Water, Water Everywhere-How Much Do We Need To Drink?

I graduated from medical school in 1968 with the advice to my patients to drink 8 glasses of water a day. If there is one health myth that will not die, it is this: You should drink eight glasses of water a day. It’s just not true. There is no science behind it. Yet the number of people who carry around expensive bottled water seems to be growing each day. A recent White House policy declared that 40 percent of Americans drink less than half of the recommended amount of water daily

There has been a fear that otherwise healthy adults and children are walking around dehydrated, even that dehydration has reached epidemic proportions.

Let’s put these claims under scrutiny.

There was a myth that people should drink at least eight 8-ounce glasses of water a day. The source of this myth was a 1945 Food and Nutrition Board recommendation that said people need about 2.5 liters or about two quarts of water a day. This report also pointed out that most of this quantity is contained in prepared foods. Water is present in fruits and vegetables. It’s in juice, it’s in beer, it’s even in tea and coffee. Before anyone writes me to tell me that coffee is going to dehydrate you, research shows that’s not true either.

Although I recommended water as the best beverage to consume, it’s certainly not your only source of hydration. You don’t have to consume all the water you need through drinks. You also don’t need to worry so much about never feeling thirsty. The human body is finely tuned to signal you to drink long before you are actually dehydrated.

Contrary to many stories you may hear, there’s no real scientific proof that, for otherwise healthy people, drinking extra water has any health benefits. For instance, reviews have failed to find that there’s any evidence that drinking more water keeps skin hydrated and makes it look healthier or wrinkle free.

Other studies fail to find benefits in kidney function or all-cause mortality when healthy people increase their fluid intake.

One possible exception is that drinking water may lead to the prevention of the recurrence of some kinds of kidney stones.

Bottom Line: There is no formal recommendation for a daily amount of water people need. That amount obviously differs by what people eat, where they live, how big they are and what they are doing. In New Orleans with high temperatures and high humidity, consuming more water especially when working or playing outside in the summer is probably a good idea.

Water-How Much is Enuf?

I graduated from medical school in 1968 with the advice to my patients to drink 8 glasses of water a day. If there is one health myth that will not die, it is this: You should drink eight glasses of water a day. It’s just not true. There is no science behind it.

These reports work up a fear that otherwise healthy adults and children are walking around dehydrated, even that dehydration has reached epidemic proportions.

Let’s put these claims under scrutiny.

There was ta myth that people should drink at least eight 8-ounce glasses of water a day. It made no difference. Many people believe that the source of this myth was a 1945 Food and Nutrition Board recommendation that said people need about 2.5 liters of water a day. But they ignored the sentence that followed closely behind. It read, “Most of this quantity is contained in prepared foods. Water is present in fruits and vegetables. It’s in juice, it’s in beer, it’s even in tea and coffee. Before anyone writes me to tell me that coffee is going to dehydrate you, research shows that’s not true either.

Although I recommended water as the best beverage to consume, it’s certainly not your only source of hydration. You don’t have to consume all the water you need through drinks. You also don’t need to worry so much about never feeling thirsty. The human body is finely tuned to signal you to drink long before you are actually dehydrated.

Contrary to many stories you may hear, there’s no real scientific proof that, for otherwise healthy people, drinking extra water has any health benefits. For instance, reviews have failed to find that there’s any evidence that drinking more water keeps skin hydrated and makes it look healthier or wrinkle free. It is true that some retrospective cohort studies have found increased water to be associated with better outcomes, but these are subject to the usual epidemiologic problems, such as an inability to prove causation. Moreover, they defined “high” water consumption at far fewer than eight glasses.

Prospective studies fail to find benefits in kidney function or all-cause mortality when healthy people increase their fluid intake. Randomized controlled trials fail to find benefits as well, with the exception of specific cases — for example, preventing the recurrence of some kinds of kidney stones. Real dehydration, when your body has lost a significant amount of water because of illness, excessive exercise or sweating, or an inability to drink, is a serious issue. But people with clinical dehydration almost always have symptoms of some sort.

