Showing posts with label erectile dysfunction. Show all posts
Showing posts with label erectile dysfunction. Show all posts

Saturday, March 31, 2012

Robert Sapolsky on Stress - How Stress Hurts Men’s Sex Lives

Greater Good has featured clips from a talk by Robert Sapolsky, Ph.D., this month, and an essay (abridged) that originally appeared in Foreign Affairs. Sapolsky is the John A. and Cynthia Fry Gunn Professor of Biological Sciences and a professor of neurology and neurological sciences at Stanford University. His most recent book is Monkeyluv: And Other Essays on Our Lives as Animals.

Here is the segment on male sexual issues brought on by stress. See the article below for a lot more information on stress, a serious issue for a lot of men.

Robert M. Sapolsky

The best-selling author and Stanford University professor explains why the stress response, which evolved for short-term physical crises, can become a long-term, chronic problem for human beings—and how we can reduce the impact of stress on our lives. More about Robert M. Sapolsky.

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Featured Clip



How Stress Hurts Men’s Sex Lives

March 2012 | TRT 3:03
Combining wit with deep knowledge, the researcher and best-selling author explains why stress interferes with male sexual response.
 This clip is from a much longer talk only available to members. Here is the abridged article the talk is based on - with a lot of good material on stress.

How to Relieve Stress

By Robert M. Sapolsky | March 22, 2012


Robert M. Sapolsky explains why stress can become a chronic problem—and how we can reduce the toll it takes on our lives.

This month, we feature videos of a Greater Good presentation by Robert M. Sapolsky, one the country’s foremost experts on stress. In this excerpt from his talk, the best-selling author and Stanford University professor explains the difference between bad stress and good stress, and how we can manage the effects of chronic stress on our lives.

In 1900, what do you think were the leading causes of death in this country? 


If you were 20 to 40 years old and a woman, the single riskiest thing you could do was try to give birth. TB, Pneumonia, influenza killed a lot of other people. But few people under the age of 100 die of the flu anymore. Relatively few women die in childbirth. Instead, we die of these utterly bizarre diseases that have never existed before on the planet in any sort of numbers—diseases like heart disease, cancer, adult-onset diabetes, and Alzheimer’s.

Now, some of this has to do with nuts and bolts biology. But some of it has to do with issues that nobody ever had to think about before in medicine—totally bizarre questions like, “What’s your psychological makeup?” or “What’s your social status?” or “How do people with your social status get treated in your society?”

And this one: “Why is it that when we’re feeling unloved, we eat more starch?” Figure that out, and you’ve cured half the cases of diabetes in this country

Indeed, when you look at the diseases that do us in, they are predominantly diseases that can be caused, or made worse, by stress. As a result, most of us in this room will have the profound Westernized luxury of dropping dead someday of a stress-related disease. That’s why it’s so urgent that we understand stress—and how to better manage it.

How stress kills

Do you remember “homeostasis,” a term I guarantee you heard in ninth grade biology? Homeostasis is having an ideal body temperature, an ideal level of glucose in the bloodstream, an ideal everything. That’s being in homeostatic balance.

A stressor is anything in the outside world that knocks you out of homeostatic balance. If you’re some zebra and a lion has ripped your stomach open and your innards are dragging in the dust and you still need to get out of there—well, that counts as being out of homeostatic balance.

So to reestablish that balance, you secrete adrenaline and other hormones. You mobilize energy and you deliver it where it’s needed, you shut off the inessentials like the sex drive and digestion, you enhance immune defenses, and you think more clearly. You’re facing a short-term physical crisis, and the stress response is what you do with your body. For 99 percent of the species on this planet, stress is three minutes of screaming terror in the savannah, after which either it’s over with or you’re over with. That’s all you need to know about the subject if you’re a zebra or a lion. 

If you’re a human, though, you’ve got to expand the definition of a stressor in a very critical way. If you’re running from a lion, your blood pressure is 180 over 120. But you’re not suffering from high blood pressure—you’re saving your life. Have this same thing happen when you’re stuck in traffic, and you’re not saving your life. Instead you are suffering from stress-induced hypertension.




