Health Topics

  1. #
  2. A
  3. B
  4. C
  5. D
  6. E
  7. F
  8. G
  9. H
  10. I
  11. J
  12. K
  13. L
  14. M
  15. N
  16. O
  17. P
  18. Q
  19. R
  20. S
  21. T
  22. U
  23. V
  24. W
  25. X
  26. Y
  27. Z
Browse All Topics

50 Shades of Greens

Since both coronary heart disease and impotence can be reversed with a healthy diet, sexual dysfunction can be used as a motivator to change poor lifestyle habits.

August 21, 2013 |
GD Star Rating


Supplementary Info

Sources Cited

S.-D. Chung, Y.-K. Chen, H.-C. Lin, H.-C. Lin. Increased risk of stroke among men with erectile dysfunction: A nationwide population-based study. J Sex Med. 2011 8(1):240 - 246.

B. G. Schwartz, R. A. Kloner. How to save a life during a clinic visit for erectile dysfunction by modifying cardiovascular risk factors. Int. J. Impot. Res. 2009 21(6):327 - 335.

F. Yao, Y. Huang, Y. Zhang, Y. Dong, H. Ma, C. Deng, H. Lin, D. Liu, K. Lu. Subclinical endothelial dysfunction and low-grade inflammation play roles in the development of erectile dysfunction in young men with low risk of coronary heart disease. Int. J. Androl. 2012 35(5):653 - 659.

G. Corona, G. Fagioli, E. Mannucci, A. Romeo, M. Rossi, F. Lotti, A. Sforza, S. Morittu, V. Chiarini, G. Casella, G. Di Pasquale, E. Bandini, G. Forti, M. Maggi. Penile doppler ultrasound in patients with erectile dysfunction (ED): Role of peak systolic velocity measured in the flaccid state in predicting arteriogenic ED and silent coronary artery disease. J Sex Med. 2008 5(11):2623 - 2634.

K.-K. Chew, N. Gibson, F. Sanfilippo, B. Stuckey, A. Bremner. Cardiovascular mortality in men with erectile dysfunction: Increased risk but not inevitable. J Sex Med. 2011 8(6):1761 - 1771.

B. P. Gupta, M. H. Murad, M. M. Clifton, L. Prokop, A. Nehra, S. L. Kopecky. The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: A systematic review and meta-analysis. Arch. Intern. Med. 2011 171(20):1797 - 1803.

K. Esposito, M. Ciotola, F. Giugliano, M. De Sio, G. Giugliano, M. D'armiento, D. Giugliano. Mediterranean diet improves erectile function in subjects with the metabolic syndrome. Int. J. Impot. Res. 2006 18(4):405 - 410.

K. Esposito, F. Giugliano, M. I. Maiorino, D. Giugliano. Dietary factors, Mediterranean diet and erectile dysfunction. J Sex Med. 2010 7(7):2338 - 2345.

F. Giugliano, M. I. Maiorino, C. Di Palo, R. Autorino, M. De Sio, D. Giugliano, K. Esposito. Adherence to Mediterranean diet and sexual function in women with type 2 diabetes. J Sex Med. 2010 7(5):1883 - 1890.

D. R. Meldrum, J. C. Gambone, M. A. Morris, D. A. N. Meldrum, K. Esposito, L. J. Ignarro. The link between erectile and cardiovascular health: The canary in the coal mine. Am. J. Cardiol. 2011 108(4):599 - 606.

K. Esposito, M. Ciotola, F. Giugliano, B. Schisano, R. Autorino, S. Iuliano, M. T. Vietri, M. Cioffi, M. De Sio, D. Giugliano. Mediterranean diet improves sexual function in women with the metabolic syndrome. Int. J. Impot. Res. 2007 19(5):486 - 491.

K. Esposito, D. Giugliano. Lifestyle/dietary recommendations for erectile dysfunction and female sexual dysfunction. Urol. Clin. North Am. 2011 38(3):293 - 301.

E. Chiurlia, R. D'Amico, C. Ratti, A. R. Granata, R. Romagnoli, M. G. Modena. Subclinical coronary artery atherosclerosis in patients with erectile dysfunction. J. Am. Coll. Cardiol. 2005 46(8):1503 - 1506.

P. Montorsi, P. M. Ravagnani, S. Galli, F. Rotatori, A. Briganti, A. Salonia, P. Rigatti, F. Montorsi. The artery size hypothesis: A macrovascular link between erectile dysfunction and coronary artery disease. Am. J. Cardiol. 2005 96(12B):19M - 23M.

G. Jackson. Erectile dysfunction and coronary disease: Evaluating the link. Maturitas 2012 72(3):263 - 264.

M. M. Fung, R. Bettencourt, E. Barrett-Connor. Heart disease risk factors predict erectile dysfunction 25 years later: The Rancho Bernardo Study. J. Am. Coll. Cardiol. 2004 43(8):1405 - 1411.

