Beyond Viagra: The Hidden Roots and Risks of Erectile Dysfunction

It’s estimated that about 50% of men over 40 have some form of erectile dysfunction (ED). And while the knee-jerk reaction is to pop Viagra or one of its cousins for a hydraulic lift, the reality is that erection medications don’t work for all men. Surprisingly, some experts say that’s a good thing. Why? ED is often an early warning sign of serious health problems ahead…A malfunctioning member shouldn’t be treated by casually popping a pill, says Dr. Ridwan Shabsigh, FACS, director of urology at Maimonides Medical Center in Brooklyn and co-author of the new book Sensational Sex in 7 Easy Steps: The Proven Plan for Enhancing Your Sexual Function and Achieving Optimum Health (Rodale Books, 2007).

Shabsigh is one of a growing number of health professionals spreading the word that when a man starts to go soft it’s a red flag that other parts of his body need medical attention, too. A healthy penis starts with a healthy body, according to Shabsigh. But because most guys would rather swallow broken glass than admit they have a problem in any part of their bodies (let alone that part), it’s up to you, ladies. Read on to learn: 1. Why an Internet prescription for Viagra isn’t the best remedy for bedroom breakdowns. 2. How getting your guy to lay off the burgers and trade the couch for some cross-trainers might beat a prescription for a little blue pill. 3. A trick to get him to the doctor that doesn’t require hog-tying or chloroform. 4. Why pinpointing the cause of his ED could save your man’s life.
You’ve said that every man can improve his sexual health and most can do it without medication. What’s the first step?

Dr. Ridwan Shabsigh: The first step is to overcome the barriers. We surveyed 32,000 men in waiting rooms of primary care physicians in America and five other countries. We asked those who had ED if they brought it up with their doctor. And we found that more than half of patients with ED did not bring it up with their doctors despite already being in the doctor’s office. When we asked them why, the reasons included denial, thinking that ED is a normal part of aging, not knowing that there’s help, and embarrassment. Embarrassment is a big issue. And we found that embarrassment was more common among younger men with ED. The younger the men, the more embarrassed they were.
In my book I talk about a number of techniques to overcome the barriers. Take someone with you to the doctor, such as your wife, who can help explain. Or write a letter to the doctor. Remember that there is nothing to be ashamed or embarrassed about. The penis is an organ like the spleen, the kidney or the liver. It can malfunction. It’s important to remember that ED is not a normal consequence of aging. It’s a progressive condition. And it should be treated.

You’ve called the penis the “thermometer” of a man’s health, and when that’s not working well it usually means there are more serious health problems brewing. What can the penis tell us about the state of a man’s health?

Shabsigh: A number of systems are required for the penis to function. These include the vascular system, which includes the blood vessels in the penis. Consequently, anything that damages the vascular system will result in erectile dysfunction. The nervous system is also required to send signals to the blood vessels in the penis telling them to open up and bring blood to the penis to make an erection. And both the nerves and blood vessels need testosterone to function.
So, think about diseases that interfere with any of these body systems. Diabetes causes nerve damage, which affects the nerves of the penis along with other nerves. It also affects the blood vessels and hormones. Testosterone is low in patients with type 2 diabetes. Low testosterone is associated with low desire, erectile dysfunction and weak ejaculation. So testosterone deficiency can warn us of future diabetes (about eight years in advance).
That is very exciting to know because diabetes in its early stages is a silent disease. Many patients’ diabetes gets discovered years after subtle symptoms like frequent urination first appear. So sexual dysfunctions aren’t just sexual dysfunctions by themselves. We realize now that they’re early warning symptoms of major medical problems.

Can ED signal other problems besides diabetes?

Shabsigh: Erectile dysfunction can be an early warning symptom of heart disease, high blood pressure and high cholesterol. What are the symptoms of high cholesterol? It’s a number on paper for the patient. But erectile dysfunction is a real tangible symptom.ED is a warning symptom of future coronary artery disease with a lag time of about three years. If you have high blood pressure and erectile dysfunction, you’re more likely to have a heart attack or stroke than if you had high blood pressure and no erectile dysfunction – it’s an indicator of how dangerous your hypertension is. This is important because hypertension is one of those silent diseases.
Does obesity play a role, too?

Shabsigh: Obesity is related to vascular disease. The more obese a person is, the more hardening of the arteries – or atherosclerosis – there is, which affects blood flow in the penis and causes difficulty in obtaining and maintaining erections. There’s another and probably more profound effect of abdominal obesity: Fat in the abdomen is especially harmful because fat cells in the abdomen have an enzyme called aromatase, which converts testosterone into estrogen. Estrogen lowers testosterone. And if you have testosterone deficiency, then you have sexual dysfunction, erectile dysfunction, low sexual desire, poor orgasm, low-volume ejaculation, and lack of pleasure and satisfaction.