We humans turn on the stress response with memories, with emotions, with thoughts, and the whole punch line is: That’s not what it evolved for. Do it regularly enough, and you’re going to damage your cardiovascular system. Increased blood flow hammers on the walls of your blood vessels, causing inflammation. Fat and glucose and cholesterol glom on and begin to clog your arteries. That’s bad news. You are more at risk for chronic fatigue, sleep disruption, muscle atrophy, and probably most importantly, adult-onset diabetes, this once obscure disease that’s just on the edge of being the number one killer in this country.

Chronic stress also does bad things to the nervous system. Stress kills neurons in the part of the brain called the hippocampus and weakens the cables between neurons, so they can’t talk to each other. This impairs the formation and retrieval of long-term memory. The opposite thing happens in the amygdala, which is where we see fear in a brain scanner. In the hippocampus, stress causes stuff to shrivel up. But stress feeds the amygdala. It actually gets bigger. Chronic stress creates a hyper-reactive, hysterical amygdala, and this tells us tons about what stress has to do with anxiety disorders.

Another domain: the mesolimbic dopamine system. Dopamine is a neurotransmitter that is about reward and pleasure. Cocaine works on the dopamine system. All the euphorians do. What are the effects of chronic stress on this part of the brain? Those pathways get depleted of dopamine, and this takes away your ability to feel pleasure. So if stress depletes your dopamine, what have you just set yourself up for? Major depression.

What about the frontal cortex? It’s the most human part of the brain; we’ve proportionally got more of it than any other species does. And what does the frontal cortex do? It does gratification postponement, self-discipline, long-term planning, emotional regulation. It’s the last part of the brain to fully mature—that doesn’t happen until you’re 25 years old, which explains a lot about the freshmen year of college.

This has a very interesting implication. If this is the last part of the brain to fully develop, by definition, then, it is the part of the brain least constrained by genes and most sculpted by experience. What does chronic stress do to the frontal cortex? Atrophy of neurons, disconnecting circuits. As a result, you make the most idiotic decisions, which are going to haunt you for the rest of your life, and yet you think they’re brilliant at the time. That’s another effect of chronic stress: Your judgment goes down the tubes.






How to manage stress

We’ve just gone on a quick tour of all the things that can go wrong from chronic stress. If you study the subject for a living, it’s amazing to you that anybody is still alive, that we haven’t just collapsed into puddles of stress-related disease.

Despite that, most of us do decent jobs at coping, and a subset of us is spectacular at coping. And thus from day one, stress researchers have wondered why some bodies and some psyches deal better with stress than others. In making sense of individual differences, what we’re essentially asking is, “What is it that makes psychological stress stressful”? And a huge elegant literature by now has shown precisely what the building blocks are.

The literature is built on experiments like this one: You have a lab rat in a cage, and every now and then, you give it a shock. Nothing major, but nonetheless, the rat’s blood pressure goes up and so do stress hormone levels. Up goes the risk of an ulcer. You are giving this rat a stress-related disease.

Now, in the second cage, there’s another rat. Every time the first rat gets a shock, so does the second. Same intensity, same duration, both of their bodies are being thrown out of homeostatic balance to exactly the same extent. 

But there’s a critical difference: Every time the second rat gets a shock, it can go over to the other side of its cage, where there’s another rat that it can bite the crap out of. And you know what? This guy’s not going to get an ulcer, because he has an outlet for his frustrations. He has a hobby.

There are other stress experiments that involve torturing rats, which suggest ways for humans to manage stress. We can give the rat a warning 10 seconds before each shock, and we find it doesn’t get an ulcer. That tells us that you are less vulnerable to a stress-related disease if you get predictive information.

Another experiment: If we give the rat a lever to press, and that rat thinks he’s in control of the shocks, that helps—a sense of control decreases the stress response.

