Selenium Supplementation for Senior Citizens

Health benefits of daily supplementation of senior citizens with a combination of selenium and Coenzyme Q10:

  • improved heart function as shown on echocardiograms
  • reduced risk of death from heart disease
  • improved health-related quality of life
Professor Urban Alehagen
In the KiSel-10 Study, Prof. Urban Alehagen and the research team administered 200 mcg/day of selenium and 2 x 100 mg/day of Coenzyme Q10 for 48 months to elderly Swedish citizens whose serum selenium status at baseline was quite low (mean: 67.1 mcg/L). The duration of the study was 48 months. The benefits of the supplementation were improved heart function and reduced risk of death from heart disease.

The combined supplementation seems to work by reducing the extent of oxidative stress, systemic inflammation, and fibrosis in the study participants [Alehagen 2022a].

Now, data from the KiSel-10 Study show the following effects of the combined supplementation with respect to Fibroblast Growth Factor 23 concentrations in blood:

  • Supplementation decreased concentrations of FGF-23 hormones.
  • The study showed a relationship between the circulating level of the FGF-23 and atrial fibrillation.
  • The study showed an association between the concentration of FGF-23 and death from heart disease.
  • The study showed an effect of reduced FGF-23 levels on the risk of death from heart disease that is independent of the level of the cardiac wall tension bio-marker NT-proBNP.
  • There exists a close interrelationship between FGF-23 concentrations and kidney function.
Why are FGF-23 Concentrations Important?

Prof. Alehagen explains that FGF-23 is a hormone that is secreted into the blood circulation. One of its primary functions is the regulation of the vitamin D metabolism and of the phosphorous metabolism in the kidneys.

However, there seems to be an association between FGF-23 activity and cardiovascular mortality even in the absence of kidney disease. Experimental data show that FGF-23 may act as a mediator for cardiac hypertrophy, cardiac fibrosis, and cardiac dysfunction [Alehagen 2022b]. read more

Antioxidant Action of Selenium and Selenoproteins

Antioxidants. Several selenoproteins play important roles as antioxidant enzymes in the protection of the cells and the mitochondria against the oxidative damage caused by harmful free radicals. Prominent among the antioxidant seleno-enzymes are the glutathione peroxidases and the thioredoxin reductases [Alehagen 2022].

Professor Urban Alehagen
Professor Urban Alehagen, the lead researcher on the KiSel-10 Study, estimates that a daily selenium intake of 110-150 mcg per day is necessary to achieve optimal expression of selenoprotein P, one of the most important selenoproteins in the plasma and the main transporter of selenium in the blood [Alehagen 2022].
Note: Oxidative stress is the bio-medical term for an imbalance in the relationship of 1) harmful free radicals, mostly of the reactive oxygen species, and 2) protective antioxidants, which should neutralize the harmful free radicals.

In many regions of the world, notably in much of Europe and the Middle East, there is selenium-poor soil and selenium-poor foodstuffs. In Sweden, for example, the average daily intake of selenium among senior citizens
is approximately 35 mcg/day, well below the amounts (110–150 mcg/day) needed for an optimal expression of the selenoprotein antioxidants [Alehagen 2022].
read more

Selenium Deficiency and Heart Failure

Heart failure – the inability of the heart muscle to pump a sufficient quantity of blood out to the body – is a debilitating disease, resulting in shortness of breath, congestion in the lungs, and pooling of blood in the lower extremities. Heart failure is equivalent to diminished quality of life.

Depiction of a mitochondrion. The mitochondria in our cells convert energy sources such as fatty acids, glucose, and ketones into ATP energy molecules. Sufficient intakes of micronutrients such as selenium, Coenzyme Q10, and zinc are important for mitochondrial energy production and for antioxidant protection of cells, lipids, proteins, and DNA.

The prognosis for heart failure is poor, and the available medical therapies for patients with heart failure are inadequate. New treatment strategies are needed [Mortensen 2015].

