Natural equivalent of Viagra?

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Natural Alternatives to Viagra with Ellen Kamhi
WebMD Live Events Transcript

Event Date: 05/26/2000.

Holistic Medicine expert Dr. Ellen Kamhi discusses her views on the latest alternative treatments for erectile dysfunction.

The opinions expressed by Ellen Kamhi are hers and hers alone. If you have questions about your health, you should consult with your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD Live's Sexual Health Auditorium. Today we are discussing Natural Alternatives to Viagra, with Ellen Kamhi, PhD, RN, HNC.

Ellen Kamhi, nationally-known as "The Natural Nurse," is the co-author of The Natural Medicine Chest, Arthritis: The Alternative Medicine Definitive Guide, and Cycles of Life: Herbs and Energetics for Women. She is a professional member of the American Herbalists Guild (AHG) and is Nationally Board Certified as a Holistic Nurse (HNC). Dr. Kamhi has been involved in the field of Natural Medicine for over 30 years. She attended Rutgers and Cornell University, and sat on the Panel Of Traditional Medicine at Columbia Presbyterian Medical School. Dr. Kamhi has practiced holistic medicine for the last 15 years with Serafina Corsello, M.D., as Head Nurse of Diagnostics and Natural Interventions at the Corsello Centers for Complementary Medicine in New York.

Dr. Kamhi, welcome back to WebMD. How widespread is the problem of erectile dysfunction (ED) in the US?

Dr. Kamhi: Erectile dysfunction is another word for impotence and we'll be referring to it both ways. Unfortunately, approximately 30 million men in the U.S. suffer from this problem who report it. Of course, there are many cases that go unreported because so many don't want to talk about it. So, it's a very widespread problem among men in the U.S.

Moderator: How successful is treatment with Viagra?

Dr. Kamhi: I would say Viagra is tremendously successful and it is one of the most widely sold drugs in the history of medicine. It absolutely has been very effective, but the problem is that it also has serious side effects when we look at the fact that over 700 men have died while using Viagra in the U.S. alone. There are also less severe side effects besides death from taking Viagra, and they include a blue discoloration in front of the field of vision after taking it, digestive disturbances, headaches and other problems. There are many health indications where taking Viagra would not be an option, for instance, men who are already taking nitrates such as nitroglycerine, and those with other kinds of cardiovascular problems, any kind of cancer, or ulcers and other bleeding disorders. By the way, people should know that the real name of Viagra is sildenafil. And, why that's important is because there are other drug companies that will be coming out with that and it won't be called Viagra. Another thing is Viagra is quite costly. It costs about $10 a pill. And, that's when you get it through a prescription through your physician. People sometimes pay a lot more for it if they're just buying it on line or through other available distribution venues.

Moderator: How widespread is Viagra-abuse? Specifically, through online purchasing?

Dr. Kamhi: Because of that very fact, there is no way that we can really say how many people are using it who shouldn't be using. And, in fact, what does abuse mean? There are those trying Viagra as a sex enhancer even if they don't have erectile dysfunction. One thing literature points out is that although Viagra can intensify performance, it can only be effective if the erectile dysfunction is due to neurological factors rather than emotional or psychological factors. So, if a man who doesn't have circulation problem it will not increase his response. In other words, Viagra is not truly an aphrodisiac which might increase sexual response, although it is an enhancer of circulation and that's why it's effective.

Moderator: What is a priapism?

Dr. Kamhi: Yes, Viagra can sometimes caused this sustained erection. In some people that can be a problem, but it's not a major side effect that's worried about with Viagra. It's not really dangerous.

Moderator: How does natural medicine differ in its approach to treatment of erectile dysfunction?

Dr. Kamhi: Natural medicine differs in its approach to treatment of erectile dysfunction in the same way that it differs in its approach to treating any illness. Rather than looking at the particular effected part of the body, in this case, the penis, natural or holistic medicine looks at what is wrong with the whole person. The three-pronged approach is paramount. Meaning, we look at the emotional and spiritual life, which is the most important consideration in any illness. Number two is diet and lifestyle choices. Number three is exercise. We will not give any kind of supplement; notice the word is supplement which means it's supplemental to other lifestyle choices that lead to overall wellness.