Yet another experiment tells us it helps to have friends: If a rat getting shocks has a friend it likes in the cage, and they are able to groom each other, the rat doesn’t get the ulcer. So social affiliation helps control stress.

In short, you are more likely to get a stress response—more likely to subjectively feel stressed, more likely to get a stress-related disease—if you feel like you have no outlets for what’s going on, no control, no predictability, you interpret things as getting worse, and if you have nobody’s shoulder to cry on.

Okay, these are very powerful observations. They’re helpful. But please don’t assume that if you get as much control in your life and as much predictive information in your life as possible, you will be protected from stress. To understand why, let me share some of the subtleties of this field.

Look at the rat that got a warning. Timing is everything. He didn’t get an ulcer when he got a 10-second warning. But if the warning light goes on one second before the shock occurs, it has no positive effect whatsoever, because there isn’t time for the rat to adjust anything. Or suppose, instead, the warning light comes two minutes before. That will make the ulcers worse, because the rat is sitting there, ulcerating away, thinking, “Here it comes, here it comes, here it comes.” When it comes to predictive information, there’s only a narrow window where it works.

When does a sense of control work? When you’re dealing with a mild to moderate stressor, because in those circumstances you know how much worse it could have been and can imagine, rightly or wrongly, that you had control over that improvement. But if it’s a major disastrous stressor, the last thing you want is an inflated sense of control, because that sets you up to think that the disaster is all your fault. In the case of a major disaster, we tend to minimize people’s sense of control—by saying, for example, “It wouldn’t have mattered if you had gotten him to the doctor a month ago, it wouldn’t have made a difference.” And one of the worst things we do, societally, is attribute more control to victims: “Well, what’s she going to expect if she dresses that way?” or “Well, what are they going to expect if they choose not to assimilate?”

In short, a sense of control is protective for mild to moderate stressors, but it’s a disaster for major ones. In that domain, the most humane thing you can do is foster denial and rationalization rather than a sense of responsibility.

When is stress good?

Just as not all stress management techniques work, not all stress is bad. In fact, we love stress. We pay good money for it in a scary movie or on a roller coaster ride. We love stress when it’s the right amount of stress.

When is it optimal? When it’s only moderately stressful, at the most. And good stress is transient—it’s not for nothing that you don’t have roller coaster rides going for three weeks! The stress also has to be happening in a context that feels safe overall. Moderately stressful at most, transient, safe—what does that define? 


That defines stimulation. That defines what play is. What is play about? 

It’s when a higher rank dog says to a lower ranking dog: “I am willing to suspend our dominance relations right now and allow all sorts of unpredictable interactions. To show how much I’m doing that, I’m going to give you access to my throat or my genitals, and we’re just having a great time here playing.” In play, you feel safe, and as a result, you are willing to give up some control and predictability. We say, “Surprise me!” That’s good stress.

There’s another lesson we can learn from dogs and other hierarchical mammals, like baboons: Social rank can cause stress, especially where rankings are unstable and people are jockeying for position. But social rank is not as important as social context. What patterns of social affiliation do you have? How often do you groom, how often does somebody groom you? How often do you sit in contact and play with kids?

What’s clear by now is if you have a choice between being a high-ranking baboon or a socially affiliated one, the latter is definitely the one that is going to lead to a healthier, longer life. That’s the baboon we want to be—not the one with power, but the one with friends, neighbors, and family.

Friday, March 23, 2012

Obesity and Radical Prostatectomy


This post is based purely on anecdotal reports, but I think it bears sharing. This may change how you think of your health and (I hope) increase your motivation to lose fat (if you are one of the 2/3 of Americans who are overweight or obese).

A young woman I know who is on her way into medical school next fall has been shadowing a surgeon on his rounds and in the O.R. over the last couple of weeks. The surgeon has performed several prostate surgeries in that time, ranging from biopsies to full removal of the gland and the associated tumor tissue (radical prostatectomy).

