Tag Archives: Glutathione

Testosterone Erectile Dysfunction Nitric Oxide

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When More Testosterone Doesn’t Help Erectile Health – Part 1 of 2

The role of vascular health on male sexual function

“I’m injecting 150 mg of testosterone cypionate every week. I look muscular. I have lots of energy – so much I actually need to take sleeping pills to wind down at night. So why can’t I get a good erection? What is wrong with me?”

I counsel countless men* with stories like this.

Typically, these fellows come to see me after visiting a “Low T” clinic and trying various hormones and hormone precursors. From testosterone creams to shots, to HCG (human chorionic gonadotropin), to breast cancer drugs and beyond, hormone treatments do indeed help some men with erectile dysfunction – but fewer men than you might think.

Erectile dysfunction (ED, impotence) is a fairly common medical condition, characterized by the inability to achieve and maintain a penile erection firm enough for satisfying sexual intercourse.1

I often explain to my clients with ED that testosterone is just one piece of the puzzle. ED can also be caused by dysfunctions in the nervous system (including mental health), in the adrenal glands, in metabolic function, in B vitamin status, and in endothelial health (the inner lining of the blood vessels). The latter is also known as “endothelial ED,” a commonly overlooked aspect of sexual health – and the focus of this article.

40% of men above the age of 40 are now estimated to have some degree of ED.

Although ED is more common among older men,16 it’s becoming more common among younger men as well: 40% of men above the age of 40 are now estimated to have some degree of ED.13 While an estimated 152 million men worldwide had ED in 1995, that number is expected to swell (no pun intended) to over 320 million people by 2025.17,18 It’s no coincidence that heart disease is also on the rise: ED is often a warning sign of impending cardiovascular disease.

The mechanics of erection

Tumescence (penile erection) relies on proper blood flow. During the male sexual response, blood flow into the penis through the arteries increases, as blood flow out of the penile veins decreases.2,3 This process effectively traps blood in the penis, resulting in an erection.

The issue with ED tends to be with the first part of this process – the delivery of blood into the penis. The integrity of the circulatory system – the system of “highways” by which blood circulates throughout the body – is essential for male sexual performance and satisfaction.4

A key component of a healthy circulatory system lies in an important little gas called nitric oxide.

Nitric oxide gets the blood flowing

Nitric oxide (NO) is a tiny gas molecule found throughout the circulatory system, causing relaxation of the cavernous smooth muscle of the penis as well as vasodilation (widening) of the penile blood vessels. These combined effects allow more blood to pass into the penis, causing a firmer erection.5,6

One of the biggest culprits for compromising NO levels, however, is inflammation – specifically inflammation of the endothelium (lining of the blood vessels).7 Vascular inflammation and the NO deficiency it causes are also to blame for other cardiovascular problems, like angina (chest pain), heart attacks, and strokes.

Erectile dysfunction can be a warning sign of other impending diseases

Even in “well-endowed” fellows, the vessels of the penis are relatively small compared to the arteries in other parts of the body. This makes the penile blood vessels fragile and sensitive to injury. The penis is therefore often the first place in the body to manifest the signs and symptoms of vascular disease.

If left untreated, the vascular inflammation and NO dysfunction associated with endothelial ED may begin to spread to blood vessels in other parts of the body, causing a variety of serious heart problems like angina (chest pain), heart attack, and stroke.8 Men can develop ED before they develop even so much as an elevated blood pressure reading!9 That’s why ED is sometimes referred to as “painless penile angina.”10

ED is a warning sign of poor vascular function and impending cardiovascular disease.

A shocking 70% of men with coronary artery disease (CAD) in one study reported that they had ED long before they developed any symptoms of CAD.11 ED is a warning sign of poor vascular function and impending cardiovascular disease.6,11-13

ED and CAD share many of the same risk factors, including obesity, sedentary lifestyle, smoking, high homocysteine levels, diabetes, high blood pressure, dyslipidemia (high cholesterol), and metabolic syndrome. All of these risk factors are also associated with poor NO activity.6,13-15

Won’t more testosterone help?

Testosterone plays an important role in sexual function via several mechanisms, including the stimulation of NO release,23 but it’s unlikely to control endothelial ED on its own for very long.

For some people with endothelial ED, testosterone replacement therapy (TRT) may help, but not sufficiently unless the dosage is ramped up high – too high. Guys on too much testosterone often experience irritability, anxiety attacks, insomnia, or other symptoms of testosterone overdose. Because of the hormone’s influence on red blood cell (RBC) production, furthermore, guys on TRT are at high risk of life-threatening events like blood clots, chest pain, heart attacks, and strokes. They’re also prone to acne, “backne” (pimples on the back), a reddish complexion, and/or a puffy appearance – effects that make a guy look a bit like the Kool-Aid Man.

For many fellows with endothelial ED, even high doses of testosterone won’t cause strong erections.

For many fellows with endothelial ED, however, even high doses of testosterone won’t cause strong erections, which does not mean that the man’s penis is “broken!”

If you have endothelial ED, it’s important to understand how and why your blood vessels are dysfunctional. Yes, there are of course nutritional supplements you can take to enhance nitric oxide production, but they’re unlikely to give you the best outcomes unless you’re also taking care to stop the cause(s) of your vascular inflammation. This is where diet and lifestyle become non-negotiable.

In the next post, we take a look at some healthy strategies for improving endothelial health, increasing nitric oxide levels, and achieving strong erections.

Improving Erectile Health – Part 2 of 2

Nitric oxide support for sexual health

In Part 1 of this series, we looked at the physiology of a type of erectile dysfunction (ED) known as endothelial ED and explained the importance of blood vessel health on male sexual function. This week, we will explore some natural strategies, that have good scientific evidence for improving vascular (and erectile) integrity.

Although not all men with ED have endothelial ED, many of them do. Nevertheless, just about everyone can likely benefit from these suggestions:

Eat vegetables – especially beets

Diets rich in vegetables have been shown to support overall heart health,[1],[2] lowering the risks of high blood pressure, heart attack, and stroke.[3],[4],[5] If you’re not eating vegetables – it’s never too late to start!

