Lifestyle Change for Erectile Dysfunction

Currently recommended treatments for erectile dysfunction—whether oral drugs, vacuum erection devices, surgical penile implants, intraurethral (pee hole) suppositories, and intracavernosal (into the shaft) injections ⦿—do nothing to treat and reverse the underlying cause of the problem. However, the American Urological Association at least encourages physicians to inform patients about the importance of lifestyle change and the European Association of Urology guidelines go a step further, recommending lifestyle changes “must precede or accompany ED treatment.” For example, a study randomizing people to Viagra-type drugs alone versus the drug plus three or more hours of physical activity a week found that the exercise add-on significantly further improved erectile function, confidence, desire, and satisfaction over the drug alone. Thirty-nine percent achieved normal erections in the drug-only group versus twice that—78%—in the drug plus exercise group. 
 
And it doesn’t take much. In one study, about 200 obese men were randomized to detailed advice about how to reduce body weight, improve their diets, and increase physical activity, or just got general advice in the control group. Only about 35% started out with normal erectile, and in the control group function hardly changed, going from 36 to 38 percent after two years. But in the detailed advice group the number went from 34 percent to 56 percent, and this, despite poor compliance. For example, only half lost the target five percent of their body weight (versus 15 percent in the control group) and less than 1 in 3 achieved the minimum recommended fiber intake (versus 12 percent in the control group). But it was enough of a difference to significantly improve sexual function. 
 
Dietary changes alone can do it. Diabetic men and women randomized to a more Mediterranean-style diet for eight years both suffered significantly less decline in sexual function, but what about improving it? Sixty-five men with erectile dysfunction were randomized to intensive instruction for eating more Mediterranean or more general information for two years. Thirty-seven percent (13 out of 35) regained normal erectile function in the more intensive dietary intervention group compared to only seven percent (2 out of 30) in the control group. What was it about the diet that seemed to help? Improvements in erectile function were tied to five things: increased intake of fruits, vegetables, nuts, beans, and essentially the ratio of plant fats to animal fats, consistent with a separate Mediterranean diet cohort, where it seemed to come down to eating more nuts, and eating more vegetables.