The Intimate Link: Heart And Sexual Health

Introduction and Guest Welcome 0:00

Well. Hello, everybody. Welcome back. Lock yourself in your chair. Put your seat belt on, and we got a good one. We have an absolutely great first time interview. I'm so excited. We missed them last year, but we had to get the best for this year. Dr. Aaron Spitz and Dr. Aaron Spitz is the author of a wonderful book I have in my office. And I felt badly I didn't bring it to his interview, so I took a picture up and let me do that for a second. It's such a great thing. Everybody, just hang on. Don't go anywhere.

I have the blur function on. Can everybody see there? What's the name of the book? Dr. Aaron Spitz. The Penis book. The Penis Book. I'm going to click right there. It's a eggplant. Then if you notice the lapel of this handsome man in a moment, we all appreciate if you had to have some kind of a symbol that is not a bad symbol for a urologist. I'm have Already spilled the beans as a urologist in Southern California all through that great book, which I've read. It's amazing book and encourage everybody to read it.

He's a leading authority on the topic. We're going to talk about male sexual health, the connections to heart disease. He also is an expert out for fertility. When The Doctors Show was recording and filming in Studio 29 at Paramount, Dr. Spitz was a regular there with Travis Stork and the rest. And many of you know him because in the great documentary in 2019, the game changers, Dr. Spitz, played a prominent role playing himself as a leading urologist. Talk about the relationship between diet and erectile function and three volunteer athletes.

It was an amazing part of the movie. Thank you for being here, Dr. Spitz. Thank you, Joel It's a real treat and it's actually an honor to be invited on to your program,

Penis Health as a Marker of Heart Disease 2:06

because I know how high quality the work you do is. So, you know, I feel legitimated being invited to share information with you, with your audience. Thank you. Kind of you. You feel excited, too. And for anybody. Let me just throw this out there. Anybody listening, watching from Southern California, you are a busy urologist, but people can see you, right? Yes. Yes. I have a practice in South Orange County, California, and we are a large urology group practice taking care of all aspects of urology.

But I sub specialize in male sexual function and male fertility. Okay. Important topics. And there's even a report in the news this week about cell phone use in male fertility. And the relationship is not a good one. So get that phone out of your pocket, guys. But we'll have to talk about that on a different summit in more detail. So why do you think I invited you on a reversing heart disease summit? And I'm setting up a question. But you're taking histories from men all the time, having erectile issues.

What's the connection that you as a urologist are aware of with your specialty and my specialty overlapping? Yes. Well, you know, now that I've been in practice over 20 years, I've really had a chance to dig into human physiology. And I've come to the conclusion that the purpose of the heart is to pump blood to the penis. And so I imagine that is why. Wait, wait, everybody. Just a minute, everybody. Write that down, please. That may be the sentence of the entire summit. The purpose of the heart is to provide blood flow to the penis.

Oh, my God. I mean, it's. It's a happy accident that it also provides blood flow to other parts, too. But that's principally the most important function of heart, at least in my world. Amazing. So that explains that connection and where it goes. The health of the heart goes the health of the penis. I think would be a reasonable conclusion, right? Yeah. No, indeed. Of course, I'm being a little facetious, but it does turn out that the penis is a really excellent indicator of heart health. And that's because the penis is a structure that's just principally comprised of blood vessels.

Little tiny blood vessels, like a tiny sponge like matrix, fill up the chambers of the penis that give us an erection. And the health of all of those blood vessels mirrors exactly the health of the bigger blood vessels in our body, and especially the blood vessels that feed blood to our heart and keep our heart pumping strong so long before the coronary arteries, the arteries that feed blood to our heart start to clog up and get disease. Those little tiny blood vessels in the penis show the signs of disease.

And that penis, therefore, is like a canary in the coal mine. When we start to see problems with the penis, it's not too late to save our hearts and it's also not too late to turn things around for the penis itself. But several years before a heart attack or stroke, a man will notice a weakening of the erections. I apologize to some of you because this is a great interview, but my third of three dogs wandered through a gate and is joining me for this interview and hopefully will be quiet or we'll have to return 'em to the shelter.

