Doctor's Note

Thankfully, Our Number One Killer Can Be Stopped. Check out my video on Eliminating the #1 Cause of Death. More background can be found in Arterial Acne and Blocking the First Step of Heart Disease.

This is the first of a 3-part video series on sexual health. Stay tuned for 50 Shades of Greens and Pistachio Nuts for Erectile Dysfunction.

Previous videos on the subject include:

A similar relationship appears to exist for female sexual function as well: Cholesterol and Female Sexual Dysfunction.

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.
  • http://treegrower.org/ Calvin Leman

    Been a vegan 1 year; erectile dysfunction went away in 4 months.

    • http://www.naturallifeenergy.com/ Aqiyl Henry

      Good for you Calvin. Spread the word. I am also a vegan, and a plant based diet in general just cures!

    • Darryl

      I was perhaps too young to have full-blown ED, but will add to the anecdotal chorus: a whole plant based diet improved the tip of my iceberg, and in about the same timeframe.

    • Plantstrongdoc M.D.

      Amazing that a plantbased diet helped in just 4 months! This is hard (!) evidence, that a plant based diet really cleans up the arteries. Thanks for sharing.

      • Alex

        A diet overhaul eliminating processed sugars, cured meats, and trans fats, while sticking to healthy protein sources and being conscious of what you eat… not necessarily jumping on a vegan diet.. can also work.

        • Aoitombo

          Do you have any studies to back your statement?

    • Skeptic

      Been vegan 8 years and am in my mid fifties. I feel like a teenager in the sack. My blood pressure is nearly identical to my 17 year old son.

  • Ramon

    I regret that you fail to provide more than basic options for avoidance and prevention of ED leading to early death. Is it because there has been little or nothing done in this area to lengthen the life of men or to prevent clogging men’s hearts. You stop short of saying a vegan lifestyle will do it. No evidence? Of all the issues you discuss, this is much more important than other subjects. More, please.

    • BiggieD

      Are you in denial, or something? Maybe a plant-based 2X4 up the side of your head will do it? What else are you imagining Dr. Greger is saying? Maybe you’ll take it from me? Eat a vegan lifestyle and you’ll get a hard on for life, prevent ED and avoid early death from a cardiac event.

      • http://www.naturallifeenergy.com/ Aqiyl Henry

        Ramon have you tried a plant based diet? I am a vegan and I know a plant based diet in general just cures. I am 45 and I have returned to my weight of when I was in my 20′s and I have the energy and stamina of when I was in my 20′s also. Stop knocking it and give it a try.

        • cyber

          anecdotal evidence is work about zip due to the propensity remember the hits and forget the misses. Real science would be nice rather than worked for me quips.

          • Tan

            He knows it’s an anecdote. It’s trivial. Real science is the hundreds of sources out there that support the vegan diet.

    • Toxins

      There are plenty of videos on this websites that share the evidence to show how a plant based diet can prevent heart disease.

      http://nutritionfacts.org/topics/heart-disease/

  • elsie blanche

    Dr. Greger, omega-3′s have been known to aid in ED. Could you please tell me why you supplement with omega-3 instead of getting the O-3′s from flax, leafy greens, walnuts, and such? I have perused the sight and have been unable to find mention by you of why you feel it is necessary to supplement. I think the 0-3 issue is super relevant to today’s wonderful video.

    Others have asked you this question in the past but unless someone here can point me to your answer, it seems as though you have yet to give some sort of explanation to your readers/viewers/followers for your silence on this issue.

    • Darryl

      He briefly covers it at the end of Algae-Based DHA vs. Flax. Evidence suggests humans can produce 20:5(ω-3) EPA from 18:3(ω-3) ALA (abundant in flax, walnuts, & leafy greens), but not enough 22:6(ω-3) DHA. In my reading, the EPA (and its ratio with 20:4(ω-6) AA) seems more important for inflammation and vascular health, whereas DHA is important in neural membranes, and brain/mental health.

