Accurate Supplements - Selenium

Brazil Nuts – An excellent source of selenium, but ingestion of >5-10 nuts may easily lead to toxicity

Mineral Supplements:

Selenium

See also:

Antioxidants:

Individual NRF2 Activators:

Selenium

Brief Description of Selenium and Where It Is Found

Selenium is a trace mineral essential for human health, playing a critical role in various physiological processes. Selenium protects cells from damage caused by stress and inflammation, which is important for conditions like arthritis. In the context of osteoarthritis, for example, selenium is of interest due to its antioxidant and anti-inflammatory properties, which may help mitigate joint damage and pain. It is a key component of selenoproteins, which are enzymes involved in antioxidant defense, immune function, and thyroid hormone metabolism.

Selenium’s Relevance to Specific Pain Conditions

Fibromyalgia:

Evidence: Limited studies suggest low selenium levels may contribute to oxidative stress and fatigue, but research is inconclusive on pain relief. A 2015 review noted potential benefits of selenium (200 μg/day) for reducing fatigue but not pain.
Role: May support antioxidant defenses in deficient patients, potentially improving fatigue and systemic inflammation.

Myofascial Pain:

Evidence: No direct studies. Selenium’s anti-inflammatory effects may reduce muscle inflammation, but clinical data are lacking.
Role: Theoretical benefit in deficient patients, but not a primary therapy.

Neuropathy/Sciatica:

Evidence: Animal studies (e.g., 2018 rat study) suggest selenium reduces neuropathic pain via antioxidant effects on nerve tissue. Human data are sparse, but a 2020 pilot study in diabetic neuropathy (50 patients, 100 μg/day) showed modest pain reduction.

Role: May be beneficial in deficient patients with oxidative stress-related neuropathy, but more research is needed.

Treatment Perspective: Selenium’s role is promising in fibromyalgia and neuropathy for deficient patients, but evidence is weak. It’s unlikely to be a primary therapy for myofascial pain or sciatica without further studies.

Sources:

Dietary Sources: Selenium is naturally found in foods such as Brazil nuts (one of the richest sources), seafood (tuna, shrimp, sardines), meats (beef, chicken, pork), eggs, dairy products, whole grains, and certain vegetables (mushrooms, spinach). The selenium content in plant-based foods depends on the soil’s selenium levels, which vary geographically.

Supplements: Selenium is available as a dietary supplement in forms like sodium selenite, selenomethionine, or selenocysteine, commonly in multivitamin capsules or standalone supplements (50–200 μg per dose).

Fortified Foods: Some processed foods may be fortified with selenium, though this is less common.

The Role of Selenium in an Anti-Inflammatory Diet for Chronic Pain Management

An anti-inflammatory diet emphasizes foods that reduce systemic inflammation, which is critical for managing chronic pain and also preventing the transition from acute to chronic pain. Selenium’s antioxidant and anti-inflammatory properties enhance the diet’s ability to reduce systemic inflammation and oxidative stress, the two driving forces in chronic pain..

Integration into the Diet:

- Foods to Include: Selenium fits perfectly into an anti-inflammatory diet, which is great for managing joint pain. Eating foods like fish, eggs, or a few Brazil nuts can help reduce inflammation in your body, which might keep your pain from getting worse. Pair these with fruits, veggies, and healthy oils for the best effect. Incorporate selenium-rich foods like Brazil nuts (limit to 1–2 per day to avoid toxicity), fatty fish (salmon, mackerel, sardines, which also provide omega-3 PUFAs), whole grains, eggs, and spinach. These align with anti-inflammatory diets like the Mediterranean diet, which emphasizes fruits, vegetables, lean proteins, and healthy fats.

- Complementary Nutrients: Combine selenium with other anti-inflammatory nutrients, such as omega-3 fatty acids (found in fish), vitamin C (citrus fruits), vitamin D (fortified dairy, sunlight), and polyphenols (berries, olive oil). These work synergistically to reduce inflammation and oxidative stress.