Make at least half of your plate at every meal greens (spinach, kale, chard, etc.) and/or brightly colored vegetables like purple cabbage, tomatoes, purple onions, carrots, and peppers. Beets (beetroot) are particularly effective in increasing nitric oxide (NO) levels, as they’re rich in nitrates, antioxidants, and phenolic compounds important for cardiovascular health.[6] Beets have been observed to increase NO levels and lower blood pressure readings in both men and women of various ages.[7],[8],[9]

Beets have been observed to increase NO levels and lower blood pressure readings in both men and women of various ages.

A powdered greens and/or powdered beetroot supplement (organic whenever possible!) can be a quick and easy way to consume more dietary nitrates.

Enjoy berries

Rich in flavonoids and antioxidants, blueberries, cherries, goji berries, and other berries are excellent for vascular health. Organic green tea, and dark chocolate can also fight oxidative stress, reverse endothelial dysfunction, and stave off cardiovascular diseases.[10]

Nix commercial mouthwash and stomach-reducing medicines

The brilliant human body converts the nutrients found in vegetables into NO. This conversion requires the presence of the right kind of bacteria in the mouth and enough stomach acid.[11]

Because most commercial mouthwashes kill both the good and the bad bacteria in the mouth, they may be contributing to endothelial ED and vascular diseases.

I also typically advise my clients to stay away from calcium carbonate tablets, omeprazole, and other medications that dampen stomach acid production.[12],[13],[14] (If you have acid reflux and think you need acid-reducing drugs, read this.)

L-arginine

The amino acid L-arginine is the raw material from which the body produces NO.[15] Low blood levels of L-arginine have unsurprisingly been correlated with poor NO production, and a significant percentage of ED patients have low levels of L-arginine and/or its precursor, L-citrulline.[16]

A significant percentage of ED patients have low levels of L-arginine and/or its precursor, L-citrulline.

L-arginine supplements may improve NO levels and erectile health – but with limited efficacy, as L-arginine only stays in the circulation for milliseconds at a time.[17] This may be why a review of L-arginine’s efficacy in the treatment of ED reports that a minimum dosage of 3 grams daily is necessary to achieve outcomes, and some studies have even dosed the amino acid at 5 grams.[18]

Thankfully, there is evidence that L-arginine may work significantly well when supplemented along with glutathione (GSH),[19] vitamin C,[20] pine bark extract,[21],[22] and/or L-arginine’s precursor, L-citrulline.

L-citrulline

L-citrulline is named for the watermelon, or Citrullus vulgaris, from which it is derived.[23] Unlike L-arginine, L-citrulline skips pre-systemic metabolism and effectively increases circulating NO levels.[24],[25] This might make L-citrulline a more advantageous nutritional supplement than L-arginine in the treatment of ED, hypertension, and related vascular conditions.[26],[27] It has also been shown to be an effective adjuvant to treatment with pharmaceutical PDE5 inhibitors (drugs like Sildenafil).[28]

What may be even more effective than L-arginine or L-citrulline monotherapy, however, is taking the two amino acids concurrently: Simultaneous oral supplementation of 1 gram of L-arginine and 1 gram of L-citrulline was shown to increase plasma L-arginine levels more than 2 g of either alone in a 2017 study.[29]

Caution: Because many viruses – including herpes simplex virus (HSV) – are dependent upon arginine for replication, L-arginine and L-citrulline supplements may be poorly tolerated by patients with frequent HSV outbreaks.[30]

French maritime pine bark extract

A standardized pine bark extract (SPBE) from the bark of the French maritime pine, Pinus pinaster – or Pycnogenol®, as it’s known in the U.S.A. by its patent name – has been shown to improve erectile function both as a standalone treatment and in combination with L-arginine.[31],[32]

SPBE has been observed to support the production and release of NO from the cells lining the blood vessels, improving forearm blood flow in humans in one study.[33]

SPBE has also been shown to improve erectile function, both as a standalone treatment and in combination with L-arginine.[34],[35] In one trial, for example, supplementation with SPBE (120 mg daily for three months) significantly reduced patients’ ED severity from moderate to mild.[36] The Pycnogenol group in this study was also observed to have increased plasma antioxidant activity and reduced total cholesterol and LDL-cholesterol levels as compared to the placebo group. These findings suggest that SPBE may not only treat ED, but also improve overall cardiovascular health.[37]

In another study of 40 males 25 to 45 years of age, a combination of L-arginine and Pycnogenol significantly outperformed Pycnogenol alone, helping 80% of men (and, after another month of the study, 92.5% of men) achieve a normal erection – as compared to only 5% of men who benefitted from Pycnogenol alone. Pycnogenol was given at a dose of 40 mg one to three times daily, with L-arginine at a dose of 1.7 g daily.[38]

A combination of L-arginine and Pycnogenol significantly outperformed Pycnogenol alone, helping 80% to 92.5% of men achieve a normal erection.

In a similar trial of 50 males, L-arginine (3 g per day) plus pycnogenol (80 mg per day day) restored normal erectile function after just one month of supplementation. Sperm quality improved in the men who took this combination and their testosterone levels increased significantly, thus suggesting enhanced fertility. The men also reported a doubling in their sexual intercourse frequency.[39]

Glutathione and other antioxidants

As the master antioxidant of the body, glutathione (GSH) strongly protects against the oxidative stress associated with endothelial dysfunction. GSH and other antioxidants may thus prevent oxidative stress, ameliorate vascular endothelial dysfunction, and stave off cardiovascular disease (among other chronic ailments).[40]

Supplementation with L-citrulline and GSH has also been shown to synergistically increase NO levels.[41]

DHEA

The steroid hormone precursor dehydroepiandrosterone (DHEA) enhances sex hormone production and positively effects NO levels, thus supporting endothelial health.[42]

A systematic review of 38 trials found that DHEA improves various aspects of sexual health.

A systematic review of 38 trials found that DHEA improves various aspects of sexual health in both males and females, including sexual interest, sexual frequency, lubrication, arousal, pain, and orgasm.[43] DHEA can also help with brain health.[44]

Avoid refined sugars and refined carbohydrates

Foods like breads, pastas, commercial pastries, candy bars, so-called “sports” drinks, sodas, most juices, cereals, crackers, and potato chips all increase blood glucose (sugar) levels and drive inflammation in the blood vessels. It’s no coincidence that men with diabetes and pre-diabetes are more likely to have ED than other guys.[45],[46]

Quit smoking and drinking

You know that smoking and drinking alcohol are harmful for your health, as does everybody else under the sun! These habits also create very high levels of inflammation and oxidative stress in the body, thus wreaking havoc on the circulatory system.[47],[48] ED may be a sign that it’s time to make some healthy lifestyle changes.

