ED and Lifestyle | Why Tobacco and Alcohol Cause ED, Are Supplements and Strength Training Effective?

To briefly summarize the mechanism of erection, it occurs in the following sequence.

If a disorder occurs anywhere in this process, ED develops. The causes of ED are broadly classified into 4 types (organic, psychogenic, drug-induced, and mixed) *1, but lifestyle disorders are mainly the cause of organic ED (vascular and neurological disorders). In addition, there are not a few cases that induce psychogenic ED through poor physical condition or loss of confidence.

Lifestyle diseases are the largest risk factor for ED. Approximately 35-75% of diabetic patients have coexisting ED *5, and hypertension and dyslipidemia (hypercholesterolemia) also accelerate atherosclerosis and cause ED *2.

What is noteworthy is that ED can be an “early warning sign” of lifestyle diseases. Since the penile blood vessels are among the thinnest arteries in the body, symptoms may appear as ED before atherosclerosis progresses throughout the entire body. When you notice ED symptoms, it is also an opportunity to review the health of blood vessels throughout your body *2.

According to a study published in European Urology Focus, smokers have approximately 1.5-2 times higher ED risk than non-smokers *8. Furthermore, the risk increases as the number of cigarettes smoked per day increases, with a dose-response relationship confirmed: 1.27 times for 1-10 cigarettes per day, 1.45 times for 11-20 cigarettes, and 1.65 times for 21 cigarettes or more.

Note that with regard to heated tobacco products (IQOS, glo, Ploom, etc.), as long as they contain nicotine, adverse effects on vascular endothelium are also a concern. Be careful that “switching from cigarettes to heated tobacco does not mean ED risk is zero.”

The effect of smoking cessation on ED improvement has been reported in many studies. Some people experience improvement in morning erections (nocturnal erections) within 1-2 days after smoking cessation, and sustained improvement in erectile function can be expected as vascular endothelial function recovers over several months to a year.

However, in the case of long-term smokers from teenage years or heavy smokers (smoking history of 40 years or more), sufficient improvement may not be obtained from smoking cessation alone. In that case, by receiving prescriptions for ED medications (Viagra, Levitra, Cialis, etc.) in addition to smoking cessation, synergistic improvement can be expected.

Moderate drinking brings relaxation effects and temporarily dilates blood vessels, so in some cases it can be expected to ease tension before sexual activity. However, drinking that exceeds “moderate” has the opposite effect.

Alcohol is a substance that suppresses the central nervous system. When consumed excessively, the brains function of sending signals for sexual arousal becomes dull, and nerve transmission necessary for erection does not work well. The so-called “drunk and unable to perform” state is due to this nerve-suppressing effect.

The Ministry of Health, Labour and Welfares “Health Japan 21” sets approximately 20g of pure alcohol intake per day (equivalent to 1 medium bottle of beer, 1 go of sake, 350mL of 7% chuhai, or 1 double of whiskey) as the moderate amount. Habitually drinking far more than this not only increases ED risk but also has adverse effects on overall health, such as liver dysfunction.

According to a study published in the International Journal of Impotence Research, there is a correlation between the severity of alcohol dependence and the severity of ED *9.

The ED-related problems caused by chronic excessive alcohol consumption are as follows.

If you find it difficult to control your drinking amount, it is important to receive specialized treatment for alcohol dependence in parallel with ED treatment. There are also many reports of ED symptoms improving by reducing drinking amounts to moderate levels.

Aerobic exercise such as jogging, walking, and swimming improves blood circulation throughout the body and improves vascular endothelial function. As a result, blood flow to the corpus cavernosum increases, and improvement in erectile function can be expected.

The recommended amount of exercise for ED improvement is moderate-intensity aerobic exercise (jogging or walking that slightly increases breathing) for 30-40 minutes, more than 3 times per week. Multiple studies have reported that the group that continued exercise at this level showed significant improvement in ED scores.

Furthermore, exercise has the effect of promoting testosterone secretion. Testosterone is a hormone directly linked to libido, and regular exercise habits maintain and improve testosterone levels, which also leads to ED prevention. In addition, it is also effective for weight management. Obesity is an independent risk factor for ED, and men with a BMI of 25 or higher are said to have approximately 1.5 times higher ED risk.

Information that “ED can be cured with strength training” is widely seen on the internet, but to be precise, strength training alone does not completely cure ED. However, lower-body strength training and Kegel exercises have strong evidence of contributing to ED improvement.

How to do Kegel exercises: The muscle that you tense as if to stop urination midway is the “pelvic floor muscle.” Repeat the cycle of squeezing this muscle tightly for 5 seconds and relaxing for 5 seconds. It can be done in any position – standing, sitting, or lying down – and can be done at home regardless of location. The important thing is to focus on only the pelvic floor muscle, not the abdominal or buttock muscles.