J.-Y. Dong, Y.-H. Zhang, L.-Q. Qin. Erectile dysfunction and risk of cardiovascular disease: Meta-analysis of prospective cohort studies. J. Am. Coll. Cardiol. 2011 58(13):1378 - 1385.

K. Esposito, D. Giugliano. Lifestyle for erectile dysfunction: A good choice. Arch. Intern. Med. 2012 172(3):295 - 296.

G. Jackson. Problem solved: Erectile dysfunction (ED) = early death (ED). Int. J. Clin. Pract. 2010 64(7):831 - 832.

R. Shamloul, H. M. Ghanem, A. Salem, A. Elnashaar, W. Elnaggar, H. Darwish, A. A. Mousa.Correlation between penile duplex findings and stress electrocardiography in men with erectile dysfunction. Int J Impot Res. 2004 16(3):235 - 237.

B. A. Inman, J. L. Sauver, D. J. Jacobson, M. E. McGree, A. Nehra, M. M. Lieber, V. L. Roger, S. J. Jacobsen. A population-based, longitudinal study of erectile dysfunction and future coronary artery disease. Mayo Clin Proc. 2009 84(2):108 - 113.

F. Montorsi, A. Briganti, A. Salonia, P. Rigatti, A. Margonato, A. Macchi, S. Galli, P. M. Ravagnani, P. Montorsi. Erectile dysfunction prevalence, time of onset and association with risk factors in 300 consecutive patients with acute chest pain and angiographically documented coronary artery disease. Eur Urol. 2003 44(3):360-364; discussion 364-365.

A. Nehra, G. Jackson, M. Miner, K. L. Billups, A. L. Burnett, J. Buvat, C. C. Carson, G. R. Cunningham, P. Ganz, I. Goldstein, A. T. Guay, G. Hackett, R. A. Kloner, J. Kostis, P. Montorsi, M. Ramsey, R. Rosen, R. Sadovsky, A. D. Seftel, R. Shabsigh, C. Vlachopoulos, F. C. Wu. The Princeton III Consensus recommendations for the management of erectile dysfunction and cardiovascular disease. Mayo Clin Proc. 2012 87(8):766-778.

G. Corona, M. Monami, V. Boddi, M. Cameron-Smith, F. Lotti, G. de Vita, C. Melani, D. Balzi, A. Sforza, G. Forti, E. Mannucci, M. Maggi. Male sexuality and cardiovascular risk. A cohort study in patients with erectile dysfunction. J Sex Med. 2010 7(5):1918-1927.

A. B. Araujo, T. G. Travison, P. Ganz, G. R. Chiu, V. Kupelian, R. C. Rosen, S. A. Hall, J. B. McKinlay. Erectile dysfunction and mortality. J Sex Med. 2009 6(9):2445-2454.


Thanks to Ellen Reid, Maxim Fetissenko, PhD, and Laurie-Marie Pisciotta for their keynote help.


Motivating patients to change poor lifestyle habits can be extremely difficult. Preventing cardiovascular events such as heart attacks or strokes are relatively distant benefits, whereas barbecued ribs and cheesecake or sitting on your butt promises almost instant gratification. So public health experts are hoping that prevention or improvement of erectile dysfunction could be a more immediate motivator that physicians can use to improve their patients’ lifestyle and in turn their overall cardiovascular health. That's how doctors can save a life during a clinic visit for erectile dysfunction.

We used to think of erectile dysfunction in young men, in their 20s and 30s, as psychogenic in origin, meaning it's all in their heads. But now we’re realizing it's more likely an early sign of vascular disease.

But even when the penis heads in the wrong direction, the heart need not follow. Atherosclerosis in both organs can be reversed with lifestyle changes. We know that a substantial body of knowledge demonstrates that the abundant consumption of vegetables, fruit, and whole grain, and the dietary patterns rich in these foods, convey a markedly lower risk of coronary disease. So one group of researchers tried putting impotent men on a Mediterranean diet, the main characteristics of which includes an abundance of plant-based food. 37% of the men on the Mediterranean diet for 2 years regained normal sexual function. What about the diet appeared to do it? Improvements in erectile function were tied to 5 things: increased intake of fruits, vegetables, nuts, beans and, essentially, the ratio of plant fats to animal fats.

Similar benefits were found for women. The same kind of diet significantly improved sexual function, together with a significant reduction of systemic inflammation. As a whole, these findings suggest that a Mediterranean-style diet may be a safe strategy for amelioration of sexual function in women with pre-diabetes or diabetes, who found significant improvement in sexual satisfaction on the healthier diet.