      • elsie blanche

        I watched the video but Dr. Greger seems to leave it vague as to specifically why he feels relying on plant based omega 3′s might not be enough, and that supplementation should be considered. Is he citing specific studies to back this up? Do you know, specifically, what he is basing this “feeling” on? Thanks, Darryl.

        • Darryl

          From that second citation:

          Short-term dietary supplementation with α-linolenic acid increases the proportion of eicosapentaenoic acid (20:5n-3) but does not increase the proportion of DHA in blood lipids. Small amounts of preformed DHA (as low as 200 mg) result in a large increase in the proportion of DHA in blood lipids in vegetarians and vegans.

          • elsie blanche

            Darryl, thank you. Am I to assume that this is what Dr. Greger is basing his choice to supplement with
            with omega 3′s? There seems to be some vegans on this website (as well as other sites) claiming vegans eating plenty of flax, greens, walnuts, and such have no need to supplement.

          • donmatesz

            Short-term. Long-term, all available evidence indicates that people eating plant-based diets can and do produce all the DHA they need without ingesting preformed DHA. Men have very low DHA needs since they don’t gestate or lactate. Women perform the conversion approximately 200 times more efficiently than men.

            AMERICAN JOURNAL OF HUMAN BIOLOGY 19:132–141 (2007). Page 138 in particular.

            Burdge GC, Calder PC. Dietary α-linolenic acid and health-related outcomes: a metabolic perspective. Nutrition Research Reviews (2006); 19: 26–52.

          • Darryl

            The failure of so many fish-oil trials made me highly suspect the pro-DHA arguments. And there aren’t any cold-water fish within 100 miles of any hominin fossil sites older than 125,000 kya, after modern humans, so clearly dietary DHA wasn’t necessary for most of hominin evolution.

            DHA is still an important part of neural membranes, so as a male, I’ll continue taking algal DHA just to be on the safe side.

    • http://www.naturallifeenergy.com/ Aqiyl Henry

      You don’t need to supplement, use wholefoods. I eat a lot of nuts, plus I add flax seed or chia seeds to my daily veggie juice.

      • Toxins

        Be cautious, as most nuts have omega 3:6 ratios so bad that you wont get much omega 3 from them. Walnuts, flax seeds and chia seeds are the best sources.

        • http://www.naturallifeenergy.com/ Aqiyl Henry

          Thanks Toxins. I basically eat walnuts, almonds, flax seeds, and chia seeds.

          • Laurie Masters

            Black walnuts: 4:1 (omega 6:3)
            Almonds: 2028:1 (ditch ‘em!!!)
            Flax: 1:4
            Chia: 1:3

          • http://www.naturallifeenergy.com/ Aqiyl Aniys

            The thing with almonds though is in studies they show an anti-inflammatory affect in the body.

          • Toxins

            Almonds have beneficial phytonutrients but as is the case with black vs English walnuts, they both have phytonutirents but one has more omega 3 which seems to make a big difference.
            http://nutritionfacts.org/video/black-versus-english-walnuts/

          • Toxins
          • Laurie Masters

            Yes, got my walnuts backward … thx
            English walnuts: 4:1
            Black walnuts: 16:1

    • http://www.DonForresterMD.com/ Don Forrester MD

      It is a bit complex but we are starting to understand it a bit better. You can follow up on the links that Darryl suggested. The studies on O-3′s and 0-6′s were done in folks on standard american diet and/or consuming alot of processed oils such as corn oil. If you are following a proper whole food plant based diet with Vitamin B12 you need to exercise caution in taking isolated supplements. The current data support this approach. It has to do with ratio of O3 to O6 in the diet as they both go through the same enzymes to make the noninflammatory and anti-clotting (EPA/DHA etc.) and inflammatory and clotting substances such as (AA etc.)… your body needs both. Patients who persist in eating a diet with high O6 to O3 ration might indeed benefit from a supplement but would certainly go with a plant based option and not consume fish or fish oil… remember it is the algae that produce the O3′s not the fish. Of course the best and cheapest option is the correct diet.

