Podcast 26 – Erectile Dysfunction

Transcription

Dr. Chad: This is Dr. Chad: Edwards and you’re listening to podcast 26 of Against the Grain. Are you tired and fatigued? Are you frustrated with doctors because they just don’t seem to listen? Do you want to fix your pain without surgery? If you answered yes to any of these questions, then we are the clinic for you.
We offer Tulsa prolotherapy, PRP or platelet rich plasma therapy and stem cell injections, IV nutritional therapies, bioidentical hormone replacement therapy, and functional medicine to get you back on track to optimal health. Call our clinic at 918 935-3636 or visit our website at www.revolutionhealth.org to schedule your appointment today.
Speaker 2: Welcome to Against the Grain Podcast with Dr. Chad: Edwards, where he challenges the status quo when it comes to medicine. We get into hot topics in the medical field with real stories from real patients to help you on your way to a healthy lifestyle. Get ready, because we’re about to go against the grain.
Marshall: Hello, hello. This is Marshall Morris here and today I’m joined by Dr. Chad: Edwards, who believes that 80% of medical recommendations are crap, technically speaking here. He’s the author of Revolutionize Your Health with Customized Supplements and he served in the US Army for 23 years as both an enlisted soldier and as an officer as a physician.
He graduated from Medical School at Oklahoma State University, and he is the founder of revolutionhealth.org and Against the Grain podcast. Dr. Chad: Edwards, thank you for joining us today.
Dr. Chad: Brother Marshall, how are you today?
Marshall: I’m doing exceptionally well. I had the 23 flavors of a Dr. Pepper earlier, so I feel pretty good.
Dr. Chad: That’s awesome. You know, I don’t drink soda or pop often but when I do, I like Dr. Pepper.
Marshall: Okay, there you go. There you go. What are we talking about today? What are we covering for all the listeners out there?
Dr. Chad: Well, I’ll tell you, this is a subject that is important to a lot of men, and actually can be important to a lot of women as well because there is some implication with them. And we’re talking about erectile dysfunction.
Marshall: Oh, wow.
Dr. Chad: So, not being able to get it up.
Marshall: Wow, that’s kind of like a truth cannon there. We’re going to get serious today about Tulsa prolotherapy.
Dr. Chad: That’s right. It’s an important thing. And, you know, I’ve said for a long time — I say kind of tongue-in-cheek, but you know there’s a lot of truth to it. Men come into the medical office, any medical office, for two reasons. One of two reasons it’s because there’s something wrong with their private parts or their wife made them come.
Marshall: [laughs]
Dr. Chad: Most of the time it’s one of those two. So if they come in and they say, “You know, I got this cold,” at the end of the appointment you have to say, “Okay, how are your erections?” And they’d say, “Well, now that you bring it up-” and you know they want a prescription for something.
Marshall: There it is, there it is. So, you talk about erectile dysfunction and, at least in terms of marketing, I’ve seen a ton of marketing come up over the past like, maybe five years, 10 years or so.
Dr. Chad: Well, some of that’s probably because now the pharmaceutical industry can do direct-to-consumer marketing, and so they can have commercials and talk about Viagra and Cialis. You know all those commercials that, “If you’ve had an erection for four hours go into the hospital.” And that can truly be a problem, but I think a lot of it has to do with that. But the other pieces — I mean, it’s those drugs are big moneymakers, and they’re big moneymakers because it’s a real problem that a lot of men have and a lot of men suffer from Tulsa prolotherapy.
So, we’re going to get into you know, what do we do about this? What is erectile dysfunction and what can we do about it? So I figured the first half of the show we will talk about erections and what causes erections and what plays into that and then what can go wrong, and then the second half of the show we’ll talk about what we can do about it.
Marshall: Okay. Well, just to understand how big of issue this maybe is, how many people does this affect? Is there like a general statistic here that, you know, in terms of your experience in men coming into the office into the clinic, is it a widespread problem? Is it a very segmented problem? How many people does this affect here?
Dr. Chad: Well, as far as quantity I can’t tell you. Certainly, it’s a bigger problem as we get older, we as men get older. It’s much more prevalent in older age. And it can affect as young as teens for a number of reasons. And then certainly with each decade it gets, you know, the bars on the graph, so to speak, get bigger and bigger; Ironically.
Marshall: [laughs] A lot of innuendo on this podcast.
Dr. Chad: Yes, probably not going to be able to avoid that.
Marshall: So, what is it?
Dr. Chad: First I think it’s important so, erectile dysfunction is the inability to get an erection sufficient for sexual intercourse. So, you know, just not being able to do that. So, you know, normally a man’s penis is flaccid, it’s not erect, and we have tissues within the penis that get full of blood and through an increase, in what we call turgor, so there’s more blood in those tissues and it blows up like a balloon just filled with water Tulsa prolotherapy.
