All too often, depression can literally feed on itself. Such is the case for the approximately eight million Americans who suffer from atypical depression, a variety of depression in which sufferers have an increased appetite leading to weight gain, sleeping too much, excessive lethargy and hypersensitivity to interpersonal rejection. Although atypical depression symptoms are quite apparent and they account for about 42% of the 19 million Americans who suffer from clinical depression, the problem frequently goes undiagnosed.

The good news for these people is that John P. Docherty, MD, CEO of Comprehensive NeuroScience Inc., and adjunct professor of psychiatry at Weill Medical College, Cornell University in New York City, headed a recent study that looked at the role of chromium salts in helping to control blood sugar, and in turn, cravings. I spoke with Dr. Docherty who says that the carbohydrates that patients overindulge in the most are not surprising -- baked goods and pasta, both ranking high as comfort foods. But the resulting weight gain adds to patients' depression, and can be a sort of double-whammy since a common side effect of selective serotonin reuptake inhibitors (SSRIs) -- antidepressant medications, such as fluoxetine (Prozac) and sertraline (Zoloft) -- is weight gain, as well.

The 113 participants in the eight-week study, all people with atypical depression and a mean body mass index (BMI) that was borderline obese, were randomized into a group taking up to 600 mg of chromium picolinate a day or a placebo group. The findings showed that the chromium picolinate group had a significant improvement -- 65% versus 33% in the placebo group -- in terms of decreased appetite and lowered carbohydrate craving.

Dr. Docherty says we don't know exactly why chromium picolinate works to decrease carb cravings, but it probably has to do with the fact that it seems to enhance insulin regulation. (Many people with diabetes type 2 take it for this reason.) Daily Health News contributing editor Andrew L. Rubman, ND, however, adds that chromium seems to increase the sensitivity of chromium receptors, which in turn increases its effect on insulin regulation. The picolinate form of chromium was used in the study not because it's the most effective form to use, but because it is the most widely available form. Chromium is abundantly available in whole-grains, seafood, green beans and broccoli, among other foods, though it can be safely supplemented with physician oversight. Diabetics especially should never start chromium supplements without medical supervision.

This research team will soon be doing further studies to understand chromium and carbohydrate craving, but in the meantime, Dr. Docherty stresses that it is important for all family members, friends and doctors to pay close attention when an individual starts to gain weight and seems unusually lethargic. These may well be signs that the person is suffering from depression and should be evaluated. Be well, Carole Jackson, Bottom Line's Daily Health News

Sources: Breaking the Food-Depression Cycle

John P. Docherty, MD, CEO of Comprehensive NeuroScience Inc., adjunct professor of psychiatry, Weill Medical College, Cornell University, New York City.

An NIH-Funded Pilot Study Demonstrates Chromium Picolinate Supplementation Is An Effective Treatment for Polycystic Ovarian Syndrome (PCOS)

Promising Nutritional Therapy for 2 Million American Women Presented at American Society for Reproductive Medicine Conference (ASRM)

October 15, 2003) -- Results of a pilot study funded by the National Institutes of Health (NIH) showed that daily supplementation with 1,000 mcg of chromium as chromium picolinate significantly enhanced insulin sensitivity. These initial results offer a potential new nutritional therapy for approximately 2 million American women suffering from Polycystic Ovarian Syndrome (PCOS). PCOS is a little- understood hormonal condition that is a leading cause of infertility, and is associated with insulin resistance, gestational diabetes and type 2 diabetes. The study was presented at the 59th Annual Meeting of the American Society for Reproductive Medicine Conference (ASRM) in San Antonio, Texas and appears in a supplement to Fertility and Sterility, September 2003.

In an effort to build on limited PCOS treatment options, researchers at the State University of New York (SUNY), Stony Brook, analyzed the effects of nutritional supplementation with chromium in the form of Chromax chromium picolinate on six women with PCOS. Results showed that glucose disposal rate (insulin sensitivity) was significantly increased by an average of 35% after two months of treatment, and baseline insulin levels decreased by 22%.

