Le sélénium fait parti de ces minéraux que l’on appelle les oligo-éléments. Les oligo-éléments forment une ribambelle de « petits trucs » dont on s’occupe assez peu en Médecine. On adore corriger les chiffres en Médecine mais pour les oligo-éléments soit on fait comme si on ne les connaissait pas soit on supplémente à la louche, la faute à des dosages peu courants me direz-vous…
Wikipedia nous apprend que le sélénium a été nommé ainsi en analogie avec la Lune. En effet il est très souvent couplé au tellure dans la nature et les chimistes n’ont pas voulu briser le petit couple Terre-Lune 🙂 C’est amusant non ?
Le sélénium est rigolo à étudier parce qu’il a été impliqué dans plusieurs phénomènes physiopathologiques assez surprenants. Il a refait surface récemment sur mon bureau avec l’essai SELECT qui testait la supplémentation en vitamine E et/ou en sélénium pour prévenir le cancer de la prostate. Cet essai est négatif, la vitamine E à 400 UI/jour ferait même pire que mieux !
Le sélénium a des propriétés redox intéressantes pour les êtres vivants. C’est un capteur d’électrons limitant/contrôlant les cascades d’oxydo-réduction. Il est particulièrement connu pour être au coeur de la glutathion peroxydase (GPx). La sélénocystéine est un acide-aminé rare, pierre angulaire des sélénoprotéines, cet acide aminé est « représenté » par un système tout à fait spécifique dans le code génétique. C’est assez amusant comme les scientifiques experts dans les éléments-traces y voit quelque chose d’éblouissant : le sélénium serait le seul oligo-élément inscrit dans notre patrimoine génétique. En fait il existe un système appelé SECIS qui modifie l’interprétation du codon stop UGA de l’ARNm pour incorporer grâce à un ARNt tout à fait spécifique la sélénocystéine aux protéines.
La littérature médicale a identifié plusieurs fonctions aux sélénoprotéines. Leurs rôles de contrôle de l’oxydation (j’aime de moins en moins le terme anti-oxydant) et de transformation des hormones thyroïdiennes sont les mieux connus.
De par leur rôle de maintien de l’intégrité cellulaire et de l’ADN, un phénomène physiopathologique très curieux a pu être identifié dans la physiopathologie d’une insuffisance cardiaque d’étiologie rare : la maladie de Keshan. Cette pathologie a été analysée à la fin des années 70 dans la région homonyme du nord-est de la Chine. Dans cette zone au sol appauvri en sélénium, la carence alimentaire a créé des conditions propices pour qu’un entérovirus banal comme le coxsackie mute. Il gagne au passage de nouveaux facteurs de virulence irréversibles responsables de la cardiopathie. Ce type de phénomène existe probablement pour d’autres virus et certains auteurs s’interrogent sur des phénomènes parallèles avec les virus grippaux et même le VIH.(J. Nutr.-2003-Beck-1463S-7S-Selenium deficiency and viral infection)
La littérature épidémiologique sur le sélénium est vaste. Son analyse est vraiment complexe. Les apports alimentaires en sélénium sont extrêmement disparates. La région, le type de produits absorbés et les variations inter-individuelles rendent impossible de prédire un taux sanguin. Ensuite on ne connait pas réellement la sélénémie plasmatique optimale. Pour certaines pathologies comme les cancers, les individus se trouvant dans les intervalles de sélénémies plasmatiques les plus hautes semblent mieux protégés, néanmoins il est difficile impossible d’en tirer des conclusions de cause à effet. La sélénémie se serait-elle pas qu’un « surrogate marker » d’une alimentation correcte ? Alimentation apportant son lot de fibres, de molécules organiques bénéfiques, etc. Encore plus difficile : dans ces mêmes études épidémiologiques où les chercheurs vont souvent chercher des sous-groupes (sic), un groupe protégé pour une pathologie peut devenir à risque pour une autre. Les joies des stats et de l’épidémio !
Bref.
On ne sait pas quel taux de sélénium est optimal et la courbe en U bénéfices/risques est probablement très étroite. C’est donc extrêmement compliqué d’encourager les gouvernements à réviser leurs recommandations d’apports et/ou d’enrichir les sols comme l’on fait les finlandais. Ainsi on ne peut pas recommander une quelconque supplémentation en sélénium partout pour tous. Les complexes multivitaminés en contiennent très souvent de l’ordre de 200 microgrammes, faites attention… Mangez de l’ail et des brocolis, l’organisme prendra ce dont il a besoin, c’est le mieux à faire.
