The Impact of Dietary Pattern on Erectile Function (ERECTION)

The Impact of a Plant-Based Diet Versus an Animal-Based Diet on Erectile Function in Healthy Men With Normal Erectile Function: The ERECTION Study

The goal of this study is to determine whether erectile function is impacted by dietary patterns in healthy men with normal erectile function.

Study Overview

• Status: Recruiting
• Conditions: Erectile Dysfunction
• Intervention / Treatment: Other: Plant based diet; Other: Animal based diet

Detailed Description

Visit 1:

After reviewing and signing consent, subjects will be screened for the study. Screening will consist of the following:

• Complete International Index of Erectile Function (IIEF) questionnaire.
• Record medical history, concomitant medications
• Measure height and weight, calculate BMI
• Vitals
• Draw blood for total testosterone, sex hormone binding globulin and Thyroid Stimulating Hormone
• Query subject regarding the presence of genital rash or lesions. Subjects will be asked, "do you have a rash or lesion on your penis or surrounding area?"

If the IIEF score is abnormal, subjects will be advised to contact their primary care provider.

Each subject will be contacted by phone with their blood results. If abnormal subject will be given the recommendation to contact his primary care provider.

If an abnormal finding is identified during screening, such as an abnormal STOP-bang score, subject will be given the recommendation to contact his primary care provider.

If the subject has no primary care provider, contact information for primary care will be given.

Subjects meeting inclusion and exclusion criteria will be randomized into the study, into either Sequence One or Sequence Two. Once enrolled, subjects will be asked to not modify their dietary habits throughout the duration of the study other than during the two evenings and two full days when food is provided (see below).

Sequence One:

Visit 2:

Subjects will return to the study center in the morning after having fasted (other than consuming water) since 11pm the night before. They will have been asked to not brush their teeth or use mouthwash and/or other breath fresheners that morning. Anthropomorphic and blood pressure and heart rate recordings will be made. Saliva will be stored for NO measurement. Blood will be drawn and stored. Urine will be collected and stored.

Subjects will be taught how to use the Rigiscan™ device. Subjects will receive one plant-based dinner (food will be provided by Montefiore-Einstein Food Services.) Subjects will then leave the study center and they will consume their usual diet until 5pm. For the rest of the evening until 11pm they will consume only the dinner provided. Water will be the only beverage allowed after 5pm. Dinner should be consumed at 8:30pm EST. Subjects will text pictures of everything they consume (eat or drink) after 5pm to Dr. Ostfeld or to a study representative and s/he will have text or verbal contact with the subject at least once that evening. That night, subjects will do a Rigiscan™ assessment overnight at their home. The time the subject goes to bed and the time the subject wakes up for the day should be recorded. The subject agrees to be in bed with Rigiscan™ on (other than for emergency or needed trips to the bathroom) for at least seven hours.

Visit 3 Subjects will return to the study center the morning after the Rigiscan™ assessment and bring the Rigiscan™ device with them. They will have been fasting other than drinking water since 11pm the night before. They will have been asked to not brush their teeth or use mouthwash and/or other breath fresheners that morning. Anthropomorphic and blood pressure and heart rate recordings will be taken. Saliva will be stored for NO measurement. Blood will be drawn and stored. Urine will be collected and stored.

Subjects will then receive one full day of plant-based meals (food will be provided by Montefiore-Einstein Food Services.) Subjects will be encouraged to eat breakfast at the study center after the initial anthropomorphic measures are made, saliva is obtained, and blood is drawn. Subjects will text pictures of all they consume during that day to Dr. Ostfeld and/or to a study representative and s/he will have text or verbal contact with the subject at least twice during that day. Dinner should be consumed at 8:30pm, EST. Subjects will fast other than water after 11pm. That night, subjects will do a Rigiscan™ assessment overnight at their home. Black coffee and/or tea is permitted only before noon. The time the subject goes to bed and the time the subject wakes up for the day should be recorded. The subject agrees to be in bed with Rigiscan™ on (other than for emergency or needed trips to the bathroom) for at least seven hours.

