Ask the Doctor—Menstrual Cramps, Erectile Dysfunction, and Toenail Fungus
By Terry Grossman, MD
I’ve suffered from debilitating menstrual cramps ever since I went through puberty. Can you tell me how I can end this monthly cycle of agony?
Menstrual cramps, also known as dysmenorrhea, are most commonly the result of high levels of prostaglandins, a type of inflammatory chemical created in the uterus. Of the many different types of prostaglandins, three relate to dysmenorrhea: PGE1 and PGE3, which decrease inflammation, and PGE2, which increases it. Your goal in controlling menstrual cramps is to decrease PGE2 while increasing PGE1 and PGE3.
Conventional medical therapy for dysmenorrhea relies on the use of a group of anti-inflammatory drugs known as NSAIDs (nonsteroidal anti-inflammatory drugs like aspirin and ibuprofen). But NSAIDs have a major shortcoming because they are nonspecific, meaning they block production of all three dysmenorrhea prostaglandins, both pro- and anti-inflammatory. By blocking production of the proinflammatory PGE2, they help reduce discomfort. But since they block production of the anti-inflammatory PGE1 and PGE3 as well, they increase the risk of gastrointestinal bleeding and hemorrhage. NSAIDs, in fact, cause 100,000 hospitalizations and 16,500 deaths in the US each year. By using nutritional methods, however, you can easily help the body get its chemistry right.
Prostaglandins are made from fatty acids. By modifying the types of fat you consume in your diet, you can manipulate your prostaglandin levels in favor of more PGE1 and PGE 3 and less PGE2. The latter comes from omega-6 fatty acids, while PGE1 and PGE 3 derive from the omega-3 fats. The precursor to PGE 2 is an omega-6 fat known as arachidonic acid (AA). The body produces AA naturally, but it also comes from dietary sources. To reduce menstrual cramps you need to cut off the supply of AA. You should begin by eliminating or sharply reducing rich dietary sources of AA such as egg yolks, beef, lamb, and high-fat dairy products. The natural production of AA in the body increases whenever you consume sugar or other high-glycemic foods such as white potatoes, white flour, and bananas. You want to minimize these foods during the second half of your cycle and during the menses as well. Eating fresh vegetables, whole grains, fruit, and moderate amounts of protein foods such as seafood and soy, will reduce AA production as well.
The anti-inflammatory/pain-reducing prostaglandins PGE1 and PGE3 come directly from the beneficial fatty acid eicosapentaenoic acid (EPA). Consuming cold water fish or fish and krill oils will increase EPA levels. Vegetarians can produce EPA indirectly from the omega-3 fats found in flax and walnuts. The two main omega-3 fatty acids found in fish oil are EPA and DHA. For general health, adult women should take a daily dose of 1,100 mg of combined EPA/DHA (1,600 mg for men). To treat menstrual cramps, you will often need to take larger doses. A teaspoon of cod liver oil contains about 1,000 mg of EPA/ DHA, and women typically need 3,000 to 5,000 mg every day to control cramps. While these doses are generally quite safe, if you find it necessary to take more than 3,000 mg a day, be aware of the possibility of blood thinning and, subsequently, increased risk for bleeding.
I’ve been getting grossed out by my toenails lately, but prescription fungus medications scare me. Any way to get my healthy nails back some other, safer way?
Doctors call this type of fungal infection onychomycosis. Warm, wet, and dark conditions—the exact conditions found on the toenail area beneath socks—encourage fungal growth. Sugar also enhances fungi, making this condition more common among diabetics. You can prevent onychomycosis (and also help treat it) by changing the environment to something the fungus doesn’t like—cool, dry, and light. So wear open toe shoes or sandals whenever possible.
Tea tree oil, which comes from the leaves of a tree that grows wild in Australia, has powerful antibacterial, antiviral, and antifungal properties. Because our nails have a relatively poor blood supply, the best way to get this naturally occurring antifungal agent in play is to apply it directly to the toenail. Unfortunately, the oil won’t penetrate very deeply beneath the surface of the thickened toenail unless it’s mixed with a solvent such as DMSO, which will enhance penetration and help carry the tea tree oil deep into infected portions of the nail.
You want to choose concentrated solutions such as 99 percent tea tree oil and 99 percent DMSO, both of which are available at most natural food stores. DMSO works so well as a solvent, however, that it will carry anything on the nail beneath the surface when it is applied. To avoid getting any unwanted substances under your nails, take a shower or wash your feet prior to application. Then simply paint the tea tree oil on the nail with a cotton ball, being careful not to allow the solution to come in contact with (and possibly burn) your skin. Immediately afterwards paint DMSO on the nail to carry the tea tree oil deeper into the nail. Put a Band-Aid on afterwards. For best results, apply this combination three times a day until the fungus disappears, which typically takes several months. Filing down the treated nail surface on
a regular basis also helps absorption.
I’m a relatively healthy guy in my late 40s with a pretty vigorous libido, but I’m a flop in the sack because of erectile dysfunction. Do you have any alternatives to the little blue pill?
A mere 25 years ago the medical profession believed that psychological problems caused more than 75 percent of erectile dysfunction cases (ED)—that the problem was located between the ears, not below the belt. Current thinking reverses that notion, believing instead that as much as 90 percent of ED has a physical origin. In addition, since so many cases of ED stem from inadequate blood flow as a result of blocked arteries, cardiologists now feel ED may be an early warning sign for coronary artery disease. And they say men with ED should be evaluated for coronary atherosclerosis.
Erection of the penis occurs in two stages. The first stage, tumescence, is characterized by the increased length and diameter of the gland. As a result of sexual stimulation, nitric oxide (NO) levels build up in the walls of the arteries supplying blood flow to the penis. NO causes the arteries to dilate and the increased blood flow fills two hollow chambers (the corpus cavernosa) lying on either side of the urethra. As these chambers expand, they compress the walls of the thinner-walled veins that carry blood out of the penis. With increased blood flow in and decreased blood flow out, the chambers quickly become engorged, resulting in the second stage—full erection. Viagra and the other ED drugs work by increasing levels of NO.
NO forms naturally in the body from the amino acid arginine. Some men find that taking supplemental arginine 30 minutes before sexual activity can enhance the strength of their erections. You can begin with 1 to 3 g and move up to 5 to 9 g if needed. Taking arginine on an empty stomach enhances absorption—it’s available in capsules and powder—but individuals with a history of herpes infections and ulcers should avoid taking it.
Another botanical, ginkgo biloba, has a long history in treating ED. The medical literature contains conflicting studies on the herb’s effectiveness, but most individuals take a dose of 40 to 120 mg one to three times daily. If you want to cover all your bases, you can safely take it along with arginine.