A significant number of advertisers and news media reports are trying to convince you otherwise. The number of people who carry around water each day seems to be larger every year

This summer’s rash of stories was inspired by a recent study in the American Journal of Public Health. Researchers used data from the National Health and Nutrition Examination Survey from 2009 to 2012 to examine 4,134 children ages 6 to 19. Specifically, they calculated their mean urine osmolality, which is a measure of urine concentration. The higher the value, the more concentrated the urine.

They found that more than half of children had a urine osmolality of 800 mOsm/kg or higher. They also found that children who drank eight ounces or more of water a day had, on average, a urine osmolality about 8 mOsm less than those who didn’t.

So if you define “dehydration” as a urine osmolality of 800 mOsm/kg or higher, the findings of this study are really concerning. This article did. The problem is that most clinicians don’t.

A doctor can tell you that I have rarely, if ever, used urine osmolality as the means by which they decide if a child is dehydrated.

In other words, there’s very little reason to believe that children who have a spot urine measurement of 800 mOsm/kg should be worried. In fact, back in 2002, a study was published in the Journal of Pediatrics, one that was more exploratory in nature than a look for dehydration, and it found that boys in Germany had an average urine osmolality of 844 mOsm/kg. The third-to-last paragraph in the paper recounted a huge number of studies from all over the world finding average urine mOsm/kg in children ranging from 392 mOsm/kg in Kenya to 964 in Sweden.

That hasn’t stopped more recent studies from continuing to use the 800 mOsm/kg standard to declare huge numbers of children to be dehydrated. A 2012 study in the Annals of Nutrition and Metabolism used it to declare that almost two-thirds of French children weren’t getting enough water. Another in the journal Public Health Nutrition used it to declare that almost two-thirds of children in Los Angeles and New York City weren’t getting enough water. The first study was funded by Nestlé Waters; the second by Nestec, a Nestlé subsidiary.

It’s possible that there are children who need to be better hydrated. But at some point, we are at risk of calling an ordinary healthy condition a disease. When two-thirds of healthy children, year after year, are found to have a laboratory value that you are labeling “abnormal,” it may be the definition, and not their health, that is off.

None of this has slowed the tidal push for more water. It has even been part of Michelle Obama’s “Drink Up” campaign. In 2013, Sam Kass, then a White House nutritional policy adviser, declared “40 percent of Americans drink less than half of the recommended amount of water daily.”

There is no formal recommendation for a daily amount of water people need. That amount obviously differs by what people eat, where they live, how big they are and what they are doing. But as people in this country live longer than ever before, and have arguably freer access to beverages than at almost any time in human history, it’s just not true that we’re all dehydrated.

Natesto- Nasal Spray For the Treatment of Low T (testosterone)

Millions of American men suffer from low testosterone. Symptoms include decreased libido or sex drive, decrease erections, and lethargy or loss of energy. Treatment at this time consists of injections of testosterone, topical gels, and pellets inserted underneath the skin. Now there is a new delivery system using a nasal spray for treating this common medical problem affecting so many middle age and older men.

NATESTO™ is a prescription medicine that contains testosterone and is used to treat adult males who have low or no testosterone due to certain medical conditions. Your doctor will test the testosterone level in your blood before you start and while you are using NATESTO™.

Who should not use NATESTO™?

Do not use NATESTO™ if you:

• Are a man who has breast cancer
• Have or might have prostate cancer
• Are pregnant or may become pregnant or are breastfeeding. NATESTO™ may harm your unborn or breastfeeding baby

Talk to your doctor before using NATESTO™ if you have any of the above conditions.

What should I tell my doctor before using NATESTO™?

