Can you walk off Erectile dysfunction?

Researchers writing in the medical journal Urology examined questionnaires returned by over 15,000 aging men and found that moderate or severe sexual symptoms occurred in 20% of men 40 to 44 years and that significant symptoms increased with age up to 67% in the men 65 to 69 years. 1

Other researchers writing in The Journal of Sexual Medicine examined sexual function in older adults and noted that 41% of the men were sexually active with an average age between 75 and 87 (yes that says 87). The men who were not sexual active reported erectile dysfunction as the main reason why. Regardless the researchers concluded that desire for sexual activity remained high among men, despite substantial problems with erectile dysfunction. 2

Erectile dysfunction

It is important to understand that dysfunction is not an inevitable aspect of getting older. In fact, it’s more of a side effect of lifestyle than aging.

My initial advice to a man wanting to preserve or restore his sexual function is, instead of drugs, tie on your running shoes and start walking or jogging and change your nutrition. The old adage, “You are what you eat” rings true for sexual health and performance. Nutrition and exercise control the entire physiology of your body, and what you eat and do reflects in your ability to perform in bed.

Aging Men, Obesity, Metabolic Syndrome, Decrease in Total Serum Testosterone Levels
Researchers writing in the Journal of Urology say that their study “…demonstrated that aging men with obesity and the metabolic syndrome have a significant decrease in total serum testosterone levels compared to aging, metabolically healthy men.” Read more

Decreased Testosterone and Erectile Dysfunction
Researchers writing in the Journal of Urology say that their study clearly demonstrated a decrease in testosterone level throughout a 4-year follow up in patients with ED. Read more

Diabetes and ED
Researchers writing in the British Journal of Urology say that about 1 in 3 men newly diagnosed with diabetes had ED. Read more

Is Erectile Dysfunction A Marker For Diabetes?
Researchers writing in the Journal of Urology say that male dysfunction was “an observable marker of diabetes mellitus, strongly so for men 45 years old or younger and likely for men 46 to 65 years old, but it is not a marker for men older than 66 years.” Read more

1. Mäkinen JI, Perheentupa A, Raitakari OT, et al. Sexual symptoms in aging men indicate poor life satisfaction and increased health service consumption Urology. 2007 Dec;70(6):1194-9.

2. Smith LJ, Mulhall JP, Deveci S, Monaghan N, Reid MC. Sex after seventy: a pilot study of sexual function in older persons. J Sex Med. 2007 Sep;4(5):1247-53.

Erectile Dysfunction and Diabetes

Researchers writing in the Journal of Urology say that male dysfunction was “an observable marker of diabetes mellitus, strongly so for men 45 years old or younger and likely for men 46 to 65 years old, but it is not a marker for men older than 66 years.”

Sun P, Cameron A, Seftel A, Shabsigh R, Niederberger C, Guay A. Erectile dysfunction–an observable marker of diabetes mellitus? A large national epidemiological study.J Urol. 2006 Sep;176(3):1081-5; discussion 1085
From the study abstract
Read more

Be Active: Reduce Diabetes Risk, Live Longer

Jonker JT,De Laet C,Franco OH, Peeters A, Mackenbach J, Nusselder WJ. Physical Activity and Life Expectancy With and Without Diabetes. Diabetes Care 29:38-43, 2006

Researchers writing in the medical journal Diabetes Care, examined the relationship between active lifestyle, diabetes, and life expectancy. From the abstract:

OBJECTIVE—Physical activity is associated with a reduced risk of developing diabetes and with reduced mortality among diabetic patients. However, the effects of physical activity on the number of years lived with and without diabetes are unclear. Our aim is to calculate the differences in life expectancy with and without type 2 diabetes associated with different levels of physical activity.

CONCLUSIONS—Moderately and highly active people have a longer total life expectancy and live more years free of diabetes than their sedentary counterparts but do not spend more years with diabetes.

Read the abstract

Low Gylcemic Index Foods for Weight Loss and Diabetes

Researchers writing in The Diabetes Educator say that incorporating more low-glycemic foods helped individuals with weight control and diabetes.

From the abstract:
“PURPOSE: This retrospective study evaluated the incorporation of low-glycemic index (GI) carbohydrates into daily meal planning as an effective behavioral lifestyle change to improve glycemic control and weight management in patients with type 1 and 2 diabetes.