      • elsie blanche

        Don, thank you. “The cheapest option is the correct diet.” I hope this is the case. Dr. Greger seems to differ. Hopefully he will do more research/videos/blogs on this subject in the future.

  • http://www.naturallifeenergy.com/ Aqiyl Henry

    Wowza!!! Thanks Dr. Greger. Keep reminding us that a plant based diet cures this. A plant based diet cures diseases in general!

  • Kris

    Dr. Greger,

    My husband had a heart attack at age 69 last year due to a bloodstream staph infection that attacked his heart. According to the angioplasty that was done, my husband did not and does not have atherosclerosis. He had to have emergency open heart surgery and a mitral valve replacement due to the heart attack and resulting death of his papillary muscle.

    My husband has had trouble maintaining an erection for a few years due to an injury to his penis during sex. On top of that, after the heart attack last year and with him now being on a beta blocker (generic Lopressor), it is very hard for him to get an erection much less maintain one. It was decided last year that his heart’s ejection fraction was too weak after the heart attack, so his Electrophysiologist implanted a combination Pacemaker/IED. He is on one beta blocker (Metoprolol) 25 mg twice a day, one ace inhibitor (Ramipril) 5 mg once a day and an enteric coated aspirin once a day. We would like to get him off all the meds if possible but must speak with his cardiologist first about the safety of doing this.

    Anyway, he has his yearly cardiologist appointment on Thursday and we want to ask the doctor among other things about the Metoprolol my husband is on and is it causing or exacerbating his ED among other things i.e. fatigue, weakness in the legs, short term memory loss etc. I’ve read that beta blockers are one of the top 19 most dangerous drugs and are implicated in actually making the heart weaker over time rather than stronger.

    For the record, we are not vegan but we don’t eat a lot of meat. What are your thoughts on the ED being exacerbated by the beta blocker? In your opinion, is it safe to either reduce or stop the beta blocker over time since my husband has not had another heart attack and the first one wasn’t caused by atherosclerosis? Could his ED also be caused by his age (now 70) and a reduction in testosterone?

    Please give me your insights on these questions and thanks! I’m a big fan of your videos and articles, by the way, so thanks for continuing to make your knowledge available to the rest of us.

    • kurriking

      the man is 69+ …what sex!?

      • Kris

        Do you think people stop wanting to have a satisfying sex life just because they age? We have always had a good sex life up until he injured his penis during sex and even after that, the sex wasn’t bad. Obviously, he was embarrassed to go to the doctor for that and so he didn’t and scar tissue built up and made an erection difficult but not impossible. Just because people get older doesn’t mean they don’t need love and affection and yes, even sex. Good grief. Ageism is alive and well.

        • kurriking

          Madam. I am impressed AND inspired.

      • Tan

        I knew a nurse that worked with the elderly and she told me stories about their desire for sex that stoned me. I like it.

