Anti-Inflammatory Diet

All health care starts with diet. My recommendations for a healthy diet are here:
Anti-Inflammatory Diet and Lifestyle.
There are over 190 articles on diet, inflammation and disease on this blog
(find topics using search [upper left] or index [lower right]), and
more articles by Prof. Ayers on Suite101 .

Thursday, October 22, 2009

Erectile Dysfunction Diet

Inflammation Leads to Hypertension, Nitric Oxide Inadequacy and Impotence

Drugs for erectile dysfunction (ED), e.g. sidenafil (Viagra), compensate for inadequate nitric oxide (NO) production from arginine by inhibiting the enzyme, phosphodiesterase (PDE5), that hydrolyzes the cyclic GMP that mediates the NO-triggered process of vascular dilation.

Inflammation Is the Core of ED

Drug treatment to compensate for inadequate NO production is a multibillion dollar industry that avoids curing the underlying cause of the ED.  All of the physiological predispositions to ED result in or derive from chronic inflammation.  The major cause of ED, hypertension, frequently as a result of kidney disease, diabetes or metabolic syndrome, can be treated with diet and exercise.  Of course the typically recommended diet is essentially the Anti-Inflammatory Diet, compromised by the unenlightened persistence in the counterproductive use of grain starches, high fructose corn syrup, omega-6 polyunsaturated fatty acids and low saturated fat.

Decreasing Testosterone Results from Declining Health -- not Age

Recent studies also indicate that testosterone levels do not normally decline with age, but rather with declining health.  Healthy men have higher testosterone levels.  I would suggest that reduction in serum testosterone could be used as a measure of chronic inflammation in men.  This also suggests that many of the symptoms associated with aging in men actually reflect increasing chronic inflammation and reduced testosterone.

ED Diets Are Just the Anti-Inflammatory Diet Plus Veggies

A chronic high starch/sugar/HFCS diet with omega-6 oils in place of saturated fats, leads to chronic inflammation, high triglycerides, risk of metabolic syndrome and obesity.  Of course, diabetics have an even lower tolerance for this type of diet.  This diet, which is rather typical in many modern cultures, also provides a high risk of damage to endothelial cells lining the circulatory system and to ED.  The opposite of the inflammatory diet is the low carb, high omega-3 fish oil, no vegetable oil, meat/fish/dairy, Anti-Inflammatory Diet.  This is supplemented with exercise and high vitamin D.  Foods labeled as beneficial to ED also include specific herbs, spices and leafy vegetables, because these contain organic chemicals that inhibit components of the inflammation system or are anti-oxidants.
ED and Biofilms

I would suspect that men with ED suffer from chronic dietary inflammation and one of the consequences of this type of diet is the accumulation of pathogenic biofilms.  Hypertension, which is a contributor to ED and a consequence of chronic inflammation, is also associated with periodontal biofilms and kidney disease (aggravated by renal biofilms.)  I suspect that endothelial cells of capillaries are compromised by biofilm-derived endotoxins that ultimately contribute to apoptosis, decrease in capillary beds and elevation of blood pressure.  All of these assaults on endothelial cells undermine penile vasculature and contribute to ED.

Viagra Can Lead to Rosacea

Men taking Viagra or other PDE5 inhibitors typically have compromised vascular systems that are the basis for ED.  Increasing the response to NO in men with ED produces an increased risk of rosacea.  Withdrawal from PDE5 inhibitors stops the rosacea, which returns if the PDE5 inhibitor use is reinitiated.  Thus, the flush that is the goal of Viagra therapy, leaves some redfaced.

Ioannides, D. et al. (2009) Phosphodiesterase-5 inhibitors and rosacea: report of 10 cases. Br. J. Dermatol. 160: 719-20.

52 comments: said...

I love my omega-3 fish oil.

Cupcakes said...

This is important for conventionally trained endurance athletes, and other athletes who incorporate high volume steady state exercise in their training regimes.

If they knew all the inflammation they are causing by pounding the track for ages, was leading to lower NO levels and depleting the body, they would surely rethink.

