Sam Burcher reports on a nutritional hypothesis with possible implications for prevention and treatment of the global pandemic
During the last decade, research has indicated an important geographical link between regions of selenium deficient soils and peak incidences of HIV/AIDS infection [1]. AIDS disease appears to involve a slow and progressive decline in levels of the trace element selenium (Se) in the blood along with CD4 cells, which are both independent predictors of mortality [2].
AIDS infection in Africa has reached pandemic proportions with over a quarter of the population said to be suffering from the disease in some areas, although there is debate over how the WHO has extrapolated their statistics (see "African Aids epidemic?" SiS 22). Figures from Harvard in the United States put infection rates as follows: Zimbabwe 25.84%, Botswana 25.10%, Zambia 19.07%, South Africa 12.91%, Côte D'Ivoire 10.06%, Tanzania 9.42%, Ethiopia 9.31%, and Congo 4.31%.
But Senegal in West Africa has the lowest numbers of AIDS prevalence at 1.77% in the general population, and 0.5% in antenatal clinic attendees along with the highest levels of selenium-enriched soil [3]. Geologically, Senegal is situated in the desiccated or dried up Cretaceous and early Eocene Sea, and the land is formed from sedimentary rocks from dissolved minerals in the evaporating seawater. Consequently, calcium phosphates are one of the country's mined mineral products used for fertilizers, and are derived from the selenium rich phosphorite. Senegal can also claim the lowest level of cancers on the African continent [4].
Geographical disease pattern analogies made by Prof E.W. Taylor, University of Georgia, suggest that AIDS, Karposi Sarcoma and cancers are rife in regions of selenium depleted soils and that this has further implications in the seemingly unstoppable spread of AIDS incidence worldwide.
In China, selenium deficient regions are known as the Chinese "disease belt". Here, the daily average intake of selenium is less than 10 micrograms. This contrasts with parts of the US and Canada where daily selenium intake is 170 micrograms. Viral diseases such as Coxsackie's B3, hepatitis B and C, and HIV/AIDS are all on the increase. Coxsackie B3 is further complicated by a heart condition known as "keshans", which is endemic in "disease belt" areas. Since the introduction of selenium-enriched fertilizers onto soils and crops and into feedstocks and table salt, there has been a decline in keshans.
A three year study of an entire town in Jiangsu Province where 20 847 residents were given table salt fortified with selenium showed that hepatitis infection decreased to 4.52 per 1 000 compared to 10.48 per 1 000 in communities using regular table salt [5]. The same researchers concluded that a 200-microgram daily dose of selenium-yeast supplement significantly reduced primary liver cancer associated with hepatitis B and C. It appears that death rates from viruses such as hepatitis, Coxsackie B3 and associated heart diseases like keshans can be greatly reduced by increasing dietary selenium intake and would be similarly effective in slowing the progress of AIDS deaths.
Prof Harold Foster of the University of Victoria in Canada has named the link between the viral diseases of HIV/AIDS, Coxsackie's and hepatitis B and C, "The selenium CD4 T cell tailspin", as a way of describing the relationship between selenium and the human immune system. Adults and children with advanced AIDS syndrome display both highly depleted selenium plasma stores and reduced CD4 Cell counts. Foster argues that the fall of selenium levels trigger the reduction in CD4 cells, which in turn cause further decline in serum selenium [1].
Retroviruses like HIV depress selenium levels in their hosts by encoding the gene for the human selonenzyme glutathione peroxidase. This allows the virus to replicate indefinitely by continuously depriving the host of glutathione (an inhibitor of reverse transcriptase,) and the four basic components of glutathione peroxidase: selenium, cysteine, glutamine and tryptophan [6]. As levels of selenium decline so do CD4 cells which allow "opportunistic" pathogens to invade the immune system and further deplete levels of selenium and CD4 cells in a positive feedback loop whereby if one variable declines, it causes further depression in the other. This downward spiral compromises the ability of the immune system to defend the body from infection, which plays a significant role in AIDS mortality.
Foster is currently treating dozens of HIV/AIDS patients in Africa using a protocol of the four nutrients - selenium, cysteine, glutamine and tryptophan. He says that the treatment of HIV/AIDS with nutrition is similar to "curing" type-1 diabetes with insulin. When high doses of all four nutrients are administered to patients, deficiencies dissolve, as do the symptoms associated with AIDS. Patients have been able to return to work within one month of receiving nutritional treatments. Treating primary nutritional deficiencies with selenium and essential amino acids costs approximately $10-$15. See Box 1.
