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L-arginine is an essential amino acid found naturally in meat, dairy, poultry and fish, It is also available as an herbal supplement and is often marketed as a 'natural Viagra'.

Nitric oxide (NO) is produced by all tissues in the body and plays a crucial role in smooth muscle relaxation. NO is formed from L-arginine using the enzyme nitric oxide synthetase (NOS).

It is well known that ED is commonly found in men with ischaemic heart disease. Vasculogenic ED may be a manifestation of atherosclerosis, and thus the L-arginine-NO pathway is hypothesized as an explanation for the association. There are only a few human studies evaluating the role of L-arginine in ED, and these have yielded mixed results.

One study investigated the effects of L-arginine in 32 patients (mean age 51.6 years) with mixed-type ED in a randomized, placebo-controlled, crossover trial [35]. Patients were administered 3 x 500 mg L-arginine/d or placebo for two 17-d courses. After a 7-d washout period, patients who initially received the placebo for 17 d were switched to L-arginine and vice versa.

Five patients (17%) reported a significant improvement in their sexual performance as measured by a validated questionnaire after the L-arginine phase, compared to 6 patients (20%) who reported a benefit after the placebo period. There was no statistically significant difference between improvements with L-arginine compared to placebo (56% vs. 43%). They concluded that L-arginine at 3 x 500 mg per day dose was no better for ED than placebo [35].

Other studies have shown positive results but have tended to use larger doses of L-arginine. One group conducted a double-blind trial in 50 men with ED [36]. Patients were given L-arginine (5 g per day) or a matching placebo for 6 weeks.

At the end of the study, 9 of the 29 arginine group reported a significant subjective improvement compared to only 2 of the 17 placebo group [36].

Another study administered Pycnogenol orally, which is known to increase the production of NO by stimulating activity of NOS, together with L-arginine as a substrate for NOS [37].

The group consisted of 40 men with ED who were given three ampoules of Sargenor a day for the first month. This is a drinkable solution of the dipeptide arginyl aspartate (equivalent to 1.7 g of L-arginine per day). During the second month, patients were additionally supplemented with 40 mg of Pycnogenol twice a day, and during the third month the daily dosage was increased to three 40-mg Pycnogenol tablets.

At the end of the first month with L-arginine alone, a statistically non-significant number of 2 patients (5%) experienced a normal erection. At the end of the second month of receiving a combination of L-arginine and Pycnogenol, the number of men with restored sexual ability increased to 80%. After the 3-month trial period, 92.5% of the men experienced a normal erection. These men also experienced a decrease in time for an erection to develop after stimulation and an extended duration of erection. The authors concluded that oral administration of L-arginine in combination with Pycnogenol causes a significant improvement in sexual function in men with ED without any side effects [37].

Although none of the studies reported side effects of receiving regular L-arginine, high doses of the drug can stimulate the production of gastrin, resulting in increased gastric acid production. Hence, it may cause gastro-intestinal problems and has been reported to induce necrotizing pancreatitis in rats [38].

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Dealing With Erectile Dysfunction

Dealing With Erectile Dysfunction

Whether you call it erectile dysfunction, ED, impotence, or any number of slang terms, erection problems are something many men have to face during the course of their lifetimes.

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