Shaun Ward MSc ANutr
Erectile dysfunction is the constant inability to achieve or maintain an erection for sexual performance.
According to studies in the United States, up to 50% of males between 40-70 years old are affected by erectile dysfunction.
National health surveys also estimate that ~20% of males under 20 years old have erectile dysfunction .
This suggests that although erectile dysfunction is positively correlated with age, it is a health issue that can be problematic for all males involved in sexual activity.
Although erectile dysfunction is not life-threatening, it should not be overlooked because it may influence interpersonal relationships and impact a couple’s relationship in a negative fashion.
The biological explanation for erectile dysfunction involves a combination of vascular, neurological, endocrinological, and psychological factors – making it extremely complex to treat.
However, avoiding poor health and cardiovascular disease is the best simple advice to reduce the risk of erectile dysfunction .
In addition, some dietary supplements are available to help treat erectile dysfunction.
A significant proportion of patients with erectile dysfunction have low arginine levels, especially if the condition stems from poor cardiovascular health .
It is also postulated that high level of homocysteine in people with erectile dysfunction may be the primary cause that impairs the nitric oxide pathway. Although this is yet to be tested, arginine supplementation in other studies has been found to lower homocysteine levels.
Hypothetically, if it were to have the same effect in erectile dysfunction patients then it may help overcome the inhibitory effect induced by homocysteine .
Initial reviews and meta-analyses provide good evidence for the effectiveness of arginine supplements for treating mild to moderate erectile dysfunction, but more serious serious cases may require more powerful supplements .
In addition, most studies that are included in such reviews only supplement arginine alongside PDE5 inhibitors which could easily exaggerate arginine’s therapeutic effect .
As they work by similar mechanisms, it would be preferable for people to first supplement with l-citrulline as it is more bioavailable.
L-citrulline is an amino acid that can be converted to arginine, another amino acid that improves blood flow by creating nitric oxide and helping to dilate blood vessels.
Common sense would have people think it is better to supplement with arginine directly, however in reality l-citrulline has an advantage over arginine because it escapes intestinal and liver metabolism and rapidly converts to arginine in the kidneys.
L-citrulline supplementation has been shown to increase the plasma arginine concentration in a dose-dependent manner .
In animal experiments, administration of L-citrulline improves intracavernous pressure and levels of nitric oxide in those with erectile dysfunction caused by poor cardiovascular health .
In the limited human studies so far, subjective scores of “erectile hardness” have improved by ~25% in ~50% of patients .
Whether l-citrulline turns out to be a legitimate treatment for erectile dysfunction is too soon to tell, but it is certainly a viable treatment option for people with mild to moderate erectile dysfunction and not willing to use PDE5 inhibitors .
Systematic reviews and meta-analyses’ confirm that ginseng may be an effective herbal treatment for erectile dysfunction, despite a clear need for more high-quality studies .
Experts in this field mention that although ginseng seems beneficial for erectile dysfunction, most of the studies are not double blinded and may potentially be overestimating the treatment effects – known as “performance bias” .
The possible mechanism of action for ginseng is that it induces the relaxation of the smooth muscles of the corpus carvernosum via the nitric oxide pathway .
This theory is based on the fact that ginseng contains ginsenosides, which have been shown to cause a dose-dependent relaxation of the corpus caverndosal smooth muscle in animal models .
Human research is necessary to confirm any potential relationship between ginseng and erectile dysfunction.
Bonus Tip: When Supplements Fail, Opt For PDE5 Inhibitors
Phosphodiesterase type 5 (PDE5) inhibitors can either be listed as a supplement or a pharmaceutical drug, but we have included it within this discussion for educational purposes due to their popularity.
PDE5 inhibitors cause vasodilation in the penis by blocking the breakdown of cyclic guanosine monophosphate (cGMP) and increasing nitric oxide production.
This is important as during sexual arousal, the increased blood flow necessary to develop an erection is dependent on nitric oxide release from the nerve terminals and endothelial cells in the penis.
Examples of PDE5 inhibitors are sildenafil, vardenafil, tadalafil, and avanafil, all of which have been proven to treat erectile dysfunction.
During the first 6 years on the market, more than 20 million men managed to treat erectile dysfunction with PDE5 inhibitors .
Recent systematic reviews and meta-analysis’ of randomized controlled trials also confirm the efficacy of PDE5 inhibitors, with an estimated ~70% of people able to achieve sexual intercourse after use. Interestingly, even placebo treatments have a ~35% success rate which conveys the psychological element of erectile dysfunction .
Keep in mind, as this substance is technically a drug as opposed to a supplement, it commonly leads to adverse effects such as headaches, flushing, and nasal congestion. There is also a rare chance of seriously prolonged and painful erections that last over 4 hours.
For this reason, many people look towards more natural supplements that we discussed earlier
The Bottom Line
Erectile dysfunction is a common issue that is defined as the inability to get or keep an erection to have sexual intercourse.
Most people try to solve this problem by using PDE5 inhibitors such as Viagra, but this may cause mild to severe side effects.
The most effective supplemental alternatives are arginine, l-citrulline, and ginseng.
However, improving overall health, especially cardiovascular health, could be necessary to treat erectile dysfunction in the long-term.