If men who are experiencing erectile dysfunction want to start a program to reverse it, they should first look at what is going on with their relationships, whether it's with a female or male. They should look at social and psychological issues involved in the relationship. Number two is looking at the diet. An organic diet is of utmost importance because any food coated with pesticides and toxic chemicals, in particular, hormones, such as bovine growth hormones which are found in non-organic dairy products, will cause the accumulation in the body of different kinds of xenoestrogens, which is a problem because that can interfere with proper testosterone levels in men. Another issue with non-organic food is bioengineering. Many foods on the market now are bioengineered, and we do not yet know the overall health effects of those foods. So, choosing organic is important. Also, decreasing bad fats which are any animal product. Number two is all hydrogenated oils. And, you need to read your labels to find these. They're in every baked good such as cakes and bagels and cookies. They are also in all fried foods and fast foods. These kinds of fats, the same ones that lead to obesity as well as high LDL cholesterol (low-density lipoprotein which is the bad cholesterol), these same kinds of fats will tend to clog up the circulatory pathway that interferes with the erection, just like it causes blockages in arteries to the heart causing cardiovascular illness. So, decreasing the bad fats, either totally eliminating them or at least decreasing them to a minimum and increasing the good fats. Good fats include omega-3 fatty acids. These are found in cold water fish such as salmon and in vegetarian sources such as flaxseed. So, an overall movement to a diet very high in vegetables including kale, Swiss chard, collard greens, romaine lettuce and other greens, and organic whole grains such as brown rice, as well as organic protein sources such as pumpkin seeds, which are very high in zinc (especially healthful to men) and soy products such as tofu, will increase overall wellness, decrease the fatty deposition that can block the arteries and veins leading to the circulatory system leading to the male organs. In particular, yoga and tai chi as well as other forms of stretching are important. Of course, cardiovascular exercise which will lead to better tone is also important. This needs to be done on a daily basis, not once a week, not on a weekend warrior schedule. So, that is where we start our program to reverse erectile dysfunction, by looking at the emotional/psychological factors, the diet and the amount of exercise.

Viagra: Natural Alternatives (cont.)

Moderator: What can people do to prevent erectile dysfunction from happening in the first place?

Dr. Kamhi: Those same things! The sooner you start that in life, the more likely you are to not get the problem as well as avoid most degenerative illnesses. And I discuss these fully in my book, Arthritis, the Alternative Medicine Guide. There are chapters on juicing and diet and exercise, even if you don't have arthritis. The same program will help to prevent cancer, heart disease, erectile dysfunction, arthritis -- all of the above that's why it's a win-win situation. Then we have specific herbs and other nutrients that can be very helpful for this problem.

Moderator: What exactly is Ginkgo biloba?

Dr. Kamhi: Ginkgo biloba is called that because the leaf of the tree which is used as a medicine actually has two lobes. This stands out as an herb because so many people know about it. It's amazing what a widespread audience it has now because of the media and this, with St. John's Wort, have been major TV stars. Ginkgo biloba is known for its ability to increase blood flow and oxygen to the brain. It was actually written up in the Journal of the American Medical Association in terms of its ability to enhance memory and also to increase mental abilities. So, this is how this herb has been known. However, when it has been tested, both for increasing mental ability and also as a mild antidepressant, men reported that as a good side effect, they also found a vast improvement in their sexual function. Now, the reason for this is that Ginkgo biloba helps to improve blood flow to all the very small vasculature throughout the body. This includes the brain. It's also good for improving circulation in diabetics who tend to get neuropathy. It can help increase circulation to the hands and feet and certainly to the penis. So, if the erectile dysfunction, again, is due to a circulatory problem which on a physical level it often is, Ginkgo biloba can be very helpful.

Moderator: What about Muira puama?