Nutrients related to erection are mainly those involved in vasodilation (promoting NO production) and hormone production. The following nutrients are recommended to be consumed in a balanced way.

As a notable dietary pattern, there are research reports that the Mediterranean diet (a dietary style centered on olive oil, fish, vegetables, nuts, and whole grains) is effective for ED prevention. Refraining from high-calorie, high-fat foods and actively consuming antioxidants and high-quality fats leads to maintaining vascular health and ultimately ED prevention.

On the other hand, there are also dietary habits to avoid. Excessive sugar intake (rapid blood sugar spikes), foods rich in trans fats (fast food, margarine, etc.), and high-salt diets (hypertension risk) worsen vascular function and increase ED risk.

There are many products claiming to be “ED-effective supplements,” but in conclusion, supplements are not pharmaceuticals and cannot replace ED treatment.

However, from the perspective of nutritional support, they have a certain meaning. There is also research showing that more than half of mild ED patients showed improvement when given citrulline, and supplementation with supplements is effective when zinc deficiency is causing testosterone decline. We also explain the effects and limits of erectile-supporting supplements in more detail in another article.

Excessive expectation that “supplements alone will cure ED” is forbidden. Use supplements as an aid to lifestyle improvement, and if ED symptoms persist, the best choice is to consult a doctor about prescriptions for ED medications.

Testosterone is mainly secreted during sleep (especially during REM sleep). Chronic lack of sleep reduces testosterone secretion and increases the risk of decreased libido and ED symptoms.

One study reported that limiting sleep to 5 hours or less reduced testosterone levels by 10-15%. This is equivalent to 10-15 years of aging. In addition, lack of sleep excessively activates the sympathetic nervous system and inhibits erections that should occur in a relaxed state.

The sleep guideline for ED improvement is 7-8 hours per day. Refraining from smartphone use and caffeine intake before bed and maintaining a regular sleep rhythm are important. Also, sleep apnea syndrome (SAS) is an independent risk factor for ED, and people with snoring or strong daytime sleepiness are recommended to see a specialist.

Erection occurs in a relaxed state where the parasympathetic nervous system is dominant *3. Chronic stress such as work pressure, relationship issues, and financial anxiety excessively activates the sympathetic nervous system and inhibits erection. This is the mechanism of so-called “psychogenic ED” *4.

ED due to stress is also common in younger generations in their 20s and 30s. There are not a few cases of falling into a negative spiral where “failure experiences in front of a partner” become new pressure, further worsening ED.

For improvement priority, we recommend starting with smoking cessation and establishing exercise habits. These two have a large impact on ED risk and abundant evidence of improvement effects. The realistic approach is to follow up with controlling drinking amount and improving sleep, then proceed with reviewing diet and managing stress in parallel.

ED medications (PDE5 inhibitors) are drugs that help erection by enhancing the action of NO (nitric oxide) and increasing blood flow to the corpus cavernosum. In other words, the healthier the vascular endothelium and the greater the NO production, the higher the effect of the medication *1.

Lifestyle improvement (smoking cessation, exercise, dietary improvement) is precisely the effort to improve this vascular endothelial function and NO production capacity. In other words, lifestyle improvement is “creating a body where ED medications work easily,” and the following 3 benefits are obtained by combining the two.

At Mens Care Clinic, we provide comprehensive ED treatment that includes lifestyle advice.

You can check the features and price list of each treatment medication on our ED treatment details page. If you “want to first review your lifestyle while also using treatment medications as needed,” please feel free to use our free counseling.

A. ED (erectile dysfunction) depends on the health of blood vessels, nerves, and hormones, so it is closely related to lifestyle. Smoking, excessive drinking, lack of exercise, unbalanced diet, lack of sleep, and chronic stress all increase the risk of ED. People with lifestyle diseases (diabetes, hypertension, dyslipidemia) are said to have 2-3 times higher ED prevalence, and lifestyle improvement is an important first step in ED treatment.

A. Yes. Smokers are said to have approximately 1.5-2 times higher risk of getting ED compared to non-smokers. Nicotine and carbon monoxide contained in tobacco damage vascular endothelium and accelerate atherosclerosis, reducing blood flow to the penis and making erection difficult. The more cigarettes per day, the higher the risk, and smoking from a young age particularly increases the risk.

A. Many cases of ED symptoms improving through smoking cessation have been reported. Some people experience improvement in morning erections within 1-2 days after smoking cessation, and improvement in erectile function can be expected as vascular function recovers over several months to a year. However, in cases of long-term smoking from teenage years or heavy smokers, improvement may be limited, and combined use with ED medications is recommended.

A. Moderate drinking may temporarily have a positive effect through relaxation, but excessive drinking suppresses the central nervous system and dulls the nerve transmission necessary for erection. Chronic heavy drinking causes hormonal imbalance through liver dysfunction and atherosclerosis, significantly increasing ED risk. The Ministry of Health, Labour and Welfares guideline is approximately 20g of pure alcohol per day (about 1 medium bottle of beer).

