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The Dr. Gundry Podcast
Erectile Dysfunction Isn’t the Problem—Here’s What It’s Really Telling You About Your Health | EP 391
00:46:17
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Sam
Sam.
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Dr. Steven Gundry
If you watch TV or check your social feeds, you probably know that we're having an epidemic of erectile dysfunction. And it's not just the 80 year old man whose wife wants some action and he, he can't give it to her. But you see it now in 35 year old men.
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Interviewer
What's with that?
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Dr. Steven Gundry
So let's talk about the possible causes of erectile dysfunction, because there are actually a lot of possible reasons.
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Interviewer
So where does it come from?
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Dr. Steven Gundry
Well, your blood vessels in your penis actually have to dilate dramatically on cue, if you will, to get lots more blood flow to get an erection. So it depended on the abilities of blood vessels to dilate dramatically and dilate quickly. Now we can measure the ability of blood vessels to dilate. Insurance used to pay for this great test that we did in our office called the Endopat, comes from Israel and it literally uses some devices. We put little cuffs on your fingers and we cut off the flow of blood to your arm for five minutes and then we release it and we watch how fast your blood vessels dialing. I'll give you a perfect example here in the LA area. Let's suppose it's in rush hour and like always there's a car accident and the eight lanes of the 405 are now funneled down to one or two lanes and the cars build up behind the blockage. Now if you're trying to get home, once that blockage is removed, once the accident is cleared, you'd really want the 405 to go from two lanes to.
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Interviewer
10 lanes so that you could get.
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Dr. Steven Gundry
To where you're going quickly. And believe it or not, that's what.
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Interviewer
We want to do.
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Dr. Steven Gundry
When our blood vessels dilate, we want to go from two lanes to 10 lanes. So how does that happen? Well, number one, we want to make sure there's not a blockage that's causing it to go down to two lanes. So one of the possible causes, real causes of erectile dysfunction, is that there are blockages in the blood vessels in a man's groin that prevents any further blood flow. So what? Well, if you have blockages in your groin, you probably have blockages elsewhere in other blood vessels like your heart.
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Interviewer
So one of the first things I.
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Dr. Steven Gundry
Do when I have a patient who asks for these medications and I will use them is I want a stress test to see if what's happening down there is happening in the heart. Because sadly, there are many instances where unbewittingly people took a drug to dilate their blood vessels and it caused a heart attack because their blood pressure dropped. And I want to know who those people are because I want to do something about their heart, but the last thing I want to do is give them an erectile dysfunction medication.
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Interviewer
Now, number two, we can also measure.
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Dr. Steven Gundry
Stiffness in blood vessels with blood tests.
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Interviewer
And they're fairly accurate.
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Dr. Steven Gundry
They can be impacted by infections, having a cold. They can, believe it or not, be impacted by having dental work, even tooth cleaning. Fun fact, every time you have tooth cleaning, you release about 2 billion bacteria into your bloodstream. Now, despite how scary that sounds, please keep getting your teeth clean. But we can measure the impact of those bacteria on flexibility in blood vessels. So one of the things I do with my patients is we look at those markers, one's called AD dma, and look at whether those are high and if we can modify them with diet or supplements. So those are the two main impacts. Where else can be a problem? Many patients are on heart medications, either blood pressure medications or heart medications, because they have angina or have had a heart attack. And as a general rule, these are called beta blockers. And one of the things these drugs do is prevent this rapid onset of dilatation, that you need to have an erection. And many times you need these beta blockers more than you need an erection. And sometimes we can work between the two, as long as we know that there's no direct, you know, two lane highways causing the problem. Does diet have an impact? Well, absolutely. I've written papers that show that diet has a dramatic impact on the ability of blood vessels to dilate. And there is no question that the plant paradox lifestyle with supplements that allow dilatation of blood vessels has a big effect. We know that nitric oxide production has a big effect. For instance, we know that oral bacteria take precursors for nitric oxide that we eat and convert them into nitric oxide that dilates our blood vessels. And sadly, many toothpaste and mouthwash which kill off oral bacteria actually kill off the ability to make nitric oxide, which is how we dilate blood vessels. And really is how almost all of these erectile dysfunction drugs work.
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Interviewer
So the next question is, okay, so.
