Do Selenium & Vitamin E Increase Prostate Cancer Risk?

Written by Dr. Steve Chaney on . Posted in Issues, Supplements and Health

Should Men Avoid Those Supplements?

 Author: Dr. Stephen Chaney

Vitamin EYou’ve probably seen the headlines saying “Supplementation with selenium and vitamin E increases the risk of prostate cancer.” The authors of the study even said “Men aged greater than 55 should avoid supplements with either vitamin E or Se (selenium) at doses that exceed recommended dietary intakes.”

In a recent “Health Tips From The Professor” I debunked the headlines saying “Omega-3 fatty acids increase prostate cancer risk“.

What about vitamin E and selenium? Is it true that they increase prostate cancer risk? If you are a man over 55, should you be concerned? Should you stop using supplements containing vitamin E and selenium?

Do Selenium & Vitamin E Increase Prostate Cancer Risk?

Previous Studies On Selenium, Vitamin E And Prostate Cancer Risk

The study that generated the initial excitement in the field was the Nutrition Prevention of Cancer (NPC) Trial that ended in 1998 (Clark et al, British Journal of Urology, 81: 730-734, 1998; Duffield-Lillico et al, British Journal of Urology, 91: 608-612, 2003).

That study showed that supplementing men who had low blood levels of selenium with 200 ug/day of selenium decreased their prostate cancer risk by 65%.

It was followed by a second, much larger trial called the Selenium and Vitamin E Cancer Prevention Trial (SELECT) (Lipmann et al, JAMA, 301: 39-51, 2009). It looked at supplementation with 200 ug/day of selenium and/or 400 IU/day of synthetic alpha-tocopherol.

The SELECT study found no protective effect of either selenium or vitamin E on prostate cancer risk, but did suggest that vitamin E might actually cause a slight increase in prostate cancer risk.

The Study That Generated The Headlines

The authors of the study that generated the recent headlines (Kristal et al, Journal of the National Cancer Institute, doi: 10.1093/jnci/djt456, 2014) were attempting to find a simple explanation for the unexpected results of the SELECT study.

They hypothesized that the baseline selenium status at the beginning of the study might have influenced the outcome of supplementation. Kristal et al reanalyzed the data from the SELECT trial, comparing the effect of selenium and vitamin E supplementation in men with low selenium status and men with high selenium status.

However, at face value their data were confusing rather simplifying. They found:

  • Supplementation with selenium had no effect on prostate cancer risk in men with low selenium status, but increased prostate cancer risk by 91% in men with high selenium status.
  • Conversely, supplementation with 400 IU of vitamin E had no effect on prostate cancer risk in men with high selenium status, but increased prostate cancer risk by 63% in men with low selenium status.

Based on this hodge-podge of data, they concluded that “Men aged greater than 55 should avoid supplements with either vitamin E or Se (selenium) at doses that exceed recommended dietary intakes.” That was the statement that generated the headlines. Was that recommendation justified?

What Do Other Experts Say?

There was an editorial evaluation of the paper by some of the top expects in the field in the same journal (Frankel et al, Journal of the National Cancer Institute, doi: 10.1093/jnci/dju005, 2014) that provided thoughtful explanations of the confusing data in the paper by Kristal et al. They examined three questions:

1)     Why did the SELECT study find no effect of selenium supplementation in men with low selenium status, while the earlier NPC trial found a 65% decrease in prostate cancer risk?

  • The authors of the editorial pointed out that the lowest baseline selenium status in the SELECT trial was much higher than the lowest baseline selenium status in the previous NPC trial. In fact the baseline selenium status in the SELECT trial was at a level in which no effect of selenium supplementation would have been expected based on the results from the NPC trial.

The authors speculated that the addition of selenized yeast to animal feed has improved selenium status in the US population to the point where selenium supplementation can no longer be expected to reduce prostate cancer risk.

2)     Why did selenium supplementation increase prostate cancer risk in men with high selenium status, but not in men with low selenium status?

  • The authors pointed out that for selenium there is a very narrow range between sufficient intake and toxicity. The daily value (DV) for selenium is 90 ug/day and the recommended upper limit (UL) for selenium intake is 400 ug/day.

The average selenium intake for adult men in this country is 151 ug/day. That’s just the average. It’s not hard to imagine that adding 200ug/day of selenium to men at the highest selenium intake could move them into the toxic range.

3)     Why did vitamin E supplementation increase prostate cancer risk in men with low selenium status, but not in men with high selenium status?

  • In part, the authors felt that the pure alpha-tocopherol used in the SELECT trial was not optimal. Pure alpha-tocopherol interferes with the absorption of the other naturally occurring forms of vitamin E, such as gamma-tocopherol – which is the form of vitamin E that decreases prostate cancer risk in animal studies.
  • The authors also noted that vitamin E and selenium work together to inactivate free radicals in cell membranes. Vitamin E reduces the free radicals to a chemically unstable intermediate that still has the potential to damage membranes. A selenium-containing enzyme is required to convert that unstable intermediate into a completely harmless compound.

So when vitamin E is present in much higher levels than selenium, as it was in the group with low baseline selenium status, unstable radicals can accumulate and membrane damage can occur. The authors felt that this was the most likely explanation of the increased prostate cancer risk when men with low selenium status were supplemented with high dose vitamin E.

The authors of the editorial had a much more nuanced interpretation of the data reported by Kristal et al. If you read their evaluation carefully you would likely conclude that you should avoid high dose selenium supplements. However, rather than simply avoiding vitamin E supplements, you should choose vitamin E supplements that contain all of the naturally occurring vitamin E forms and contain near DV amounts of selenium.

