Natural approaches for erectile dysfunction
Many drugs unsuitable for some men with diabetes
Approximately 60% of men with diabetes experience occasional to complete erectile dysfunction (ED). Viagra works for only about 60% of them, and it is contraindicated in many who use nitrosamines for angina. They’re flocking to waiting rooms full of despair, looking for an oasis in their sexual desert, and clinging to any hope — even those born of late-night television commercials promising this or that herbal formulation works just as well as Viagra. So what can you do about this emotionally distressing problem in millions of men?
The unfortunate news is that there is little scientific evidence validating herbal remedies or dietary supplements for impotence. The good news is that almost anything can work, says endocrinologist Bruce Bower, MD, FACP, LACP, MACE, clinical professor of medicine at the University of Connecticut in Hartford. "There is a tremendous amount of placebo effect in these things, so whether it is actually effective, or it’s placebo, or it’s a combination of the two, everything contributes," says Bower.
Erectile dysfunction is common in men with diabetes because of microvascular complications and peripheral nerve damage that frequently accompany the disease. Few men will raise the issue with their physicians, perhaps out of embarrassment, says Bower, so the problem may be even more widespread than is generally acknowledged.
Even with physiological factors that may effect erectile function, fear of failure and other psychological factors may worsen a minor problem. When a man complains of ED, the first step should be to order a testosterone level to make sure it is normal, says John Seibel, MD, FACP, MACE, an Albuquerque, NM-based endocrinologist. "If testosterone levels are subnormal, supplemental testosterone may take care of the problem," says Seibel. "But in men with diabetes, there is usually a dual problem of neuropathy and microvascular damage, so it gets more complicated."
Aerobic exercise can help
Whatever the cause, says Seibel, regular aerobic exercise is perhaps the single most effective way of addressing ED in men with diabetes, and it can be a powerful motivating factor.
Not only does aerobic exercise address circulatory issues, it is enormously helpful in controlling blood sugar, says Ken Snow, MD, director of the sexual function clinic at Boston’s Joslin Diabetes Center. "Anything that helps control blood sugar will have a positive effect on erectile function," he points out. A recently published study from New England Research Institutes in Watertown, MA, shows that healthy men who burn 200 calories or more a day in aerobic exercise cut their risk of ED in half.1 "I wouldn’t be surprised if that would generally apply to men with diabetes, too," says Snow.
Seibel adds that sexual dysfunction is relatively common, although rarely discussed, among women with diabetes. The underlying causes, he says, are the same as the causes of ED in men: microvascular complications and neuropathy.
For those patients you can’t persuade to get out on the basketball court or to run track with the suggestion they may prevent or alleviate ED, here is the best available information on the herbs and supplements they may bring to your office:
Yohimbe
Made from the bark of a tall African tree, yohimbe is widely used in the United States for ED and as an aphrodisiac. It also is commonly included in multiherb formulas. While there are virtually no data on the safety or efficacy of yohimbe itself, there have been numerous studies on yohimbine, an indole alkaloid, which is one of the major constituents of yohimbe. Prior to the introduction of Viagra, yohimbine hydrochloride was a commonly prescribed pharmaceutical for male sexual dysfunction.
The Commission E monograph reports a few studies showing the usefulness of yohimbine for impotence, especially for those of vascular, diabetic, or psychogenic origins, to improve the staying power of erections, usually without increasing sexual excitement. Reported side effects include dizziness, nervousness, and anxiety.2 "I have seen some success with yohimbine and it may be even more effective if used in combination with vitamins or other remedies," Bower says.
Ginseng
While various subspecies of the plant Panax ginseng are used as a general tonic and there has even been recent evidence that it may be helpful in controlling blood sugar, there is little evidence that ginseng is helpful as a specific treatment for erectile dysfunction. One Korean study suggests it may be effective,3 and the German Commission E monographs say clinical data support its use as a prophylactic and restorative agent for enhancement of mental and physical capacities. . . ."
Horny goatweed (Avena sativa)
Little is known about this herbal agent widely used in traditional Chinese medicine and touted as "natural Viagra." There are no English-language trials using horny goatweed. Writing in CTCC’s companion newsletter Alternative Medicine Alert (February 2000, pp.19-22), Michael Cirigliano, MD, FACP, assistant professor of medicine at the University of Pennsylvania School of Medicine in Philadelphia, says health care professional should discourage the use of horny goatweed because of lack of evidence for its efficacy and the suggestion it may act as a vasodilator, which may be contraindicated for patients using anti-hypertensives and nitrates.
L-arginine
An amino acid used by many patients as an adjunct to therapies for high cholesterol, l-arginine has gained a reputation for enhanced sexual function. One small clinical study suggests dramatic improvement in sexual function with the use of a supplement called ArginMax, which contains l-arginine, ginseng, Ginkgo biloba, antioxidants, vitamin B complex, and minerals such as zinc and selenium.4
Researchers theorize that l-arginine is broken down to nitrous oxide which relaxes blood vessels and helps improve blood flow to the penis. "I think it’s worth trying and worth studying further, since three-fourths of the men with ED reported improvement in their overall sex lives," says lead author Thomas Ito, MD, assistant professor of surgery at the University of Hawaii in Honolulu.
Vitamin supplementation
Many men are using vitamin therapy on the theory that nutrient deficiencies may be responsible for decreased sex drive. Some are using vitamin A because it is an antioxidant and on the theory that it contains the precursor to testosterone (there are no clinical studies to support this theory).
Some men use large doses of vitamin C to boost circulation to the genital area and some takes doses of B vitamins to help calm nerves. Excessive dosages of vitamins, however, can be toxic and lead to a number of adverse physiologic effects.
References
1. Derby CA, et al. Modifiable risk factors and erectile dysfunction: Can lifestyle changes modify risk? Urology 2000; 56:302-306.
2. Ernst E, Pittler MH. Yohimbine for erectile dysfunction: A systematic review and meta-analysis of randomized clinical trials. J Urol 1998; 159:433-436.
3. Choi HK, et al. Clinical efficacy of Korean red ginseng for erectile dysfunction Int J Impot Res 1995; 7:181-186.
4. Ito T, et al. The effects of ArginMax, a natural dietary supplement for enhancement of male sexual function. Hawaii Med J 1998; 57: 741-744.
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