Before using NATESTO™, tell your doctor about all of your medical conditions, including if you:

• Have or have had nose (nasal) or sinus problems or nasal or sinus surgery
• Have had a broken nose (fracture) within the past 6 months
• Have or have had a fracture of your nose that caused the inside of your nose to be crooked (deviated anterior nasal septum)
• Have or have had problems with swelling of the lining of your nose (mucosal inflammatory disorder)
• Have breast cancer
• Have or might have prostate cancer
• Have urinary problems due to an enlarged prostate
• Have heart problems
• Have liver or kidney problems
• Have problems breathing while you sleep (sleep apnea)

Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins, or herbal supplements.

Using NATESTO™ with certain other medicines can affect each other. Especially tell your doctor if you take:

• Insulin
• Medicines that decrease blood clotting
• Corticosteroids

How should I use NATESTO™?

• Use NATESTO™ exactly as your doctor tells you to. Your doctor will tell you how much NATESTO™ to use and when to use it
• NATESTO™ is for use in your nose (intranasally) only
• NATESTO™ can be used with a type of nasal spray called sympathomimetic decongestants such as oxymetazoline. NATESTO™ should not be used with other nasal sprays. It is not known if NATESTO™ is safe and effective when used with other nasal sprays

What are the possible side effects of NATESTO™?

NATESTO™ may cause serious side effects, including:

• Nose (nasal) problems. Signs and symptoms of nasal problems may include runny nose, congestion, sneezing, nosebleed, nasal discomfort, nasal scabbing, or nasal dryness
• If you already have enlargement of your prostate gland, your signs and symptoms can get worse while using NATESTO™. This can include: increased urination at night, trouble starting your urine stream, having to pass urine many times during the day, having an urge that you have to go to the bathroom right away, having a urine accident, being unable to pass urine or weak urine flow
• Possible increased risk of prostate cancer. Your doctor should check you for prostate cancer or any other prostate problems before you start and while you use NATESTO™
• Changes in red blood cells
• Blood clots in your legs or lungs. Signs and symptoms of a blood clot in your legs can include leg pain, swelling, or redness. Signs and symptoms of a blood clot in your lungs can include difficulty breathing or chest pain
• • In large doses, NATESTO™ may lower your sperm count
• Possible increased risk of liver problems. Signs and symptoms of liver problems may include: nausea or vomiting, yellowing of your skin or whites of your eyes, dark urine, or pain on the right side of your stomach area (abdominal pain)
• Swelling of your ankles, feet, or body, with or without heart failure. This may cause serious problems for people who have heart, kidney, or liver disease
• Enlarged or painful breasts
• Problems breathing while you sleep (sleep apnea)

Call your doctor right away if you have any of the serious side effects listed above.

The most common side effects of NATESTO™ include:

• Increased prostate specific antigen (a test used to screen for prostate cancer)
• Headache
• Runny nose
• Nosebleeds
• Nose pain
• Sore throat, cough
• Upper respiratory infection
• Sinus infection
• Nose scabs

Bottom Line: Natesto is a new treatment option for men with documented low testosterone levels. The drug helps restore testosterone to normal levels and help men with symptoms of low T levels.

Safety of Testosterone Reported In Two Medical Journals

Two recently published studies significantly contribute to current knowledge regarding testosterone therapy and cardiovascular health. Researches from Harvard reported that 3 years of testosterone replacement therapy (TRT) in older men with low or low-normal testosterone does not cause progression of subclinical atherosclerosis o hardening of the arteries. The clinical trial was published in JAMA (2015; 314:570-81).

In addition, an article in the European Heart Journal (Aug. 6, 2015), showed that testosterone replacement therapy significantly reduced risks of death, myocardial infarction, and stroke.

The findings of both studies add to the ongoing evidence of testosterone treatment safety, cardiovascular safety in particular.

Bottom Line: These studies provide substantial confidence regarding the use of testosterone therapy when administered and monitored appropriately in well-selected individuals. These are men who have symptoms of low testosterone and confirmed by a blood test that documents low testosterone.