Also, I looked a little further into cognitive-enhancing effects of Sildenafil, but the effect seems to be small, and best gotten from post-training administration of a task. And there definitely seems to be doubts whether the benefits will be had in humans. Here's an abstract


Cupcakes said...

That abstract I tried to link to can be found on Pubmed searching for:

dissociable effects of acetylcholinesterase

Anonymous said...

Two questions: the blog says the anti-inflammatory diet includes "specific herbs, spices and leafy vegetables, because these contain organic chemicals that inhibit components of the inflammation system or are anti-oxidants." However, the linked blog does not identify these. Is there a list somewhere on this blog?

Second, concerning omega-6, what about nuts and seedss? Most nuts and seeds have omega-6, yet nuts are generally touted as anti-inflammatory. I suppose the issue is amount, with raw nuts being preferred and low omega-6 nuts being preferred (hazelnuts, macadamia nuts). Any views on nuts?

Echolight Studio said...

Anonymous asked, "Any views on nuts?" a matter of fact, yes. refer to the photo at the top of this post.

(did you think i could resist?) ;D

Anonymous said...

Shel, thanks for the pointer.


Dr. Art Ayers said...

My feeling about nuts is that you have to keep them cool or they go bad. Thus, raw nuts are healthier than fried or roasted nuts. If you have your nuts roasted you may well suffer from ED.

btw, do you recognize the sculpture, artist and gallery?

Unknown said...

Could you please give the references to the recent studies showing that testosterone doesn't normally decline with age, but with declining health?

More specifically, what do you believe causes low testosterone?

Thackray said...

Dr Art,

I gather that intestinal biofilms are supported by the fermentable fiber we eat but what supports renal biofilms? (hydrogen in the blood?).

You said “ED diets are just the anti-inflammatory diet plus veggies”. By veggies I assume you mean the low sugar, low starch type (broccoli for example) - but don’t these veggies have significant fiber that would feed the bacteria in the colon (support biofilms)?

Like many of your other commentators, I’m really interested this biofilm thing.

Do you think it is the nitrates in leafy vegetables that provide the N for nitric oxide?

What spices and herbs actually work to limit ED?


Philip Thackray

Anonymous said...

Spinal Bifida occulta here. 2 questions.

In the absence of gum disease, hypertension, kidney disease gastrointestinal symptoms and low testosterone, is it reasonable to assume that biofilms are not contributing to the ED issue?

The plan is to continue with the diet, exercise and vitamin D and avoid gluten strictly. May try intermittent fasting. Gluten seems to have been the primary inflammatory agent. Celiac testing was negative.

Also plan to use daily minimal dose of cialis - this is supposed to help preserve function - do you think this is wise?

Sue said...

Regarding biofilm displacement:
How much vinegar, pectin, natto do you recommend? What is source of pectin - green apple?
I'm very interested in doing this with the PEG.
Recently have been coming up with facial and front of neck red, hot rashes and facial swelling. First attack July, then Sep, and twice in October. Possible allergy? Also have hashimotos.

Sue said...

Forgot to mention, after rashes - its as if the skin was burned and so skin starts peeling like sun-burn. Small, fine skin peeling on face and larger skin peeling on front of neck (in front of thyroid gland).
P.S. I know you are not giving medicial advice but interested in your ideas.

Anonymous said...

My husband loves mixing Adams peanut butter and honey for dessert. I shudder when he eats that stuff!! I don't know the proportions..maybe 1/4 cup peanut butter mixed with 2-3 Tablespoons of honey, maybe more of each. We keep to an anti-inflammatory diet most days, strict on no wheat, good D3 supplementation, grass-fed beef and eggs over here in Eastern Oregon. I am trying to present a good reason why he should not continue this dessert but I am not getting through. Anything concise I can say to him?? Your thoughts would be very welcome!

Dr. Art Ayers said...

I am beginning to suspect hydrogen metabolism to be a big deal for cryptic bacteria and biofilms. Fiber doesn't do all that well for gut biofilms. The situation for other biofilms in tissues seems to me to be very different from epidermal adhering biofilms, e.g. gut, lung, bladder. So, I would initially think that cryptic bacteria, either intracellular or in small distributed populations, would be more likely in kidneys. The problem with kidneys, prostate and pancreas, is that there can be a backup from other typical biofilm areas.