Dr. Kamhi: This is an herb from Brazil and from the Amazon and also it has been used for thousands of years. It has a very long history of use in the Amazon among the tribes people who used it as an aphrodisiac. It's called several other nicknames, such as potency wood. When indigenous people call plants by these names, you usually know that it has some kind of sexual effect. And it is being sold throughout Brazil as well as the U.S. One herbalist from the Amazon said it makes you feel like a young man again. There isn't as much scientific study of Muira puama but also there is no known negative side effect, so it might be worth trying. Now, we know that in the few tests that have been done in a clinical setting, we have gotten very, very good results. Again, it does increase circulation, so that's another good thing to look at. By the way, in the Amazon, both men and women use this herb.

Moderator: What type of effect does it have on women?

Dr. Kamhi: It increases desire and it probably increases circulation to the sexual organs, as it does in men. Again, this hasn't been really well studied. We're giving you anecdotal reports, but they've been gathered for thousands of years in the area where that plant grows. By the way, we do talk about many of these herbs in my book, The Natural Medicine Chest and I have a full section on increasing desire in women in my upcoming book, Cycles Of Life: Herbs and Energetics for Women.

Moderator: Circulation seems to be a recurring effect of these treatments. Is much of sexual function contingent on good circulation?

Dr. Kamhi: Absolutely yes, for both men and women. More so in men because, as we know, women can have sex even if they're not really excited or into it. But, men can't. It is important for both in terms of sexual function, but even more important for men because sometimes the spirit can be willing but the body is not. That is how Viagra works, also. It works because it releases nitric oxide, which is an irritant which causes blood vessels to open allowing more blood to flow in. That's why a vegetarian diet and stretching exercises are so important, because by eating fatty foods we clog up the circulatory system, which leads to every illness and one of the first warning signs is erectile dysfunction.

Arginine is good. I've used it in my clinical practice often for couples who come in and are infertile. Not only does this help with impotence, it also increases the quality of sperm. I am always amazed when I look at sperm under the microscope which we do in the office, how many men who are part of an infertile couple, have sperm which are malformed. Very often the tails are either broken off or aren't strong enough to create that tadpole-like swimming motion that we see in healthy sperm. More and more research is pointing to toxic chemicals in the environment including pesticides being cause of these problems. There is so much we can do to combat that by increasing our use of organic foods, and one supplement is arginine. And supplements such as arginine can help. Arginine has a lot of research on it. In the Journal of Urology, a study was published in 1997 that says there is data to support the use of arginine for treatment of erectile dysfunction. There was another study done in 1999, but I don't know what journal that was in. Arginine is an amino acid that is quite safe and, actually, also increases the level of nitric oxide. So it has similar mode of action, but is much less dangerous than Viagra. I will talk about one down side of arginine. If you have a problem with viruses, for instance, herpes, you wouldn't want to take arginine during a breakout because arginine can increase the reproduction of viruses, just like it can increase our own reproduction. One way to offset that side effect is to use another amino acid along with the arginine. That amino acid is L-Lysine. This will offset the viral-enhancing effect of arginine

Viagra: Natural Alternatives (cont.)

Moderator: What is damiana, also known as "ram goat dash along?"

Dr. Kamhi: Not too many people know that damiana is also called "ram goat dash along"but damiana is a very interesting herb from Mexico. It's a small shrub that grows in Mexico and it's interesting that its genus and species Latin name is turnera aphrodisiaca. Well, what does that name tell us? That it has been known for thousands of years as an aphrodisiac. It's also a good tonic for the kidneys and urogenital system as well as the reproductive organs. And it can be helpful for both men and women. It may stimulate the production of testosterone. It's also good for infertility because it helps improve the quality of the sperm. It's also a mild antidepressant. We use it in women for hot flashes as well, so damiana can be a very important part of a sexual enhancement program.

Moderator: Can you tell us about yohimbe?