Visit 4 Subjects will return to the study center the morning after the Rigiscan™ assessment and bring the Rigiscan™ device with them. They will have been asked to not brush their teeth or use mouthwash and/or other breath fresheners that morning. Anthropomorphic and blood pressure and heart rate recordings will be taken. Saliva will be stored for NO measurement. Blood will be drawn and stored. Urine will be collected and stored.

There will then be a washout period for 8-12 days and subjects will be instructed to return to their usual dietary habits during this washout period. Number of days of the washout period will be recorded.

Visit 5 After the washout period, subjects will return to the study center in the morning after having fasted (other than consuming water) since 11pm the night before. They will have been asked to not brush their teeth or use mouthwash and/or other breath fresheners that morning. Anthropomorphic and blood pressure and heart rate recordings will be taken. Saliva will be stored for NO measurement. Blood will be drawn and stored. Urine will be collected and stored.

Subjects will receive one animal-based dinner (food will be provided by Montefiore-Einstein Food Services.) Subjects will then leave the study center and they will consume their usual diet until 5pm. For the rest of the evening until 11pm they will consume only the dinner provided. Water will be the only beverage consumed after 5pm. Dinner should be consumed at 8:30pm, EST. Subjects will text pictures of all they consume (eat or drink) after 5pm to Dr. Ostfeld or to a study representative and s/he will have text or verbal contact with the subject at least once that evening. Subjects will fast other than water after 11pm. That night, subjects will do a Rigiscan™ assessment overnight at their home. The time the subject goes to bed and the time the subject wakes up for the day should be recorded. The subject agrees to be in bed with Rigiscan™ on (other than for emergency or needed trips to the bathroom) for at least seven hours.

Visit 6 Subjects will return to the study center the morning after the Rigiscan™ assessment and bring the Rigiscan™ device with them. They will have been asked to not brush their teeth or use mouthwash and/or other breath fresheners that morning. Anthropomorphic and blood pressure and heart rate recordings will be taken. Saliva will be stored for NO measurement. Blood will be drawn and stored. Urine will be collected and stored.

Subjects will then receive one full day of animal-based meals (food will be provided by Montefiore-Einstein Food Services.) Subjects will be encouraged to eat breakfast at the study center after the initial anthropomorphic measures are made, saliva is obtained, and blood is drawn. Subjects will text pictures of all they consume during that day to Dr. Ostfeld and/or to a study representative and s/he will have text or verbal contact with the subject at least twice during that day. Dinner should be consumed at 8:30pm, EST. Subjects will fast other than water after 11pm. That night, subjects will do a Rigiscan™ assessment overnight at their home. Black coffee and/or tea is permitted only before noon. The time the subject goes to bed and the time the subject wakes up for the day should be recorded. The subject agrees to be in bed with Rigiscan™ on (other than for emergency or needed trips to the bathroom) for at least seven hours.

Visit 7 (End of Study) Subjects will return to the study center the morning after the Rigiscan™ assessment and bring the Rigiscan™ device with them. They will have been asked to not brush their teeth or use mouthwash and/or other breath fresheners that morning. Anthropomorphic and blood pressure and heart rate recordings will be taken. Saliva will be stored for NO measurement. Blood will be drawn and stored. Urine will be collected and stored.

Sequence Two:

Sequence Two is identical to Sequence One, except that the order of the plant-based and animal-based meals is reversed.

• Study Type: Interventional
• Enrollment (Estimated): 46
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Robert Ostfeld, MD; Phone Number: 718-920-5197; Email: ROSTFELD@montefiore.org

Study Locations

• United States
  • New York
    • The Bronx, New York, United States, 10467
      • Recruiting
      • Montefiore Medical Center, Department of Medicine, Division of Cardiology
      • Contact: Robert J Ostfeld, MD, MS; Phone Number: 718-920-8011; Email: rostfeld@montefiore.org

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 14 years to 25 years (Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Subject provides written informed consent and HIPAA authorization in English before any study procedures are conducted.
• Subject is taking no medical therapy other than: prn MDIs, medication(s) for anxiety, depression, and/or ADHD (these medications include, but are not limited to, SSRIs, SNRIs, Stimulants), no change in supplements if applicable.

