Erectile dysfunction improvement: pistachio or placebo effect

Abstract

I read with interest the paper by Aldemir et al.1 They conducted a before and after study evaluating the pistachio diet on erectile function parameters and serum lipid profiles in patients with erectile dysfunction (ED). They concluded that pistachio diet improved erectile function parameters without any side effects in patients with ED. I think this study design is not appropriate for the evaluation of this relationship, because its main limitation is the lack of a control group, which makes it difficult to establish a causal relationship. The effect of pistachio on ED may be a placebo effect because de Araujo et al.2 showed that treatment of ED with oral placebo agents demonstrates clinical effects, improving erectile function and quality of erection. In addition, in recent years patients have more positive attitudes to complementary medicine.3 We see in our daily practice a large number of patients who think herbal medicine has more effect and lower adverse effect than conventional treatments. This positive attitude can increase the placebo effect of herbal medicine.