Little Blue Pill (Viagra) For Men and Now A Little Pink Pill (Addyi) For Women

Now women with sexual dysfunction will have a solution to their problem with decrease in libido or sex drive. A 2002 study found that up to one-third of adult women might experience hypoactive sexual desire disorder, a technical term for when women lack sexual desire or fantasy.
Recently the FDA approved flibanserin, which will be sold as Addyi, for the treatment of sexual dysfunction in premenopausal women.
This is the first FDA approved treatment for sexual desire in men or women.

Today’s approval provides women distressed by their low sexual desire with an approved treatment option. The approval is not without warnings. In fact, the agency approved the drug with a risk warning to ensure safety. Of greatest concern, an increased risk of severe low blood pressure, so low it can cause a temporary loss of consciousness. This is more of a concern in patients who drink alcohol while taking the drug. The doctor will be required to warn patients of the risks of consuming alcohol while taking Addyi.

Addyi is frequently referred to as “female Viagra” because it’s a pill for sexual dysfunction in women. However, experts say it’s a misnomer to describe it as such because it works in a distinctly different way to target the brain.
Viagra treats erectile dysfunction, a physical problem, and does not induce sexual desire. Addyi works on the central nervous system, which is why it’s in the same category as an antidepressant.
Another difference is that men take Viagra as needed before a sexual encounter, and women will need to take Addyi once every night. Taking it at night will reduce the likelihood of adverse reactions from low blood pressure and sleepiness or depression from a depressed central nervous system.
Other common side effects include dizziness, nausea, fatigue, insomnia and dry mouth.
In clinical trials, women taking the drug experienced a 37% increase in sexual desire.

Addyi will cost about the same per month as a one month supply of Viagra for men.

Bottom Line: Nearly as many women as men suffer from sexual dysfunction. Addyi is the first drug to address this problem in women. However, women need to be cautious about the use of this new medication. For more information, speak to your physician.

The Link Between Low T (Testosterone) and Depression

Most men think of testosterone as the sex hormone responsible for libido or sex drive. Yes, that is true but there is a also link between low testosterone levels and depression.

A study released at this year’s meeting of the Endocrine Society bring important news that men should know: Depression can go along with borderline or low testosterone levels.

A solid 56 percent of testosterone-deficient participants in the study, from the division of endocrinology at George Washington University in Washington, D.C., had significant symptoms or a diagnosis of depression and/or were taking an antidepressant.

The study involved men with testosterone levels of between 200 and 350 nanograms per deciliter. (A level below 300 ng/dL is considered low.)

Although I don’t recommend screening for low testosterone levels, I do suggest that men who are feeling depressed or not as happy as they would like to feel, consider getting their T levels checked.  It’s something your doctor could have missed that is very important to be addressed.

 Discussions about sex and erections

In general, doctors say men don’t like to discuss symptoms of low testosterone – such as erectile dysfunction and reduced sex drive – and that can make getting to the root cause of the condition and treating it harder.

There are symptoms of low testosterone that are specific to low testosterone – like a blood level less than 300 ng/dL, erectile dysfunction, low sperm count, large breasts and osteoporosis – and symptoms that are not, such as weight gain, decreased muscle strength and mood changes. Depression falls into the non-specific category.

If a person is treated for low testosterone and their mood improves, it could be said in hindsight that low testosterone probably caused their depression, but it’s hard to make a definite correlation at the onset.

Testosterone naturally starts to drop after age 30 at a rate of about 1%\year.

Testosterone replacement therapy, which can be given in the form an injection, a patch, a topical gel or a pellet inserted beneath the skin which lasts for 4-6 months.

Low T and Other Medical Problems

There is a correlation between low testosterone and a variety of indicators of poor health – obesity, high blood pressure, diabetes, metabolic syndrome, cardiovascular disease, a lack of exercise as well as depression.

There is a well known connection between low T and obesity.  Obesity is the No. 1 cause of low testosterone levels and if you lose 10 to 15 percent of your total weight, your testosterone level will come up. In patients who have a testosterone level of less than 200 ng/dL and in younger patients who have a disease or a cancerous tumor that is causing low testosterone, medication is the obvious choice and usually yields improvement.