CONCLUSIONS: Daily incorporation of low-GI carbohydrates in meal planning can be an effective diabetes self-management strategy for glycemic control and weight management. The documented responses to the subjects’ conceptual and practical knowledge of the GI confirm their acceptance of this approach as a permanent behavioral lifestyle change and not a “diet.” The positive results of this study attest to what worked for these subjects, inviting diabetes educators to consider offering low-GI dietary advice to their diabetes patients.”

Read the abstract
Burani J, Longo PJ. Low–Glycemic Index Carbohydrates. An Effective Behavioral Change for Glycemic Control and Weight Management in Patients With Type 1 and 2 Diabetes. The Diabetes Educator, Vol. 32, No. 1, 78-88 (2006)

Weight, Obesity, and Diabetes Research

Menopause and Obesity
After menopause, many women notice that their muscle-to-fat ratio tilts in favor of the latter and the battle of the bulge is increasingly difficult. All the hormones, especially estradiol and testosterone, can help tip the scale back in the right direction.

Estradiol, increases fat breakdown from body fat stores so that it can be used as fuel and increases basal metabolic rate, while testosterone has been shown to maintain muscle tone, volume, and strength, increase metabolism, and decrease body fat. In a 2000 study, featured in Menopause, estrogen supplementation had effects on body fat distribution in postmenopausal women that was associated with improved lipid parameters.

The Journal of Clinical Endocrinology and Metabolism reported that obese women given low doses of testosterone lost more body fat and subcutaneous abdominal fat, and gained more muscle mass than women who were placed on a placebo.

In a 2006 study, researchers writing in the medical journal Diabetes, Obesity & Metabolism found “HRT reduces abdominal obesity, insulin resistance, new-onset diabetes, lipids, blood pressure, adhesion molecules and procoagulant factors in women without diabetes and reduced insulin resistance and fasting glucose in women with diabetes.”

Women are not alone in the hormonal decline department. Men also experience a falling off of hormone levels. In my practice, I have found that most men over forty suffer from low levels of testosterone, a condition called andropause, or male menopause. Testosterone decline may be linked to many age-related symptoms like muscle weakness, bone loss, memory complications, weight gain and heart disease. As far as quality of life is concerned, in the absence of normal-to-high levels of testosterone, men suffer from mood swings, fatigue, and libido dysfunction

Not everyone will benefit from hormone supplementation. The goals, realities, and risks of hormone supplementation should be discussed, at length, with your physician prior to onset of treatment.

Insulin Resistance, Weight Gain Lead to Early Aging
When we eat, our bodies release insulin into our blood stream so that we can process glucose (sugars) from our foods to make energy, especially in our muscles. Glucose belongs in our cells and not in our blood. When it remains in our blood we produce more insulin. Increased insulin, according to many researchers, is the number one factor for accelerated aging.

Waist Size and Health Risks in 50-95 Year Olds
Researchers writing in the medical journal Diabetes Care say that while overall body fat and fitness levels are important in predicting health risks, it is your waist size or the measurement of abdominal obesity that is the still the measurement to assess health risk among older adults.

Exercise, Abdominal Fat, Insulin Resistance
Researchers writing in The Journal of Applied Physiology studied 16 obese men and women, about 63 years old, during a 12 week exercise program.

Low Gylcemic Index Foods for Weight Loss and Diabetes
Researchers writing in The Diabetes Educator say that incorporating more low-glycemic foods helped individuals with weight control and diabetes.

UCSD Study Sheds New Light on Insulin’s Role in Blocking Fat Breakdown in Patients with Type II Diabetes
“Chronically high levels of insulin, as is found in many people with obesity and Type II diabetes, may block specific hormones that trigger energy release into the body, according to researchers at the University of California, San Diego (UCSD) School of Medicine. Their findings, which may point to new approaches to developing improved treatment options for the disease…”

Be Active: Reduce Diabetes Risk, Live Longer
Researchers writing in the medical journal Diabetes Care, examined the relationship between active lifestyle, diabetes, and life expectancy.

Exercise, Diabetes, Diabetes Risk
Researchers writing in the Medical Journal Diabetes Care say patients may need more convincing that exercise assists in diabetes management and diabetes risk management.

Obesity and Decreased Hormone Production
Researchers writing in the medical journal Clinical Endocrinology say that “Obesity may predict greater decline in testosterone and SHBG levels with age.”

