In Your Pants with Dr. Susie G - Optimizing Erectile Health

Starting point is 00:00:00 you're listening to the in your pants podcast i'm your host dr suzy gronski your penis friendly pelvic health physical therapist sex counselor and educator helping you get in the know down below on today's show we are diving into the effects of diet on erectile dysfunction what medical conditions increase the risk for erectile dysfunction and what their research says about testosterone testing and how much does it really play in the etiology of erectile dysfunction lastly we talk about supplements supplements for erectile dysfunction promise a quick fix for ED but what are these companies really selling you and do they actually work? This episode is filled with so

Starting point is 00:01:05 much wisdom from Dr. Jason Stevens, a doctor of clinical nutrition and registered dietitian nutritionist who completed his advanced practice residency with me, Dr. Susie G, where he worked with men with chronic pelvic pain. He was awarded the medal for outstanding clinical performance for his residency work. In his 12 years as a dietitian, he has worked as a clinical oncology dietitian, taught clinical nutrition in an accredited educational program for dietetic students, and is currently a full-time college educator. His research interests include advanced level practice in the field of nutrition and dietetics, and the role of nutrition in pelvic Health. We hope you enjoy the show. Hi, Dr. Jason. Thank you so much for being on the show today.

Starting point is 00:01:59 Hi, Susie. Thanks so much for having me. A pleasure. Pleasure to have you. So let's dive right into it. Let's talk about erectile dysfunction and what the top causes are for erectile dysfunction. Sure. This is a great question. So erectile dysfunction is very complex. So I tend to think of it as having sort of three buckets. So vascular, which we're really talking about the cardiovascular system, right? So in order to get and maintain an erection, your cardiovascular system has to be able to pump blood effectively, right? It can be hormonal. So we talk about things like testosterone, and it could also be psychological. And so it's very complex. As you know, you work with a lot of men who fall anywhere in this whole spectrum of things,

Starting point is 00:02:48 and it could be more than one cause. So I think nutrition touches on a lot of those areas, but it often gets overlooked. So it's one of those things that when we think about treating sexual dysfunction or erectile dysfunction, we often don't go immediately to diet. Right. Because immediately people go to testosterone. Let's talk about that. right? Sure, sure. Yeah. And certainly low testosterone can be associated with erectile dysfunction or sexual dysfunction. But interestingly, the association is not as strong as you might think. And some men who have what would be considered low testosterone perform perfectly fine and have no problems. And some men who have very normal testosterone

Starting point is 00:03:30 have erectile dysfunction. So we often actually look more at the vascular cause of erectile dysfunction than so much of the hormonal cause. And really, it depends too on what population we're talking about. So as we get older, the cardiovascular system tends to be the more likely culprit for erectile dysfunction. And there is a risk factor with if you're noticing sexual dysfunction, erectile dysfunction regarding cardiovascular health, right? Can you talk to us a little bit about what the research says around cardiovascular health in general with erectile dysfunction? Yeah. So erectile dysfunction is actually a strong predictor of future cardiovascular disease. So the way that I think about it is erectile dysfunction itself is a

Starting point is 00:04:17 symptom of something else. And so it really pays to be an investigator and get in and look to what the cause underlying it is. So we'll talk a little bit about maybe some tests that you might consider getting if you have erectile dysfunction. But I like to think of it sort of like the canary in the coal mine, that expression of it might be the first sign that something is brewing under the surface. And especially what we call metabolic syndrome, the two are strongly connected. Yes. So metabolic syndrome, and you have mentioned this several times in our collaboration together with other patients. We often collaborate well as a team. And you had mentioned to me metabolic syndrome several times. And I thought, I was like, this would be a really good educational moment

