Healthy Arteries–Good for the Heart, and Another Part

Arginine and Policosanol Help Blood Flow Where It’s Needed

Healthy Arteries–Good for the Heart, and Another Part
Both arginine and policosanol contribute importantly to optimal arterial function
By Will Block

ou’ve seen the scene in the movies: a man sits disconsolately in bed, looking embarrassed, while the woman in bed with him looks frustrated or angry. Or perhaps she says soothingly, “It’s OK, Honey, it happens—it’s no big deal.” No big deal to her, maybe, but to him it’s a Really Big Deal, and he’s feeling very . . . small. What had been performance anxiety a short while ago is now full-blown panic. How could this happen to him? It’s so unfair!

How often this poignant scenario has played out in bedrooms the world over is anyone’s guess (do numbers even go that high?). It is surely scant solace to any man, however, to know that he’s not alone (he is, in fact, in the company of over 30 million American men). Nor would he want to hear that the fault might well be his own for having made some poor lifestyle choices throughout his adult life. Thinking that the problem is the result of a cruel and capricious fate, or perhaps an inevitable symptom of “normal aging,” is, after all, more tolerable than reflecting on one’s own foolishness and having to say, “If only I had . . . .”

If only I had . . . what? What is it that he could have—should have—done differently? He should have paid more attention to his cardiovascular risk factors, that’s what. For the cardiovascular system to work optimally, the arteries—which are muscular in nature—must be able to expand and contract readily according to the shifting needs of the body’s various tissues and organs—including the penis. When an artery expands (reduced blood pressure), blood flows more freely; when it contracts (increased blood pressure), the flow is restricted. Uh-oh.

Arginine, via NO, Regulates Endothelial Function

Many factors play a role in creating the exquisite balance of forces required to maintain a healthy cardiovascular system and optimal blood circulation, and the interplay of these factors is manifested in the arteries’ endothelium. This is the layer of flat, tightly packed endothelial cells that line the inner walls of the blood vessels and the heart. When the endothelium is working optimally, so, probably, is the cardiovascular system. Endothelial dysfunction, however, presages many problems, including heart disease, type 2 diabetes, and erectile dysfunction (or impotence, as it was known before the Euphemism Police took over).

In a recent article in this magazine (“Take Arginine to Heart,” February 2004), we saw how the nutrient amino acid arginine, through its production of the neurotransmitter nitric oxide (NO), helps maintain healthy endothelial function and thus healthy blood flow to all parts of the body. And in the sidebar to that article, “The Heartbreak of Impotence,” we saw that heart disease is a warning sign for impotence, and vice versa: the two organs are inextricably linked through their shared dependence on a healthy circulatory system—which depends critically on NO.

What Are the Risk Factors for Impotence?

Now even stronger evidence for this link has been published by researchers at the University of California, San Diego, who queried 570 men about their erectile function, or lack of it, and analyzed the results in terms of the men’s cardiovascular health over a 25-year period.1 What they found, in a nutshell, was that a man with significant cardiovascular risk factors in midlife is more likely to wind up impotent (if he doesn’t die first) than a heart-healthy man.

In the early 1970s, the adult population of Rancho Bernardo, California,* was recruited for a long-term study of cardiovascular health, which included medical examinations and questionnaires. A total of 1810 men (82% of the male population) signed up; 25 years later, 944 of them were still alive, and 570 of those participated in the current study; the average age of these 570 at baseline (the outset of the study) was 46.

*Rancho Bernardo is a planned community near San Diego consisting primarily of older, educated, middle-class to upper-middle-class Caucasians. Although this group is not representative of the population at large, the conclusions reached in this study are in general agreement with those of other studies.

Policosanol has been shown to rival
or even exceed the statins in
efficacy for patients with mild to
severe hypercholesterolemia—
and it’s extremely safe to boot.

The men completed a standardized questionnaire that evaluates a man’s sexual activity during the past 6 months in terms of his ability to achieve and maintain an erection. They had not been asked about their erectile function at baseline, but the objective now was to correlate their recent erectile status with risk factors for coronary heart disease (CHD), based on whatever changes had occurred in their cardiovascular status during the intervening quarter-century.

The risk factors considered were age, obesity, high cholesterol, high triglycerides (fats), diabetes, hypertension, and smoking. Age is the best-established risk factor, probably because it often brings with it increases in various other risk factors. Note, though, that, whereas aging is inevitable, all the other risk factors listed here are well within our control, mainly through eating sensibly (preferably with some help from judiciously chosen supplements) and exercising regularly.

Obesity and High Lipid Levels Were Major Risk Factors

Now (in 1998) the surviving men were 25 years older (average age 71), and age and the CHD risk factors had taken their toll: 13% of the men had severe or complete erectile dysfunction (ED), 12% had moderate ED, 21% had mild ED, and 23% had none; the remaining 31% were not sexually active for various reasons, among which was surely ED.