- Meal Ideas: A salmon and spinach salad with a sprinkle of Brazil nuts provides selenium, omega-3s, and antioxidants. A breakfast of eggs with whole-grain toast and berries is another option.

- Recommendation: Consider selenium as part of a broader anti-inflammatory diet for patients with mild to moderate arthritis, alongside exercise and weight management. Avoid high-dose supplements unless deficiency is confirmed, and monitor for toxicity.

Practical Considerations:
- Dosage: The Recommended Dietary Allowance (RDA) for selenium is 55 μg/day for adults, with an upper limit of 400 μg/day to avoid toxicity. Dietary sources can meet this easily, so supplements are not commonly needed and should be used cautiously.
- Toxicity Risk: Excessive selenium intake (>400 μg/day) can cause selenosis (symptoms: hair loss, nail brittleness, nausea). Patients should avoid over-supplementation, especially if consuming selenium-rich foods like Brazil nuts. The HANES study suggests a possible increased arthritis risk with high selenium intake.

Mechanisms of Action

Selenium’s potential benefits in osteoarthritis and chronic pain management stem from its roles in reducing oxidative stress and inflammation, which are key drivers of chronic pain and pain sensitization.

“Oxidative Stress” and Antioxidants

Current nutritional research supports the belief that many diseases, including diabetes, hypertension, cardiovascular diseases, obesity, liver disease, arthritis and some cancers, are a result of “Oxidative Stress.” Oxidative Stress is an over-abundance of reactive oxygen species (ROS), or “free radicals”, which are destructive molecules that are in our food, our environment and created by our cells during normal metabolic processes. ROS cause oxidation – or damage – to DNA, RNA, proteins and cells analogous to rust damaging steel. To combat these ROS, our cells have protective systems that manufacture antioxidants which neutralize ROS, but as we age there is a gradual impairment of these systems resulting in less antioxidant activity thus greater damage to our DNA, RNA and cells which impairs function and can lead to the above diseases.

Ever since Linus Pauling, science has turned to antioxidants to offset the damages of oxidative stress as a means of promoting health. Antioxidant supplements are widely recommended and their use is widespread. Studies have shown that diets high in natural antioxidants (such as the Mediterranean (anti-inflammatory) diet, Okinawan or Paleo diets) seem to provide protection against oxidative stress. Statistics suggest that populations following these diets have less degenerative disease and greater longevity.

As an antioxidant, selenium reduces harmful molecules that damage cartilage and cause pain. It also calms down inflammation signals that make your joints hurt more and may help keep pain from becoming a long-term problem. Selenium’s mechanisms involve modulation of oxidative and inflammatory pathways via selenoproteins and the Nrf2/NF-κB axis. This dual action may protect articular chondrocytes, reduce synovial inflammation, and potentially interrupt the peripheral-to-central pain sensitization cascade, making it a promising adjunct in arthritis management.

Antioxidant Activity:

- Selenium is a cofactor for selenoproteins, such as glutathione peroxidase (GPx), superoxide dismutase (SOD), and glutathione reductase, which neutralize reactive oxygen species (ROS). ROS are harmful molecules that damage cartilage and joint tissues in arthritis, contributing to pain and inflammation.

- By enhancing antioxidant enzyme activity, selenium reduces oxidative stress in chondrocytes (cartilage cells), protecting them from cell death and matrix degradation.

Anti-Inflammatory Effects:

- Selenium activates the nuclear factor E2-related factor 2 (Nrf2) pathway, which upregulates antioxidant gene expression (e.g., GCLC, GCLM, GPx, SOD). This reduces intracellular ROS levels, which in turn inhibits the pro-inflammatory NF-κB signaling pathway, decreasing the production of cytokines like IL-1, IL-6, and TNF-α that drive inflammation in arthritis.

- By lowering these inflammatory mediators, selenium may reduce joint inflammation and pain.

Impact on Pain Sensitization:

- Peripheral Sensitization: In arthritis, inflammation and oxidative stress in the joint (synovium and cartilage) amplify pain signals through peripheral nerves. Selenium’s ability to reduce ROS and inflammatory cytokines may dampen this process, potentially preventing the escalation of acute pain to chronic pain states.