Starting point is 00:05:07 here to share with our audience about what is metabolic syndrome? How does it impact sexual function? And what are some of the tests that someone can take to rule it in or rule it out? Great question. So metabolic syndrome is sort of a constellation of risk factors that strongly predict future cardiovascular disease and chronic disease. So we tend to look at blood pressure, so high blood pressure or hypertension, high blood sugar, high cholesterol, or high triglycerides, so high blood fats or lipids in the blood. And then we also look at, hang on, there's a fifth factor, large waist circumference. I knew it was going to come to me. So accumulation of belly fat. And that does tell us a bit about, you know, especially if we see that the high waist circumference, a lot of abdominal fat accumulation, you know, these things all are highly

Starting point is 00:06:07 interrelated. So a lot of belly fat or fat around the abdomen might actually be producing hormones that might be changing sexual function, for example, estrogen. So it's a very complex. So the metabolic factors might be driving the vascular and the hormonal changes that lead to erectile dysfunction. But I often think, you know, this area of our body is so sensitive to these changes that often it may be the first thing you notice. You might notice erectile dysfunction before you notice any of these other things or even have them tested. Wow. Wow. So if someone wanted to test, well, you had mentioned lipid, um, blood sugar, uh, high blood, you know, checking your blood pressure,

Starting point is 00:06:52 what other things might, uh, a male person, a person with a penis want to do as far as just general lab work, uh, to get some sort of baseline of, of what their health markers look like? Yeah, good question. So I would say certainly, you know, if you're noticing changes in your sexual function or erectile function, I think that's a great sort of starting point to get back in to see the physician if you haven't in a while, and get some of those sort of baseline labs done. So a blood lipid panel, having not just a fasting blood sugar, but a hemoglobin A1c, which gives us more of a long range view of what your average blood sugar has been over the last few months. A complete metabolic panel might be appropriate and your doctor can kind of help you

Starting point is 00:07:38 decide if you need all of that. And then looking at hormones. So in particular, looking at your testosterone levels and just getting a baseline to see where you're at. And then having a team of folks like you and myself, along with your doctor to help look at the whole picture, to take a holistic view of where you're at with your health and strategize how you can not just use, you know, medical therapy and treatments, but also lifestyle therapy and treatments. Well, speaking of other treatments to consider, Dr. Jason, as a nutritionist yourself, let's talk about how diet can affect a person's sexual function. Yeah, so diet definitely plays a role if you look at the risk factors. So for example, diabetes,

Starting point is 00:08:25 which is strongly associated with lifestyle, your risk of erectile dysfunction with diabetes is two to three times higher. So we know that the same nutrition and lifestyle risks that put you at risk for diabetes are going to put you at risk for erectile dysfunction. And same with cardiovascular disease. So a diet that's high in refined grains and processed sugar, red and processed meats, those kinds of things are going to increase your risk for diabetes, cardiovascular disease, and ultimately erectile dysfunction as well. And there are things that are protective. So if we look at, and that's what I like to focus on.

Starting point is 00:09:01 So not so much on the don'ts, but like, what do we put on our plate? How can we fill our plate with healthier options that protect us and nourish us? And so I typically think of the Mediterranean diet as being one of the things that has a strongest amount of research with reducing your risk of both cardiovascular disease

Starting point is 00:09:21 and there's research directly on erectile dysfunction. And it makes sense. If the underlying cause of erectile dysfunction is typically vascular problems, a diet that helps improve your cardiovascular system is going to help improve that as well. And so a diet that's rich in whole grains, fruits and vegetables, healthy fats like olive oil, fatty cold water fish like tuna and salmon, those are all great options. And a diet that's sort of built on those things is going to help protect your health in the long run. And I would say it's what I would add to that is none of that is probably going to shock

Starting point is 00:10:01 your audience. It's not going to shock you. I don't think any of that stuff is like shattering information. Right, right. I don't think anybody's sitting there going, wow, I had no idea that this was the stuff I should be doing. So what I would say to those of you in your audience who are listening is you probably have more trouble sticking with those things and carving out a pattern and getting support. And so really it's how do you hold yourself accountable? How do you have a partnership with someone who can help you navigate this very complex relationship that we have with food? I think that's what people really have more trouble with. Thank you, Dr. Jason. And you're and you're probably right you're right you know onto something there it's

