Erectile dysfunction (ED) affects millions of men in the UK, prompting many to explore natural remedies such as tart cherry and beetroot extracts. Whilst these supplements contain compounds that may support general cardiovascular health through improved blood flow, there is currently no clinical evidence demonstrating they can cure or effectively treat erectile dysfunction. ED often signals underlying health conditions, particularly cardiovascular disease, making proper medical assessment essential. This article examines the scientific basis for these supplements, reviews current evidence, and outlines proven treatments available through the NHS that offer significantly higher success rates than any natural product.

What Is Erectile Dysfunction and Its Common Causes

Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity. It is a common condition affecting millions of men in the UK, with prevalence increasing with age. Whilst occasional difficulty with erections is normal, ED becomes a clinical concern when it occurs regularly, typically over a period of at least three months, though men should seek help earlier if concerned.

The causes of ED are multifactorial and often interconnected. Physical causes include:

• Cardiovascular disease – atherosclerosis (narrowing of blood vessels) reduces blood flow to the penis

• Diabetes mellitus – damages blood vessels and nerves essential for erections

• Hypertension – both the condition and certain antihypertensive medications can contribute

• Hormonal imbalances – particularly low testosterone (hypogonadism)

• Neurological conditions – such as multiple sclerosis, Parkinson's disease, or spinal cord injury

• Medications – including antidepressants (particularly SSRIs/SNRIs), antipsychotics, beta-blockers, thiazide diuretics, 5-alpha-reductase inhibitors, antiandrogens, and opioids

• Surgical or radiation treatments – particularly those affecting the pelvic region

Psychological factors play a significant role in many cases, including anxiety, depression, stress, and relationship difficulties. These can exist independently or alongside physical causes, creating a complex clinical picture.

Lifestyle factors substantially influence erectile function. Smoking damages blood vessel walls, excessive alcohol consumption affects nerve function, obesity increases cardiovascular risk, and sedentary behaviour contributes to poor vascular health. Importantly, ED often serves as an early warning sign of cardiovascular disease, as the penile arteries are smaller than coronary arteries and may show symptoms of atherosclerosis earlier. This makes proper medical assessment essential rather than simply seeking symptomatic relief through supplements.

How Tart Cherry and Beetroot Extracts May Affect Blood Flow

Both tart cherry and beetroot extracts have gained attention for their potential cardiovascular benefits, primarily through mechanisms that theoretically could support erectile function. Understanding these mechanisms helps contextualise their potential role, whilst recognising the distinction between general vascular health and specific treatment of ED.

Beetroot extract is rich in dietary nitrates, which the body converts to nitric oxide (NO) through a pathway involving oral bacteria and enzymatic reduction. Nitric oxide is a crucial signalling molecule that relaxes smooth muscle in blood vessel walls (vasodilation), thereby improving blood flow. This affects the same NO-cGMP pathway involved in erections, but at a different point than phosphodiesterase-5 (PDE5) inhibitors like sildenafil. While PDE5 inhibitors work by preventing the breakdown of cGMP (thus prolonging NO signalling), beetroot potentially increases NO availability. Studies have demonstrated that beetroot juice consumption can lower blood pressure and improve exercise performance in healthy individuals, suggesting genuine vascular effects.

Tart cherry extract (typically from Montmorency cherries) contains high levels of anthocyanins and other polyphenolic compounds with antioxidant and anti-inflammatory properties. These compounds may support endothelial function—the health of blood vessel linings—which is essential for proper vasodilation. Some research suggests tart cherry consumption may reduce markers of oxidative stress and inflammation, both of which contribute to endothelial dysfunction in cardiovascular disease.

Whilst these biological mechanisms are scientifically plausible, there is no official link established between consuming these extracts and curing or effectively treating erectile dysfunction. The concentration of active compounds in commercial supplements varies considerably, and the doses used in cardiovascular research often differ substantially from those in available products. Furthermore, supporting general vascular health is not equivalent to treating the specific pathophysiology of ED, which often involves multiple contributing factors beyond simple blood flow limitation.

Current Evidence on Natural Supplements for ED

The evidence base for natural supplements in treating erectile dysfunction remains limited, with most products lacking the rigorous clinical trials required to demonstrate efficacy and safety. Understanding this evidence landscape is essential for making informed decisions about ED management.

For tart cherry and beetroot specifically, there appear to be no published randomised controlled trials examining their effects on erectile function as a primary outcome. Whilst beetroot juice has been studied for cardiovascular benefits, these studies typically measure blood pressure, exercise capacity, or endothelial function rather than sexual function. The extrapolation from general vascular effects to ED treatment is speculative and not supported by clinical evidence.

Other supplements have received more research attention:

• L-arginine – an amino acid precursor to nitric oxide – has shown modest benefits in some small studies, particularly when combined with pycnogenol, but evidence remains inconsistent. Caution is needed when used with antihypertensives or nitrates due to potential blood pressure effects.

• Ginseng (particularly Korean red ginseng) – has demonstrated some positive effects in meta-analyses, though study quality varies. May interact with anticoagulants, antidiabetic medications and stimulants.

• Yohimbine – derived from tree bark, has some evidence but carries risks of side effects including anxiety, elevated blood pressure and psychiatric symptoms. It is not licensed as a medicine in the UK and is not recommended by NICE.