Chromium picolinate, which has positive effects on insulin sensitivity in people with type 2 diabetes, looks like it has great potential as a safe, effective long-term therapy to fill a void in treating PCOS,¡¨ said Michael L. Lydic, MD, assistant professor at SUNY Reproductive Endocrinology Division, who led the study. ¡§If larger, controlled trials confirm chromium picolinate's efficacy, PCOS patients could potentially take the supplement every day to decrease their risk of diabetes and possibly improve other physical and symptomatic effects of PCOS. It also has potential to be used in combination with prescription insulin-sensitizing drugs.

Today there is no FDA-approved drug specifically to treat PCOS. Some doctors prescribe insulin-sensitizing agents, such as metformin. However, many women experience unwanted side effects such as nausea, diarrhea, and loss of appetite, making ongoing treatment for insulin resistance prohibitive. Dr. Lydic added, "Our goal is to explore potential long-term therapies to bring insulin resistance under control and decrease risk of diabetes. Ideally, we hope to compare chromium picolinate with metformin in a clinical setting."

"An emerging body of research continues to confirm the findings that chromium insufficiency is an important nutritional factor in insulin resistance which is strongly associated with the type 2 diabetes epidemic," said Gail Montgomery, President and CEO. ¡§It is rewarding to see that Chromax supplementation shows promise as an affordable, convenient therapeutic option for women suffering from PCOS.

The study was a non-randomized, prospective study, which included six women of reproductive age (18 ¡V42 years old) with PCOS and signs of insulin resistance. Hyperinsulinemic, euglycemic clamp tests, the most accurate measure of insulin sensitivity, were used on all subjects.

Researchers measured hormonal, physical and symptomatic effects of improved insulin function. They reported that one subject without menstrual cycles, who had the largest change in glucose disposal rate, had a spontaneous menstrual period after 2 months. No adverse side effects were reported among the study participants.

The study was funded by an NIH grant and product was supplied by Nutrition 21, Inc.

Chromium is an essential mineral that is needed for insulin activity in carbohydrate, fat and protein metabolism. Numerous clinical trials have shown that chromium as chromium picolinate reduces insulin resistance, improves blood sugar control and may help reduce the risk of cardiovascular disease and type 2 diabetes.

May 13, 2003, http://www.youngagain.com

STATEMENT

Dr. Richard Anderson, USDA researcher from the Human Nutrition Research Center in Beltsville, MD comments, "Based on decades of extensive scientific research, I believe that consumers can continue to use chromium picolinate with confidence. In fact, many of those with insulin resistance are likely to benefit from chromium supplementation in the picolinate form."

"The FSA's attempt to raise dramatic safety concerns about chromium picolinate is alarming. I'm disappointed that this U.K. Agency has misrepresented the large body of scientific evidence that supports the safety of chromium picolinate supplementation, which is affirmed as Generally Recognized as Safe (GRAS) in the United States."

"There is no data to suggest that oral chromium picolinate supplementation in humans or animals has the potential to cause cancer or result in any other adverse event. The FSA suggested proposal to ban the use of chromium picolinate in manufacturing of food supplements in the U.K. is unfounded. In fact, the weight of evidence suggests that chromium as chromium picolinate has real potential to help millions of people, demonstrating consistent efficacy in supporting blood sugar control in people with type 2 diabetes, a disease that is reaching epidemic proportions in the U.S."

USDA research showing that chromium picolinate was safe in a 24-week animal toxicity study in which animals were dosed at chromium levels several thousand times the upper estimated safe intake for humans (Anderson, 1997). · The National Toxicology Program, a government agency, conducted an AMES test for chromosomal aberrations and a genotoxicity test for mutagenesis with chromium picolinate and found no toxicity.

These tests were performed under Environmental Protection Agency standards for evaluating toxicity of minerals (NTP-CASNO 14639-25-9). These same tests were replicated, further confirming the safety of chromium picolinate (Greenberg, 1999; Juturu, 2002). · The Institute of Medicine (IOM) Food & Nutrition Board recently conducted a scientific review and concluded that there was no basis for setting a tolerable upper level intake (UL) for chromium (The National Academies Press, 2002) · No adverse effects of chromium picolinate supplementation were found in 2,000 subjects who participated in 35 published clinical trials. More than a decade of safe use in human and animal U.S. nutrition markets with more than 10 million consumers using chromium picolinate supplements annually.

