DOES SELENIUM PLAY A ROLE IN AIDS?
By RFD Columnist, David Crowe
According to Canadian Geography Professor Harold D. Foster, lack of the trace element selenium plays a role in causing AIDS. Well, lest you think that he is a true AIDS dissident, questioning any role for HIV in AIDS, he also believes that HIV causes AIDS. And he slams Peter Duesberg and other dyed-in-the-wool dissidents in order to establish his mainstream credentials. [Foster, 2002]
Foster starts his book, What Really Causes AIDS, by quoting from the Durban Declaration[Durban, 2000] that 250 million people will probably die from AIDS by 2015. This declaration is the Nicene Creed of HIV/AIDS dogma, an assertion of the true faith, written in the reaction to the embarrassment of having an international AIDS conference in South Africa when President Mbeki was questioning the connection between HIV and AIDS. According to the organizer of the declaration, Simon Wain-Hobson of Insitut Pasteur, it was not important to have any specific knowledge of the debate over the cause of AIDS, but it was important to have impressive credentials. Undergraduates were shunned, but PhDs in any subject were welcome to sign.
After criticizing the declaration for being an attempt to impose a dogma. Foster thereby carves out a position as a critic on the edge of mainstream views, but not outside them.
Foster claims that Hepatitis B and C, Coxsackie B and HIV-1 and HIV-2 viruses rely on a selenium-containing enzyme (selenoenzyme glutathione peroxidase) to function. One would think that a shortage of selenium would therefore hurt these viruses, but Foster believes that they can out-compete the rest of the body for this element, exacerbating the damage that low selenium levels do. This is the core of his theory; that HIV and a shortage of selenium are co-factors that jointly cause AIDS.
Foster provides evidence that low selenium levels predict the occurrence of AIDS in Africa better than sexual practices (although, for a geographer, it is surprising that no map showing this association is included). In criticizing the theory that sexual transmission explains HIV infections and AIDS in Africa, he is echoing the criticisms of Gisselquist and others who have noted many anomalies in the association between heterosexual intercourse and AIDS in Africa, such as a lack of a strong association between the number of sexual partners and the disease, and the greater likelihood that a woman in a sexual partnership in Africa will be HIV+ than the man, even though men are more promiscuous. [Gisselquist, 2002]
Foster also notes research that has shown an association with low selenium levels and disease and death in HIV-positive drug addicts and HIV-positive infants (who often have mothers who are drug addicts as well as HIV-positive). There is also an environmental component to his theory. He believes that acid rain has hindered the ability of selenium to enter the food chain, creating new geographical pockets of low selenium.
The process described by Foster is a selenium-CD4 T cell tailspin, whereby a lack of selenium depresses the immune system (of which CD4 cells are a common surrogate marker) allowing viruses like HIV to prosper, which then consume the diminished resources of selenium, further depressing the immune system.
Foster casually dismisses the alternative multifactorial theory of Duesberg, who believes that HIV is a passenger virus, carried by risky activities, but not the cause of the accompanying diseases. Foster notes that Gaetan Dugas, a highly promiscuous, well-traveled, gay man, could be linked to 9 of the first 19 AIDS cases in Los Angeles, 22 cases in New York and nine patients in either other North American Cities. He views this as compelling evidence of a common denominator, but it could be a common lifestyle (e.g. excessive use of inhalant nitrites and other drugs) rather than a sexually transmitted pathogen. Fosters casual dismissal of the work of Duesberg and others is a bit surprising, especially considering that his theory would probably be quite compatible with these points of view.
Ironically, considering this criticism, Foster often lapses into his own multi-factorial theory, although his is based on a lack of micronutrients, rather than an excess of immune suppressants. Foster believes that HIV also out-competes the body for cysteine, glutamine and tryptophan, and through out most of the book he incorporates these other factors in his theory and in his nutritional recommendations.