Abdominal Fat Strongest Indication of Health Risks
Researchers writing in the medical journal Obesity, say that waist measurement is one of the most useful indicators of health risk.

Sleep and Diabetes Risk in Men
Researchers writing in the medical journal Diabetes Care say that too little or too much sleep increases diabetes risk. The researchers say that men getting 5 to 6 hours of sleep a night were twice as likely to develop diabetes, men getting more than 8 hours were three times more likely to develop diabetes. They also noted that testosterone may be a factor in sleep on diabetes.

Testosterone, Diabetes, and Cardiovascular Disease
New research says Testosterone may have a protective role in the development of metabolic syndrome and subsequent diabetes mellitus and cardiovascular disease in aging men.

Middle Aged Men, Metabolic Syndrome, Stroke Risk
Finish researchers say that middle aged men with Metabolic Syndrome have twice the risk of suffering from a stroke. Read more

Metabolic Syndrome and Stroke
Researchers writing in the Archives of Internal Medicine say that preventing and controlling Metabolic Syndrome is likely to reduce risk of stroke.

Exercise, Diabetes, Diabetes Risk

Researchers writing in the Medical Journal Diabetes Care say patients may need more convincing that exercise assists in diabetes management and diabetes risk management.

From the study abstract:
“With increased focus on the obesity and diabetes epidemics, and the clear benefit of exercise in disease prevention and management, this study determined the lifetime prevalence of health professional advice to exercise among individuals with or at risk for diabetes.

A total of 73% of adults with diabetes were told by a health professional to exercise more versus 31% of adults without diabetes. The proportion receiving advice increased as the number of diabetes risk factors increased until reaching similar rates as people with diabetes.

Health professionals advised most patients with or at highest risk for diabetes to exercise, suggesting recognition of its importance for disease management. As risk factors declined, fewer patients were advised to exercise, suggesting missed opportunities for disease prevention. However, exercise has not increased proportional to exercise advice. The challenge remains converting patient awareness into behavior change.”

Morrato EH, Hill JO, Wyatt HR, Ghushchyan V, Sullivan PW. Are Health Care Professionals Advising Patients With Diabetes or At Risk for Developing Diabetes to Exercise More? Diabetes Care 29:543-548, 2006

Click for article abstract

Diabetes and ED

Researchers writing in the British journal of urology say that about 1 in 3 men newly diagnosed with diabetes had ED.

The prevalence and predictors of erectile dysfunction in men with newly diagnosed with type 2 diabetes mellitus.Al-Hunayan A, Al-Mutar M, Kehinde EO, Thalib L, Al-Ghorory M. BJU Int. 2006 Oct 9;

From the article abstract
OBJECTIVE To determine the prevalence of and risk factors for erectile dysfunction (ED) in men newly diagnosed with type 2 diabetes mellitus (DM).

PATIENTS AND METHODS All consecutive samples of men newly diagnosed with type 2 DM attending the diabetes centre in the capital of Kuwait were included in the study. Face-to-face interviews with the men were conducted using the International Index of Erectile Function (IIEF)-5 questionnaire. A threshold IIEF-5 score of <21 was used to identify men with ED. Pertinent clinical and laboratory characteristics were collected. RESULTS Of 323 men with newly diagnosed type 2 DM, 31% had ED; comparing potent men and men with ED, there were statistically significant differences for smoking, duration of smoking, hypertension, education level, body mass index and serum glycosylated haemoglobin level. Among these, age was the most important risk factor identified by multivariate logistic regression.

CONCLUSION About a third of men with newly diagnosed type 2 DM had ED; this was associated with many variables, but most notably with age at presentation.

Sleep and Diabetes Risk in Men

Researchers writing in the medical journal Diabetes Care say that too little or too much sleep increases diabetes risk. The researchers say that men getting 5 to 6 hours of sleep a night were twice as likely to develop diabetes, men getting more than 8 hours were three times more likely to develop diabetes. They also noted that testosterone may be a factor in sleep on diabetes.

Highlights from the study abstract
“OBJECTIVE—Short-term partial sleep restriction results in glucose intolerance and insulin resistance. The purpose of this study was to assess the long-term relationship between sleep duration and the incidence of clinical diabetes.

