REVIEW OF SUPPLEMENTS FOR MALE SEXUAL PERFORMANCE
Byron J. Richards, CCN
June 23, 2012
It doesn’t seem like you can watch a TV show without seeing an ad for Cialis, Viagra, Levitra, or some type of dietary supplement that will help a man perform better. And then there are the low T commercials, guaranteed to make any tired man feel he needs testosterone. Sorting out this non-stop and bewildering advertising blitz is not easy, especially understanding the risks as well as the claims in the typically over-hyped commercials. This article seeks to give you a better understanding of the subject so that you can formulate a healthy plan that works for you.
Cialis, Viagra & Levitra
Cialis, Viagra, and Levitra are drugs known as phosphodiesterase type 5 inhibitors (PDE5 inhibitor). As a nutrition health writer I will spend some time explaining these drugs because they are in widespread use and because they serve as an excellent learning example in terms of why they work, what that implies about your health, what their actual risks are, and what you should be doing to naturally improve your health.
Upon sexual stimulation blood vessels within the penis release friendly nitric oxide (eNOS), helping blood flow into the penis. eNOS in turn stimulates the production of another compound called cGMP (cyclic guanosine monophosphate), further enhancing blood flow into the penis and supporting the relaxed muscle function within the penis needed for an erection. These two compounds interact synergistically to have the net result of significantly increase nitric oxide, dilation of the arteries into the penis, and enough blood supply to produce an erection.
The arteries into the penis are small, yet they must accommodate a rapid 80% dilation in order for enough blood to flow into the penis to enable an erection. There is no other part of the body that requires such an extreme dilation for normal function (10% - 20% is common in other areas). This is why the penis is so sensitive to general circulatory issues.
While eNOS is the on switch for cGMP there is also a natural off switch, an enzyme called phosphodiesterase type 5 which will take cGMP apart. Cialis, Viagra, and Levitra all work by deactivating the enzyme that is trying to take cGMP apart, helping in many cases to produce and sustain an erection by prolonging the existence of cGMP and thus eNOS. This biochemistry activity occurs in men who “need it” or not, which is why the recreational or performance-enhancing use of these drugs is rampant.
When a man “needs” one of these drugs in order to have a satisfactory sexual experience it is a symptom of a larger cardiovascular problem; i.e., risk factors for cardiovascular disease are already established and typically progressing in the wrong direction. An ED problem existing alongside extra body weight and low testosterone is especially predictive of cardio risk. You might say that sexual problems are a red flag for cardiovascular problems, as the penis is very sensitive to the progression of general circulatory issues.
Ironically, blood pressure medication often starts ED or makes it worse. Such drugs force less circulation and since the penis is a rather sensitive endpoint of the circulatory system its blood supply is reduced and existing struggles are then magnified, not improved. On the other hand, circulatory problems that are driving up blood pressure also cause ED. In medical literature these chicken and egg issues are hotly debated, which is why you need to understand the actual nature of the problem so you can truly fix it. Quite frankly, the medical profession’s treatment paradigm is lacking, if not dangerous.
The side effects of Cialis, Viagra, and Levitra are worth understanding, since they are relatively easy to manage. And heaven forbid that a man should get an erection lasting more than four hours.
While the goal of these drugs is to inhibit the phosphodiesterase type 5 enzyme, they also inhibit other phosphodiesterase enzymes. This may adversely affect eyesight or hearing, especially in people with structural issues in these body parts. The risk of this type of side effect is considered minimal for most people.
The more common side effects are headache and backache, which researchers think is mostly caused by excessive inappropriate dilation of your general circulatory system. This means that the blood-brain barrier becomes more leaky; potentially allowing compounds in your circulation to enter your head that should not necessarily get in.
What the researchers do not seem to understand and report on is that significantly increasing the pool of nitric oxide with these drugs can have rather unpredictable results. This is because nitric oxide can be both anti-inflammatory (friendly eNOS) or pro-inflammatory (unfriendly iNOS).
In practical terms, what happens after a person takes the drug will likely determine what kind of nitric oxide they get. For example, if sexual stimulation and pleasure occurs then it is likely that eNOS will be made at high levels. But what happens if you unfortunately have an argument with your partner after taking the drug? Now you will get a lot of iNOS and when that is combined with increased permeability into your brain you just exposed your head to an excitotoxic buzzsaw.