Dr. Kamhi: Yohimbe is extremely interesting because it is one herb that actually has been used as a drug. In fact, your doctor can prescribe yohimbe for you and the names of the prescription include Yohimex and Yocon. There's another one called Actibine. And, yohimbe is from Africa and it's a very, very potent sex enhancer. Most men will notice an effect after taking yohimbe right away, within a half hour. It's one herb to use right before sex as you would also use ginseng that way. Now, yohimbe does influence the central nervous system and is a stimulant. It's also increasing blood flow to the vessels of the penis and we're starting to see here that that is important for most sexual stimulants, to increase blood flow. Of all the herbs we've discussed, yohimbe is probably most potent and works most quickly. Now, another thing to know about yohimbe is that you can have side effects with it and they can be rather serious with some people. These include insomnia, headaches, high blood pressure and irritability. In fact, yohimbe extracts have been used to purposefully cause anxiety in experiments where they wanted to test other antianxiety drugs. So, if someone takes it and finds they get anxiety attacks, they probably can't use it. Yohimbe is very well researched. There's an article in the February 1998 issue of the Journal of Urology if you'd like to see more scientific evidence about the efficacy of yohimbe.

Moderator: Is it available without a prescription?

Dr. Kamhi: Absolutely. It's available as an herbal extract which you can find in any health food store.

Moderator: And one should be careful?

Dr. Kamhi: Yes, this is one where there are serious side effects, not as serious as Viagra, but you should still be aware of them.

Moderator: Tell us about horny goat weed?

Dr. Kamhi: Yes, horny goat weed. Now goats must know something. Remember, damiana is called "ram goat dash along." Damiana is called ram goat dash along by the native people of Jamaica. I regularly take people to indigenous areas such as Jamaica to study with local shamans. Many of the herbs are known to have sexual enhancement effects, and that is my interest and I go there to learn about them ( is where you can find out more about the 'ecotours' for cures). Damiana got that name from the local people because when the male goats eat the damiana, they are really jumping on everything and dashing along. Now, we have another herb from China that is called horny goat weed. So that's very interesting. There is more to this herb than just the name. This plant is in the epimedium family and it dates back to very ancient time, at least 200 BC in China. This plant is actually responsible for many different kinds of sex enhancing effects. It increases production of sperm and also increases the level of testosterone. And, this is the male hormone linked to sex drive in both men and women because testosterone stimulates the section of the brain having to do with love and lust, and is also responsible for secondary sex characteristics in men. So, horny goat weed has been used in both sexes and it's an interesting one.

Moderator: And finally, what about kava kava (Piper methysticum)?

Dr. Kamhi: We discuss that herb in depth in the book, The Natural Medicine Chest. Kava kava is well known now in the U.S. It's another herb that's made it on TV. Again, kava kava is most often used as an antianxiety treatment, and mainstream medical studies have verified its efficacy for use as an antianxiety herb. This is with very low level of side effects. Kava kava is used in areas of the world where it grows such as Tahiti and Hawaii as a socialization herb. They use it in the evening at gatherings, as well as during business meetings. I have a picture in my book of Pope Paul being served kava kava, as well as Lady Bird Johnson and Hillary Clinton. So it's also used for socialization. It puts people in a good mood. Now, kava kava might be a better aphrodisiac for women than for men because in large doses it can cause a relaxation, which at first is good (even alcohol will do that) but in large doses it might not be good in terms of aiding an erection. However, it's something men could certainly try because some people get excellent results due to the good mood it puts one in, as well as it's being a happy herb, basically.

Moderator: Where can someone purchase these natural remedies?

Dr. Kamhi: Well, they are widely available. I can tell you some websites that are excellent. Every health food store will carry all of these. Some brand names that are reputable include one that I use myself in my practice called Nature's Answer. They are widely available as liquids in all health food stores. If you prefer capsules, there is Nature's Way that is a well known long standing herb company. Many of these herbs are available in combination products where the same herbs we talked, about you'll see several of them already together in various combinations. Be sure to read the sections on the bottle that say "other ingredients" because you want something that doesn't have colorings, colors, fillers and other things you don't want to take.

Viagra: Natural Alternatives (cont.)

Moderator: Shouldn't someone consult with a physician before taking any of these remedies?

