NMT150 NUT WK 13 (1).pdf

WEIGHT & ERECTILE DYSFUNCTION AUTHOR: D R. M A R YA M YAVA R I , M D, P H. D. , N D NMT150 2023 LEARNING OBJECTIVES Considerations for providing nutritional guidance as it relates to this week’s case presentation: Diet Reduce Alcohol and smoking L arginine Life Style TREATME...

WEIGHT & ERECTILE DYSFUNCTION AUTHOR: D R. M A R YA M YAVA R I , M D, P H. D. , N D NMT150 2023 LEARNING OBJECTIVES Considerations for providing nutritional guidance as it relates to this week’s case presentation: Diet Reduce Alcohol and smoking L arginine Life Style TREATMENT GOALS Address presenting symptoms and improve patient comfort Support full and speedy recovery to return to regular activities Patient education Monitor and Prevent sequelae  VASCULAR HEALTH T2DM incidence in the US has increased. This increase is associated with sedentary lifestyle, obesity, and an aging population. Obesity is a major risk factor for ED in diabetics, with a prevalence of 32.2% in the US. Testosterone deficiency and Metabolic syndrome are strongly associated. https://www.sciencedirect.com/science/article/abs/pii/S1743609515310031  VASCULAR HEALTH Erectile dysfunction (ED) is common in patients with cardiovascular disease (CVD). ED affects quality of life and is an independent risk factor for future cardiovascular events. A 3-year time period between onset of ED symptoms and CVD event allows for risk mitigation. Sexual function should be included in CVD risk assessment for all men. https://academic.oup.com/eurheartj/article/34/27/2034/440049  DIET Eating a balanced diet help maintain sexual function and decrease the risk of ED. A study found that men who more strictly followed a Mediterranean diet had a reduced risk of developing ED. In particular, they consumed less red or processed meat and primarily ate: Fruits, vegetables, legumes, nuts, Fish Another study similarly found that eating more fruits, vegetables, and flavonoids lowered the risk of ED in men ages 18 to 40. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8451697/ https://www.sciencedirect.com/science/article/abs/pii/S1743609515310031  DIET & FREE RADICALS Oxidative stress is involved in arteriogenic ED, which may result from lack of perfusion, antioxidant deficiency, and waste product accumulation. Oxidative radicals contribute to impaired endothelium- dependent smooth muscle relaxation, mitochondrial injury, endothelial structural damage, and erectile tissue fibrosis in arteriogenic ED. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8451697/ https://www.sciencedirect.com/science/article/abs/pii/S1743609515310031  DIET & FREE RADICALS Antioxidant therapy can efficiently improve molecular and ultrastructural alterations in erectile tissue, but it may not have a significant effect on fibrosis and functional deficit. Long-term consumption of dietary antioxidants may improve erectile function by removing oxidative products and preserving NO bioavailability and endothelial and mitochondrial structural integrity. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2605.2010.01083.x https://www.foodingredientsfirst.com/news/rapid-testing-for-food-antioxidants-developed-by-researchers-in-japan.html  DIET & PAD A diet without the right balance of nutrients can contribute to the development and progression of Peripheral Artery Disease Following a heart-healthy diet is key, which involves reducing intake of saturated fats, simple sugars, fats, and trans fats, limiting sodium, and increasing fiber intake Certain diets like the Mediterranean diet and DASH diet can improve vascular health in people with PAD by increasing healthy fats, fruits and vegetables, nuts, and decreasing unhealthy fats, sodium, and sugar intake Following a healthy diet for PAD can lessen symptoms such as leg pain, numbness, or weakness and improve quality of life. https://jamanetwork.com/journals/jama/fullarticle/1817779 https://www.sciencedirect.com/science/article/abs/pii/S0021915018302922  ALCOHOL Studies have shown mixed results for the effects of alcohol on ED. Short-term consumption of alcohol can cause a temporary inability to get an erection by depressing the central nervous system, decreasing penis sensitivity, and limiting blood flow to the penis. Alcohol is a diuretic, leading to dehydration and increased levels of angiotensin, which can narrow blood vessels and limit blood flow to the penis. https://www.nature.com/articles/3901556  ALCOHOL Chronic consumption of large amounts of alcohol can damage nerves, increase the risk of cardiovascular disease, and damage blood vessels, all of which can impact erectile function. Chronic heavy alcohol users may experience dysfunction of the autonomic nervous system, with ED being a common symptom. ED is closely related to cardiovascular disease, and heavy alcohol