Starting point is 00:10:49 it's it's just changing behavior and changing a habit and that can be very challenging especially in a world that is driven by convenience and accessibility and you know the messaging around nutrition in general and food, that health promotion is sorely lacking in in all areas of our, at least I can only speak to the United States culture and our culture of how that's even promoted, even from a medical perspective. I totally agree. And, you know, my day job. So my full time gig is that I'm a college professor. So I teach, you know, typically students who are coming in at a high school, or maybe who are kind of in that college range of age. And I always ask them, have you had any nutrition education in your entire K through 12 experience, and I will

Starting point is 00:11:46 usually get two or three hands. And so we we don't get it during the the most important time of our life to really start building those healthy habits. And then we're surprised when it's hard for us to maintain them. So I always think it's not an you know, it was partly it is an education issue that I think if we we get that information earlier in life when we can start building those habits but once we get to adulthood it's more about our behavior I think at this point we've heard this message about what we should be doing it's getting the support and and lifestyle change is hard so I'm not here to judge anybody I think we probably talked about this before but you know some people think a dietician is sort of the food police that we're you know I'm watching you um

Starting point is 00:12:33 when I used to be a clinician, I would go into the cafeteria because I wanted to see what foods my patients were being served in the hospital cafeteria, right? And patients would sometimes duck. Like they would see me and go like, oh, no, no, he's gonna look at what's on my plate and judge me. And I think that's the last thing I'm doing. What we're here to do is really listen, support you, encourage you, and understanding we're all human beings, right? That we all have a relationship with food that's complex. It's not just, you know, medicine, right? Like there's that expression, food is medicine. And I think that's true, but it's more than that, right? Food is love, food is culture, food is so much broader than just that. So I think a holistic approach

Starting point is 00:13:15 makes the most sense. Beautifully said, Dr. Jason. And it reminds me of sexual health education as well. The way that you describe the gap in education and knowledge and the habits and behaviors that might be otherwise instilled at a very young age, sexual health is right in line with what you're talking about in nutrition. And also I would add pain education pain neuroscience education those three things are really lacking in just foundational aspects of understanding our bodies understanding how what we put into our bodies and how we use our bodies influence our overall experience in and outside of our bodies so thank you so much for you know shining the light on that perspective because it it does

Starting point is 00:14:13 parallel with a lot of other aspects of, of health promotion in general. And I would say that that's one of the biggest joys that I get at working with you is that we really look at all of these things that I think are so overlooked, right. And, you know, talking about sexual function too, it is a tab, sort of a taboo topic where it shouldn't be. And so many of our patients we find, you know, we also work with guys that have digestive problems. These are all things that a lot of our patients have suffered in silence because we haven't done a great job of educating people and getting them comfortable about talking about these things.

Starting point is 00:14:53 But I think that's also one of the great joys that we have is that when we can sit down with a patient and make them comfortable and put them in a space where they feel like I can talk about all these things that maybe I haven't felt comfortable in other spaces to talk about, and we can really help their healing journey that way. Absolutely, Dr. Jason. And it is really a privilege to be alongside you on this collaborative approach that we support our patients with. So a little token of gratitude here for you. Thank you. The feeling is 100% mutual. Thank you, Dr. Jason. So I have, we'll kind of segue into supplements because it sells, it's sexy, and it's a very, it sells, really, it sells. Why? Because there's a promise for a quick fix. and that's with medications and i'm not saying that medications don't have especially for

Starting point is 00:15:44 erectile dysfunction don't play a role as a sexual resource it's how that medication or that supplement is used and and really when we're i'm going to just focus on the supplements because a lot of them can actually have more harmful and detrimental effects on the individual so i wanted to get your i wanted to pick your brain about this about the ed supplements and maybe even the prostate supplements, because a lot of them just overlap. But let's talk about that, Dr. Jason. Sure. Wow. So this, there's a lot to unpack here, right? So, you know, from working with me for quite a while, I have a lot of feelings about supplements and the supplement industry in particular. And so I think kind of starting at the beginning, which is the first thing that you said

