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vomiting, garlic odor on the breath, and a metallic taste (3,7).  Selenium poisoning may also be associated with facial flushing, lightheaded- ness, muscle tenderness, and tremor (7). ARE THERE ANY REPORT- ED INTERACTIONS WITH HERBS, SUPPLEMENTS OR DRUGS? Herb and supplement inter- actions Iodine  and selenium may have synergistic effects in the treatment of Kashin-Beck dis- ease, a joint condition found in China where the soil con- tent of selenium is poor (8). Vitamin C taken along with selenium may actually decrease the absorption of selenium (9). Vitamin E along with seleni- um may have synergistic effects (3).  They both act as antioxidants. Drug interactions Cisplatin (Platinol-AQ) used in combination with selenium may actually exhibit increased toxicity in the pres- ence of ethylenediaminete- traacetic acid (EDTA) (10). ARE THERE ANY INTERACTIONS WITH LAB- ORATORY TESTS? Creatinine kinase, a com- mon blood test of muscle destruction, may be elevated in the presence of selenium toxicity (6). to a cardiomyopathy found in people receiving artificial nutrition (5).  Despite these associations, the role of selenium in relieving the symptoms or improving the prognosis of patients with CHF has not yet been estab- lished.  As a result, selenium has not been recommended for routine use in people suf- fering from CHF. IS IT FOR ME? It is too early to tell whether or not selenium will play a role in the prevention of either CHF or CHD.  Low levels appear to be associat- ed with an increased inci- dence of both CHF and CHD.  However despite these associations,  supple- mentation has not been clearly demonstrated to pre- vent or improve these condi- tions. IS IT SAFE? Selenium supplementation is considered safe when taken in doses up to 400 mcg per day (6).  However,  acute toxicity may occur at higher doses with symptoms includ- ing nausea, vomiting, nail changes, fatigue and irritabil- ity (7).  Chronic toxicity is similar to arsenic poisoning with symptoms including hair loss, white horizontal streak- ing on fingernails, parony- chia, fatigue, irritability, hyperreflexia, nausea, EKG changes suggestive of a myocardial infarction (heart attack) may occur in the setting of selenium toxi- city (6). WHERE CAN IT BE FOUND NATURALLY? Selenium is most frequently obtained from foods grown in the soil. Soil levels are highly variable throughout the world. Some fish also provide selenium through the diet including salmon and haddock (2,11,12).  In the US, the Eastern Coastal Plain and the Pacific Northwest have the lowest selenium levels.  People in these regions typically ingest between 60 to 90 mcg per day (11,12).  The average person in the United States ingests 125 micrograms (mcg) per day through their diet (11,12). WHAT IS THE MOST APPROPRIATE DOSAGE? No clear guidelines have been established for sup- plementation, however 200 mcg per day is felt to be appropriate (13).  The real question is whether or not selenium should be supple- mented for the prevention and treatment of cardiovas- cular disease?  It seems the evidence is lacking despite a theoretical benefit due to its role as an antioxidant. Those choosing to take

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