For centuries,
men have tried all sorts of natural remedies for erectile dysfunction (ED) --
the repeated inability to get or maintain an erection firm enough for sexual
intercourse. But, do they really work? It is simply not scientifically known at
this point. Furthermore, you take these remedies at your own risk, because
their safety profiles have not been established. What follows are commentaries
by experts and reviews in the field of alternative treatments that are
available over the counter for erectile dysfunction.
"Just
because there is evidence doesn't mean it is a good evidence," says Andrew
McCullough, MD, associate professor of clinical urology at New York University
Langone Medical Center in New York City, and one of the original clinical
investigators for the ED drug Viagra (sildenafil). "And before men with ED
start down the naturopathic route, it's smart to make sure that there isn't
some underlying medical condition that needs to be corrected." Moreover,
it is estimated that 30 million American men have erectile dysfunction, and 70%
of cases are a result of a potentially deadly condition like atherosclerosis,
kidney disease, vascular disease, neurological disease, or diabetes.
Additionally, ED can also be caused by certain medications, surgical injury,
and psychological problems.
Experts feel that
treating erectile dysfunction on your own, without consulting a doctor, is
unsafe. "If you have ED, the first thing you need is a diagnosis,"
says impotence expert Steven Lamm, MD, a New York City internist and the author
of The Hardness Factor (Harper Collins) and other books on male sexual health.
He says men with severe erectile dysfunction probably need one of the
prescription ED drugs, which include Levitra (vardenafil) and Cialis
(tadalafil) as well as Viagra. But, he says, mild ED -- including the feeling
that "you're not as hard as you could be" -- often responds to
natural remedies.
Natural Remedies Review
1. Arginine
The amino acid
L-arginine, which occurs naturally in food, boosts the body's production of
nitric oxide, a compound that facilitates erections by dilating blood vessels
in the penis. Studies examining L-arginine's effectiveness against impotence
have yielded mixed results. A 1999 trial published in the online journal BJU
International found that high doses of L-arginine can help improve sexual
function, but only in men with abnormal nitric oxide metabolism, such as that
associated with cardiovascular disease. In another study, published in 2003 in
the Journal of Sex & Marital Therapy, Bulgarian scientists reported that ED
sufferers who took L-arginine along with the pine extract pycnogenol saw major
improvements in sexual function with no side effects. Arginine can be helpful,
says Geo Espinosa, ND, director of the Integrative Urological Center at NYU
Langone Medical Center. Espinosa says that men with known cardiovascular
problems should take it only with a doctor's supervision; L-arginine can
interact with some medications.
2. Watermelon
Watermelon may be
a natural Viagra because it is richer than experts believed in an amino acid
called citrulline, which relaxes and dilates blood vessels much like Viagra and
other drugs meant to treat erectile dysfunction (ED). "We have known that
watermelon has citrulline," says Bhimu Patil, PHD, director of the Fruit
and Vegetable Improvement Center at Texas A&M University, College Station.
Until recently, he tells WebMD, scientists thought most of the citrulline was
in the watermelon rind. "Watermelon has more citrulline in the edible part
than previously believed," he says.
How could
watermelon be a natural Viagra? The amino acid citrulline is converted into the
amino acid arginine, Patil says. "This is a precursor for nitric oxide,
and the nitric oxide will help in blood vessel dilation."
3. DHEA (Dehydroepiandrosterone)
Testosterone is
essential for a healthy libido and normal sexual function, and erectile
dysfunction sufferers known to have low testosterone improve when placed on
prescription testosterone replacement therapy. Similarly, studies have shown
that taking over-the-counter supplements containing DHEA, a hormone that the
body converts to testosterone and estrogen, can help alleviate some cases of
ED. But DHEA can cause problems, including suppression of pituitary function,
and its long-term safety is unknown, says McCullough. For this reason, many
experts discourage use of the supplements.