And there’s a lot of factors that go into that, and when any or all of those components go south you can have erectile dysfunction. And it can be something relatively minor or it could be a big problem with multiple things. It’s really important to get to the root of what’s causing erectile dysfunction in order to treat it appropriately, because they’re very different based on what’s causing it.
Marshall: So we know kind of mechanically how erections work now. What are the things that contribute to getting an erection, and how does that relate to erectile dysfunction?
Dr. Chad: Yes. So, generally I categorize. There’s four components that are necessary for men to get erections. First of all, there’s got to be that emotional, sexual drive and desire, they have to be in the mood. There’s got to be some kind of stimulus for them to get an erection.
The second component is the nervous system. So, when you get in the mood you want to have an erection, sometimes in the middle of the night you get an erection, you wake up with an erection, the brain sends the signal that says you know, “It’s time to get an erection,” and so it sends that signal via the nervous system. So, the nerves have to be working well because the nerves are going to innervate the arteries and the veins.
So, when the signal is sent, basically you’re causing a relaxation of the arteries and you’re causing a constriction of the veins. So that means more blood flow in, then flows out. So then you have more blood in the penis and you have an erection. If the signal is being sent but there’s some kind of nerve problem and probably the most common one that we see is a neuropathy usually associated with diabetes.
So if there’s — you know, we’ve talked in the past about glycation, which is that process where blood sugar attaches to these proteins and causes a problem, and that’s the neuropathy that we get associated with diabetes is because of those advanced glycation end products. Or in that case, you know, we’re measuring the hemoglobin A1c. It’s just too much blood sugar, basically poisons those proteins and the nerves don’t work well. There are some things that we can do for that, and we’ll talk a little bit about in that last half of the show.
The third component we kind of touched on, which is the vascular system. So the nerves send the signal to the arteries and to the veins. Well if the arteries are so stiff that they can’t relax or they can’t dilate, then you can’t increase blood flow into the penis. And the other side is if the veins can’t kind of constrict a little bit then that’s probably more has to do with the arterial side than the venous side, but it’s that net flow of blood into the penis Tulsa prolotherapy.
So, if the blood vessels are not responsive to that signal then they can’t do what they’re supposed to do. And you can actually measure the — and we’ll have a show about this in the future about the endothelial function. So, the artery on that inner lining it’s one cell layer thick called the endothelium and it’s the lining of the artery, and the medical community is almost considering that almost as an organ in and of itself, because it is so reactive and it’s actually predictive about like, cardiovascular disease.
And speaking of that, if you have someone that has cardiovascular disease, then the risk of erectile dysfunction is much, much higher. The flip side of that is if they have a erectile dysfunction, you know, what happens in the small arteries around the penis can happen everywhere else as well, so they’re at much higher risk for cardiovascular disease. So we have to keep all of those things in mind.
And then the fourth component is hormones. And we’ve had some podcasts about testosterone replacement and, all those kinds of things. And we so commonly see hormone deficiencies, and certainly stress plays a role, and certainly the hormone piece can go along with that you being in the mood, you may not have that drive, and all those kinds of things.
So the hormones need to be in place as well, and obviously in our clinic we can do testosterone replacement, we check the adrenals; there’s a lot of things that we look at. And of course, we talk to women and they have sexual dysfunction– of course you can listen to our podcast on sexual dysfunction and women, it’s number 12-
Marshall: Yes it’s called “Low sex drive” I think is what it’s titled Tulsa prolotherapy.
Dr. Chad: Okay. So several podcasts ago but we go a little bit more into that but the emotional piece is so critical for women. It’s important for men to but I think to a less common extent. But for women if they work all day long and they get home and there’s just nothing left and they are like, “I’m there out, I’m going to bed,” men actually suffer from that as well it’s just far less common in my experience.
So you have to be able to get the mood so you have that psychological component. The nervous system has to be working well to send the signal to the to the arteries, the arteries have to be able to dilate so the vascular system has to be in place and you have to have the hormones that can set the stage for all of that.