We got him. But he's too sweet to turn her back at Lucy. As I apologize, I'm not having any gas. I'm just so excited about what you're saying. So, erectile dysfunction.

How Erections Work and Why They Fail 6:00

You called it a canary in the coal mine, and there's going to be people that are wondering, what the heck is that analogy? Can you just break that little down a bit? Yeah. many many Many, many years ago, before we had all the advanced technological sensors that we have now, coal miners would bring canaries with them to sense toxic fumes down in the mines. And the canary was much more sensitive to the fumes than the humans were. And so if they saw that canary drop dead in the cage, well, it was too late for the canary, but it wasn't too late for the miners.

They could get out of there and be saved. So when we see our penis drop dead, it's still not too late for our heart and our brain. We can back out of whatever bad habits or bad foods we've been eating that led to that canary in the coal mine dropping over and start to get healthy and restore. You can't bring the canary back in the cage, but you can bring your penis back. So, you know, that's that's the difference. Now, a lot of people are listening saying this is the most time I've heard the word penis in 5 minutes.

All right. Just get used to it. It's okay. We're two doctors talking with each other So many people are listening and our females and females know males. So please don't ignore this topic. You might be married to one. You might be friends with them. You'd be working with them. Yeah. You know, you might hear this conversation and, you know, it's been decades of this relationship, but this early warning detector system, no hard symptoms, no clue to heart disease, but the penis isn't working and, you know, the visit to the urologist is important, but not all urologist are keyed in.

Like Dr. Spitz, I wish they all aware that it's not just a prescription for a medication or a blood test for your testosterone. It's a thought about your heart. Just tell us a little bit. You mentioned about, you know, blood flow being the key to healthy erections, which all of us are listening to this, because at one point somebody had a healthy erection and led to a pregnancy. So, you know, it's normal, normal life. Yes. There's a little bit more about, you know, arteries, healthy arteries and male sexual health.

I mean, just any comments? Yeah, absolutely. So an erection is basically a hydraulic event. So there are these two chambers that are in the shaft of the penis, like my two fingers side by side. And inside the chambers is this sponge like matrix of tiny blood vessels and there are arteries that pump blood into the penis. And of course, those arteries eventually are branches from your aorta off your heart. And as the blood fills those spongy spaces, they expand with blood. And as they expand with blood, they stretch out the lining of that chamber, and they make the lining wider and they make the lining longer.

And that's what an erection is. It's those two chambers getting longer and getting wider because they're being filled up with blood. And the reason that that spongy space can expand as it grows with blood is because the cells that line all of those spaces are tiny little muscle cells that can stretch out nice and wide as we age and as our body gets deteriorated from poor lifestyle choices, poor dietary choices and age itself, or perhaps other medications, disease states, what have you, those little muscles that can stretch get fibrotic and they can't stretch anymore.

And so even though the artery is pumping blood into those two chambers, the blood can only fill it up so much. And it's only a partial expansion. It's only a partial lengthening. And that's what erectile dysfunction is. So if we can keep those tiny little spongy blood vessel spaces nice and stretchy, which means keeping them healthy, keeping them youthful, we can preserve our erections longer. But those changes in those spaces can happen as early as in our thirties. We may not notice it yet, but then by our forties, about half of men are starting to notice some weakening in their erection.

By their sixties, 60%, 70, 70%, 80, 80%. And that's because those spongy spaces are now fibrotic and won't expand anymore. Not only do they have to expand to fill up the chamber, the blood that goes in will drain right back out. If they don't expand so much that they squeeze off the veins that are returning the blood out of the penis. And so some men can get a partial erection and then lose it right away because it wasn't enough not only to fill the chambers, but to pinch off the return of the blood back out of the penis.

Because when the penis fills up, that blood actually gets trapped in there temporarily. It's not just pumping, pumping, pumping, you know, like like like a big blood vessel. It fills and it traps. So the artery to the penis, it, too, can get disease. It can get clogged up with atherosclerosis, just like the arteries to your heart and the arteries to your brain. But, well, before that happens, just those little tiny blood vessels themselves. Becoming fibrotic is the most common reason that we have trouble with erections.

