Guys named Ed probably don’t feel honored to have one of the most devastating complications of diabetes named after then. But erectile dysfunction – or just ED for short – is both personally ego-destroying and all too common. At least they don’t say nowadays that ED is the same as impotence.
From 15 million to 30 million American men suffer from it, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). That U.S. Government agency also estimates that between one-third and one-half of men with diabetes have ED.
For something this important to the good life, it’s not surprising that we have many treatment choices. The first line of approach is to quit smoking, lose excess weight, and increase exercise.
If that doesn’t do the trick, then injections, pumps, and implants are other options that have been available for years. But it wasn’t until 10 years ago that drug options became available.
You know of the names of these three drugs, so I won’t mention them here. In fact, if I did, this site wouldn’t show them because they are banned words, partly because so much spam goes out in their names.
Neither will I explicitly describe what ED is. If you or your partner has it, you know what I mean. But I know from many messages that men with ED and their wives are desperate for a cure for ED and that even these drugs don’t often work.
The anonymity of the Internet has the wonderful advantage of letting men who suffer from ED discuss their problem with a total stranger. It’s easier, in fact, to talk about it with somebody you don’t know than with someone whom you might think would snicker at you behind your back.
The drugs and other medical options sold to conquer ED are stop-gap remedies. They can provide temporary relief. And like other treatments, they have their costs, which in dollars can be substantial, since insurance rarely if ever covers them.
These costs, according to the manufacturer of the most popular of these drugs, also include side effects. They can include a sudden decrease or loss of vision or of hearing. That’s rare, but no minor matter.
No one who takes nitrates – like nitroglycerin for chest pain – even once in a while should take this drug. The most common side effects are headache, facial flushing, and upset stomach. Less commonly, you may have bluish or blurred vision or sensitivity to light.
With these costs, why then are these drugs so popular? Simply because they provide such an ego-boosting service.
These drugs treat the symptoms. But you can treat the cause. You can cure ED.
Generally, the longer you have had diabetes the longer it will take to cure ED. That’s because ED results from neuropathy or vascular disease or both. And neuropathy comes in two forms.
If your blood glucose levels have been elevated for years, you may have autonomic neuropathy, which the actual destruction of nerves causes. Dr. Richard K. Bernstein, the author of Dr. Bernstein’s Diabetes Solution, gave the best explanation I’ve ever heard of the causes and treatments of erectile dysfunction on one of his recent webcasts. (His next webcast is April 30; for details you can check my “Diabetes Update” newsletter.)
If your neuropathy is autonomic, the nerves have to regrow. That takes time, but isn’t impossible. “In a young, healthy non-diabetic, nerves regrow at the rate of a millimeter a day,” Dr. Bernstein explained. “So to get from the tip of your toe to your spine might be one meter – a thousand millimeters. That would be a thousand days and if you were in poor health and older, it might be two thousand days.”
On the other hand, if your blood glucose level hasn’t been too high for years and years, your neuropathy could be simply metabolic. By bringing your blood glucose level down to normal you can reverse metabolic neuropathy “in a matter of weeks,” he says.
But the cause of ED might not be either metabolic or autonomic neuropathy. It might be due to vascular disease as well as or instead of neuropathy.
If the cause is vascular, the problem becomes more difficult, Dr. Bernstein says. But you can reverse vascular disease too. He knows, because he reversed his own vascular disease. Diagnosed with type 1 diabetes in 1946, his blood glucose levels were high and uncontrolled for many years until about 1973. “I had a number of bits of evidence of vascular disease before I started controlling my blood sugars. It certainly did serious damage to my kidneys.”
Maybe just as important, Dr. Bernstein started doing strenuous cardiovascular exercise in the early 1970s. Studies show that this can reverse atherosclerosis.
“I had one of these high-speed electron beam tomographic studies done a couple of years ago,” he says. "And this measures the amount of calcification of the coronary arteries. The score at this particular institution was 0 to 100. Zero means no calcification, 100 means the most severe form. And I had a score of 1, with one little fleck. At that time I was 72 years old and diabetic just below 60 years, I guess. And here had almost no vascular disease."
If you have had diabetes for a long time and are well over the age of 40, you probably have both vascular disease and neuropathy, Dr. Bernstein says. He distinguishes between these two problems by measuring penile blood pressure. If it’s low, it means that the problem is vascular.
He also uses an EKG machine to do an R-R interval study of the vagus nerve. This measures the time elapsing between two consecutive R waves in the electrocardiogram.“If that is grossly abnormal, it means you have neuropathic problems.” Then, they confirm the results of the R-R interval study with a complete pelvic neurologic exam.
Whether the cause of ED is metabolic neuropathy, anatomic neuropathy, or vascular disease, you can cure it. Conveniently, maintaining normal blood glucose and doing strenuous exercise are exactly what we all need to do to control our diabetes.
David Mendosa was a journalist who learned in 1994 that he had type 2 diabetes, which he wrote about exclusively. He died in May 2017 after a short illness unrelated to diabetes. He wrote thousands of diabetes articles, two books about it, created one of the first diabetes websites, and published a monthly newsletter, “Diabetes Update.” His very low-carbohydrate diet, A1C level of 5.3, and BMI of 19.8 kept his diabetes in remission without any drugs until his death.