pickles on cutting board

Peyronie’s Disease: Bent or Curved Penis Caused By Diet?

[toc]King Louis XV of France reigned during the 18th century. While there’s no historical documentation to suggest he had this condition, it was named after his personal surgeon; François Gigot de la Peyronie.

Wouldn’t you like your last name to go down in history for that?

Probably not!

What is Peyronie’s disease?

Peyronie’s disease (PD) is the abnormal curvature of a man’s penis. While 10 to 15 degrees is still considered within normal range, this disease is earmarked by higher curvature. When it causes a downward or upward curve of more than 30 degrees, or to either side of more than 45 degrees, sexual intercourse can be greatly impacted. The most severe PD cases involve curvature that’s as much as 110 degrees from normal.

Research has found that most men overestimate the severity of their case.

The average amount of curvature, as measured by medical professionals using photos, was found to be 34 degrees. That’s according to a study out of Cornell University, in which 68 men were seeking treatment from urologists. (1)

The true average though is unknown and likely lower, because men with milder cases are much less likely to seek medical treatment or advice, and hence, aren’t part of the diagnosis pool.

Rather than a curved arc, many cases of Peyronie’s are described as a bent penis. Like an elbow, the bend in the shaft is sharp and “L” like. Less commonly, the disease manifests itself in other anatomical abnormalities including divots, indentations, an hourglass or Coke bottle appearance. Some cases present themselves as a hybrid of these things.

Whether it’s the curved/bent shaft or a more unusual shape, they are all caused by plaque buildup.

cross section diagram of penis shaft

The plaque, which is sometimes called a scar tissue, builds up inside of the tunica albuginea. That’s a fibrous layer that surrounds the corpora cavernosa, which are the cavities that fill with blood during an erection.

diagram showing Peyronie's plaque in penis shaft causing curved appearance
diagram credit: Xiaflex

When a man has Peyronie’s disease, the plaque buildup creates a pulling or anchoring effect midway on the shaft. That’s what causes the abnormal curvature/bending of the penis, or other shape abnormalities, during an erection and less commonly, when flaccid.

In addition to an abnormal curve in any direction, symptoms of Peyronie’s disease can include pain with an erection (and sometimes without), erectile dysfunction (ED), as well as the stress and anxiety that accompany a different appearance.

Effects on fertility

couple making out in bedGenerally, Peyronie’s does not cause infertility issues since it’s unrelated to the testicles which produce the sperm.

Even in severe cases, the curved or bent shaft will not normally obstruct the flow of semen through the urethra. However, the abnormal shape of the penile shaft can pose challenges during sexual intercourse, which in turn, may make it more difficult to impregnate a woman.

Is there a cure for Peyronie’s disease?

Peyronie’s disease is treatable. From least to most evasive, treatment options include; pentoxifylline or potassium para-aminobenzoate (Potaba) pills, direct injections of verapamil or collagenase (Xiaflex) to help dissolve the plaque/scar, and in severe cases, surgical removal and tissue grafting.

No treatments are guaranteed cures, though one or more methods can often provide sufficient improvement for most men.

Spontaneous resolution is possible, particularly early on with mild cases, with a minority of patients. For that reason, some urologists advise waiting 1-2 years before using treatments like injections or surgery. There is evidence to suggest some supplements may help but they remain unproven.

Men who have had a curved penis for many years are unlikely to experience a spontaneous reversal without medical treatment.

Some online sources claim the spontaneous resolution rate is 50%, however this number appears to originate from a small 1970’s study.

In a larger 2006 study, when 246 PD patients were followed for 18 months, the following was seen:

  • 12% had a spontaneous improvement in curvature
  • 40% remained stable
  • 48% got worse

The bad news is that the disease probably won’t resolve on it’s own, nor is there a surefire cure. The good news is that there are numerous treatment options available that are relatively effective. (2)

PD vs. lymphocele

Peyronie’s is different than lymphocele and the two should not be confused.

A lymphocele is a collection of lymphatic fluid that can develop in parts of the body, most often following surgery but also after trauma. Since fluids drain with gravity, sometimes that can lead to buildup in and around the penis, especially following pelvic and abdominal surgeries. Lymphocele is temporary and resolves with proper drainage.