4. Ginseng
Korean red
ginseng has long been used to stimulate male sexual function, but few studies
have tried systematically to confirm its benefits. In one 2002 study involving
45 men with significant ED, the herb helped alleviate symptoms of erectile
dysfunction and brought "enhanced penile tip rigidity." Experts are
not sure how ginseng might work, though it has thought to promote nitric oxide
synthesis. "I would recommend ginseng [for men with ED]," says
Espinosa. Discuss with your doctor before taking it since ginseng can interact
with drugs you may already be taking and cause allergic reactions.
5. Pomegranate juice
Drinking
antioxidant-rich pomegranate juice has been shown to have numerous health
benefits, including a reduced risk for heart disease and high blood pressure.
Does pomegranate juice also protect against ED? No proof exists, but results of
a study published in 2007 were promising. The authors of this small-scale pilot
study called for additional research, saying that larger-scale studies might
prove pomegranate juice's effectiveness against erectile dysfunction. "I
tell my patients to drink it," says Espinosa. "It could help ED, and
even if it doesn't, it has other health benefits."
6. Yohimbe
Before Viagra and
the other prescription erectile dysfunction drugs became available, doctors
sometimes prescribed a derivative of the herb yohimbe (yohimbine hydrochloride)
to their patients suffering from ED. But experts say the medication is not
particularly effective, and it can cause jitteriness and other problems.
"It's not a great drug," says McCullough. "And I suspect the
herb is not as potent as the pharmaceutical version." What's more,
evidence shows that yohimbe is associated with high blood pressure, anxiety,
headache, and other health problems. Experts discourage its use.
7. Horny goat weed
Horny goat weed
and related herbs have purportedly been treatments for sexual dysfunction for
years. Italian researchers found that the main compound in horny goat weed,
called icariin, acted in a similar way as drugs like Viagra.
8. Ginkgo biloba
Known primarily
as a treatment for cognitive decline, ginkgo has also been used to treat
erectile dysfunction -- especially cases caused by the use of certain
antidepressant medications. But the evidence isn't very convincing. One 1998
study published in the Journal of Sex & Marital Therapy found that it did
work. But a more rigorous study, published in Human Pharmacology in 2002,
failed to replicate this finding. "Ginkgo has come out of fashion in the
past few years," says Ronald Tamler, MD, assistant professor of medicine
and codirector of the men's health program at Mount Sinai Medical Center in New
York City. "That's because it doesn't do much. I can say that in my
practice, I have not seen ginkgo work -- ever."
9. Damiana
Another herb,
which may help improve sexual function in both men and women, is Damiana.
Damiana, which grows wild in Central America and Mexico, was the favorite
aphrodisiac of the ancient Mayan people. While its precise effect on the body
is not known, Damiana's botanical name - Turnera aphrodisiaca - hints at its
libido-enhancing effects. Its effects take hold quite quickly after ingestion,
making it ideal for use on an 'as required' basis. For rapid absorption into
the body, Damiana is probably best taken in tincture (alcoholic extract) form.
One teaspoonful should be taken about one hour before sex.
10. Catuba (Catuaba)
Catuba, a species
of evergreen tree, which grows in the Amazon rainforest, is another natural remedy
for enhancing libido. Brazilian people for hundreds of years have revered the
inner bark of this tree, as a potent aphrodisiac. When the Brazilian government
researched more than 100 plants used to treat sexual problems, only three of
them were singled out for a further research. Catuaba was one of them. You can
buy it in health food stores. Indigenous tribes of the Amazon Rainforest and
city dwellers in Brazil have used catuba bark for generations as a natural
herbal remedy for libido enhancement.
11. Muira Puama
Used historically
as a folk remedy in Brazil for erectile dysfunction, joint pain and digestive
complaints, muira puama is a flowering bush or tree native to the Brazilian
Amazon. It is now mainly used as a treatment for erectile dysfunction and as a
male aphrodisiac.Three preliminary case-series (by the same author) suggest
that it may be effective, but well-designed studies on the effectiveness and
safety of muira puama are lacking.