Marshall: So it’s these four things that all four of them contribute to getting an erection. Where does the case of erectile dysfunction typically happen for most men is it a combination of those things is it typically one or the other of those four or where is the problem generally why?

Dr. Chad: It could be any of those as far as frequency of which one is causing it not sure. Any time I have a man coming into my clinic that’s complaining of erectile dysfunction I have to consider all of them and of course we believe that when you fix the underlying health, the healthier you make someone the less each of these become a problem.

So it becomes a little less focused on the specific problem and more on their overall health. We want to optimize their health period and we’ll see a lot of these things diminish but we want to target each one of these as well.

Marshall: So you’ve talked about what it is; the things that contribute to erectile dysfunction. You know where the problem falls for somebody coming in, what would classify as symptomatic? I think most of the listeners might understand the broad concept of what erectile dysfunction you can’t get interaction. But is that ever? Is that maybe once in a while or how frequently is that? What would you classify as having a problem?

Dr. Chad: I would say if it’s more than once or if the patient is concerned about it. So just that level of anxiety can be enough and that goes into that first piece that psychological component. So you know if they’re with their significant other and they go in there and they are ready to do the deed and consummate the evening and they can’t get an erection, the next time it’s time to have sex, if they couldn’t get an erection last time there may be some performance anxiety and they may be like, “My gosh I hope it happens, I hope that didn’t happen again.”

You’re in the mood and you want to make that happen and it doesn’t happen and it can set the stage to have a psychogenic erectile dysfunction where it’s a repetitive recurrent problem.

Marshall: Yes it becomes kind of the snowball effect. Where it becomes more of a problem than when it just started right.

Dr. Chad: So you have someone that has a primarily vascular problem and now they have erectile dysfunction now it can transfer over into a psycho genic problem as well. So you have to treat both of those.

Marshall: We’re going to take a quick break here and then when we come back I want to talk to you about what people can do about it?

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Marshall: Now we’re back with Dr. Chad Edwards talking about erectile dysfunction. So what can men do about this? They’ve identified the problem. What are the first steps in terms of getting this diagnosed and treated?

Dr. Chad: I think the first thing that generally comes up is men will come in and they are asking for medications and the class of medications that they’re asking for is the PTE five or the phosphodiesterase five inhibitors. So that’s a chemical in your body that contributes to erections. So the medicines make it where you have– I’m pretty sure it works through nitric oxide but it enhances that chemical. So it allows the endothelial lining to relax and can open up. So you’re chemically setting the stage or tipping the scales so that there’s more blood flow going into the penis than coming out.

So you’re just giving a drug to cause that to happen. Does not address the underlying problem it doesn’t fix why they may be having erections. But when you consider someone that has a little bit of a vascular problem as we alluded to a minute ago and they’re wanting to get an erection and one time it doesn’t happen then you can have a little bit of that performance anxiety and so next time it’s almost like there’s a threshold for the blood vessel problem.

You may be hanging out right at that threshold where you can have an erection you can’t have an erection, have an erection you ride on that line and then any little thing may tip it over where now you don’t have enough stimulus. You don’t have enough and now you’ve got it worse erectile dysfunction that wouldn’t necessarily completely be fixed by the medicine. But you take the medicine you think it’s going to help so there’s probably a placebo effect associated with that now that they’re only they only work by the placebo effect.

So you have that component and then it also helps the blood vessels to relax and that enhances the success. So it lowers that psychogenic component as well. So you’re almost treating two things at the same time. So it’s an interesting component associated with that. So the phosphodiesterase inhibitors would include like Viagra, Cialis, Levitra those are the three most common ones of that I see.

Unfortunately we talk about supplements and crappy quality of supplements anyone that gets these medications and these things aren’t cheap. I don’t look at the exact price but you’re easily talking 10 dollars a pill. It wouldn’t be surprising and so when you factor in cost of dinner and flowers and now you got your den dollar bill and we’re talking having sex once.

If two to three times a week and you’re talking 30 bucks a week, 120 bucks a month just to be able to have sex and that’s crazy. So they’re not cheap and many insurances don’t cover them.

Marshall: That’s just treating it chemically with pills, that’s not addressing the underlying problem which is what your clinic and probably more of a successful long term solution could be.

Dr. Chad: Exactly. In my opinion it’s more cost effective and we’re also addressing again. Go back to that cardiovascular component if there’s erectile dysfunction at higher risk and there are studies showing that, there are higher risk of cardiovascular disease as well because if the arteries aren’t working down there they’re not working other places also. It doesn’t select out just that one particular area.

The medications are effective we talked about — you heard on the commercials avoid nitrates, avoid nitroglycerin. And this is a problem because cardiovascular patients, patients with cardiovascular disease heart attacks things like that have cardiovascular disease. Cardiovascular disease contributes to erectile dysfunction. So you take Levitra, Cialis or Viagra for erectile dysfunction but you’re on nitroglycerin for your chest pain and it can result in a very unsafe drop in blood pressure.

So it’s something that you have to be very careful for. You can’t take both medicines at the same time. In fact as a physician if they’re on nitroglycerin, I have to spend a significant amount of time counseling them and they have to ensure me that they will not take those two in conjunction. I don’t care if they’re having sex and get chest pain don’t take your nitroglycerin because it could potentially kill you don’t do that. That’s bad. Again haven’t addressed the underlying problem.