Obesity was a strong predictor of ED in these men, i.e., at baseline there was a significantly higher incidence of obesity in the men who eventually reported being severely or completely impotent or sexually inactive than in those who did not. Also strong predictors were high lipid levels (cholesterol and triglycerides), which is hardly surprising, since clogged penile arteries just don’t work very well.

A Surprise—Then the Realization

The remaining CHD risk factors—hypertension, diabetes, and smoking—did not show statistically significant associations with ED, even though, like all the other risk factors, they were more prevalent at baseline in the men who did eventually report ED than in those who did not. Furthermore, other studies have shown strong links between these three conditions and ED. The fact that this study did not is therefore surprising at first.

Because of the central role of NO in
blood flow to the genitals, both men
and women might benefit doubly from
arginine, in terms of its effects on
themselves and on their partners.

Then, however, the realization dawns: this study spanned 25 years, much longer than any of the others. By that time, many of the men who had been afflicted at baseline with hypertension, diabetes, or smoking were already dead. We will never know how many of them had become impotent before they died, but it’s a safe bet that the proportion was substantial and that, had they lived long enough, their data points would have strengthened the conclusions reached in this study.

The main conclusion is that heart disease risk factors predispose men in midlife to impotence later on. In what may have been a considerable understatement, the lead author of the study, Dr. Elizabeth Barrett-Connor, said, in an interview with Reuters Health, “Patients may be more inclined to use lipid-lowering medications if they can prevent ED as well as heart disease.”2 Bet on it.

Policosanol Helps Keep Arteries Clear—In Men and Women

Lipid-lowering medications—mainly the statin drugs—are very effective (and very expensive), but so is the much more economical natural supplement policosanol, a sugar-cane derivative about which we have published many articles in the past three years (see “A Sea Change in Cholesterol Thinking” on page 21 of this issue, and the previous articles cited therein). In numerous randomized, double-blind, placebo-controlled trials of policosanol conducted by Cuban researchers, policosanol has been shown to rival or even exceed the statins in efficacy for patients with mild to severe hypercholesterolemia—and it’s extremely safe to boot. The typical daily dosage is 20 mg.

A new study in this series examined the efficacy of the low daily dosage of 5 mg in 100 patients, aged 25–75 (average 52), with borderline to mildly elevated cholesterol levels.3 Upon completion of the 8-week regimen, the researchers found a typical spectrum of policosanol’s benefits: it had substantially lowered the patients’ total cholesterol, LDL-cholesterol (“bad cholesterol”), and triglyceride levels; at the same time, it had raised their HDL-cholesterol (“good cholesterol”) levels. The placebo had no significant effects.

Arginine Helps Keep Arteries Vigorous— In Men and Women

Reducing cholesterol levels is only one of the strategies for preventing atherosclerosis, however. Another is maintaining healthy endothelial function, because normal blood pressure depends on it and because plaque deposits tend to form where the endothelial lining has been compromised by inflammation. All the more reason to supplement with arginine as well as policosanol—for the potent benefits of the NO molecules it releases in the endothelial cells.

Two recent studies—one on healthy young men in Italy and the other on healthy old men and women in Germany—have demonstrated the beneficial effects of arginine supplementation on impaired endothelial function, which can occur even in outwardly healthy people.

The first study examined the problem of impaired endothelial function resulting from eating a high-fat meal, which temporarily diminishes the bioavailability of NO and fosters an oxidative state in the endothelial cells, owing to the copious production of free radicals.4 Arginine supplementation (6 g/day) in 7 healthy young men (average age 23) significantly improved their NO levels and hence their endothelial function. The effect was attributed to arginine’s indirect antioxidant action (see sidebar for more on this).

Arginine Boosts Antioxidant Status

A study conducted in Poland suggests that arginine may exert an antioxidant effect indirectly through its action in promoting the antioxidant functions of other molecules.1 For 4 weeks, researchers administered two dosages of arginine (2 g or 4 g) three times daily, for a total of 6 g or 12 g daily. The patients were 32 hospitalized men and women, average age 60, with peripheral arterial disease, an atherosclerotic narrowing of the arteries in the legs that results in impaired circulation and pain in walking (called intermittent claudication in medical jargon). Arginine is known to be beneficial for this condition through its release of NO in the arteries, which improves endothelial function.*

*Policosanol is known to be helpful as well. See “Policosanol Helps with Painful Walking” in Life Enhancement, August 2003.

Comparing the two groups at the end of the study, the researchers found (surprisingly) that the lower daily dose of arginine produced a much greater boost in the patients’ NO levels than the higher dose: with the higher dose, the levels were more than doubled over the baseline value, but with the lower dose, they were more than quadrupled.

