Erections and aging
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Of men between ages 40 and 70, about half have ED (Feldman, 1994), increasing markedly with each decade so that the large majority of men will have ED by their 70’s (10% at age 40 and over 80% after age 70 (O'Leary, 2003). However, averages are very deceiving. In men with no risk factors (coronary artery disease, obesity, diabetes, hypertension, lack of exercise, poor diet, and/or inflammatory conditions (e.g. gingivitis, autoimmune diseases), the chance of ED would be very small. For those men it is more a matter of improving and maintaining erectile function, their relationship with their partners, and the satisfaction each is receiving from his/her love life. For those with a lot of risk factors the man may not be able to achieve an erection at all; with careful attention to reducing those risk factors, the response to and satisfaction from Viagra-like drugs may markedly improve. One of the most insightful sayings is that it doesn’t matter as much what happens to you, as how you handle it. In this section we will discuss the reasons that erectile health decreases so dramatically with aging.
Risk factors that accelerate the effects of aging on ED
Oxidative stress (OS)
OS increases with age and plays a central role by interfering with No production and therefore the health of your blood vessels. OS causes resistance to the action of insulin, which naturally stimulates NO and keeps blood sugar levels down. OS can also damage the delicate molecules and processes within each cell, including DNA and therefore increasing the risk of cancer. OS is increased with obesity, diabetes, excessive intake of fat and sugar, and inflammatory conditions. Part of the age-related increase is because one of the central antioxidant systems protecting every cell, glutathione, decreases with age (Suh, 2004). Antioxidants, from food and supplements and stimulated by exercise and Viagra-like drugs, strongly oppose the adverse effects of OS. For example, chocolate intake decreases the chance of dying following a heart attack (Janszky, 2009), and blueberries counteract insulin resistance (Stull, 2016).
Obesity increases with age because there are 365 days in every year. An extra 10 calories each day (a small lifesaver candy) will add up to 10 pounds per year and 40 pounds in 40 years, which is enough to raise BMI to the obese range (Meldrum, 2017). Besides being an important cause of OS and inflammation, obesity makes it more difficult to exercise, and burning the increased number of calories required to maintain the larger mass of tissue further increases OS. Obesity also increases the chance of high blood pressure and diabetes, each further increasing the likelihood of ED.
Lack of Exercise
Exercise decreases with age, likely due to factors such as greater use of non-active forms of entertainment, promotions to desk jobs, increased body weight, and onset of joint issues and diseases that make exercise more difficult. A sedentary lifestyle increases the chance of erectile difficulties by 10-fold, and of full-blown ED 3-fold. It is the single most important way to improve erectile function, mainly by markedly decreasing OS. It also is the most important way to decrease vascular and heart diseases and to prevent senility and Alzheimer’s. Being less active also causes loss of lean muscle mass, and that contributes to insulin resistance, as circulating glucose is primarily cleared by muscle tissue. Physical inactivity is associated with a decreased level of the principal circulating antioxidant, Pon-1, and its associated protective blood lipid, HDL cholesterol (Senti, 2003). Active exercising may also contribute to pelvic floor strength, although walking at a relaxed pace may be naturally accompanied by relaxation of those muscles and decreased pelvic floor strength (Sousa, 2018). If a man gets in the habit of contracting the pelvic floor during all exercise, that is a convenient time to strengthen those muscles without taking any more time from his day.
The frequency of coitus decreases with age (Brewis, 2005). Men having a coital frequency of less than once per week have a doubling in ED (Koskimaki, 2008). The marked increase of blood flow into the penile arteries and penile tissue stimulates NO release from the blood vessel lining by “shear force” (the mechanical deforming of the lining stimulates NO). Increasing blood flow into the penis has been used successfully to maintain erectile function after radical prostate surgery (Pace, 2010). Use of Viagra-like drugs helps after such surgeries by enabling spontaneous and induced erections (Salonia, 2012).
Anatomic penile changes with aging
In animal models of aging, decreased smooth muscle and increased fibrosis have been observed, which were largely reversed by chronic administration of sildenafil (Viagra) (Ferrini, 2007). Increased NO and better erections may prevent these anatomic changes due to aging.
L-arginine is the raw material from which NO is produced. Arginase, an enzyme that breaks down L-arginine during absorption, increases with age (Segal, 2012). The normal diet contains on average about 5 grams of L-arginine, but again, averages are misleading. Chicken and turkey contain large amounts whereas a vegetarian may consume much smaller amounts, magnifying the effect of aging. Studies examining L-arginine supplements showing little benefit may have had small numbers of men with a low intake. For older men with low protein intake, L-arginine supplements could yield important benefits.
Diet (excessive sugar and fat)
As a person ages, better finances may mean a better and fattier grade of beef, more eating out where portion sizes are larger and added sugar and calories are part of attracting customers, or the ability to spend more at the grocery store. In our book “Survival of the Firmest”, available on Amazon/kindle or itunes, we gives lots of handy suggestions for a healthier diet.
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For much more detail, you can download our book, “The Obesity Crisis – learning to survive in a health-hostile environment" $9.99
Gingivitis, which increases with age and is associated with an increased chance of heart attacks, increases inflammation and decreases NO (Tonetti, 2007). A marked effect on NO production and erection has been shown in animal models (Zuo, 2011). Regular dental prophylaxis, and more frequently with actual gum disease, is money well spent rather than having the costs, morbidity, mortality and tooth loss that may otherwise occur. In the above study (Tonetti, 2007), 6 months after agressive treatment of gingivitis vascular NO was significantly increased
compared to controls. Autoimmune diseases have been reported to increase the chance of ED. Inflammation increases OS as well as directly decreasing NO. A prudent (“Mediterranean”) diet is anti-inflammatory, as are omega-3’s (Ferrucci). For anyone living with inflammation, including obesity, both an improved diet and fish oil supplements will have important benefits for health.
Low testosterone (T)
Circulating T decreases with age and T supplementation can improve erectile function and the response to PDE-5 inhibitors like Viagra. Calculation of bioavailable T requires measurement of total T and its serum binding proteins, sex hormone binding globulin (SHBG) and albumen (the latter is generally included in blood chemistry panels). On the Greek island of Ikaria, one of the "Blue Zones" where an unusual proportion of inhabitants live into their 90's, a survey of men ages 65 to 100 revealed that 4 out of 5 were still having sex regularly. On the island inhabitants enjoy a mediterranean diet with an unusual proportion of vegetables and they maintain a normal weight, the hilly terrain makes exercise an integral part of daily life, and their stress level is low. A 102 year old man has been featured who worked building stone fences until he finally retired at 100!
How long can a good thing last?
Low testosterone (T)
Circulating T decreases with age and T supplementation can improve erectile function and the response to PDE-5 inhibitors like Viagra. Calculation of bioavailable T requires measurement of total T and its serum binding proteins, sex hormone binding globulin (SHBG) and albumen (the latter is generally included in blood chemistry panels).
On the Greek island of Ikaria, one of the "Blue Zones" where an unusual proportion of inhabitants live into their 90's, a survey of men ages 65 to 100 revealed that 4 out of 5 were still having sex regularly. On the island inhabitants enjoy a mediterranean diet with an unusual proportion of vegetables and they maintain a normal weight, the hilly terrain makes exercise an integral part of daily life, and their stress level is low. A 102 year old man has been featured who worked building stone fences until he finally retired at 100!