Whatever happened...? And chromium - Are you getting enough?

Two quick follow-ups of stories that might have left you curious about what happened.

The Food and Drug Administration has completed its analysis of those dietary supplements being sold as “Total Body Formulas” and made a troubling finding.

In March, as you may remember, the FDA had issued a warning to consumers to not use these products after receiving dozens of reports of adverse reactions. The CDC issued a similar health advisory last month. Today, we learn that there have been 195 confirmed cases of adverse health reactions among people who had used this supplement.

According to the FDA news release, its analysis found not only high levels of selenium, but dangerous amounts of chromium:

The samples contained up to 3,426 micrograms of chromium for the recommended serving (17 times the recommended intake). The recommended chromium intake for an adult ranges from 35 to 45 micrograms per day. Excessive consumption of chromium can cause fatigue, muscle cramps, hyperactivity, hypoglycemia, renal failure and liver toxicity. Excessive chromium intake also can interfere with certain medications.

Chromium, itself, is sold as a dietary supplement, so the seriousness of this finding may not be fully understood because there is a lot of misinformation out there about chromium. It might be helpful to learn a little about this supplement and much more fun ways to get it, if you believe you need extra. :)

All chromium compounds come from chromite ore and are found in air, water, soil and biological samples (people, animals, fish, and foods) in varying amounts and chemical forms. Trivalent chromium (Chromium III) compounds are the most common kind in our foods. Chromium III is also the form found in supplements, such as chromium chloride, chromium nicotinate, chromium picolinate and high-chromium yeast. Chromium is a trace mineral that is essential to the body and while its precise role isn’t fully understood, it appears to have an important role in a number of biological functions, such as the metabolism of fats, proteins and carbohydrates.

Even though chromium levels vary considerably in foods, and in people around the world, actual deficiencies are extraordinarily rare. According to the Merck Manual, four people receiving long-term TPN (total parenteral nutrition, where all of their nutrients must come from an IV because they can’t eat) were believed to have developed chromium deficiency and, as a result, suffered peripheral neuropathy, encephalopathy, ataxia, and weight loss and glucose intolerance despite adequate calories. The symptoms resolved in three of them when trace amounts of chromium was added to their intravenous solutions. Such rare cases in the medical literature were reported in the 1970s-1980s before chromium was realized to be an essential trace element for our bodies and necessary when medically providing complete nutrients.

There are no reliable, objective tests to identify chromium deficiencies, according to nutrition researchers, Sandra Mutama and colleagues, at the School of Applied Science, South Bank University, and the Centre for Food, Nutrition and Public Health, University of Westminster, in London, writing in Nutrition & Food Science. So, beware of any alternative practitioner or laboratory claiming to be able to diagnose chromium deficiency. There are big discrepancies in the reported values from different testing methods, which brings caution to comparing different populations and has made it difficult for scientists to pinpoint precisely our minimum requirement.

But suffice it to say, it is a trace nutrient... needed in trace amounts. Based on the amounts in the diets of healthy people, the Food and Nutrition Board has set adequate intake levels for adults at 20-35 micrograms/day (depending on age and gender). Adults in the United States, on average, take in about three times that each day, according to the CDC, and comparable to people in many other countries. Basically, if you’re eating... food... you, too, are probably getting what you need because it’s in so many things we eat and drink.

There are lots of claims that getting more chromium will increase your muscles or help you lose weight, will improve glucose tolerance and prevent diabetes, or will lower cholesterol and prevent heart disease. But none of the claims have been proven in randomized clinical trials. According to researchers with the Linus Pauling Institute at Oregon State University, 15 randomized clinical trials found chromium had no effect on glucose or insulin concentrations in nondiabetics or nondeficient people; 12 randomized, placebo-controlled studies found no effect on lean body mass or body fat (even using the most sensitive and accurate measuring methods — dual energy x-ray absorbtiometry or DEXA and hydrodensitometry or underwater weighing); and 10 recent randomized, double-blind, placebo-controlled trials found no clinically relevant weight loss. The FTC has ruled there is no basis that chromium picolinate promotes weight loss or fat loss in humans. Chromium levels in urine appear to increase with endurance exercise or intense weight lifting, leading some to claim that athletes need supplements — but, said the Linus Pauling researchers, absorption was also found to increase, leading to negligible net loss and no benefit from supplementation.

A 2005 FDA review of the scientific evidence and randomized, clinical trials found no credible support for claims that chromium can reduce insulin resistance, cardiovascular disease, high blood sugars, type 2 diabetes, retinopathy, or kidney disease. In fact, no medical benefit has been proven from taking chromium supplements other than in correcting deficiencies.

While there are no proven benefits, whether it’s safe to take supplements long-term or in notably higher amounts also isn’t known. According to the FDA, we don’t know how much or for how long chromium can be taken until people suffer adverse effects. Toxicology studies are also underway by the National Toxicology Program to determine if it causes cancer or genetic mutations. [Chromium IV is a very different story, however, and considerably more toxic.]

Hence, research hasn’t yet been able to set a precise upper safe level, but there have been reports of serious adverse reactions to chromium supplements even taken for just 2 weeks and in healthy young people. People have suffered kidney failure and impaired liver function and liver necrosis from 600 mcg/day taken for just 6 weeks and after 1-2 grams/day taken over 4 months. A formerly healthy 33-year old woman, for example, suffered renal failure, liver problems, anemia and thrombocytopenia that required blood transfusions and dialysis and her symptoms finally resolved a year later.

So, if you still believe that you need more chromium, it’s safer to get it from food. And tastier, too. You can't eat enough chromium in foods to get into trouble. Health food advocates will tell you that the best source of chromium is brewer’s yeast (if you don’t mind the gas and nausea) and that it’s also found in organ meats, beef, chicken, oysters, broccoli (11 mcg per 1/2 cup), prunes, oatmeal, wheat germ, grapes, orange juice, apples (1.4 mcg/medium), bananas, and green peppers. All true.

But what they probably won’t tell you is that canned and other processed foods are richer sources of chromium than fresh foods, as Mutama and colleagues noted. During food processing — such as canning, grinding, slicing and homogenation — the food usually comes into contact with stainless steel equipment, which imparts chromium, especially under acidic conditions. Brown sugar and molasses are also very rich in chromium, as Mutama and colleagues point out, as well as coffee, wide varieties of sweets, cocoa, beer and wine. An English muffin has three times the chromium as an apple or banana. A 6-ounce glass of Grenache or Syrah, for example, has ten times that, and about as much chromium as the same amount of broccoli. And the second best source to brewer’s yeast is beer. (Brewer’s yeast – beer, get it?) The lowest sources among our staple foods are cereals and milk.

We only absorb about 1-2% of the chromium in foods, but it doesn’t take all that much to get the trace amounts our bodies actually need. It’s easy by eating a variety of foods and enjoying pretty much everything. Fears that we’re all deficient are greatly exaggerated. A processed turkey ham deli sandwich will get you there. So will an 8-ounce waffle and glass of juice. And a beer and cheeseburger will give you a whopping 120 mcg.

Or, you could eat brewer’s yeast and liver, if you really wanted to. :-)

The second follow-up story is for those worried about what to do for their case of blogging disease. As you’ll remember, in March, IAD (internet addiction disorder) was proposed as a psychiatric diagnosis for the upcoming issue of Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

The National Geographic has reported that therapists in China have developed a “treatment” for internet addicts: what they call "nanometer wave machines." :-)