The "anti-inflammatory diet plus veggies" comments was just sloppy writing on my part. I was referring to the typical articles in print, which just grab the food pyramide and slap on some veggies that have high anti-oxidant levels as judged by measuring consumption of oxidant. I think that those are a joke. The activity of any veggies as anti-inflammatory components is not going to be due to its anti-oxidant level, but rather to the binding of key components to proteins and action on the gut biofilms. Most of the phytochemicals never get out of the gut. I didn't want to get into all of that, so I cut the sentence a little short.

I don't think that nitrate has anything to do with NO production. The precursor is arginine. Arginine levels a very important and polyamines are related and also very important. Arginine availability is also important in different parts of the body.

Dr. Art Ayers said...

Anon --Spinal Bifida occulta,
I don't have a lot of confidence in H. pylori or celiac testing. I think that they have too many false negatives. You may not have full blown celliac and still suffer from gluten intolerance. Grains are overrated and full of starch. Skip them and feel better.

I would assume that ED has an inflammation foundation, just because treating inflammation helps ED. Therefore, I would also suspect biofilms too.

I would also count the SPO as inflammatory. The result for simple approaches would be the same: anti-inflammatory + exercise. You have the exercise and most of the AID. What about your fish oil and vagal exercises? You can also see how much vitamin C it takes to loosen you up. You may have a source of oxidative stress.

Thanks for the comments.

Cristian said...

Not just having a ... hard time getting an erection, but also to became a father.

Overweight men may face fertility issues

Kyle Schneider said...

Hi Art,

Any thoughts on how the use of Propecia can interfere w/ training? How does it hormonally affect testosterone levels?

I'm currently using Propecia but am wondering your thoughts on its hormonal effects and potential affect on testosterone/ability to increase muscle mass.

Kyle Schneider

Sue said...

Dr Art,
Please reply to my comments. Regards,

Dr. Art Ayers said...

Sorry -- I was incommunicado with family on the cold Oregon coast. Beautiful but wet.

I don't know anything about the rashes, but the rest sounds like classic celiac (gluten intolerance) leading to Hashimoto's. Inflammation/celiac leads to multiple allergies.

The obvious is to eliminate grains, lower starch, check your vitD, eliminate vegetable oils (use olive, butter), eliminate HFCS, supplement with at least 6 capsules per day of fish oil. Then think about biofilms, probiotics, etc.

I focus on what should work if my explanations are correct, i.e. it is conceptual. Unfortunately that makes me weak on the practical prescriptions, i.e. the ideas have not been clinically tested or optimized. So, I have a hard time recommended quantities of vinegar, pectin, etc. I have no idea what the upper limits of vinegar and pectin are. People frequently take tablespoons at a time and that seems low to me, but I wouldn't know if it is easy to tolerate more than a quarter of a cup.

Pectin is available for jams and jellies. A concentrated solution is available from Certo. I think that I used half a pouch in a glass of concord grape juice -- that is also an arthritis remedy. Action on biofilms is probably the point.

Natto is a food and should just be eaten as such. There is also a capsule form of the protease. I think that there is a protocol on the autism/biofilm treatment web site mentioned on me first biofilm stripping article.

If you find treatments that seem to be effective, please comment on them.

Thackray said...

Dr Art,

Where does MRSA fall in the biofilm discussion? Is the SA possibly hiding in biofilms and/or are these particular SA simply methicillin resistant on their own?

Can the SA bacteria use blood hydrogen as fuel?

Thanks for your time.


Philip Thackray

Dr. Art Ayers said...

I was just looking at the Wikipedia article on Propecia. It was developed as an inhibitor of testosterone synthesis and testosterone reduction is useful for control of prostatate enlargement and hair loss.

I would expect that the decreased production of testosterone with Propecia use would make weight training less productive.

Thanks for your comments.

Dr. Art Ayers said...

Staph has some very neat features for avoiding host defenses. The MRSA is a drug resistant variant. I think that most drug resistance develops in biofilms, because the biofilm environment is adapted to enhance transformation and gene exchange. It seems to me that combining the prevalent use of antibiotics in large scale agriculture and hospitals, plus personal use on an individual antibiotics, will make certain that multiple drug resistance plasmids are transferred within all residents of biofilms. Thus, MRSA is being continually made in bowels everywhere.

