How poor gut health increases your risk of erectile dysfunction

New research suggests that nurturing your gut through your diet could alleviate symptoms of ED – here’s how

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More than half of men aged 40-70 will experience difficulties achieving or maintaining an erection during sex. Though exact figures are difficult to establish, it’s thought that erectile dysfunction affects an estimated one in five men in the UK.
“I don’t think it’s an overstatement to say that men are coming to us in their droves with this problem,” says Dr Channa Jayasena a consultant in reproductive endocrinology at Imperial College London. He believes it’s set to rise over the coming decades and especially in middle age, partly because people are living longer.
But, he says, it’s positive that men are increasingly prepared to seek help – and particularly those in their 50s, 60s, 70s and even 80s. “This is positive, because it’s easy to underestimate how important reproductive health is for many men and their partners, particularly in later life.”
Erectile function is a complex process influenced by a variety of factors. Blood circulation disorders, hormonal imbalances, obesity, hypertension and diabetes can all have a detrimental effect – coupled, of course, with psychological stumbling blocks such as relationship problems, chronic stress and performance anxiety.
And now, doctors, medical researchers and nutritionists are looking closely at the link between ED and the gut microbiome with intriguing results. Studies have already confirmed that men who suffer from it tend to have inferior gut health and, given that our gut microbiome is known to play a crucial role in a range of biological functions, it seems likely that having poor gut health will increase your risk of erectile dysfunction. 
So, can nurturing your gut with changes to your diet really help alleviate ED? 
“Erectile dysfunction is like a window into a man’s health,” says Dr Jayasena. “If you are holistically less fit and healthy than you used to be, you are at much higher risk of experiencing it. This makes perfect sense, because lots of things have to be right [in order for your body to be ready to have sex]. 
“You have to be in the right mood, so mental health problems can make this more difficult. You need good vascular health, which is reduced by diabetes, high blood pressure and high cholesterol. And of course, many of these conditions also affect your gut microbiome.” 
Eating certain foods is not a surefire way to improve your ability to attain an erection but recent studies have identified a causal link between poor gut health and erectile dysfunction. One 2021 study found there were certain gut microbiota less likely to be detected in the group who experienced ED than the group of men who did not. 
There’s a lot more to understand yet but Dr Jayasena sees nutrition as an important step in addressing ED. “I would advise people not to adopt faddy diets that only target the microbiome,” he says, “but to think holistically about their health – simple things like eating plenty of vegetables and making positive changes to your levels of activity.”
“Our gut microbes help to regulate the balance of hormones in the body,” says nutritionist Stephanie Moore, author of Eat Your Brain Happy. She is convinced that maintaining a happy, balanced gut could offer new ways to prevent or treat ED. “They are part of our endocrine system. And the gut microbiome is particularly involved in controlling the levels of androgens – of which testosterone is one – so if your gut microbiome is compromised, your ability to manage these hormones is also compromised.”
In essence, our gut microbiota are constantly engaged in sensing what is going on around the body. And while they might not actually produce hormones, they facilitate their production. As Moore puts it: “They are part of the pathway of hormone production as well as clearance of excess hormones. Gut microbiota connect up a complex series of checks and balances that either turns up or turns down the production of hormones from the testes, from the adrenal glands or via the brain.”
She also points out that “an unhealthy gut may also produce too much beta glucuronidase. This makes it harder for the body to eliminate excess hormones such as oestrogen, which men are exposed to in all sorts of different ways. An excess of oestrogen may lead to a loss of libido and ED.”
Beyond sex hormones, a healthy gut also absorbs nutrients more effectively, including zinc and magnesium, which contribute to our cardiovascular wellbeing. Poor gut health is also associated with conditions such as IBS, which can weaken libido. IBS sufferers often have elevated levels of cortisol – known as “the body’s stress hormone” – which may also make it harder to maintain an erection. “We know that IBS disproportionately affects people who suffer from anxiety and depression,” says Dr Jayasena, “and of course mental health is a significant factor in ED.”
When there’s an imbalance in the gut’s microbial community, it can lead to something called gut dysbiosis. That can trigger inflammation, insulin resistance and metabolic disorders, all of which contribute to ED. 
