Erectile dysfunction happens when a man is unable to get or keep an erection. The problem is more common than most people think. ED affects around 30 million men in the United States alone. That’s approximately 30% of all men.
ED can result in serious emotional, self-esteem, and relational issues as well as considerable stress. It may also point to underlying health issues. Once you address the root causes of ED, you can improve your overall health and sex life with some natural strategies.
What is erectile dysfunction?
Erectile dysfunction (ED) refers to an inability to get or keep an erection that’s firm enough for sexual intercourse. Many men experience occasional erectile dysfunction, especially during stressful times. This is nothing to worry about.
However, frequent erectile dysfunction may be a sign of some underlying health issues that need attention. It may also be due to emotional or relationship problems.
Erectile dysfunction may develop due to issues during any stage of the erection process. It helps to understand that process. Men get an erection due to an increased blood flow to the penis that may happen because of direct physical contact to the penis or sexual thoughts or other intimate connections.
Sexual excitement leads to relaxation of the muscles of the penis. As a result, the blood flow in the penile arteries increases, filling the two chambers of the penis with blood and leading to a firm erection. When the muscle contract and the blood flow decreases, the erection will end. Some men have problems getting an erection at all. Others struggle to keep it.
Symptoms of erectile dysfunction
Erectile dysfunction means that a man is unable to get or keep an erection. However, this doesn’t mean that every man with erectile dysfunction experiences issues every time they try to have sex. Symptoms may vary from person to person.
Symptoms of erectile dysfunction may include:
- Being unable to get an erection at all
- Being able to get an erection, but being unable to keep an erection long enough to have or last through sex
- Having difficulty getting or keeping an erection sometimes, but being able to get an erection at other times you want to have sex
Risk factors for erectile dysfunction
You may develop erectile dysfunction at any age. There are factors that may increase your risk for erectile dysfunction, including:
- Side effects of certain medications, including antidepressants, tranquilizers, sedatives, blood pressure medication, ulcer medication, appetite suppressants, and antiandrogens for prostate cancer
- Emotional and psychological issues, including fear of sexual failure, guilt related to sexual activities or performance, stress related to sex, general stress, anxiety, depression, or low self-esteem
- Certain chronic health conditions, including type 2 diabetes, atherosclerosis, heart and blood vessel disease, high blood pressure, multiple sclerosis (MS), chronic kidney disease, Peyronie’s disease, urological problems, surgery for bladder cancer, injury to the penis, spinal cord, pelvis, bladder, or prostate, and injury from radiation for prostate cancer or prostate surgery
- Other health or lifestyle-related factors, including being overweight or obese, smoking, drinking too much alcohol, illegal drug use, and a sedentary lifestyle. Additionally, the overuse of pornography and masturbation can lead to erectile dysfunction as well.
Root causes of erectile dysfunction
There are certain health factors that may play a role in the development of erectile dysfunction. Here are the major root causes of erectile dysfunction:
Gut infections and dysbiosis
In a healthy body, there is a healthy balance between beneficial and harmful bacteria in your gut microbiome. When there are ongoing gut infections and there are too many harmful bacteria and too few beneficial bacteria in your gut, it causes gut dysbiosis and microbiome imbalance. This may lead to chronic inflammation and various chronic health issues, including erectile dysfunction.
A 2016 population-based study found that there may be a link between inflammatory bowel disease (IBD) and erectile dysfunction. Men with IBDs may be more likely to develop erectile dysfunction than those without. A 2020 study found a significant link between a poor gut microbiome and erectile dysfunction. Another 2020 study also identified a poor microbiome as a risk factor for erectile dysfunction.
High toxic load
Environmental toxins can significantly increase the risk of chronic inflammation, oxidative stress, hormonal issues, and chronic health problems. They may increase the risk of erectile dysfunction. A 2021 study found that environmental toxins, such as air pollution, heavy metals, radiation, pesticides, and endocrine disruptors, may contribute to erectile dysfunction.
A 2007 study found that chronic lead exposure may increase the risk of erectile dysfunction. A 2018 study found that Bisphenol A (BPA) may also increase the risk of erectile dysfunction. A 2021 study found that cadmium exposure may also increase the risk of erectile dysfunction and male reproductive issues.