The anxiety, depression, and/or ADHD will have been controlled (per report of subject) for the last 6 months.

• IIEF score greater or equal to 22
• Subject will have had penile-sexual intercourse (either vaginal or anal penetration) within 12 weeks of enrollment.
• Male aged 18-35 years old
• Lives within commuting distance of Montefiore Health System
• Subject's significant other (if applicable) agrees to support the subject during the study
• Subject agrees to photograph and share all items consumed/drunk during the dietary intervention
• Subject agrees to avoid all illicit drugs, NSAIDS, and alcohol for at least two days prior to Rigiscan™ recording and on the days and nights of Rigiscan™ recording
• Subject agrees to refrain from sexual activity for at least 24 hours prior to Rigiscan™ placement and to have no sexual activity on the days and nights of Rigiscan™ recording.
• Subject agrees to not view, read, or otherwise consume erotic or pornographic material for 24 hours prior to both the days and nights of Rigiscan™ recording and on the days and nights of Rigiscan™ recording.
• Subject agrees to not have an orgasm for 24 hours prior to both the days and nights of RigiscanTM recording and on the days and nights of Rigiscan™ recording.
• Subject agrees to come to Montefiore to undergo Rigiscan™ training
• Subject agrees to only consume/drink permitted food/beverages.
• Subject agrees to attend all in person visits at Montefiore, to begin fasting at 11pm the night before each visit, and to undergo all blood draws/salivary/other testing.
• Subject agrees to not use mouthwash or mouth rinses or intentionally spit for the entire duration of the study. Subjects will be asked to refrain from using mouthwash for at least 2 days prior to enrollment. Subject agrees to not brush his teeth in the morning of the day of each study visit. Tooth brushing is otherwise permissible.
• BMI <30, BMI >=18.5, weight >110 lbs.
• Subject agrees to comply with the study procedures and visits.
• Subject exercises for at least 15 minutes at least two times per week
• If exercise is done, subjects will exercise for the same amount of time and at a similar intensity each day of Rigiscan™ testing. Otherwise, no exercise will be performed on Rigiscan™ days.
• If enrolled, subjects agree to not modify their dietary habits throughout the duration of the study other than during the two evenings and two full days when food is provided.

Exclusion Criteria:

• Relevant dietary allergy
• Vegetarian or Vegan dietary pattern
• History of an eating disorder and/or food addiction
• Hypertension and or history of hypertension with or without medical treatment. Systolic blood pressure > 150mmHg and/or diastolic blood pressure >100mmHg on Visit one. Heart rate >99 on Visit one. Systolic blood pressure < 85mmHg and/or diastolic blood pressure < 50mmHg on Visit one. Heart rate < 35 on Visit one.
• BMI >=30, BMI <18.5, or weight <= 110lbs
• Known chronic medical disease other than non-inflammatory musculoskeletal disease, asthma, anxiety, depression, and/or ADHD.

Subjects who have had changes in the dosage or type of their medication(s) for anxiety, depression, and/or ADHD within 3 months of enrollment.

Subjects who have scheduled or planned medication and/or medication dose changes during the study period. These medication changes include the initiation of a new medication, discontinuation of a medication, modification of medication dose, and/or the route of administration of a medication.