- Central Sensitization: Chronic pain in arthritis involves central nervous system changes, where pain signals are amplified in the brain and spinal cord. By reducing systemic inflammation and oxidative stress, selenium may indirectly suppress central sensitization by lowering the inflammatory burden that sensitizes pain pathways (e.g., via reduced NF-κB activation).

Cartilage Protection:

- Selenium may slow cartilage degradation by reducing matrix metalloproteinases (MMPs) and glycosaminoglycan loss, which are involved in cartilage breakdown in arthritis.

Mechanistic Synergy – the Science: Selenium’s role in reducing ROS and pro-inflammatory cytokines complements the anti-inflammatory effects of omega-3 PUFAs and polyphenols, which also inhibit NF-κB and reduce cartilage degradation. This multi-targeted approach may help reduce peripheral inflammation, potentially reducing the risk of central sensitization and chronic pain.

Conclusion

Selenium holds promise as a nutraceutical for osteoarthritis (OA) and chronic pain management due to its antioxidant and anti-inflammatory properties, which may protect cartilage, reduce inflammation, and theoretically mitigate peripheral and central pain sensitization. Preclinical studies provide moderate evidence of its benefits, but clinical data in OA are limited and mixed, with some suggesting a risk of increased osteoarthritis with high intake. Its low cost and integration into an anti-inflammatory diet make it an accessible option, but caution is needed to avoid toxicity. Physicians and patients should approach selenium as a complementary strategy within a holistic OA management plan, prioritizing dietary sources and monitoring intake.

Evidence of Benefits

Preclinical Laboratory Studies:

A 2002 study in STR/1N mice (prone to mechanically induced OA) found that a diet supplemented with selenium and vitamins reduced OA incidence by ~35% (from 100% in controls to ~65%) and severity (mostly grade 2 vs. grade 3–4 in controls). It also increased serum glutathione peroxidase activity, supporting its antioxidant role.

A 2022 study in human chondrocyte cell lines (SW1353) and Wistar rats showed that 0.3 μM selenium protected chondrocytes from sodium iodoacetate-induced damage via the Nrf2 pathway, increasing antioxidant enzyme expression and reducing pro-inflammatory cytokines (IL-1, IL-6, TNF-α). In rats, 2 weeks of oral selenium supplementation reduced cartilage loss and inflammation.

Clinical Studies:

Rheumatoid Arthritis (RA): While more data exist for RA, results are mixed. A 2021 study of 51 RA patients found that 200 μg selenium twice daily for 12 weeks, alongside standard treatments, did not significantly reduce pain, morning stiffness, or NSAID use compared to placebo. A review of three RCTs (40–70 participants, 3–6 months) also found no significant benefit of selenium (200–256 μg/day) for RA symptoms.

Osteoarthritis: Clinical evidence for OA is limited. A 2023 cross-sectional analysis using NHANES data (2003–2016) found that high dietary selenium intake was associated with an increased risk of OA (odds ratio 1.33, 95% CI 1.07–1.65), particularly in diabetic patients, suggesting caution with excessive intake. However, earlier studies, like Wang et al. (2018), reported that lower selenium levels were linked to higher OA risk in older adults, indicating a potential U-shaped relationship where both deficiency and excess may be detrimental.

Pain and Sensitization:

While direct evidence on selenium’s role in preventing the transition from acute to chronic pain is sparse, its reduction of inflammatory cytokines and ROS suggests a theoretical benefit in mitigating peripheral sensitization. By lowering systemic inflammation, selenium may also reduce central sensitization, though no clinical trials specifically address this in arthritis.

Summary of Evidence:

Studies show selenium can help protect joints in animals by reducing damage and inflammation, but human studies are less clear. Some show it might not help much with arthritis pain, and one study even suggested too much selenium could increase arthritis risk, especially in people with diabetes. More research is needed to know how well it works for joint pain.