RESEARCH DESIGN AND METHODS—A cohort of men from the Massachusetts Male Aging Study without diabetes at baseline (1987–1989) were followed until 2004 for the development of diabetes. Average number of hours of sleep per night was grouped into the following categories: 5, 6, 7, 8, and >8 h. Incidence rates and relative risks (RRs) were calculated for the development of diabetes in each sleep duration category. Those reporting 7 [hours] of sleep per night served as the reference group.

RESULTS—Men reporting short sleep duration (5 and 6 [hours] of sleep per night) were twice as likely to develop diabetes, and men reporting long sleep duration [more than 8 hours of sleep per night] were more than three times as likely to develop diabetes over the period of follow-up.

Elevated risks remained essentially unchanged after adjustment for age, hypertension, smoking status, self-rated health status, education, and waist circumference. (Relative Risks) were altered considerably for the two extreme sleep groups when adjusted for testosterone…suggesting that the effects of sleep on diabetes could be mediated via changes in endogenous testosterone levels.

CONCLUSIONS—Short and long sleep durations increase the risk of developing diabetes, independent of confounding factors. Sleep duration may represent a novel risk factor for diabetes.”

Yaggi HK, Araujo AB, McKinlay JB. Sleep Duration as a Risk Factor for the Development of Type 2 Diabetes. Diabetes Care 29:657-661, 2006.
Read the full abstract

Does Being Optimistic Really Lower Risk From Cardiovascular Disease in Elderly Men?
Researchers writing in the medical journal the Archives of Internal Medicine say that having an optimistic outlook, DOES lower mortality risk associated with cardiovascular disease. Read more

Hypoandrogen-Metabolic Syndrome in Men

Gould DC, Kirby RS, Amoroso P. Hypoandrogen-metabolic syndrome: a potentially common and underdiagnosed condition in men. Int J Clin Pract. 2007 Feb;61(2):341-4.

Researchers writing in the International Journal of Clinical Practice say Men with (Hypoandrogen-metabolic syndrome) and symptoms of androgen deficiency may be managed by, in the absence of contraindications, testosterone replacement therapy along with weight reduction and other measures to normalize glucose, lipid and blood pressure control.

The researchers noted that symptoms of androgen deficiency (hypoandrogenaemia (hypogonadism, hypotestosteronaemia) may be a common accompanying factor in men with the metabolic syndrome and when androgen deficiency and metabolic syndrome are present together “they may be considered as a specific entity, the hypoandrogen-metabolic (HAM) syndrome.”

The researchers concluded: “The prevalence of both hypoandrogenaemia and the metabolic syndrome increases with age and the clinician will frequently attend to men in their middle to advanced years with obesity, low androgen levels and metabolic syndrome.

These conditions place men at an increased risk of cardiovascular and coronary heart disease and type 2 diabetes and can be simply investigated with weight, waist and blood pressure measurement and blood sample analyses.

Men with HAM and symptoms of androgen deficiency may be managed by, in the absence of contraindications, testosterone replacement therapy along with weight reduction and other measures to normalise glucose, lipid and blood pressure control.”

Testosterone, Diabetes, Metabolic Syndrome

Recent research in the International Journal of Impotence Research say testosterone may have a protective role in the development of metabolic syndrome and subsequent diabetes mellitus and cardiovascular disease in aging men. However, clinical trials are needed to confirm this assumption.

Svartberg J.Epidemiology: testosterone and the metabolic syndrome.Int J Impot Res. 2007 Mar-Apr;19(2):124-8.

Low levels of testosterone, hypogonadism, have several common features with the metabolic syndrome. In the Tromso Study, a population-based health survey, testosterone levels were inversely associated with anthropometrical measurements, and the lowest levels of total and free testosterone were found in men with the most pronounced central obesity.

Total testosterone was inversely associated with systolic blood pressure, and men with hypertension had lower levels of both total and free testosterone.

Furthermore, men with diabetes had lower testosterone levels compared to men without a history of diabetes, and an inverse association between testosterone levels and glycosylated hemoglobin was found. Thus, there are strong associations between low levels of testosterone and the different components of the metabolic syndrome. In addition, an independent association between low testosterone levels and the metabolic syndrome itself has recently been presented in both cross-sectional and prospective population-based studies. Thus, testosterone may have a protective role in the development of metabolic syndrome and subsequent diabetes mellitus and cardiovascular disease in aging men. However, clinical trials are needed to confirm this assumption.

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