Chapter 32. Selenium Part Three - Mega-Dose Vitamin Therapy in the ICU

Chapter 32.  Selenium Part Three - Mega-Dose Vitamin Therapy in the ICU

Decades ago, when Linus Pauling and Abram Hoffer first proposed Mega-Dose Vitamin Therapy as a serious treatment, mainstream medicine and the news media promptly discredited this idea as quackery.  To this day, the media faithfully bombards us with the message that vitamins and minerals are useless, harmful or even killing us.(1-6)  When one considers the lowly vitamin pill as an economic rival to pharmaceutical drugs, and the dependence of the media on drug company advertising, the motivation to discredit mega-dose vitamins becomes all too obvious.  Seemingly oblivious to this negative message, physicians quietly go about their business using Mega-Dose Vitamin Therapy in the intensive care unit (ICU) with considerable success.  Recent reports of this have been appearing in medical journals, finally vindicating Linus Pauling and Abram Hoffer as yes, of course, they were right all along.(7-9)

Septic Shock - a Preterminal Event

Forty years ago, during my training days working in the intensive care unit, the onset of septic shock was a grave sign, and usually a preterminal event.  In spite of the best treatment with high powered antibiotics and high dose hydrocortisone, these severely ill patients invariably succumbed.  Survival was so rare, it was declared a miracle.  While treatments have improved since the old days, septic shock still carries a fifty percent mortality rate.

Intravenous (I.V.) Selenium For Septic Shock in the ICU

In 1999, Dr Angstwurm showed that many critically ill patients have low selenium levels.  Selenium is a component of glutathione peroxidase, the key selenoprotein anti-oxidant.  In 2007, Dr Angstwurm recruited 249 septic shock patients from eleven intensive care units in Germany, and gave them intravenous  (IV) selenium over a 14 day protocol.  Results showed mortality reduced to 39% for the selenium treated group, compared to fifty percent mortality otherwise. An impressive result, considering the high mortality rate and futility of most other treatments.(10-11)  In 2008, Dr Carlos studied septic shock patients and found that selenium levels could be used to predict clinical course. Those with the highest selenium levels had the best outcome, and the lowest selenium levels had the worst.(12)

A Basket of Mega-Dose Vitamins

If one antioxidant, selenium, was beneficial in the ICU setting, then perhaps a basket of antioxidants would be even more so.  In 2008, Dr Giladi of Vanderbilt tested this hypothesis with a shopping cart of antioxidants.  Intravenous Vitamin C, E and Selenium was given over a 7 day protocol to 2,200 ICU trauma patients, and compared to placebo.  Dr Giladi reported a 28% mortality reduction for the Mega-Dose Vitamin group.(13)  A second report on the same patient study group February 2010 showed that the Mega-Dose Vitamin group also benefited from a 53% reduction in abdominal wall infections, and 38% reduction in respiratory failure.(14)

Reducing Infection Rates, and Time on Ventilators

In 2006, Dr Berger reported that a trace mineral infusion with zinc, copper and selenium reduced by half the infection rates for burn patients in the ICU. These infections were nosocomial pneumonia and ventilator associated pneumonia. (15)  In 2009, Dr Alison Avenell from Edinburgh, Scotland reported a 10-15% reduction in infection with pneumonia and Clostridia Difficile Enterocolitis in ICU patients treated with a 5 day protocol of IV selenium. (16)  In November 2009, Dr El-Attar reported that trace mineral infusions with selenium, zinc and manganese given to patients with chronic lung disease resulted in reducing by half the time on mechanical ventilation.(17)

Animal Model of Inflammatory Hepatic Vasculitis

A 2000 report from China evaluated the effect of selenium and vitamin E on an animal model of experimental hepatic vasculitis (note: vasculitis is inflammation of the arteries).  They found the two agents, Selenium and Vitamin E dramatically reduced hepatic inflammation in the experimental animals down from 100% to 20%. (18)

 Why Do We Need Selenium? 

Left image: Exhaust from the tailpipe of a car courtesy of wikimedia commons.

