Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

In 2013—I can’t believe it’s already been so long, I posted a video based on this study, that found that three weeks of pistachios resulted in a significant improvement in erectile function in men. It’s always nice to see a whole food intervention have clinical effects, and I was curious to revisit the topic and see what’s been published since.

Even if you ignore all the lab animal studies on, you know, how much hazelnuts improve the function of rat testicles, you still never know what you’ll find searching the medical literature for nuts and sexual function––like this case of penile strangulation with a metal hex nut. I guess nuts can sometimes make things worse, if you can’t remove them. They tried the Dundee Technique, which involves creating 20 puncture holes to relieve the pressure, but that didn’t work; so, a diamond disk cutter was used to saw through it, and they slipped a few times: all’s well that ends well.

Well, that got me curious. Evidently, penile entrapment is so common, there’s an entire grading system that emergency room docs can use. If a drill is not available, these surgeons advise, a hammer and chisel may be used.

A drill? Oh, a dental drill. I like how they brag about the precisely cut edges. Looks pretty jagged to me.

To “preserve the penis from a fatal outcome” (that’s a strange way to put it), urologists should be aware of all the available armamentarium, and if you don’t know how to operate the saw, you can always call in the local blacksmith.

Yeah, but how are you going to remove a barbell or steel sledgehammer head? A heavy-duty air grinder provided by the fire department, requiring six hours of cutting, with the patient protected from the sparks with fire coats—whatever it takes. Hack saw. Cement eater. Or, the silk winding method pioneered by Dong et al.

Consumption of at least one serving of vegetables a day and more than two servings of nuts a week was associated with a more than 50 percent decrease in the probability of erectile dysfunction in a snapshot-in-time cross-sectional study. But such observational studies can’t prove cause and effect. It’s like finding that men who eat healthier are better swimmers. Maybe men who eat nuts, are just health nuts, and the improvement is due to some other factor, like exercise. What we need is an interventional trial and, here we go.

The effect of nut consumption on semen quality and functionality: randomized controlled trial. A Standard American Diet with or without a handful of walnuts, and a half handful of each almonds and hazelnuts. And the nut group experienced significant improvements in their total sperm count, vitality, motility, and shape, perhaps because those in the nut group showed a significant reduction in SDF, sperm DNA fragmentation. The nuts appeared to protect their sperm DNA. Too bad while they were at it, they didn’t measure the guys’ erectile and sexual dysfunction…oh, but they did!

The effect of nut consumption on erectile and sexual function from the same study. The researchers report that those in the nut group saw a significant increase in orgasmic function and sexual desire. But, uh, what about erectile function? Any time you see this kind of selective glass-half-full reporting, you suspect some kind of industry funding, and indeed, that was the case here. Yes, there was a marginal increase in orgasmic function and sexual desire of questionable clinical significance, but no improvement in erectile function, intercourse satisfaction, or overall satisfaction. And with so many comparisons, even the so-called significant findings may not even be statistically significant.

But why did the pistachios I talked about back in 2013 work, while these other nuts didn’t? Well, if you remember in the original study, it was done on men in their 40s and 50s who already had chronic erectile dysfunction, whereas the average age in the new study was 24 years old; so, they may have started out with near-maximum circulation, not leaving much room for the nuts.

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