Why? Well, as dietary fiber may have anti-inflammatory roles, it may be due to the fiber content of all those plants in the Mediterranean diet, magnified by all the antioxidants. This is the current thinking, given the anti-inflammatory and antioxidant effects of a plant-based diet. But does it really matter? From a public health perspective, it may be unnecessary to elucidate every mechanism of single components: let's just recommend people eat healthy, such as by decreasing fat and increasing whole grains and greens.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Ariel Levitsky.

To help out on the site please email

Dr. Michael Greger

Doctor's Note

This is the second of a 3-part video series on sexual health. If you missed it, check out my last video Survival of the Firmest: Erectile Dysfunction and Death, and stay tuned for the next video, Pistachio Nuts for Erectile Dysfunction.

More on preventing sexual dysfunction in women in the first place in: Cholesterol and Female Sexual Dysfunction.

A similar Mediterranean diet failed to help fibromyalgia in the short term (see Fibromyalgia vs. Mostly Raw & Mostly Vegetarian Diets), but diets that were even more plant-based were found to be beneficial: Fibromyalgia vs. Vegetarian & Raw Vegan Diets.

Other benefits of fiber may include improved bowel function (Bristol Stool Scale) and frequency (Prunes vs. Metamucil vs. Vegan Diet), lower colorectal cancer risk (Stool Size Matters), lower breast cancer risk (Relieving Yourself of Excess Estrogen and Fiber vs. Breast Cancer), lower blood pressure (Whole Grains May Work as Well as Drugs), lower blood cholesterol (How Fiber Lowers Cholesterol), weight loss (Beans and the Second Meal Effect) and a longer lifespan (What Women Should Eat to Live Longer).

For more context check out my blog: Top 10 Most Popular Videos from 2013, Foods for a Long Life and Love Life, Pills vs. Diet for Erectile Dysfunction, and Pistachios May Help Erectile Dysfunction.

If you haven't yet, you can subscribe to my videos for free by clicking here.

  • LumLum2500

    When I taught patients as a Certified Diabetes Educator, motivating them to make lifestyle changes was nearly impossible until I started to emphasize the connection to E.D., then their EARS perked up!

    • Steve Mayer

      Their EARS perked up. Well, it’s a start :-).

  • Plantstrongdoc M.D.

    This site will not only save people`s lives, but also their marriage :-)

  • notsure

    When it comes to (especially) young men clogged arteries is not the only reason. See here:

  • healthyguy

    Thanks for the great videos!

  • Patricia Robinett

    Remember those fruits and vegetables that resemble the parts of the body that they benefit? Same with greens. The vessels and capillaries that require clear passage for sexual juices are clearly indicated by the beautiful, intricate structure of a leaf. The blood in those tiny tubes is similar to the chlorophyll-hemoglobin parallel. Fascinating stuff, anatomy and physiology. Eat yer greens!!! An easy way to eat greens: KALE CHIPS!!!!!!!!! yum!!!

  • fannybrobb

    Dr. greger, “we used to think erectile dysfunction in young men as psychogenic in origin”, are you saying the problems of cholesterol and plaque could appear in men in their 20′s?

    And do cigarettes also cause that same plaque?

    • frank0

      It could even be during their teen years, and not only men. Although I don’t have the references in hand, I remember reading autopsy studies of people (age range between early teens to mid 30s) who died from traumatic events, which found that virtually all people studied had some level of atherosclerosis in their arteries.

      • Don Forrester MD

        You are referring to the Prevalence and Extent of Atherosclerosis in Adolescents and Young Adults published in JAMA in 1999. See a brief summary of results in my post above. Another study “Vascular Age” is Advanced in Children with Atherosclerosis Promoting Risk Factors” published in Circulation in 2009 used carotid artery thickening measurements to demonstrate advancing arterial disease in children aged 6 to 19. So when I speak to audiences I like to point out it isn’t a question of if you have coronary disease but what you will do about it.

        • Plantstrongdoc M.D.

          In your opinion, is atherosclerosis inevitable as we get older, or could one imagine 80 years old arteries totally free of even fatty streaks, in a person living on WFPD without any added oils, from birth? Or will we still see some degree of atherosclerosis, but not progressive enough to be problematic?

    • Don Forrester MD

      Cigarette smoking causes constriction of all the arteries of the body decreasing blood flow. I imagine that some of the many chemicals in cigarette smoke also interfere with the nitrous oxide system which is necessary for healthy arteries.

  • Esther

    Awesome video. Thanks for the relevant, informative and easy-to-digest videos!

  • Fred H

    YOUTUBE TERMINATED THIS ACCOUNT? With all the junk they keep? Crazy.

  • Emily Newman

    Wow, plants are so awesome! It’s amazing what they can do to heal the body! What took me so long to become so fascinated with plants?

  • Tuba

    Why? Because the problem night not be fat/cholesterol but simple carbs, thus yes what is working in the Med. Diet is important to ID.