    • http://www.DonForresterMD.com/ Don Forrester MD

      The beta blockers and all antihypertensive medications have erectile dysfunction as a possible side effect. The issue of arterial health is itself complex involving both blockages and the nitrous oxide system. It is impossible to know if the damage to the mitral valve was solely due to the staph infection or a “heart attack” in small vessels supplying the papillary muscles of the mitral valve or a combination. It is clear at this point that the healthiest diet for the arterial system is a whole food plant based diet with vitamin B12 and no processed oils. Drs. Esselstyn and Ornish published that work in the 1990′s. Dr. Esselstyn has a new article due out in the near future on the follow up of his patients with severe coronary arterial disease. I would encourage you to read his book on preventing and reversing heart disease. It is estimated that over 90% of patients on antihypertensive medicines can be taken off their medications if they follow the correct diet. This needs to be done with the guidance of your regular physicians. I recommend that my patients get a home blood pressure cuff and take their blood pressures in the morning and record on a run chart for each month. The Y axis has the blood pressure values both systolic and diastolic and the X axis had the day of the month. His ED could be contributed to by other factors but given his history it’s most likely arterial disease. The weakness and fatigue have many causes including medications. I would recommend that you go to John McDougall’s website and follow the hot topic link to view how he treats some of the conditions you are interested in. You might start with his November 2009 article in his monthly newsletter entitled, “How I treat patients with elevated blood pressure”. His website has alot of other supportive information including recipes by his wife Mary and his lecture on the starch solution. I have been amazed by the power of the correct diet in my patients to allow the body to stabilize, reverse and/or cure chronic conditions. Keep tuned to nutritionfacts.org as the science keeps coming. Good luck.

      • Kris

        Thanks, Don. I checked out McDougall’s website, and I’ll probably buy his newest cookbook, The Starch Solution. I appreciate the heads up. I have heard of Dr. McDougall as well as Dr. Esselstyn and Dean Ornish. I have Dr. Esselstyn’s son’s cookbook, The Engine 2 Diet. When I cook at home, I almost always prepare vegetarian meals unless I’m cooking fish which is rare. However, when we dine out, we eat whatever we are hungry for and that sometimes includes meat.

        I would imagine years of my husband eating whatever he wanted to helped contribute to some hardening/clogging of arteries even though my husband has always been extremely active. According to two cardiologists, he doesn’t show signs of atherosclerosis, but from what I read on McDougall’s website, my husband’s hypertension was caused by a “sick” vascular system. Also, his father died of heart disease so there is a genetic factor at work, too.

        Chickens always come home to roost and I guess this eating “high on the hog” plus the staph infection probably caused the heart problems. Anyway, thanks again, Don for the information.

        • HemoDynamic, M.D.

          One thing I wanted to add is that when a cardiologist says that your husband doesn’t have signs of atherosclerosis they are only looking at a shadow image of his heart which is the angiogram. It (the angiogram) cannot see the actual arterial wall and if there is any fatty infiltration of the wall (atherosclerosis). So even though it may look “normal” on the angiogram, the wall could in fact be quite diseased.

          Also most Cardiologist’s will call an artery “normal” if there is no blockage greater than 25% because it takes a blockage of about 30% to actually be seen by the angiogram. And some of the time the significance and amount of disease is a judgement call.

          It is also now well established in the literature that if you are eating animal foods and added oils greater than 10% of the diet you are causing meta-inflammation (low level inflammation) throughout your arterial system which activates the immune system to try and repair the “damage” caused by these foods on the arterial system. It’s this “repair” process that causes atherolsclerosis.

          Also toddlers who have died suddenly and have had autopsies have shown atherosclerosis when they were eating significant animal products and processed oily foods. It starts at a very young age and more likely than not your husband has atherosclerosis even though it may appear “normal”.

          • Kris

            Thank you for that information.

          • HemoDynamic, M.D.

            No problem. You’re on the right track. Keep up the good work!

          • Plantstrongdoc M.D.

            And it is not the old, large plaques that are most dangerous, but the smaller and “younger” plaques, that have the highest risk for rupture, and hence occlude the artery, meaning that you can drop dead from a massive heart attack the day after your cardiologist has told you and your wife that everything is fine.

          • HemoDynamic, M.D.

            Quite true as well!

  • Van

    Excellent presentation! Very, very well done! Thank you so much!
    Van

  • HemoDynamic, M.D.

    A very “prick-ly” subject.

    America #1. “Red, White, and Blue. . . Pills” says it all.
    ;-)

  • Richard

    It’s not that simple. ED can result from a number of causes, not just atherosclerosis. While plaque may be the leading cause, it is by no means the only cause. I am on a plant based diet, have been for 2 years. It hasn’t reduced my symtoms in the least because they are not the result of arterial disease. (other causes can be injury, nerve damage, the inability for the penis to shunt the veins after erection, and others) I think that Dr. Gregor loses credibility when he covers a topic from such a biased point of view.