To understand the importance of selenium, consider the toxic fumes produced by your automobile.  You might be surprised to know your body makes the same foul toxic exhaust called byproducts of oxidation, also known as free radicals.  Instead of an exhaust pipe to get rid of the oxidative by-products, our bodies have the selenoprotein anti-oxidant system.  The main selenoprotein is glutathione peroxidase which works together with other antioxidants, such as Vitamin C and E, to remove the oxidative by-products of cellular energy production.  Severe illness leads to depletion of selenoproteins and build up of oxidative by products which may overwhelm the body's defenses leading to catastrophic outcomes.  Replenishing selenium and other anti-oxidants in this setting makes sense, and is in fact extremely beneficial.

Mega-Dose Vitamins outside the ICU

Dr Lamm reported Mega-Dose vitamins useful in prevention of cancer recurrence.  Published in the 1994 Journal of Urology, Dr Lamm gave megadose vitamins A, B6, C, E and Zinc 65 to patients with biopsy proven bladder cancer. The patients were followed, and cancer recurrence was reduced in half for patients on the mega-dose vitamin therapy. (19)

For references: see web site www.bioidenticalhormones101.com

References for Chapter 32. Selenium Reduces Mortality in the ICU

(1) http://well.blogs.nytimes.com/2008/11/20/news-keeps-getting-worse-for-vitamins/
New York Times- November 20, 2008,  News Keeps Getting Worse for Vitamins By TARA PARKER-POPE

(2) http://cbs5.com/health/vitamins.study.damaging.2.679134.html CBS News- Mar 17, 2008 Doctor: Vitamins Don't Work, Could Be Harmful (CBS 5)

(3) http://www.necn.com/Boston/Health/2009/02/09/Study-Multivitamins-not-that/1234208748.html
Study: Multi-vitamins not that effective-

(4) http://articles.latimes.com/2008/dec/21/science/sci-vitamins21 LA Times - Vitamins aren't a cure-all, In fact, taking them does nothing to fight cancer, studies find. December 21, 2008 by Karen Kaplan -

(5) http://www.dailytelegraph.com.au/lifestyle/vitamins-could-be-killing-you/story-e6frf00i-1111113075043  Daily Telegraph - Vitamins could be killing you, By Tamara McLean From: The Daily Telegraph March 01, 2007  

(6) http://www.throng.co.nz/inside-new-zealand/inside-new-zealand-series-premiere-are-vitamins-killing-you  Inside New Zealand: Are Vitamins Killing You? 

(7) http://journal.ics.ac.uk/pdf/1001038.pdf  Review articles - Selenium in critically ill patients by S Strachan, D Wyncoll. The Intensive Care Society 2009 Volume 10, Number 1, January 2009 JICS 

(8) http://www.pulmonaryreviews.com/09may/C1.html How Can Pharmaconutrition Benefit Patients in the ICU? Pulmonary Reviews Vol. 14, No. 5 May 2009.

(9) http://www.ncbi.nlm.nih.gov/pubmed/15605227 Intensive Care Med. 2005 Mar;31(3):327-37. Epub 2004 Dec 17. Antioxidant nutrients: a systematic review of trace elements and vitamins in the critically ill patient. by Heyland DK, Dhaliwal R, Suchner U, Berger MM. Department of Medicine, Queen's University, Kingston, ONT, Canada.

(10) http://www.ncbi.nlm.nih.gov/pubmed/17095947  Selenium in Intensive Care (SIC): Results of a prospective randomized, placebo-controlled, multiple-center study in patients with severe systemic inflammatory response syndrome, sepsis, and septic shock by Matthias W. A. Angstwurm, MD et al. Crit Care Med 2007 Vol. 35, No. 1

(11) http://www.ncbi.nlm.nih.gov/pubmed/10507602 Crit Care Med. 1999 Sep;27(9):1807-13.
Selenium replacement in patients with severe systemic inflammatory response syndrome improves clinical outcome. Angstwurm MW, Schottdorf J, Schopohl J, Gaertner R.

(12) http://www.advancesinsepsis.com/pdfs/4407.pdf Selenium in Early Sepsis: A Marker for Change? by W Graham Carlos, MD, Curtis Ramsey MS, and Joseph Fraiz, MD St Vincent Hospital and Health Systems, Indianapolis, IN, USA Adv Sepsis 2008;6(3):99–102.