The moral of the story is don’t ever take these drugs unless you are going to be really nice and planning on a good time. Avoid stress while the drug is in your system. Avoid excess alcohol.
Cialis has been approved at a lower dose for daily use and some researchers suggest that this can have general anti-inflammatory effects on the circulation and even be used to manage blood pressure. Unfortunately the issue is not so simple, as I have explained these drugs can readily turn pro-inflammatory. Why on earth would anyone want that drug in their system when they are dealing with the day to day pressures of work?
It is possible to guard against the issues of excess vascular permeability into your brain and the unwanted production of unfriendly iNOS. I would suggest that any man using these drugs also take nutrients that help eNOS while protecting the vascular system from excess dilation. Top choices include grape seed extract, resveratrol, hawthorn berry, and horse chestnut.
There is no arguing that these drugs can be helpful for many men, as a temporary remedy for a system that is in distress. Indeed, the stress of a sexless relationship can be traumatic for both man and woman, having a significant negative overall health impact. My interest in explaining all of this is to hopefully encourage men to actually fix their health. After all, wouldn’t you like to live longer with a high quality of health so you have more opportunities for pleasure?
Boosting Friendly eNOS and Lowering Inflammation
As can be understood from the previous section, activating and sustaining cGMP and eNOS levels is a major key to erectile function. It makes sense that by correcting the reasons cGMP and eNOS levels are being depressed, then normal erectile function will return or be improved.
There are two critical issues to improve to achieve this result: boosting up levels of eNOS which stimulate the formation cGMP in the first place and reducing levels of inflammation which cause excessive activity of the enzyme phosphodiesterase type 5 which is taking cGMP apart too fast.
The availability of eNOS in the penis is subjected to the overall availability and status of eNOS in your circulatory system. The most important form of exercise to develop better eNOS function is aerobics. If you don’t do aerobics 2 – 3 times per week you simply will not turn on genes that activate eNOS production. Supplements can still help eNOS in the absence of exercise, but their result is much better if combined with aerobics.
Many supplements can help you boost the production of friendly eNOS. Top choices include grape seed extract, resveratrol, Q10, L arginine, panex ginseng, quercetin, and magnesium. These may help to some extent if taken before sexual activity, but they do not work like the drugs which force chemistry reactions. Rather, nutrients along with exercise help to build the pool of available friendly nitric oxide. As you improve your fitness and eNOS status you will eventually reach a point where your eNOS supply is adequate for normal erectile function. Thus, these supplements should be used on a regular basis, including before exercise, while also working to improve factors that deplete friendly eNOS.
Friendly nitric oxide levels are depleted by stress of any type and especially by weight gain. If you are overweight then you must engage the process of weight loss for any truly long-lasting improvement in friendly nitric oxide status, improvement in sexual function, and reduction in cardio risk.
Excess body weight, high stress, and toxins are all inflammatory in nature. It is interesting that research on the sex drugs has actually demonstrated that high levels of inflammatory TNFa increase the activity of the enzyme phosphodiesterase type 5, which deteriorates cGMP status and makes erections more difficult.
For example, many men experience an occasional erectile issue following a period of high stress or a traumatic stressful event. As the stress issues dissipate then the erectile issues also improve. This is a common example of high stress temporarily taking its toll on cGMP.
Excess body weight is a huge issue in this regard, since white adipose tissue will constantly release excess TNFa into the bloodstream, eventually taking its toll on cGMP. While it may take a while for excess weight to interfere with sexual function, once it does the problem is fairly stubborn to solve. A man must become committed to a much healthier lifestyle.
Every supplement mentioned above not only helps the production of friendly eNOS, they also help multiple aspects of inflammation. And there are many other nutrients, especially DHA, that are vital for proper ongoing reduction of inflammation. How many you will need to take depends on your health status, your lifestyle, your exercise, your diet quality, how much sleep you get, and managing any other factor affecting your health. You want to establish a combination program for yourself that involves improved aerobic fitness, stress and inflammation management, proper diet, weight loss if overweight, and rejuvenation of your overall cardiovascular system. The side effect of this approach is eventually a male sexual system in good working condition.