    • http://www.naturallifeenergy.com/ Aqiyl Henry

      Richard, he is covering ED from the perspective of atherosclerosis, which appears to be the main cause of ED. He mentions atherosclerosis specifically and not every other cause of ED.

    • http://www.DonForresterMD.com/ Don Forrester MD

      You are correct there are different causes of ED. It should be viewed as a condition and not a diagnosis. However in evaluating men for ED there are some conditions that can be checked for such as low thyroid and low testosterone but in my clinical experience you find that rarely. Even if you find something it doesn’t mean that arterial dysfunction isn’t a contributing factor. There is no good way to evaluate arterial dysfunction of the penis. The treatments are limited as well. As a primary care physician there is no downside to working to improve your arterial system. As pointed out in the PDAY study it is present by age 15 in individuals consuming a standard american diet.

  • Plantstrongdoc M.D.

    It is not manly to smoke, soon it is not manly to eat a steak.
    Maybe this video will convince men to go plantbased !

    • http://www.DonForresterMD.com/ Don Forrester MD

      “Throw another log on the fire” guys who go plant based have better body odor for details see… http://nutritionfacts.org/video/body-odor-diet-2/.

      • Plantstrongdoc M.D.

        So the meat eating guy not only gets heart attack, stroke, prostatecancer,fat, diabetes and impotent – he also stinks !
        I`m off to my broccoli…..

  • Veganrunner

    You men are having so much fun with this topic today! Love the screen pic above.

  • Mike Quinoa

    Just a question regarding the logic behind cardiac bypass surgery. As Dr. Greger mentioned, atherosclerosis affects all vascular systems in the body. That means someone needing a bypass probably has occluded arteries everywhere.
    I would imagine then that the surgeon would harvest for transplant veins and arteries (even though somewhat occluded) of a larger inherent diameter than the cardiac arteries. Is this correct?

    • Plantstrongdoc M.D.

      Typical the surgeon use a vein from the lower part of the leg. The “low pressure system” (veins) are not so atherosclerotic, but they are not “built” to the “high pressure system” (arteries), so they easily get clogged efter by-pass surgery, when inserted in the “high pressure system”, and then you will get a stent, and then a new pypass, and then a stent, and then you will die, unless you are wise enough to shift to a whole foods plantbased diet…..

      • Mike Quinoa

        Thanks for the excellent explanation, Plantstrongdoc M.D.

    • HereHere

      I know that one of my acquaintances had a major vein removed from his arm, instead of his leg. I think it was a quadruple bypass. He hurt like heck afterwards, and couldn’t sleep comfortably or get up comfortably for months. Still can’t convince him to go veg, but he was a daily meat eater (BBQ none the less). He has certainly made efforts over the past year to boost his plant intake and his exercise.

      • Plantstrongdoc M.D.

        Some people never learn. My farther, first heart attack at age 46, later dilation of the coronary arteries two times and by-pass surgery at age 62 still gorge on meat, eggs, butter, dairy, “healthy” oils, white bread and all kinds of junk. His best argument is that I am the only doc telling him to go plantbased. I think it was Søren Kirkegaard who said – trust the minority, not the majority…

        • Thea

          Plantstrongdoc: It’s so hard when our loved ones don’t listen to us. You actually help all sort of people, but one of the people you really want to help the most doesn’t pay attention. It’s a pretty common human reaction (“what does the kid know anyway”), but it still hurts the kid.

          By the way, for some reason I laughed out loud when I read your comment previously about, “So the meat eating guy not only gets heart attack, stroke, prostatecancer,fat, diabetes and impotent – he also stinks ! I`m off to my broccoli…..” Thanks for the smile. And speaking as one of the ladies, I do so appreciate the broccoli eating type of man.

