Why is it Important to Manage Erectile Dysfunction (ED)?
It is common. It is the first clinical manifestation of atherosclerosis which affects quality of life.
The ED is typically a warning sign of vascular disease (atherosclerosis). Penile arteries are smaller in diameter than atreries in the the heart / brain / limbs. At an early stage of atherosclerosis, the penile arteries are constricted when the blood supply of the other organs is still adequate.2 In clinical trials, erectile dysfunction precedes coronary artery disease (chest pain and heart attack) by 2-3 years on average. 3 In this respect, erectile dysfunction is the optimal stage for initiating therapy with the purpose of preventing progression of arteriosclerosis.
Causes of Еrectile Dysfunction: Major Role of Аtherosclerosis
Atherosclerosis, stimulation disorder, stress
The Mechanism of Erection: the Key Role of Nitrogen Oxide (NO)
Brain stimulation, nerve stimulation, nitrogen oxide release
The erection cycle requires fine tuned co-operation between the brain, the artery wall and the enzymes.
- As a result of stimulation, the brain signals the enzyme eNOS (endothelial nitric oxide synthase) to produce more nitric oxide (NO).
- NO stimulates the production of guanyl cyclase enzyme (cGMP), which causes vascular smooth muscle relaxation, enabling erection.
- Phosphodiestherase-5 (PDE5) enzyme reduces cGMP levels, eliminating erection.
The most important risk factors for ED are also the main risk factors for endothelial dysfunction, atherosclerosis, and reduced NO production: hypertension, high cholesterol, high blood sugar, obesity, smoking, aging.6-8 ED is probably an early indication of non-diagnosed diabetes. 9
What Can Men Do for Healthy Sexual Function?
Lifestyle, counseling, medicines / dietary supplements?
- Lifestyle changes to improve the condition of blood vessels
- Psychosexual counseling
- Oral medicines, dietary supplements.
- Injection treatment
- Operation (penis implant) 5
Requirements for Drugs / Dietary Supplements Recommended to Improve Erectile Function
Proven, increase NO level, cardiovascular protection, no side effects
- Have proven effects in appropriate clinical trials.
- Increase NO production (this may affect the most common cause of the problem). 6
- Reduce major risk factors for erectile dysfunction (blood pressure, cholesterol, blood sugar. 2-4, 9
- No side effects or interaction with widely used drugs.
Male Enhancing Drugs and Vigor: Two different, Complementary Concepts
The active ingredients in Vigor improve erectile function naturally and enhance cardiovascular protection by increasing the NO level.
Vigor acts at the beginning, male enhancement drugs act at the end of the process
Male enhancement drugs (PDE-5 inhibitors) inhibit the phasing out of smooth muscle relaxation. A part of the smooth muscle relaxation leading to erection is retained, the cGMP saved can reach the level required for erection, but the drugs do not affect the cause, the reduced release of NO and the atherosclerosis. This is a non-physiological approach with significant side effects. 10
The active ingredients of Vigor naturally restore the ability of blood vessels to produce a spontaneous erection in response to sexual stimulation. Vigor acts on the cause of the problem (the inadequate synthesis of NO in mild ED). NO stimulates cGMP production in smooth muscle that increases penile blood flow through muscle relaxation
Male enhancement drugs work temporarily for planned events, while Vigor restores body’s own potential, and naturally ensures the possibility of spontaneous erection and vascular protection. 10-22
The PDE-5 inhibitors are ineffective in at least 30% of men with ED, 23 because selective blocking of normal hydrolysis of cGMP can only partially reverse the deficiency of the NO / cGMP pathway. Insufficient production of NO (caused by age or difeerent diseases / conditions) does not allow production of adequate level of cGMP needed for the effects and benefits of PDE-5 inhibitors. For men with insufficient production of NO (a 50-year old man produces 50% of NO he used to produce at the age of 30), the active ingredients of Vigor can promote the effectiveness of PDE-5 inhibitors, so the two approaches can complement each other.
Active Ingredients in Vigor Capsules
Aminoacids required for NO production, Pycnogenol, Indian ginseng (ashwagandha)
- L-Arginine: Amino acid essential for NO production. Immediately precedes NO in the metabolic chain. Our body is able to produce it, but with age, our production capacity is greatly reduced (85% lower in 60 years olds compared to than 20-30 year olds ) 11,12
- L-citrulline: amino acid, permanently increases NO level. 13,14 In a clinical trial, L-citrulline alone improved the spotting function. 14
- Pycnogenol: Provides complex protection for the cardiovascular system, 15 in combination with L-arginine spectacularly improves erectile function 16, 17
- Ashwagandha (Indian ginseng): enhances libido and NO levels. 18-20
Why do We Recommend Vigor Capsule?
