How many of you remember the Smiling Bob TV commercials for a natural product called Enzyte? Whether he was holding a limp hose as he watered the grass, or dressed as Santa next to a strategically placed North Pole, we all chuckled, and the owners sold a ton of ineffective, untested, poor quality products. That is, until they were raided, sent to prison for mail fraud, money laundering and bank fraud. Their company went bankrupt, though a third party bought the rights to the name. Did this stop exploitive practices by other supplement makers preying on men with sexual health problems? No, it did not.

There is also a big problem in the male sexual enhancement market with adulteration. Researchers in 2013 looked at 58 products in the United States sold as natural male erectile formulas and found a whopping 81 percent were adulterated with drugs like sildenafil and tadalafil, which are the generic versions of Viagra and Cialis. That can produce a life threating situation if a man unknowingly takes an “herbal” product that contains an unlabeled drug and also takes a certain kind of medication for his heart. This can cause a fatal interaction.

So why do we see all these fraudulent claims, this disrespectful activity for a legitimate health concern? Perhaps because of the embarrassment factor. Many men with ED (erectile dysfunction) do not want to publicly discuss their problem. Perhaps because we associate masculinity with penis performance, and men are quite self-conscious of failing to measure up. Regardless of the reason, it is time to consider that impediments to sexual health are impediments to health. Period. If the penis isn’t function properly, it is rarely because of a problem specific to the anatomical penis. It is most often an issue with stamina, circulation, nitric oxide production, abnormal blood sugars and diabetes. Mood can certainly play a role as well.

How is an Erection Attained and Maintained?

Erections start because of physical and/or mental stimulation, so erections start in the brain as it responds to this stimulation. The brain sends a signal that relaxes blood vessels in the penis, so more blood rushes to the area to fill the corpus cavernosum. A crucial element of this relaxation is nitric oxide. If there is greatly diminished nitric oxide production, an erection will not occur. At the same time, the blood vessels that carry blood out of the penis temporarily shut down, so the blood is trapped and keeps the penis erect. After the culmination of the sexual encounter, the blood vessels relax and the blood flows out of the penis, and the penis returns to its non-erect state.

I am often asked how a person knows if failure to achieve an erection is psychological or physical. If a man has erections alone, or in his sleep, but has difficulties with sexual performance with others, it is likely a psychological issue and counseling and other techniques can be quite useful.

If a man has infrequent erections despite desiring more, or the erections are not fully hard and/or are not maintained of sufficient duration. regardless of whether alone or with a partner, it is likely a physical issue.

Diabetes and Prediabetes

One of the biggest health challenges that contributes to erectile dysfunction is diabetes or even pre-diabetes. According to the Mayo Clinic, reducing excessive blood sugar can prevent damage and irritation to both nerves and blood vessels that play a role in ED. Therefore, getting blood sugar levels back to normal can be highly beneficial. In our current epidemic of blood sugar metabolism dysfunction, it is not surprising that erectile dysfunction is also becoming much more frequent.

A well-investigated herb called Hintonia latiflora has been proven to provide significant benefits for reducing blood sugar levels. In an eight-month study of 178 people with diabetes or prediabetes, the bark extract of this plant was tested for effects on HbA1c, fasting, and postprandial glucose, as well as for the development of symptoms associated with diabetes (sweating, gastrointestinal symptoms, abnormal sensations, itching and neuropathies). The study participants continued on their previous diabetic treatments.

Individuals were in one of four categories: treated with oral antidiabetic medications, treated with insulin, treated with both oral medications and insulin, or diet changes only. The HbA1c values improved significantly over the course of the study with a high level of clinical relevance of 10.4 percent. Fasting blood sugars and post-prandial blood sugars decreased by 23 to 25 percent. The sum score of the diabetic symptoms improved more than 65 percent. Improvements were also determined in blood pressure, blood fats and liver values. The tolerance was excellent, with no hypoglycemic (low blood sugar) episodes. In 39.5 percent of participants using medication, the substance could be reduced or stopped entirely.

Two other clinically studied, blood sugar lowering herbs are cinnamon and berberine. Dramatically improving blood sugar metabolism is a powerful step in the right direction for restoring proper male sexual function.

Red Ginseng Power

An ancient root used for millennia for recovery, strength, stamina and longevity has impressive studies for helping men with erectile dysfunction. One of the measurements used in human clinical studies is called the International Index of Erectile Function, or IIEF. This test records changes in certain aspects of sexual function success, including the hardness of the penis, duration of the erection and overall sexual performance. A gold-standard double-blind, placebo-controlled study of men with erectile difficulties showed significant improvements on the ILEF, going from a 16.4 to 21.0—a nearly 33 percent improvement. There were no changes in the placebo group.