Quality of Evidence

Preclinical Evidence: Moderate to high quality. Animal and cell studies consistently demonstrate selenium’s antioxidant and anti-inflammatory effects, with clear mechanisms (e.g., Nrf2 activation, NF-κB suppression). However, these findings need translation to human models.
Clinical Evidence: Low to moderate quality for arthritis. The NHANES study suggests a potential risk with high selenium intake, but it relies on dietary questionnaires, which are prone to recall bias and confounding factors. Rhematoid Arthritis trials show no significant benefit, and ostoarthritis-specific studies are lacking. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) for nutraceuticals in arthritis generally rates evidence as low due to small sample sizes, inconsistent results, and variable study designs.

Limitations: Few RCTs focus on selenium alone for arthritis, and most combine it with other nutrients, making it hard to isolate its effects. The U-shaped dose-response curve (benefit at moderate doses, harm at high doses) complicates recommendations. Long-term outcomes and effects on pain sensitization are understudied.

Summary:

The preclinical data are promising, but clinical evidence is weak, particularly for OA. The NHANES findings raise concerns about high doses, necessitating caution. Research with larger sample sizes and arthritis-specific outcomes are needed to establish efficacy and optimal dosing.

Selenium and Blood Levels

Role of Monitoring Serum Selenium Levels

Clinical Utility: Measuring blood (serum) selenium levels can help identify deficiency or toxicity, particularly in patients with chronic pain conditions where oxidative stress and inflammation play a role (e.g., fibromyalgia, neuropathy). Serum levels reflect recent dietary intake and are a reliable biomarker for short-term selenium status, though whole-blood or erythrocyte selenium may better indicate long-term status.

When to Monitor:

- Suspected Deficiency: Monitor in patients with conditions associated with low selenium intake or absorption, such as gastrointestinal disorders (e.g., Crohn’s disease, celiac disease), malnutrition, or restricted diets (e.g., vegan diets in selenium-poor regions).

- High-Dose Supplementation: Monitor blood levels in patients taking selenium supplements (>100 μg/day) to prevent toxicity, especially if combined with selenium-rich foods (e.g., Brazil nuts).
- Chronic Pain Conditions: In conditions like fibromyalgia or neuropathy, where oxidative stress is implicated, baseline selenium levels may guide supplementation decisions, though evidence is limited.

Practical Considerations: Routine monitoring is not standard in pain management unless deficiency or toxicity is suspected, as testing can be expensive ($50–150 per test, depending on the lab) and not always covered by insurance. Clinical symptoms (e.g., fatigue, muscle weakness for deficiency; hair loss, nausea for toxicity) suggest a need to test.

Summary:

Serum selenium testing is warranted in patients with risk factors for deficiency or those on high-dose supplements. It’s not routinely needed for most pain patients but may be useful in fibromyalgia or neuropathy cases with suspected nutritional deficits due to a limited diet.

Risks for Selenium Deficiency

Risk Factors:

Geographic Variation: Soil selenium content varies widely, affecting food sources. Regions like parts of China, New Zealand, and some European countries have low soil selenium, increasing deficiency risk. In the U.S., selenium levels in soil are generally adequate, but local variations exist (e.g., lower in the Pacific Northwest).

Dietary Patterns:
- Low intake of selenium-rich foods (e.g., seafood, nuts, meats) due to vegetarian/vegan diets, food insecurity, or poor dietary diversity.
- Malabsorption syndromes (e.g., inflammatory bowel disease, short bowel syndrome) reduce selenium absorption.

Medical Conditions:
- Chronic Pain Conditions: Fibromyalgia and neuropathy may be associated with higher oxidative stress, potentially depleting selenium stores, though direct evidence is sparse.

- Critical Illness: Conditions like bone infections or severe systemic infections (e.g., sepsis) may increase selenium demand due to heightened oxidative stress.

- HIV/AIDS or Cancer: These conditions are linked to selenium deficiency due to increased metabolic demands or malabsorption.
Medications: Long-term use of proton pump inhibitors (PPIs) such as Nexium or other medicines to reduce acid in the stomach when treating reflux (GERD) or peptic ulcers, corticosteroids, or chemotherapy may impair selenium absorption or metabolism.