Chronic inflammation
Chronic inflammation is the underlying root cause of most chronic health issues, including erectile dysfunction. When it comes to erectile dysfunction, it’s important to mention cardiovascular inflammation. Since erections depend on a healthy blood flow, erectile dysfunction may be an early sign of cardiovascular inflammation and cardiovascular health issues.
A 2006 study published found that inflammation is a major issue in those with erectile dysfunction. A 2013 systematic review has also found a link between erectile dysfunction, cardiovascular inflammation, and cardiovascular disease.
Chronic stress & poor sleep
Stress and other emotional issues can contribute to erectile dysfunction. Chronic stress can increase sleep issues and poor sleep may lead to chronic stress. They can both increase chronic inflammation and lead to various health issues, including erectile dysfunction.
A 2020 cross-sectional study found that work-related stress and burnout may increase sexual problems, including erectile dysfunction. A 2018 study found that over 50 percent of participants with erectile dysfunction had obstructive sleep apnea. A 2019 review found that obstructive sleep apnea may contribute to testosterone deficiency, a risk factor of sexual problems in men.
Insulin resistance
Insulin resistance means that your body is unable to respond to insulin well and unable to use blood sugar for energy effectively. Insulin resistance may increase the risk of prediabetes and type 2 diabetes. It may also increase the risk of various other health issues, including erectile dysfunction.
A 2013 study and a 2016 study found that insulin resistance may increase the risk of erectile dysfunction. A separate 2016 study found that insulin resistance and erectile dysfunction may increase the risk of cardiovascular issues.
Chronic viral infections
Chronic viral infections may increase chronic inflammation and chronic health issues, including erectile dysfunction. Chronic viral infections that may contribute to erectile dysfunction may be of all kinds, including some sexually transmitted and respiratory infections.
A 2013 review found that viral hepatitis may increase the risk of erectile dysfunction. A 2013 population-based study published in Andrology has found that a herpes simplex virus infection may be linked to erectile dysfunction and they may increase the risk of cardiac events. A 2021 study found that a COVID-19 infection may also increase the risk of erectile dysfunction.
Nutrient deficiencies
Nutrient deficiencies may also increase the risk of erectile dysfunction, including deficiencies in vitamin D, magnesium, omega-3 fatty acids, B vitamins, and zinc. A 2016 study found that vitamin D deficiency may increase the risk of erectile dysfunction. A 2020 study published in Nutrients has also found a link between erectile dysfunction and low vitamin D levels.
A 2017 study published in Clinical Interventions in Aging found that magnesium levels may influence erectile dysfunction. A 2019 study published in BMJ Open found that deficiency in vitamin B12 and folate may increase the risk of erectile dysfunction. A 2009 study published in the Journal of Human Reproductive Science has found that zinc plays an important role in male sexual function and testosterone levels.
Low testosterone
Testosterone is the male sex hormone that plays a critical role in male sexual function and reproduction. Not surprisingly, low testosterone levels may contribute to erectile dysfunction. A 2011 study published in the Canadian Journal of Urology found a link between low testosterone and erectile dysfunction.
A 2019 study published in the International Journal of Impotence Research has found it is not enough to look at the total testosterone level of men. One may have normal total testosterone levels but low free testosterone. Researchers found that low free testosterone may be linked to erectile dysfunction even when one has normal total testosterone levels.
Key functional labs to look at
There are a variety of key functional lab markers we can look at to determine your risk and uncover the underlying root causes of erectile dysfunction.
Insulin resistance
Blood sugar imbalances may increase your risk of inflammation. Fasting insulin can recognize elevated blood sugar levels and can detect inflammation, insulin resistance, blood sugar issues, and diabetes. The clinical range for fasting insulin is 2.6 – 24.9 uIU/ml and the optimal range is 1.0 – 5.0 uIU/ml.
Hemoglobin A1C (HbA1c) gives the average amount of glucose in your blood or blood sugar over the past 3 months making it one of the top tests for inflammation and diabetes. The clinical range is between 4.8 and 5.6 while the optimal range is 4.5 – 5.2.
Your lipid profile may be another indication of inflammation and related issues, including cancer risk. Having a balanced ratio of LDL to HDL and triglycerides to HDL is essential for your health. Ideally, we are looking for an LDL: HDL ratio: 3:1 or less, 2:1 being optimal. For triglycerides, we are looking for an HDL ratio: 2:1 or less, 1:1 being optimal. Higher rates may indicate insulin resistance and inflammation. Optimal levels:
VLDL cholesterol: The ideal range is 5 to 30 mg/dl.