How many men have it?

Is it normal to have a curved penis?

Peyronie’s disease is less common in young males. As with erectile dysfunction, getting older is the number known risk factor for developing it. The older you get, the more at risk you are.

Anywhere from 1% to 23% of men between 40 and 70 years of age have Peyronie’s disease. That’s according to The National Institute of Diabetes and Digestive and Kidney Diseases, which is a division of the U.S. government’s NIH. (3)

Of course, this is a wide-ranging estimate, which just goes to show you how little is truly understood about it.

Endo Pharmaceuticals sells Xiaflex, which is a prescription drug that is injected by an urologist into the penis shaft, to help weaken and break down the plaque. This treatment, along with prescribed stretching and straightening exercises, can improve many cases of Peyronie’s but it may not work as a complete cure. Their marketing literature reports 3% to 9% of men worldwide have the disease.

Perhaps the best piece of research estimating prevalence of Peyronie’s disease was that which was published in 2016 in PLoS One (a respected peer-reviewed journal). Based on 7,711 U.S. respondents which covered all regions, educations, and income levels, it was found that:

  • 0.7% had definitive Peyronie’s disease
  • 11% had probable Peyronie’s disease

As with ED, given the embarrassment and awkwardness of the disease, it may be more common than those only 1% of population. Simply put, guys don’t want to talk about it and hence, it goes underdiagnosed. (4)

Even if you added in the 11% in the “probable” category to the 0.7% who were definitive, that still only equals about 12% of the population. Since 88% of men do not have a curved penis, it is not normal. At least in regards to curvature that’s more than 10 or 15 degrees.

Without medical intervention, Peyronie’s disease is typically a permanent condition. The longer you have it, the more likely it is to stay. It can heal itself, but only about 1 in 8 men (12%) experience spontaneous resolution.

What causes it?

antique paper on curved penises by François Gigot de la PeyronieIn 1743, Dr. Francois de La Peyronie wrote a paper describing the condition and what he believed the origin of it was:

“…I thought that this indurations could be venereal, or even, if they were not, could be well treated by mercury, a strong medicine in which I had more confidence than it deserved… His health which was somewhat impaired by the remedy was totally restored within 2 months; but the indurations of the penis remained as before, and even worse.”

He cites syphilis and generic venereal disease as suspected causes but from reading his work, it’s clear he doesn’t have a clue what’s causing it.

Today, our understanding isn’t much better!

The actual translations of what King Louis XV’s personal surgeon believed about the condition can be found in Peyronie’s Disease: A Guide to Clinical Management.

We may chuckle and gasp at his usage of mercury for Peyronie’s disease treatment – which of course is highly toxic and ridiculous in retrospect – yet today there are touted home remedies which aren’t poisonous, but they are the science of snake oil salesman nonetheless.

According to the NIH, the main theories as to what causes Peyronie’s disease are injury to the penis (one-time or repeated) and/or autoimmune disease(s), leading to abnormal tissue formation in the shaft.

An injury caused by trauma, where there is bleeding and swelling in the tunica albuginea, could indeed create buildup of scar tissue and the formation of plaque as a result. This plaque then hardens and calcifies, creating a deposit which causes a pulling effect.

The origin of trauma is certainly true in some cases but many men suffer from this disease without having any known injuries.

The autoimmune theory suggests that the body incorrectly identifies healthy cells in the penis as bacteria, viruses, or other foreign pathogens and attacks them, which creates the same outcome; plaque formation.

The location of the plaque determines the appearance:

  • Dorsal penile plaque – Located on the upper part of shaft, this causes the penis to curve up or to the right or left.
  • Ventral Peyronie’s plaque – Located on the lower part of the shaft, this causes the penis to point down. This is a less common form of the disease, as only 10-20% of patients have it.
  • Distal Peyronie’s plaque – Located near the tip, it causes the curvature to be closer to the tip rather than the base.

How foods may play a role

gourmet burgerWhenever there is a disease with an unknown/unproven etiology – like this one – any and all reasonable theories deserve consideration.