These recommendations would be a much better fit to the data, but don’t lend themselves to dramatic headlines – so the editorial has been largely ignored by the press.

The Bottom Line:

1)     Ignore the scary headlines about selenium and vitamin E causing prostate cancer. You can continue to use your supplements as long as you choose ones that are well balanced.

2)     Conversely, if you are at risk of prostate cancer, there is no good evidence that supplementation with either selenium or vitamin E will reduce your risk.

3)     The results of this study are fully consistent with my longstanding recommendation to follow a holistic approach to supplementation and to avoid high dose single nutrient supplements.

4)     There is no reason to supplement with 200 ug/day of selenium. If you are already getting good amounts of selenium from your diet, that dosage could be toxic and may actually increase your risk of cancer. Make sure that your supplements have no more than the DV (70 ug) of selenium.

5)     Avoid high purity alpha-tocopherol supplements. Look for vitamin E supplements containing the full spectrum of tocopherols and tocotrienols in addition to alpha-tocopherol. In addition, make sure that your vitamin E supplement also contains selenium at near DV levels.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Latest Article

How to Choose the Right Pillow

Posted April 17, 2018 by Dr. Steve Chaney

Wake Up Each Morning Pain Free

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney

 

how to choose the right pillow without headachesThe way you sleep is often a key to discovering the cause of headaches and more. If you wake up with neck pain, a headache, or you suffer from ringing in your ears, dizziness, or ear pain, there is a good possibility that it may be caused by the way you are sleeping. Your pillow may be the culprit.  But if you need to know how to choose the right pillow for you, it’s easy.   It just takes a little “investigation.”

 

How to Choose the Right Pillow if You Sleep On Your Side

Your head, neck, and spine need to always stay in a nice straight line, just as it is when you are standing up, but that takes a little thought and understanding of the way you sleep.  So, get comfy in your bed and then notice how your head is resting.

how to choose the right pillow to sleep painfreeIf you sleep on your side, your pillow needs to be just the right size, so your head doesn’t point down toward the mattress (your pillow is too soft) or up to the ceiling (your pillow is too thick). Either of these positions will make the muscles on the side of your neck stay in the contracted position for hours and pull your vertebrae in that direction, especially when you try to turn over to your other side.

Your SCM Muscle May Cause Serious Problems

You also need to notice if you turn your head a bit, especially if you are turning into your pillow or turning your head up toward away from your pillow. In either of these two cases you will be causing your sternocleidomastoid (SCM for short) to be held shortened for hours.

Your SCM originates on your collarbone and inserts into the bone behind your ear.  When it contracts you turn your head to the opposite side. However, if the muscle is tight (for example, when you’ve held your head turned toward one side for an extended period of time) and then you bring your head back so you are facing forward, the tight muscle will pull on the bone behind your ear and cause havoc.

The symptoms for a tight SCM are tinnitus (ringing in the ear), dizziness, loss of equilibrium, ear pain, headaches, pain in the eye and around the skull, pain at the top of the head, and even pain in the throat. Amazing! What’s even more amazing is that it’s rare that this muscle is considered when a medical professional is searching for the cause of your symptoms.

These are the things to know when considering how to choose the right pillow if you sleep on your side.

How To Choose The Right Pillow If You Sleep On Your Back

how to choose the right pillow for sleeping on your backIf you sleep on your back, your head should be on the mattress (not propped up with a pillow) and you should have a tiny support (like a folded washcloth) under your neck.  Or, you can have a wedge pillow that starts at your mid-back and gently raises your entire trunk and head up while still allowing your head and back to be in a straight line.

It’s always a challenge for people who toss and turn during the night, sometimes on their side and sometimes on their back.  The best thing I’ve found for this situation is to have the pillow below shoulder level so when you turn on your side your shoulder will automatically slide to the edge of the pillow while still supporting your head properly, and when you turn onto your back, the pillow will start at shoulder level so your head and neck are supported, but your head is being pushed in a way that causes your chin to move down to your chest.

hip pain causes and treatment pain freeIt’s tricky, but I can personally attest to the fact that it will work.  I can always tell when I’ve had my head tilted (I toss and turn during the night) because I will wake with a headache. When that happens I’m grateful that I know how to self-treat the muscles of my neck and shoulders so the headache is eliminated quickly.  If you already have Treat Yourself to Pain Free Living,  you can self-treat all your neck and shoulder muscles to release the tension.

How To Choose The Right Pillow If You Sleep On Your Stomach

If you sleep on your stomach, this is the one position that is so bad that it behooves you to force yourself to change your position. Your head is turned to the side and held still for hours, putting a severe strain on all your cervical and upper thoracic vertebrae. Not only will this cause headaches, tinnitus, and a list of other pains, but it can cause problems down your entire spine. It can also impinge on the nerves that pass through the vertebrae on their way to your organs.

If you do sleep that way, let me know and I’ll give you some suggestions that work to change your habit of sleeping. It takes time and energy, but the results are worth the effort.

In every case, the way you sleep may cause neck pain that won’t go away until the pillow situation is resolved.

Now you should know how to choose the right pillow for the way you sleep.

Wishing you well,

Julie Donnelly

About The Author

julie donnelly

Julie Donnelly is a Deep Muscle Massage Therapist with 20 years of experience specializing in the treatment of chronic joint pain and sports injuries. She has worked extensively with elite athletes and patients who have been unsuccessful at finding relief through the more conventional therapies.

She has been widely published, both on – and off – line, in magazines, newsletters, and newspapers around the country. She is also often chosen to speak at national conventions, medical schools, and health facilities nationwide.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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