Impotence
“ Not only does testosterone increase outward facing muscle bulk , it also increases the size of the heart muscle .”
Nitric oxide supplements can help stave off impotence .
normal blood vessels with no obstruction . When cardiac disease begins to develop , the lining of the blood vessels , known as the endothelium , is unable to stretch to compensate for increases in blood flow . This may happen in the heart , the arteries in the arms or legs , or the arteries that flow into the penis .
As is well-known , cholesterol and the effects of inflammation can lead to cholesterol deposition and atherosclerotic plaque , which slow down blood flow . The presence of erectile dysfunction can therefore forewarn the likelihood of a later heart attack .
“ This is like a silent barometer of what ’ s going on in your heart , so don ’ t take your erectile dysfunction lightly ,” said Dr Sriram . “ But sadly , erectile dysfunction therapy is often begun with some tablet being given to the patient . Instead , it should begin with a full coronary assessment , especially with older patients who are most likely to have coronary disease .”
While Dr Sriram decries the easy dispensing of “ magic pills ”, he believes that nitric oxide supplements could be pivotal in staving off impotence while also improving the elasticity of blood vessels .
The compound , which is best known as a pollutant from car exhausts , is produced in the endothelium . It was found by three American scientists to protect the heart , stimulate the brain , and trigger erections by dilating blood vessels , leading them to win the Nobel Prize for Medicine in 1998 . Viagra is designed to increase nitric oxide ’ s effect .
As we grow older , our own production of nitric oxide diminishes , lowering the endothelium ’ s ability to repair and replenish itself . This is common for both erectile dysfunction and coronary artery disease .
“ I do believe most men over 40 or 45 should now be taking nitric oxide supplementation in the form of l-arginine ,” said Dr Sriram . “ It ’ s a very safe drug that ’ s normally in our food . It ’ s an essential amino acid to make proteins in our body , and it does not have any side effects of significance .”
Since it would need a “ truckload ” of fresh fruits and vegetables to meet the equivalent of 2-3 grams of nitric oxide a day , l-arginine pills would represent a manageable option .
Of course , ageing and damaged blood vessels are not the only cause of erectile dysfunction but are likely the most common . Other causes include endocrine diseases , like diabetes and its associated impaired blood flow , hormone levels , and nerve damage . Several neurological and nerve disorders , such as Alzheimer ’ s disease , multiple sclerosis , and brain and spinal tumours , can increase the risk of impotence . Taking medications that affect blood flow , often for cardiac conditions , can also lead to erectile dysfunction . Depression , anxiety , and drug abuse are similarly associated with the condition .
The most common treatment is in the form of pills , with Viagra , Cialis and Spedra being the most common . These drugs cause inhibition of the phosphodiesterase 5 ( PD5 ) enzyme , which destroys the nitric oxide after it has done what it needs to do to repair the blood vessel . By inhibiting the PD5 , they prolong the action of nitric oxide , though they do not cause the body to produce more nitric oxide .
While popular , pharmaceutical erectile dysfunction treatments do have contraindications that can be life threatening . For example , taking Viagra and Cialis with nitrates for chest pain and angina can cause blood vessels to expand too rapidly , leading blood pressure to drop by 20-30 percent , resulting in severe hypotension and occasionally death .
Another potentially risky treatment is testosterone replacement for older individuals . “ Not only does testosterone increase outward facing muscle bulk , it also increases the size of the heart muscle ,” said Dr Sriram . “ Therefore , you now have more muscle in the heart and that means even more blood supply . If there ’ s any underlying cardiac disease , or if cardiac failure is already in place , then testosterone replacement can make this much worse .”
Cardiac drugs such as the beta-blockers atenolol and propranolol and thiazide diuretics can cause erectile dysfunction fairly rapidly . There are also some mixed data to suggest that statins can cause impotence , but this is not proven , and many studies suggest that the drugs are actually beneficial in reducing cholesterol plaque .
“ The assessment of coronary artery disease in patients with erectile dysfunction is essential before therapy is begun , yet too often we find the blue pill being prescribed under the table ,” Dr Sriram said . “ It ’ s very dangerous to do that , but yet it ’ s a practice that seems to be quite prevalent .”
48 APRIL 2021 GlobalHealthAsiaPacific . com