Pill-Free Ways to improve Your Sex Life

“Sex is important to health,” according to the Harvard Health Letter. “Frequent sexual intercourse is associated with reduced heart attack risk.” But, as I discuss in my video Do Men Who Have More Sex Live Longer?, that seems to be the perfect case of reverse causation. They’re implying that more sex leads to healthier arteries, but isn’t the opposite more likely—that is, healthier arteries lead to more sex? Blood flow in the penis is so reflective of blood flow elsewhere that penile Doppler ultrasound can predict cardiovascular disease. However, low frequency of sexual activity may predict cardiovascular disease in men independently of erectile dysfunction. This suggests that sex may be more than “just fun” and may also be therapeutic, or at least so says an editor of the Journal of Sexual Medicine and colleagues in discussing whether or not “frequent sexual activity can be prescribed” to improve general health. In men, they suggest it’s because more sex means more testosterone.

When men have sex, they get a big spike in testosterone levels in their blood, but, interestingly, in contrast, they don’t get a testosterone boost when they masturbate, as you can see at 1:21 in my video. This may be because “testosterone increases with competitive success,” like if you win a sports game. While sex “is not usually regarded as a competitive event…one’s mental state following coitus could nevertheless be something like that of a winner,” as opposed to the mental state after masturbation.

As you can see at 2:00 in my video, the spike in sex hormones in the blood is so great that men’s beards actually grow faster on days they have sex. And, since low testosterone levels are associated with increased risk of mortality, this could help explain the health benefits of having sex.

So, do men who have more sex actually live longer? I searched Pubmed for sexual activity and longevity and found a study supported by the U.S. Department of Agriculture, titled “Sexual activity and longevity of the southern green stink bug”—clearly an example of our taxpayer dollars hard at work. I was less interested in whether or not screwworms live up to their namesake and more interested in a study on sex and death, in which the objective was “to examine the relation between frequency of orgasm and mortality.” The researchers found that men with “high orgasmic frequency” appeared to cut their risk of premature death in half and, apparently, the more, the better: There was an associated 36 percent drop in mortality odds for every additional 100 orgasms a year. “Conclusion: Sexual activity seems to have a protective effect on men’s health”—but, apparently, not if you cheat. “Unfaithfulness in men seems to be associated with a higher risk of major cardiovascular events,” like heart attacks and strokes. “Extramarital sex may be hazardous and stressful because the lover is often younger…[and] a secret sexual encounter” may be more stressful.

In a large autopsy series, the majority of cases of sudden death during sex occurred in men during extramarital intercourse. The absolute risk is low—“only one out of 580 men might be expected to suffer a sudden death attributable to sexual intercourse”—but for those at high risk, research shows that “[s]ex in familiar surroundings, in a comfortable room temperature, and with the usual partner adds less stress to the heart” and may be safer.

Speaking of safe sex, you thought drinking and driving was bad? “While it is generally assumed that sexual behavior happens in parked cars, there is little discussion…in the research literature of sexual activity in moving vehicles.” About one in five college students report engaging in sex while driving, nearly half while going more than 60 miles an hour. Researchers suggest maybe this is something students should be warned about in health class.

When done right, though, love may protect your lover’s life. Given the benefits of sexual activity, “intervention programmes could also be considered, perhaps based on the exciting ‘At least five a day’ campaign aimed at increasing fruit and vegetable consumption—although the numerical imperative may have to be adjusted.”

What are some pill-free ways to improve your sex life? Exercising, quitting smoking, not drinking too much alcohol, not weighing too much, and eating a healthy diet. But what does it mean to “eat a healthy diet”? As I discuss in my video Best Foods to Improve Sexual Function, heart-healthy lifestyle changes are sex-healthy lifestyle changes, which have been demonstrated in studies from around the world, including in women. “Sexual function in women is significantly affected” by coronary artery disease, atherosclerotic narrowing of blood flow through our arteries, including the arteries that supply our pelvis. So, high cholesterol may mean “lower arousal, orgasm, lubrication, and satisfaction,” and the same holds for high blood pressure.

Given this, putting women on a more plant-based diet may help with sexual functioning.   Researchers found that improvements in female sexual function index scores were related to an increased intake of fruits, vegetables, nuts, and beans, and a shift from animal to plant sources of fat. The same for men: a significant improvement in international Index of Erectile Function scores. In fact, the largest study on diet and erectile dysfunction found that each additional daily serving of fruits or vegetables may reduce the risk of ED by 10 percent. But why? It may be due to the anti-inflammatory effects. Two years on a healthier diet resulted in a significant reduction in systemic inflammation, as indicated by reduced levels of C-reactive protein. Fiber itself may play an anti-inflammatory role. Those who eat the most fiber tend to have significantly lower levels of inflammation in their bodies, as you can see at 2:06 in my video. The opposite was found for saturated fat, “associated with an increased likelihood of elevated CRP”, C-reactive protein levels.