Note: This statement is the personal belief of Dr. Richard Anderson, not the official policy of the USDA. Nutrition 21, a leading researcher and marketer of chromium picolinate distributed this statement. Dr. Anderson has no financial ties to Nutrition 21. www.Nutrition21.com

Working together with insulin, chromium is a vital part of the body's natural mechanism for controlling blood sugar levels.

Chromium may also play a role in regulating blood cholesterol levels. In fact, a recent study indicated that 200mcg per day of chromium may lower total cholesterol.

Researchers have found that patients with coronary heart disease have significantly lower chromium levels than healthy people. Other studies suggest that chromium supplementation may support healthy vision and help fight glaucoma. Finally, chromium supplementation may help decrease body fat while increasing lean body mass. Chromium has been used in the treatment of diabetes and hypoglycemia.

Chromium may also play a role in regulating blood cholesterol levels. In fact, a recent study indicated that 200mcg per day of chromium may lower total cholesterol.

Chromium is an essential trace mineral nutrient. Like iron, zinc, selenium, copper, and several other essential trace minerals, chromium plays a critical role in maintaining normal health and well-being.

Chromium helps insulin to work efficiently. Most people are familiar with insulin as the shot diabetics give themselves in order to control their high blood sugar. But, what some people don't realize is that insulin is a master hormone of our metabolism; it not only helps controls blood sugar levels, but also helps regulate the metabolism of fats, proteins, and energy (calories). The precise way in which trivalent chromium affects insulin's actions is not presently known but is under active investigation. (See below for more on insulin)

The chromium that our body requires is called trivalent chromium, which means it has a net electronic charge of plus three (3+). The electronic charge on a molecule (also called "valence") is a major determinant of how the molecule will react chemically with other molecules. Trivalent chromium is sometimes written in a short-hand form (Cr+3).

There is another type of molecular chromium with a valence of six, Cr+6 or hexavalent chromium. Unlike trivalent chromium, hexavalent chromium does not occur naturally in significant amounts. Hexavalent chromium forms as a by-product of certain industrial processes such as the making of stainless and hard-alloy steels and in the manufacture of certain pigments. The name "chromium" comes from the Greek word for color.

Hexavalent chromium has been shown to be carcinogenic in humans, especially when inhaled as a dust. It is important to understand that the cancer-causing potential of hexavalent chromium has nothing whatsoever to do with trivalent chromium, which is the dietary form that is essential to health. There are many other examples of different molecular forms of the same substance having completely distinct chemical and/or biochemical properties (oxygen and iron come readily to mind).

Trivalent chromium has been tested over several decades and has never been shown to cause cancer in any animal ever studied. And, it should be noted that trivalent chromium cannot change into hexavalent chromium inside the body.

(Also, please see Safety section below)

It was known by the 1950s that chromium was required by animals to control blood sugar, but it wasn't until the 1970s that chromium's essential role in humans was clearly proven. This proof came accidentally, as a result of a new procedure that had been introduced to nourish hospitalized patients who could not take in any food by mouth. This procedure, giving specially-made feeding solutions directly through the patient's vein, is referred to as Total Parenteral Nutrition or TPN.

TPN was designed to give patients all the carbohydrates, proteins, fats, vitamins and minerals they needed to maintain health until they could once again eat normally and obtain these nutrients from food. Some of these patients who had been fed intravenously for months developed high blood sugars just as if they were diabetic (which they weren't). The doctors then had to start insulin therapy in order to treat this diabetes-like condition and even then the insulin they were given didn't appear to work as well as it should have.

Since it was already known that chromium was necessary for insulin action, it was thought that this trace element may have been lacking in these patients' TPN solutions. Thus it was deduced that these patients were showing signs of very severe chromium deficiency. The physicians caring for them then added chromium in very small amounts less than 50 micrograms (abbreviated as mcg; equal to 1/1000 of a milligram) to their IV feeding solution and quickly noted an improvement.