Starting point is 00:16:28 that I want to acknowledge why people choose these products, because I think that's important that sometimes one of the things that I noticed, and I have a history of practice in oncology, so working with cancer patients, sometimes what I would find is patients would be reluctant to share with their providers that they were taking these supplements. There was some level of shame about it because sometimes their healthcare provider would just dismiss it right off hand. And I think it's important to understand that people often go to supplements because they're frustrated with having to take medications that they fear because of the side effects that they come with, or maybe the cost associated with access to those medications. And they're attractive

Starting point is 00:17:09 because they're natural, right? We're talking about vitamins, minerals, herbs, right? Amino acids, these things, you know, that we tend to think, okay, natural means good means healthy. But what we've discovered is many of these substances on their own, they can act like drugs in the body. So vitamins, minerals, particularly in very high amounts, can begin to have almost pharmaceutical effects in the body, especially when you're megadosing on them. Same thing with herbs and those types of products. They can also begin to not only act like medications, but interact with your medications. So that's another point of caution is that so many of these things, they don't always play well together. So herbs and vitamins can interact with

Starting point is 00:17:59 each other, and with the medications that you're taking. The other point is this, the supplement industry is very poorly regulated. So unfortunately, the burden is on the consumer to protect themselves. So the way it currently works in the US, and I always love to educate people on this, because I think it's very important is that manufacturers can put a supplement on the market with zero testing as to whether that product is safe or effective or contains what it says it contains. Then the burden is on the FDA to prove that a supplement is unsafe. So it's the opposite of the pharmaceutical industry, right? Isn't that wild? So think about how much testing a drug has to go through before it can go on the market. So you've got to go through phase one, phase two,

Starting point is 00:18:51 clinical trials, and even then, some of those drugs never make it. And the ones that do make it, we know, still have problems with them years later after they've gone to market. Now take a supplement where none of that has been done. And then the burden is on the FDA to prove a product is unsafe. Well, think about how many products are on the market. It is virtually impossible for them to keep track of it. And they do take action. So I don't want to act like the FDA is doing nothing. It's simply that they're not staffed or funded to the point where they could possibly keep track. And so oftentimes when they do take action, it's because a number of consumers have been harmed and reported it. But another thing to think about is how many times

Starting point is 00:19:35 have you gotten sick or had some sort of weird side effect? And you would never know to look at your supplement cabinet to point out that as the problem. Exactly. So it's extremely complex, extremely complex. So on the other hand, knowing that this is a choice that many consumers make and that not all supplements are equally bad. So the other side to this is some companies are very responsible. Some companies test and there are agencies that independently test supplements for puracy, not often potency though. So one of the big struggles we have is that most companies cannot prove that their products work

Starting point is 00:20:15 and there's often very little testing and research that's done on supplements to prove that they work. And part of that is because it's not a moneymaker. Studying herbs and vitamins and minerals, that's never gonna pay out as well as pharmaceuticals do. So the people that fund those studies, who do you think is gonna fund a study on a supplement? Okay.

Starting point is 00:20:36 but people can make the supplement, right? And then we automatically should have some doubt about the results of those studies. So yes, absolutely. And I look at all of that. So when I look at whether I might recommend a particular supplement, I first look to, is there any evidence that it works? If it does have some evidence that it works, I also want to make sure that it's safe. So I look for efficacy, safety, then I will like research a brand. So I will go to some of the databases that I have access to to see, has this brand been tested for purity or potency, making sure it actually has what it says it has in it before I make a recommendation to a patient. That's three steps that most consumers do not take when they walk into a pharmacy or drugstore or supermarket or any of those places and pick up a supplement. No, exactly. Thank you so much. That is very important and crucial information to understanding really what that, to be an educated