Symptoms of Deficiency:

Fatigue, muscle weakness, hair loss, immune dysfunction, and potentially worsened pain or inflammation in conditions like fibromyalgia or neuropathy. Severe deficiency is rare in developed countries).

Summary:

Deficiency is more likely in patients with malabsorption, restricted diets, or chronic inflammatory states. Pain management physicians should consider selenium status in fibromyalgia or neuropathy patients with poor nutritional status or persistent symptoms despite standard therapies.

Risks of Excessive Selenium

Sources of Excessive Intake:

Dietary Overconsumption:

- Brazil Nuts: A single Brazil nut can contain 50–100 μg of selenium, and consuming multiple nuts daily (e.g., 5–10) can easily exceed the UL of 400 μg/day. This is a common cause of unintentional toxicity in health-conscious individuals.

- Regional Foods: In selenium-rich soil areas (e.g., parts of the U.S. Midwest), locally grown grains or vegetables may have high selenium content.

Environmental Exposure:

- Water or Soil Contamination: In rare cases, drinking water or crops from selenium-contaminated areas (e.g., near mining sites) can lead to excessive intake.

- Occupational Exposure: Workers in industries like electronics or glass manufacturing may be exposed to selenium compounds, though this is less relevant to dietary toxicity.

Medications/Supplements:

- Over-the-counter multivitamins or “joint health” supplements may contain selenium, leading to cumulative excess if combined with a selenium-rich diet.

- Mislabeling or unregulated supplements (e.g., some herbal or “natural” products) have caused toxicity in rare cases.

Reducing Risk:

Limit Brazil nut consumption to 1–2 per day.
Assess total selenium intake (diet + supplements) in patients with high dietary exposure.
Avoid supplementation in patients with adequate serum levels (>100 μg/L) unless clinically indicated.

Summary:

Excessive selenium from dietary sources like eating too many Brazil nuts (more than 1–2 a day). Brazil nuts are a real risk, particularly in those unaware of their potency. Environmental exposure is rare but should be considered in specific populations. Always calculate total intake before recommending supplements.

Optimal Blood (Serum) Selenium Levels

Reference Ranges:

Normal Range: Serum selenium levels typically range from 70–150 μg/L (0.89–1.91 μmol/L) in healthy adults, though optimal levels for specific conditions are not well-defined.

Optimal for Pain Management:
- Levels of 100–120 μg/L are often cited as optimal for maximizing selenoprotein activity (e.g., glutathione peroxidase) without risking toxicity. This range supports antioxidant and anti-inflammatory effects relevant to chronic pain conditions.
- No specific guidelines exist for fibromyalgia, neuropathy, or other pain conditions, but maintaining levels within the upper-normal range may theoretically optimize anti-inflammatory benefits.

Evidence for Pain Conditions:

Fibromyalgia: Limited studies suggest low selenium levels may correlate with increased oxidative stress and fatigue, but no research confirm optimal levels for symptom relief.

Neuropathy: Selenium’s antioxidant effects may protect nerves from oxidative damage (e.g., in diabetic neuropathy), but clinical data are lacking. Levels of 100–120 μg/L may support nerve health indirectly.

Myofascial Pain/Sciatica: No specific data exist, but selenium’s anti-inflammatory effects could theoretically reduce muscle or nerve-related inflammation.

Summary:

Maintain serum levels of 100–120 μg/L in pain patients with suspected deficiency, to balance antioxidant benefits with toxicity risks. Adjust supplementation dosing based on baseline levels and dietary intake.

Conditions Potentially Benefiting from Supplementation Due to Deficiency Risk

Conditions with Potential Benefit:

Fibromyalgia: Small studies (e.g., a 2010 trial in 30 patients) suggest selenium supplementation (200 μg/day) may reduce fatigue and oxidative stress, but pain outcomes are inconsistent. Patients with confirmed deficiency may benefit from supplementation to restore levels to 100–120 μg/L.