Mindfulness practice

NO helps with more than just the dilation of blood vessels: it also supports immune function, balances the nervous system,[49] and protects against various types of dementia.[50] NO helps us feel more relaxed, in turn supporting further NO production.[51] In fact, experienced meditators were found to have higher levels of NO precursors in their blood than non-meditators, in one study.[52]

Move your body

A sedentary lifestyle is a significant risk factor for ED and other cardiovascular diseases. Exercise is the number one lifestyle factor most strongly correlated with erectile health.[53]

Exercise is the number one lifestyle factor most strongly correlated with erectile health.

A review of ten studies found that moderate to vigorous aerobic exercise (four times weekly for six months) improved erectile function in men with ED caused by sedentary lifestyle, obesity, high blood pressure, cardiovascular disease, and/or metabolic syndrome.[54]

Physical activity is an effective way to prevent – and likely treat – ED because it increases NO levels, improves vascular function,[55] and increases testosterone.[56] Considering that exercise helps with a wide array of other health conditions, physical activity should be a part of just about every person’s day. (Too busy to move? Read our tips for fitting exercise into your day.)

Conclusion

During male sexual arousal, nitric oxide (NO) delivers blood to the penis, resulting in erection. Erectile dysfunction may therefore sometimes be a symptom of poor circulatory health, high vascular inflammation, and/or low nitric oxide (NO) levels – all of which can predispose a man to more serious problems like high blood pressure, angina, heart attack, and stroke. ED can therefore serve as an important warning signal of bigger problems to come.

Thankfully, some simple, natural strategies can make all the difference.

Note: The words “man,” “guy,” “fellow,” and “male” as used within this article refer specifically to individuals who were born with XY chromosomes and a penis. I acknowledge and honor that not all men are born with this anatomy, and that not all people born male identify with that gender.

Erectile Dysfunction: The Canary in the Cardiovascular Coal Mine?

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Erectile Dysfunction: The Canary in the Cardiovascular Coal Mine?

The role of endothelial function on tumescence – and beyond


By Erica Zelfand, ND

The stories I hear of men* with erectile dysfunction (ED) are strikingly similar: The issue begins insidiously and is initially treated at a “low T clinic” with gradually increasing doses of exogenous testosterone in regimens that yield varied but ultimately insufficient results.

A review of the lab work of these individuals reveals that they are typically overdosed on their prescription hormones, with total testosterone levels often above 1000 ng/dL. While supraphysiological levels of testosterone do, in fact, enhance the sexual desire and performance of some men, they come with significant health risks and pesky side effects like anxiety, irritability, and insomnia. Other men, however, find that even high doses of anabolic steroids fail to engender desired outcomes in the bedroom.

Erectile dysfunction (ED, impotence) is a fairly common medical condition, characterized by the inability to achieve and maintain a penile erection firm enough for satisfying sexual intercourse.1 ED is also on the rise: While the condition affected an estimated 152 million males worldwide in 1995, that number is expected to swell (no pun intended) to over 320 million people by 2025.2,3

Just last week, a new patient shouted at his wit’s end, “I’m taking testosterone, HCG [human chorionic gonadotropin], and anastrozole. I’m lifting more weight than the other guys at the gym. I look amazing. I have tons of energy—so much I can’t fall asleep at night – but I after two years of playing with all my doses I still can’t get hard. What the heck is wrong with me!? What are my other doctors missing? I really hope you can figure it out.” [Note: This patient employed more expletives when expressing himself.]

Time and time again, I explain to exasperated fellows like this one that sex hormone levels are just one piece of the puzzle. The successful treatment of ED often also entails assessing the nervous system (including mental health), adrenal function, metabolic health, and endothelial integrity, with the latter being among the most overlooked aspects of sexual health.

Tumescence is a hemodynamic process characterized by enhanced penile arterial inflow and reduced venous outflow.4,5 Because the physiology of tumescence (penile erection) requires that the penis engorges with blood, the integrity of the vascular system—and ergo the status of nitric oxide production—is of utmost importance to male sexual performance and satisfaction.6


Nitric Oxide: The Endothelium Relaxer

Our understanding of nitric oxide (NO) is relatively new: In 1998 three American pharmacologists received the Nobel Prize for their discovery of NO’s effects as a signaling molecule within the cardiovascular system.7

This tiny gas molecule is produced in the blood vessels, nerves, and immune cells. Neuronal and endothelial NO causes relaxation of the surrounding smooth muscle, resulting in vasodilation.8,9 With regard to male sexual health, NO triggers the relaxation of the cavernous smooth muscle of the penis, allowing for engorgement and  subsequent erection.

NO production declines with age, however, placing males at increased risk of ED as they grow older.10 It is now estimated that nearly half of men above the age of 40 have some degree of ED.11

Endothelial inflammation undermines NO production and is thus a significant determinant of ED and other vascular diseases.12 It is also a culprit that can effectively be treated with naturopathic medicine.


Erectile Dysfunction as Coronary Risk Marker

Due to the relatively small size of the penile vasculature (on even the most well-endowed of individuals), ED may be understood as a warning sign of poor vascular function and impending coronary artery disease (CAD).9,11,13,14 ED may present well before the observation of so much as an elevated blood pressure reading.15 If left unchecked, the vascular inflammation and dysfunction associated with many cases of ED may lead to ischemic heart disease;16 ED has thus been referred to as “penile angina.”17

ED is such a strong predictor of cardiovascular disease in men,3 in fact, that providers are now advised to assess the cardiovascular health of patients presenting with the condition.16 While not all men with ED have cardiovascular problems, a significant percentage of males with angiographically demonstrated CAD have been observed to have ED.13 ED was also shown in one study to precede CAD in a whopping 70% of male CAD patients.13

It is perhaps no surprise that ED and CAD go hand-in-hand, as they share many of the same risk factors, including sedentary lifestyle, obesity, diabetes, smoking, hypertension, dyslipidemia, metabolic syndrome, and declining NO activity.9,11,18,19

Conventional Treatments of ED

The first-line therapy for ED entails phosphodiesterase type 5 inhibitors (PDE5i) like sildenafil.20 Although these drugs do not directly increase NO, they do augment NO-mediated pathways.21

When PDE5i’s fail to improve symptoms, vacuum devices, intracavernous injections, and penile prosthesis implantation are considered second- and third-line therapies. Few patients are eager to try these interventions, however, which may not be too great of a tragedy, as none of these methods adequately addresses the underlying metabolic, neurological, hormonal, or endothelial aspects of ED.