12. Ashwagandha
Ashwagandha herb
- also known as Indian winter cherry - is a shrub cultivated in India and North
America whose roots have been used for thousands of years by Ayurvedic
practitioners in many medicinal ways. The root contains flavonoids and many
active ingredients of the withanolide class. Several studies over the past few
years have looked into whether this herb has anti-inflammatory, anti-tumor,
anti-stress, antioxidant, mind-boosting, immune-enhancing, and rejuvenating
properties. Historically ashwagandha root has also been noted to have
sex-enhancing properties. Many people notice a relaxing effect within hours of
taking a 500 mg pill.
13.Tongkat Ali
Tongkat Ali has
been used by men for many years and has been referred to as Asian Viagra
because it is made from the roots of a tree that grows in Malaysia, Thailand
and Indonesia. Tongkat Ali is used to treat erectile dysfunction, and to
increase sexual desire, libido and sexual performance. It is thought to work by
increasing levels of testosterone, the dominant male hormone. Testosterone
powers male primary and secondary sex characteristics, and maintains
cardiovascular health in men. In addition to treating erectile dysfunction,
testosterone replaces fat with lean muscle mass, increases energy level and
sexual desire, and creates positive mood. Tongkat Ali is a favorite of body
builders looking for increased lean body mass and strength. If you develop side
effects such as insomnia, anxiety and restless, it means you are taking too
much. This is easily corrected by lowering the dosage to a level where these
effects do not occur.
14. Schisandra
Stemming from a
berry, schisandra is revered in the East and was consumed by Chinese royalty
and Taoist masters. Schisandra has been in use since the beginning of Chinese
civilization and is as central to Chinese medicine as ginseng. It has said to
be a highly effective sexual tonic when consumed on a regular basis. Those who
have experienced schisandra say it increases production of sexual fluids,
sexual endurance, and it can alleviate sexual fatigue. Many men experience ED
when they are under heavy stress. Schisandra relaxes the body and strengthens
sexual organs, allowing for increased sexual performance.
15. Tribulus terrestris
A spiny plant
used in the medicine systems of China and India for centuries, tribulus
terrestris’ active compounds are found in its fruit and leaves. Tribulus is
used to strengthen erections and boost fertility and libido. One study
published in 2013 found that it releases nitric oxide, a feature that may
contribute to an erectile response independent of testosterone level. Tribulus
also increases testosterone and luteinizing hormone as well as DHEA. Tribulus
is a favorite of athletes and body builders, some of whom have reported
increased breast tissue at high dosages, due to the conversion of testosterone
to estrogen. Although Tribulus has been used for centuries in the East,
researchers in the West have yet to document its safety.
16. Epimedium
This is another
herb used for centuries in Chinese medicine to treat erectile dysfunction and
low libido. A study from 2008 found that
the herb blocks the effects of an enzyme that restricts blood flow to the
penis. Researchers believe horny goat weed, also known as epimedium, acts as a
natural phosphodiesterase inhibitor, the same action as seen in erectile
dysfunction drugs such as Viagra or Cialis. However, the research indicated
that horny goat weed can work more effectively and cause fewer side effects
than the drugs.
17. L-Carnitine
L-carnitine is a
compound involved in energy metabolism in the body. It is produced naturally in
the body but it is also found in food, particularly in animal products, and in
supplement form. Although there are various forms of carnitine supplements,
propionyl L-carnitine has been used for blood flow issues and has been explored
for erectile dysfunction. Two forms of L-carnitine (propionyl-L-carnitine and
acetyl-L-carnitine) may benefit men with erectile dysfunction according to a
study published in Urology. The study compared testosterone undecanoate,
L-carnitine and placebo in the treatment of male aging symptoms, including
erectile dysfunction. Testosterone and the carnitines significantly improved
symptoms.Another study published in Current Medical Research and Opinion
examined the effectiveness of propionyl-L-carnitine supplements plus sildenafil
(Viagra) in men with erectile dysfunction and diabetes who were previously
unresponsive to Viagra alone. After 24 weeks of treatment with
propionyl-L-carnitine (2g daily) plus Viagra (50mg twice weekly) or Viagra
alone, therapy with propionyl-L-carnitine plus Viagra was more effective than
Viagra alone. Further research is needed, as the effect of L-carnitine is not
clear when it is given as a combination treatment.