Subjects who are taking benzodiazepines and/or beta blockers

• History of kidney disease or hyperkalemia
• Subject has received an investigational drug within 30 days prior to signing consent
• Erectile dysfunction
• Has any condition (e.g., psychiatric illness) or situation that, in the investigator's opinion, may confound the study results, or may interfere significantly with the patient's ability to adhere with study procedures
• Currently undergoing treatment for Peyronie's Disease
• Abnormal Testosterone or Thyroid Stimulating Hormone level
• Treated hypogonadism or hypothyroidism
• Planned travel during the study
• The subject is trans-gender
• History of substance abuse in the last 12 months
• Illicit drug use, smoking, or vaping within 4 weeks
• Upper respiratory illness within two weeks on screening
• If profession requires being on call, no overnight or on call duties during the study
• Subject reports any communicable skin or venereal disease
• Subject reports rash or lesion on the penis or surrounding area.
• STOP-Bang score > 2
• Having the diagnosis of Restless Leg Syndrome.
• Having insomnia as defined by: Subject with insomnia would have difficulty initiating or maintaining sleep (30 minutes or more at sleep initiation or 30 minutes or more to fall back asleep if wakes during the night). The above occurs at least 3 times per week for at least 1 month. Furthermore, there must be adequate opportunity for sleep and there must be associated morbidity (feels tired during the day). Definition based on: The International Classification of Sleep Disorders - Third Edition (ICSD-3), 2014.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Plant-based arm; The plant-based arm consists of 3 visits to the clinical research center, following a plant-based diet and using the Rigiscan™ device to measure the frequency, rigidity, and duration of nocturnal erections.	Other: Plant based diet; Food will be provided by Montefiore-Einstein Food Services
Active Comparator: Animal-based arm; The animal-based arm consists of 3 visits to the clinical research center, following an animal- based diet and using the Rigiscan™ device to measure the frequency, rigidity, and duration of nocturnal erections.	Other: Animal based diet; Food will be provided by Montefiore-Einstein Food Services

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percent of time ≥70% erect during overnight sleep after 4 meals.	Total time (in minutes) when penile rigidity is ≥ 70% at both the tip and the base of the penis as measured by Rigiscan™ during overnight sleep, divided by the total time (in minutes) of overnight sleep. Overnight sleep is defined as the time in minutes from the onset of the first nocturnal erection to the end of the last nocturnal erection (as measured by Rigiscan™).	During overnight sleep directly after consuming the 4 meals.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percent of time ≥70% erect during overnight sleep after 1 meal.	Total time (in minutes) when penile rigidity is ≥70% at both the tip and the base of the penis as measured by Rigiscan™ during overnight sleep, divided by the total time (in minutes) of overnight sleep. Overnight sleep is defined as the time in minutes from the onset of the first nocturnal erection to the end of the last nocturnal erection (as measured by Rigiscan™).	During overnight sleep directly after consuming the 1 meal.
Erection events per hour during overnight sleep after 4 meals.	Total number of erection events lasting ≥5 minutes and with ≥70% rigidity at both the tip and the base of the penis as measured by Rigiscan™ during overnight sleep. Overnight sleep is defined as the time in minutes from the onset of the first nocturnal erection to the end of the last nocturnal erection (as measured by Rigiscan™). This result will be reported as Events/hour.	During overnight sleep directly after consuming the 4 meals.
Tumescence events per hour during overnight sleep after 4 meals.	Total number of tumescence events lasting ≥5 minutes and when penile circumference increases by ≥2cm at both the tip and the base of the penis compared to their respective baselines as measured by Rigiscan™ during overnight sleep, divided by the total time (in minutes) of overnight sleep. Overnight sleep is defined as the time in minutes from the onset of the first nocturnal erection to the end of the last nocturnal erection (as measured by Rigiscan™). This result will be reported as Tumescence events/hour	During overnight sleep directly after consuming the 4 meals.