The researchers also found that the patients’ total antioxidant status (i.e., the degree to which free radical activity was effectively suppressed in a specific blood test to measure this effect) was significantly increased in both groups of patients, with no statistically significant difference between them. The authors stated that the concurrent increase of NO levels and of total antioxidant status in these patients suggests the potential importance of orally administered arginine in terms of antioxidant activity.

  1. Jablecka A, Checinski P, Krauss H, Micker M, Ast J. The influence of two different doses of L-arginine oral supplementation on nitric oxide (NO) concentration and total antioxidant status (TAS) in atherosclerotic patients. Med Sci Monit 2004;10(1):CR29-32.

The second study examined a different problem—that of the substantial decline in endothelial function that comes with age.5 As with the youngsters, arginine supplementation (16 g/day in this case) in 12 healthy old men and women (average age 74) significantly improved endothelial function. Based on the results of other studies, a sustained action such as this could be expected to diminish the subjects’ risks for heart disease and, for the men, for impotence.

But what about sexual function in women? Although direct scientific evidence for the role of arginine in enhancing a woman’s sexual response is still lacking, it seems likely that arginine would indeed be of benefit. Why? Because the NO-mediated increase in blood flow to the genitals plays a central role in sexual arousal in both sexes. Both men and women, therefore, might benefit doubly from arginine, in terms of its effects on themselves and on their partners.

Do the Right Thing

Men, if you had to choose between saving your heart and saving your penis, which would it be? Silly question. You could live without your penis—but you wouldn’t want to if it weren’t working properly. Luckily, you can do both your heart and your penis a world of good simultaneously, by minimizing those cardiovascular risk factors. Eat right, get your exercise, and make arginine and policosanol a part of your life. You-know-who will be grateful.


  1. Fung MM, Bettencourt R, Barrett-Connor E. Heart disease risk factors predict erectile dysfunction 25 years later. J Am Coll Cardiol 2004;43: 1405-11.
  2. Anon. Prevent heart disease, avoid erection problems. Reuters Health report, New York, April 20, 2004.
  3. Castaño G, Más, Fernández J, López E, Illnait J, Fernández L, Mesa M. Effects of policosanol on borderline to mildly elevated serum total cholesterol levels: a prospective, double-blind, placebo-controlled, parallel-group, comparative study. Curr Ther Res Clin Exp 2003;64:522-37.
  4. Marchesi S, Lupattelli G, Siepi D, Roscini AR, Vaudo G, Sinzinger H, Mannarino E. Oral L-arginine administration attenuates postprandial endothelial dysfunction in young healthy males. J Clin Pharm Ther 2001;26:343-9.
  5. Bode-Böger SM, Muke J, Surdacki A, Brabant G, Böger RH, Fröhlich J. Oral L-arginine improves endothelial function in healthy individuals older than 70 years. Vasc Med 2003;8:77-81.

Arginine and Policosanol Are Complementary

For those who desire healthy blood vessels, Life Enhancement recommends the NO-producing amino acid arginine and the Hawaiian sugar-cane extract policosanol (which is not a sugar). Both are designed to support proper cardiovascular function (and hence erectile function) through their beneficial effects on the arteries. When arginine is presented as a delicious drink mix, it should also contain the antioxidant vitamins C and E, as well as choline (a precursor to the neurotransmitter acetylcholine) and its cofactor pantothenic acid (vitamin B5), which help to potentiate some of arginine’s biological effects.

The recommended serving sizes for maximum benefit are 18 g/day of arginine for men and 12 g/day for women, preferably taken all at once on an empty stomach, about an hour before exercise or athletics or sexual activity, or at bedtime. This optimizes the release of growth hormone by the pituitary gland, which is stimulated by arginine, and provides nitric oxide-mediated vasodilation when it is most needed.

For supporting proper cardiovascular function, it’s preferable to take half the maximum amount of arginine and divide the daily serving into three portions of 3 g (for men) or 2 g (for women) each. The totals are then 9 g/day for men and 6 g/day for women. It’s best to drink the three portions at midmorning, midafternoon, and bedtime so as to avoid conflict with protein-containing meals.

In addition to policosanol, three other heart-healthy nutrients should be taken: coenzyme Q10, niacin (a B-vitamin that lowers cholesterol), and green tea extract. The niacin is in the form of inositol hexanicotinate (IHN), which does not produce the notorious “flushing” effect of niacin itself. Each capsule should contain 5 mg of policosanol, and the recommended daily serving is 4 capsules, taken with meals and at bedtime (20 mg total).

Other products which may be helpful to support cardiovascular health are those containing EDTA and Omega-3 Fish Oils. The former helps prevent and reduce the buildup of plaque in the arteries, thus permitting blood to flow more freely. The latter provides the essential omega-3 fatty acids DHA and EPA, which act to provide anti-inflammatory protection to the arteries (inflammation is a key factor in the development of arterial plaque).

Will Block is the publisher and editorial director of Life Enhancement magazine.

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