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Dr. Steven Gundry
We'Ve eliminated all the mischievous causes of erectile dysfunction. We've eliminated that you have heart disease. We've eliminated that there might be blockages in your blood vessels in your groin. So what is that okay to take? Viagra or Cialis or any of the other ones? There are short term uses like Viagra, and there are longer uses like Cialis. Now, there's one paper that is interesting in that these medications may have an effect on lessening dementia. Now, there's not enough long term studies, but why would there be a correlation between these erectile dysfunction medications and dementia? Well, just like you'd like to get more blood flow to your penis, your brain would definitely like more blood flow. And it looks like that these medications not only help blood flow to your penis, but they may help blood flow to your brain. And so there we don't know the cause and effect yet, but certainly more blood flow to your brain, probably a good idea. Does that mean you want to take it chronically? Well, most of these medications are not covered by Medicare or insurance. Sometimes we can get them covered. There is some evidence that low dose Cialis affects bph, shrinking a big prostate. So there may be other benefits besides the main thing you're looking for of taking these medications. On the other hand, remember that if the reason that you're not getting erection is because you're not getting more blood flow and you're using this as a crutch to get the thing you're looking for, you want to take action to see that the other parts of you, like your heart, like your brain, are getting it constantly rather than when you pop that blue pill. Because your heart and your brain want the better blood flow 24 hours a day, not just on demand. And whenever I work with my patients for this problem, we have to understand that for most men, erectile dysfunction is just a warning sign of a much bigger problem that's happening throughout their bodies. And that working on the bigger problem may get us better action on the problem they came in for.
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Interviewer
So let's start with some questions about libido. What do you think about Viagra? Is it good or bad for your gut buddies? Well, the good news is Viagra has nothing to do with your gut buddies. But here's the bad news that I tell any one of my male patients who's looking for erectile help from one of these medications, if you can't get it up without assistance from Viagra or any of the other compounds, you have serious health issues.
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Dr. Steven Gundry
Serious.
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Interviewer
And it has nothing to do with an erection. It turns out that the same process that's preventing you from getting an erection is happening in your coronary arteries and in the blood vessels to your brain. And countless studies show that the need for Viagra or any of the other medications, like Cialis, for instance, means that that your arteries in your heart and in your brain are incapable of dilating properly. And there's an expression in longevity that says you are only as young as your blood vessels are flexible. And I couldn't agree more with that assessment. So number one, I won't prescribe Viagra or Cialis or any of the other ones without a stress test first to show me that when you possibly can dilate your blood vessels with this medication, you won't have a heart attack. But the point is, if you need these medications, that is probably the best wake up call that what you're doing at any point in your life is really a warning sign that there's something going on with the blood vessels in your heart and brain. And I got news for you. If you know Joe won't wake up when he needs to, that means your brain won't wake up when it needs to. So this is a huge warning sign and that's the first thing that you should look for. Second, many men don't realize that the inability to get an erection has nothing to do with testosterone. And I'll get to that in a minute, so please stay tuned. Is there a natural Viagra? That's a great question. There are actually many natural compounds that aid in dilatation of blood vessels. There's actually a very good study that suggests having about a half a cup of walnuts will produce more L arginine, which is the precursor for nitric oxide, which, believe it or not, that's what Viagra does. L citrulline is the precursor for L arginine. I personally think it works much better than L arginine. Word of warning with L arginine. The herpes virus actually uses L arginine to reproduce. So if you have a history of cold sores, if you're going to take L arginine, make sure you supplement with another amino acid called L lysine, which will block herpes ability to use L arginine. There are several other compounds that dilate blood vessels. One is hawthorn. And interestingly enough, there's recent research that shows that aged garlic extract will actually dilate blood vessels in a totally different mechanism. So all of these are options for, quote, natural Viagra. But the important thing is if you're looking for help in the erection department, you need to totally examine your diet and change it immediately. It's one of the scariest things that you should be aware of. I have a very good friend in longevity who used to say, men, no matter what your age, if you don't wake up early in the morning with a boner, death is on the way. And he actually makes an incredibly good Point. And all you guys who are listening, you better be waking up with one or something's radically wrong with your blood vessels.
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Sam
Whoa.
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Interviewer
Is that scary or what?