Among the many risks and side effects of a radical prostatectomy include (all quotes are from WebMD):
  • Sexual impotence - "About half of men are able to regain some of their ability to have erections.3 But this takes time. It can take as little as 3 months. But for most men, it will be 6 months to a year.4"
  • Urinary incontinence -  "Up to half of all men who have a radical prostatectomy develop urinary incontinence, ranging from a need to wear urinary incontinence pads to occasional dribbling. Studies show that one year later, between 15% and 50% of men report urinary problems.5"
  • Additional issues - "Damage to the urethra," "damage to the rectum."  "The same general risks as other major operations, including heart problems, blood clots, allergic reaction to anesthesia, blood loss, and infection of the wound."
Once of the ways modern medicine has tried to reduce these risks and outcomes is through nerve-sparing surgery. The hope is to preserve as much nerve function as possible so that these men do not become impotent or suffer from urinary incontinence. Outcomes are better with this approach, but still not ideal.

And this brings me to the point of this post. After seeing several "normal" men (i.e., overweight, and mostly with intra-abdominal fat) get this procedure, with the attempt to spare as much nerve tissue as possible, she saw the same procedure performed on a man with very low bodyfat, probably 6-8%.

With the prior men the surgeons literally had to dig through yellow adipose tissue to find the prostate, and then identifying and preserving the nerves was difficult, but with the low-bodyfat patient there was no significant adipose tissue to dig through, the nerves were easily identified and marked, and in all likelihood, he will suffer none of the negative side effects.

The moral of this story is that if you are a man, about 1 in 6 will be diagnosed with prostate cancer during our lifetimes, but only 1 in 36 men die from the disease. Since this is now a disease that most men will live with, who wants to live those years with impotence and wearing an adult diaper?

We reduce the risk of that outcome significantly simply by being in good, healthy shape, which means regular exercise and healthy diet. It's not too much to ask, is it, if it will allow you a better quality of life? 

Thursday, March 3, 2011

Non-Steroidal Anti-Inflammatory Drugs Linked to Erectile Dysfunction

http://www-americansingles.us/wp-content/uploads/2010/09/curcumin-tepung.jpg

For the last few years, I have recommended only curcumin or enteric coated aspirin to my clients for pain relief - not ibuprofen, not acetaminophen, and not naproxin sodium, two of which may cause heart damage (despite what the article below says) and one destroys your liver (that would be acetaminophen).

Now it turns out these drugs cause ED (erectile dysfunction) in men, which is probably more likely to get men to stop taking them than mere health issues.

So it's curcumin, a cox-2 inhibitor with no side effects other than lower cholesterol, lower risk of neurodegenerative diseases (Alzheimer's Disease and others) and lower risk of several forms of cancer. Below the main article is some research info on curcumin for pain.

Here is the article reference:
Joseph M. Gleason, Jeffrey M. Slezak, Howard Jung, Kristi Reynolds, Stephen K. Van Den Eeden, Reina Haque, Virginia P. Quinn, Ronald K. Loo, Steven J. Jacobsen. Regular Nonsteroidal Anti-Inflammatory Drug Use and Erectile Dysfunction. The Journal of Urology, 2011; DOI: 10.1016/j.juro.2010.11.092

Non-Steroidal Anti-Inflammatory Drugs Linked to Increased Risk of Erectile Dysfunction

ScienceDaily (Mar. 2, 2011) — Men who take non-steroidal anti-inflammatory drugs three times a day for more than three months are 2.4 times more likely to have erectile dysfunction compared to men who do not take those drugs regularly, according to a Kaiser Permanente study published online in The Journal of Urology.

While previous research showed a trend toward this same finding, this observational study used electronic health records, an automated pharmacy database and self-reported questionnaire data to examine NSAID use and ED in an ethnically diverse population of 80,966 men aged 45 to 69 years throughout California.

After controlling for age, race, ethnicity, smoking status, diabetes, hypertension, heart disease, high cholesterol and body mass index, the researchers found that ED was 1.4 times more likely -- a modest risk -- among regular NSAID users compared to men who did not take the drugs regularly. This association was consistent across all age groups.