Paying attention to decreased testosterone is important because low testosterone raises a man’s risk of death and its decline is markedly accelerated by each co-morbidity.

Kegel Your Way To Treating Urinary Incontinence

Urinary incontinence affects millions of American women. Certainly there are medications and surgery that can help control the problem. However, first line treatment is often natural methods and exercises to help with women suffering from urinary incontinence.

Many people don’t realize it, but physiotherapy is a really effective, low-risk treatment for urinary incontinence. Here is how physiotherapy can help you.

Physiotherapy is one of the best and most effective treatments for urinary incontinence. Not only is it a low-risk solution, but a good physiotherapist can help you retrain your bladder and strengthen your pelvic floor muscles to help resolve the problem.
Depending on the different types of urinary incontinence, there are many different exercises and ways in which physiotherapy is beneficial. Leaking isn’t just a symptom of a weak pelvic floor, it could also be a sign of muscles that are too tight as a result of knots in the pelvic floor, endometriosis or even constipation. This is why a full assessment is vital.
1. Stress incontinence: This refers to the involuntary need to urinate when there is increased intra-abdominal pressure – such as coughing, jumping or running. The pelvic floor muscles are not being used properly to keep the bladder closed when it is subjected to pressure.
2. Urge incontinence: Also known as an overactive bladder, this is characterized by an overwhelming need to urinate and the involuntary passing of urine because of this. Sometimes this can be triggered by something as small as hearing running water or seeing the toilet.
3. Mixed incontinence: This is a combination of both forms.
A physiotherapist should be able to diagnose the type of incontinence following a short examination which includes obtaining details about your bladder control, your health history including any surgeries or pregnancies, your diet and your current lifestyle.
The ultimate goal of physiotherapy is to help you regain control of your bladder, and is primarily focused on the pelvic floor muscles and how to tighten or relax them so that they function properly to keep you dry.

Exercises and treatments
Behavioral modification, which involves re-learning how to go to the toilet and learning how to effectively empty the bladder. Simple as it sounds, she says some incontinence issues stem from bad toilet-going habits such as pre-emptive urination (going to the toilet when you don’t actually need to), as well as straining excessively when on the toilet. Both put unnecessary pressure on the bladder and weaken it over time.
Pelvic Floor Exercises are probably the most well known forms of exercise for pelvic dysfunction. This involves a conscious tightening of the muscle around the anus, vagina and front passage to “lift it up” and inwards without clenching the buttocks. These can either be done in a slow-squeeze and hold or a fast squeeze with no hold. Both are most commonly known as Kegel exercises and are designed to strengthen the pelvic floor.
Neuromuscular stimulation is another method used which activates nerves and their associated muscles. In the case of incontinence, an internal probe with light electrical currents is applied to the pelvic floor to stimulate the nerves and cause muscle contractions with the aim of teaching the correct action and use of the pelvic floor muscles or calming of overactive nerve responses.
Weighted vaginal cones are plastic, cone-shaped devices which the physiotherapist inserts into the vagina to help exercise the pelvic floor muscles. Weights can be added to them or removed and they work by gradually stretching the vaginal opening as the cone drops lower. This stimulates the pelvic floor to contract and tighten up to try and hold the cone in place. It’s the sensation of falling out which triggers a contraction to keep it in.
Bladder retraining literally means retraining the bladder how to work. Although bladder training can take at least six weeks before it has a noticeable effect, many people find it a successful endeavor.
Tips for training the bladder:
– Don’t pee “just in case”: Try to wait a little longer when you feel the need to urinate, which will stretch the bladder and encourage it to hold bigger volumes.
– Keep calm: When the urge to go appears, try to sit down and hold a pelvic floor contraction hard enough to prevent leaking for as long as you are able, allowing the “desperate urge” to pass, and buying you a few more minutes.
– Keep hydrated: Don’t restrict your fluid intake as this will only result in stronger urine, which will only irritate the bladder. If you wake to go to the loo during the night, however, limit your liquid intake two hours before bed.
– Limit caffeine and alcohol: Some bladders react negatively to caffeine and alcohol and limiting your intake of these substances may reduce your need to urinate.

