ED. Erectile Dysfunction. Impotence. A few years ago, this topic was taboo, but now billions of dollars are spent to advertise and 'educate' the public. Politicians and NASCAR drivers act as spokesmen for ED medicines, which are also promoted in Superbowl commercials. People are finally opening their eyes to a problem that was formerly ignored and denied.

ED is defined as being unable to get it up or keep it up. If you prefer medicial terminology, it is the innability to achieve or maintain an erection.

Sometimes ED is caused by psychological factors. But as time passes, a physical explanation is emerging for more and more cases of impotence.

Erectile dysfunction can be compared to cardiovascular disease (heart disease), and ED appears to be related to to heart disease - the most common cause of ED is malfunction of the tiny blood vessels that go in and out of the penis. Alarmingly, a recent study found that people with ED were far more likely to experience heart disease in the five years after noticing Johnson trouble than a comparable group of people the same age.

ED is a multi-factor disease like cardiovascular disease - while sometimes it is possible to say that a person has ED or heart disease from a single factor, it is usually a combination of factors that interact to cause the problem.

Some Common Causes of ED (and cardiovascular problems) include:

• Obesity
• Diabetes
• Metabolic Syndrome
• High Blood Pressure
• Elevated Cholesterol, Trigylcerides and/or Homocysteine
• Smoking
• Heavy Alcohol Consumption
• Poor Diet
• Lack of Exercise
• Excess stress, anxiety disorder
• Intermittent Claudication

If you think you might have ED, the first thing to do is see a doctor. Occasionally, there is an underlying medical condition that needs to be treated. In addition to diabetes, high blood pressure, and metabolic syndrome (all too common and dangerous), some cases of ED may be caused by low testosterone or other hormone disturbances. Very rarely, a tumor that causes over-production of prolactin or another hormone may be the cause.

But in most cases, there is no single identifiable factor that a doctor can treat - it is necessary to work on the underlying life-style issues. Meanwhile, you are probably thinking about ...

Viagra, Cialis, Levitra and other ED Drugs.

People like to joke about Viagra (along with anything else related to sex). Jokes aside, there's no stigma or shame in using Viagra or any other medication to treat ED. Nothing at all wrong with enjoying a better functioning body. While there are a few potential side effects that you and your doctor need to consider, the biggest potential problem that I see with these drugs is that some people might assume that they are fixing the problem. Taking a blue pill once or twice a week may have some benefit on the blood vessels, but it is not enough to reverse a vascular problem. Think of these meds as a temporary reprieve and as an incentive - what if you could function and feel that way all the time again? Exercise, control your diet, cut back on vices, and there is a good chance that your health, energy, and sexual function will improve.

Maybe you object to the pharmaceuticals as 'unnatural' or the cost is prohibitive (and nearly 40 million Americans are without health insurance). There are some alternatives to consider. They are listed here as a starting point - don't just go out and take something without researching it, and don't combine it with the prescription meds listed above ... some alternatives have a mode of action similar to the pharmaceuticals, which could cause a problem.

Alternative Treatments

The Mediterranean Diet has been shown to reverse ED and improve sexual function in a significant group of men. If you have metabolic syndrome, this may be an ideal strategy.

For Impotence with psychological causes, consider cognitive-behavioral therapy or self-hypnosis. Hypnotist Wendi Friesen has a tape called " Cure Impotence with Self-Hypnosis."

Ginseng - a long anecdotal history and a mounting pile of scientific studies suggest that ginseng can help with ED. Like Viagra, ginseng inhibits the enzyme PDE-5, which increases blood flow to key organs. Ginseng is less expensive than prescription meds. Quite a few studies have also shown that ginseng may reduce the risk of various cancers.

Goji Berries have been shown to have a beneficial effect on sexual function in males, and they improve blood sugar and, cholesterol to boot. This isn't an instant-on like the pharmaceuticals; take it for a few weeks as a tonic before expecting any results.

Gingko - this herb improves circulation, and (like Viagra and ginseng) it inhibits the enzyme PDE. Not usually a quick acting herb, but taken over the course of weeks, it can help with some circulatory conditions.

Anthocyanins - the red/purple/blue pigments in many fruits may prevent and even help reverse ED. These have a very beneficial effect on blood vessels, and most people don't eat nearly as much of these as the scientists recommend.

Arginine - this amino acid is needed to produce nitric oxide, a key chemical that regulates blood flow to the penis.

DHEA - a raw material that the body converts to testosterone. No shortage of reports that DHEA helps, but there are long term questions on the safety of this supplement.