This high degree of skepticism about alternative views (except his own) and an uncritical acceptance of most mainstream views (except those that conflict with his selenium theory) is found throughout his book. He quotes the rather strange results of Nduati and other researchers who found a much higher death rate among breastfeeding HIV+ mothers than among formula feeding HIV+ mothers, even though these researchers could not find the higher death rate among the breastfed children of these women that they clearly expected to find. There are two choices with research like this accept the research and attempt to explain the findings, or question the underlying research. In this case, if Foster had been more skeptical he would have found that only a minority of women invited into the study agreed to participate; that women were only included if they had access to municipally treated water (unusual in Africa); and that a significant numbers of mothers in the breastfeeding arm used formula and mothers in the formula arm also breastfed, but were included in the analysis based on the feeding method to which they were originally assigned. [Eastman, 2002] Improper randomization is at least as likely an explanation for the results. Researchers, clearly biased in favour of formula feeding, might have assigned healthier women to the formula feeding arm in an unconscious effort to help them. This would have resulted in a higher death rate in the breastfeeding women being artificially introduced.
Foster also is not disturbed that virologists still cannot explain how HIV causes AIDS while still maintaining that it is a fact that HIV does cause AIDS. Foster grasps this conundrum as ammunition for his belief that HIV+co-factors causes AIDS without wondering, as Duesberg and many others have, whether HIV could be removed from the equation entirely.
AIDS has had several definitions in the United States, although Foster seems unconcerned that now about 25 different diseases have been thrown into the bag Americans know as AIDS because selenium deficiency can be a cause of all of them (including the low CD4 cell count non disease that has counted as AIDS in America since 1993). Strangely, given his focus on Africa, he does not even address the radically different Bangui definition [WHO, 1986] which does not even involve an HIV test, and is satisfied by the presence of extremely non-specific symptoms (two of Weight Loss/Chronic Diarrhea/Prolonged Fever along with one of Persistent Cough/Generalized Itchy Dermatitis etc.).
Foster also is apparently not concerned that detection of HIV is largely based on antibody tests that have never been validated against the gold standard of virus isolation, and that might be particularly subject to false positive cross-reactions in poor countries where people are exposed to many pathogens and parasites. An association between positive HIV tests and illness and death does not prove that the tests are accurate; it is also consistent with antibodies being produced as a result of variety of illnesses (e.g. an auto-immune reaction to fragments of dead cells), and therefore might be a symptom of disease, not a marker for its cause.
With all these caveats, Foster does make a good case for selenium being important for health. He is especially enthusiastic about Brazil Nuts, which have very high selenium levels, but also recommends a variety of other foods such as garlic, mushrooms, lobster, shrimp, oysters, barley and egg noodles.
Foster provides a table of foods ranked by the amount of glutamate, tryptophan, cysteine and selenium that they include. Apart from Brazil Nuts in the top spot, he also gives high marks to dried salted cod, sunflower seeds, certain types of yeast and tofu as being particularly good sources of these nutrients. This is a useful reference for people who are concerned about the micro-nutrient status of people who have perhaps been malnourished for some time.
After Fosters book was published, Foster informed me that a test of his dietary recommendations is having success in Botswana, with 99% of patients improving. Symptoms of the Bangui definition of AIDS (e.g. rash, diarrhea and fever) disappear; subjects regain their appetite and gain weight. [Foster, 2003] He also mentions that a drug and alcohol abuser who was fighting Hepatitis A, B, AIDS and retroviral drug side-effects has adopted his nutritional plan (and stopped using drugs and alcohol) has recovered his health and is back to work.
Unlike antiretroviral therapy, nutritional interventions are much cheaper and have little risk of adverse effects.
[Foster, 2002] Foster HD. What really causes AIDS. Trafford Publishing. 2002. mailto: firstname.lastname@example.org.
[Durban, 2000] The Durban Declaration. Nature. 2000 Jul 6; 406(6791): 15-6. For an alternative view see.
[Eastman, 2002] Eastman A et al. Breastfeeding vs formula-feeding among HIV-infected women in resource-poor areas. JAMA. 2002 Mar 6; 287(9): 1111.
[Foster, 2003] Foster HD. Personal correspondence. 2003 Oct 10.
[Gisselquist, 2002] Gisselquist D et al. HIV infections in sub-Saharan Africa not explained by sexual or vertical transmission. Int J STD AIDS. 2002 Oct; 13(10): 657-66.
[WHO, 1986] WHO/CDC case definition for AIDS. WER. 1986 Mar 7; 61(10): 69-76.