But if there’s a group of patients that need those medications, it’s the group that’s at higher risk for being on the other medication it’s just crazy. But sometimes you need it. So other things that you can do, you look at counseling. I was a medical assistant years ago back as a medic in the 1990’s and I had a guy coming in for testosterone injections and this is probably 1995 or so we didn’t have Viagra and all those medications at the time.

So he was coming in for his testosterone injections that was helping but somehow I don’t remember if I mentioned it, is Dr. Bao I don’t remember I love to take all the credit for but I just thought it was very striking when he came back he was like, “This is my last shot, I don’t need this anymore, I’m able to get erections everything is good,” And I was like, “Well what happened?” He said, “I went to counseling and identified something in past and we talked a little bit” and he said, “Boom problem solved.” And he never had an issue from that point.

So I mean, it could be relatively minor, it could be something in their past, it could’ve been some kind of sexually related problem dysfunction, certainly things like sexual abuse and all those kinds of things you have to be mindful of those kinds of things as well. But, counseling or therapy may be a big deal so always something that I would consider in any patient with erectile dysfunction.

Then you have tobacco use, so tobacco causes vasoconstriction it destroys your overall health in so many ways it’s just not funny you got to quit smoking. And, if you have erectile dysfunction that’s just a further indicator that you got to quit smoking. It’s inhibiting your overall health in more ways than just erections so absolutely smoking is detrimental and you got to stop that.

Too much alcohol can actually cause some erectile dysfunction as well, so we want to be mindful of how much alcohol someone’s taking. There are things like a penile pump when you know back in in the old days when I was just doing normal inside the box traditional medicine and I had a patient that the p5 medications weren’t working for.

I would consider sending them to urologist and having one of these pumps put in and it’s just like you know the air Jordan’s you just pump, pump, pump, pump, pump, pump, pump in and it does the same thing but it’s a just penis pump and you can get an erection that way. So, when you don’t have any other options that’s an option there are a lot of other things that you can consider as well and the goal of this podcast is not to comprehensively cover all of those it’s just kind of address erectile dysfunction globally and comprehensively from an underlying cause perspective.

And then, how we focus in our click. So, those are most of the traditional things that we focus on but there’s some things that you can consider some have benefits, some have risks. Things like some of the herbals like Panax Ginseng that can be beneficial a chemical called DHEA which is a Dehydroepiandrosterone. It’s a precursor to testosterone certainly if you’re low and DHEA it can be beneficial to take that you can take it in supplement form in other words over the counter you can — we’re working on getting our online store up and running and we’ll have the DHEA up sometime hopefully soon.

And all of ours are manufactured in the — to my knowledge the only FDA certified pharmaceutical manufacturing facility in which supplements are made. So, in other words the supplements are held to the same scrutiny as the pharmaceutical chemicals and drugs. So, very, very high quality stuff, and so DHEA is a possibility. I personally recommend the topical version as opposed to a capsule, the liver when you take a capsule the liver gets first pass at it and I think the topical generally works a little bit better.

There are things like Yohimbe, you know a lot of our listeners may be familiar with that one and Pycnogenol is another sample you can look up and take care of. The last thing and I really commonly start with this one is l-arginine, and the form that I recommend is Arginine alpha ketoglutarate. It’s a specific form of arginine but arginine is a precursor to nitric oxide and sometimes we’ll use it in conjunction with l-citrulline and we’ll talk more about this in another podcast on endothelial function.

But, the l-arginine helps to enhance nitric oxide which of course relaxes that endothelial lining and allows the artery to relax. So, it almost works as a cheap over the counter Viagra and some men get tremendous effect some don’t see as much. So it just varies but that’s kind of a comprehensive, touching on multiple different ways that you can treat this they’re all also some other injections that you can do directly into the penis which sounds awful but if you can’t get an erection then it probably worth it and we do some of that in our clinic as well.

Marshall: Well this definitely is — well the kind of 30,000-foot overview of a lot of different things that go into erectile dysfunction. What it is, what causes it, how most people they cure it or treat it, or what the alternatives are? What are the ways to fix the underlying issues? So, I appreciate you touching on all these different things today and I know that we can get into some more coming up later but thank you.

Dr. Chad: Absolutely if you’ve got erectile dysfunction come see us in our clinic or search out a functional medicine physician is going to get to the bottom of that issue and get you optimally treated.

Marshall: Thanks so much and we will talk to you later.

Dr. Chad: Thanks Marshall

Marshall: Thanks.

Automated voice: Thanks for listening to this week’s podcast with Dr. Chad Edwards. Tune in next week when we’ll be going Against the Grain.

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