By far the most common cause of ED is vascular dysfunction. When the arteries that supply the penis with blood to achieve and maintain an erection are blocked or hardened, or the lining of these arteries is damaged, blood flow is reduced. Vascular dysfunction not only affects the small arteries of the penis, but the larger coronary arteries of the heart, too. Astute doctors now recognize that ED may actually be an early warning sign of impending cardiovascular disease, showing up several years before a cardiovascular event, such as a heart attack or stroke.¹ To maintain healthy vascular function, and in turn, normal erectile function, consider these supplements:

• L-arginine is an amino acid that is necessary for the lining of the blood vessels to produce nitric oxide. Nitric oxide allows the blood vessels to relax, thus improving blood flow throughout the body, including to the penis. Studies on L-arginine and erectile dysfunction have used between 2,000 and 5,000 mg a day in divided doses.² Supplemental arginine is best taken on an empty stomach.³
• L-citrulline is an amino acid that the body can convert to arginine and then to nitric oxide to improve blood flow. It may be more readily usable by the body than arginine, and in one small study, men with ED saw improvements after taking 1,500 mg a day for one month.⁴
• Pycnogenol^® is a potent antioxidant that stimulates the enzyme needed to convert arginine to nitric oxide.⁵ It also helps to protect the arteries from oxidative damage that can lead to ED. In Stop Prediabetes Now, Jack Challem recommends 100 mg two times daily to support healthy erectile function.⁶
• Vitamin C and bioflavonoids both help to protect the arteries from damage, and vitamin C enhances the bioactivity of arginine. Look for vitamin C with a measurable amount of bioflavonoids listed on the label. Try 500 to 1,000 mg a day.⁷

Another potential cause of ED is prediabetes and diabetes—35-50 percent of men with diabetes also have ED. First, chronically elevated blood sugar damages the arteries (there’s the vascular connection again) and nerves, including those that stimulate the penis. Prediabetes and diabetes are also generally accompanied by excess weight, especially around the mid-section. These excess fat cells convert testosterone into estrogen, negatively altering the testosterone to estrogen ratio. This ratio is futher reduced by increased insulin, which is elevated in response to high blood sugar and also upregulates the production of the enzyme aromatase, causing increased conversion of testosterone to estrogen. Excess estrogen, independently of prediabetes and diabetes, interferes with the hormonal cascade necessary to produce and maintain an erection. Although many men may reach for a testosterone booster, this may actually make matters worse, causing even more testosterone to be converted to estrogen. A more effective means is to improve blood sugar levels, support the body’s metabolism and elimination of estrogen, and to lose excess weight around the middle. To support healthy blood sugar balance and estrogen metabolism try:

• Pycnogenol^® supports healthy blood sugar levels by inhibiting the activity of the enzyme that breaks down sugar and carbohydrates during digestion.⁸ It also protects nerves from oxidative damage caused by high blood sugar.
• Alpha-lipoic acid is an antioxidant that supports healthy blood sugar levels and insulin function. It is also well-recognized for its ability to improve neuropathy (nerve damage) associated with diabetes. The suggested dose of alpha-lipoic acid is 100 mg three times daily, before meals.⁹
• Lignans and flavonoids such as those found in flax seeds, sesame seeds, veggies, fruits, and green tea may help to block the conversion of testosterone to estrogen, thus improving overall testosterone availability.^{10 11} Aim to get a variety of these foods regularly in the diet.
• Diindolylmethane (DIM), or its precursor Indole-3-carbinol (I3C), helps to metabolize estrogen in the male body, ridding the body of excess estrogen and restoring healthy testosterone levels. The typical dose for men is 200 to 400 mg per day, taken with food.¹²

Another common cause of ED for many men is stress. When the body is under stress—either mental or physical—the sympathetic nervous system kicks in, releasing a cascade of stress hormones. Chronic stress leads to elevated levels of these hormones, which can lead to weight gain around the middle; and remember, those excess fat cells convert testosterone to estrogen. Stress also reduces sexual drive and leaves very little physical energy for sex. If chronic stress is a problem, try these supplements:

• B-vitamin complex helps to support normal energy production and is also essential for supporting the normal functioning of the body during times of stress. Stress quickly depletes the body’s reserves of the B vitamins. Look for a B-complex containing 20-50 mg of vitamins B1, B2, and B3, the other B vitamins will usually match in their relative proportions.