So how does losing weight help?

Shabsigh: If you lose weight, a number of things improve: The arteries become more flexible. Blood pressure improves. If you’re borderline diabetic, or even diabetic, that will improve. In addition, your testosterone goes up. It’s been shown that if you have abdominal obesity and you lose inches and pounds, your testosterone will go up, your sexual desire will go up, your erections will improve, and your orgasm and ejaculation will become more pleasurable. To see a difference in sexual function, you need to lose ten percent of your weight, which can improve things significantly.

Is smoking also an issue?

Shabsigh: Smoking damages blood vessels and reduces blood circulation in the penis. So the same way that it affects the heart and coronary arteries, it also affects the penile arteries, keeping in mind that the penile arteries are smaller than the coronary arteries. If you’re taking Viagra, Levitra or Cialis and you stop smoking, your response to the medications will improve.
According to the Health Professionals Follow-Up Study (an ongoing survey of men’s health administered by the Harvard School of Public Health), watching more than 20 hours of TV a week, along with excessive consumption of alcohol, smoking and being overweight, was associated with higher levels of ED.

Shabsigh: Watching football, drinking beer and smoking cigars are typical guy things. If you have a sedentary lifestyle and you start exercising, you improve your sexual function. But it has to be aerobic exercise. That improves the function of the arteries and the veins in the body. Remember, the penis is a complex vascular organ, and you need healthy blood vessels for it to function.

Any other lifestyle factors that affect sexual function?

Shabsigh: Acute stress releases adrenalin, which restricts blood vessels and makes erections less effective. In addition, when people are under chronic stress, they frequently cope poorly. They overeat. Some people also resort to alcohol, which has two effects: If you drink enough, you go to sleep, and some parts of you go to sleep before other parts. If you abuse alcohol for years, you will damage the nerves in the body. That’s why many men with a history of alcohol abuse report not only erectile dysfunction but also sensory numbness in the penis.
So your prescription for sexual health is to quit smoking, exercise, lose some weight, manage your stress, and drink less. How do we start?

Shabsigh: The first step is to know where you are. Calculate your BMI [Body Mass Index] to know whether you’re normal, overweight, obese, or extremely obese. If you want to reduce your [weight], you have to … eat less and exercise more. How you do that? The general rule is that any diet that is healthy for the vascular system and the prostate is healthy for sex. As for exercise, I recommend thirty minutes a day, four to six days a week. Choose the activity most suitable to you, individually. Exercise also reduces anxiety and improves the ability to deal with stress. So do meditation and yoga.
Perhaps many men would disagree, but you’ve said that the day a man is diagnosed with ED can actually be a good day for him. What do you mean by that?

Shabsigh: It could be a good day because it’s a day to review a man’s health. Many men haven’t been to a doctor in years. Women are used to going to the doctor. Once a year you get your Pap smear, your mammogram. Men aren’t like that. They go ten years without going to the doctor.Taking a pill is the easy part of this. That’s why I tell my patients that asking for samples of Viagra or Cialis or Levitra is not helpful because what they really need is a review of their health. I ask my patients, Do you know your blood pressure? Do you know your cholesterol? Do you smoke? Do you know your weight? Do you know your BMI? Do you know your waist circumference? Do you know your testosterone level? Do you have any prostate or urinary problems? Are you depressed? How is your relationship? Are you under stress? Do you have too much anxiety? Are you overcommitted in life? Do you exercise regularly? Do you overeat? Do you over-drink? This review makes coming to the doctor about erectile dysfunction more valuable than just taking a pill. Sure, there is value in pills for ED. There’s also value in using penile injection therapy for those who don’t respond to the pills. There’s great value in having a penile implant if medications don’t work. There’s value in taking testosterone if your testosterone is low. There is value in all these things. But alone they’re not enough. Just taking Viagra and maintaining bad lifestyle habits is not good.


Are Drinks Making You Fat?- Get a Grip on That Glass

Having trouble dropping pounds? It’s time to think before you drink. What you’re sipping through that straw may actually be keeping the scale from budging. Beverages alone can cause gastronomical increases in calorie intake, rounding out your waistline. In fact, Americans get more than 20% of their calories from beverages – way too much for both health and weight loss. So how should you quench your thirst?Conventional wisdom would tell us that it doesn’t matter if you choose a 150-calorie drink or a 150-calorie snack. After all, a calorie is a calorie… right?