Yin et al have analyzed the data from 39,757 adults in a cross-sectional study from the 2005–2018 US National Health and Nutrition Examination Survey. Their findings suggest that high levels of combined dietary antioxidant micronutrients are associated with decreased prevalence of various forms of cardiovascular disease and that selenium has the greatest contribution to this association [Yin 2022]. read more

Selenium and Coenzyme Q10 Combination

The Swedish cardiologist Dr. Urban Alehagen has written persuasively that there exists a special inter-relationship between selenium and Coenzyme Q10 in the prevention of cardiovascular diseases.

Professor Urban Alehagen
Professor Urban Alehagen lecturing about the therapeutic cardiovascular benefits of combined selenium and Coenzyme Q10 supplementation.

Briefly, Prof. Alehagen, together with the Norwegian professor Jan Aaseth, makes the point that low selenium intakes and status could restrict the cells’ ability to get optimal concentrations of Coenzyme Q10 and that the cells need adequate of Coenzyme Q10 to permit optimal function of selenium [Alehagen & Aaseth 2015a].

The clinical outcomes of the KiSel-10 intervention study in which community living Swedish citizens, average age 78 years, were administered selenium and Coenzyme Q10 daily for four years show that combined selenium and Coenzyme Q10 supplementation, compared to placebo treatment, can be beneficial in populations that have low selenium status: read more

Selenium Status and Inflammation and Heart Disease

Low plasma selenium status is significantly associated with heart disease risk and with elevated blood bio-markers of chronic inflammation.  A 2021 cross-sectional study of elderly individuals in central Italy has revealed that individuals with a plasma selenium status lower than 60 mcg/L are especially at risk of heart disease [Giacconi 2021].

Ancona, Italy
Researchers in Ancona, Italy, have done a cross-sectional study that shows that low plasma selenium status is associated with increased risk of heart disease and with elevated levels of blood bio-markers for chronic inflammation.

Moreover, in the peripheral blood mononuclear cells of elderly individuals diagnosed with heart disease, the researchers found that low plasma selenium status was significantly associated with enhanced gene expression of inflammatory cytokines and chemokines and with a downregulation of sirtuins SIRT-1, SIRT-5, SIRT-6, and SIRT-7 [Giacconi 2021].

Note: The peripheral blood mononuclear cells are lymphocytes (e.g., T cells, B cells, NK cells) and monocytes as distinguished from such blood cells as erythrocytes, granulocytes, and platelets. read more

Selenium Status and Mortality and Type 2 Diabetes

Higher serum selenium concentrations are associated with a statistically significant 31% lower all-cause mortality and a statistically significant 34% lower heart disease mortality in individuals with type-2 diabetes [Qiu 2021].

This is the conclusion of researchers who conducted a relatively large cohort study of patients with diabetes with a long follow-up period. They analyzed the data from 3199 American adults with type-2 diabetes; the average follow-up period was 12.6 years [Qiu 2021].

During that follow-up period, 1693 deaths were documented, including 425 heart disease deaths [Qiu 2021].

Highest Quartile of Serum Selenium Compared to Lowest Quartile

Individuals in the highest quartile of serum selenium concentration had significantly lower all-cause mortality rates and significantly lower heart disease mortality rates when compared with individuals in the lowest quartile of serum selenium concentration [Qiu 2021]. read more

Plasma Selenoprotein P Levels and the Risk of Cardiovascular Disease

Research conclusion: “The 20% with lowest SELENOP concentrations in a N orth European population without history of cardiovascular disease have markedly increased risk of cardiovascular morbidity and mortality” [Schomburg 2019].

Heart attack
Selenoprotein-P deficiency predicts cardiovascular disease and death. Low selenium intakes result in sub-optimal bio-synthesis of selenoprotein P in the liver. Now, research shows that low selenoprotein P concentrations are associated with increased risk of cardiovascular disease and mortality.

This is the conclusion from the Malmö Preventive Project, a population-based prospective cohort study in southern Sweden, that examined the relationship between plasma selenoprotein P status and 1) risk of all-cause mortality, 2) risk of cardiovascular mortality, and 3) risk of a first cardiovascular event in 4366 study participants.