As an incredible explanation, and I hope everybody, you know, gets it that the plumbing, the hydraulics I keep thinking of the Woody Allen movie, Everything You Want to Know About Sex and that great scene where he was just a business for money. If you've missed that movie, please go back and watch it. This guy, at least 35 years ago. Two quick questions as we kind of wrap up our first segment, this interview. And those are the one from a urologic perspective. A 45 year old man walks in your office and says, My family, doc, that I should talk to you.

I'm having erectile dysfunction for the past year. Just forget the cardiology implications. The canary. What are you going to recommend in your starting workup of that situation? Well, the foundation of treatment is going to be letting him know that this is something that he can improve with some natural means diet, exercise, wise and habits. One of the keys to healthy blood vessels, those little spongy blood vessels being nice and stretchy, is that they have plenty of nitric oxide. Nitric oxide is this very important molecule that gets released and it last for a few moments and it actually triggers the relaxation and the stretching of the blood vessel and it allows for an erection to happen.

Lifestyle, Sleep, and Medical Causes of ED 13:00

Nitric oxide is what is harnessed by Viagra, Ira and Cialis. These pills. The reason they give erections is because they allow nitric oxide to last longer and work better. But you can naturally increase the nitric oxide in the penis with dietary choices. So vegetables and fruits give you much more nitric oxide than animal products do, particularly the green leafy vegetables. And when you're a young man twenties, up to mid thirties, you make all the nitric oxide you need. You don't actually have to supplement it, but you start hitting your mid thirties, your cells start making enough nitric oxide and you really do need to supplement it with what you're eating.

And so one thing for this guy is, hey, what kind of diet you have? Let's move you into more of a plant based diet. Secondly, exercise. When you're exercising and your muscles are contracting, they will release molecules that help protect nitric oxide in your bloodstream and even boost nitric oxide. Just the shearing force of blood pumping through your arteries faster causes a release of nitric oxide into those blood vessels and also to into the penis tissues. So get off the couch, make sure you're doing regular, vigorous exercise.

Are you drinking a lot? Are you smoking? Are you doing a lot of marijuana? A lot of people in California are doing a lot of marijuana because it's legal and constant chronic use of marijuana, smoking, cigarets, drinking excessively. All of these things kill your erection. They damage the nerves and damage the blood vessels. So let's limit that, because a typical 45 year old may be not realizing that the amount of recreational substance using he's doing is really actually all that harmful for him because in his twenties, in his thirties, frankly, he was pretty bulletproof.

But now it's starting to catch up to him. Now, once we've addressed all that and we're taking a look at his medication list, maybe by now he's had some high blood pressure and he's on an antihypertensive like a beta blocker or a hydrochlorothiazide. That's going to hurt his erections, too. Maybe he can get shifted to a different antihypertensive, or maybe with the same diet and exercise and lifestyle recommendations. You can get rid of his high blood pressure and get off those medications. Also is is sugar under good control?

Diabetics have nerve damage and blood vessel damage of the tiny little nerves and tiny little blood vessels like the kind that are in the penis. Is your sugar under tight control? And if not, let's get it under tight control. That'll help your erections to and sleep. Are you getting enough sleep at night? Because testosterone is a key molecule for penis health. If a man's testosterone levels too low, those little blood vessels, they also get fibrotic and they don't stretch real well. And the only time a man is making testosterone is when he's in REM sleep, deep sleep when he's dreaming.

And if a guy's not getting enough sleep at night, he's not getting enough REM sleep at night. His testosterone level might be lower than normal. Or if he's got sleep apnea, which is constantly at a subconscious level, waking him up, he may not be consciously awake, but he can't get into that deep REM sleep. If he's got sleep apnea left untreated, that's depriving him of making normal levels of testosterone. And not only that, the stress of the sleep apnea is making his body release a bunch of adrenaline to cope with that, with that suffocation that's happening through the night.

And that adrenaline causes those little spongy spaces in the penis to constrict just as the muscles can relax. Nitric oxide, the adrenaline constricts them down and keeps the blood from flowing in. So these are all the sort of the natural approaches to non-pharmaceutical approaches, but even so, men often still need in the short term anyway and on sometimes in the long term pharmaceutical intervention. And that's where pills come in like viagra cialis levitra you know them by the generic name sildenafil tadalafil vardenafil and they all work in a very similar way.