“Inflammation is a key mechanism through which conditions such as obesity and diabetes affect aspects of your health,” says Dr Jayasena. “We know that when you have the flu or any other immune challenge, it is very bad for your reproductive health, including erections, testosterone production and sperm production. 
“In a sense, this is almost a protective evolutionary measure. If a caveman had an illness and needed to conserve energy, it was not the right time to father a child. It’s that ancient sort of mechanism that we haven’t really shifted from.”
Moore concurs: “When the body is in recovery mode the production of sex hormones is bound to drop, because it’s completely inappropriate to be having sex at that time – particularly for men, because ejaculation is very depleting of nutrients.”
She adds that inflammation is also known to impair the production of nitric oxide, “which reduces blood pressure and improves blood flow, and this in turn can increase your risk of ED. Another factor to consider is reactive oxygen species (ROS). These are nasty molecules that cause damage to our insides, almost like internal rust. The more oxidative stress you have, the more inflammation you get. And the more inflammation you have, the more you’re at risk of experiencing ED.”
Reducing the amount of ultra-processed and sugary foods, alcohol, antibiotics and antacids you consume will help safeguard your gut microbiome, contributing to your overall wellbeing and, ultimately, your sexual health. “As men get older they are more likely to suffer from chronic disease, obesity, diabetes, inflammation, etc,” says Moore. “And when systems of the body are compromised, one of the first things that will be suppressed is sexual function.”
She adds that feeding your microbial community well with a wide variety of fibre-rich plant-based foods and good quality animal products, and having extended fasting breaks between meals, will benefit your gut microbiome. “And that way,” she says, “your body will be more equipped to sort out problems, system-wide.”
Dr Jayasena agrees that eating foods that contribute to a healthy gut microbiome will help to make us healthier in general and could therefore reduce our risk of ED. “All of the things that are good for your microbiome also happen to be good for living longer and being healthier,” he says. “In the same way, particularly if you’re north of 40, they are likely to have a positive impact on your reproductive health, including your ability to attain and maintain erections. Finally, don’t ignore your mental and emotional health. It’s important to remember that sexual health is hardwired to fail if those other things deteriorate.”
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Foods like broccoli, cauliflower and cabbage contain sulforaphane and indole-3-carbinol, which help improve the balance of testosterone to oestrogen. They’re particularly useful when it comes to clearing oestrogen. They also contain some very helpful compounds including calcium D-glucorate, which helps to break down beta-glucuronidase.
Vitamin D is hugely important for balancing your hormones. We get it through exposure to sunlight but realistically this is difficult to achieve year-round in the UK. Instead, vitamin D can be found in dairy foods and in red meats – especially organ meats like liver. Organ meats are excellent for general organ function and in particular for hormonal health, mental health and ED.
To make testosterone, the main hormone in men that will allow for healthy erectile function, the body requires zinc. It’s really quite hard to get enough zinc – I see a lot of people whose levels are low. Unfortunately, not many plant-based foods contain it, but pumpkin seeds are a good source. They’re a great thing to throw into breakfast foods or onto yogurt. They’re tasty, they contain fibre and they’re great for your gut microbes.
Zinc is also very important for the conversion of thyroid hormones – and low thyroid is almost always present in men who have low libido and poor erectile function, because, again, it’s all linked to hormone production. Good quality red meat is another great source of zinc, which is vital for our immune system.
The reason why oysters are associated with being an aphrodisiac is because they’re very high in zinc. Shellfish and prawns in general are a good source – and it really is vital.
Nitric oxide is fundamental to many biological functions but our bodies make less of it as we get older. It keeps blood vessels flexible, opening them up, reducing blood pressure and increasing blood flow, which will of course help to alleviate ED. Doing moderate exercise and eating good foods that contain nitrates – like beetroot and spinach – will help your body to make more nitric oxide.
Reactive oxygen species (ROS) – which can exacerbate ED – are triggered by ultra-processed and sugary foods as well as charred foods like overly barbecued meats. The damage caused by oxidative stress can be mitigated, however, by eating plenty of gut-friendly, plant-based antioxidant-rich foods, including brightly coloured vegetables and fruits, especially pomegranates, berries, and dark leafy greens. Fresh herbs, spices and pecan nuts are also great for this.
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