Note that this was a study done with study participants who had no history of cardiovascular disease. It was truly a study of the relationship between selenium status and the risk of heart disease. read more

Selenium and Heart Failure Risk

Cardiologists at the University of Groningen in The Netherlands have published a comprehensive review of the current knowledge about selenium deficiency and the role of selenoproteins in heart failure patients [Al-Mubarak 2021].

Heart failure is a form of heart disease with high morbidity and mortality and with increasing prevalence. It is estimated that there are more than 26 million heart failure patients worldwide. Suboptimal selenium intakes and status adversely affect heart muscle function.

The key points in their review are as follows:

  • Selenium is an essential micronutrient. It is incorporated into 25 different selenoproteins that have many biological functions in the body.
  • Suboptimal selenium intakes and status lead to the impaired cellular synthesis of these selenoproteins and to the diminished function of selenoproteins, which may aggravate oxidative stress and inflammation, both of which are associated with greater severity of heart failure.
  • 70% of patients diagnosed with heart failure have suboptimal serum selenium levels (below 100 micrograms per liter).
  • The heart failure patients with suboptimal serum selenium concentrations have lower exercise capacity, lower quality of life, and a worse prognosis than heart failure patients with serum selenium concentrations above 100 mcg/L.
  • Clinical trials of the efficacy of selenium supplementation in patients with heart failure have shown improved clinical symptoms such as improvements in NYHA function class, in left ventricular ejection fraction, and in lipid profile.
Selenium Deficiency and Heart Failure
Observational Studies of Selenium Concentration and Heart Failure

Three meta-analyses have provided evidence of a relationship between selenium status and the risk of heart disease:

Studies of Selenium Supplementation – the KiSel-10 Study

The most interesting clinical study is the KiSel-10 study in which elderly community living citizens, average age 78 years, with low selenium status (mean baseline status: 67.1 mcg/L), were treated with a combination of 200 mcg of an organic high-selenium yeast preparation and 200 mg of Coenzyme Q10 daily for four years. read more

Selenium Deficiency A Big Risk Factor for Heart Disease

Ash tray with cigarette butts
In the Italian study (Giacconi et al. 2021), only smoking ranked above selenium deficiency as a risk factor for heart disease. Age, BMI, cholesterol and triglyceride levels, and gender all ranked lower than selenium deficiency as risk factors for heart disease.

Results from an Italian study have added to the evidence that adequate selenium status is necessary to prevent heart disease, especially in elderly individuals.

The Italian study data showed that study participants with plasma selenium concentrations below 60 micrograms per liter were 1.9 times more likely to suffer from cardiovascular disease compared to study participants with higher selenium status [Giacconi 2021].

Reduced plasma selenium status was associated with elevated levels of biomarkers of inflammation, increased expression of cytokines, and down-regulation of sirtuins in peripheral blood mononuclear cells [Giacconi 2021].

Selenium Status and Risk of Cardiovascular Disease

The KiSel-10 Study Results

In a clinical trial with combined selenium and Coenzyme Q supplementation of elderly citizens, average age: 78 years, with low selenium status (mean: 67.1 micrograms per liter), for 48 months, researchers found reduced cardiovascular mortality after 10 and 12 years of follow-up [Alehagen 2018, 2015). read more

Selenium and Antioxidants to Prevent Heart Disease

Heart trouble
Selenium deficiency (< 70 mcg/L) and low selenium status (70 – 100 mcg/L) are associated with reduced exercise capacity and higher risk of death in heart failure patients [Bomer 2019].
Canadian researchers have concluded that the addition of selenium should be considered for antioxidant supplements if the antioxidant mixtures are to be associated with reductions in the risk of heart disease and all-cause mortality [Jenkins 2020].

How did they arrive at this conclusion? First, they did a preliminary analysis of the available research literature and found that antioxidant supplements seemed to reduce incidence of all-cause death when the supplements included selenium [Jenkins 2020].

Systematic Review of Supplements With and Without Selenium

Next, they did a systematic review and meta-analysis of randomized controlled trials to evaluate the effect of selenium supplementation alone and the effect of antioxidant mixtures with or without selenium on the risk of heart disease and all-cause mortality [Jenkins 2020]. read more