Which Disease Is Associated with Vitamin E and Selenium Deficiencies?

December 22, 2025 •

4 min read

According to the National Institutes of Health, Keshan disease, a potentially fatal form of congestive cardiomyopathy, is associated with a severe selenium deficiency, often compounded by viral factors. This disease, alongside nutritional muscular dystrophy (often called white muscle disease in animals), highlights the critical and synergistic roles of both vitamin E and selenium in maintaining physiological health.

Quick Summary

Vitamin E and selenium deficiencies are linked to several serious conditions, most notably Keshan disease, a cardiomyopathy affecting humans, and nutritional muscular dystrophy, which primarily impacts livestock. These micronutrients function as powerful antioxidants, and a lack of them impairs cellular protection, immune function, and muscle integrity, particularly in the heart and skeletal muscles.

Key Points

Keshan Disease: A severe congestive cardiomyopathy in humans caused by a complex interaction between severe selenium deficiency and a mutated Coxsackievirus.
Nutritional Muscular Dystrophy (NMD): Also known as white muscle disease, this condition affects young livestock and results from a combined vitamin E and selenium deficiency, causing degeneration of skeletal and heart muscles.
Synergistic Antioxidants: Vitamin E and selenium function together to protect cells from oxidative damage, with vitamin E neutralizing free radicals and selenium-dependent enzymes cleaning up peroxides.
Dietary and Environmental Factors: The prevalence of these diseases is often tied to geographic regions with selenium-deficient soil, which affects the nutritional value of locally grown food.
Preventable with Proper Nutrition: Both conditions are preventable and treatable with adequate dietary intake of vitamin E and selenium, often through supplementation in high-risk areas.
Impact on Heart and Muscle: Both diseases manifest with severe consequences for cardiac and skeletal muscle tissue due to compromised cellular defense mechanisms against oxidative stress.

The Critical Link Between Vitamin E, Selenium, and Disease

Nutritional science has long recognized the crucial, often synergistic, roles of vitamin E and selenium in the body. Both act as powerful antioxidants, protecting cells from damage caused by free radicals. A deficiency in one or both of these micronutrients can lead to significant health problems. While historically tied to endemic areas with poor soil quality, these conditions demonstrate the profound impact of nutrition on overall health and disease prevention.

Keshan Disease: A Human Cardiomyopathy

Keshan disease is a severe form of congestive cardiomyopathy, a condition where the heart muscle becomes weak and enlarged. It was first identified in Keshan County, China, where the soil and local food supply were severely depleted of selenium. The disease primarily affects children and women of childbearing age and can be fatal.

Key Pathophysiology: The disease's etiology is a complex interaction between a severe selenium deficiency and a mutated Coxsackievirus. Selenium deficiency impairs the body's antioxidant defenses, leaving heart cells vulnerable to viral damage. This synergy between nutritional deficiency and viral infection is what makes Keshan disease so devastating. For more detailed information on the scientific background, the NCBI's StatPearls offers an authoritative overview of Selenium Deficiency.
Clinical Presentation: Symptoms can be acute, subacute, chronic, or latent, with severe cases involving cardiogenic shock, arrhythmias, heart failure, and pulmonary edema.
Prevention: Since the widespread supplementation of selenium in affected regions of China, the incidence of Keshan disease has dropped dramatically, proving the effectiveness of nutritional intervention.

Nutritional Muscular Dystrophy (White Muscle Disease)

Nutritional Muscular Dystrophy (NMD), commonly known as white muscle disease, affects primarily young livestock such as calves, lambs, foals, and poultry. This condition results from a combined deficiency of vitamin E and selenium, leading to the degeneration of skeletal and cardiac muscles.

Cause: Like Keshan disease, NMD is linked to grazing on plants grown in selenium-deficient soil, or in cases of vitamin E deficiency, feeding animals poor-quality hay or grains.
Symptoms: The muscle degeneration results in stiffness, weakness, and a reluctance to move. The muscles appear pale with whitish streaks due to necrosis and calcification, leading to the name "white muscle disease". Cardiac involvement can lead to sudden death from heart failure.
Prevention and Treatment: This condition is preventable and treatable with supplements and injections of vitamin E and selenium. Early intervention is crucial for a better prognosis.