As HIV/AIDS sufferers are often extremely deficient in all four nutrients associated with glutathione peroxidase, the "selenium CD4 T cell tailspin" hypothesis which describes HIV/AIDS as a disease of nutrient deficiency caused by a virus may explain how HIV progresses to AIDS.
The American AIDS expert Dr Roberto Giraldo said at a recent seminar in South Africa that AIDS can presently be conquered and curtailed although not totally cured through the adequate ingestion of appropriate micro-nutrients in sufficiently large doses, such as vitamins, amino acids and minerals [7].
The cause of progression of HIV to AIDS is still unknown, but the role of nutrition and supplementation in the prevention and treatment of the disease cannot be ignored. Prof Luc Montagnier (the co-discoverer of HIV) states that AIDS is characterised by a persistent oxidative imbalance and a decrease of glutathione. Changes in biochemical markers cause systemic oxidative stress and damage and Montagnier believes that antioxidants are useful in inhibiting viral replication and associated apoptosis in HIV/AIDS patients.
Glutathione (GSH) is the ubiquitous tripeptide essential for the function of all cells. Studies show that low GSH levels increases HIV replication and impairs T cell function that can lead to a progression of HIV disease. And oral administration of the GSH-producing drug N-acetyl Cysteine (NAC) improves survival rates in HIV/AIDS patients. NAC helps the body to synthesise glutathione and is beneficial in protecting lung tissue through its antioxidant activity as well as supporting nerve cells, and is effective in treating liver failure where drug toxicity is indicated. NAC also counteracts apoptosis (cell death) and helps maintain and replenish the HIV damaged CD4 T lymphocytes, crucial for dampening the progression of HIV to AIDS [2].
NAC supplement is recommended to HIV/AIDS sufferers who are receiving anti-retroviral treatments as well as those who are not. There is growing evidence that HIV/AIDS patients want alternative and non-toxic immune-boosting treatments, but would prefer them to be prescribed by the doctors or health care professionals. Despite billions of pounds spent on AIDS research very little funding or research is allocated for the provision of these types of treatment on the NHS [8].
Raising glutathione levels encourages the immune system to go into anti-cancer and anti-viral mode by replacing decreased levels of plasma cysteine, a major source of sulphur. Patients with advanced HIV infection have tryptophan levels at less than 50% of those in age and gender matched controls and boosting levels of tryptophan can enable to body to synthesise serotonin and niacin which protect against dementia. Improving glutamine levels can alleviate depression and improve digestion by increasing intestinal cell proliferation, and intestinal fluid/electrolyte absorption, which can help combat diarrhoea [6].
Three major factors have contributed to selenium depletion in the soil. Acid rain is caused by large quantities of sulphur and nitrogen that convert into sulphuric and nitric acids in the atmosphere and changes the capacity of soil to bind elements at pH neutral or slightly alkaline. The altered pH balance increases bioavailability of certain elements and decreases that of others including selenium. Heavy metals in rainfall also contain mercury, which can combine with selenium to produce the insoluble mercury selenide. Soil acidification therefore lowers the abundance of selenium in the global food chain, which may have contributed to the rapid increase of cancers and HIV/AIDS [9].
Chlorofluorocarbons are unique to the latter half of the 20th Century and have contributed to the thinning of the ozone layer, which causes an excess of ultraviolet B radiation. Overexposure to ultraviolet light decreases helper T-lymphocytes and increases suppressor T-lymphocytes making the individual more susceptible to diseases [10].
Chemical pollutants also play a role in altering the immune function and lowering host resistance to pathogens. The World Health Organisation estimate that there are 500 000 pesticide related illnesses and 20 000 deaths per year. Scientific studies on PCB's show that glutathione peroxidase activity is depressed and induces apoptosis of pre B-lymphocytes in the plasma of animals [11].
Whey protein, a derivative of milk production routinely discarded by the diary industry contains all the essential and non-essential amino acids necessary to improve immunity by increasing glutathione levels in the blood [12]. Oral supplementation of whey proteins can also help to combat wasting associated with AIDS.
A wide variety of nutrients, vitamins, amino acids, herbs and minerals such as copper, zinc, and selenium are clearly beneficial in slowing death rates in the HIV infected individual [13]. And vitamins A, C and E can help to reduce the oxidative stress and viral load that characterises HIV/AIDS sufferers [14]. This is especially important in areas where combination therapies are unavailable
Worryingly in Europe, moves are afoot to prohibit the sale of fourteen forms of selenium including organic forms, selenium yeast and selenomethionine if the EU Directive on Food Supplements comes into force in August 2005 [15].
A geographical perspective into the possible causes for the late 20th century phenomenon of AIDS is welcome adjuvant in the absence of a conventional vaccine or safe affordable treatments for all.
Article first published 20/07/04
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