HDL cholesterol: The ideal range is 55 to 80. Levels above 100 can indicate chronic inflammation or active infection in the body.
Triglycerides: The ideal range is 40 to 80.
Vitamin D & plasma zinc
Vitamin D deficiency, high levels of zinc, low levels of copper, or a poor zinc-copper ratio may also increase your risk of erectile dysfunction.
Vitamin D3 is an important vitamin that most of our population is deficient in. Poor levels may indicate inflammation. Optimal levels of vitamin D3 (25-OH) are between 50-100 ng/mL.
Zinc and copper compete against each other as antagonists to regulate physiological pathways. A proper balance between the two is essential for maintaining good health. I recommend checking your plasma zinc and serum copper levels and their balance. The proper zinc-copper ratio should be 1:8, the normal range for zinc is 90 – 135µg/dL, and the serum copper ratio should be between 1 and 1.2.
Inflammation
Since chronic inflammation is one of the root causes of erectile dysfunction, I recommend checking for inflammation markers.
The C-Reactive Protein or CRP test measures a protein (CRP) produced in your liver that indicates inflammation levels in your body. The clinical range is between 0 and 3 mg/L while the optimal range is 0 to 1 mg/L. Levels over 1 mg/L indicate that you may be having an inflammatory response that could be due to acute trauma or chronic conditions.
The C-Reactive Protein or CRP test measures a protein (CRP) produced in your liver that indicates inflammation levels in your body. The clinical range is between 0 and 3 mg/L while the optimal range is 0 to 1 mg/L. When I see levels over 1 mg/L, I know the individual is having an inflammatory response that could be due to acute trauma or chronic conditions.
Lactate Dehydrogenase (LDH) is an enzyme found in all living cells. Elevated levels may indicate inflammation. Optimal levels are between 140-180. Levels over 180 indicate inflammation.
Serum ferritin measures the level of ferritin in your body to detect iron deficiency anemia and other health issues. Elevated serum ferritin levels may indicate inflammation, liver disease, autoimmune disease, or even cancer. The clinical range is 30 to 400 and the optimal range is 50 to 150 for males.
Liver enzymes
Liver enzyme levels may also indicate inflammation. They may also indicate liver, gallbladder, bile, or kidney issues. Alkaline phosphatase is a liver enzyme that is made by the mucosal cells that line the bile system of the liver and helps normal bile flow. Elevated levels (over 95) may indicate inflammation and liver and gallbladder problems.
Alanine aminotransferase (AST) is a liver enzyme. Elevated levels may indicate inflammation. Normal levels are between 10 and 26 IU/L. Aspartate transaminase (ALT) is an enzyme present in the liver that spills out during times of increased liver stress. Elevated levels may indicate inflammation Normal levels are between 10 and 26 IU/L.
Gamma-Glutamyl Transpeptidase (GGT) is an enzyme in the liver, pancreas, and kidneys. Elevated levels may indicate inflammation and liver disease, usually due to alcoholism and/or sluggish gallbladder or gallstone obstruction. Normal levels are between 10 and 26 IU/L. Levels lower than 10 IU/L can be an indication of a vitamin B6 deficiency.
Natural support strategies
There are a number of natural support strategies for erectile dysfunction and improved health.
Reduce stress & improve sleep quality
Chronic stress and poor sleep can increase the risk of erectile dysfunction. Taking care of your body by reducing stress and improving sleep quality is critical. Reduce stressful situations and people that bring stress into your life as much as possible.
Learn to respond to stress better through mindset shifts, focusing on the positive, gratitude, positive affirmations, breathwork, and improving communication. Lower your stress levels and improve relaxation by practicing meditation, breathwork, visualization, guided relaxation, journaling, gratitude, and prayer.
Aim to get 7 to 9 hours of restorative sleep at night. Prepare your body and mind for bed by avoiding sugar, caffeine, alcohol, and electronics several hours before bedtime and developing a relaxing evening routine.
Choose activities that calm your mind and relax your body, such as taking a relaxing bath, sipping on herbal tea, reading, listening to calming music, coloring, crossword puzzles, journaling, prayer, and gratitude. Ensure that your bedroom is a safe sanctuary with a supportive bed, bedding, and pillows, calming colors, dim lights, and calming essential oils. Blackout curtains and sleep masks can help you fall asleep easier.