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percent of time ≥50% erect during overnight sleep after 4 meals.	Total time (in minutes) when penile rigidity is ≥50% at both the tip and the base of the penis as measured by Rigiscan™ during overnight sleep, divided by the total time (in minutes) of overnight sleep. Overnight sleep is defined as the time in minutes from the onset of the first nocturnal erection to the end of the last nocturnal erection (as measured by Rigiscan™).	During overnight sleep directly after consuming the 4 meals.
Percent of time ≥50% erect during overnight sleep after 1 meal.	Total time (in minutes) when penile rigidity is ≥50% at both the tip and the base of the penis as measured by Rigiscan™ during overnight sleep, divided by the total time (in minutes) of overnight sleep. Overnight sleep is defined as the time in minutes from the onset of the first nocturnal erection to the end of the last nocturnal erection (as measured by Rigiscan™).	During overnight sleep directly after consuming the 1 meal.
Erection events per hour during overnight sleep after 1 meal.	Total number of erection events lasting ≥5 minutes and with ≥70% rigidity at both the tip and the base of the penis as measured by Rigiscan™ during overnight sleep. Overnight sleep is defined as the time in minutes from the onset of the first nocturnal erection to the end of the last nocturnal erection (as measured by Rigiscan™). This result will be reported as Events/hour.	During overnight sleep directly after consuming the 1 meal.
Tumescence events per hour during overnight sleep after 1 meal.	Total number of tumescence events lasting ≥5 minutes and when penile circumference increases by ≥2cm at both the tip and the base of the penis compared to their respective baselines as measured by Rigiscan™ during overnight sleep, divided by the total time (in minutes) of overnight sleep. Overnight sleep is defined as the time in minutes from the onset of the first nocturnal erection to the end of the last nocturnal erection (as measured by Rigiscan™). This result will be reported as Tumescence events/hour.	During overnight sleep directly after consuming the 1 meal.
Percent of time ≥70% erect during overnight sleep after 4 meals versus after 1 meal by dietary pattern.	This outcome will evaluate whether a difference is present in the percent of time ≥70% erect during overnight sleep (as defined in outcomes above) directly after consuming the 4 meals versus directly after consuming the 1 meal by dietary pattern, for each dietary pattern. (e.g. is there a greater percentage of time ≥70% erect on the second night versus the first night when consuming the plant-based diet?).	During overnight sleep directly after consuming the 4 meals versus overnight sleep directly after consuming the 1 meal by dietary pattern, for each dietary pattern.
Percent of time ≥50% erect during overnight sleep after 4 meals versus after 1 meal by dietary pattern.	This outcome will evaluate whether a difference is present in the percent of time ≥50% erect during overnight sleep (as defined in outcomes above) directly after consuming the 4 meals versus directly after consuming the 1 meal by dietary pattern, for each dietary pattern. (e.g. is there a greater percentage of time ≥50% erect on the second night versus the first night when consuming the plant-based diet?).	During overnight sleep directly after consuming the 4 meals versus overnight sleep directly after consuming the 1 meal by dietary pattern, for each dietary pattern.
Tumescence events per hour during overnight sleep after 4 meals versus after 1 meal by dietary pattern.	This outcome will evaluate whether a difference is present in the total number of tumescence events per hour (as defined in outcomes above) directly after consuming the 4 meals versus directly after consuming the 1 meal by dietary pattern, for each dietary pattern. (e.g. is there a greater of tumescence events per hour on the second night versus the first night when consuming the plant-based diet?).	During overnight sleep directly after consuming the 4 meals versus overnight sleep directly after consuming the 1 meal by dietary pattern, for each dietary pattern.
Heart rate	Comparing heart rate by dietary pattern at both time points (after overnight sleep after consuming the 1 meal and after overnight sleep after consuming the 4 meals) and compared to its respective baseline in beats/minute. Definition: In regard to the following anthropometric, vital sign, and laboratory data (blood, urine, and saliva) pre-specified outcomes included in this pre-specified outcomes section, at "both time points" is defined as in the sentence above and "respective baseline" refers to either visit 2 or visit 5, as visit 2 is the baseline for one dietary arm (plant or animal) and visit 5 is the baseline for the other dietary arm (plant or animal).	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Blood Pressure	Comparing blood pressure by dietary pattern at both time points and compared to its respective baseline in mmHg	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Weight	Comparing weight by dietary pattern at both time points and compared to its respective baseline	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Fibrinogen	Comparing it at both time points by dietary pattern and compared to its respective baseline in mg/dL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