The patients no longer required insulin injections, and their blood sugars and other abnormalities returned to normal. After these cases of chromium deficiency and its serious consequences were reported, medical and nutrition experts agreed that chromium was an essential nutrient for humans and advised health professionals administering TPN about the danger of omitting chromium from the solutions.

Both the Food and Drug Administration (FDA) and the Food and Nutrition Board of the National Research Council (the quasi-governmental body that determines the Recommended Dietary Allowances or RDAs ) have therefore designated chromium an essential nutritional trace element.

Although insulin mainly works in muscle, fat and the liver, this hormone also exerts profound effects on many other body tissues. Insulin is the primary hormone that controls how the body's cells absorb, use and store nutrients and energy. Besides regulating the cellular absorption and utilization of glucose, amino acids (the building blocks of protein) and fatty acids, insulin also activates and inactivates enzymes (the protein catalysts for the body's biochemical reactions) and directly affects certain genetic processes including protein synthesis.

While trivalent chromium works with insulin to move glucose into cells, we currently do not know how many other critical actions of insulin require chromium to function. However, regarding the insulin-induced movement of glucose into cells, it is likely that chromium is either involved with the binding of insulin to its receptor (the site on the cell membrane which responds to signals from biochemical messengers such as hormones, drugs and nutrients and then stimulates or inhibits specific cellular functions) or with certain of the reactions which take place after the initial receptor site activation, reactions that are referred to as post-receptor events.

Because of chromium's connection to insulin function, it should come as no surprise that most of the research with this trace mineral relates to diabetes or to non-diabetic persons who develop high blood glucose levels after ingesting simple sugar. There are at least 16 clinical studies, which have tested specific chromium compounds in such patients using proper scientific methods (other studies on chromium supplementation in diabetics which used questionable methods in their study design are not included in the following summary).

While three of the 17 properly designed studies showed no benefit of chromium supplementation in diabetics, 14 did show blood glucose improvements in the patients tested. For example, a recent study that has been reported (which was presented in 1995 at the annual meeting of the American College of Nutrition) showed dramatic improvements in blood sugar using less than one milligram of supplemental chromium picolinate in a group of women who developed gestational diabetes (that is, they showed symptoms and signs of diabetes only during their pregnancies).

The latest study to examine the issue of chromium supplementation and adult-onset diabetes was presented in June, 1996 at the annual Scientific Sessions of the American Diabetes Association held in San Francisco, CA. Researchers from the Human Nutrition Research Center of the United States Department of Agriculture collaborated with Chinese researchers from the Beijing Medical University.

They randomized 180 adult-onset diabetics into 3 groups of 60 each: one group received placebo twice per day, the second received 100 mcg twice daily of chromium as chromium picolinate and the third received 500 mcg of chromium as chromium picolinate twice daily. Their blood work was examined at baseline, at 2 months and at 4 months.

The patients were told to remain on their anti-diabetic medications and continue with their diets and activity levels as before.

The results were impressive: blood glucose, insulin levels, cholesterol and glycated hemoglobin (a measure of blood sugar control over the previous few months) all decreased, with the higher dose generally (but not always) more effective than the 200 mcg.

How could such tiny amounts of chromium have such profound effects on insulin's action? Again, the answer is not known with certainty, but the evidence so far suggests that chromium strengthens certain effects of insulin on the body's cells; in other words, it doesn't work by stimulating the body to make more insulin, but rather chromium makes the insulin which is present function more effectively in the cells of the body.

When the body does not respond to insulin in the normal manner, doctors refer to this as insulin resistance. Insulin resistance signifies that the insulin, which is circulating in the blood, is not able to have its usual effects on various tissues in the body. This is not the problem with the type of diabetes (referred to as type I or juvenile-onset) that strikes young children: these individuals cannot make insulin anymore and thus must take it by injection. However, most diabetics suffer from maturity-onset diabetes (or type II; increasingly referred to as NIDDM or non-insulin dependent diabetes mellitus; this type of diabetes affects 90% of people with the disease).

