Diet and ED: the Mediterranean diet evidence, and the food myths

In short: what you eat is part of the erectile dysfunction (ED) picture, but not in the way most food headlines suggest. The National Institutes of Health (NIH) says a healthy diet can lower the risk of ED and improve ED symptoms, and it names the Mediterranean diet. The evidence behind that comes from a handful of small trials and some very large long-term studies of eating patterns. It does not come from any one “erection food”. This guide sets out what those studies found, which foods the NIH suggests limiting, and what is and is not known about beet juice, watermelon and coffee.

Does diet affect ED?

Yes, according to the NIH. Its National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says research shows “a healthy diet can lower the risk of developing erectile dysfunction (ED) and improve ED symptoms,” and that certain diets, such as the Mediterranean diet, help decrease the chance of getting ED (NIDDK, Eating, Diet, & Nutrition for ED). NIDDK explains the link through other conditions: foods and drinks that raise the risk of diabetes, heart disease and obesity can also raise the chance of having ED. That is why diet sits alongside the other lifestyle factors in ED, such as activity, alcohol and smoking.

What does the NIH say to eat for ED?

NIDDK lists these as healthy food choices for men with ED: vegetables such as cabbage, leafy greens and beets; fruits such as apples, berries, kiwifruit and oranges; legumes such as lentils, beans and peas; unsaturated fats from nuts, seeds and fatty fish; and whole-grain foods such as oats, brown rice and quinoa (NIDDK, Eating, Diet, & Nutrition). It points to the Dietary Guidelines for Americans for more on the Mediterranean pattern. It also says a health care professional may suggest working with a registered dietitian, who can build an eating plan around your own needs.

What did the Mediterranean diet studies find?

Two studies from the same research group in Naples, Italy, are the main evidence. Both are small, and both ran for two years.

• Obese men, diet plus exercise (2004). In a randomized, single-blind trial published in JAMA, 110 obese men aged 35 to 55 with ED, and without diabetes, high blood pressure or high cholesterol, were split into two groups. The 55 men in the intervention group got detailed advice on losing weight by eating fewer calories and moving more; the control group got general information on healthy food and exercise. After two years, the average erectile function score improved in the intervention group and stayed flat in the control group, and 17 men in the intervention group versus 3 in the control group reached a score in the normal range. The authors concluded that lifestyle changes were associated with improved sexual function in “about one third” of the men (Esposito et al., JAMA 2004).
• Men with metabolic syndrome, diet focus (2006). This study drew 65 men with ED and metabolic syndrome from the group’s earlier lifestyle trials: 35 had been assigned a Mediterranean-style diet and 30 a control diet. After two years, the Mediterranean group ate more fruit, vegetables, nuts, whole grains and olive oil, and 13 men in that group versus 2 in the control group reached a normal erectile score. Markers of blood vessel function and inflammation also improved in the diet group (Esposito et al., Int J Impot Res 2006).

These results are encouraging but narrow. Most men in both studies did not reach a normal score, the first trial changed exercise and weight as well as food, and the second was assembled from earlier trials rather than run as a fresh randomized trial. A 2010 review by the same group summed it up carefully: the Mediterranean diet “may be associated with an improvement” in ED (Esposito et al., J Sex Med 2010). A wider meta-analysis of six randomized trials found that lifestyle change and treatment of heart risk factors improved erectile function scores on average (Gupta et al., Arch Intern Med 2011).

What do the large long-term studies show?

The biggest data come from the Health Professionals Follow-up Study, which has tracked US male health professionals for decades. In 21,469 men who did not have ED, heart attack, diabetes or stroke at the start, those under 60 with the highest Mediterranean diet scores had a 22% lower risk of developing ED than those with the lowest scores, and the link was weaker in older age groups (Bauer et al., JAMA Netw Open 2020). A later analysis of the same cohort found that a healthy plant-based diet went with lower ED risk in men aged 60 to 70, while a plant-based diet heavy in less healthy foods went with higher risk in men under 60 (Yang et al., BJU Int 2022). In 25,096 men, higher intake of fruit and certain flavonoids (plant compounds found in foods such as berries and citrus) was linked with a lower rate of new ED; for the flavonoids, the link was seen only in men under 70 (Cassidy et al., Am J Clin Nutr 2016).

A meta-analysis published in late 2024 pooled 14 studies with 27,389 participants and found plant-based diets, low-fat diets, nuts, and diets rich in fruit and vegetables were all associated with lower ED risk, and that diet combined with exercise lowered the odds of ED (Yang et al., Asian J Androl 2025). Most of this evidence is observational. Men who eat well often also exercise more, smoke less and weigh less, and the studies can adjust for some of that but not all of it. These figures describe groups, not a prediction for one man.

Which foods does NIDDK suggest limiting?

NIDDK suggests avoiding or limiting the foods and drinks that raise the risk of diabetes, heart disease and obesity (NIDDK, Eating, Diet, & Nutrition):

The link to diabetes matters here, because diabetes is one of the conditions most often tied to ED, and our guide to cholesterol, statins and ED covers the blood fat side.

Do beet juice, watermelon or coffee help ED?

None of the three has been shown to treat ED when eaten or drunk as food. Each has a plausible story behind it, and that story is usually what gets shared.

• Beet juice. Beets are on NIDDK’s list of healthy vegetables, as one food among many, not as an ED remedy. A 2022 review notes that beetroot juice raises blood levels of nitrite, a marker of nitric oxide, the molecule that helps blood vessels relax (Kiani et al., J Prev Med Hyg 2022). We found no trial of beet juice in men with ED. The same review says nitric oxide supplements may have side effects, may worsen some health conditions or interfere with some medicines, and should only be taken under medical supervision.
• Watermelon. Watermelon is a natural source of citrulline, an amino acid the body uses in the nitric oxide pathway (Rimando and Perkins-Veazie, J Chromatogr A 2005). The ED evidence we found is for citrulline as a supplement, not watermelon, such as a small single-blind study of 24 men with mild ED, in which the authors noted it was less effective than prescription ED medicines (Cormio et al., Urology 2011). We found no trial of eating watermelon for ED.
• Coffee. A US survey of 3,724 men found that men in the middle ranges of caffeine intake were less likely to report ED than men who took in almost none, with no steady trend as intake rose, and the authors called for long-term studies (Lopez et al., PLoS ONE 2015). A 2024 genetic (Mendelian randomization) study found no link between coffee or caffeine intake and ED risk (Xiang et al., Front Endocrinol 2024). The fair reading is that coffee is not a treatment, and neither study found that it raised the odds of ED.

Supplements sold for ED are a separate question. Our comparison of natural remedies and medication covers the ingredient evidence, and our guide to FDA tainted-supplement warnings covers products found to contain hidden drugs.

Can changing my diet replace ED treatment?

The studies above do not show that. In the trials, diet and lifestyle change helped a share of men over two years, not all of them, and the men studied had specific profiles such as obesity or metabolic syndrome. NIDDK presents eating well as one part of managing or preventing ED. A healthier diet and an ED medicine prescribed by a clinician are not either-or choices, and which treatment fits is a decision for you and your prescriber, based on your health and other medicines.

The bottom line

The NIH says a healthy diet can lower the risk of ED and improve symptoms, and names the Mediterranean diet. Two small two-year Italian studies saw more men reach a normal erectile score with diet and lifestyle change, and large US studies link healthier eating patterns, fruit and plant foods to less ED. The evidence points to an overall eating pattern, not a single food: beet juice and watermelon have no ED trials as foods, and coffee studies disagree. Diet works alongside medical care, not in place of it.

Sources

Every clinical statement on this page traces to a primary or guideline source:

• NIH NIDDK, Eating, Diet, & Nutrition for Erectile Dysfunction (last reviewed October 2024): a healthy diet can lower ED risk and improve symptoms; the Mediterranean diet; foods to choose and foods to limit; working with a registered dietitian.
• Esposito K, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial (JAMA, 2004): 110 obese men; 17 of 55 in the intervention group versus 3 of 55 controls reached a normal erectile score after 2 years.
• Esposito K, et al. Mediterranean diet improves erectile function in subjects with the metabolic syndrome (Int J Impot Res, 2006): 65 men; 13 of 35 on the Mediterranean diet versus 2 of 30 on the control diet reached a normal erectile score after 2 years.
• Esposito K, et al. Dietary factors, Mediterranean diet and erectile dysfunction (J Sex Med, 2010): review concluding the Mediterranean diet may be associated with improvement of ED.
• Gupta BP, et al. The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction (Arch Intern Med, 2011): meta-analysis of 6 randomized trials with 740 participants.
• Bauer SR, et al. Association of Diet With Erectile Dysfunction Among Men in the Health Professionals Follow-up Study (JAMA Netw Open, 2020): 21,469 men; highest versus lowest Mediterranean diet score HR 0.78 in men under 60.
• Yang H, et al. Plant-based diet index and erectile dysfunction in the Health Professionals Follow-Up Study (BJU Int, 2022): healthy plant-based diet linked with lower ED risk at 60 to 70; less healthy plant-based diet linked with higher risk under 60.
• Cassidy A, et al. Dietary flavonoid intake and incidence of erectile dysfunction (Am J Clin Nutr, 2016): 25,096 men; higher fruit and flavonoid intake linked with lower ED incidence; flavonoid links seen only under 70.
• Yang B, et al. Association between improved erectile function and dietary patterns: a systematic review and meta-analysis (Asian J Androl, 2025): 14 studies, 27,389 participants.
• Lopez DS, et al. Role of Caffeine Intake on Erectile Dysfunction in US Men: Results from NHANES 2001-2004 (PLoS ONE, 2015): cross-sectional survey of 3,724 men.
• Xiang N, et al. Potential genetic association between coffee/caffeine consumption and erectile dysfunction (Front Endocrinol, 2024): Mendelian randomization study finding no association.
• Rimando AM, Perkins-Veazie PM. Determination of citrulline in watermelon rind (J Chromatogr A, 2005): watermelon as a natural source of citrulline.
• Cormio L, et al. Oral L-citrulline supplementation improves erection hardness in men with mild erectile dysfunction (Urology, 2011): single-blind study of 24 men; the authors note citrulline is less effective than PDE5 inhibitors.
• Kiani AK, et al. Dietary supplements for improving nitric-oxide synthesis (J Prev Med Hyg, 2022): studies report beetroot juice raises plasma nitrite; nitric oxide supplements should only be taken under medical supervision.