"This study is a great example of how we work to understand the safety and effectiveness of what we recommend for our patients. We went into this study thinking we would find the opposite effect: that NSAIDs would have a protective effect because they protect against heart disease, which is also linked to ED," said study senior author Steven J. Jacobsen, MD, PhD, an epidemiologist and director of research for Kaiser Permanente Southern California. "The next step is to dive a bit deeper to understand the underlying physiology of what might be happening with these drugs."

Erectile dysfunction is a common problem in many middle-aged and elderly men. According to the National Institutes of Health, approximately 5 percent of 40-year-old men and between 15 and 25 percent of 65-year-old men experience ED on a long-term basis.

However, the researchers caution that men should not stop taking NSAIDs based on this study.

"There are many proven benefits of non steroidals in preventing heart disease and for other conditions. People shouldn't stop taking them based on this observational study. However, if a man is taking this class of drugs and has ED, it's worth a discussion with his doctor," Jacobsen said.

Study authors included: Joseph M. Gleason, MD, and Howard Jung, MD, from the Kaiser Permanente Los Angeles Medical Center; Jeffrey M. Slezak, MS; Kristi Reynolds, PhD, MPH, Reina Haque, PhD, MPH, Virginia P. Quinn, PhD, MPH, and Steven J. Jacobsen, MD, PhD, with the Kaiser Permanente Southern California Department of Research & Evaluation; Ronald K. Loo, MD, Kaiser Permanente Downey Medical Center; and Stephen K. Van Den Eeden, PhD with the Kaiser Permanente Northern California Division of Research.

The following comes from a review article on various alternatives to NSAIDs, and it's a 2010 article, so the information is current. The article is open access, available by clicking on the doi link.

Article Reference:
Maroon, JC, Bost, JW, & Maroon, A. (2010, December). Natural anti-inflammatory agents for pain relief. Surgical Neurology International; 1: 80. doi: 10.4103/2152-7806.73804
Curcumin (turmeric)
Curcumin is a naturally occurring yellow pigment derived from turmeric (Curcuma longa), a flowering plant of the ginger family. It has traditionally been used as a coloring and flavoring spice in food products. Curcumin has long been used in both Ayurvedic and Chinese medicines as an anti-inflammatory agent, a treatment for digestive disorders, and to enhance wound healing. Several clinical trials have demonstrated curcumin’s antioxidant, anti-inflammatory, and antineoplastic effects. Results of a study by Zandi and Karin suggested that curcumin might be efficacious in the treatment of cystic fibrosis because of its anti-inflammatory effect.[121] Curcumin is known to inhibit inflammation by suppressing NF-kB, restricting various activators of NF-kB as well as stemming its expression.

Curcumin has also been suggested as a treatment for colitis, chronic neurodegenerative diseases, arthritis, and cancer. In addition, it regulates the activity of several enzymes and cytokines by inhibiting both COX-1 and COX-2. Most studies to date have been performed in animals, but given the centuries of use of curcumin, as well as its now demonstrated activity in the NF-kB, COX-1, and COX-2 inflammatory pathways, it may be considered a viable natural alternative to nonsteroidal agents for the treatment of inflammation.

The usual dosage of standardized turmeric powder is 400–600 mg taken three times per day.[13] Side effects are few, but with extended use, this agent can cause stomach upset, and in extreme cases gastric ulcers may occur at very high doses. Caution should be used if the patient is taking anticoagulant medications or high doses of nonsteroidal drugs. Studies have shown that curcumin may be used in combination with lower doses of nonsteroidal medications.[79,11,21,40,87,111,121]
Look for 95% pure extracts of curcumin, of at least 500 mg per capsule (up to 1000 mg per capsule). I take three caps a day, spaced out with meals. My knee arthritis rarely bothers me any more. A 64 year old client with severe arthritis in his fingers and hands has had similar results.