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Dr. Steven Gundry
Next question.
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Interviewer
I have low testosterone and it's affecting my sex drive. How do I improve? Well, first of all, are you sure you have low testosterone? The usual test that's available in most doctors offices, most labs, is total testosterone. But what you actually want is free testosterone. The reason for that is there are a large number of men who make this hilariously sounding compound called sex hormone binding globulin. And if you make sex hormone binding globulin, a great deal of your testosterone will be bound to this protein and it will not be available. So, for instance, I see many men who walk through the door with testosterone of 1000, and yet they are weak. They have no muscle mass. And when we measure their free testosterone, their free testosterone is low because they have a very high sex hormone binding globulin, which we also measure. On the other hand, the vast majority of men who I see with low t, with low testosterone actually have a normal free testosterone. So you can ignore total testosterone as a useful test. What you want to ask for is free testosterone. Now, here's the other important point. Most men who I see with low testosterone can absolutely, positively have a normal free testosterone if they will give up sugars and carbohydrates. Remember those commercials when testosterone was available as prescriptions and you could advertise it? All those guys talking about their low T were sitting around the campfire eating chips and having a beer. And it's amazing the number of men that I see who have prediabetes, high insulin levels or diabetes, who have low testosterone. And they come in looking for a testosterone prescription. And first of all, I won't write for it because I have not met a man yet who cannot get a normal free testosterone by changing his diet, by getting rid of the sugars and carbohydrates in their diet. And these men come back shocked that they now have normal testosterone. The other important thing to realize if you are considering testosterone replacement is that testosterone will suppress your testicle ability to produce testosterone, and your testicles will shrink to little bitty tiny balls. And if you stop testosterone, you in fact will take a very long time to regenerate your own testicles ability to make testosterone. Lastly, on the same point, the reason you do not see testosterone commercials on TV anymore is that the FDA banned it because most men who take testosterone don't realize that they convert a lot of that topical testosterone into estrogen, the female hormone. And the reason testosterone commercials are banned is because of this fact. And we now know that topical testosterone replacement increased estrogen in men. And estrogen is one of the leading causes of heart disease and strokes. And that explains why testosterone replacement was causing more more heart attacks and more strokes, not because of testosterone, but because it was converted to estrogen. And lastly, guys, you'll convert the testosterone into estrogen and guess what? You'll get man boobs. And that's not what you're looking for with testosterone replacement. So lots of good reasons not to look for topical testosterone or those crazy testosterone pellets. And I'll have more to say about that. So, women, if you have a low libido, what can you do to amp up your sex life? So I've been taking care of women and men in my practice for over 20 years now. And one of the things I've learned from listening to a great deal of men and women is one of the worst ways to screw up your libido is when you're busy with a project such as a child. Sex goes way down the line. The other thing that you should know is that during lactation and during breastfeeding, your child and your interaction actually suppresses your desire to have sex, because quite frankly, your child wants your undivided attention. And there is a really cool hormonal interplay between breastfeeding and not having a desire for sex. And this has actually been shown over and over again, particularly in societies where breastfeeding is done until three or four years of age. And it's actually a very useful way of limiting the population. So number one, don't feel bad that they're somehow something wrong with you hormonally because you're not very interested in sex. Your children are keeping you from doing that. Now one of the interesting things that I see in women, particularly in the perimenopause or even the post menopause period, is there is a huge amount of information out there that that menopause is going to decrease your sex drive or that perimenopause is going to decrease your sex drive and you need hormonal replacement to get your sex drive back. Quite frankly, there's some very fascinating studies in psychology looking at the effect of a long term monogamy, monogamous relationship on sex drive in the women. And it has nothing to do with hormones. And this is going to shock a lot of people. But check with Dr. Google, you'll find the studies women in a long term monogamous relationship tend to lose their libido, their sex drive, and it appears to have a psychologic weakness reason to drive the long term sexual partner, usually the husband, absolutely crazy as to why you're not interested. And it actually keeps the husband fascinated with trying to get sex from you. Now one of two things happen. Either the husband finds an affair, a mistress, and can't