• DHEA – may help in cases of low testosterone but evidence is limited. It is not licensed as a medicine in the UK and is not recommended by NICE.

In the UK, most supplements are regulated as foods by the Food Standards Agency and Trading Standards, not as medicines by the MHRA (Medicines and Healthcare products Regulatory Agency). This means they undergo less stringent safety and efficacy testing. Quality control can be inconsistent, with actual content sometimes differing from labels. The MHRA has repeatedly warned about supplements marketed for ED that contain undeclared pharmaceutical ingredients, posing serious safety risks.

NICE guidance does not recommend supplements as first-line treatment for ED, instead emphasising lifestyle modification and evidence-based pharmaceutical interventions. Whilst supplements are unlikely to cause harm in most cases, relying on them may delay proper diagnosis and treatment of underlying conditions, including serious cardiovascular disease.

Proven Medical Treatments for Erectile Dysfunction

Evidence-based treatments for erectile dysfunction are highly effective, with success rates significantly exceeding those of any natural supplement. NICE Clinical Knowledge Summary guidance provides a clear treatment pathway that should be followed after proper assessment.

First-line pharmacological treatment involves PDE5 inhibitors, which include:

• Sildenafil – taken approximately one hour before sexual activity, effective for 4-6 hours

• Tadalafil – longer-acting (up to 36 hours), also available as a daily low-dose option

• Vardenafil – similar profile to sildenafil

• Avanafil – faster onset of action (15-30 minutes)

These medications work by inhibiting the enzyme that breaks down cyclic GMP, thereby enhancing the natural erectile response to sexual stimulation. They are effective in approximately 70-80% of men with ED. Common side effects include headache, facial flushing, nasal congestion, and indigestion. Sildenafil may cause visual disturbances, while tadalafil more commonly causes back pain or myalgia.

Contraindications include concurrent use of nitrate medications (for angina) or recreational amyl nitrite ('poppers') due to risk of severe hypotension. Caution is required with alpha-blockers, in patients with recent myocardial infarction or stroke, severe hypotension, severe hepatic or renal impairment, and certain eye conditions including retinitis pigmentosa. In the UK, sildenafil 50mg (Viagra Connect) is available from pharmacies following assessment by a pharmacist.

Second-line treatments for men who cannot use or do not respond to oral medications include:

• Intracavernosal injections (alprostadil) – self-administered into the penis, highly effective but requires training

• Vacuum erection devices – mechanical devices creating negative pressure to draw blood into the penis

• Intraurethral alprostadil – less commonly used due to lower efficacy and discomfort

Surgical options, including penile prosthesis implantation, are reserved for men who have not responded to other treatments.

Testosterone replacement therapy may be appropriate for men with confirmed hypogonadism (low testosterone), though this alone rarely resolves ED without addressing other factors. Treatment should always be accompanied by lifestyle modifications: smoking cessation, reducing alcohol intake, increasing physical activity, achieving healthy weight, and managing underlying conditions like diabetes and hypertension. Psychological interventions, including psychosexual counselling, benefit many men, particularly when psychological factors contribute significantly.

Patients should report any suspected side effects from medications to the MHRA through the Yellow Card scheme.

When to Seek Professional Help for ED

Seeking timely medical advice for erectile dysfunction is crucial, both for effective treatment and because ED may indicate serious underlying health conditions. Many men delay consultation due to embarrassment, but ED is a common medical condition that GPs manage routinely and confidentially.

You should contact your GP if:

• Erectile difficulties persist for three months or longer

• ED develops suddenly, which may indicate a psychological trigger or acute medical issue

• You experience ED alongside chest pain, breathlessness, or other cardiovascular symptoms

• You have reduced libido (sexual desire), which may suggest hormonal issues

• There are relationship difficulties related to sexual function

• You have risk factors for cardiovascular disease (smoking, diabetes, hypertension, high cholesterol, family history)

• You notice penile pain, curvature or trauma during erection

Seek urgent medical attention (call 999 or attend A&E) if you experience:

• Chest pain or pressure during sexual activity

• A persistent erection lasting more than four hours (priapism) – a medical emergency requiring immediate treatment to prevent permanent damage

What to expect at your GP appointment: Your doctor will take a detailed medical and sexual history, including questions about the nature and duration of symptoms, relationship factors, and psychological wellbeing. Physical examination typically includes blood pressure measurement, cardiovascular assessment, and genital examination. Blood tests may be arranged to check:

• HbA1c (diabetes screening)

• Lipid profile (cholesterol)

• Testosterone levels (measured in morning and repeated if low)

• Additional hormones if indicated (LH, FSH, prolactin)

• Thyroid function

• Renal function

Your GP will assess cardiovascular risk, as ED can be an early indicator of cardiovascular disease. This assessment may lead to referral to cardiology if indicated. Specialist referral may be appropriate in various circumstances: urology for complex cases, young men with ED, or when first-line treatments fail; endocrinology for hormonal abnormalities; or psychosexual services/NHS Talking Therapies for psychological factors. Remember that effective, evidence-based treatments are available, and proper medical assessment ensures both symptom management and identification of potentially serious underlying conditions.

Frequently Asked Questions