And what they do is they let the nitric oxide that is getting into the system even though it's less than it used to be last March longer and activate those muscles much longer to stretch and open up than it normally would. That's how it works. And so I may well provide that man with a prescription for one of these pills. Oh, that was absolutely one of the best, you know, concise explanations. And I learned I did not know about the REM sleep. I mean, people can wear an aura ring if they want to track that and work on it.

People, you know, get information from their updated Apple Watch on REM sleep or just, you know, don't go to bed at four in the morning and some better sleep hygiene. That's and the sleep apnea component. It's very easy now to do a home sleep apnea test to talk to your provider if you have concerns and low testosterone. So we've been speaking with the author of The Penis Doctor Aaron Spitz from SoCal. And I think it's been a wonderful, you know, discussion about the canary in the coal mine and why on a reversing heart disease summit.

We also want to reverse erectile dysfunction because of this tight tag connection. We're going to go a little bit longer with Dr. Spitz here, who's been very generous with his time and his knowledge. The author of The business book, a practicing urologist in Southern California and the star of the game changers movie. I'm sure you all watched it, but watch it again. And you see. Yeah, he was a he was great in that natural there is a game changers do coming up isn't there. Yes that's what I've heard.

I don't know a lot of details about it, but I'm pretty excited for it. Okay. But they haven't signed a contract with you yet. I no, I'll bet it out but I'll tell you something interesting. The scene that we did in the movie for people who haven't seen it was we took three college athletes, we gave them meat burritos for dinner, pork, chicken and beef. And then we put a device on their penis to measure how many erections and how hard those erections were while they were asleep. Because men get erections spontaneously while they're asleep, they can't control it.

It's just a normal natural function.

Diet, Game Changers, and the Vegan Burrito Study 19:30

Then we take those same three guys and we gave them vegan burritos and we recorded that same with that same device, their erections that night. And we compare it if there was going to be any difference. I mean, these guys were normal. They had normal erections. But could one meal affect the erections different from another meal, you know, plant based versus versus animal based? And low and behold, what we saw in these three guys was like a 3 to 5 times increase and the number of erections they had that night.

But that's just three guys. And and Joel, you and I know that that's not robust science. That's not a true clinical trial. So what I'm excited to tell you is that there is now a true clinical trial underway in my mind at this hospital with Dr. Robert OBSTFELD as the lead investigator. And we're looking at many young, healthy medical students, and we're doing the exact well, just about the exact same experiment to see with robust science. Does this difference really play out? I suspect it will, but we'll see what the data really shows.

And it's very exciting that we've been able to actually go from, you know, a very flashy movie scene to now really taking it to scientific scrutiny. So I'm excited to see how that plays out. Yeah, that is very exciting. And although there's been a lot of growth of vegetarianism and veganism, if we can prove this point, we'll catch them below the waist. If we can't catch them above the waist. In terms of healthy prevention message. Jake, Great. Well, last few minutes here, since you're such a wealth of knowledge, there's been in the news cycle constantly.

A gentleman that I did interview for the summit, Brian Johnson and a multimillionaire tech executive who has been focusing on reversing his age and uses a plant based diet but sort of humorous. His last name is Johnson, and he spends a lot of time talking about his Johnson as is commonly described, and trying to anti age his sexual health as much as he's trying to and age his entire health. And he's achieving great reversal of whatever measures of age. I believe he wore the same device that you used in the movie.

He has a financial capacity to buy it. I think he did buy the same device and he's been using in addition to a plant based diet and exercise and optimal body fat and lean muscle mass. He's been going through a procedure that's officially called low intensity shock wave therapy, also commercially, sometimes known as gains wave therapy. You have experience with it and you give us a urologist perspective that maybe the diet and the exercise and the REM sleep and the reversal of sleep apnea didn't do it all.

And some guy wants, you know, a mechanical solution. So where does that fit in? Yeah. No, it definitely has a role. I actually do perform low intensity shockwave therapy for my patients as well because it does work. Now, it's important to know that this therapy, like any therapy, works on many, but it doesn't work on all. So as with anything, always be aware of claims that, you know, this will, you know, make you 18 again, no matter what. That's not true. And that's not true for Viagra. That's not true for any remedy.