Testosterone as a Foundation
Testosterone is the foundation of male sexual function. Everything I have just written about eNOS, inflammation, and cGMP will be improved when testosterone status is good and will deteriorate or be hard to correct when testosterone status is bad. Unfortunately, testosterone levels decline with age and many factors speed up their decline.
When a man has inappropriately high blood levels of leptin due to being overweight, then he automatically forces his testosterone levels down. Leptin and testosterone are synergistic opposites. Thus, losing weight is the first thing a man should do to correct low T.
On the flip side of the coin, weakened states of health are associated with leptin that is too low as well as low testosterone. While this issue is mostly associated with frail health conditions, it can also be produced trying to lose weight too fast via starvation. Lose weight in a healthy way, follow the Leptin Diet. I should point out that extra zinc may be needed during weight loss to prevent a slide into worsening testosterone status (meaning your sex drive leaves you whenever you try to lose weight). It is vital that you properly lose weight to optimize your potential testosterone levels.
Just as you can do aerobics to turn on genes that condition better eNOS function, so it is that you can do strength training or demanding sports to turn on genes to enhance testosterone production. If you don’t use your muscles intensely several times a week then you are failing to take one of the most basic actions that can drastically improve your testosterone status.
There are dietary supplements that can help normalize testosterone levels, improve drive, and also help improve performance. Three of the better studied nutrients in this category panex ginseng (up to 2000 mgs per day), acetyl-l-carnitine (2000 mg per day) and saw palmetto (320 mg per day).
Yohimbine is one nutrient in this category that I do not recommend because it is also a stimulant that can drive up blood pressure. Since many men seeking improved sexual function also have cardio issues, this is not a safe combination.
Many of the testosterone-support aphrodisiac herbs have a long history of folk use in traditional medicine of various cultures. None of these raise testosterone abnormally high. Rather, they may have a rejuvenating effect on a tired-out testosterone system. Two of my favorite herbs in this category are muira puama and tribulus terristrus.
Muira puama, also called “potency wood,” is a small tree native to the Brazilian Amazon. It has been used traditionally as a tonic for muscles, an aide for weak digestion, and as a sexual stimulant. Early explorers, noting the aphrodisiac properties of muira puama, brought it back to Europe where it has been part of herbal medicine. Tribulus is an herb that has been used for centuries in India as a male system tonic and aphrodisiac.
In my way of looking at health, trying to replace testosterone with a drug to boost your levels can be done, but it would be my last choice after working on all of the above. As you get older testosterone metabolism is more unpredictable, especially as you have other health problems that frequently occur with erectile dysfunction. For example, testosterone can fuel prostate cancer even though levels are lower in older men. This is because of all the other hormonal confusion going on in a man who is not fit and is overweight. It is far safer to correct health issues that impede testosterone production than to take testosterone with multiple health issues. If you have all of your health issues moving in the right direction and testosterone levels are still low, then trying some at the lowest dose that seems to help is workable, as you get your body into better shape.
A Comment on Cardiovascular Disease Progression
It is unfortunate that the longer health problems remain in place the more difficult they are to solve. In the context of the subject matter of this article, that means that there can be a progressive accumulation of damage in the walls of the arteries leading into the penis. Plaque forming in penile arteries, which is common during aging, will make the issues more difficult to resolve.
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Such problems can and should be fixed, but they take some time. Some men may need more comprehensive cardio support than I have outlined in this article. Simply taking some nutrients or improving your diet does not automatically fix the plaque that has accumulated. Importantly, you must first create a personalized program that enables you to quit forming plaque. Once on track, then you have created an environment wherein your body can begin to undo plaque from your arteries, including your penile arteries. This is a slow and steady process that will require that you are quite consistent doing healthy things for many months. There are no quick fixes. Drugs for cardiovascular health are Band-Aids that often make your health worse. You aren’t trying to manage numbers; you are actually trying to be healthy. Your sexual performance is direct predictor of your cardio health.
On the positive side your body considers sex to be one of the most important functions in terms of survival of the human race. This means that your body will make every effort to help you restore natural and healthy sexual function – if you give it the chance to do so.
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