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8 réponses sur « Focus sur le sélénium »
Intéressant, en bref: on a aucune idée… Merci pour cette info qui a le mérite d’être honnête. Ah et chez moi le lien vers la biblio tombe sur une erreur pubmed.
merci pour le commentaire… le lien fonctionne chez moi, peut-être un cookie qui facilite la tâche chez vous et pas chez moi.
Le lien complet pour la bilbio : http://www.ncbi.nlm.nih.gov/sites/myncbi/collections/public/1VOePBRQ4rkIu0vxv50ccrck4/
Je fais un HS pas très interessant peut-être mais je tiens à le dire ! Je trouve que les jeunes médecins sont maintenant beaucoup plus savants que nous l’étions, y’a pas photo. C’est peut-être le bon coté de l’ECN qui vous fait bosser comme des mules du début des études à la fin. Et c’est vrai pour tous, MG comme spécialistes. Après, sur le plan de la clinique et de la relation au patient, je ne sais pas mais les blogs médicaux ont tendance à me conforter sur la qualité d’un certain nombre.
Bon, maintenant direction la salle d’attente et au boulot.
Hello,
les commentaires c’est fait pour discuter, et on cause encore de qu’on veut ici 🙂 No problemo, du HS tant que vous voulez 😉
Quant au côté savant des jeunes docteurs, en fait même si je critiquais l’EBM dans un billet précédent, je voulais surtout traduire en filigrane la perversité du système « publish or perish »… Et kyste a eu raison de nous rappeler qu’il faut lire et encore lire. Ce type de billet n’est qu’une prise de recul sur deux trois « reviews » qu’on peut trouver dans la biblio.
voili voila 🙂
A bientôt
Je sais que vous êtes jeûne, sportif et plein d’optimisme …ce que confirme votre phrase : « dont
on s’occupe ASSEZ PEU en Médecine ». Dans un CHU, les laboratoires de
biologie n’ont pas les kits pour effectuer certains dosages, pour
appréhender (ou tenter) d’approcher directement ou indirectement des
oligo éléments. Personnellement, j’aurais tendance à dire que les
oligo-éléments n’intéressent personne, dans le chronique ambulatoire. Un
exemple : demandez aux diabétiques si on a essayé d’approcher leur
statu en chrome, une seule fois dans leur passé de diabétiques? Quand
vous croisez cette question avec le résultat d’une étude anglaise
montrant que 94% des seniors ne peuvent avoir un apport suffisant
alimentaire et qu’une supplémentation peut améliorer le profil
glycemique de certains (ceux qui sont uniquement déficitaires); on peut
se demander pourquoi le chrome brille par son absence dans les esprits.
Oui même réflexion avec le zinc qui sert à la synthèse du collagène pour leurs pieds et plaies et également la synthèse de l’insuline…
Néanmoins dans cette medecine qui veut des preuves il y a malheureusement peu d’essais à bon niveau de preuve
Le 7 déc. 2011 à 15:42, « Disqus » a écrit :
On doit pouvoir étendre le questionnement à d’autres oligo-éléments. Le problème est que cela n’intéresse pas les médecins hospitaliers, de CHU, car cela est à la limite de la prévention, et participe, il faut bien le reconnaitre, un peu à l’amélioration possible ou potentiel des patients et pas dans tous les cas. Ce qui me gène est non pas l’absence de preuve mais l’absence d’études, l’absence de curiosité pour aller voir derrière le mur, de réfléchir sur le sujet. SUVIMAX, fait par des médecins, est intéressante comme étude, mais c’est un peu grossier comme approche clinique. Cela quantifie le minimum syndical nutritionnel . Mon côté dubitatif découle de tout cela. Vous voyez : je n’ai pas changé d’avis sur le sujet depuis nos premières communications.
oh ben je vous refait le crédo du moment : pas de labo pas de sous pas de leader d’opinion pas d’étude
il y a des universitaires calés en nutrition qui s’intéressent aux éléments trace (Mette Berger en Suisse et JF Zazzo en France dans le domaine de la réa) et un des autres champions m’a confié aujourd’hui aux Journées Françaises de Nutrition qu’ils voulaient organiser une sorte d’atelier de réflexion sur le sujet… à suivre