Nearly 10 percent of men have had a diagnosis of coronary heart disease, which is a term for clogged heart arteries causing angina chest pressure, myocardial infarctions, and the need for heart stents and bypass surgery. Tragically, half of the men who die suddenly of coronary heart disease, hundreds of thousands, have no previous warning symptoms and no chance in the traditional medical model to be diagnosed before death. Of all oddities, erectile dysfunction or ED may be the first clue that identifies sick arteries both above and below the waist that threaten both the quality and quantity of life. ED can include a low interest in sex, difficulty or inability achieving an erection, or difficulty or inability maintaining an erection. Knowing more about ED can truly save a life, perhaps yours or someone you care about and love.

What Causes Erectile Dysfunction?

Blood vessel problems are the most common cause of ED, but the condition can also stem from muscular, hormonal, psychological, and/or nervous system-related issues.


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Furthermore, physical and psychological problems can interact to cause or worsen erectile dysfunction: Difficulty achieving an erection due to a minor physical issue can cause anxiety; that anxiety can, in turn, cause further difficulty. Also, depression, stress, and relationship issues all can result in ED. Some of the physical causes of ED include hardening of blood vessels to the pelvic arteries (atherosclerosis); a variety of heart diseases often due to atherosclerosis; smoking; high blood pressure; cholesterol disorders; diabetes mellitus; multiple sclerosis; alcoholism; prior prostate cancer surgery; spinal cord injury; poor dental health; prescription drug effects; and Parkinson’s disease.

What Is the Connection Between ED and Arteries?

The inner lining of every artery, including arteries to the pelvis, is a single layer of cells called the endothelium. It is estimated that your endothelium would cover six to seven tennis courts of surface area if stretched out! An appreciation of the endothelium won three researchers the Nobel Prize in Medicine in 1998: They figured out that when this wallpaper-like lining was healthy, it produced the gas nitric oxide (NO), which resists plaque, clotting, or constriction of arteries. A good endothelium leads to good sustained erections, just as it leads to good heart artery flow. 

What Is the Heart Risk with ED?

ED is a powerful predictor of future heart events even in men who have no known heart issues. For example, if you live in Olmsted County, Minnesota, near the Mayo Clinic, and are a man between the ages of 40 and 49 without known heart disease but with ED, you have up to a 50-fold higher likelihood of eventually having new heart events compared with men the same age without ED. Rarely in medicine is there ever a risk factor this powerful. 

Are Diabetes and ED Connected?

Men with diabetes have nearly twice the risk of ED. Recent data indicate that in diabetic men ED predicts the presence of diseased arteries and future heart events several years before a heart attack or heart death—making ED a stronger predictive factor than smoking, high blood pressure, or even a family history of early heart disease

Furthermore, in diabetic men who have ED, the risk of future heart events may be three to four times the rate of nondiabetic men who have ED. Recognizing the connection between diabetes, ED,  and cardiovascular disease allows time to identify, treat, and reverse arterial damage.  

How Do Lifestyle and Diet Impact ED?

Lifestyle factors are known to harm the endothelium and its production of nitric oxide, leading to ED. The standard American diet (high in processed foods packed with chemicals, fat, sugar, and salt), lack of exercise, poorly managed stress, environmental toxins such as BPA, and poor sleep are among the lifestyle factors that produce ED. Diets emphasizing whole plant foods—low in saturated fats and rich in minerals, vitamins, and phytonutrients—promote arterial health and erectile success. The flavonoids in fruits, vegetables, herbs, and teas work to prevent ED. 

How Do I Check My Heart If I Have ED?

The first step when ED develops is to seek out a health care practitioner for complete lab work and assessment for undiagnosed heart disease and other medical conditions. The American Heart Association recently updated its guidelines for the management of cholesterol to consider a simple CT scan of the heart known as a coronary artery calcium score (CACS) as pivotal in deciding on therapy and identifying silent heart disease. Abnormalities of blood pressure, blood sugar, cholesterol, sleep, and weight, and lifestyle risk factors such as smoking and stress need to be corrected. 

How Do I Treat ED?

For nearly three decades it has been known that just as arteries can worsen with time, they can also improve. Sometimes reversal will require prescription medication to lower blood pressure, cholesterol, and sugar, but natural approaches have been proven to work and actually address the root cause of most cases of ED: arterial health. 


In 1990, Dean Ornish, MD, showed that atherosclerosis of heart arteries was reversible using a whole-food, plant-based diet and other lifestyle measures. The data has become so robust that the Ornish Lifestyle Medicine program was recognized by Medicare in 2010 for reimbursement as a therapy for CAD. A similar plant-based dietary program based out of the Pritikin Longevity Center in Miami received the same Medicare designation for intensive therapy and reversal of heart disease. Many men pursuing these programs report improvements in ED. 


The role of exercise combined with diet is crucial for the success of these programs. Research studies indicate the greater the commitment to exercise, the lower the risk of ED. 

Prescription Medications vs. Natural Remedies

A variety of prescription and natural remedies are specifically used for ED. Sildenafil (Viagra) was originally developed and studied as a heart drug when male research subjects reported an unexpected “side effect”: greatly improved erections. The plans for Viagra as a heart drug were abandoned and a new class of drugs, which now includes Levitra and Cialis, was launched and have become blockbusters with a high safety margin. However, these drugs do not reverse the root causes of ED. Natural agents such as maca, bergamot, berberine, aged garlic, pomegranate, citrulline, and beetroot all may support healthy artery function and are often used as over-the-counter aids for ED. 

Low-Intensity Extracorporeal Shockwave Therapy (LIST)

The newest addition to the treatment of ED is low-intensity extracorporeal shockwave therapy (LIST). Extracorporeal shockwave therapy was first introduced first for kidney stones, and then adapted as a heart treatment in Europe at a much lower intensity, hence LIST. The shock waves stimulate blood vessel and nerve growth, stem cell release, and production of more NO to correct the most common underlying pathologies leading to ED: impaired nerve and blood vessel function. LIST is a simple and effective addition to the treatment of ED in men (and soon to be adapted for sexual impairment in women) that I use in my clinic with quite impressive results. I have found that the positive response to LIST opens the door for many men to take better care of their overall health and adopt a whole-food, plant-based diet

Ready to get started? Check out our Plant-Based Primer to learn more about adopting a whole-food, plant-based diet.

This article was originally published on Sept. 20, 2019, and has been updated.

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