          • Plantstrongdoc M.D.

            Thea,
            Thanks for your (always) thoughtful response(s).

      • Mike Quinoa

        Yeah, my older brother is slated for a triple bypass in a few months. I mentioned to him and his wife that a plant-based diet might allow him to bypass the bypass. Unfortunately, I only got a very lukewarm response.

        I’m reading a very interesting book called “The Great American Heart Hoax,” the author of which opines that many bypasses are performed unnecessarily. The author suggests a near plant-based diet to obviate the need for heart surgery.

        Of course, two great heart books are Dr. Esselstyn’s “Prevent and Reverse Heart Disease,” and Dr. McDougall’s “The McDougall Program for a Healthy Heart.”

        • Plantstrongdoc M.D.

          And Dean Ornish`s work and book: Reversing heart disease – from 1990. The knowledge has been around for so many years, and I heard absolutely nothing about this in medschool, or when I worked in a strokeunit.

          • Mike Quinoa

            Thanks. I forgot that one. D’oh!
            1990? You think we would have clued in by now. Still, I think the word is slowly getting out there.

        • d1stewart

          Yes, eating meat is definitely more tasty and enjoyable than obviating bypass surgery.

  • Wendy

    I am a little weary about the statistics about the US’s ED and the rest of the world. I don’t know how much of the rest of the world is up about reporting how many of their men can’t get it up.

    • d1stewart

      True enough. But then, this isn’t the Olympics. If you want to conclude that one can keep eating an artery clogging diet because the numbers about ED rates aren’t internationally comparable due to sampling errors, though, I think you’re getting the wrong takeaway.

  • Linda L

    What about ED due to diabetic neuropathy? Is that a different type and what can plant-based diets do to correct it, if anything?

  • mike at the river

    Dr’s Pulde and Lederman, in “Keep It Simple, Keep It Whole” note that while most people who eat a whole food, plant based diet and limit Omega 6, can see their omega 3′s produce EPA/DHA. However, even with a proper plant based diet (limited Omega 6, plenty of Omega 3 from flax), Diabetics might still not convert the Omega 3 to DHA. Maybe still not enough enzymes such as arachadonic acid? Might be advisable for them (especially Type 1 Diabetics) to take an algae based DHA supplement?…Mike

  • Guy Martin

    Thank you so much Dr Greger for the accurate infos your are giving me with each video… this is so important to know the thruth about our healt!

  • Dr P

    Is it fair to conclude that interventions that improve erectile function are good for my heart, like pornography?

    • http://www.DonForresterMD.com/ Don Forrester MD

      You shouldn’t confuse things that cause erections with the measure of erectile function. If you are concerned about your heart function and avoiding heart disease I would advise reading Dr. Esselstyn’s book on preventing and reversing heart disease. The best approach is a whole food plant based diet with adequate Vitamin B12 intake. Exercise can be helpful but it is probably more like >80% diet and <20% exercise in non smokers. Other common disorders that are associated with arterial disease are back pain, narrowed disc see video's… http://nutritionfacts.org/video/cholesterol-and-lower-back-pain/.

  • Disgruntled Reader

    Something else for me to worry about. Thanks for nothing.

  • John Ammerman

    Two years ago, before embarking on a plant based, I had to seek a blue pill before lovemaking, or come up with an excuse.

    Now, an erection has become my morning wake-up call.

  • HO

    I am 75 and every year, since turning 65 I have recieved a cup with ” 65(age0 and it still works”. I will turn 76 shortly, expecting a cup again, as I EARN it throught the year. Go, plant based diet, makes my skin soft but stiffens in the right place. My wife makes the cups herself.

  • Christie

    LOL, I love this image!!

  • Dutch Martin

    This is one reason why I’m so glad I’ve embraced more vegetarian/plant-based eating habits.

  • Nick

    Works for me too!