We’re used to seeing changes in inflammatory markers over weeks, months, or years, but people don’t realize that the level of inflammation in our bodies can change after only a single meal. For example, there’s a pro-inflammatory signaling molecule in our bodies called interleukin 18, thought to play a role in destabilizing atherosclerotic plaque. As such, the level of interleukin 18 in the blood “ is a strong predictor” of cardiovascular death.

What would happen if you fed people one of three different types of meals: sausage-egg-butter-oil sandwiches, cheeseless pizza with white flour crust, or the same cheeseless pizza but with whole-wheat crust? Within hours of eating the sausage sandwich, interleukin 18 levels shot up about 20 percent, an effect not seen after eating the plant-based pizza. In contrast, those eating the whole food, plant-based pizza made with the whole-wheat crust had about a 20 percent drop in interleukin 18 levels within hours of consumption, reinforcing dietary recommendations to eat a diet high in fiber and starches, and low in saturated fat to prevent chronic diseases.

But the billions in profits are in pills, not plants, which is why the pharmacology of the female orgasm has been studied ever since 1972 when a researcher at Tulane University implanted tubes deep within the brain of a woman so he could inject drugs directly into her brain and was able to induce repetitive orgasms. A man who had electrodes placed into similar parts of his brain was given a device for a few hours that allowed him to press the button himself to stimulate the electrode. He pressed the button up to 1,500 times.


For more on male reproductive health, see:

Also check out my other men’s health videos, such as:

What effect might that inflammation directly following an unhealthy meal have on our artery function? Check out my three-part endotoxins series starting with The Leaky Gut Theory of Why Animal Products Cause Inflammation.

And why exactly is fiber anti-inflammatory? Watch my video Prebiotics: Tending Our Inner Garden.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

Consequences of Prostate Cancer Treatment

A cancer diagnosis is seen as a teachable moment in medicine where we can try to get people to eat healthier, but “research has suggested that male cancer patients may be reluctant to introduce dietary modification…This has been attributed to dietary modifications often being viewed as mimicking “feminine” eating behaviours, such as emphasizing an increase in fruit and vegetables.” 

As I discuss in my video Changing a Man’s Diet After a Prostate Cancer Diagnosis, “[a]lthough healthy eating might enhance long-term survival, few men with prostate cancer make diet changes to advance their well-being.” Many of the cancer survival trials require adherence to strict plant-based diets, and though researchers tried providing extensive nutrition education and counseling programs, dietary adherence was still a challenge.

Apparently the way Dean Ornish was able to reverse the progression of prostate cancer with a plant-based diet was by home-delivering prepared meals to the subjects’ doors, figuring men are so lazy they’ll just eat whatever’s put in front of them. After all, male culture tends to encourage men to drink beer and eat convenience food and meat.

Take Men’s Health magazine, for example. Included in the list of things men should never apologize for were liking McDonald’s, not offering a vegetarian alternative, and laughing at people who eat trail mix. The magazine features articles with such titles as “Vegetables Are for Girls” and sections like “Men and Meat: There’s Only One Kind of Flesh We Like Better and Even Then She’d Better Know How to Grill.”

To appeal to male sensibilities, doctors are advised to use ‘body as machine’ metaphors, framing “men’s health in terms of mechanical objects, such as cars, requiring tuning.” But if men are so concerned about their masculinity and manhood, maybe we instead should share a bit about what prostate cancer treatment entails. The prostate is situated at the base of the penis, so when you core it out with a radical prostatectomy, you lose about an inch off your penis, if it gets erect at all. Only 16 percent of men undergoing the procedure will regain their pre-surgery level of erectile functioning.

Patients are typically quoted erectile dysfunction rates around 60 to 70 percent, but studies have generally considered erectile function recovery “as the ability to maintain an erection hard enough for penetration about 50% of the time…” So, occasionally being able to get an erection is considered recovery, but when a surgeon tells patients they will recover function, the patients probably assume that means the kind of function they had prior to surgery, which only happens 16 percent of the time and only 4 percent of the time in men over 60. Only 1 in 25 gets his baseline sexual function back.

Erections aren’t the only issue. Patients experience other problems like orgasm-associated pain even years later and urinary incontinence during foreplay, stimulation, or orgasm. The vast majority of couples overestimate how much function they’re going to recover. Couples reported feeling loss and grief. Having cancer is bad enough without the additional losses. You’d think that would be enough to motivate men to improve their diets, but almost a fourth of the men newly diagnosed with prostate cancer state they would prefer to have their lives cut short rather than live with a diet that prohibits beef and pork. More men would rather be impotent than improve their diet. It appears pleasures of the flesh may sometimes even trump pleasures of the flesh.