A. Strength training alone does not completely cure ED, but lower-body strength training contributes to ED improvement by promoting testosterone secretion and improving blood flow around the pelvis. In particular, squats and Kegel exercises (pelvic floor muscle training) are effective for maintaining erectile function. The effect is further enhanced when combined with aerobic exercise.

A. Yes. Kegel exercises (pelvic floor muscle exercises) have been confirmed in multiple clinical studies to be effective for ED improvement. Strengthening the pelvic floor muscles improves blood flow to the penis and improves erection hardness. Effects become easier to feel when continued for more than 3 months with 10 contractions, 3 times a day. The advantage is that they can be done at home without equipment.

A. While specific foods alone do not dramatically improve ED, a diet conscious of nutrients related to blood flow improvement and hormone balance is effective. Zinc (oysters, liver), citrulline (watermelon, cucumber), arginine (soybeans, chicken), and vitamin E (nuts) are noted. The Mediterranean diet has also been reported in research to be effective for ED prevention.

A. Supplements are not pharmaceuticals, so they cannot replace ED treatment. However, ingredients such as zinc and citrulline can be used as nutritional supplements. Some research shows that more than half of mild ED patients showed improvement with citrulline intake, but evidence is limited. Use supplements only as a supplement, and we recommend receiving prescriptions for ED medications for fundamental treatment.

A. Yes. Chronic lack of sleep reduces testosterone secretion and increases the risk of ED onset. Since testosterone is mainly secreted during sleep (especially during REM sleep), the quality and quantity of sleep are directly linked to ED prevention. We recommend 7-8 hours of sleep per day and refraining from smartphone use and caffeine intake before bed. Sleep apnea syndrome is also a risk factor for ED.

A. In cases of psychogenic ED mainly caused by stress, symptoms may be alleviated through lifestyle improvement and relaxation. Moderate exercise, sufficient sleep, and securing time for hobbies lower stress hormones (cortisol) and regulate the balance of the autonomic nervous system. However, when severe stress or trauma is in the background, combined use with psychological counseling is necessary.

A. In cases of mild ED or where lifestyle is the main cause, symptoms may significantly improve with smoking cessation, exercise habits, and dietary improvement. However, in cases of moderate to severe ED or organic ED, lifestyle improvement alone is often insufficient, and combined use with ED medications such as Viagra is effective. Research shows that the combination of lifestyle improvement and ED medications shows higher improvement rates than medications alone.

A. ED medications are fast-acting, but they do not solve the root causes (decreased vascular function, hormonal imbalance, etc.). By combining lifestyle improvement, you obtain 3 benefits: 1) creating a body where medications work easily, 2) the possibility of future medication reduction or discontinuation, 3) overall health improvement including cardiovascular disease. The ideal strategy is to ensure fast-acting effects with medications while changing your physical constitution through lifestyle improvement.

ED is not an “embarrassing disease,” but a condition that can be improved with lifestyle review and appropriate treatment. By incorporating the lifestyle improvements introduced in this article one by one, and using the power of ED medications as needed, significant improvement in QOL (quality of life) can be expected.

At Mens Care Clinic, we provide ED treatment at our 3 clinics – Shimbashi Clinic, Akihabara Clinic, and Omotesando Clinic – and through online consultation. You can start with pay-per-visit from 390 yen per tablet. Including lifestyle improvement advice, please feel free to consult us first with our free counseling.

For more information about ED treatment, please also see “What Are the Causes of ED (Erectile Dysfunction)?” and “Self-Check List for Early Symptoms of ED.”

*1) Japanese Society for Sexual Medicine “ED Clinical Practice Guidelines [3rd Edition]”
*2) Bayer Pharmaceuticals “ED caused by vascular and neurological disorders (organic ED)”
*3) National Hospital Organization Kyoto Medical Center, Department of Urology “Male Climacteric II Erectile Dysfunction”
*4) Translational Andrology and Urology 2017 “Erectile dysfunction in fit and healthy young men: psychological or pathological?”
*5) Daito Pharmaceutical Industries Co., Ltd. “Causes, Diagnosis, Treatment, and Prevention of Erectile Dysfunction (ED)”
*6) e-Health Net “Smoking and Cardiovascular Disease”
*7) e-Health Net “Smoking and Diabetes”
*8) European Urology Focus “The Link Between Cigarette Smoking and Erectile Dysfunction”
*9) International Journal of Impotence Research “Alcohol intake and risk of erectile dysfunction”
*10) Ministry of Health, Labour and Welfare “Health Japan 21 (Third Edition)” Drinking Guidelines
*11) Journal of Sexual Medicine “Effects of aerobic exercise on erectile dysfunction”
*12) Urology Journal “Cycling and male sexual and reproductive health”