What Do Back Pain, Erectile Dysfunction and Heart Disease Have in Common?

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August 23, 2015

More than you would think, it turns out. A few weeks ago, I attended a conference about Nutrition in Medicine that focused on prevention of cardiovascular disease. It was hosted by the Physicians Committee for Responsible Medicine and George Washington University in Washington, D.C.In 2013, their conference focused on nutrition and the brain, showing how a plant-based diet, exercise and sleep all contribute to better health — i.e., less dementia, less cancer and less heart disease.

This year, the focus was on how a plant-based diet could prevent and reverse heart disease. You’ll have to read on to see how this pertains to back pain and erectile dysfunction (ED).

One of the presenters was Dr. Caldwell Esselstyn, Jr., a former Olympic rowing champion and current physician and Director of the Cardiovascular Prevention and Reversal Program at the Cleveland Clinic Wellness Institute. He describes cardiac disease as being a ‘food borne epidemic’. In normal arteries, the cells of the vessel wall produce nitric oxide (NO), which inhibits inflammation and protects against the development of plaque.

The nitric oxide that is produced by normal vessels dilates the arteries and allows for increased blood flow. This provides enough blood and oxygen to the heart, muscles and other organs whenever it is needed. For instance, it allows you to exercise without chest pain or muscle cramps.

The current Western diet leads to the development of plaque in the arteries and decreased function of the NO. Once the plaque forms, the cause of 90% of heart attacks is the rupture of that plaque. A blood clot forms at the site of rupture and increases in size until it blocks all the blood flow in that area and causes a heart attack.

With numerous anecdotes and collection of data, Dr. Esselstyn showed that a totally plant-based diet – in his words, avoiding “anything with a mother or coming from something with a mother” actually results in regression of the plaques. He showed several examples of dye studies in which previously ragged-looking arteries became wider and smooth following just 9 months of a vegan diet. This would include LOTS of greens and other vegetables, fruit, whole grains, legumes/lentils, and no added oils. It eliminates all products derived from animals, such as dairy, eggs and even honey. Maple syrup is a good sweetener substitute that is natural and low in fructose. Here is a link to explain the difference between a plant-based diet, which is typically more liberal than a strict vegan diet, which Dr. Esselstyn advocates.

In patients with a heart attack, his data showed less than 1% recurrence of an attack over the following years for those who followed a strict vegan diet, vs 20% recurrence in other studies without this diet. The number of patients he follows is small, due to time consideration. Ninety percent of the patients he counsels follow the diet strictly, which is not likely to happen for the rest of us docs. The difference, he says, is that he spends over 5 hours with each patient initially explaining the impact the diet is likely to have on their long term health.

So, finally, how do these concepts affect low back pain and ED? Adequate blood flow is necessary for all of our bodily functions. Dr. Leena Kauppila from Finland reported her research findings that narrowing of arteries supplying the spine can cause low back pain. Atherosclerosis in these vessels can compromise muscles, disks and vertebrae, and can present with the same symptoms as back pain from other causes. She presented good supporting evidence showing that calcium at certain levels in the aorta predicted later back pain at that same level, presumably due to decreased blood flow. There was also a correlation between high LDL (‘bad’ cholesterol) level and incidence of low back pain.

Dr. Stephen Kopecky, a cardiologist at the Mayo Clinic, presented the data about ED being a predictor of future heart disease. An erection requires increased nitric oxide and increased blood flow. As I described above, diseased vessels may be narrowed and have decreased nitric oxide production. So early onset ED is like a ‘canary in the coal mine’ whose death signals that there is too much carbon monoxide and warns the miners to escape. In this case, ED occurring at a younger age represents a vascular problem and is an early marker of coronary artery disease. It is a predictor of early death. The risk factors for ED are the same as for heart disease – high blood pressure, diabetes, high cholesterol, obesity, and sedentary lifestyle. Abdominal obesity in particular leads to low testosterone and low sperm counts which leads to decreased fertility. Based on the data for heart disease, perhaps this will improve as well on a plant based diet.

If there is one take home message from all this, it is, “You are what you eat.” I would need to see more data on the REgression of plaques in arteries, but I have no doubt that a healthy plant-based diet – even if it is not strictly vegan – can decrease the rate of PROgression of plaques. The same process of atherosclerosis is occurring in all the arteries of the body. This affects the risk of heart attacks, strokes, leg pain, back pain, ED, etc. Any change you make toward a more plant-based diet may be beneficial. I will have many of the books listed below available at my office for my patients’ perusal. Please take the time to investigate this info and see if you can improve your longterm health.

We will be adding more plant-based recipes to the website over time. Be well!


Davis, Brenda and Melina, Vesanto. Becoming Vegan, Express Edition – the everyday guide to plant-based nutrition, 2013.

Esselstyn, Ann Crile and Jane. The PRevent and Reverse Heart Disease Cookbook, 2014.

Kahn, Joel, The Holistic Heart Book – A Preventative Cardiologist’s Guide to Halt Heart DIsease Now, 2013.

Popper, Pamela and Merzer, Glen, Food Over Medicine, The Conversation That Could Save Your Life, 2013.

Sroufe, Del, The China Study, Quick and Easy Cookbook, 2015.



Previous Lady Docs articles:

Exercise Nutrition and the Brain

Nutrition and the brain Part 2 – Sleep and Vegetables