take it anymore and can frequently leave the marriage over that. But what's fascinating is, and I see this with a lot of my patients, let's suppose either the husband dies or the husband does go off and they get a divorce. The woman who supposedly has no sexual desire, no libido, then meets a new partner and that woman, universally I've not seen it otherwise, becomes phenomenally interested in sex again, her libido goes crazy even though she's had no change in hormone status. So there's really good psychology behind all this. Now, how about hormonal replacement in females? So I do use hormone therapy in females, but it's not for often the reasons you think. There are about 5% of women who are very vascularly sensitive to the effects of estrogen. And those women, as they go into perimenopause and menopause, they notice a distinct difference in the way their thought processes work. And I was taught by an excellent gynecologist on our staff that a small dose of estrogen, preferably topical. Please folks, do not swallow an estrogen containing substance. A small dose of estrogen will do dramatic changes in the way women feel. And I can see that very small dose of estrogen on their labs. But what amazing is the women, without knowing their estrogen level will automatically say that was it, that's what's missing. And sometimes they'll actually forget the patch or change the patch and we'll see it on their labs and they'll come in and say something's not right. No, I'll go, what's with your patch? Oh, that's right, you know, I forgot it or I ran out and I didn't refill it. So that's number one. Number two, there are a number of women who as their progesterone levels drop as they enter menopause, have great deal of difficulty sleeping. Now the nice thing about progesterone is that it is absorbable orally and easy to obtain from a compounding pharmacy. And usually the dose of progesterone that works works is about 100 milligrams a day. Now the third thing I'll mention about hormone replacement is my good Friend and colleague Dale Bredesen, who wrote the End of Alzheimer's is probably, I think, one of the greatest neurologists in dementia there is, told me a number of years ago now that one of the missing links is another hormone called pregnenolone. Pregnenolone is sometimes called the queen of all hormones, the master of all hormones, because when we're young, pregnenolone is made in our adrenal glands, and quite frankly, it's the precursor for estrogen, progesterone, testosterone, dhea. You name it, it comes from pregnenolone. But what's fascinating is that as we get older, our adrenal glands, for most of us, stop making pregnenolone in, in any amount whatsoever. About 95% of adults don't make pregnenolone. And Dr. Bredesen has shown, and others as well, that pregnenolone is probably very important in keeping neurons in your brain active and alive as we get older. So what Dr. Bredesen has shown is that he thinks, and I certainly have come to agree with him, that much of what we assume is forgetfulness as we get older is actually the effect of falling levels of pregnenolone. Now, the good news is pregnenolone is over the counter in general. And, you know, everybody's different because I measure the effects of these doses every three months in my patients. In general, general, 50 milligrams a day for women is usually the right dose. 100 milligrams a day in men is.
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Dr. Steven Gundry
Usually the right dose.
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Interviewer
Now, I'm not prescribing that to you, I'm not suggesting it. I've just found through the last few years of using this compound, that that usually works out to the, to the level that Dr. Bredesen likes. But everybody's different. And if you're going to take a supplement, a hormonal supplement, you've got to measure what it's going to do. And it's actually easy to do with simple blood tests. Now, the last big misconception about women's libido is that somehow testosterone, either with creams or with pellets, is going to drive women crazy, wild about having sex. About 85% of women will not respond to testosterone with sex drive. And as my colleague in gynecology has reminded me through the years, and I've certainly seen it in the last 20 years, that if a woman is complaining about libido, about sex drive, then he wants to talk about their marriage rather than giving her testosterone. Because 85% of women in general will not respond to testosterone replacement with a sex drive. 15% will. And I have certainly seen this in my practice, but it doesn't happen very much. And I live in two communities where we have what are called Dr. Feelgoods that all they do is a large amount of hormone replacement, usually with pellets. And what happens to these women is they will keep giving these women testosterone until, I kid you not, these women are shaving their arms, they're shaving their beards, and they still don't have a sex drive even though their testosterone levels approach that or exceed that of their husbands. So I can assure you that testosterone is not, not the cure for a relationship issue. And so talk to your family counselor if that's what you need. Okay, so here's some more Instagram questions. Partnerless sex. Can you masturbate too much? You know, this is actually getting a lot of attention from mass media. The idea of. Of is partnerless sex the new in thing? And quite frankly, partnerless sex is on the rise. Whether it is Internet porn based, whether