I don't know which bacteria use hydrogen gas as an energy source, but cryptic bacteria that do, would be at a huge advantage.
Thanks for your comments.

Brian said...

Dr. Ayers,

I am an avid reader of your blog and find your approach to be quite refreshing, as it manages to be progressive and challenge the standard medical dogma, yet remain solidly grounded in science. I was wondering if you could further expand on your views on Helicobacter Pylori - you've made a few comments on it here and there but nothing substantial. I have been digging into the literature and have found it interesting how there are rather conflicting studies on its effects, perhaps pointing towards heterogeneity of strains. Would love to get your perspective.


Brian said...

Some interesting reading -

My thoughts are that children who have used antibiotics more frequently will have (1) a higher chance of asthma/allergies and (2) a lower chance of H. Pylori colonization, explaining the outcomes of the studies.


Brian said...

Looks like links are getting cut off by blogger. Let's see if this works.


Tanya said...

Read a blurb in a magazine today recommending cranberry juice for preventing/treating H pylori. Found this study when I was checking out the claim.

I found the asthma/H pylori idea interesting. My middle daughter was a formula baby due to galactosemia (spelling?) and had ear infections til age 4. She is 9 now and often complains of pain in her ear but they don't get infected...and sometimes no fluid to see either. Will watch her for asthma type symptoms now too.

Dr. Art Ayers said...

Having raised three daughters and treated numerous ear infections, my impression is that use of antibiotics is the foundation for most ear infections. Simple palliative methods and patience is most prudent. I now think that use of castor oil around the base of the ear may be effective. I don't know if castor oil should be used in the ear or not. If it is safe, it should also be helpful. In most cases the problem is a blocked eustachian tube as a result of inflammation in the back of the mouth/throat.

I think that asthma/allergies cannot develop unless chronic inflammation is established first. Hence, an anti-inflammatory diet is a simple preventative for all allergies.

Chronic inflammation may have the opposite effect on Tregs as Helicobacter, i.e. it lowers overall Tregs and leads to immunological intolerance. Lack of Helicobacter because of persistent antibiotic use in a whole population plus dietary changes leading to chronic inflammation is a prescription for allergies, autoimmunity and degenerative diseases.

Thanks for your comments.

Anonymous said...

Dr. Ayers,
You have persuaded me about the benefits of castor oil and inflammation. I have been applying to a stiff shoulder now for 3 months and the pain has been reduced, and mobility has definitely improved.
I suffered as a kid from glue ear, (blocked eustacian tubes) and I have had conductive deafness for as long as I can remember. It's my "normal".
Retrospectively, I believe that inflammation is the underlying cause for many maladies for me, and I am fitter than most for my age at 55.
I have been on a paleo diet for 3 years now, and discovered that I am lactose intolerant a month ago, after unexplained inability to gain weight.
Your blog has been such a help in my goal of attaining optimal health, within the limitations of damage (relatively minimal) already done.
If I only knew then what I know now... Such is life.

Cristian said...


"I have discovered that in order for probiotics to work most effectively, the gut lining first needs to be matured through the selective use of probiotics that specifically stimulate SIgA (secretory Immunoglubulin A), and must then be exposed to key strain specific probiotics. SIgA is the great, forgotten immunoglobulin, but I’ve championed it for twenty years because it is so beneficial to the GI tract. SIgA determines our ability to communicate to our immune system exactly what bacteria we are harboring and what to do about it. If you don’t have enough SIgA, you can consume probiotics forever and never transfer enough of their relevant information to the appropriate immune tissues in enough volume to impact health. SIgA and the T-regulatory family of cells work in a cooperative manner to maintain tolerance, yet SIgA requires bacteria in the mucosal lumen to be stimulated.

If you give probiotics in a cavalier manner to someone who does not have enough SIgA, you won’t get a good clinical response because of diminished immune interpretation. In other words, the immune system does not process information from bacteria and pathogens as effectively as it needs to when levels of SIgA are low. I discovered nearly twenty years ago that if we can improve an individual’s SIgA status, we will then see a change in how they respond to subsequent probiotics."

