When it comes to sex, we Brits have a unique attitude and reputation. We seem obsessed by it — though judging by the number of people who watch Love Island, the obsession is with others having sex, as surveys show we’re having it less and less (and even then, we’re not that great at it, according to surveys of satisfaction levels).
Meanwhile, problems such as erectile dysfunction are often not taken seriously; the attitude is very much, if you suffer from impotence, just take Viagra — that will sort it, and no need to worry.
Impotence is actually very serious: and while its causes are a complex mix of the psychological and the physical, for a significant number of men, the key problem is reduced blood flow to the penis.
Meanwhile, problems such as erectile dysfunction are often not taken seriously; the attitude is very much, if you suffer from impotence, just take Viagra — that will sort it, and no need to worry.
Many men get Viagra over the counter or over the internet without seeing their doctor
In fact, the risk factors for heart disease and stroke also lead to an inability to get an erection; that’s high cholesterol, increased blood pressure, lack of exercise, obesity and metabolic syndrome (where your insulin levels are perpetually high because you’re eating too much carbohydrate and sugar).
It’s a ‘canary in the mine’ type of condition — the first sign that there could be blocked arteries elsewhere in your body, especially the heart, which is why it’s so vital to seek medical help as soon as you experience it.
About two thirds of men who’ve had a heart attack have had erectile dysfunction in the previous five years. And you’re nearly 50 per cent more likely to have a heart attack if you have erectile dysfunction.
I have seen so many patients who have come into A&E with a heart attack, who when you ask them about any other medical issues, then reveal that they have problems getting erections.
DYNAMIC DUOS: Nutrients that are best consumed together
This week: Iron and vitamin C
A lack of iron is quite common in children and adolescents during periods of rapid growth, in women of menstrual age and during pregnancy. Symptoms include low energy, being more susceptible to infections and in severe cases, heart palpitations.
‘Red meat and offal are rich sources of haem iron, which is well absorbed by the body,’ says dietitian Orli Rhodes. ‘Fish and poultry offer useful amounts of this type of iron, too.’
Red pepper provides vitamin C
Iron from plant sources such as pulses, legumes, nuts, grains and dark green leafy vegetables, known as ‘non-haem’ iron, is absorbed less easily, she explains, which can affect those on vegetarian or vegan diets, or who eat little red meat. But vitamin C (found in citrus fruit, red peppers, berries or tomatoes) can boost the absorption of non-haem iron.
Try: Spinach and lentil-stuffed red peppers; fortified breakfast cereal with blueberries; tofu stir-fry (with broccoli).
However, many never spoke to their doctor about it or simply got Viagra over the counter or over the internet, and so the risk factors which led to the heart attack were left unmanaged.
So if you’re suffering from erectile dysfunction, it warrants a wider health review — not just buying a prescription online.
Not least as we know that it’s also associated with developing dementia. This was proved beyond doubt in a 2015 study published in the journal Medicine, which looked at a million men over a seven-year period: those with erectile dysfunction had a 68 per cent higher chance of also developing dementia in that time.
So to me, it was no great surprise when a couple of weeks ago I saw the headlines that ‘Viagra can help stop dementia’. And the study, published in the highly respected journal Neurology, really does provide good evidence for this association: the researchers compared two groups of men with erectile dysfunction — those who took Viagra and those who didn’t; in total, over a quarter of a million men.
By the end of the study, 1,119 of them had been diagnosed with Alzheimer’s. Those who’d taken Viagra were 18 per cent less likely to get dementia — and the benefits of Viagra were greater the more you took, with more than 20 prescriptions leading to a 44 per cent reduction in dementia risk.
If Viagra is the key (and that the dementia benefits aren’t down to sex alone), how does it work in reducing dementia? And could women benefit in the same way if they took it?
The drug was originally developed to treat angina, a condition caused by a lack of blood flow to the heart. Viagra helps the blood vessels to dilate, improving blood flow and reducing the symptoms of angina such as chest pain.
The mechanism is complex, but in essence the drug enhances the effect of nitric oxide, a compound that helps relax blood vessels.
An unanticipated — but welcome — side-effect was that men on the trials reported it helped their erectile dysfunction.
From this we can reasonably conclude that the dilation of the blood vessels Viagra causes so effectively in the penis, happens in the brain, too.