Testosterone plays an important role in sexual function via several mechanisms, including the stimulation of NO release.22 As more and more males become afflicted with ED, the increasing number of “low T” clinics that have cropped up over the years now comprise a multi-billion-dollar industry.23,24 Testosterone replacement therapy (TRT) does help many men with ED—though not all. In my experience and opinion, focusing on NO augmentation—either in lieu of or in addition to hormone prescription—may serve ED patients in both the short and long term.

Erectile Dysfunction: The Canary in the Cardiovascular Coal Mine?

Two Pathways of Nitric Oxide Production

There are two pathways by which NO is created in the body (see Figure 1).25 One pathway entails the reduction of dietary nitrates to nitrite and then NO.26 Another pathway depends upon the enzyme nitric oxide synthase (NOS) to convert L-arginine to NO.27

Oral Hygiene

In the NOS independent pathway of NO production, facultative oral microflora reduce dietary nitrates (NO3–) to nitrites (NO2–), which are then converted to NO in the acidic environment of the stomach.26

In this pathway, the presence of particular oral bacteria and the stomach’s low pH are invaluable for NO production. These requisite conditions are undermined, however, by antiseptic mouthwashes, proton-pump inhibitors, and over-the-counter antacid medications—agents commonly used in industrialized societies.28–30 Although restoring a patient’s gastric acidity is a relatively straightforward task for the naturopathic physician, as of this writing there is no nutritional probiotic supplement that contains the oral bacteria essential for nitrate reduction. We may still, however, advise patients to avoid commercial mouthwash products.26


Dark Leafy Greens and Beetroot

Vegetable-rich diets have been shown to support heart health,31,32 in part due to their nitrite and nitrate content. High nitrate diets lower the risks of hypertension, heart attack, and stroke,33–35

Although dietary nitrites such as those naturally found in bacon have been vilified, nitrites and nitrates are actually naturally occurring molecules produced in the body that are important to health.36,37 (The culprit in processed meats is likely not nitrite, but rather the carcinogenic compound nitrosamine.38,39)

In addition to eating plenty of green, leafy vegetables, powdered greens products, beetroot (also known simply as “beets”), and beetroot products may all be used as supplemental sources of nitrates, antioxidants, and phenolic compounds pertinent to cardiovascular health.40 Beetroot is a particularly rich source of nitrates and antioxidant compounds and has been observed to increase NO levels and lower blood pressure readings in both men and women of various ages.41–43

Although dietary nitrites such as those naturally found in bacon have been vilified, nitrites and nitrates are actually naturally occurring molecules produced in the body that are important to health.36,37 (The culprit in processed meats is likely not nitrite, but rather the carcinogenic compound nitrosamine.38,39)

In addition to eating plenty of green, leafy vegetables, powdered greens products, beetroot (also known simply as “beets”), and beetroot products may all be used as supplemental sources of nitrates, antioxidants, and phenolic compounds pertinent to cardiovascular health.40 Beetroot is a particularly rich source of nitrates and antioxidant compounds and has been observed to increase NO levels and lower blood pressure readings in both men and women of various ages.41–43

L-Arginine and L-Citrulline

L-Arginine may be acquired from nutritional supplements and/or endogenously derived from the amino acid L-citrulline, and serves as the source raw material from which the body produces NO via NOS (Figure 1).44 Low serum levels of L-arginine have unsurprisingly been correlated with poor NO production.45

A significant percentage of ED patients have low L-arginine or L-citrulline levels, placing them at increased risk of disease.45 Because of this and because the NOS-dependent route of NO production was the first pathway discovered, the nutraceutical product market is now replete with L-arginine-containing formulae.46

Although oral L-arginine supplementation may improve NO-mediated vasodilation and endothelial function, its effects as a monotherapy are transient due to the short duration of its presence in the circulation (on the order of milliseconds).47 This may be why a review of L-arginines efficacy in the treatment of ED reports that a minimum dosage of 3 g daily is necessary to achieve outcomes. Some studies have even dosed the amino acid at 5 g and higher.48

The efficacy of L-arginine may be improved by delivering it alongside N-acetylcysteine or glutathione (GSH), both of which contain sulfur residues or thiols. NO binds GSH, forming S-nitrosoglutathione. This molecule then transports and circulates NO, has a half-life of hours, and is just as vasoactive as NO.49 Antioxidants like ascorbate also are able to cleave or release bound NO.50 L-arginine also pairs particularly well with Pycnogenol, as is explored in the section below.

Unlike L-arginine, its precursor L-citrulline (named for the watermelon, or Citrullus vulgaris, from which it is derived51) evades presystemic metabolism, effectively increasing circulating NO levels.45,52,53 This may make L-citrulline a more advantageous nutritional supplement than L-arginine in the treatment of ED, hypertension, and related vascular conditions.54,55

Although L-citrulline supplements are less effective than PDE5i’s (at least in the short term), they are an effective adjuvant to PDE5i treatment.54,56 L-citrulline has also been shown to be safe and psychologically well tolerated.54

What may be even more effective than L-arginine or L-citrulline monotherapy, however, is the administration of the two NOS substrates concurrently: Simultaneous oral supplementation of L-arginine and L-citrulline (1 gram of each) increased plasma L-arginine levels more than 2 g of either alone in a 2017 study.57 (Note that because many viruses, including herpes simplex virus [HSV], are dependent upon the bioavailability of arginine,58 L-arginine and L-citrulline supplements may be poorly tolerated by patients with frequent HSV outbreaks.)

In addition to augmenting the body’s supply of L-arginine, it is also important to support conversion of the amino acid into NO.38 This conversion is enhanced by oxygen, NADPH, heme, tetrahydrobiopterin (THB, also known as BH4), and other coenzymes. Things as simple as checking oxygen saturation and ferritin levels may therefore prove advantageous.