It is these patients with NIDDM who demonstrate insulin resistance and are the ones most at risk for chromium deficiency and its consequences. Further, there is some evidence that marginal chromium deficiency may be important in other areas of health and disease. These other diseases where chromium may be important are some of the most common and significant illnesses of industrialized nations (see below).

The following is the ending to the chapter on chromium nutrition in the latest edition of the standard reference textbook on medical nutrition:

"Based on current knowledge of chromium function and nutrition, the possibility cannot be ignored that inadequate chromium status may be responsible in part for some cases of impaired glucose tolerance, 'hyperglycemia, hypoglycemia, glycosuria [sugar in urine], and refractoriness to insulin." Modern Nutrition in Health and Disease, Eighth Ed.., 1994. Shils, Olson and Shike, eds.

HEALTH NOTE

It is important to note that persons with diabetes who are on insulin or other anti-diabetic medications should check with their doctors before supplementing their diets. Because chromium may decrease the amount of insulin resistance present, it may change the type or amount of medication needed to treat the diabetes and/or the frequency with which blood sugar monitoring needs to be done.

This is especially important for those persons with diabetes who are under tight blood glucose control. Adding supplemental chromium in this situation has the potential to cause low blood sugar (hypoglycemia).

The combination of obesity, diabetes, hypertension (high blood pressure) along with abnormalities in blood cholesterol and fat( lipid) has long been noted in the medical literature. By the late 1980s, a noted diabetes expert from Stanford University (Dr. Gerald Reaven) proposed that the basic combination of high blood sugar, high blood pressure and abnormal blood lipids all constituted disease that was based on increased insulin resistance; he noted that while increased insulin resistance is the first step in the development of maturity-onset or type II diabetes, it is the body's response to the insulin resistance which determines whether or not the individual becomes a diabetic or not.

"Even if high blood sugar does not develop, insulin resistance does not appear to be a good thing to have: The fact that an insulin-resistant subject may not become diabetic does not mean that they suffer no untoward consequences. Indeed, an argument can be made that the more insulin sensitive an individual, the better off he or she is, and that the attempt to compensate for insulin resistance sets in motion a series of events that play an important role in the development of both hypertension and coronary artery disease." Reaven GM. Role of Insulin Resistance in Human Disease. Diabetes, 37:1595, Dec., 1988.

Since chromium reduces insulin resistance, this essential trace element could therefore have wide-ranging effects on high blood pressure and abnormal blood lipids in addition to lowering blood sugar. However, Dr. Reaven did not connect any insulin resistance to possible marginal chromium status, and we cite him here only to point out his contribution to describing this syndrome. It is also important to note that while studies in peer-reviewed medical journals have shown that chromium supplementation lowers blood lipids such as triglycerides, for now there are no human data on chromium and blood pressure.

Another area that is gaining more interest lately is the possible effect of chromium on body composition; that is, how chromium affects the relative amounts of lean body mass (mainly muscle) compared to the amount of body fat. At present, there are positive results from studies with four separate animal species supplemented with chromium picolinate: pigs, lambs, rats and chickens. In all of these species, there were increases in muscle mass and decreases in fat body mass. And, in the case of pigs, these findings have been confirmed by several additional studies. For humans, however, the evidence was not as clear until quite recently. In October, 1996 a study published in a peer-reviewed medical journal looked at 154 slightly overweight individuals split into three groups who were supplemented with either 200 mcg of chromium as the picolinate compound, 400 mcg of chromium as the picolinate compound or a placebo.

Previously, some human studies had shown either no effect, an effect similar to that seen in animals (that is, reduction in fat and increase in muscle) or an effect in women but not in men. The main problem with these older studies was that they had looked at very few individuals sometimes as few as 12; so, while it appeared that chromium was having an effect on body composition, since there were so few persons involved in the studies we could not be absolutely certain.

Further, some of the prior studies looked at young athletes (such as college football players) who, because of their high degree of fitness upon entering the study would not, in all likelihood, make the best subjects in which to observe these changes.