Neuropathy (e.g., Diabetic Neuropathy): Preclinical studies show selenium protects against oxidative nerve damage, and a 2018 study in diabetic rats found 0.5 mg/kg selenium reduced neuropathic pain. Human data are limited, but supplementation may help in deficient patients.

Myofascial Pain/Sciatica: No specific studies, but selenium’s role in reducing muscle inflammation (via NF-κB suppression) may offer theoretical benefits in deficient patients.

Supplementation Guidelines:

Dose: 50–200 μg/day is typically safe for supplementation in deficient individuals, aiming to achieve serum levels of 100–120 μg/L.

Form: Selenomethionine is better absorbed than sodium selenite and is commonly used in supplements.

Duration: Short-term (3–6 months) supplementation is usually sufficient to correct deficiency, followed by dietary maintenance.

Summary:

Supplementation is may be justified in fibromyalgia or neuropathy patients with confirmed deficiency or high oxidative stress. Monitor response and levels after 3 months to avoid over-supplementation.

Maximum Serum Levels for Safety and Toxicity Risks

Maximum Safe Levels:

Upper Limit: Serum selenium levels >150–200 μg/L (2.54 μmol/L) increase the risk of toxicity, particularly with chronic exposure. The tolerable upper intake level (UL) for dietary and supplemental selenium is 400 μg/day for adults to prevent selenosis.

Toxicity Symptoms (Selenosis): Hair loss, brittle nails, nausea, diarrhea, fatigue, irritability, garlic-like breath odor, and, in severe cases, neurological symptoms or liver damage. Chronic levels >400 μg/L are associated with increased risks of type 2 diabetes and certain cancers (e.g., prostate cancer in some studies).

Evidence on Toxicity:

A 2008 RCT (SELECT trial) found that 200 μg/day selenium supplementation in men with adequate baseline levels increased diabetes risk (HR 1.07, 95% CI 1.01–1.13), highlighting the risks of excessive intake in non-deficient individuals.

The NHANES 2003–2016 analysis noted an association between high dietary selenium and increased osteoarthritis risk, possibly due to excessive levels disrupting joint homeostasis.

Summary:

Avoid serum levels >150 μg/L to minimize toxicity risks. Regular monitoring is essential for patients on supplements, especially those with high baseline dietary intake. Too much selenium (above a blood level of 150–200) can cause problems like nausea or hair loss.

Summary of Selenium’s Relevance to Specific Pain Conditions

Fibromyalgia:

Evidence: Limited studies suggest low selenium levels may contribute to oxidative stress and fatigue, but RCTs are inconclusive on pain relief. A 2015 review noted potential benefits of selenium (200 μg/day) for reducing fatigue but not pain.

Role: May support antioxidant defenses in deficient patients, potentially improving fatigue and systemic inflammation.

Myofascial Pain:

Evidence: No direct studies. Selenium’s anti-inflammatory effects may reduce muscle inflammation, but clinical data are lacking.

Role: Theoretical benefit in deficient patients, but not a primary therapy.

Neuropathy/Sciatica:

Evidence: Preclinical studies (e.g., 2018 rat study) suggest selenium reduces neuropathic pain via antioxidant effects on nerve tissue. Human data are sparse, but a 2020 pilot study in diabetic neuropathy (50 patients, 100 μg/day) showed modest pain reduction.

Role: May be beneficial in deficient patients with oxidative stress-related neuropathy, but more research is needed.

Summary:

Selenium’s role is promising in fibromyalgia and neuropathy for deficient patients, but evidence is weak. It’s unlikely to be a primary therapy for myofascial pain, sciatica, or osteomyelitis without further studies.