Including your diet.

The idea that there are foods to avoid for Peyronie’s disease should not be misconstrued as meaning those are a root cause. Certainly when it’s due to traumatic injury, it would be silly to suggest food caused it.

However, as is the case with heart disease, high blood pressure, stroke, osteoporosis, certain cancers, and many other diseases, what you eat and drink can be worsening factors and sometimes, even the primary cause.

Just as some people can get away with eating unhealthy food, while others develop dietary-related diseases from food offenses which are trivial in comparison, our genetics play a big role in determining how much – or not – what we eat affects our risk of developing various diseases and conditions.

Sure, it’s not fair, but neither is life.

There is scientific evidence to suggest dietary factors may play a role. Some foods may worsen it. While there aren’t known foods to cure Peyronie’s disease, there is reason to believe certain diets may improve and/or stabilize the condition.

Right off the bat – before even digging into the science – you are given a clue of this from the stats; it’s relatively rare in adolescents/teens, infrequent in young men, yet it gets progressively more common as men get older.

That describes an age-related disease, most of which are at least influenced by diet and lifestyle.

The next clue comes from the physical abnormality which causes the penis to curve… plaque.

What causes plaque to build up in arteries?

diagram of normal vs. diseased artery, showing plaque and blood clot

Plaque is a catch-all term to describe the combination of calcium, cholesterol, fat, fibrin, and cellular waste which accumulate over time on the arterial walls.

How to get rid of fibrous plaque is a lot harder after it forms, versus preventing it in the first place. That said, certain diets tend to correlate with slowing its buildup and in some cases, reversing it.

The best diet for Peyronie’s

The science suggests an oil-free, plant-based diet is the best way to combat plaque formation in the body.

This method of halting heart disease was first popularized by Dr. Dean Ornish over two decades ago. He was a clinical fellow at Harvard Medical School and today he teaches at UCSF. He’s also famous for Bill Clinton’s traumatic health transformation after his presidency. He’s the author of bestselling books, including Program for Reversing Heart Disease: The Only System Scientifically Proven to Reverse Heart Disease Without Drugs or Surgery.

Cholesterol, which is a major component of plaque, only comes from animal-based foods, such as meats, dairy, and eggs. If you are on a 100% plant-based diet, your intake of cholesterol will be zero.

Fats are good for you and needed in your diet. The biggest problem with them is they are so calorically dense, so people don’t realize how many calories they’re consuming when they eat fatty foods. Ornish and others don’t chastise all fats, but rather those in oil form.

Which makes complete sense when you think about.

oil being poured in waterAs with refined sugar, refined oils are not naturally occurring in nature. Sure, there are miniscule amounts in both veggies and meats, but what you pour out of the bottle of olive oil is a far cry from eating fresh and raw olives. Pure culinary oils are unnatural and as with refined sugar, our body isn’t very good at processing them.

“No oil. Not even olive oil!”

That’s a quote by Dr. Caldwell Esselstyn. Former Director of the Cleveland Clinic’s Cardiovascular Disease Prevention and Reversal Program, and President of the American Association of Endocrine Surgeons, among other accolades. Oh yeah, and he too is a New York Times bestselling author; Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure.

This anti-plaque diet is aimed at cardiovascular diseases (CVD). That covers coronary heart disease, peripheral arterial disease, deep vein thrombosis and pulmonary embolism, atherosclerosis, heart attacks, strokes, congestive heart failure, and others which fall under the CVD umbrella.

Given the fact that calcified plaque buildup is also the structural cause of a curved penis, we should seriously consider the idea that a plant-based and oil-free diet may work as a natural treatment for Peyronie’s disease.

And speaking of the calcification…

A recent paper out of Oregon Health & Science University, which reviewed 100 urology patients who were treated for the disease, had this to say:

“Densely calcified plaques occurred in 6% of a surgical series of Peyronie’s disease patients. The vibrating bone saw is a novel technique to incise calcified plaques before grafting or IPP placement.”

