Declining folic acid levels associated with increasing ED severity

January 29, 2019

A report published online on December 13, 2018 in the journal International Urology and Nephrology reveals a greater risk of erectile dysfunction (ED) among men with lower levels of the B vitamin folic acid in comparison with men who had higher levels.

The study compared 60 married men aged 30 years or older with ED to 30 age-matched control participants who did not have the condition. Men who had severely deficient testosterone levels or other specified conditions were excluded from the study. Self-administered questionnaires were scored for ED severity. Fasting blood samples were analyzed for hemoglobin A1c, total testosterone, lipids, folic acid and other factors.

While the median folic acid level of men with ED was 7.1 nanograms per milliliter (ng/mL), the median level of the control group was nearly twice as high at 13.4 ng/mL. Smokers and those diagnosed with diabetes or high blood pressure had lower median folic acid values in comparison with nonsmokers, nondiabetics and men with normal blood pressure. After adjustment for diabetes, hypertension, smoking, age and serum testosterone levels, low serum folic acid levels were significantly associated with a greater risk of ED. Men whose ED was categorized as severe had folic acid levels that were significantly lower than men with moderate ED, and those with moderate ED had lower levels of the vitamin in comparison with men whose ED was considered mild.

The authors suggest a possible decrease in homocysteine levels, reduced progression of atherosclerosis (as indicated by an association between higher serum folic acid and lower serum cholesterol levels in the current study), and other factors as potential protective mechanisms for folic acid against ED.

“A significant association between low serum folic acid level and erectile dysfunction severity was detected in the present study,” authors A. A. A. Attia and colleagues conclude. “Serum folic acid level decreased as the severity of ED increased even after adjustment of age, serum testosterone, diabetes mellitus, hypertension, and smoking. Thus, folic acid deficiency might be an independent risk factor of ED.”

Apply What You’ve Learned: ED

  • Erectile dysfunction is a warning flag for cardiovascular disease, the primary cause of ED. Men experiencing ED should undergo a thorough examination by their physicians to evaluate their cardiovascular health and rule out the presence of other conditions.1
  • Recent research has provided evidence that having a genetic risk of type 2 diabetes is a cause of ED.2
  • Some cases of ED are psychological in nature. Possible non-physical causes include stress, performance anxiety and relationship difficulties.
  • A heart-healthy lifestyle helps the entire body. Regular, physician-approved exercise, maintaining a healthy weight, and a diet high in fruit, vegetables, and flavonoids may help inhibit ED and support other aspects of good health.3,4
  • Decreased antioxidant defenses are common in men with ED and play a role in lowering vascular nitric oxide, which helps support healthy arterial function (including the penile artery). Supplementation with antioxidant vitamins and minerals will help improve antioxidant status and support vascular health.5
  1. Azab SS et al. J Sex Med. 2018 Jun;15(6):880-887.
  2. Bovijn J et al. Am J Hum Genet. 2018 Dec 21.
  3. Gerbild H et al. Sex Med.2018 Jun;6(2):75-89.
  4. Mykoniatis I et al. J Sex Med. 2018 Feb;15(2):176-182.
  5. Meldrum DR et al. Int J Impot Res. 2012 Mar-Apr;24(2):61-8.

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