But for well selected patients, it truly does improve erections. And the way it works is that there are these low intensity sonic impulses, shockwaves, we call them, that hit the penis. About 1500 to 2000 of these impulses are delivered over the course of a treatment session, which might last about 20 minutes and what these impulses are doing is fake, injuring the penis. What I mean by that is it doesn't actually injure the penis at all, but the tissues inside the penis respond as if they were injured with a healing mechanism.

So growth factors are released, stem cells are mobilized, and the blood vessels of the penis are rejuvenated. And even some new blood vessels grow as well. When our bodies injured, we have a healing response to grow new blood vessels, to grow in the tissue. And this low intensity shockwave is tricking the penis into having that same kind of a healing response.

Shockwave Therapy and Choosing the Right Treatment 24:15

And so all those little spongy spaces of those those muscle cells in there that are starting to get fibrotic from age, they get rejuvenated and the fibrosis goes away and they get more stretchy again and new cells grow as well. And so the penis then can fill with blood and expand and widen and lengthen better after the shockwave therapy. However, it won't work on everybody. It will work best on men who have mild to moderate disease of their penis, mild and moderate degrees of this fibrosis. If it's real severe, it's not sufficient to reverse it enough to where you can have natural erections.

It may downgrade how much medicine you need, but if you want to get to natural erections in off pills, it's best in in that mild to moderate category if a person is in the younger age range, what I mean by that forties to maybe mid-sixties, it's going to work better in that population than a guy in his eighties. So it's important to have realistic expectations. And it is important for me as a urologist to select my patients appropriately too. But if you look at all comers, for lack of a better word, it works in about 65% of men.

So that means it doesn't work in about 45% of men. Also, it causes no harm. That's the nice thing, is that even if it doesn't work, if it doesn't get the desired outcome, it's not going to hurt the man. And when it works, it can last for a few years. But you know, we don't stop aging and those changes keep happening. And so eventually the beneficial effect of it may wear down, but it can be done again. And you can get booster therapy. One of the tricks with this for the patient is knowing which practice to go get their care from.

It's not covered by insurance and it's quite pricey, but not all low intensity shockwave therapies are the same. There are devices that are touted as providing low intensity shockwave, but they don't actually provide the true low intensity shockwave energy. And so those growth factors in those stem cells are not being mobilized. They still make impulses and they look like the machine and they sound like the machine, but they're not the machine. And so it's important to be careful where you select to have your therapy.

Our practice has a best in class device, and typically you're going to find best in class devices, in urologist practices. But when you venture outside of urology, into naturopaths and chiropractors and aestheticians, more often than not, those machines are not the real ones. Why don't they get the real ones? Because the real ones cost about three times as much. Also, they may not have the sophistication and the medical understanding to know that they're not using the real ones. They may have all the best intentions, unwittingly purchasing, you know, a device that's not really going to be very effective.

So it is it's an important thing to understand and to choose wisely. If you're going to select this therapy. All right. Real wisdom from the expert, the author of the penis book, the star of The Doctor Show. Although I missed that show, I know it's too. Yeah, for a couple of years, but it was a great one when it was on a run.

Closing Thoughts on ED and Cardiac Evaluation 27:45

I had the pleasure being on a number of times and. Yes. Of course the game changers movie. So, Dr. Spitz, thank you for taking your time and recording this, you know, really relevant information. And, you know, I think the message is guys and women that are in relations with guys, erectile dysfunction is a heart event. It's a heart warning. And go see your knowledgeable urologist. But also be sure you follow up your primary care doctor. Arrange an appointment with a preventive cardiologist and get the full cardiac workup.

Don't miss the clue right? Absolutely. I rely heavily on my cardiology partners when I'm managing my men with erectile dysfunction. I want to know that that's been covered. I'm not a cardiologist. I understand the relationship and I want to know that my patients are in good hands from a heart standpoint. Good. Okay. At that comment, I think we'll leave it there and say goodbye to Dr. Spitz and wish you a wonderful day. Thank you.