Pycnogenol

A standardized extract from the bark of the French maritime pine, Pinus pinaster—or Pycnogenol, as it’s known in the US by its patent name—can improve erectile function both as a stand-alone treatment and in combination with L-arginine.59,60

In a double-blind study of 21 males suffering from ED, patients received 120 mg of Pycnogenol or placebo daily. After three months, Pycnogenol significantly improved the symptoms of ED from moderate to mild stage. Perhaps more importantly, a significant increase in plasma antioxidant activity was noted among those who received Pycnogenol, while no such benefit was found in those who received placebo. The Pycnogenol group further enjoyed reductions in total cholesterol and LDL-cholesterol levels (from 5.41 to 4.98 mmol/L and from 3.44 to 2.78 mmol/L, respectively). (No significant changes in triglycerides or HDL were observed.) These findings suggest that Pycnogenol may not only treat ED but may also temper some of the more serious vascular changes that succeed it.61

In another study of 40 males, 25 to 45 years of age, a combination of L-arginine and Pycnogenol significantly outperformed Pycnogenol alone, helping 80% of men (and, after another month of the study, 92.5% of men) achieve a normal erection – as compared to only 5% of men who benefitted from Pycnogenol alone. Pycnogenol was given at a dose of 40 mg one to three times daily, with L-arginine at a dose of 1.7 g daily.60 (It is worth noting that the minimum effective daily dosage of L-arginine as a standalone treatment of ED may be 3 g,62 though this study suggests that lower doses may be used within the milieu of co-treatment with Pycnogeol.)

In a similar trial of 50 males, L-arginine (3 g/day) plus Pycnogenol (80 mg/day) restored normal erectile function after just one month of supplementation. Sperm quality improved in the men who took this combination and their testosterone levels increased significantly. The men also reported a doubling in their sexual intercourse frequency.63


Glutathione and Other Antioxidants

Supplementation with L-citrulline and GSH has also been shown to synergistically increase NO levels.

In addition to providing thiols for the formation of S-nitroso glutathione, GSH also affects the NOS enzyme function. In a GSH-depleted environment, NOS becomes uncoupled, resulting in the production of toxic superoxides instead of salubrious NO. Endothelial NOS (eNOS) uncoupling has been implicated in numerous conditions marked by vascular endothelial dysfunction, including heart failure, ischemia/reperfusion injury, hypertension, atherosclerosis, and diabetes.65

As the master antioxidant of the body, GSH strongly protects against the oxidative stress associated with endothelial dysfunction. Like other antioxidants, GSH may prevent eNOS uncoupling by scavenging free radicals, mitigating certain radical-generating pathways, maintaining the optimal ratio of reduced to oxidized glutathione, and protecting the endothelium against damage by toxic metabolites.66

GSH and other antioxidants can thus prevent oxidative stress, ameliorate vascular endothelial dysfunction, and stave off cardiovascular disease (among other chronic ailments).66


DHEA

The steroid hormone precursor dehydroepiandrosterone (DHEA) not only augments hormone production, but also positively affects eNOS. Supplementation with DHEA may thus further support endothelial health.67 A systematic review of 38 trials found that DHEA improves various aspects of sexual health in both males and females, including sexual interest, sexual frequency, lubrication, arousal, pain, and orgasm.68


Carnitine and Taurine

Carnitine and taurine have been shown to support NO production and vascular health. Specifically, propionyl-L-carnitine (PLC) has been observed to stimulate NO production and facilitate the delivery of free fatty acids into the mitochondria.69 When administered alongside acetyl-L-carnitine, PLC enhances the efficacy of sildenafil in treating the symptoms of ED in men who have undergone bilateral nerve-sparing prostatectomy.70

Taurine also increases NO, likely by decreasing asymmetric dimethylarginine (ADMA), as an inhibitor of NO synthesis.71,72

Meditation

Beyond erectile function and blood pressure, NO’s benefits include blood clot prevention, immune function enhancement, and nervous system support.7 NO may also contribute to the relaxing effects of meditation and mindfulness practice—and mindfulness practice may likewise enhance NO production.73 In one study, for example, experienced meditators were found to have lower levels of subjective stress and higher nitrate and nitrite levels.9 This finding may be added to the long list of reasons to recommend meditation and other mindfulness-based practices to those with ED and other cardiovascular ailments.


Exercise

Sedentary lifestyle is a significant risk factor for both ED and cardiovascular disease.9 Physical activity is known to increase vascular NO levels and improve vascular function,74 which explains at least in part why exercise is hailed as the lifestyle factor most strongly correlated with erectile health.74,75

A 2018 systematic review of 10 studies concludes that moderate to vigorous aerobic exercise four times weekly for six months improves erectile function in men who have ED caused by sedentary lifestyle, obesity, hypertension, cardiovascular disease, and/or metabolic syndrome.9 Considering that exercise helps with a wide array of other health conditions, physical activity should be a basic treatment guideline for just about every patient.


Conclusion

During sexual arousal, the vessels of the penis rely upon nitric oxide to help blood—and the oxygen and nutrients it carries—engorge the penis, resulting in tumescence. Erectile dysfunction may therefore represent poor endothelial health and a deficit of NO in many cases—and thus serve as a warning sign of more serious vascular ailments to come.

Because there is no standard lab test for assessing NO levels,76 it is important for healthcare providers to make astute clinical assessments of their patients’ cardiovascular status when labs and imaging fall short.

Simple, natural strategies and supplements—like oral health, digestive hygiene, green vegetables and beetroot, L-arginine, L-citrulline, glutathione, DHEA, carnitine, Pycnogenol, meditation, and exercise—may well serve the men who suffer from erectile dysfunction. Even in the context of testosterone replacement and phosphodiesterase inhibitor prescription, nitric oxide support may further improve sexual performance and safeguard against more serious vascular disease.

  • L-Arginine and L-Citrulline
  • Pycnogenol
  • Glutathione and Other Antioxidants
  • Carnitine and Taurine
  • __Berkeley Life Pro, __ M3 Powder, __  NO Max ER
  • Testosterone __ IM, __Troche,__ Topical
  • DHEA
  • Meditation
  • Exercise

Mushrooms

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NOTE: Before reading this post which I hope you do, I would like to preface it by advising when working with mushrooms, consult with a practitioner who is knowledgeable and qualified to advise on how to use and maximize mushrooms to unleash their full healing power-recommending the best mushroom quality money can buy.. It is one thing to state mushrooms cure cancer and another to prove it.

