Case Presentation
Mr. C is a 52-year-old with cardiovascular disease who presented to our Cardiac Wellness Program at Montefiore on February 2024.
Since at least 2019, he reported not having morning erections and having worsening erectile function. He was not on medications associated with erectile dysfunction (ED).
In January 2021, he had a drug-eluting stent placed in his left anterior descending artery for stable angina.
He has hyperlipidemia for which he has been on statin since the age of 28. He has no known history of myocardial infarction, diabetes, stroke, hypothyroidism, hypogonadism, heart failure, smoking, or illicit drug use. He has never used medications to treat ED.
He exercised regularly since June 2021.
Blood pressure was 110/72, pulse 79, BMI 28kg/m2. Physical exam was unremarkable.
He had been eating “healthfully” from 2011 until April 2022. From Sunday until Friday night his diet consisted of salads, beans, mushrooms, whole grains, soups, plant-based shakes, and processed vegan snack foods. From Friday night until Sunday he would consume “high volumes” of cheese, meats, and highly processed foods.
In April 2022, he started a whole-food plant-based diet (WFPB). About three months later, he noticed improvements in his erectile function.
In July of 2023, he heard that eating more green leafy vegetables may increase nitric oxide production, so he increased his daily servings (each serving was a handful) of greens from 3 to 6. His erectile function normalized within months.
He was given the International Index of Erectile Function-5 questionnaire, a validated measure of erectile function and answered as if he were at the following time points:
1/2021: Directly before stent placement: 9 (Moderate ED)
3/2022: Directly before beginning a WFPB diet: 9 (Moderate ED)
6/2023: Directly before beginning 6 daily servings of greens: 20 (Mild ED)
2/2024: 25 (Normal sexual function)