Comparison of Diseases Associated with Vitamin E and Selenium Deficiencies


Feature	Keshan Disease	Nutritional Muscular Dystrophy (NMD)
Primary Affected Species	Humans, particularly children and women of childbearing age.	Livestock, especially young ruminants and poultry.
Key Organ System Affected	Cardiovascular system (congestive cardiomyopathy).	Muscular system (skeletal and cardiac myopathy).
Underlying Cause(s)	Severe selenium deficiency, often compounded by viral infection (e.g., Coxsackievirus).	Combined vitamin E and selenium deficiency from poor diet/soil quality.
Symptom Onset	Can be acute, subacute, or chronic, with symptoms of heart failure.	Typically subacute, with muscle stiffness, weakness, or sudden death.
Primary Treatment	Selenium supplementation.	Vitamin E and selenium supplementation.
Prevention Strategy	Selenium fortification in diet and monitoring selenium levels.	Proper animal nutrition and supplementation in at-risk areas.

The Antioxidant Connection: How Vitamin E and Selenium Interact

The reason these deficiencies lead to similar tissue damage lies in the powerful antioxidant functions of these two nutrients. They work synergistically to protect the body's cells, particularly those with a high metabolism like heart and muscle tissue, from oxidative damage caused by free radicals.

Glutathione Peroxidase (GPx): Selenium is an essential component of several antioxidant enzymes, including glutathione peroxidase. This enzyme breaks down harmful peroxides into harmless water and alcohols. A lack of selenium reduces GPx activity, increasing cellular vulnerability.
Cell Membrane Protection: Vitamin E is a fat-soluble antioxidant that embeds itself in the lipid-rich cell membranes. It prevents the oxidation of polyunsaturated fatty acids, which is a key process in oxidative stress. By doing so, vitamin E protects the structural integrity of the cell membrane itself.

When both are deficient, the body's antioxidant defenses are severely compromised. While vitamin E quenches free radicals within the cell membranes, selenium-dependent enzymes handle the cleanup of already-formed peroxides. Without this two-pronged defense, muscle cells and heart tissue are highly susceptible to irreparable damage, leading to the clinical manifestations seen in Keshan disease and NMD.

Dietary Sources of Vitamin E and Selenium

To prevent these debilitating conditions, it is important to ensure adequate intake of both nutrients. The selenium content of food is highly dependent on the soil quality where it was grown, while vitamin E is more consistently found in specific food types.

Excellent sources of Vitamin E include:

Nuts (almonds, hazelnuts, peanuts)
Seeds (sunflower seeds)
Plant oils (sunflower, safflower, wheat germ oil)
Leafy green vegetables (spinach, broccoli)
Fruits (mango, avocado)

Excellent sources of Selenium include:

Brazil nuts (extremely potent; consume in moderation)
Seafood (tuna, cod, halibut)
Meats and poultry (beef, turkey, chicken)
Organ meats
Whole grains and dairy products

Conclusion

The diseases associated with vitamin E and selenium deficiencies, such as Keshan disease and nutritional muscular dystrophy, underscore the vital importance of these antioxidants. Their synergistic action is essential for protecting the heart and muscle tissues from oxidative damage, and deficiencies can lead to severe, often fatal, outcomes. Fortunately, these conditions are largely preventable through a balanced diet rich in varied food sources or, where necessary, targeted supplementation. Understanding the critical roles of vitamin E and selenium allows for proactive health management, especially in vulnerable populations and agricultural settings where soil nutrient content may be poor.

Frequently Asked Questions

The primary human disease is Keshan disease, a congestive cardiomyopathy primarily caused by a severe selenium deficiency that makes the heart vulnerable to damage from a coxsackievirus.

Nutritional muscular dystrophy, or white muscle disease, is a condition affecting young livestock due to a deficiency in both vitamin E and selenium, leading to degeneration of skeletal and cardiac muscles.

These two nutrients work synergistically as antioxidants. Vitamin E protects cell membranes by neutralizing free radicals, while selenium is a component of the enzyme glutathione peroxidase, which breaks down harmful peroxides.

Yes, both diseases are largely preventable. Keshan disease incidence has been drastically reduced in endemic areas through selenium supplementation. White muscle disease in animals is prevented by ensuring adequate dietary intake of both vitamin E and selenium.

Symptoms include muscle stiffness, weakness, difficulty standing or walking, and in severe cases, sudden death due to heart failure. The affected muscles may appear pale with white streaks.

Good sources of vitamin E include nuts, seeds, plant oils, and leafy greens. For selenium, Brazil nuts, seafood, and organ meats are excellent sources, though soil content can affect plant-based sources.

Soil quality is critical because the selenium content of plants and, consequently, the animals that eat them, depends on the amount of selenium present in the soil. Low-selenium soil directly contributes to dietary deficiencies.