NOTE: Because there is a lot of” BS” out there, it is imperative to use only the absolute best gradient mushrooms available.

Aside from being rich in valuable nutrients such as fiber, vitamins B and C, calcium, potassium, phosphorus, magnesium, selenium and zinc, mushrooms are also excellent sources of antioxidants, including some that are entirely unique to mushrooms. Ergothioneine and glutathione, both of which are found in mushrooms, are recognized as “master antioxidants” that inhibit oxidative stress. Both are considered important anti aging compounds.

As noted in The Guardian, “… [Scientists think [ergothioneine and glutathione] may help to protect the body against the maladies of old age, such as cancer, coronary heart disease and Alzheimer’s disease.” Ergothioneine appears to have a very specific role in protecting your DNA from oxidative damage, while glutathione is important for successful detoxification of heavy metals and other contaminants.

In the U.S., half of the nation’s mushroom crop come from Chester County, Pennsylvania, where indoor farms produce more than a million pounds of mushrooms per day. It’s important to eat only organically grown mushrooms, though, as they absorb and concentrate whatever they grow in, for better or worse. Mushrooms are known to concentrate heavy metals, as well as other air and water pollutants that can defeat their medicinal value.

Mushrooms Offer Potent Immune Support

Mushrooms also contain a number of compounds that modulate and strengthen immune function.This is one reason why they’re so beneficial for preventing and treating cancer. Immune-regulating compounds include not only vitamin D but also long-chain polysaccharides, which have a variety of beneficial properties, including:

  • Anti-inflammatory
  • Hypoglycemic
  • Anti-ulcer
  • Antitumorigenic
  • Immunostimulating

Alpha and beta glucan molecules are among the most important polysaccharides. Beta glucan in particular enhances immunity through a variety of mechanisms, many of which are similar to those of echinacea or astragalus root. For example, it binds to macrophages and other scavenger white blood cells, activating their anti-infection activities. The beta-glucan in mushrooms also plays a role in fat metabolism and may help support healthy cholesterol levels.

Mushrooms also contain a number of other unique nutrients that many do not get enough of in their diet, including B vitamins like riboflavin, niacin and pantothenic acid, as well as copper, the latter of which is one of the few metallic elements accompanied by amino and fatty acids that are essential to human health.

Since your body can’t synthesize copper, your diet must supply it regularly. Copper deficiency can be a factor in the development of coronary heart disease. Other bioactive and medicinal compounds include terpenoids, steroids, phenols, and all of the essential amino acids (they’re especially good sources of lysine and leucine).

Mushrooms Have Valuable Anticancer Properties

Cordyceps, also called Caterpillar fungus or Tochukasu, has been studied for its antitumor properties. This parasitic mushroom is unique because, in the wild, it grows out of an insect host instead of a plant host. It has long been used within both traditional Chinese and Tibetan medicine.

Scientists at the University of Nottingham have been studying cordycepin, one of the active medicinal compounds found in these fungi, as a potential cancer drug.15 A protein extract from turkey tail mushrooms is also being used to boost cancer patients’ immune function in countries including Japan. Mushrooms may also have direct anticancer effects. For instance:

  • In a Japanese animal study, mice suffering from sarcoma were given shiitake mushroom extract. Six of 10 mice had complete tumor regression, and with slightly higher concentrations all 10 mice showed complete tumor regression.
  • In another study, 18 the lentinan in shiitake mushrooms was found to increase the survival rate of cancer patients. Lentinan also has antiviral, antibacterial, antifungal and immune-boosting effects
  • Extracts from maitake mushrooms, when combined with vitamin C, were shown to reduce the growth of bladder cancer cells by 90 percent, as well as kill them
  • In Japan, the top two forms of alternative medicine used by cancer patients are a mushroom called Agaricus subrufescens and shiitake mushroom extract
  • Ganoderic acid in reishi mushrooms may be useful in treating lung cancer

Mushrooms Are a Superfood Worth Indulging In

Considering the scientific evidence, it’s easy to understand why mushrooms have been valued for their medicinal properties for centuries. In ancient Egypt, mushrooms were thought to bring long life, and today we know that this may be due to the many beneficial phytochemicals and other compounds they contain.

For example, Herbal Medicine: Biomolecular and Clinical Aspects has the following to say about reishi mushrooms: ” … there are data that support its positive health benefits, including anticancer effects; blood glucose regulation; antioxidant, antibacterial and antiviral effects; and protection against liver and gastric injury.”

One dietary analysis found that mushroom consumption was associated with better diet quality and improved nutrition. Other health benefits associated with mushroom consumption include:

• Weight management: One study found that substituting red meat with white button mushrooms can help enhance weight loss. Obese participants with a mean age of just over 48 years ate approximately 1 cup of mushrooms per day in place of meat. The control group ate a standard diet without mushrooms.

At the end of the 12-month trial, the intervention group had lost an average of 3.6 percent of their starting weight, or about 7 pounds. They also showed improvements in body composition, such as reduced waist circumference, and ability to maintain their weight loss, compared to the control group.

• Improved immune response to pathogens: A study done on mice found that white button mushrooms enhanced the adaptive immunity response to salmonella, a common food borne pathogen that can cause food poisoning.

• Enhanced athletic performance and more: Cordyceps is a favorite of athletes because it increases ATP production, strength and endurance, and has anti-aging effects.Cordyceps also has hypoglycemic and possible antidepressant effects, protects your liver and kidneys, increases blood flow, and has been used to treat Hepatitis B.

• Anti-inflammatory effects. Cordyceps are also recognized for their potent anti-inflammatory characteristics, which may be useful for conditions such as asthma, rheumatoid arthritis, renal failure and stroke damage. One of the active medicinal compounds in cordyceps responsible for many of these effects is cordycepin.

 

Examples of Medicinal Mushrooms to Add to Your Diet

With all the evidence supporting mushrooms’ medicinal superfood status, I highly recommend adding some to your diet. They’re an excellent addition to any salad and go great with all kinds of meat and fish. “Let food be thy medicine” is good advice indeed, and with mushrooms that is especially true, as they contain some of the most powerful natural medicines on the planet.

