Erectile dysfunction (ED) is a common clinical entity that affects mainly men older than 40 years and so it has been generally thought that aging is a factor. It is associated with several lifestyle factors, including obesity, limited or absence of physical exercise and lower urinary tract symptoms. It has also long been associated with diabetes and hypertension and is a strong predictor for coronary artery disease. Therefore, a patient presenting simply with ED as his only symptom should receive cardiovascular assessment. Metabolic syndrome is the term given to a cluster of biochemical and physiological abnormalities associated with the development of cardiovascular disease and type 2 diabetes. It is reported to be the most important public health issue threatening the health of men and women all over the world. Its current prevalence is said to be approximately 30% but the numbers are continuously increasing. The syndrome is considered a risk factor for ED by itself.
The Autonomic Nervous System
As has been described in the pages of this website many times, the autonomic nervous system (ANS) is almost completely automatic and is governed by controls in the limbic system of the brain and the brainstem. It consists of two major components, the sympathetic and parasympathetic systems. These two branches of the ANS always work in concert, emphasizing the “do’s” and “don’ts” of body functions. In order to become erect, the arterial blood is pumped into erectile tissue in the penis and the venous return is occluded. This action is under the control of the sympathetic branch of the ANS, while ejaculation is under the control of the parasympathetic branch. Obviously, this is complex because the two branches have to be able to coordinate their activity. That is why ED is a symptom of dysautonomia, a condition that may present with a variety of seemingly unrelated symptoms. These include: fatigue, difficulty concentrating, orthostatic intolerance, heart palpitations, constipation or diarrhea, poor appetite or early satiety, urinary retention or incontinence and, as we have pointed out, ED. Failure to connect the diverse symptoms with a single underlying mechanism may lead to incorrect diagnoses, inappropriate interventions and frustration on the part of both doctors and patients.
An otherwise fit young man, leading an active life, whose only complaint at presentation was dizziness after extreme exertion, has been reported. Subsequently, he developed typical symptoms of autonomic failure, with postural dizziness, urinary abnormalities and erectile failure. Although so-called psychogenic ED is more prevalent in the younger population, at least 15 to 20% of these men have an organic etiology, shown to be a predictor of increased future morbidity and mortality. It is estimated that it affects 20% of men above 40 years of age with the incidence increasing with increasing age. For this reason studies are more frequently carried out among middle-aged and elderly man with underlying the comorbidities such as diabetes, cardiovascular or neurological pathologies and medication. Please note the inclusion of medication, many of which are known to precipitate thiamine deficiency.
The Role of Nutrition in Erectile Dysfunction
A variety of studies have indicated a beneficial effect from vitamin D supplementation on the development of type-2 diabetes. The vitamin biotin also regulates the synthesis of insulin. Benfotiamine, a derivative of thiamine, together with pyridoxamine, a vitamer (any one of a number of chemical compounds, generally having a similar molecular structure, each of which shows vitamin activity in a vitamin-deficient biological system) of vitamin B6, both have properties that make them valuable therapeutic adjuvants in the treatment of diabetic complications. Thus, various vitamins and their derivatives have profound therapeutic potential in the prevention and treatment of type-2 diabetes.
Thiamine is an essential cofactor in carbohydrate metabolism and individuals with diabetes are thiamine deficient. The pathophysiology of recognized complications of thiamine deficiency is similar to that underlying atherosclerosis and the metabolic syndrome, namely oxidative stress, inflammation and endothelial dysfunction. The potential benefit of long-term replacement of thiamine in diabetes is not yet known but may reduce cardiovascular risk and other complications.
A 42-year-old HIV-positive woman had recurrent episodes of vomiting and developed severe dysautonomia, together with the classical manifestations of Wernicke’s encephalopathy. The authors go on to say, “As dysautonomia is frequently the earliest sign of beriberi (the classical thiamine deficiency disease), this case illustrates the continuum between these two diseases whose cause, symptomatic thiamine deficiency, is the same”. It is probably true to say that the recurrent episodes of vomiting were the first manifestations of beriberi rather than being a precipitating factor. Recurrent vomiting as a symptom of beriberi is rarely appreciated by physicians. In fact none of the symptoms are pathognomonic (essential to THAT diagnosis). The point that I am trying to make here is the fallacy of believing the present medical model that different diseases each have their specific differences in etiology and their separate names.
We have tried to show that ED is a form of dysautonomia and has the same underlying cause as metabolic syndrome, diabetes and cardiovascular disease, namely a deficiency of cellular energy, particularly in brain. That is why dysautonomia is the key to understanding why it has been associated with so many different named diseases. It is because the control mechanisms of the autonomic nervous system in the limbic system and brainstem are so highly sensitive to defective energy metabolism as depicted by thiamine deficiency. In our book “Thiamine Deficiency Disease, Dysautonomia and High Calorie Malnutrition” we make a plea for recognition of the widespread ingestion of empty calories as a cause of thiamine deficiency. It is suggested that the common presentation of erectile dysfunction is a symptom that represents poor nutrition, fed by perhaps the commonest of all addictions, namely sugar. The reason for the association of ED with aging is probably because of a natural slow decline in energy metabolism. Is it possible that energy metabolism is the key to all manifestations of disease?
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