Evidence-based, increases NO level, cardiovascular protection, no side effects
Ingredients in Vigor Capsule
Two capsules contain 500 mg L-arginine, 500 mg L-citrulline, 40 mg Pycnogenol.
The active ingredient in a capsule is 250 mg L-arginine HCl ( 206.7 mg L-arginine), 250 mg L-Citrullin, 20 mg Pycnogenol, 25 mg Indian ginseng (ashwagandha), 32.2 mg zinc citrate (10 mg zinc), 3.9 mg copper gluconate (1 mg copper), 37.5 mcg selenium (from selenium-rich yeast). In clinical trials, the best results were achieved with a ratio 1: 1 L-arginine:L-citrulline. 7
Who do we Recommend the Vigor Capsule?
- Feldman HA et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol 1994; 151:54–61;
- Montorsi P, Montorsi F, Schulman C.Is Erectile Dysfunction the ‘‘Tip of the Iceberg’’of a
SystemicVascular Disorder? European Urology 44 (2003) 352–354
- Montorsi P et al. Association between erectile dysfunction and coronary artery disease. Role of coronary clinical presentation and extent of coronary vessels involvement: the COBRA trial.Eur Heart J 2006; 27, 2632–2639;;
- Billups KL.Erectile dysfunction as an early sign of cardiovascular disease. Int J Impot Res 2005; 17, S19–S24;
- Az Eü Minisztérium szakmai protokollja. ED EAU guideline, 2013;
- Vallance P, Chan N. Endothelial function and nitric oxide: clinical relevance. Heart 2001; 85: 342–350;
- Andersson K-E. Pharmacology of Penile Erection. Pharmacological Reviews September 2001, 53 (3) 417-450;
- Dean RC, Lue TF. Physiology of Penile Erection and Pathophysiology of Erectile Dysfunction. Urol Clin North Am. 2005 November ; 32(4): 379–403
- Kouidrat Y et al. Systematic Review or Meta-analysis High prevalence of erectile dysfunction in diabetes: a systematic review and meta-analysis of 145 studies. Diabet. Med. 34, 1185–1192 (2017);
- Downey M.Enhance Erectile Function by Improving Vascular Health. http://www.lifeextension.com/Magazine/2017/8/Reverse-Erectile-Dysfunction-by-Improving-Vascular-Health
- Gerhard M et al. Aging progressively impairs endothelium-dependent vasodilation in forearm resistance vessels of humans. Hypertension 1996; 27: 849–853;
- Celermajer DS. Endothelium-dependent dilation in the systemic arteries of asymptomatic subjects relates to coronary risk factors and their interaction. J Amer Coll Cardiol 1994; 24: 1468–74;
- Morita M et al. Oral supplementation with a combination of L-citrulline and L-arginine rapidly increases plasma L-arginine concentration and enhances NO bioavailability. Biochem Biophys Res Commun 2014; 454(1): 53-57;
- Carnio L et al. Oral L-citrulline supplementation improves erection hardness in men with mild erectile dysfunction.Urology 2011 Jan; 77(1): 119-22;
- Kiss I, Tavaszy M, Farsang Cs. Pycnogenol a klinikai gyakorlatban. LAM (Lege Artis Medicinae) 21. évfolyam 10. szám, 2011. október: 621–626 o.;
- Stanislavov R et al. Improvement of erectile function with Prelox: a randomized, double-blind, placebo-controlled, crossover trial. Int J Impot Res 2008 Mar-Apr; 20(2): 173-80
- Stanislavov R, Nikolova V. Treatment of erectile dysfunction with pycnogenol and L-arginine. J Sex Marital Ther 2003; 29:207-13.
- Iuvone T et al. Induction of nitric oxide synthase expression by Withania somnifera in macrophages.Life Sci 2003 Feb 21; 72 (14): 1617-25;
- Wankhede S et al. Examining the effect of Withania somnifera supplementation on muscle strength and recovery: a randomized controlled trial. J Internat Soc Sports Nutrition 2015; 12: 43;
- Chandrasekhar K, Kapoor J, Anishetty S. A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Indian J Psychol Med 2012 Jul; 34 (3): 255-62;
- Vecchio M et al. Interventions for treating sexual dysfunction in patients with chronic kidney disease. Cochrane Database Syst Rev 2010 Dec 8; (12): CD007747;
- Rayman MP. The importance of selenium to human health.Lancet 2000; 356: 233–241.
- Ferguson JE, Cullex CC. Phosphodiesterase type 5 inhibitors as a treatment for erectile dysfunction: Current information and new horizons. Arab J Urol 2013 Sep; 11(3): 222–229.