Just make sure they’re organically grown, to avoid harmful contaminants that the mushroom absorbs and concentrates from soil, air and water. Also, avoid picking mushrooms in the wild unless you are absolutely sure you know what you’re picking.

There are a number of toxic mushrooms and it’s easy to get them confused unless you have a lot of experience and know what to look for. Growing your own is an excellent option and a far safer alternative to picking wild mushrooms. A few of my favorite health-enhancing mushroom species include:

Shiitake (Lentinula edodes): Shiitake is a popular culinary mushroom used in dishes around the world. It contains a number of health-stimulating agents, including lentinan, which has antitumor properties and helps protect liver function,relieve stomach ailments (hyperacidity, gallstones, ulcers), and may lower your risk of anemia, ascites and pleural effusion.

Shiitake mushrooms also demonstrate antiviral (including HIV, hepatitis and the “common cold”), antibacterial and antifungal effects; blood sugar stabilization; reduced platelet aggregation and reduced atherosclerosis.
Reishi (Ganodermalucidum): Reishi is known as Lingzhi in China, or “spirit plant.” It’s also been given the rather telling nickname of “mushroom of immortality.” Reishi has been used medicinally in Asia for thousands of years. One of its more useful compounds is ganoderic acid (a triterpenoid), which is being used to treat lung cancer,33 leukemia and other cancers.

The list of Reishi’s health benefits includes:antibacterial, antiviral (herpes, Epstein-Barr) and antifungal (including Candida) properties; anti-inflammatory properties; immune system upregulation; normalization of blood pressure; reduction of prostate-related urinary symptoms in men.
Turkey Tail (Trametes versicolor): Turkey Tail is also known as Coriolis versicolor, or “cloud mushroom.” Two polysaccharide complexes in Turkey Tail are getting a great deal of scientific attention, PSK (or “Kreskin”) and PSP, making it the most extensively researched of all medicinal mushrooms with large scale clinical trials.

A seven-year, $2 million NIH-funded clinical study in 2011 found that Turkey Tail mycelium improves immune function when dosed daily to women with stage I–III breast cancer. Immune response was dose-dependent, with no adverse effects.

PSP has been shown to significantly enhance immune status in 70 to 97 percent of cancer patients.Turkey tail is also being used to treat many different infections, including aspergillus niger, Candida albicans, E. coli, HIV, herpes and streptococcus pneumonia. It’s also hepatoprotective and may be useful for chronic fatigue.
Himematsutake (Agaricus blazei): Himematsutake, also called Royal Sun Agaricus, is a relative of the common button mushroom. Himematsutake mushroom is attracting worldwide scientific attention due to its remarkable anticancer properties related to six special polysaccharides.

Like many other medicinal mushrooms, this fungus can also protect you from the damaging effects of radiation and chemotherapy. But its benefits don’t stop there. Himematsutake may also help decrease insulin resistance in diabetics, improve your hair and skin, and even treat polio.

NOTE: For more information about the Miraculous Healing Potential of Mushrooms, contact me at [email protected] or 619-231-1778.

Good ol’ Glutathione – the Antidote to Snake Oil “Detoxes”

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Good ol’ Glutathione – the Antidote to Snake Oil “Detoxes”

When patients make the decision to clean up their diet and put more effort into establishing and maintaining healthy lifestyle habits, many of them find benefit in starting out with some type of guided cleanse or detox. Television and magazine ads provide no shortage of slick programs promising miraculous transformations in health and physique through following these strategies, which typically range anywhere from a week to a month in duration. No doubt, clever marketing and pretty packaging can convince people who are fatigued, overweight, and living with chronic pain, that the answer to their woes lies in subsisting on cabbage soup, green smoothies, or a diet made up entirely of raw foods.

Patients would come in with drops, tablets, pills all claiming miracle detoxification.  The glitz and glamour these quick-fixes are wrapped up in obscure, the simple and perhaps even boring truth: the body “detoxes” itself constantly. Compounds that are produced by the body, itself, albeit with the aid of accessory nutrients, are the most effective things for internal housekeeping, and these cleansing processes take place all the time, with no need for drastic measures like drinking copious amounts of lemon juice, maple syrup and cayenne pepper. Through eating a whole-foods, nutrient-dense diet, patients can support their body’s primary antioxidant and detoxification powerhouse: glutathione

Glutathione does not appear out of nowhere. It is manufactured by the body and is considered the mother of all antioxidants. Until recently, the only way to supplement our own reserve of glutathione was through IV injections. The enzymes responsible for its synthesis and recycling require several vitamin and mineral cofactors. The short list includes magnesium, riboflavin and selenium. Magnesium is needed for the synthesis of glutathione, itself. Selenium is required for glutathione peroxidase (GPx), which converts potentially harmful hydrogen peroxide into water, leaving behind oxidized glutathione (GSSG). At least five variants of GPx are known to be selenoproteins: GPx1 (in the cytosol), GPx2 (specific to epithelial cells in the lungs and intestinal lining), GPx3 (thyroid and kidneys), GPx4 (phospholipid-hydroperoxide), and GPx6 (active in the olfactory epithelium). Moving along in the glutathione redox cycle, riboflavin, as part of flavin adenine dinucleotide (FAD), is used by glutathione reductase, which restores oxidized glutathione into reduced glutathione (GSH).

  • GSH resides in the cell  —  There are approximately 50-72 trillion cells in the body
  • GSH is the mother of all antioxidants
  • It is considered the strongest antioxidant in the world because it is what your own body produces
  • Glutathione is a tri-peptide meaning it has 3 amino acids

The name, glutathione, is indicative of the presence of at least two of its components: the amino acid glutamine, and the presence of sulfur (thio), in the form of the amino acid cysteine. Glycine is the third amino acid that makes up the glutathione tripeptide. Being that it is a tripeptide, it’s especially amusing that many of the popular quick-fix cleanse and detox programs marketed to uninformed consumers are low in protein. While plant foods do, of course, provide protein, vegetable-based proteins are typically not as bioavailable nor as complete as animal proteins. Programs that call for the elimination of animal foods, at least, temporarily, run the risk of not providing the body with enough of the amino acids it needs to support the synthesis of its own in-house detoxifying substances, of which glutathione is only one.