Did I say reverse the progression of cancer? See Cancer Reversal Through Diet? and my overview video How Not to Die from Cancer.

For more on prostate cancer prevention and survival, check out:

Interested in more information on maintaining male sexual function? See:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Best Foods for COPD and Peripheral Artery Disease

It’s great we can improve athletic performance by eating a few beets, but so what if you run 5% faster? It can be a fun experiment to eat a can of beets and maybe shave a minute off your 5k time, but there are people who could really benefit from a more efficient use of oxygen: those suffering from emphysema. Young, healthy adults eating greens and beets can swim, run, and cycle faster and farther, but what about those who get out of breath just walking up the stairs? Do nitrate-rich vegetables work where it counts? Yes–. Time on the treadmill in COPD pateints was significantly extended after two shots of beet juice. I discuss these benefits of nitrate-rich vegetables in my video Oxygenating Blood with Nitrate-Rich Vegetables.

Beet juice can also decrease blood pressure in young, healthy adults, but what about in those who need it––older, overweight subjects? Just one shot a day of beet juice (versus berry juice as a control) led to a significant drop in blood pressure in a few weeks. But within just a few days after stopping three weeks of beeting themselves up, blood pressure went back up. So we have to eat our vegetables and keep eating our vegetables.

Why did it take until 2015 to publish a study on using nitrates to lower blood pressure in people with high blood pressure? You’d think that’d be the first group to try it on. Who’s going to fund it, though—Big Beet? Blood pressure medications rake in more than $10 billion a year. You can’t make billions on beets.

But that’s why we have charities like the British Heart Foundation, which funded a study to give folks with high blood pressure a cup of beet juice a day for four weeks. After all, high blood pressure may be the number-one risk factor for premature death in the world. In ten years, it could affect nearly one in three adults on the planet. But put them on beet juice and blood pressures dropped and kept dropping until they stopped drinking it after a month. With so many people with high blood pressure even despite treatment, the researchers concluded, “an additional strategy, based on the intake of nitrate-rich vegetables, may prove to be both cost-effective, affordable, and favorable for a public health approach to hypertension.”

What about those with peripheral artery disease? There are tens of millions of people with atherosclerotic clogs impairing blood flow to their legs. This can cause a cramping pain in the calves called claudication, due to lack of blood flow through the blocked arteries, severely limiting one’s ability to even just walk around. But when they simply drink some beet juice, they can walk 18% longer. Researchers measured the actual oxygenation of blood within the calf muscle and found that patients were able to maintain more oxygen in their muscles after drinking beet juice.

The nitric oxide from vegetable nitrates not only improves oxygen efficiency but also oxygen delivery by vasodilating blood vessels—opening up arteries—so there’s more blood flow. I’m surprised beet juice companies aren’t trying to position themselves as veggie Viagra! It could certainly explain why those eating more veggies have such improved sexual function, though that study was a snapshot in time so technically you can’t tell whether eating veggies resulted in improved sexual function or improved sexual function led to eating more veggies. However, it seems more reasonable that low fruit and vegetable consumption contributes to erectile dysfunction, rather than the other way around.

What about the most important organ… the brain? Poor cerebral perfusion—lack of blood flow and oxygen in the brain––is associated with cognitive decline and dementia. Researchers showed that the nitrate in vegetables may be beneficial in treating age-related cognitive decline. They showed a direct effect of dietary nitrate on cerebral blood flow within the frontal lobes, the areas particularly compromised by aging. This is a critical brain area for so-called executive function, the basic task and problem solving important for day-to-day functioning. The nitrite from nitrate has been shown to not only increase blood flow to certain areas of the body but also to act preferentially in low oxygen conditions, allowing it to increase blood flow precisely in the areas where it is needed most, and that’s what they found in the brain: increased blood flow to the at-risk areas of the aging brain. The only side effect of beeting your brains out? A little extra color in your life (they noted some of the study subjects started peeing pink).


Nitrates are one of the reasons I recommend eating dark green leafy vegetables every day. See Slowing Our Metabolism with Nitrate-Rich Vegetables and “Veg-Table” Dietary Nitrate Scoring Method. Beets are another good option and not just drinking the juice; take a look at Whole Beets vs. Juice for Improving Athletic Performance.

What else can we do for high blood pressure? See the following videos:

Why is blood flow to the brain so important? I go into depth on the potential consequences in Alzheimer’s and Atherosclerosis of the Brain.

More on diet and pelvic blood flow in men can be found in:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: