Fifty Shades of Green with Plants and Sex
You do not need to keep this book wrapped in a brown paper cover, but let’s have some real conversation here. I hope this is the section of the book most highlighted and with the most page corners turned over. I hate to burst your bubble so early in the chapter, but we have more bravado and testimonials of enhanced sexual prowess on plant-based diets than we have peer-reviewed scientific reports. The most famous may be the scene in the movie Forks Over Knives, where reference is made to the ability to “raise the flag” again on a plant-based diet. There is also an accompanying video on the topic of plants and sexual power that gained considerable public attention.1 There is every reason to believe that the Plant-Based Solution is the most reliable path to male and female potency for as long as possible, and the science as it exists supports that notion.
For the estimated 30 million men in the United States with erectile dysfunction (ED), both their romantic lives and their heart health can suffer. In fact, research shows that ED can be an early warning sign of heart disease. Not only are both endothelial (blood vessel) dysfunction and erectile dysfunction “ED,” but they are related, as you will see. When there is endothelial dysfunction, there is usually at least some erectile dysfunction. Around 300 years ago, Ben Franklin wrote that an ounce of prevention is worth a pound of cure. Similarly, I often tell my male patients “to be older and hard, exercise and eat no lard!”
Stiff Evidence for a Plant-Based Diet
Stan’s heart scare was a blessing in disguise. His text to me that he was having a strange feeling in his chest while exerting himself at the gym alarmed me. When a sixty-year-old man says those words, the diagnosis of a badly clogged heart artery is over 90 percent likely. It had been only a few weeks of having the feeling of two to three minutes of fullness in the chest, which quickly resolved with rest, something called classic angina. Stan came to my office the same day, and his EKG was abnormal. I arranged an urgent cardiac catheterization, and two of his major heart arteries were 95 percent clogged. The third had disease, but it was moderate. He received two stents in the hospital and went home uneventfully.
On his first follow-up visit, he was doing fine; all of his symptoms had resolved. He was a very educated man and came with a list of questions based on his careful Internet research. He was in the health-care field himself but admitted to not placing his health as a priority. Exercise had been rare, his weight had steadily crept up over a quarter century of practice as a health-care consultant, and his sleep was interrupted by loud snoring, which he ignored. He also indicated that he had bothersome erectile dysfunction, which he attributed to age and stress.
His decision to adopt the Plant-Based Solution was immediate, and he was struck by a presentation by Dr. Caldwell Esselstyn he watched on YouTube while still in the hospital recovering from his stents. He also read several other books and visited many health websites. He began a twenty-one-day immersion into plant-based eating without added oils and found it satisfying. He entered a Pritikin Intensive Cardiac Rehabilitation program locally where he took plant-based nutrition, cooking, and exercise classes. He said goodbye to his old diet and was 100 percent on board with the only heart disease reversal diet ever proven to work, a plant-based, no-added-oil program.
At his three-month visit, he was beaming with pride as the scale showed a fourteen-pound weight loss, and he felt great. His fasting blood sugars no longer ran 120 and were in the low 80s, which is normal. He was about to finish cardiac rehabilitation and was looking forward to working out at the local gym with renewed confidence and stamina. Stan was most excited, however, by his restored ability to obtain and maintain an erection without the blue pills. He said it was “a zillion” times better. He told me that he had told his buddies, many of whom had erectile dysfunction, that “Spanish fly was overrated—all you have to do is eat like a gorilla.” 
The Sexiest Foods Are Plant-Based
An estimated 300 million men worldwide will soon suffer from erectile dysfunction,2 and most of those men will also be at risk for heart disease and stroke. Fruit may be part of the solution.
Researchers from Harvard Medical School performed the first observational study of dietary habits and sexual function over a ten-year period. The study concentrated on flavonoid intake from plant-based foods disclosed on food-frequency questionnaires collected every four years. Over 25,000 participants rated their erectile function in 2000 and again in 2004 and 2008.3
During ten years of follow-up, 36 percent of the men reported ED. After analyzing other factors like smoking and diabetes (classic cardiovascular disease risk factors), several classes of dietary flavonoids—flavones, anthocyanins, and flavanones—were associated with reduced ED. A higher intake of flavanones, anthocyanins, and flavones was significantly associated with a reduction in risk of ED in men younger than seventy years old, but not older men. A higher total intake of fruit, a major source of anthocyanins and flavanones, was associated with a 14 percent reduction in risk of ED. It is now widely appreciated that erectile dysfunction is often an early barometer of poor vascular function and offers a critical opportunity to intervene and prevent cardiovascular disease, heart attack, and even death.
I would advise you to not wait until you’re dealing with ED to take charge of your health. Avoidance of ED can be added to numerous other benefits of adopting the Plant-Based Solution.
Prevent ED with Flavonoid-Rich Foods
Add fruit to keep the blue pill away. Data suggest that a higher habitual intake of specific flavonoid-rich foods is associated with reduced ED incidence. Preserve your sexual responsiveness by including these foods in your meals: apples, blueberries, citrus, pears, red wine, and strawberries.
Science Corner: The Hard Truth about Sexy Plants
Katherine Esposito, MD, of Naples, Italy, has done a series of studies on the Mediterranean diet and erectile dysfunction. While the MED diet often advises fish over red meat and is not a fully plant-based pattern, it is a very plant-strong model to study, and there are many people who follow a “vegiterranean” version. In one study, the effect of a Mediterranean-style diet on ED in men was examined.4 The sixty-five men in the study had ED and also the metabolic syndrome, which includes abdominal obesity, high cholesterol or triglycerides, high blood pressure, and an elevated blood sugar that together predict increased cardiac risk. Thirty-five of them were assigned to the Mediterranean-style diet and thirty to the control diet. After two years, men on the Mediterranean diet consumed more fruits, vegetables, nuts, whole grains, and olive oil as compared with men on the control diet. Inflammatory blood markers like the C-reactive protein improved in the MED diet group but were unchanged in the control group. There were thirteen men in the MED diet group and two in the control group that reported improved ED measures. The study suggested that a Mediterranean-style diet rich in whole grains, fruits, vegetables, legumes, walnuts, and olive oil might be effective in reducing the prevalence of ED in men with the metabolic syndrome.
The Endothelium and ED
How are flavonols and other plant-based foods able to boost the sexual response? Recall from chapter 2 that inside every blood vessel is a single-cell lining called the endothelium, and this layer of cells makes that miraculous chemical called nitric oxide. The production of NO leads to the creation of a compound called cyclic GMP. To get blood rushing and swelling to the sexual parts involved, lots of NO is needed. In fact, the erectile dysfunction drugs that you see advertised on TV also work by increasing cyclic GMP levels.
How is nitric oxide generated in these key blood vessels? The amino acids L-arginine and L-citrulline cycle back and forth and create it. This system is particularly active before the age of forty. If you want to boost levels of NO, eat healthy foods high in L-arginine, such as pine nuts, peanuts, walnuts, almonds, pistachios, and Brazil nuts. Grains, including oats and wheat germ, also have significant amounts of L-arginine.
I mentioned the amino acid citrulline above and how it can help arteries support romance and passion. Where do you find it? Watermelon has the highest concentration of citrulline (particularly the white rind) in nature, followed by onions and garlic. You might want to stick to watermelon, however, before going on a date! Yellow watermelon has even more citrulline than red melon. Remember that there is a second way to generate NO and its blood flow–enhancing effects. Chemicals called dietary nitrates found in many foods (like greens and beets) are converted in our saliva to nitrites, absorbed, and then converted to NO. Antiseptic mouthwashes prevent this healthy conversion and should be avoided if you want the benefit of plant-based dietary NO boosters.
Arugula, rhubarb, kale, Swiss chard, spinach, bok choy, and beets are at the top of the list of plant-based sources of dietary nitrates. If you also try to add grapes, pomegranates, apples, and green teas to your diet, you have a dynamite erotic potion.
Over 400 years ago, English physician Thomas Sydenham said, “A man is as old as his arteries.” Four centuries later, we know just how right he was and that it is not only men who benefit. Women also need blood flow for romance, and the same systems work in the female body, although women are studied less often in research protocols.
Some men like to brag about their sexual prowess, whether in the gym or the bedroom. It seems that the Paleo movement has done a better job of presenting shirtless and confident men as representatives of a diet that is often heavily meat-based and deflating to arteries and the sexual response. In reality, the sexiest man is the one holding a baby lamb or chicken saved from slaughter and not eating it. And that man probably has preserved sexual responsiveness due to the concentration of plant-based nutrients that promote vascular health, NO production, and sexual competency. While more research is needed, the best blue pill is a blueberry. The best aphrodisiac is a person in tune with kindness to animals, the confidence knowing the environment is suffering as little as possible by wise plant-based food choices made, and sexually powered with plant-fueled genitals.
THE PLANT-BASED PLAN Try a Meal-Kit Delivery Service or Take a Cooking Class
You’ve probably noticed the trend in meal-kit delivery services—those that deliver a box of premeasured, and often precut, ingredients with recipes to your home. Purple Carrot (purplecarrot.com) is one such service that offers vegan options. Don’t want to cook at all? Sakara (sakara.com) delivers fully prepared vegan meals to your door.
When new patients begin the Plant-Based Solution, one of the first things I do is suggest a cooking class. Culinary Rx (plantricianrouxbe.com) offers a plant-based online cooking course for $99.