If you’re a man reading this article, there’s a reasonable chance that you have erectile dysfunction (ED)—you haven’t been able to achieve and maintain an erection that is satisfactory for you and your partner. While it happens to some younger men, by age 40 22% of men have ED in some form, ranging from moderate/intermittent to severe, and by age 70, about 50% do. It’s often progressive—it’ll get worse if you don’t do something about it.

But isn’t the solution easy? After all, Viagra, Levitra and Cialis—prescription drugs that increase blood flow to the penis—are popular. They certainly help. But side effects can be severe, including headache, facial flushing, blurred vision, temporary hearing loss and back pain. Worse yet, these drugs actually can interfere with enjoyable sexual intercourse, says integrative urologist Geo Espinosa, ND, because another possible effect is penile desensitization—you get an erection but can’t enjoy intercourse. Yet another is difficulty reaching ­orgasm.

The good news is that in most cases ED can be prevented—or treated—without these drugs, Dr. Espinosa told Bottom Line Personal. He rarely prescribes them, generally only when impotence is caused by medical care such as treatment for prostate cancer. That’s because the more natural interventions discussed below almost always work to restore erections…

These Supplements Make a Difference 

There are four nutrients and herbs that I prescribe to prevent or reverse ED.

Important: Don’t start taking these on your own. Do so under medical ­supervision (more on that below). You’ll also need a little patience. These supplements work gradually, so they’re best used on a daily basis, not right before sex. Here they are…

L-citrulline. This amino acid converts in the body to L-arginine, which in turn boosts levels of nitric oxide, a gaseous chemical that relaxes the “smooth muscle” in the penis, opening up penile arteries and improving blood flow. These changes also are good for your cardiovascular system—L-­citrulline can reduce high blood pressure, for example.

Scientific research: L-citrulline has been shown in clinical studies to improve erectile function in men with ED. In research at David Geffen School of Medicine at UCLA, it also has been shown to be effective when combined with other supplements. My ­typical prescription is to take L-citrulline twice a day on an empty stomach for a daily total of 750 milligrams (mg) to 1,500 mg. Warning: If your blood pressure is low, either naturally or through treatment, L-citrulline can bring it down too low.

Horny goat weed (Epimedium grandiflorum). This herb is rich in ­icariin, which, like the L-citrulline described above, boosts nitric oxide. It also helps normalize enzymes that control penile blood flow. My typical prescription is to take horny goat weed twice a day on an empty stomach for a daily total of 200 mg to 400 mg. Like L-citrulline, it may reduce blood pressure too low in people with low pressure.

Ashwagandha. This herb from India boosts testosterone. Testosterone deficiency is a common cause of low libido and ED. Ashwagandha also is an adaptogen, an herb that helps the body deal with stress, a major factor in ED. It reduces the stress hormone adrenaline, which in excess tightens arteries, decreasing blood supply to the penis. My typical prescription is to take ashwagandha twice a day on an empty stomach for a daily total of 500 mg to 1,500 mg. It may cause stomach upset in some people. Important: Don’t take this supplement unless you have a testosterone deficiency—only a test done by your doctor can tell you that.

Rhodiola rosea. This is another herbal adaptogen that helps restore physical and mental energy. Exhaustion, particularly at the end of a difficult day, is a common cause of ED.

Scientific research: Salidroside, one of the active ingredients in rhodiola, helps maintain the flow of oxygen to the corpora cavernosa, the spongy penile tissue that fills with blood to create an erection, according to a study published in Evidence-Based Complementary and Alternative Medicine.

How to Use These Supplements

Seek out a complementary/integrative health professional, such as a naturopathic doctor, who can guide you. These supplements often work best in some combination depending on the patient’s overall health profile. It’s especially important to work with a complementary health-care professional if you already are being treated for ED—and even more so if you have another condition such as diabetes or heart disease and already take prescription medications or other supplements. A good integrative physician also will help you make essential lifestyle changes that are part of your journey back to sexual health.

The Good-in-Bed Diet

Men with ED often have cardiovascular disease and/or diabetes, both of which impair blood flow. A diet proven to control and reverse those two deadly diseases also is effective for ED—the Mediterranean diet, rich in vegetables, fruits, beans, whole grains, fish, nuts and seeds, and olive oil, with a minimum of red meat, processed meat and refined carbohydrates.

Scientific evidence: In research published in The Journal of Sexual Medicine, Italian doctors studied more than 600 men with diabetes. Compared with men who ate the fewest foods in the Mediterranean diet, those who ate the most were 17% less likely to have any level of ED and 38% less likely to have severe ED (having erections infrequently or not at all). In another study, men newly diagnosed with type 2 diabetes ate either a Mediterranean diet or a low-fat diet. After eight years, those eating the Mediterranean diet were much less likely to have developed ED.

The Exercise Prescription

Exercise is a must in any approach to preventing and reversing ED. It improves circulation, boosts testosterone and reduces stress.

New scientific finding: In a scientific paper published in Sexual Medicine, researchers analyzed data from 10 studies on exercise and ED and found that six months of regular exercise helped reverse ED in men who were sedentary, overweight, had high blood pressure or had cardiovascular disease. My ­recommendations…

Interval training. Compared with moderate aerobics, high-intensity interval training will help you shed more weight, get fitter faster and add more testosterone-triggering muscle. What to do: Whether your aerobic activity is walking, running, biking or swimming, do it at a moderately easy pace for 60 seconds—and then as fast as you can for 15 to 20 seconds. Caution: Men who have not regularly physically stressed their bodies should consider getting a cardiovascular evaluation that includes a stress test to confirm that their heart can handle the workout.

Dead lifts. A circuit of strength­-training exercises for all your muscles is great for you. One particular exercise should be part of your training, though—the dead lift. You lift a weighted bar off the ground to the level of your hips, then lower it slowly back. Dead lifts use the large muscles of the legs, buttocks and back, and the more muscle, the more testosterone. Safe, correct form is key, so learn from a trainer at a gym or by watching one of the many YouTube videos on dead lifts. Do the exercise as part of your strength-training program at least two to three days a week. A set is lifting the weight six times in a row. Work up to six sets, resting two minutes between sets. If you are able to do more than six repetitions without resting, the weight is too light.

Reducing Performance Anxiety

If you’re not confident before sex—if you’re anxious about achieving or keeping an erection, an anxiety common in men who have experienced ED—it’s more likely you will have erectile difficulties.

Smart idea: Just as professional athletes visualize their desired outcomes before performing, creating mental images of a successful performance such as getting a hit, making a basket or sinking a putt, you can visualize successful sexual performance. Take a few minutes to visualize yourself getting erect and enjoying intercourse. And then start sex with more confidence.

It’s important to realize that no one thing alone reverses ED. But the right diet, exercise regimen, supplement combination and mental attitude can indeed reverse ED—close to 100% of the time.

Note: Look for a feature on women’s sexual health in an upcoming issue.