Dr. Kamhi: I think everyone should have their own personal physician. Most doctors, however, are not trained at all in the use of herbs medicinally So, you may want to seek out a doctor who IS trained in holistic medicine. A good place to check for that is if you have a naturopathic doctor that's an N.D. They study herbal medicine and, in particular, botanical pharmacology for many years, and are in an educated position to decide if an herbal remedy is right for you. There are many chiropractors and osteopaths and some MDs who have now trained themselves in the proper use of natural medicine. The American Holistic Medical Association has lists of doctors. Another source is ACAM (American College for Advancement in Medicine) which has lists of MDs who are training or trained in natural medicine. But you should certainly share with your doctor that you intend to use the natural remedies. Many do have side effects and if you get a rash, that can happen with anything, natural or not. Also, if you're already taking various kinds of drugs, it could interfere with the safety and effectiveness of an herbal remedy.

maggy29_WebMD: What about combinations of these herbs and/or amino acids?

Dr. Kamhi: Yes, as stated, in the health food store you'll find many products now available that combine several of the herbs we talked about and some others. As I mentioned briefly, ginseng is one, as well as the amino acid arginine. You may find products with these already mixed together for you.

maggy29_WebMD: Do you think combining the herbs adds to the positive effects of taking the herbs?

Dr. Kamhi: In many cases, yes, it will. Other people find that using them singularly works best. One that I've seen is a very good combination is damiana, kava kava and yohimbe. That seems to help many people and it is widely available in combinations. Or, you can get them each separately. You may want to also consider saw palmetto. Saw palmetto is a fruit from a plant that grows prolifically right here in the U.S. We talked about many other herbs, such as ginseng and yohimbe from Africa and Muira puama from Brazil and damiana from Mexico, but saw palmetto is a native herb right here in the U.S. and is a fruit that grows on a palm-like bush in Florida. Saw palmetto (Serenoa repens) is excellent for prostate health. And, very often a congested prostate is part of the overall problem in sexual dysfunction. So that's one you might want to add to your overall wellness program

Moderator: What are the typical causes of erectile dysfunction?

Dr. Kamhi: The main cause, as we've stated, is interruption in circulation to the penis, because that's exactly how an erection happens, through an engorgement of blood in that area. Poor nutrition is the main cause. Things like caffeine, alcohol, tobacco and foods that are high in carbohydrates and the wrong kinds of fats. That's what causes it. It's not really a mystery. Now, of course, there are always psychological factors that may be part of it as well. If a man is in an unhappy relationship, that can cause it. Also, anxiety. Once a man begins to have the problem of erectile dysfunction, he will almost immediately will worry the next time he goes to have sex and this can interfere with an erection. So, that's where a psychological component comes in very strongly. The Journal of the National Cancer Institute found that men who eat red meat more than five times a week have a three times higher risk of developing prostate cancer than men who eat meat less than once a week. So, not only does the prostate become congested, but erectile dysfunction can also result

Moderator: Are they always related?

Dr. Kamhi: No, they're not necessarily always related. Men may experience erectile dysfunction even if they have a healthy prostate.

Moderator: What are some common ways that erectile dysfunction was treated prior to the introduction of Viagra?

Dr. Kamhi: There were other drugs that attempted to increase circulation but perhaps were not as effective. And I'm sure people heard of mechanical implants that were used and are still being used, various pumps and other apparatus that are surgically or externally used to pump the area. There are also penis rings that aid in keeping circulatory engorgement in place so an erection is effective. There were other drugs attempted, but none had as much success as Viagra. There were also injections that people use directly in the penis. All of these are still being used.

Moderator: At what age are men likely to experience erectile dysfunction?

Dr. Kamhi: Well, it can happen at any age. However, it's certainly more prevalent as age increases, as are all kinds of degenerative illness specifically related to decreased circulation. So the incidence does increase with age. Also, testosterone levels decrease with age which can also add to the problem.

Moderator: Doctor, this has been most interesting and informative. As we near the end of our time, would you care to offer some final thoughts?

Dr. Kamhi: Again, erectile dysfunction can be corrected. That's the good news. And, the natural approach involves healthy habits that can not only solve the problem of erectile dysfunction, but increase overall levels of wellness, decrease obesity, decrease the chance of getting other kinds of degenerative illness and increase overall health and happiness.

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