How to restore it:

"If SIgA is low, I give Saccharomyces boulardii, which is superb at promoting SIgA and has hundreds of peer-reviewed studies demonstrating its safety and effectiveness. I begin with as little as ¼ capsule in children and ½ capsule in adults, because this probiotic is very potent. Saccharomyces boulardii helps the body break down carbohydrates more effectively, reduces gut candida and neutralizes clostridium difficile toxins A and B, thus improving mucosal barrier effectiveness. It also lowers inflammatory IL-8."

Dr. Art Ayers said...

This IgA first approach highlights the communication that goes on between gut flora and gut, but I don't think that there is evidence for its support. It seems to be mostly product marketing.

It seems that the important gut flora studies that need to be done, aren't being done, because there is not a pharmaceutical at the end. In most cases health results from removing pharmaceuticals and reinstating healthy eating and exercise. I opine that 90% of medical "care" in the US could be eliminated by eliminating bad food and bringing back healthful communication where our body meets our food.

Tanya said...

My other two girls (I have three like you!) were breast fed til a year old and had almost no infxns.

A local doctor, one of the country doctor types, told me to use warm olive oil for pain relief in her ear. I tried castor oil last night for her. She slept but said it hurt just as bad when I woke her up. I have had good luck with Vicks since reading that here, so will try that around her ears and along her jaw.

When they put tubes in her ears, they also did surgery to open up her tear ducts. The theory before surgery was that the ducts had not fully formed. What they found was excess tissue in the nose that was blocking them, which they had never encountered before. I wonder if that is a factor for the ear as well.

Re: Bill's comment...Perhaps I am just not patient enough with the remedies...Bill--how long after starting did you feel relief or did it take three months?

Anonymous said...

I found that if I applied whenever possible throughout the day, probably every 4-6 hours as well as before bed, and after showering, I had real relief within a week or so.
I prefer to Vicks because castor oil is virtually odourless.
I still feel "clicking" around the joint, but the pain has diminished to the point that rotation and mobility is probably 90%. I am able to throw a ball without discomfort now, although not as far as I used to.
I will persevere with this cheap and effective treatment, it definitely works.
The continuous application does make a difference.

Dr. Art Ayers said...

Just a note about lactose intolerance. Many people suffer from lactose intolerance, even though many gut bacteria are able to hydrolyze lactose. The problem is that their gut flora are simply adapted to low lactose. The bacteria can be trained to metabolize lactose just by gradually incorporating more milk into the diet over a series of weeks. Apparently it takes a couple of weeks and then intolerance symptoms disappear.

Thanks for your comments and testing my speculations.

Cristian said...

And it's pivotal, when it comes to reverse lactose intolerance, to heal the gut with a gluten free diet: Regression of lactose malabsorption in coeliac patients after receiving a gluten-free diet.

And don't forget to read the best blog around:

Cristian said...

I mean ... the second best blog around :-)

Anonymous said...

LOL re the FB post, this blog might get Bill Clinton's attention regarding his new stents.

He probably is surounded by too many lobbyists though. Public figures, especially high profile ones like Bill Clinton, attract them like honey attracts flies. He reminds me very much of Eisenhauser. He too suffered an early death at the hands of his doctors' cholesterol lowering misguidance.

Billy, primal food can't be bad for us. We evolved on it! Whatever diet you follow has to be congruent with nature. Granulated sugars, HFCS, sugar alcohols, and refined grains, even the so called "healthy" whole grains, are not natural. They are all poison!

If your heart doesn't kill you first, you can expect an endocrine cancer or some form of dimensia to step in and take over. None of that stuff is fun and especially not when you suffer from ED!

BTW I voted for ya.

Dr. Art Ayers said...

My perspective is that most ED is due to chronic inflammation and in most cases diet-based inflammation. It doesn't make sense to me to treat that type of ED with NO drugs or with herbs. It makes more sense to just change to a healthier diet. In many cases ED is a symptom and many other diseases will also result from the underlying chronic inflammation. So, I recommend a change to an easily sustainable anti-inflammatory diet and lifestyle.