Regular movement and strength training
Regular movement and exercise are important for your overall health. It’s critical for erectile function as well. A 2018 study published in the Journal of Education and Health Promotion has found that physical fitness is beneficial for sexual functioning.
Stay active throughout the day by stretching regularly, taking a stroll, walking or biking instead of driving if possible, taking the stairs, dancing to your favorite song, walking your dog, playing with your kids, or trying a few yoga moves.
Strength and resistance training is particularly important for healthy testosterone levels. By balancing testosterone, it may help to lower the risk of erectile dysfunction as well. You may incorporate weight lifting, bodyweight exercises, TRX suspension trainers, kettlebell workouts are great options. High-intensity interval training (HIIT) combines the benefits of cardiovascular fitness and strength and resistance training.
Eat an anti-inflammatory nutrition plan
A 2018 study published in the Journal of Sexual Medicine found that following an antioxidant-rich, anti-inflammatory diet may be beneficial for erectile dysfunction. Eliminate inflammatory foods, such as refined oils, refined sugar, artificial ingredients, deep-fried foods, junk food, and highly processed foods. Choose organic food whenever possible.
Follow an anti-inflammatory, antioxidant-rich, nutrient-dense diet with a lot of greens, vegetables, sprouts, herbs, spices, low-glycemic index fruits, mushrooms, fermented foods, grass-fed beef, pasture-raised poultry and eggs, wild-caught fish and seafood, and wild game.
Try a high-protein diet with lots of healthy fats. Eat plenty of berries and avocados for their libido-enhancing properties. Cacao and dark chocolate improve dopamine which is critical for sexual function. Seafood, especially oysters, is a great source of zinc, and wild-caught salmon and other wild-caught fish help to boost your omega-3 fatty acid levels. Grass-fed beef is a great source of protein, iron, vitamin B12, and carnitine.
Intermittent fasting
Intermittent fasting is a way of eating that cycles between periods of not eating (fasting) and periods reserved for meals (feasting) within one day. Intermittent fasting may offer many health benefits, including reduced inflammation, better insulin sensitivity, improved cellular repair, and overall better health. Insulin resistance may also improve sexual function in men. According to a 2020 study published in Urology, intermittent fasting combined with an organic whole foods diet may improve erectile dysfunction.
If you are new to intermittent fasting, begin with a 12 hour fast, including your overnight sleep. You simply stop eating after dinner and don’t eat until breakfast, 12 hours later, in the morning.
You can gradually increase your fasting window until you find what works the best for your body. Most people feel their best using the 16:8 method (16 hours fasting and 8 hours for your meals), but you may find that fasting for a somewhat longer or shorter period works better for you.
Improve detoxification pathways
Viral infections, gut infections, and toxin overload can contribute to erectile dysfunction. Improving your detoxification pathways may help. Follow an antioxidant-rich, anti-inflammatory, nutrient-dense diet to help your body’s ability to detoxify and cleanse itself.
Hydrate your body well with lots of purified water, green juices and smoothies, herbal tea, and hydrating vegetables to support detoxification through sweating and urine. Exercise regularly and use an infrared sauna several times a week to support detoxification through sweating. Practice rebounding and dry skin brushing to support your lymphatic pathways and lymphatic detoxification.
Support your gut flora and healthy elimination with high-quality probiotics. Use activated charcoal to remove toxins from your intestinal tract. Support your two major detoxifying organs, your kidneys and liver, and support their healthy functioning with kidney and liver support supplements.
Reduce toxic and pathogen load and improve microbiome
Since gut dysbiosis, infections, and toxin overload are major risk factors for erectile dysfunction, it’s critical to reduce toxin and pathogen load and improve your microbiome health. Avoid pesticide and herbicide exposure by buying organic produce and food. Reduce chemical exposure by choosing organic, natural, and homemade alternatives instead of conventional cleaning, hygiene, body, and beauty products.
Drink filtered and purified water instead of tap water. Avoid smoking and second-hand smoke. Use a high-quality air filtration system to reduce toxins and allergens in your indoor air. Reduce the use of plastic, especially BPA, and choose alternatives made of glass, bamboo, wood, stainless steel, and organic cotton.