That’s right… they’re now using motorized BONE SAWS to cut these calcified deposits off the penis, in the most severe cases which don’t respond to non-invasive treatments. If that isn’t motivation enough for you to eat healthy and not smoke (which is another plaque risk factor), then probably nothing can convince you! (5)

In theory, the best foods for Peyronie’s disease sufferers will be those of a vegan diet, with limited amounts of added oils.

Examples include substituting cholesterol-rich chicken with a protein-rich meal of quinoa and lentils. Eating fresh and frozen vegetables without butter. Fats that are not refined, like pistachios. To be clear, Daiya cheese and Oreo cookies are vegan, but they’re junk food… not the whole food you should be eating!

With over 100 plant-based recipes, check out The How Not to Die Cookbook for ideas.

The science on supplements

athlete holding supplementsHow to straighten a bent penis naturally?

Human clinical trials have been conducted using various supplements for Peyronie’s disease. This includes vitamin E, Co10, acetyl-L-carnitine, propionyl-L-carnitine, omega 3, propolis from bees, blueberry extract, and others. None have enough data to determine whether or not they work for straightening the penis when plaque deposits are the cause.

Some are controversial, some can ruled out based on the preliminary findings, though a couple actually have compelling cases that they might help, particularly when part of a regimen that incorporates traditional medical treatments.

Vitamin E

Vitamin E is the most studied supplement. The clinical studies suggest it may work for patients with early-stage PD, though the benefit appears more to do with its antioxidant activity rather than vitamin E specifically.

A study done in Italy tested it with the drugs pentoxifylline, which is a vasodilator and anti-inflammatory, and topical diclofenac sodium, which is a NSAID sold under the brands Voltaren, Cambia, and Solaraze.

Using 120 men split into different groups, they added the use of one or more of the following herbal treatments; vitamin E, bilberry, silymarin (from milk thistle), and ginkgo biloba. All of these are known for their antioxidant activity.

“Outcomes after 6 months of treatment showed that combined antioxidant therapy is effective in treating PD. Statistical analysis showed significant differences between the treatment groups with regard to: improvement and disappearance of penile pain; percentage of reduction in the volume of penile plaque; reduction in penile curvature; recovery of erectile function in patients with erectile dysfunction; increase in the International Index of Erectile Function score; and reduction of psychosexual impact.”

Next came the evidence that it’s not vitamin E specifically, but rather the antioxidant (and anti-inflammatory) effects of E which might be the mechanism. Depending on the group, men got anywhere from 1 to 5 of those antioxidants, which was in addition to the traditional drugs.

“Furthermore, we observed that the clinical efficacy of combined therapy is greater when topical use of diclofenac gel and perilesional injection of PTX are added to oral treatment with more than one antioxidant.”

Published in 2017, that was the first human study that demonstrated how a greater benefit was seen when more antioxidants were used in the treatment. (6)

A similar study as done a few years prior, where 70 men were treated with the drug verapamil, which is a calcium channel blocker and antihypertensive drug. It was given as an injection and transdermally. In addition to medicine, they received antioxidants from blueberries and propolis.

  • Group A = vitamin E, blueberries, and propolis
  • Group B = blueberries and propolis

Group A experienced a -12.25° improvement in curvature, while group B had -6.73°. (7)

Walter Reed Medical Center and a university in Turkey have both conducted separate trials to test oral vitamin E therapy and weekly injections of interferon alpha 2B (Intron A). That’s a drug used for hepatitis, cancer, and genital warts, among other indications. Both concluded that the vitamin E did not work. (8) (9)

If you search the PubMed database on the topic of vitamin E for Peyronie’s, you will come across over 100 pieces of medical literature and a couple dozen human studies using it. It is the most researched natural remedy for PD, though its efficacy remains unproven. Especially as a stand-alone treatment, since almost all of the clinical work involves combing it with oral medicines and injections.

Acetyl-L-carnitine

Acetyl-L-carnitine was pitted against tamoxifen (Soltamox). That’s prescription estrogen modulator. It’s primarily used for breast cancer prevention in high-risk women who are prone to estrogen-sensitive cancers.