  • It is 5000 times stronger than Vitamins C & E
  • Vitamin C has 5 extra electrons to donate
  • Vitamin E has 3 extra electrons to donate
  • GSH has 1 million extra electrons to donate

Although glutathione is synthesized by the body, there are health situations that may benefit from supplementation. Specifically, these include conditions associated with rampant oxidative stress, in which the use of glutathione might outpace production, or which may be caused or exacerbated by reduced levels of this key antioxidant. For example, cytosolic glutathione levels are markedly reduced in the substantia nigra of patients with Parkinson’s disease. Damage to mitochondria is believed to underlie several other neurodegenerative conditions, such as Alzheimer’s disease. Increasing glutathione levels in the brain is being explored as a therapeutic adjunct for slowing or preventing Alzheimer’s and its precursor, mild cognitive impairment.

Supplemental glutathione is sometimes an appropriate choice for patients, but can be difficult to deliver to the body. Until recently, the only way to supplement our own reserve of glutathione was through IV injections. As a peptide, glutathione administered orally would be broken down during digestion. Providing precursor molecules, such as N-acetyl-cysteine, or glutathione in its reduced form or as S-acetyl-glutathione, in which the acetyl group protects the compound from being degraded in the GI tract, are ways to boost levels of this crucial compound.

  • Raising cellular glutathione increase the release of toxins
  • Toxins are most always attached to fat molecules such as bile
  • GSH forces toxins to attach to fats (bile) which is then returned to the Liver
  • How your body rids itself of toxins is directly related to NOT getting Cancer
  • You can never downgrade inflammation without cellular detoxification

*If you check Pub-Med, as of 922/15 there are 321,156 studies done on Glutathione for most every disease complex

*Also on PubMed as of 9/22/15 there are 6,217 research articles on Glutathione’s affect on aging

Here is an excellent link from Huffington Poast on Glutathione–Mother of all Antioxidants

In my result driven practice, I use Glutathione supplements which absolutely, undoubtedly work as they should. Please contact me at [email protected] or call 619-231-1778

Vitamin E & the Brain

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Vitamin E & the Brain

Among fat-soluble vitamins, vitamin E often gets sidelined in favor of compounds with better-known functions. People automatically associate vitamin A with vision and eye health, vitamin D with calcium homeostasis and bone health, and vitamin K with proper blood clotting. When vitamin E makes a rare appearance in discussions about health and nutrition, it’s often in the context of infertility, since deficiency of this nutrient is associated with reproductive difficulties  in animals and humans. But with advances in technology, scientists continue to uncover previously unknown and under-appreciated roles for vitamins and minerals. In the case of vitamin E, this nutrient might have a significant role to play in brain health and neurological function.

Results of a recent animal study support a requirement for sufficient vitamin E in order to deliver and maintain adequate levels of DHA and DHA-dependent phospholipids in the brain. Neuronal cell membranes are rich in cholesterol and polyunsaturated fats, which are highly susceptible to oxidation. With vitamin E having an antioxidant function, a deficiency can have dangerous consequences for brain health. In fact, severe vitamin E deficiency can manifest as cerebellar ataxia, demonstrating the importance of this nutrient for proper functioning of the central nervous system. Vitamin E deficiency also results in reduced myelination of spinal cord fibers, and leads to neuropathic and myopathic lesions all of which may have disastrous consequences for cognition and neuromuscular coordination.

A small, double-blind, placebo-controlled crossover study demonstrated that vitamin E supplementation led to improved scores on the Abnormal Involuntary Movement Scale (AIMS) in tardive dyskinesia patients who had had the condition for less than five years. The vitamin intervention was less effective in subjects with more longstanding disease.

The cerebrospinal fluid (CSF) of Alzheimer’s disease patients has been shown to be low in Vitamin E.While this specific finding may play a direct role in disease pathology, it might also simply be a reflection of overall poor nutrient status resulting, in part, from the modern diet, which is high in refined carbohydrates and low in micronutrients. However, considering the important role of vitamin E in the central nervous system, a lower level of this nutrient in CSF may expose neurons to profound free radical damage, leading to memory loss and declining cognitive function. Compared to placebo, patients with moderately advanced Alzheimer’s given 2000 IU of vitamin E per day experienced delayed deterioration of cognitive function. . Other studies indicate vitamin E is more effective in combination with another important antioxidant, vitamin C.

Reviews and meta-analyses of studies involving the use of supplemental vitamin E show mixed results, leading researchers to stress using caution regarding high doses of vitamin E. Some study authors suggest emphasizing food sources of vitamin E, or a multivitamin with around 30 IU of alpha-tocopherol, rather than isolated vitamin E supplements that deliver a higher dose. As is true for the use of any nutritional compound in a healthcare setting, caution should, of course, be practiced when dosing vitamin E. However, the mixed outcomes of studies employing vitamin E may be the result of confounding from the makeup of the supplements themselves. For example, a high alpha-tocopherol preparation may result in different effects than one with a higher fraction of gamma-tocopherol.

While frank vitamin E deficiency is rare, it is not unheard of. Vitamin E Deficiency can result from inborn errors of tocopherol transfer proteins, as well as disorders of lipid absorption, transport, and assimilation. Conditions that affect digestive efficiency, such as celiac disease and Crohn’s  disease, may interfere with proper absorption of fat-soluble nutrients. Biliary insufficiency resulting from compromised liver or gallbladder function may also contribute. An additional cause of vitamin E deficiency (as well as deficiency of many other nutrients) is bariatric surgery. While this can be a lifesaving procedure for many people, altering the anatomy of the digestive tract can have severe consequences for nutrient absorption, and extra care should be given to ensuring sufficient nutrient uptake in the body.

The foods richest in vitamin E are nuts and seeds, whole grains, and vegetable oils, such as corn, soybean, and safflower oils. However, overly large intake of these oils is not recommended, due to the potential for skewing the dietary omega-6/omega-3 fatty acid ratio toward the generally pro-inflammatory omega-6 pathways.

NOTE: GCEL (Glutathione) is 5000 times stronger than Vitamins C & E,

  • Vitamin C has 5 extra electrons to donate
  • Vitamin E has 3 extra electrons to donate
  • GSH has 1 million extra electrons to donate