Unfortunately, drinks don’t do much to curb appetites since the brain doesn’t seem to register the calories from beverages the way it does from food. In fact, studies show that people rarely compensate for liquid calories by cutting calories at that meal or later on, whereas they would normally do that had they taken in extra calories from a food source.

Drink size is also a problem. In the last few decades, beverage portions seem better suited for thirsty horses than people. Not to mention that most popular drinks usually have a vat of sugar in them as well. The average soft drink has ballooned from 13 to nearly 20 ounces – and the average woman increased her daily caloric intake by 335 calories. No wonder Americans are fatter than ever before – more than 57% of us are overweight.

Sipping Sodas

There’s not much in the way of nutrients that heads up that straw either. One 12-ounce can of regular soda has about 150 calories. Sure, that doesn’t seem like much. But keep in mind that it’s above and beyond what your normal calorie intake would be, since your brain won’t register the extra calories.
n extra 150 calories a day can pack on 15 pounds a year. But who’s stopping with one can? Restaurants and quick marts offer cups as large as 32 ounces – often with free refills. Kick back one Big Gulp (32 ounces) and you’re chugging 400 or more calories without a second thought.Diet sodas offer flavor without calories, but experts caution here too: Diet sodas may condition us to prefer sweetness.

Coffee or Tea?

Coffee and tea are calorie-free, so drink up. In fact, recent studies suggest that they may actually be good for you. Coffee may act as a mild antidepressant and protect against type 2 diabetes. And a cup of tea offers antioxidants and disease-fighting chemicals you can’t find elsewhere.But dress those beverages up and all bets are off: You add 45 calories for each tablespoon of sugar, 25 for cream and 20 more for a pump of flavored syrup. Down several of those a day, and your coffee and tea habit could tip the scales out of your favor. In fact, some specialty drinks can climb to 500 calories and beyond.

Coffee and Tea Facts:
6-oz. white chocolate mocha = 510 calories
6-oz. latte with whole milk = 260 calories
6-oz. latte with nonfat milk = 160 calories
6 ounces black coffee = 10 calories
6 ounces black tea = 2 calories

Get Real

One hundred percent real fruit juices can be nutritional powerhouses loaded with taste and disease fighters – and unfortunately, calories. That’s why experts recommend you drink no more than eight ounces daily. If you do choose juice over fruit, reach for the unusual. Tropical and berry juices like mango, passion fruit and blueberry are rich in antioxidants that block cell damage. Cranberry juice helps prevent urinary tract infections and fights dental plaque. Pomegranate juice may have some heart benefits.Fruit drinks or cocktails, however, are not the same thing as fruit juice. Although their calorie count is similar, they’re full of added sugar – sucrose, dextrose and high fructose corn syrup – and lacking in nutrients. Watch out for fruit drinks that say “10% real fruit juice” because the other 90% is sugar water.

Juice Facts:
 ounces pomegranate juice = 160 calories
 ounces cranberry juice = 140 calories
 ounces fruit punch = 120 calories
 ounces orange juice = 110 calories

Got Milk?

Research suggests that drinking milk aids weight loss, although the studies are conflicting. Still, milk is a great source of calcium, vitamin D and protein.The important thing is to choose skim milk, not full-fat. Switching from eight ounces of whole to skim milk saves 60 calories and five grams of artery-clogging saturated fat.

Milk Facts:
 ounces low-fat chocolate milk = 150 calories
 ounces whole milk = 150 calories
 ounces 2% milk = 130 calories
 ounces 1% milk = 120 calories
 ounces nonfat milk = 90 calories

Alcohol: To Drink or Not to Drink?

An occasional glass of wine or beer won’t toss your diet out the window. Light to moderate alcohol consumption is even associated with a reduced risk of heart disease and type 2 diabetes. But at 70-150 calories a drink (more for mixed cocktails and specialty drinks), regular imbibing can undo your calorie count as well as your restraint. A few glasses of wine and that cheese platter just tastes better and better. Watch out: the calories add up fast.

When you’re at parties or out with friends, try alternating alcoholic drinks with zero-calorie or low-calorie beverages. Sip on club soda with a twist of lime.Or try something more substantial (and nutritious) like tomato or vegetable juice – these typically only have about 50 calories per eight ounces.To avoid overeating, decide in advance what and how much you’re going to eat. Leave it up to chance, and you’ll get caught up in fun and forget to watch your calories.Carry a plate of raw veggies or other low-calorie food; your hands will stay full – and out of the chips and dip. In fact, step away from the buffet table.