consumption increases the risk of developing high blood pressure, which is a risk factor for sexual dysfunction. https://www.nature.com/articles/3901556  SMOKING Impotence is twice as likely to occur in smokers than non- smokers, with exposure to second-hand smoke being a significant factor. Smoking can affect the nervous system, hormones, and vascular system required for sexual functioning, leading to impotence. https://www.canada.ca/en/health-canada/services/health-concerns/tobacco/smoking-your-body/smoking-diseases/impotence-smoking.html  SMOKING Long-term smoking causes physiological damage and increases the risk of moderate or severe impotence. Quitting smoking can partially or fully recover erectile function, depending on the degree of damage inflicted and which system is affected. Heavy smokers (40+ cigarettes/day) had "softest" night-time erections, and smoking was related to an abnormal decline of blood pressure in the penis. Men who have reported losing their erections before orgasm have completely reversed this situation by quitting smoking. https://www.canada.ca/en/health-canada/services/health-concerns/tobacco/smoking-your-body/smoking-diseases/impotence-smoking.html  WEIGHT MANAGEMENT Obesity and overweight are independent risk factors of erectile dysfunction (ED). ED is significantly more common in men with obesity, who are overweight, or with a larger waist circumference. https://pubmed.ncbi.nlm.nih.gov/34644814/  WEIGHT MANAGEMENT Meta-analysis was performed to clarify the therapeutic effect of weight loss on erectile function: 5 studies with 619 participants were enrolled in the meta-analysis. It showed that weight loss can improve erectile function in overweight or obese men. Losing weight could serve as an adjuvant therapy for ED. https://pubmed.ncbi.nlm.nih.gov/34644814/  WEIGHT MANAGEMENT Being overweight is linked to erectile dysfunction (ED). Obesity lowers testosterone in men, which can affect sex drive. Extra weight can cause circulatory problems and heart disease, which can also lead to ED. Medications that treat conditions caused by extra weight can also cause ED. Stress, depression, and anxiety related to weight can also cause ED. Regular exercise can lower the risk of ED and boost mood and body image. https://www.sciencedirect.com/science/article/abs/pii/S0140673612605200 https://www.sciencedirect.com/science/article/abs/pii/S1743609515310031  L-ARGININE L-arginine is an amino acid obtained through dietary sources or produced from L-citrulline L-arginine may be more effective in patients with ED with low nitric oxide L-arginine can allow for long-duration treatment for ED. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8451697/ INDICATIONS Taking 2.5-5 grams of L-arginine daily by mouth may improve sexual function in people with ED. L-arginine, when taken with medications such as sildenafil and tadalafil, may work better than taking either L-arginine or the medication alone for ED. L-arginine by mouth may improve symptoms and exercise tolerance in people with angina but does not seem to widen narrowed blood vessels. L-arginine by mouth can reduce blood pressure in healthy people, people with high blood pressure, and people with slightly high blood pressure with or without diabetes. OTHER LIFESTYLE FACTORS Sleep Exercise Psychotherapy Stress reduction  CASE John is a 55-year-old man who presents to your naturopathic clinic with complaints of erectile dysfunction (ED) for the past year. He has no significant medical history, is not taking any medications, and denies tobacco or recreational drug use. He reports a healthy diet and moderate exercise routine. Physical examination is unremarkable. Laboratory testing reveals normal testosterone levels, lipid panel, and fasting glucose. As a naturopathic doctor, you decide to take a holistic approach to John's ED, incorporating both nutritional and lifestyle interventions to address the root cause of his condition. which of the following dietary changes would be beneficial for John? a) Eating a diet rich in fruits, vegetables, whole grains, and lean protein b) Reducing or eliminating processed foods and sugar c) Increasing intake of omega-3 fatty acids through fatty fish or supplements d) All of the above REFERENCES CDC: https://www.cdc.gov/ Online source Center for Disease Control and Prevention Updates 2022 Prousky J. Textbook of Integrative Clinical Nutrition. CCNM Press Inc.; 2012. Katz D. Nutrition in Clinical Practice. 2nd Edition. Lippincott Williams & Wilkins; 2008. Katsilambros N. Clinical Nutrition in Practice. WileyBlackwell; 2010. Pizzorno J and Katzinger J. Clinical Pathophysiology. Mind Publishing; 2012. Marz RB. Medical Nutrition from Marz. 2nd edition. Quiet Lion Press; 1999. Murray MT. 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