Off-label, doctors have used tamoxifen as an oral medication for PD, though it has not been clinically proven for that purpose. The theory of using it is based on low serum testosterone levels being detected in a study comparing 106 PD patients to 99 normal men. (10)

In the first study which compared acetyl-L-carnitine versus tamoxifen in 48 patients who were in the early stages of the disease, the results seemed encouraging:

“Acetyl-L-carnitine was significantly more effective than tamoxifen in reducing pain and in inhibiting disease progression. Acetyl-L-carnitine reduced penile curvature significantly, while tamoxifen did not; both drugs significantly reduced plaque size.”

That was an old study, from 2001 out of Italy. (11)

Only a couple papers have been published since on the usage of L carnitine. The most recent was in 2016 and they used it as part of a combo therapy.

“Early medical combination therapy in Peyronie’s disease may present better results in patients whose curvature angle is less than 30°.”

That was their conclusion, based on 109 patients, some of whom were treated with 20 mg of tamoxifen and 300 mg of acetyl-L-carnitine, taken as a twice daily dosage, along with what’s called a phosphodiesterase type 5 inhibitor. (12)

Who know what benefit, if any, the L carnitine was having in that combo.

CoQ10

natural rates of CoQ10 decline from agingCoQ10, which is most known for supporting heart health, has only been used in one trial for PD. It was well-designed; double-blinded, placebo-controlled, and randomized. Conducted at an urology practice in Tehran, this is how it worked:

  • 186 men with chronic or early PD participated.
  • 93 were given a daily 300 mg dosage of CoQ10.
  • 93 got placebo.
  • Both treatments were used for 24 weeks.
  • Results were based on Erectile function (EF), plaque volume, measured curvature, pain during erection, and treatment satisfaction.

The results…

“Mean plaque size and mean penile curvature degree were decreased in the CoQ10 group, whereas a slight increase was noted in the placebo group (both P=0.001)… Of the patients in CoQ10 group, 11 (13.6%) had disease progression vs. 46 (56.1%) in placebo group (P=0.01). In patients with early chronic PD, CoQ10 therapy leads plaque size and penile curvature reduction and improves erection function.”

Intriguing findings, especially considering the P values of 0.01 and less (lower = more statistically significant results). Though keep in mind this is only one study and that’s far from being proof. (13)

Omega 3

Also out of Tehran was a similar study involving omega 3.

A total of 224 patients were given a high dose of EPA and DHA omega 3 (1.84 g/day) or a placebo. (14)

“No significant improvements were observed with regard to the penile curvature, pain during erection, and erectile function.”

Other antioxidants

Gotu kola, garlic, castor oil, and Ayurvedic treatments that are sometimes purported to be natural remedies for Peyronie’s disease have never been studied.

Sponsored by Men’s Health Boston, a phase 1 clinical trial is underway pitting vitamin D and E together, with and without prescription testosterone pellets (Testopel).

According to that filing on ClinicalTrials.gov, the dosage of vitamin E ranges from 200 to 400 IU daily. For vitamin D2, it’s 2,000 IU daily. Both are in the form of softgel supplements. No study results have been published. (15)

While there are no current of planned trials involving next generation antioxidants, hopefully there will be. With up to 550x the antioxidant activity of vitamin E and 6,000x for vitamin C, astaxanthin seems like a worthy contender for a study.

Our favorites

Jarrow QH Absorb bottle photoTo be clear, the men at Superfoodly do not have PD, nor have they ever had it. So none of us can rate/review in that regard.

Though coincidentally, we are on plant-based diets and a number of these antioxidants we use daily. We take them as anti-aging dietary supplements, NOT for any disease/condition. You should consult a doctor before using.

For CoQ10, we use the 100 mg softgels, one with each meal, which equals 3x daily (300 mg total). We have been buying the same brand for several years now on Amazon; Jarrow Formulas Ubiquinol QH-Absorb, High Absorption/Enhanced Stability CoQ10.

For vitamin E, we only take it as part of a twice-daily multivitamin. Because it’s fat soluble, overdosing on E is easy to do and high amount are linked to adverse health effects. For that reason, we stay within the RDA. With breakfast and dinner, we take Mykind Organic men’s whole food multivitamin.

These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.