Starting point is 00:21:42 consumer. And as you say, unfortunately, the burden is on the consumer. However, with people like yourself, you know, nutritionists who are professionals in knowing how to weed through the noise and really be able to tailor a recommended nutritional plan, care plan and nutrition therapy. I mean, that in itself is just priceless to be able to have that resource in your back pocket without needing to feel like you have to weed through all the BS that exists on the internet around. Exactly. And I think having somebody, having access to somebody that can help you navigate, that's really important and very helpful. And especially I think with some of the patients that we work with who may be on multiple medications, who may be taking

Starting point is 00:22:34 multiple supplements and who have really been through the ringer. I think I would say, and hopefully this is accurate, but that many of the, most of the time, by the time patients get to us, they have seen multiple providers. They may have been given, you know, multiple prescriptions, sometimes from different providers. And we really help them navigate that. And we take a holistic look. And I know you are super well-educated on all of the medications that have potential sexual side effects and that you can help. I mean, we don't put or take people on and off medications. We're not qualified to do that, but we can help partner with patients to empower them to talk to their prescribing providers and say, hey, you know, I didn't know, but these medications

Starting point is 00:23:14 might be interacting with each other or causing sexual side effects. Or, you know, certainly with supplements, though, I probably take more people off supplements than I put people on supplements. Thank you for that. And really, it's more cost effective that way. And honestly, it's like, why spend? Because they're priced very high, some of these medications, because of the way that they're sold and marketed and unfortunately it is taking advantage of people who are in vulnerable states especially the state of you know all of a sudden a part of your body is no longer functioning in the way that you are used to and it's starting to impact your your sexual identity your voice perhaps your relationships your roles as far as the gender that you identify with with that body

Starting point is 00:24:05 part. I mean, there's all sorts of, as you say, it's deep, there's many layers to that conversation. And so I do feel that it's unfortunate. But it is the reality of the world that we live in, that there are, there are people who are taking advantage of that situation. Very beautifully said. And I'm really glad you brought that up. Because, and we've talked about this before too, it's a high threat, right? When this part of our body or this function of our body, you know, we talk about two P poop, sexual function. Those are all like very vital primary functions of our body. And when any of those functions are threatened it is a high stakes situation for us. And unfortunately people do prey on that. And I saw the same with oncology.

Starting point is 00:24:53 So when I worked with cancer patients, it was the same thing because it's such a high stakes situation. There are companies and providers that unfortunately prey on that. And the expense too, and a thing I would point out is you're paying for the marketing. A lot of times, like when you pay for a supplement, you're not paying for the ingredient. You can get a lot of this stuff out of the food that you eat. So we think about nutrients that are vital for sexual function. So for example, zinc, vitamin E, your B vitamins. Sure, you could take that in a pill. You're oftentimes paying much more and getting a lot more than you need out of a supplement than you would get from just eating healthy foods that contain those nutrients, right? And unfortunately,

Starting point is 00:25:37 carrots don't have great marketing, right? Our fruits and vegetables, you know, their ad councils don't have a huge budget. But your bang for your buck is so much higher with those things. Another thing I'd mentioned too, that I forgot to kind of bring up with diet is it's a slow change right i think that we have to sort of equip our patients to understand that when they embark on this journey particularly changing their lifestyle the shifts are going to come incrementally and so there it's not going to be an overnight change like i eat a salad today and tomorrow all of a sudden everything is better right i wish that were the case uh but unfortunately it is not you might get like a placebo effect right you might or a confidence boost because

Starting point is 00:26:24 like hey i made a great choice for myself today um but oftentimes it's the pattern and we could take advantage of that part of the part of it is that since it's a pattern it means that one bad meal or you know bad i don't i don't believe in bad foods per se unless they're spoiled or rotten those are bad foods i think everything has its place it's about the pattern and just more often choosing those foods that are going to nourish you and protect your health and still finding a way to enjoy the things that you love. Because I think that's important too. You have to carve out space for those things that make you happy, that make your heart sing. You know, maybe that's chocolate. You've got to have space for that if that's something that you enjoy. That's right.