Selenium supplements might help a bit with fibromyalgia fatigue or nerve pain if blood levels are low, but it’s not a cure-all. There’s not much proof it helps with muscle pain or bone infections

Conclusion

Monitoring serum selenium levels is not routine but is justified in patients with risk factors for deficiency (e.g., malabsorption, restricted diets) or those on supplements to prevent toxicity.
Optimal levels of 100–120 μg/L maximize antioxidant and anti-inflammatory benefits relevant to chronic pain conditions like fibromyalgia and neuropathy, though evidence is limited.
Conditions with high oxidative stress or inflammation may benefit from supplementation in deficient patients, but data are sparse for myofascial pain, sciatica, or osteomyelitis.
Toxicity risks increase above 150–200 μg/L or 400 μg/day intake, with Brazil nuts and regional foods posing risks beyond supplements.
Pain management should integrate selenium into a broader anti-inflammatory strategy, prioritizing dietary sources and cautious supplementation with monitoring as needed.

References:

Selenium Lessens Osteoarthritis by Protecting Articular Chondrocytes from Oxidative Damage through Nrf2 and NF-κB Pathways – www.mdpi.com
Frontiers | A national cross-sectional analysis of selenium intake and risk of osteoarthritis: NHANES 2003–2016 – www.frontiersin.org
Selenium supplementation in patients with fibromyalgia: A systematic review – pubmed.ncbi.nlm.nih.gov
Effects of selenium on neuropathic pain in diabetic rats – www.sciencedirect.com
SELECT trial: Selenium and Vitamin E Cancer Prevention Trial – www.ncbi.nlm.nih.gov
Dietary vitamins and selenium diminish the development of mechanically induced osteoarthritis and increase the expression of antioxidative enzymes – pubmed.ncbi.nlm.nih.gov
Nutraceuticals and osteoarthritis pain | Request PDF – www.researchgate.net
Micronutrients: Essential Treatment for Inflammatory Arthritis? – PMC – www.ncbi.nlm.nih.gov

Reference Publications:

Listed below are many recently published research articles that explore the many potential benefits of supplementing with NRF2 activators. In addition to these articles are many links listed in the individual pages for each of the nutrients listed above.

Antioxidants & NRF2 Activators – brief introduction
NRF2 as Regulator – Overviews

NRF2 – Pain

Emphasis on Education
Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.
For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.
Should you wish more information regarding any of the subjects listed – or not listed – here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.
For more information, please contact Accurate Clinic.
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Purchasing Supplements
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Mineral Supplements:

Selenium

Selenium

Brief Description of Selenium and Where It Is Found

Selenium’s Relevance to Specific Pain Conditions

Fibromyalgia:

Myofascial Pain:

Neuropathy/Sciatica:

The Role of Selenium in an Anti-Inflammatory Diet for Chronic Pain Management

Mechanisms of Action

“Oxidative Stress” and Antioxidants

Conclusion

Evidence of Benefits

Preclinical Laboratory Studies:

Clinical Studies:

Pain and Sensitization:

Summary:

Selenium and Blood Levels

Role of Monitoring Serum Selenium Levels

Summary:

Risks for Selenium Deficiency

Risk Factors:

Symptoms of Deficiency:

Summary:

Risks of Excessive Selenium

Sources of Excessive Intake:

Optimal Blood (Serum) Selenium Levels

Reference Ranges:

Summary:

Conditions Potentially Benefiting from Supplementation Due to Deficiency Risk

Conditions with Potential Benefit:

Supplementation Guidelines:

Summary:

Maximum Serum Levels for Safety and Toxicity Risks

Maximum Safe Levels:

Summary:

Summary of Selenium’s Relevance to Specific Pain Conditions

Fibromyalgia:

Myofascial Pain:

Neuropathy/Sciatica:

Summary:

Conclusion

Reference Publications:

NRF2 – Activators, Overviews

NRF2 – Activators, Curcumin

NRF2 – Activators, Luteolin

NRF2 – Activators, Vitamin D

NRF2 – Cardiovascular Disease

NRF2 – Depression

NRF2 – Diabetes

NRF2 – Fasting/Calorie Restriction

NRF2 – Inflammation

NRF2 – Kidney Disease

NRF2 – Neurodegeneration, Nerve Damage

NRF2 – Obesity

NRF2 – Ophthalmology