Follow a gut-friendly, anti-inflammatory nutrition plan. You may benefit from prebiotic-rich foods, such as Jerusalem artichokes, jicama, asparagus, yacon roots, garlic, onion, leeks, and apples. However, if you are on a low-FODMAP diet, the Carnivore Diet, or feel irritated from too much prebiotic fibers, reduce your load or avoid them. Eat plenty of probiotic-rich foods, such as sauerkraut, fermented vegetables and herbs, coconut kefir, coconut yogurt, and kombucha.
Take a daily high-quality probiotic supplement. Improve your gut microbiome with postbiotics, such as apple cider vinegar, kombucha, coconut kefir, and fermented vegetables or take postbiotic supplements. If you are dealing with chronic infections, working with a functional medicine doctor can help to offer a personalized plan with herbs and supplements to improve your specific issues.
Optimize vitamin D levels
Deficiencies in vitamin D may increase your risk of erectile dysfunction. To optimize your vitamin D levels, I recommend spending time out in the sun and eating vitamin D-rich fatty fish, egg yolks, and beef liver. However, sunshine and food are not enough. You may consider a daily supplement with vitamin D3.
Pairing vitamin D3 with vitamin K2 helps improve calcium absorption and inflammation control. I recommend taking a vitamin D3 supplement with at least 3,000-5,000 IU’s of vitamin D3 and at least 90 mcg of vitamin K2. Both of these supplements support your immune, skin, cardiovascular, and bone health.
Typically, taking 1,000 IU per 25 lbs. of body weight will help you get your levels into a healthy range. You want to test your vitamin D levels at least 1-2 times each year and get your levels between 50-100 ng/ml. It has been hypothesized that a therapeutic level for major health conditions is going to be between 70-100 ng/ml.
Optimize zinc, omega-3 fats, magnesium, and B vitamin levels
Deficiencies in zinc, omega-3 fatty acids, magnesium, and B vitamins may also increase your risk of erectile dysfunction. Optimizing your levels of these nutrients is critical for your sexual health.
Your plasma zinc and serum copper levels should be a ratio of roughly 1 to 1.2, meaning you should have equal or slightly higher levels of plasma zinc than you have serum copper. Fortunately, the foods that are high in zinc, such as meat, seafood, nuts, and pumpkin seeds, are also very high in copper, so you get both of these together in your diet.
You may improve your Omega-3 levels by consuming foods rich in omega-3 fatty acids, such as wild-caught fish and seafood, algae, hemp seeds, chia seeds, flax seeds, and walnuts.
To improve magnesium, try a supplement for energy, brain health, pain relief, bone health, muscle health, joint function, and better sleep. To improve your B vitamin levels, try a B vitamin complex and B12 Power. You can benefit from foods rich in B vitamins, such as meat, fish, shellfish, liver, kidney, eggs, and dark leafy greens.
Consider herbs that support testosterone and erectile function
You may also consider some herbs that support testosterone and erectile function.
Horney goat weed
A 2006 study published in the Asian Journal of Andrology has found that horny goat weed can mimic testosterone. A 2010 study published in the Journal of Sexual Medicine has found that horny goat weed may improve erectile dysfunction.
A 2020 study published in Dose-Response has found that it can also improve hormonal health in men. The active ingredient Icariin acts as a phosphodiesterase inhibitor which blocks the effects of an enzyme that restricts blood flow to the penis. This allows for easier and longer-lasting erections.
Ginkgo Biloba
A 1998 study published in the Journal of Sex & Marital Therapy has found that Ginkgo Biloba may help to improve sexual dysfunction caused by antidepressants.
Tongkat Ali
A 2017 review published in the Chinese Journal of Natural Medicine has found that Tongkat Ali may support male sexual health. Tongkat Ali may improve sexual health, testosterone levels, erectile function, and prostate health in men.
Chrysin
A 2012 animal study published in Andrologia has found that chrysin may help to improve male reproductive health. A 2003 study published in the Journal of Medicinal Food has found that chrysin may help to improve testosterone levels in men.
DIM
Diindolylmethane (DIM) may increase free testosterone levels, thus may reduce the risk of erectile dysfunction. A 2016 study published in EPMA Journal has found that DIM may be beneficial for men’s health, including prostate, urinary, and penile health.
Final thoughts
Erectile dysfunction affects about 30 million men in the United States alone. It can be a great source of stress, emotional issues, self-esteem issues, and relationship difficulties. Look for the root causes of ED and try the above natural support strategies to improve your overall health.