D-dimer	Comparing it at both time points by dietary pattern and compared to its respective baseline in ng/mL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Total cholesterol	Comparing it at both time points by dietary pattern and compared to its respective baseline in mg/dL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
HDL cholesterol	Comparing it at both time points by dietary pattern and compared to its respective baseline in mg/dL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
HDL efflux capacity	Comparing it at both time points by dietary pattern and compared to its respective baseline.	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
LDL cholesterol	Comparing it at both time points by dietary pattern and compared to its respective baseline in mg/dL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Triglyceride	Comparing it at both time points by dietary pattern and compared to its respective baseline in mg/dL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Oxidized LDL cholesterol	Comparing it at both time points by dietary pattern and compared to its respective baseline in U/L	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Free Fatty Acids	Comparing it at both time points by dietary pattern and compared to its respective baseline in micromoles	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Myeloperoxidase	Comparing it at both time points by dietary pattern and compared to its respective baseline in ug/L	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Factor VII	Comparing it at both time points by dietary pattern and compared to its respective baseline in percentage.	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
lysolecithin	Comparing it at both time points by dietary pattern and compared to its respective baseline in mg/mL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Apolipoprotein B	Comparing it at both time points by dietary pattern and compared to its respective baseline in mg/dL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Omega 3 index	Comparing it at both time points by dietary pattern and compared to its respective baseline in percentage of erythrocyte fatty acid	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Lipoprotein-associated phospholipase-A2 (Lp PLA2) activity	Comparing it at both time points by dietary pattern and compared to its respective baseline in nmol/min/mL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Lipoprotein (a)	Comparing it at both time points by dietary pattern and compared to its respective baseline in nmol/L	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Homocysteine	Comparing it at both time points by dietary pattern and compared to its respective baseline in umol/L	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
methylmalonic acid (MMA)	Comparing it at both time points by dietary pattern and compared to its respective baseline in umol/L	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Asymmetric Dimethylarginine (ADMA)	Comparing it at both time points by dietary pattern and compared to its respective baseline in umol/L	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
symmetric dimethylarginine (SDMA)	Comparing it at both time points by dietary pattern and compared to its respective baseline in mg/dL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Total testosterone	Comparing it at both time points by dietary pattern and compared to its respective baseline in mg/dL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Sex Hormone Binding Globulin	Comparing it at both time points by dietary pattern and compared to its respective baseline in nmol/L	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
cystatin C	Comparing it at both time points by dietary pattern and compared to its respective baseline in mg/dL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
remnant cholesterol particles	Comparing it at both time points by dietary pattern and compared to its respective baseline in mg/dL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
uric acid	Comparing it at both time points by dietary pattern and compared to its respective baseline in mg/dL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
interleukin 1	Comparing it at both time points by dietary pattern and compared to its respective baseline in pg/mL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
