Exercise & Diet

Content Written By: Martin Miner, MD

There are peer-reviewed, evidence-based published data that metabolic syndrome affects sexual health, and therefore a change in eating habits, in particular to the Mediterranean diet that improves endothelial health, can positively influence the sexual health of women.
Contemporary women, in general, have decreased their physical activity and increased digestion of processed foods. The result has been an increase in metabolic syndrome, obesity, hypertension, high cholesterol, high blood levels of glucose, and diabetes. Man evolved from the hunter-gatherer caveman who ate fruit, nuts, berries, fish, and little meat, consistent with the current Mediterranean diet. The genetic material that existed in the caveman is the same genetic material that exists in contemporary times. The real life and health match, especially for vascular health, is the match of our genetic information with our ancestral diet, that is, the Mediterranean diet.

The Mediterranean diet reflects the eating habits traditionally followed by the people of the countries that border the Mediterranean Sea, and varies according to culture, ethnic background, and religion of the region. The hunter/gatherer diet must be supported by its active lifestyle; translated to modern times, at least 20 minutes per day of physical activity is critical. The diet consists of a high consumption of fruits, vegetables, potatoes, beans, nuts, seeds, breads, and other cereals relying on local, seasonal fresh produce. The contemporary Mediterranean diet utilizes olive oil widely for cooking and dressings, with a low to moderate amount of full fat cheese and yogurt. There is a modest consumption of wine, usually with meals, as well as a moderate amount of fish but little meat. An adequate intake of water must be maintained.

The key scientific finding is that the Mediterranean diet has been shown in placebo-controlled studies to lower endothelial inflammation, potentially contributing to the prevention of vascular diseases such as coronary heart disease. The reason for the Mediterranean diet lowering endothelial inflammation is not fully understood. Antioxidants and inducers of detoxification enzymes exist in abundance in vegetables, fruit, and virgin olive oil.
There are data that the Mediterranean diet lowers endothelial inflammation and reduces the prevalence of metabolic syndrome. A three-year study was conducted among men and women with metabolic syndrome. Men and women assigned to the Mediterranean diet were instructed to follow a Mediterranean-style diet and received detailed advice about how to increase daily consumption of whole grains, fruits, vegetables, nuts, and olive oil. Men and women consuming the Mediterranean diet had significantly reduced serum concentrations of multiple markers of endothelial cell inflammation, including C-reactive protein. In those individuals on the Mediterranean diet, the score of Endothelial Function improved. In those on the control diet, Endothelial Function scores remained elevated. At 2 years of follow-up, a significant number of men and women with metabolic syndrome on the Mediterranean diet and no other treatment were successfully managed and no longer met criteria for metabolic syndrome compared with subjects eating the control diet.

Are there data to support that the Mediterranean diet might be effective in reducing the prevalence of sexual dysfunction in men and women with metabolic syndrome? A 2-year study of men with metabolic syndrome and erectile dysfunction showed an improvement in the sexual function for the Mediterranean diet group. Another study compared pre-menopausal women with metabolic syndrome and sexual health problems with a control general population of women. Compared with the control group, women with metabolic syndrome and sexual dysfunction had lower total sexual function scores, lower sexual satisfaction scores, and higher markers of endothelial inflammation such as C-reactive protein. Thus, in women with metabolic syndrome, there is the same inverse relation of sexual function to markers of endothelial inflammation. Research is ongoing to see if women with metabolic syndrome and sexual health concerns who follow the Mediterranean diet will improve sexual function. Given the results in men, it appears that returning to the caveman days, eating and exercising more appropriately, makes good sense for sexual health as well as overall health.

References:

Davey DA. Hormone replacement therapy: time to move on? Br Menopause Soc. 2006;12:75–80.

Esposito K, Pontillo A, Di Palo C, Giugliano G, Masella M, Marfella R, Giugliano D. Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women: a randomized trial. JAMA. 2003;289:1799–804.

Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, D'Armiento M, D’Andrea F, Giugliano D. Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA. 2004;292:1440–6.

Esposito K, Ciotola, M, Marfella, R, Di Tommaso, D, Cobellis, L, Giugliano, D. Sexual Dysfunction in Women With the Metabolic Syndrome. Diabetes Care. 2005;28:756.

Esposito K, Ciotola M, Marfella R, Di Tommaso D, Cobellis L, Giugliano D. The metabolic syndrome: a cause of sexual dysfunction in women. Int J Impot Res. 2005;17:224–6.

Esposito K, Ciotola M, Giugliano F, De Sio M, Giugliano G, D'armiento M, Giugliano D. Mediterranean diet improves erectile function in subjects with the metabolic syndrome. Int J Impot Res. 2006;18:405–10.

Giugliano F, Esposito K, Di Palo C, Ciotola M, Giugliano G, Marfella R, D'Armiento M, Giugliano D. Erectile dysfunction associates with endothelial dysfunction and raised proinflammatory cytokine levels in obese men. J Endocrinol Invest. 2004;27:665–9.

Miller EL, Mitchell A. Metabolic syndrome: screening, diagnosis, and management. J Midwifery Womens Health. 2006;51:141–51.

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