Lifestyle and metabolic approaches to maximizing erectile and vascular health

Abstract

Oxidative stress and inflammation, which disrupt nitric oxide (NO) production directly or by causing resistance to insulin, are central determinants of vascular diseases including ED. Decreased vascular NO has been linked to abdominal obesity, smoking and high intakes of fat and sugar, which all cause oxidative stress. Men with ED have decreased vascular NO and circulating and cellular antioxidants. Oxidative stress and inflammatory markers are increased in men with ED, and all increase with age. Exercise increases vascular NO, and more frequent erections are correlated with decreased ED, both in part due to stimulation of endothelial NO production by shear stress. Exercise and weight loss increase insulin sensitivity and endothelial NO production. Potent antioxidants or high doses of weaker antioxidants increase vascular NO and improve vascular and erectile function. Antioxidants may be particularly important in men with ED who smoke, are obese or have diabetes. Omega-3 fatty acids reduce inflammatory markers, decrease cardiac death and increase endothelial NO production, and are therefore critical for men with ED who are under age 60 years, and/or have diabetes, hypertension or coronary artery disease, who are at increased risk of serious or even fatal cardiac events. Phosphodiesterase inhibitors have recently been shown to improve antioxidant status and NO production and allow more frequent and sustained penile exercise. Some angiotensin II receptor blockers decrease oxidative stress and improve vascular and erectile function and are therefore preferred choices for lowering blood pressure in men with ED. Lifestyle modifications, including physical and penile-specific exercise, weight loss, omega-3 and folic acid supplements, reduced intakes of fat and sugar, and improved antioxidant status through diet and/or supplements should be integrated into any comprehensive approach to maximizing erectile function, resulting in greater overall success and patient satisfaction, as well as improved vascular health and longevity.

Deleterious effects of obesity upon the hormonal and molecular mechanisms controlling spermatogenesis and male fertility

“…Increased urbanisation and industrialisation in the Western world has promoted a sedentary lifestyle and unfavourable diet in the general population leading to an increased incidence of obesity (Meldrum et al, 2012;Stefan et al, 2013). Studies have observed a parallel decrease in male fertility potential over the past decades in regions where obesity is prevalent (Swan et al, 2000).…”

Preconception diet or exercise intervention in obese fathers normalizes sperm microRNA profile and metabolic syndrome in female offspring

“…Interestingly, in humans, an overweight or obese male partner with a female of normal body mass index has an increased-odds ratio for time to conceive (47,59) and increased rates of sexual dysfunction (55). This reported sexual dysfunction in humans has been shown to be reversed by weight loss through diet and exercise interventions (24,40). Because our exercise-only group (HE) maintained their preintervention adiposity and reduced mating rates, mating success maybe more related to adiposity and the hormonal changes that can be associated with this (12,29,63).…”

Recent scenario of obesity and male fertility

“…Increased caloric intake and sedentary lifestyle, lack of exercise, easy transportation along with various modern technologies that can reduce the need for physical activity may explain the prevalence of obesity around the world (Meldrum et al, 2012). Obesity is a condition in which excess body fat has been accumulated and associated with an increased risk of many serious illnesses such as cardiovascular diseases, diabetes mellitus, and diseases like cancer (Eisenberg et al, 2014).…”

“…Therefore, numerous causative factors implicated in infertility can be affected by lifestyle behavior (i.e., smoking, alcohol consumption, and junk food) and also co-pathologies, which can impair sperm function (Meldrum et al, 2012). Dietary habits of people from different ethnic background may have some effect on reproductive potential as it has been documented that males who were taking high fat diet to induce obesity had reduced sperm motility and decreased percentage of spermatozoa with normal morphology (Du Plessis et al, 2010); however, it should be noted that a number of studies had significant reduction in testosterone and altered glucose homeostasis in their high fat diet groups which could be contributing to the results (Norman et al, 2010).…”