18. Niacin
According to a
study published in the Journal of Sexual Medicine, niacin, or vitamin B3 –
found in chicken, fish and grains — may help men with erectile dysfunction if
they also have high cholesterol. The results indicate that the men in the
study, who had moderate or severe erectile dysfunction, reported an improvement
in their ability to maintain an erection after taking a niacin supplement for
12 weeks. The initial dose was 500mg niacin taken nightly to ensure that they
had no adverse side effects from taking the vitamin. The dose was increased to
1000mg daily and then to 1500mg at week six, if tolerated, and then continued
until the end of the study. The most common side effect was skin flushing and
itching. Further studies are warranted.
19. Zinc
Zinc is a mineral
involved in regulating many enzymes and hormones. It is found in a wide variety
of foods such as red meat, poultry, oysters, beans, and fortified cereal. Low
levels of zinc have been associated with sexual dysfunction. Certain medical
conditions and medications put people at risk of zinc deficiency and may lead to
sexual dysfunction. These conditions include digestive disorders (such as
ulcerative colitis, Crohn’s disease, short bowel syndrome), chronic liver or
kidney disease, sickle cell disease, diabetes, cancer, alcoholism, and chronic
diarrhea. People on a vegetarian diet are more susceptible because of reduced
bioavailability of zinc and also because of greater intake of phytates from
legumes and whole grains, which bind zinc and inhibit its absorption. Zinc
deficiency has been associated with reduced serum testosterone levels. Mild
zinc deficiency is often overlooked because symptoms, such as impaired immune
function, weight loss, hair loss, altered sense of taste and smell, and reduced
appetite, can be overlooked. Zinc supplementation appears to increase serum
testosterone, dihydrotestosterone, and insulin-like growth factor-I levels in
human studies. It appears to only raise testosterone levels in people who are
deficient in zinc.
20. Oysters, Peppers, Garlic and Chocolate
Oysters have a
well-established history as an aphrodisiac for both men and women. Ancient
Romans were some of the strongest believers in the libido-increasing abilities
of oysters, and Casanova once wrote that he ate 50 oysters for breakfast in
“The Story of My Life.” Just look at that suggestive shape. These mollusks are
jam-packed with the feel-good hormone dopamine, and also with zinc, a mineral
that stimulates testosterone, and amino acids that stimulate testosterone and
progesterone production (the progesterone part is probably why this food works
so well for the ladies too).
Ever heard of the
“shaky bridge experiment”? In this experiment, men were asked to walk across a
tall, shaky bridge, and then asked by an attractive researcher at the end of
the bridge to fill out a survey. Compared to men who walked across a much safer
bridge, the shaky bridge men were more likely to give the researcher a call
later on. It was hypothesized that the men mistook the physiological arousal
from the bridge (increased heart rate, feeling a bit warm, breaking a sweat)
for actual sexual attraction and arousal. So how can you simulate the shaky
bridge with food, and also stimulate increased nitric oxide and blood flow? You
guessed it: peppers (or any other hot and spicy food).
Garlic, another
provocatively shaped food, garlic is associated with increased blood
circulation, resulting in greater arousal for both men and women. Garlic is
also a traditional aphrodisiac in the Mahayana Buddhist tradition, and is one
of the five pungent roots monks were told to avoid because of garlic’s effect
on sexual desire.
And, finally,
there is of course chocolate. Chocolate contains a compound called
phenylethylamine, which floods the body with feel-good chemicals such as
serotonin and endorphins. It also boost blood flow, and one technique I used
when I was bodybuilding to gain on-stage vascularity was to chomp on dark
chocolate backstage due to its nitric oxide enhancing effects.
No matter what
erectile dysfunction treatment or treatments a man ultimately decides upon,
experts say it is important to eat healthily and to avoid smoking and heavy
drinking. Moreover, adequate exercise, stress reduction, and sleep can improve
erectile dysfunction in many.
Sources and Additional Information: