Selenium and HIV and opportunistic infections

Individuals infected by the human immunodeficiency virus (HIV) that causes acquired immunodeficiency syndrome (AIDS) commonly have low selenium status. Selenium supplementation can prevent or delay the decline of immune system function and can protect against opportunistic infections.

Selenium supplements – especially selenium supplements as a component of a multi-micronutrient cocktail – can help to delay the decline of the immune system and can reduce the risk of death in HIV-infected patients.  Most of the data that we have comes from randomized controlled studies carried out in African countries, but the results are relevant to the United States and Europe.  Moreover, the results from studies of HIV-infected patients speak to the issue of the anti-microbial protection and antioxidant protection that comes with adequate selenium status.

Selenium and HIV and CD4 counts
CD4 cells are white blood cells that are part of the immune system.  Specifically, the CD4 cells fight infections in the body.  The HIV virus kills CD4 cells.  When a person has fewer CD4 cells, he or she is at greater risk of contracting an infection.

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Selenium and reduced risk of cancer

The results of Dr. Larry Clark’s Nutritional Prevention of Cancer trial showed the efficacy of selenium supplementation in reducing the risk of colon cancer, lung cancer, and prostate cancer. Now, a meta-analysis of 69 studies shows that higher selenium exposure is associated with reductions in the risk of breast cancer, lung cancer, and prostate cancer.

Authors of a recent meta-analysis of 69 studies of selenium exposure and cancer risk have concluded that high selenium exposure can reduce cancer risk, especially high selenium exposure that is reflected in high plasma or serum selenium status and/or in high toenail concentrations [Cai 2016].  Admittedly, higher selenium intakes (as compared to lower selenium intakes) can affect different forms of cancer differently.  We still need more research to sort out which forms and dosages of dietary and supplemental selenium are most effective at reducing cancer risk.  In this article, I want to summarize the findings of Dr. Xianlei Cai and colleagues.

What is a meta-analysis of selenium exposure and cancer risk?
A meta-analysis is a research method of combining the data from several selected research studies to reach conclusions that have greater statistical power.  In the present case, Cai et al selected 69 studies that met their inclusion criteria.  Each one of the 69 selected studies had the following characteristics:

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Selenium and heart disease

A study of serum selenium levels and supplementation with a patented organic selenium yeast preparation shows an association between serum selenium concentrations and the rate of deaths from heart disease in healthy elderly study participants.

There have been two noteworthy discoveries from a recent randomized controlled trial conducted by Dr. Urban Alehagen of Linköping University (Sweden) and his colleagues.

Firstly, people with low concentrations of selenium in their blood were found to be at significantly higher risk of death from heart disease.

Secondly, a combination of a patented high selenium yeast supplement and a proven Coenzyme Q10 supplement taken daily for four years provided significant protection against heart disease in people with low serum selenium status.

The KiSel-10 study of cardiovascular mortality
The study enrolled 668 healthy elderly individuals aged 70-80 years.  The study was well-designed and well-executed.  One group of 219 randomly selected individuals received 200 micrograms of selenized yeast tablets and 200 milligrams of Coenzyme Q10 capsules daily for four years. A second randomly assigned group of 222 individuals received matching placebos.  The remaining group of 227 individuals received no treatment at all.

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Selenium and heart muscle tissue

Daily nutritional supplementation with a combination of organic high-selenium yeast and Coenzyme Q10 for four years slowed the decline of heart function that is frequently associated with ageing.

The heart muscle tissue is frequently the first tissue in humans to suffer damage caused by selenium deficiency.  When the cell membranes in the heart muscle tissue are damaged by the action of harmful free radicals (this is called oxidative damage), many of the healthy heart muscle cells are replaced by fibrous tissue.  The resulting condition is called cardiomyopathy.

Cardiomyopathy is a disease of the heart muscle in which the heart is enlarged, thick, and rigid [Mayo Clinic].  As the cardiomyopathy worsens, the weakened heart muscle is less and less able to pump adequate quantities of blood to carry oxygen and nutrients to the cells and tissues throughout the body.  Eventually, symptoms such as shortness of breath, early fatigue, and swelling in the legs and feet and abdomen appear, the symptoms of chronic heart failure.

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Statin medications and selenium

Statin medications. What do we know? Yes, the statins are good at inhibiting the body’s own production of cholesterol. But the statins have the unintended side-effect of also inhibiting the body’s production of Coenzyme Q10 and of inhibiting the body’s ability to form selenoproteins. The inhibition of Coenzyme Q10 and selenoprotein production may lead to premature ageing and to  degenerative diseases.

Statin medications: good news and bad news?  On the one hand, statin medications are effective at reducing cholesterol levels, and, are good, apparently, at reducing the number of deaths from heart attacks.   On the other hand, we have seen a very considerable rise in the number of cases of chronic heart failure … in the same period that statin medications have been prescribed.  Drs. Okuyama and Langsjoen and their colleagues have explained the pharmacological mechanisms by which this medical paradox may be occurring [Okuyama].

Statins inhibit the body’s production of Coenzyme Q10
Okay, I was aware of the evidence from well-designed studies linking the taking of statin medications to decreased plasma levels of Coenzyme Q10.   Coenzyme Q10 is an important factor in cellular energy production and is an important lipid-soluble antioxidant [Folkers, Littarru, McMurray].  And I knew that the energy-deprived heart is a failing heart [Folkers, Molyneux, Mortensen].  So, I knew that anyone taking a statin medication needs to talk to his or her cardiologist about taking a good Coenzyme Q10 supplement.

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Daily intakes of selenium

Dietary intakes of selenium vary considerably from person to person and region to region. Selenium supplements are necessary to raise selenium status sufficiently to prevent oxidative damage to the cells, to improve immune function, and to reduce the risk of cancer and heart disease.

How much selenium from food and supplements do we need on a daily basis?  Which bio-markers of optimal selenium status seem to be most useful to answer this question?  Dr. Rachel Hurst and Dr. Susan J. Fairweather-Tait, Norwich Medical School, United Kingdom, and their colleagues set out to find answers.    The design of their study is very interesting.

They enrolled 119 healthy British men and women aged 50 – 64 years in a randomized, double-blind, placebo-controlled study that lasted 12 weeks [Hurst]. They excluded the following persons from the study:

  • smokers
  • overweight people
  • people with already high plasma selenium status
  • people with long-term illnesses
  • people on various medications
  • people unwilling to discontinue taking vitamins and herbal remedies at least one month prior to the start of the study

The 119 study participants received either placebo or one of the following treatments:

  • selenium-enriched yeast tablets containing 50, 100, or 200 micrograms of a patented organic selenium (SelenoPrecise® preparation delivered by Pharma Nord, Denmark)
  • selenium-enriched onion meals that provided the equivalent of 50 micrograms of selenium per day
  • unenriched onion meals that provided the equivalent of less than 4 micrograms of selenium per day

Measurements of selenium
Selenium is a trace element.  We measure its intake in micrograms per day, not milligrams.  We measure selenium status in plasma and serum in terms of micrograms per liter (or equivalently, in nanograms per milliliter).  Selenium in toenails or hair, then, we measure in micrograms per gram.

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A basic guide to selenium

Selenium is a by-product of the mining and refining of copper. There are no sites in the world for the mining of selenium alone. Given its relative scarcity and its many uses — industrial and agricultural as well as nutritional — selenium for supplements will surely be more expensive in the future, and there may well be shortages of it in the future. Accordingly, it is important for us to use it wisely and to conserve it.

Selenium is an important micronutrient.  It is essential for life for both people and animals.  The body cannot synthesize selenium and is dependent upon the selenium that it can get from food.  In many regions of the world, there is too little selenium in the soil and in the food, and supplementation is necessary for optimal health.

Regions with selenium-poor soil
In many regions of the world, the content of selenium in the soil is quite low.  In large parts of Asia, China in particular, and in much of Europe and the Middle East, there are low levels of selenium in the soil.

Plants accumulate inorganic selenium from the soil and convert it to organic selenium. In that way, the selenium enters the food chain. For example, cows eat grass containing selenium, and the some of the selenium enters the meat and the milk of the cows.  People eat the meat and drink the milk.  Too little selenium in the soil means too little selenium in the food.

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What is a high selenium yeast supplement?

Baker’s yeast and brewer’s yeast and high selenium yeast … all strains of the same species of yeast … Saccharomyces cerevisiae … High selenium yeast preparations are the most effective form of selenium supplements. The yeast in the tablets is dead and inactive. There is no risk of a yeast infection from a high selenium yeast preparation.

The trace element selenium is an essential component of the selenium-dependent enzymes called selenoproteins.  We need these selenoproteins for the optimal biological functioning of our cells.  Specifically, we need adequate daily intakes of selenium for the protection of cellular DNA, for successful reproduction, for proper thyroid gland function, for protection against infections, for anti-oxidative protection against the damage caused by free radicals, and for the prevention of cancer and heart disease.

What form of selenium is best?
Many of us cannot get enough selenium in our diets, especially if we do not regularly eat Brazil nuts (very high in selenium) or if we eat relatively little meat and fish.  However, there are various supplemental forms of selenium available to us as consumers.

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Our bodies cannot make selenium for us

Cancer studies
The research base for supplementation with selenium shows the need for adequate daily selenium intakes and adequate selenium status. The formulation and the dosage of the selenium supplement are very important.

Daily selenium intakes?  We need to get this essential trace element – selenium — in our diets and in our supplements because our bodies cannot make it for us. The work of Dr. Gerhard N. Schrauzer, Dr. Raymond J. Shamberger, and Dr. Douglas V. Frost has shown that there is an inverse relationship between our selenium status and the risk of cancer mortality.  Animal studies show an inverse correlation between selenium status and incidence of cancer.  Observational studies show lower risk of various types of cancer with higher selenium status.

Intervention studies of selenium supplementation and cancer
Clinical studies in China
Large interventional studies in China, a region of the world with selenium-poor soils and foodstuffs, have shown that selenium supplements protect against hepatitis B virus and primary liver cancer [Yu] and that supplementation with a combination of selenium and other antioxidants reduces cancer incidence and mortality in a region characterized by high cancer mortality rates [Blot].

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How we know that selenium supplementation is important

Selen supplementation, virus
Adequate intakes of selenium are needed to ensure the optimal functioning of the selenoproteins in the body. Selenoproteins provide protection against the development of cancer and heart disease; they are important for immune system defense; they protect against damage caused by heavy metals and chemical toxins and radiation. And, there is evidence that some of the selenoproteins have anti-viral properties.

Selenium?  A trace element?  You might well ask: How do we know that adequate amounts of dietary and supplemental selenium are important to us?
The first answer is: because we can see that selenium deficiency makes people sick.
A further answer is that we now know that selenium is an essential component of antioxidant enzymes.
And, on the basis of the results of randomized controlled trials, we know that selenium supplementation reduces the risk of cancer, reduces the risk of heart disease, and improves immune function.
Selenium is also very useful for reducing the toxic effects of heavy metals in the body.

Reason number one: Selenium-deficiency diseases
Keshan disease
In the 1960’s and 1970’s, thousands of people living in a region of China with selenium-poor soil, and, consequently, with selenium-poor food, died from the effects of a form of heart disease.  The disease, which took its name from Keshan county in the afflicted region of China, is characterized by inflammation and enlargement of the heart muscle and excess fluid in the lungs. The primary cause of the disease was selenium deficiency.

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