Thanks for the comments.

kdmac said...

A lucky set of circumstances has led me to discover inflammation and the potential for addressing numerous diseases through its treatment. I'm a 22-year-old who began experiencing intermittent ED a little over 2 years ago. After a physical with my old doctor - and a humbling experience visiting a urologist - found everything including testosterone, hormones, etc. to be in order, I erroneously convinced myself that some kind of emotional/psychological cause was to blame (with obviously counter-productive results) and started using generic viagra when needed to get by.

About a year ago, however, on a trip to a different doctor on the occasion of a strep throat infection, it was discovered that I had dangerously high blood pressure, and was subsequently placed on anti-hypertensives, a dose which was soon to be doubled.

After doing some research on my own and discovering the causal links between diet and inflammation, and its common contribution to both high blood pressure and erectile problems, I was able to work with my doctor on a new gluten-free, low glycemic diet, supplemented by an arsenal of antioxidants and tons of omega3s. As of this spring, I've been completely off of the prescription meds, have pressure well within the normal range, and am much improved in the sexuality department.

However, my erectile problems continue to come and go, seem to flare up after meals even when following anti-inflammatory guidelines flawlessly, and render me completely useless if I go a day without a barrage of fish oil (they also completely subside if I take an inordinately high dose of said oil, pointing clearly to general inflammation as the cause).

I discovered your blog just a few days ago, and after pouring over most everything here, am feeling really validated and more motivated than ever to commit to your dietary recommendations. The issue of biofilms is entirely new to me, however, and I suspect that dysfunctional gut flora may be responsible for the persistence of inflammation despite my dietary/exercise improvements.

kdmac said...


I've noticed that for some folks here you recommend working in probiotics, and for others with seemingly more severe cases you recommend a full bowel irrigation, followed by a more aggressive approach to the biofilms. I'm also intrigued by your experience with The Cure, most specifically those first two weeks on the whey protein shakes. My question for you is what approach you think might be most useful for me. I'm planning on running all of this by my doctor first, but I like the idea of a few days' fast preceding a PEG cleanse, the enzymes you've mentioned to loosen up the biofilms (I've been shopping online for relatively inexpensive lactoferrin, pectin, and natto supplements - in addition to vinegar, do you think this would be sufficient?) some berberine capsules as a natural anti-microbial (deemed necessary by the Olmstead article linked to in your biofilm post) followed a few hours later with an anti-inflammatory meal and pre/probiotic supplement that I will continue to take as part of my daily regimen plus some glutamine to sooth everything. I've noticed a lot of colostrum supplements that have lactoferrin in them, as well as those whey shakes, and pectin is in a lot of the probiotic supplements, but I imagine taking probiotics or anything else beneficial in that first post-PEG step with the anti-biofilm enzymes would be rendered useless by the use of the anti-microbial in the next step? I'm excited at the idea of a one-day jumpstart, but am a little afraid to mess up my GI tract with perhaps too aggressive or amateurish an approach. Do you think a more modest integration of probiotics into my diet, or The Cure's method of altering gut flora through those first few weeks of the shakes would be a more sensible approach for someone like me? I do not have any problems related directly to my colon like some of the others in the comments who have yeast in their stool or IBD, but I have had other experiences such as lifelong allergies, antiobiotic treatments in response to pneumonia on a number of occassions, bouts of rosacia in my adolescence, and an appendicitis that was described by my doctor as somewhat unusual, that lead me to believe a dysfunction in the GI ecosystem might definitely be something worth addressing.

I apologize for the excessively long post and the number of questions, but have been beyond impressed by your clarity and attention to numerous queries from folks in the comments and would be very grateful for your advice, too!

Thanks so much,

Anonymous said...

I am 51, 6ft and about I'm clearly slim. I do not have hypertension (or diabetes)and get a lot of excersize and I have had ED for 10 years. I do have an inflammatory condition as I can feel what I can only describe as vascular inflammation in my penis. Generally I have burning sensations AND freezing like Reynauds. I've been told it's chronic non bacterial prostatis but remain unconvinced. Needless to say this is a fairly hellish thing to live with. I will try your advise regarding diet.

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