Alcohol Facts:
2 ounces beer = 120-180 calories
2 ounces light beer = 70-125 calories
 ounces daiquiri = 112 calories
 shot (1.5 ounces) 80-proof rum = 100 calories
 ounces red or white wine = 80 calories

Wet Your Whistle with Water

Since 60% of your body weight is water and every cell in your body relies on water to function properly, drinking lots of water is a no-brainer.There’s no better way to stay hydrated than to down this all-natural, zero-calorie drink: bottled, tap, or flavored water.

Water Facts:
6 ounces water = 0 calories
6 ounces artificially sweetened flavored water = 0 calories
6 ounces vitamin- or nutrient-enhanced water = varies; up to 100


Look and Feel Years Younger without Drugs & Surgery

Is it possible to look and feel years younger than what you are now without expensive drugs and surgery? Yes, of course you can. Here is how:
* Do Cardio Exercises – When you exercise your cardiovascular system, your heart and lungs get stronger. You will breathe better and oxygen circulates better. You may be able to avoid age related diseases like high blood pressure, stroke and heart problems. Since your blood circulates well, that will put a glow of pink health on your skin and face. And since you are fitter, you won't look tired and haggard. Cardio exercises will also help you to maintain a healthy weight. With low body fat, you will also avoid many age related diseases besides look great and younger.

* Build Muscle – In order to build muscles, you will need to lift weights. Weightlifting with strengthen your bones too and helps prevent other aging diseases like osteoporosis and muscle dystrophy (wasting away of muscles). With cardio exercises, weightlifting and correct eating habits, you will keep your body fat down and owned an attractive well toned body. This will boost your self esteem and your added confidence will be another look young factor.

* Avoid Direct Sunlight– Always wear at least an SPF 15 sun block when out in the sun even on cloudy days. Sunlight is now known to be one of the main factors of skin aging. Prolong exposure to sunlight will cause wrinkles, skin pigmentation, rough and coarse skin and even skin cancers.

* Vitamins and Antioxidants – Take multi vitamins and antioxidants regularly as a supplement. They will mop up free radicals and improve your general health besides providing better immunity to diseases and great looking skin.

* Sleep – Sleep at least 8 hours a day. More even better. Sleep helps your body to recharge and repair itself from stress and work. Your muscles build up from the exercises you have done during your sleep. Furthermore, with enough rest, you will look fresh and radiant. They don't call it "beauty sleep" for nothing right?* Water – Drink lots and lots of plain water. It will help flush out toxins and waste products and thereby hydrating your skin for a better glow.

* Say No To Cigarettes and Alcohol – Cigarettes and alcohol are a no no if you want smooth beautiful skin. Cigarettes with its many toxins will speed up the aging process. Wrinkles and fine lines on your face and hands will appear even when you are young. Alcohol will dehydrate your skin and you will have with flaking and dry skin. Combined the two together, you will look much older than you really are. Just do all these anti aging and very soon, you will look years younger without surgery or drugs.


It's easy to beat the bulge

Forget the gym. Get fitter, leaner and stronger in just six weeks – by walking. Try this simple plan:

If you're unsure of your fitness levels, make an effort to walk more. It's the ideal way to kick-start an exercise regimen. A one-hour power walk can burn up to 350 calories, help tone your body and boost energy levels.

Start by wearing a pedometer for seven days. Record how many steps you do each day. The greatest number is your baseline. You'll need to improve on the baseline each week.

Always aim to walk briskly but ensure you can still talk. Find a route that will allow you to increase your number of steps. You could get off the bus early, walk with a friend in the streets near your home or find a park to pound around.

Once a week, test your fit

ness by taking your pulse for one minute before you start walking. Take it again when you finish and again after a minute's rest. The quicker your heart rate returns to the pace it was before you began, the fitte

r you are.

Lower blood pressure, stronger bones and improved sleeping patterns are just some of the benefits walking promotes. So get out there and start walking.

Week One Buy a pair of good- quality, comfortable walking shoes. Aim to walk enough steps to equal your baseline number every day.

Week Two Add 1000 steps to your baseline on five days. Maintain three minutes of continuous intensity walking (a brisk pace, with-out stopping) on three of those days.

Week Three Add 2000 steps to your baseline on five days. You should notice you are sleeping better.

Week F

our Repeat week three.

Week Five Add 3000 steps to your baseline on five days this week. Also do four minutes continuous-intensity walking on three of those days.

Week Six  Add 5000 steps to your baseline on five days and do five minutes continuous walking on three of those days.

On the last day of each week, take the fitness test. You'll be surprised by how quickly things change.

Joanna Hall in "The GI Walking Diet"