(13) http://www.ncbi.nlm.nih.gov/pubmed/18596309  Impact of High-Dose Antioxidants on Outcomes in Acutely Injured Patients JPEN J Parenter Enteral Nutr. 2008 Jul-Aug;32(4):384-8. Bryan R. Collier, Aviram Giladi et al

(14) http://www.ncbi.nlm.nih.gov/pubmed/20149369  Injury. 2010 Feb 9. High-dose antioxidant administration is associated with a reduction in post-injury complications in critically ill trauma patients. by Giladi AM et al

(15) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1794452 Crit Care. 2006; 10(6): R153. Reduction of nosocomial pneumonia after major burns by trace element supplementation: aggregation of two randomised trials . Mette M Berger,1 Philippe Eggimann,1 Daren K Heyland,2 René L Chioléro,1 Jean-Pierre Revelly,1 Andrew Day,2 Wassim Raffoul,3 and Alan Shenkin4

(16) http://www.bapen.org.uk/res_press_signet_results.html Issued: 15 October 2009 RESULTS OF ‘SIGNET’ TRIAL REVEALED EXCLUSIVELY AT BAPEN CONFERENCE 2009  by Dr Alison Avenell, Health Services Research Unit, University of Aberdeen AB25 2ZD 2Professor P J Andrews, Dept of Anaesthesia, Critical Care and Pain Medicine, University of Edinburgh, Western General Hospital, Edinburgh  Scotland.

(17) http://www.ncbi.nlm.nih.gov/pubmed/19761535 Respirology. 2009 Nov;14(8):1180-7. Epub 2009 Sep 16. Serum trace element levels in COPD patient: the relation between trace element supplementation and period of mechanical ventilation in a randomized controlled trial. El-Attar M, Said M, El-Assal G, Sabry NA, Omar E, Ashour L.Chest Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.

(18) http://www.ncbi.nlm.nih.gov/pubmed/11866925 Zhonghua Bing Li Xue Za Zhi. 2000 Aug;29(4):279-83. [Study on the modulation of the inflammatory response in mouse hepatic vasculitis with sodium selenite and vitamin E antioxidants] [Article in Chinese] by Xu M, Hou J, Wu Y, Ling Y. Institute of Basic Medical Sciences, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100005, China.

(19) http://www.ncbi.nlm.nih.gov/pubmed/8254816 J Urol. 1994 Jan;151(1):21-6. Megadose vitamins in bladder cancer: a double-blind clinical trial. Lamm DL, Riggs DR, Shriver JS, vanGilder PF, Rach JF, DeHaven JI. Department of Urology, West Virginia University School of Medicine, Morgantown.

(20) http://www.ncbi.nlm.nih.gov/pubmed/20424130 Cancer Prev Res (Phila Pa). 2010 Apr 27. [Epub ahead of print] A Large Prospective Study of SEP15 Genetic Variation, Interaction with Plasma Selenium Levels, and Prostate Cancer Risk and Survival. Penney KL, Schumacher FR, Li H, Kraft P, Morris JS, Kurth T, Mucci LA, Hunter DJ, Kantoff PW, Stampfer MJ, Ma J.

(21) http://www.ncbi.nlm.nih.gov/pubmed/20413070 J Trace Elem Med Biol. 2010 Apr;24(2):119-23. Epub 2009 Oct 23. Supplementation of selenium reduces chemical hepatocarcinogenesis in male Sprague-Dawley rats. Alwahaibi N, Mohamed J, Alhamadani A. Department of Biomedical Sciences, Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia (UKM), Julan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia.

(22) http://acam.typepad.com/blog/2009/09/selling-the-vitamins-dont-work-myth-whats-the-real-story.html September 02, 2009 Selling the “Vitamins Don’t Work” Myth: What’s the Real Story? by John Pittman, MD

(23) http://www.pharmapal.com/pharmapal/pdf/selenase.pdf Selenase from BioSyn

(24) http://www.biomedcentral.com/content/pdf/cc5109.pdf Seleno-enzymes and seleno-compounds: the two faces of selenium by Xavier Forceville

(25) http://ccforum.com/content/10/6/180  BioMed Central. Selenium protects cells and inhibits many inflammatory cell mechanisms through antioxidant seleno-enzymes.

Author: Dr Dach

Jeffrey Dach MD