it's subscription service, or whether it's now AI models that have replaced the old inflatable dolls. There are now lifelike mannequins that can be purchased on the Internet. And the interesting thing about can you masturbate too much? No, you won't go blind. That's the good news. It turns out that the problem with porn in general is that what we're finding with men and women is that what happens with porn is you actually get this huge, big burst of dopamine. And what you're actually looking for is this dopamine hit in your brain. And what happens with more and more porn, as was shown in a very famous coffer, is that you have to have more and more. And you have to have more and more, for lack of a better word, erotic or kinky porn, to have the same dopamine effect. Effect. And eventually it really fails to work because you flooded your dopamine receptors and you no longer get the hit you're looking for. So that's the danger of too much of a good thing. There's nothing. You know, obviously it's big business, but the problem is it's addictive in the same way any other addiction is addictive in that you have to have more, more and more to get the same result. And that's the slippery slope. Now, here's another great question. Is celibacy healthier than being sexually active or vice versa? A few years ago, a colleague of mine who's well Known in health suggested, and he's a male suggested that as you get older, men should stop having sex and they should stop masturbating because he believes that your sperm, your semen, is your life force, and that as you get older, you have to conserve your life force. And so the natural thing to do is to stop having sex and stop masturbating. Now, quite frankly, that goes against everything we know from an evolutionary perspective, particularly for men, and that is if you are sexually active or if you are ejaculating, that tells your genes, guess what? I'm still in the business of recreating myself, of making or at least attempting to make a new copy. And from a genetic standpoint, the more you demonstrate that you're capable of doing that, the more your genes keep you around. The interesting thing is we know that sexual activity, particularly among couples, is one of the best ways to prevent, promote a healthy lifespan. Now, here's the other thing that's been fascinating to me for the last 20 years, and that is listening to women in their late 70s, their early 80s, their mid-80s, their late 80s, begging me to get them some help for their husband to get an erection because. Because they want it. And they can't believe that hubby isn't willing to help out in that department. So, no, there's. I think, evolutionary. The deal is the more you are sexually active or act like you're sexually active from masturbation, the better your genes think that you're still involved in recreation. So, great question. All right, let's get some more questions from Instagram. Can oral sex give you bad bacteria? Well, the vaginal microbiome is actually very interesting and replete with its own set of microbiome that's actually different than the oral microbiome. But here's the deal. A few years ago, a very famous actor got throat cancer and went through, thankfully, successful treatment for that throat cancer. Now, I got a lot of talk in the tabloids, but in fact, we now know that about 75% of all oral and throat head and neck cancers are caused by the HPV virus, the human papillomavirus. And we all hear about HPV injection shots, vaccines for young kids and prepubescent females. And we're now actually finding that men can contract the human papilloma virus virus from oral sex. Now, here's. I guess the good news is that if you have a head and neck cancer that tests positive for HPV, and about 75% of them now test positive for HPV, that the treatment the chemotherapy treatment, the radiation treatment is incredibly effective at curing that problem. Quite frankly. My long term partner at Loma Linda, Dr. Leonard Bailey, eventually passed away this past year from recurrent head and neck cancer. And I am no way saying that it was hpv because we didn't test for that back then. But the point is that used to be a lethal disease, almost no cures, but now we're incredibly successful at treating that disease. If you're positive for hpv, but be careful, and that is a real consideration, we now know that if you are infected with hpv, that that's a consideration. The same thing we know about anal sex. Number one, please use protection. In my community of Palm Spring Springs, a huge number of my patients are gay or lesbian and anal sex is a huge part of their lifestyle. But just as you can get the HPV virus transmitted orally, you can also transmit the HPV virus anally. But we also see a large number of men get anal and rectal cancers from viral transmission. So let's be careful out there. That's all I'm going to say on the subject. All right. Finally, can you fix Peyronie's disease with a lectin free diet? So Peyronie's disease is where your penis is not straight, but it's got a curve like a banana, just like the things you see. Believe it or not, Peyronie's disease is an autoimmune disease caused by lectins. And I have a number of men who've come to me with that problem. And then we get a lectin free diet and guess what? Willy straightens right back up. So Peyronie's disease is curable with a lectin free diet. I've seen it in my own practice.
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Podcast Host
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