Starting point is 00:27:07 Oh, that's beautiful. Thank you, Dr. Jason, for emphasizing the fact that it does take courage, first of all, to acknowledge the spaces that we're in and then to start to change in the ways that we want to see change. And that isn't an easy overnight task. Like you said, you can't expect to eat a salad and then have a raging erection the next day. Or maybe you can. I mean, again, I only think about what you said about the marketing and how they just don't eat around carrots and and food and things like that you know imagine what our world would be like if if nutritious food was marketed like some of these sexual aid supplements and viagra and etc like could you imagine what those markets the line at the grocery store would be you know

Starting point is 00:28:00 we'd have to like staff the produce section exactly the produce that we would be completely sold out of carrots and greens and etc i mean everyone would be fighting themselves off as if it was like you know a big sale on um uh friday after thanksgiving you know sort of thing so anyway i i do appreciate that emphasis of this is a crock pot process not a microwave and to have to manage or at least yeah manage our expectations around the process and being just present and mindful of the process appreciating the efforts that you're tending to as far as nourishing your soil because that once you do that once you keep cultivating that the seeds that you plant I mean it's only inevitable that they will ripen that they will all ripen and they will produce a

Starting point is 00:28:59 bountiful array of results and outcomes. Absolutely. And I would say, too, that, you know, if you had a quick fix, I think that that experience would be totally different than the long term shifts that happen when you when you put in the effort and the work. I mean, imagine that your output is probably comparable to your input, that the more effort and I don't want to say challenge because again i don't want people to think of these lifestyle changes as being some kind of hurdle they have to overcome right like they just imagine this cornucopia fruits and vegetables just taking over their life like no it's not not like that but just that that the amount of time it takes right that that harvesting kind of metaphor that you use is

Starting point is 00:29:47 perfect because that the time the attention it is like that and i think that the the output that you get at the end is going to be so much greater. And I think one of our jobs as, as providers who work with patients in this situation is sometimes just to help our patients see where they've come from is that because sometimes these changes are slow and gradual, we can kind of help them look and see, you know, Hey, you may not be to the top of the mountain, but you're halfway up it. And you probably didn't even realize how far you'd gotten. Exactly. Exactly. Dr. Jason. Well, thank you so very much for this illuminating conversation with you today. I really appreciate all the wisdom that you shared with us. If folks wanted to connect with you, can you speak a little

Starting point is 00:30:34 bit about how they can connect with you and work with you if they wanted to? Absolutely. I would say reach out to Dr. Susie. I am part of Dr. Susie's healthcare team. And so if you are working with her, I am available to work with you as well. And so we take a holistic team-based approach to care for men who have chronic pelvic pain and other related conditions. And so if you think nutrition might be a part of the puzzle for you, particularly not just sexual health, but we work with plenty of guys who have bowel and bladder problems that may be driving some of these issues, we're here to help. And I'm definitely part of the team. So I would certainly say to reach out and we're here to help. Thank you so much, Dr. Jason. And we'll be sure to link the website,

Starting point is 00:31:20 drsusig.com where you can learn more about jason and his background on our website so again thank you so much for being here and to all of our viewers and listeners we appreciate you watching and listening until next time my friends in loving wellness for your pelvis this is dr susie g thanks for listening to today's episode be sure to visit my website drsusig.com for show notes and related resources on today's topic if you like what you're hearing head on over to YouTube and subscribe to my channel on my youtube channel you'll find content related to sex pelvic health and expert interviews for men if you got a question or a topic that you'd like me to answer on my

Starting point is 00:32:10 channel be sure to type it in the comment box below

In Your Pants with Dr. Susie G - Optimizing Erectile Health

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