interleukin 6	Comparing it at both time points by dietary pattern and compared to its respective baseline in pg/mL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
hsCRP	Comparing it at both time points by dietary pattern and compared to its respective baseline in mg/L	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Blood Urea Nitrogen (BUN)	Comparing it at both time points by dietary pattern and compared to its respective baseline in mg/dL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Carbon Dioxide (CO2)	Comparing it at both time points by dietary pattern and compared to its respective baseline in mmol/L	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
creatinine	Comparing it at both time points by dietary pattern and compared to its respective baseline in mg/dL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
glucose	Comparing it at both time points by dietary pattern and compared to its respective baseline in mg/dL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
serum chloride	Comparing it at both time points by dietary pattern and compared to its respective baseline in meq/L	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
serum potassium	Comparing it at both time points by dietary pattern and compared to its respective baseline in meq/L	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
serum sodium	Comparing it at both time points by dietary pattern and compared to its respective baseline in meq/L	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
alanine aminotransferase (ALT)	Comparing it at both time points by dietary pattern and compared to its respective baseline in units/L	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
aspartate aminotransferase (AST)	Comparing it at both time points by dietary pattern and compared to its respective baseline in units/L	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
estimated glomerular filtration rate (eGFR)	Comparing it at both time points by dietary pattern and compared to its respective baseline in mL/min/1.73m2	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
vitamin c	Comparing it at both time points by dietary pattern and compared to its respective baseline in mg/dL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
reduced glutathione	Comparing it at both time points by dietary pattern and compared to its respective baseline in umol/L	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
superoxide dismutase	Comparing it at both time points by dietary pattern and compared to its respective baseline in ng/mL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
vitamin e	Comparing it at both time points by dietary pattern and compared to its respective baseline in mg/L	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
selenium	Comparing it at both time points by dietary pattern and compared to its respective baseline in ng/mL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
malondialdehyde	Comparing it at both time points by dietary pattern and compared to its respective baseline in umol/L	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
non coding RNA	Comparing it at both time points by dietary pattern and compared to its respective baseline in copies/mL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
micro RNA	Comparing it at both time points by dietary pattern and compared to its respective baseline in copies/mL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Lnc RNA	Comparing it at both time points by dietary pattern and compared to its respective baseline in copies/mL	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
trimethylamine-N-oxide (TMAO)	Comparing it at both time points by dietary pattern and compared to its respective baseline in umol/L	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
phenylacetylglutamine (PAG)	Comparing it at both time points by dietary pattern and compared to its respective baseline in uM (micrometers)	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Comparing urine albumin-to-creatinine ratio (UACR)	Comparing it at both time points by dietary pattern and compared to its respective baseline in mg/g	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Comparing salivary nitrite level as a correlate of plasma nitric oxide (NO) level	Comparing it at both time points by dietary pattern and compared to its respective baseline in micromoles/L	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)
Comparing salivary nitrate level in as a correlate of plasma nitric oxide (NO) level	Comparing it at both time points by dietary pattern and compared to its respective baseline in micromoles/L	Time zero (Visit 2, ~1-21 days after screen), at ~24 hours after time zero (Visit 3), at ~48 hours after time zero (Visit 4), after 8-12 day washout (Visit 5), at ~24 hours after 8-12 day washout (Visit 6), at ~48 hours after 8-12 day washout (Visit 7)