Bottom Line: Urinary incontinence can almost always be controlled and in some cases actually cured. Help is available. Speak to your doctor.

Testosterone Safety In Men Receiving Hormone Replacement Therapy

The medical literature states that one of the adverse effects of testosterone replacement therapy is increased in the red blood cell count or polycythemia. The increased red blood cell count increases the viscosity or thickness of the blood and makes men amenable to clots forming in the lower extremities. These clots can break loose and go to the lungs and cause a medical emergency

Middle-aged and older men undergoing testosterone replacement therapy aren’t at increased risk of these fatal clots.

Researchers studied 30,572 men 40 years of age and older who were enrolled in one of the country’s largest commercial insurance programs between Jan. 1, 2007 and Dec. 31, 2012. They identified 7,643 cases, defined as men diagnosed with deep vein clots or pulmonary embolism at any time during the study period who received at least one prescription for an anticoagulant to prevent clots from reforming.

Exposure to testosterone therapy within 15 days of the event/index date wasn’t associated with increased risk of VTE (adjusted odds ratio, 0.90), nor were any of the routes of administration that the authors examined—topical, transdermal, or intramuscular. The finding extended to men who received therapy 30 or 60 days before the VTE diagnosis.

Bottom Line: I still recommend that men who are receiving testosterone replacement therapy have their red blood cell count checked every six months. If the red cell count is too high, I suggest that the man cut his dosage or decrease the frequency of testosterone replacement therapy. I still believe that testosterone is effective in men who have symptoms of low testosterone and have documented evidence of a low blood level of testosterone.

Prostatitis: When It Hurts Down There

One of the most common infections affecting men is infections of the prostate gland. This is the gland that is the size of a walnut located at the base of the bladder that surrounds the urerthra or the tube in the penis that transports urine from the bladder to the outside of the body.

There are two kinds of bacterial prostate infections: acute and chronic, but only a few of men with symptoms of prostatitis actually have a documented bacterial infection.

An acute infection of the prostate is characterized by high fever, lower abdominal pain, marked urinary frequency, urgency, muscle aches and pains, pain going down the inner aspect of the thigh, and sometimes urinary retention. The patient looks very ill and the prostate is exquisitely tender on rectal examination. Because it is very difficult for antibiotics to penetrate the prostate and cure the infection, it is important that you take culture specific antibiotics for about six weeks. If the symptoms don’t subside within a few days of starting antibiotics, it is important to be sure that a prostatic abscess is not present as this is a urologic emergency and requires a surgical procedure to drain the abscess. At this stage, it can be difficult to be sure on examination, but an abdominal ultrasound or CAT scan can usually make the proper diagnosis.

In chronic bacterial prostatitis, the symptoms are more subtle. The patient’s main complaint is usually frequency of urination, aching in the prostate or testicles and pain of fullness in the lower abdomen. Patients with chronic bacterial prostatitis usually have a history of a bacterial urinary tract infection. The diagnosis is made by doing a special examination of the urine and prostatic secretions known as bacterial localization cultures. This is done by splitting the urine sample into different segments. You begin to urinate and catch the first few drops in a specimen container. Then you continue to urinate and obtain a sample in the middle of urination (a mid-stream sample). You stop urinating and then your doctor examines the prostate with his finger in the rectum. He presses on the prostate with a technique called prostatic massage. This causes some fluid, called expressed prostatic secretions, to leak from the tip of the penis. These secretions are put into another container and, finally, you finish urinating and the last urine specimen is obtained. All of the samples are sent for analysis and culture. If there are white blood cells or pus cells and bacteria in the prostatic secretions, but not in the urine, a diagnosis of chronic bacterial prostatitis is made. Treatment is prescribing culture specific antibiotics for 6-12 weeks.

