m not talking about the “male enhancement” garbage you see in the gas station checkout line. (In fact, I urge you to stay far away from those sketchy products.)

Instead, I’m talking about a common sense regimen to shore up microcirculation and keep blood flowing where you need it, when you need it. So some of these recommendations are going to be very familiar:

  • Pycnogenol®—This French maritime pine bark extract is one of my favorite supplements of all time. It’s a must-have for strong microcirculation. And it stimulates endothelial nitric oxide synthase, the enzyme that produces nitric oxide in your artery linings from the amino acid l-arginine. I recommend 200 mg per day.
  • L-arginine—This amino acid is necessary in order for your body to form nitric oxide, allowing proper vasodilation and facilitating erections. I recommend 3,000 mg twice per day.
  • Icariin—This natural substance blocks an enzyme called phosphodiesterase-5 (PDE-5), which is tasked with winding down erections. (Viagra and its ilk are pharmaceutical PDE-5 inhibitors.) I recommend 500 mg twice per day.
  • Diosmin—This is a potent bioflavonoid that supports and promotes a healthy vascular system. I recommend a dose of 250 mg twice per day.
  • Turmeric—A great anti-inflammatory supplement that is essential for supporting the endothelial lining from attack. I recommend 500 mg twice per day.

I’ll wrap this list up with a brief mention of a supplement you should be taking already—vitamin D.

Why? Because a recent analysis of data collected from participants in the National Health and Nutrition Examination Survey (NHANES) 2001-2004 revealed a striking trend. Namely, that men with vitamin D levels below 20 ng/mL were 30% more likely to struggle with ED than men with levels above 30 ng/mL. (A level that I would consider barely sufficient, at best.)

What’s worse, when researchers focused on cases of severe ED, they found the adjusted risk of erectile problems to be as high as 80% in men with vitamin D deficiency.3

Needless to say, vitamin D deficiency is common. And it’s an especially big problem during the winter months, when—if your schedule is anything like mine—you’ll have days when you arrive at and leave the office without exposure to a single ray of sunshine.

Bottom line: Don’t neglect your D levels. I recommend a bare minimum of 2,000 to 5,000 IU of D3 daily. But up to 10,000 IU is safe with regular monitoring. Often, it takes that much to get back up to optimal levels. But I really can’t think of a simpler route to restoring lost virility once and for all.


  1. European Society of Cardiology (ESC). “Mediterranean diet linked to improved CV function in erectile dysfunction patients.” ScienceDaily. 3 December 2014.
  2. Simon RM, et al. J Sex Med. 2015 May;12(5):1202-10.
  3. Faraq YM, et al. Atherosclerosis. 2016 Sep;252:61-7.