• Adaptogenic herbs such as ginseng, holy basil, and rhodiola help bring balance to the body during times of stress. As an added bonus, ginseng, especially Panax ginseng, is traditionally used to improve sexual desire and function. Follow manufacturers’ directions for individual adaptogens.

If you’ve addressed all the possible underlying causes of ED or you’re looking for a little support while you address the roots of the problem, you may want to try some herbs traditionally used to support male sexual function.

• Tongkat ali (Eurycoma longifolia, aka longjack and Malaysian ginseng) is an herb that has been traditionally used as a general tonic to improve mental and physical function, for anti-aging, and as an aphrodisiac.¹³ Research has found it may increase testosterone levels, in particular restoring them back to normal levels in those with decreased levels.^{14 15} Tongkat ali may also support strength, libido, and male fertility.^{16 17}
• Horny goat weed (Epimedium grandiflorum and Epimedium sagittatum) has a long history of use in Traditional Chinese Medicine. While it may be used to for conditions ranging from nervous system dysfunction, infections, and skeletal health, it is most popular as a sexual function aid.¹⁸ In animal and test tube studies, icariin, the most researched constituent in horny goat weed, improves erectile function and is believed to work by acting as a PDE5 inhibitor, the same compound popular prescription drugs for erectile dysfunction target.^{19 20 21 22}    
• Yohimbe (Pausinystalia yohimbe) is an evergreen tree native to central and west Africa. The bark was traditionally used to treat a variety of ailments, but in the West it has gained attention as a sexual stimulant, an aid for ED, and an aid for weight loss and athletic performance.²³ The most recognized compound in yohimbe bark is yohimbine, which studies have shown to improve erectile function better than placebo.²⁴ Supplements use the whole yohimbe bark and should not to be confused with yohimbine hydrochloride, a standardized form of yohimbine previously available by prescription in the United States. Yohimbe may interact with a variety of over-the-counter and prescription medications and in high doses or sensitive individuals can cause changes in blood pressure, anxiety, heart palpitations, and dizziness.²⁵
• Muira puama (Ptychopetalum olacoides) is a shrub that is native to the Amazon, where it is known as potency wood. The root and bark have been used traditionally for “nervous weakness”, characterized by lethargy, depression, tremors, and sexual impotence.²⁶ Animal studies have found muira puama, used in conjunction with other herbs, to be beneficial for halting or reversing physical and functional changes associated with age-related erectile dysfunction.^{27 28} It also appears to exert an adaptogen-like effect that may be useful to counteract chronic stress.²⁹
• Tribulus (Tribulus terrestris) root and fruit have a long history of use in many traditional medicine practices around the world.³⁰ It is most commonly used to improve sexual and athletic function. While the research is somewhat mixed, it appears to increase testosterone and improve erectile function and libido.^{31 32 33} It also improves sperm motility, quantity, and function and may support male fertility.³⁴ Tribulus may exert some its benefits through antioxidant properties.³⁵ People taking MAO inhibitors should consult their doctor before taking tribulus.³⁶

While ED may seem like a monumental problem on its own, it is usually a sign of a bigger health issue. It is important to isolate and address underlying issues and support overall health by cleaning up your diet, maintaining healthy blood sugar balance, quitting smoking, regularly moving your body, and managing stress appropriately. Along with these healthy lifestyle changes, a carefully chosen natural supplement routine can offer additional support so you can regain your vitality and get on with enjoying your life.

References

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