Bottom Line: Prostate infections are a common affliction of men. The diagnosis is made with a careful history and physical examination. For bacterial infections the treatment is antibiotics that are specific to the bacteria in the prostate.

WHAT’S KEEPING YOU AND YOUR ERECTIONS DOWN?

Millions of American men suffer from ED or erectile dysfunction. For young men having difficulty achieving an erection, here are some common causes:
Stress : Among men in their teens, 20s and 30s, most cases of ED are linked to psychological issues. Anxiety and stress are a major factors especially if these are factors right before sex. Many young men who are inexperienced feel pressure to perform the best sexually and also have concerns about size. This stress can lead to performance anxiety. This buildup of stress can cause an influx of adrenaline or epinephrine which can inhibit an erection.
Too much bike riding : Now, just to be clear, if you’re an avid biker, it doesn’t mean you’re going to develop ED. But if you experience numbness as you ride within the first few miles or after biking marathons you may be causing long-term damage. Below the prostate (and what directly rests on the bicycle seat) are the nerves responsible for bringing blood the penis, which is what happens during an erection. Try getting fitted for a better seat if you’re experiencing this.
Medicines : Cold medications like Sudafed contain pseudoephedrine, which acts as epinephrine in the body and decreases the ability to achieve an erection. It increases your body’s natural fight or flight reaction and makes your body think you’re scared of something. The effects of the drug aren’t permanent.
Partying : Drinking and recreational drug use may also serve as a proponent of ED. Alcohol is a depressant and relaxes you but can cause the inability to perform. Cocaine for example, will lower your testosterone levels.
Cancer treatments : If young men have been diagnosed with testicular cancer or another cancer and are being treated with chemotherapy and radiation may lower testosterone levels which affect blood flow to the penis. Radiation can also directly damage the lining of the blood vessels or cause nerve damage.
Diabetes and high blood pressure are other causes of ED because diabetes impacts the body’s ability to produce nitric oxide. Another major factor is being obese or overweight. Anything that’s bad for your heart is bad for your penis. Blood vessels are tiny in the penis and if they’re clogged the blood won’t flow there. Eating right and exercising makes everything work better.

1. STOP SMOKING

Heart problems aren’t the only issue keeping men down. Erectile dysfunction is commonly caused by stress, medications, partying, cancer treatments, or even bike riding.

Smoking can cause blood vessels to narrow, which can have a detrimental effect on blood flow to sex organs. Similarly, smoking diminishes your stamina, limiting the amount of rigorous activity one can handle – which unfortunately can leave your partner wanting more.
2. WORK IT OUT
Notwithstanding my earlier comments about biking, moderate regular exercise has been shown to help improve blood flow to the sexual organs. Exercises focused on thighs, buttocks and pelvis are especially good for genital circulation. In addition, exercise boosts self-image and confidence. Anything that improves self-esteem will in turn improve libido.
3. LOSE WEIGHT
Study out of Duke, found that up to 30% of obese people seeking help controlling their weight indicate problems with sex drive, desire, performance, or all three. This is because being overweight can reduce blood flow and lower testosterone levels. High cholesterol as well as type 2 diabetes, both associated with being overweight, impact sexual performance. Both can cause penile arteries to shut down when arteries get clogged with fat deposits. Erectile dysfunction leads to decreased sexual desire and libido.
4. GINGKO BILOBA
Herbal remedies like tea or supplements derived from ginkgo biloba can have a positive effect on sexual desire and even orgasm. This age-old remedy is known to improve circulation, yet again enhancing sex.
5. TRY SOME LIBIDO-BOOSTING FOODS
Certain foods, like those high in zinc (think oysters!) can increase sperm production and testosterone- the hormone in men responsible for sex drive. Also, foods high in essential fatty acids like flaxseeds, sardines, and nuts help to increase testosterone production and increase libido.

This article was written by Dr. Samadi a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery, and an expert in robotic prostate surgery in New York City.