And increased blood flow in the brain means more oxygen to its cells and less cell damage.
So could this work in women, too? Viagra for sexual dysfunction in women has shown no benefit — doubtless partly because there are far fewer receptors that the drug works on in women’s genital area than in the penis, but also because female arousal is so much more complex than blood flow.
But what about preventing dementia in women — or in people without erectile dysfunction? This research hasn’t been done, but it could be that one day, more of us, not just men struggling with impotence, could be prescribed Viagra to save their brains.
Personally I don’t think that’s a great idea because of its side-effects (such as headaches, flushing, indigestion and visual problems).
More interesting for anyone who wants to protect their brain is what this unexpected Viagra study reveals about the debate over what actually causes dementia.
For a long time the view has been that Alzheimer’s — the most common cause of dementia — is caused by tangles of proteins damaging neurons in the brain.
SECRETS OF AN A-LIST BODY: How to get the enviable physiques of the stars
Jennifer Aniston showed off her sculpted arms at the Screen Actor’s Guild Awards on Sunday.
The 55-year-old actor’s exercise regimen includes the ‘15-15-15’ — 15 minutes each on a spin bike, cross trainer and running machine. She also travels with 8lb weights to do arm exercises ‘watching TV or talking on the phone’. For the past few years she’s been a fan of the Pvolve workout — described as Pilates with a twist.
Jennifer Aniston and her sculpted arms
What to try: Use light weights to do the ‘sparklers’ Pilates move. Hold the weights in front of your thighs, palms facing in. Draw small circles with the weights, then lift arms as you continue drawing circles up to the sky. At the top, reverse direction and draw small circles as you lower back down. This will tone the entire arm as well as the chest. Do three sets of eight repetitions, every other day.
In fact, billions has been poured into drugs to tackle these for more than 30 years, and even the new ‘breakthrough’ treatments of the last year or so, such as lecanemab, have plenty of question marks over them.
And if these proteins were the cause, this couldn’t explain the study results showing that men on Viagra had a lower risk of dementia.
But if it’s the lack of blood flow that causes the dementia, and the protein tangles are a side-effect of cell damage, then this could explain Viagra’s impact.
And we can easily replicate the way Viagra works by increasing nitric oxide levels in the blood going to the brain.
In so-called ‘blue zones’ — places such as Sardinia in Italy and Okinawa in Japan, where life expectancy is incredibly high and levels of dementia incredibly low — their diets are rich in foods that are high in nitrates, which the body converts into nitric oxide. These are leafy vegetables such as seaweed, spinach, kale, beetroot, celery and radish.
Eating foods abundant in L-arginine — which gets converted to nitric oxide — could also help: these include nuts, seeds and beans; as well as foods containing L-citrulline — found in squash, pumpkin, cucumber, melon and watermelon. L-citrulline is converted in the body to L-arginine and is absorbed more readily.
Supplements of L-arginine and L-citrulline are also being investigated for their potential benefits. In 2020 in the journal Alzheimer’s and Dementia, L-citrulline was shown to slow cognitive decline in mice — meanwhile a study in 2022, published in the journal Frontiers in Cardiovascular Medicine, involving 72 frail patients with high blood pressure, showed those who were given L-arginine for four weeks had improved levels of cognition — not just a slower decline — better than a placebo group.
Antioxidants may also help — these molecules neutralise the harmful effects of free radicals, formed after various chemical reactions and that damage cells ; antioxidants also boost the production of nitric oxide. Higher levels of antioxidants mean more nitric oxide.
Foods rich in antioxidants include fruit, vegetables and dark chocolate. (Be careful about taking supplements of antioxidants, though, as these may reduce your body’s own production of them and cause harm).
Eloquent proof that antioxidants could help prevent dementia came in a study published in the journal Neurology in 2022, which found that higher levels of antioxidants in the blood was associated with lower levels of the condition.
High blood pressure can impair nitric oxide production by directly damaging the lining of the blood vessels that makes it. And finally, regular physical activity is also crucial to stimulate nitric oxide production as well as naturally increasing antioxidant levels.
So what can we take from all this? Crucially, if you have erectile dysfunction, don’t just take a pill — seek medical help to tackle the underlying issues. And for the rest of us, a healthy and active lifestyle is, as always, key.