Other research has shown that compounds in ginseng called ginsenosides stimulate GABA, serotonin and dopamine in the brain. These neurotransmitters play a role in sexual arousal and performance.

One caveat with red ginseng: this plant is so valued that it is commercially extinct in the wild and is now sometimes cultivated using some very toxic pesticides and fungicides. Make sure you select a red ginseng with no pesticides or toxins used in its cultivation.

Nitric Oxide

I have made the joke that without NO, there is no YES. This is met with (very) occasional laughter, but there is truth in this statement. Nitric oxide, or NO, is necessary for the blood vessel relaxation that allows the corpus cavernosum to fill with blood, and is part of the physiology that keeps the blood temporarily trapped in the penis for a full erection.

A blend of botanicals has been shown to improve NO production. This blend contains apple and grape polyphenols, along with saffron. Used as a clinically tested formula, this blend can make a real difference in male sexual function.

In a human clinical trial of men over the age of 45 who experienced unsatisfactory erection, use of this blend had a significant impact. Of the men in the study, 74 percent had an improved hardness score, and 72 percent significantly improved their ILEF score of overall performance. There were no serious adverse events reported.

NOT Herbal Viagra!

Please remember that vitamin, mineral, herbal, and supplemental interventions for ED do not work like Viagra or Cialis—and thank goodness for that! Prescription drugs for same-day erections are fraught with serious adverse effects.

These are not event-specific products. They work to improve the underlying physiology, and the conditions, for healthier sexual activity. While you may notice some changes in the first week (especially with red ginseng) please give these interventions at least six weeks before you judge their effectiveness. You (and your partner) may be in for a very pleasant surprise. And the good thing about natural supplements is that they often work even better with long-term use. VR

References:

Campbell N, Clark JP, Stecher VJ, Thomas JW, Callanan AC, Donnelly BF, Goldstein I, Kaminetsky JC. Adulteration of purported herbal and natural sexual performance enhancement dietary supplements with synthetic phosphodiesterase type 5 inhibitors. J Sex Med. 2013 Jul;10(7):1842-9.

Mayo Clinic Patient Care and Health Information. Available at: www.mayoclinic.org/diseases-conditions/erectile-dysfunction/in-depth/erectile-dysfunction/art-20043927. Accessed Nov. 21, 2019.

Erectile Dysfunction/Sexual Enhancement. National Institutes of Health web site. Available: https://nccih.nih.gov/health/sex/erectiledysfunction.htm. Accessed: Nov. 20, 2019.

Preventing Erectile Dysfunction. National Institutes of Diabetes and Digestive and Kidney Diseases (NIDDK). Available: www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/prevention. Accessed: Nov. 20, 2019.

Schmidt M, Hladikova M. Hintonia concentrate – for the dietary treatment of increased blood sugar values: Results of a multicentric, prospective, non-interventional study with a defined dry concentrate of Hintonia latifloa. Naturheilpraxis mit Naturmedizin. February 2014.

de Andrade E, de Mesquita AA, Claro Jde A, et al. Study of the efficacy of Korean Red Ginseng in the treatment of erectile dysfunction. Asian J Androl. 2007 Mar;9(2):241-4. Epub 2006 Jul 11.

Hong B, Ji YH, Hong JH, Nam KY, Ahn TY. A double-blind crossover study evaluating the efficacy of korean red ginseng in patients with erectile dysfunction: a preliminary report. J Urol. 2002 Nov;168(5):2070-3.

Choi YD, Park CW, Jang J, et al. Effects of Korean ginseng berry extract on sexual function in men with erectile dysfunction: a multicenter, placebo-controlled, double-blind clinical study. Int J Impot Res. 2013 Mar-Apr;25(2):45-50. doi: 10.1038/ijir.2012.45. Epub 2012 Dec 20.

Price A, Gazewood J. Korean red ginseng effective for treatment of erectile dysfunction. J Fam Pract. 2003 Jan;52(1):20-1.

Allaert F, Guillement D, Herpin F. Evaluation of the effectiveness of polyphenols from grape and apple combined with saffron on erectile function. Phlébologie. 2018; (73) 63-71.

Cheryl Myers is an integrative health nurse, author, and an expert on natural medicine. She is a nationally recognized speaker who has been interviewed by the New York Times, Wall Street Journal and Prevention magazine. Her many articles have been published in such diverse journals as Aesthetic Surgery Journal and Nutrition in Complementary Care, and her research on botanicals has been presented at the American College of Obstetrics and Gynecology and the North American Menopause Society. Myers is the head of scientific affairs and education for EuroPharma, Inc.