Collaborators and Investigators

• Sponsor: Montefiore Medical Center
• Collaborators: National Institutes of Health (NIH); Nitric Oxide Innovations LLC; The Purjes Foundation; The Greenbaum Foundation; Dr. Irwin Goldstein
• Investigators: Principal Investigator: Robert Ostfeld, MD, Montefiore Medical Center

Publications and helpful links

General Publications

• Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994 Jan;151(1):54-61. doi: 10.1016/s0022-5347(17)34871-1.
• Chung F, Abdullah HR, Liao P. STOP-Bang Questionnaire: A Practical Approach to Screen for Obstructive Sleep Apnea. Chest. 2016 Mar;149(3):631-8. doi: 10.1378/chest.15-0903. Epub 2016 Jan 12.
• Gupta BP, Murad MH, Clifton MM, Prokop L, Nehra A, Kopecky SL. The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis. Arch Intern Med. 2011 Nov 14;171(20):1797-803. doi: 10.1001/archinternmed.2011.440. Epub 2011 Sep 12.
• Thompson IM, Tangen CM, Goodman PJ, Probstfield JL, Moinpour CM, Coltman CA. Erectile dysfunction and subsequent cardiovascular disease. JAMA. 2005 Dec 21;294(23):2996-3002. doi: 10.1001/jama.294.23.2996.
• Vogel RA, Corretti MC, Plotnick GD. Effect of a single high-fat meal on endothelial function in healthy subjects. Am J Cardiol. 1997 Feb 1;79(3):350-4. doi: 10.1016/s0002-9149(96)00760-6.
• Nehra A. Erectile dysfunction and cardiovascular disease: efficacy and safety of phosphodiesterase type 5 inhibitors in men with both conditions. Mayo Clin Proc. 2009 Feb;84(2):139-48. doi: 10.4065/84.2.139.
• Ong PJ, Dean TS, Hayward CS, Della Monica PL, Sanders TA, Collins P. Effect of fat and carbohydrate consumption on endothelial function. Lancet. 1999 Dec 18-25;354(9196):2134. doi: 10.1016/s0140-6736(99)03374-7.
• Esposito K, Nappo F, Giugliano F, Giugliano G, Marfella R, Giugliano D. Effect of dietary antioxidants on postprandial endothelial dysfunction induced by a high-fat meal in healthy subjects. Am J Clin Nutr. 2003 Jan;77(1):139-43. doi: 10.1093/ajcn/77.1.139.
• Shimabukuro M, Chinen I, Higa N, Takasu N, Yamakawa K, Ueda S. Effects of dietary composition on postprandial endothelial function and adiponectin concentrations in healthy humans: a crossover controlled study. Am J Clin Nutr. 2007 Oct;86(4):923-8. doi: 10.1093/ajcn/86.4.923.
• Sakakibara S, Murakami R, Takahashi M, Fushimi T, Murohara T, Kishi M, Kajimoto Y, Kitakaze M, Kaga T. Vinegar intake enhances flow-mediated vasodilatation via upregulation of endothelial nitric oxide synthase activity. Biosci Biotechnol Biochem. 2010;74(5):1055-61. doi: 10.1271/bbb.90953. Epub 2010 May 7.
• Esposito K, Ciotola M, Giugliano F, De Sio M, Giugliano G, D'armiento M, Giugliano D. Mediterranean diet improves erectile function in subjects with the metabolic syndrome. Int J Impot Res. 2006 Jul-Aug;18(4):405-10. doi: 10.1038/sj.ijir.3901447. Epub 2006 Jan 5.
• Wing RR, Rosen RC, Fava JL, Bahnson J, Brancati F, Gendrano Iii IN, Kitabchi A, Schneider SH, Wadden TA. Effects of weight loss intervention on erectile function in older men with type 2 diabetes in the Look AHEAD trial. J Sex Med. 2010 Jan;7(1 Pt 1):156-65. doi: 10.1111/j.1743-6109.2009.01458.x. Epub 2009 Aug 17.
• Cassidy A, Franz M, Rimm EB. Dietary flavonoid intake and incidence of erectile dysfunction. Am J Clin Nutr. 2016 Feb;103(2):534-41. doi: 10.3945/ajcn.115.122010. Epub 2016 Jan 13.
• Yaman O, Tokath Z, Inal T, Anafarta K. Effect of sildenafil on nocturnal erections of potent men. Int J Impot Res. 2003 Apr;15(2):117-21. doi: 10.1038/sj.ijir.3900978.
• Corbin JD, Francis SH. Cyclic GMP phosphodiesterase-5: target of sildenafil. J Biol Chem. 1999 May 14;274(20):13729-32. doi: 10.1074/jbc.274.20.13729. No abstract available.
• Greenstein A, Chen J, Salonia A, Sofer M, Matzkin H, Montorsi F. Does sildenafil enhance quality of nocturnal erections in healthy young men? A NPT-RigiScan study. J Sex Med. 2004 Nov;1(3):314-7. doi: 10.1111/j.1743-6109.04045.x.
• Burris AS, Banks SM, Sherins RJ. Quantitative assessment of nocturnal penile tumescence and rigidity in normal men using a home monitor. J Androl. 1989 Nov-Dec;10(6):492-7. doi: 10.1002/j.1939-4640.1989.tb00148.x.

Study record dates

Study Major Dates

• Study Start (Actual): October 30, 2023
• Primary Completion (Estimated): December 1, 2026
• Study Completion (Estimated): December 1, 2026

Study Registration Dates

• First Submitted: March 27, 2020
• First Submitted That Met QC Criteria: April 15, 2020
• First Posted (Actual): April 16, 2020

Study Record Updates

• Last Update Posted (Actual): November 12, 2025
• Last Update Submitted That Met QC Criteria: November 10, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: Diet; Erectile function; Plant-based; Animal-based
• Additional Relevant MeSH Terms: Urogenital Diseases; Genital Diseases; Mental Disorders; Genital Diseases, Male; Male Urogenital Diseases; Sexual Dysfunction, Physiological; Sexual Dysfunctions, Psychological; Erectile Dysfunction; Therapeutics; Diet, Food, and Nutrition; Physiological Phenomena; Nutritional Physiological Phenomena; Diet Therapy; Nutrition Therapy; Diet; Diet, Plant-Based
• Other Study ID Numbers: 2019-10465

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No