What is Chromium Deficiency?
Dietary minerals are elements found naturally that our bodies need for good health and proper functioning. Some of these minerals, like cobalt, copper, fluoride, iodine, manganese, molybdenum, selenium, zinc, and chromium, are only needed in small amounts to help maintain regular bodily processes. These are referred to as trace elements.
Chromium, one such trace element, has several different forms. The trivalent form helps the body process fats and carbohydrates and is thought to be important for several bodily enzymes that process carbs, proteins, and fats. This form of chromium can be found in a variety of foods like grains, meats, and high-bran cereals. It also boosts the impact of insulin, a hormone that helps manage blood sugar levels. This is why trivalent chromium is generally recommended as a necessary part of a regular diet, and is seen as vital for people who are on total parenteral nutrition, a method of feeding that bypasses the gastrointestinal tract.
However, recent research questions whether trivalent chromium is truly essential. Although animal studies suggest trivalent chromium is beneficial, it might not be required for normal body functions. Additionally, while earlier studies suggested chromium deficiency could cause problems with blood sugar control and insulin resistance, it now seems unlikely that a lack of chromium causes these issues. This perspective was backed up by the European Food and Safety Authority in 2014, who stated that an essential role for chromium wasn’t proven.
In light of this, it’s important that healthcare providers, including doctors, pharmacists, and dietitians, stay informed about chromium’s current status as an essential element. They need to understand its functions in the body and develop appropriate guidelines on chromium supplementation, especially for individuals on total parental nutrition. They should also understand how and when chromium replacement therapy should be used, particularly in health conditions where it is marketed as beneficial. This means staying updated on recent research on chromium’s role as a dietary trace element, its functions, potential effects of deficiency, and replacement guidelines for those receiving total parenteral nutrition.
What Causes Chromium Deficiency?
There is some disagreement in the medical world about whether chromium is a necessary mineral in our diet. The controversy stems in part from the fact that chromium is common in the typical human diet and often ends up in our food after coming into contact with machines made of stainless steel that are used to process food or cookware made of stainless steel. On average, people in America consume about 30 micrograms of chromium per day, which falls within the acceptable intake range set by the Food and Nutrition Board of the National Academy of Sciences Institute of Medicine. Furthermore, no deficiencies have been reported in healthy individuals.
However, some research suggests that older people and people who have severe health issues, like severe injuries or infections, might be more susceptible to a chromium deficiency. Infection has also been linked to lower chromium levels in the body, which might explain the high blood sugar levels often observed in these situations. Moreover, people who have trouble absorbing nutrients, particularly those with a condition called short bowel syndrome and who are therefore on special nutritional support (known as parenteral nutrition) without added chromium, are also at risk.
Most chromium leaves the body through urine in individuals with healthy kidneys. However, even long-term continuous kidney therapies have not been linked to abnormal chromium levels.
Risk Factors and Frequency for Chromium Deficiency
Chromium deficiency is not a usual occurrence in healthy people who eat a balanced regular diet. A few cases, less than 10, were noted decades ago where people showing signs of glucose intolerance and insulin resistance treated with a form of nutrition delivered directly into their bloodstream seemed to benefit from additional chromium. This treatment involved the daily administration of chromium doses, much higher than the typical levels found in healthy people’s blood which may indicate chromium’s potential in helping to treat glucose intolerance or insulin resistance. But it doesn’t seem to play a vital role as a necessary element for those following a regular balanced diet.
In these reported cases, even before adding extra chromium, the levels of chromium in the blood and urine were above normal. Most researchers and health experts agree there is no evidence that people eating a common diet would have a deficiency of chromium. An added complication is that the methods to measure chromium levels aren’t very dependable.
Signs and Symptoms of Chromium Deficiency
Chromium deficiency is somewhat of a medical mystery, because it’s quite rare and we don’t understand fully what chromium does in the body. Therefore, it’s difficult to nail down exact symptoms of chromium deficiency. In healthy people, there’s no evidence of signs or symptoms linked to a lack of this mineral. However, a few cases have been reported where individuals had to receive all their nutrition through a vein (a condition known as ‘total parenteral nutrition’) and their diets did not include chromium supplementation. Some of these individuals had a condition known as ‘short gut syndrome’.
In these few cases, the main symptom of chromium deficiency was trouble maintaining steady blood sugar levels, even with more insulin. Some of these individuals also experienced weight loss, nerve damage in the arms and legs (known as ‘peripheral neuropathy’), and an increase in the quantity of fats in the blood. These symptoms improved when chromium was added to their diets.
Today, medical professionals usually suspect chromium deficiency in people who are critically ill and having unexplained problems with blood sugar levels, or needing more insulin all of a sudden. If a patient shows signs of this condition, doctors should conduct a thorough clinical evaluation, including a detailed medical history.
- They should find out the timing of changes in the patient’s metabolism, as well as any potential risk factors.
- Important information includes whether the patient has ever been diagnosed with malnutrition, including conditions like anorexia nervosa and alcoholism.
- Any procedures the patient has undergone, or past trauma, should also be noted.
- Conditions such as severe physical injuries or burns, or short bowel syndrome, could reduce the body’s ability to absorb and use chromium.
- Patients who have been in the hospital for a long time and have been receiving all their nutrition through a vein should also be checked for possible chromium deficiency.
Testing for Chromium Deficiency
To assess chromium deficiency, doctors measure the levels of chromium in a patient’s blood plasma. Typical results range between 1 and 5 micrograms per liter. But, these tests aren’t perfect. They don’t reflect the amount of chromium stored in a person’s liver, spleen, bones, or other soft tissues. Therefore, you can’t fully trust these measurements. Another thing to note is that illness can lower chromium levels in the blood even if the body has sufficient chromium reserves.
Doctors have also tried measuring chromium levels in urine. Although some initial studies relied on this method, it doesn’t give accurate results. Like blood tests, urine tests for chromium only show what’s been recently consumed in the diet, not the amount of chromium stored in body tissues.
Another way to find out if a person has a chromium deficiency is testing glucose tolerance after having given chromium to the patient. Although this method goes roundabout, it’s a reliable way to detect this deficiency.
Due to these limitations, regular chromium level testing or glucose tolerance testing for monitoring purposes isn’t advised. Even for very ill patients receiving all nutrition through an intravenous tube, routinely checking chromium levels isn’t recommended. If a doctor suspects a chromium deficiency, the most likely approach would be to test glucose tolerance before and after giving chromium to the patient.
Treatment Options for Chromium Deficiency
The Food and Nutrition Board of the National Academy of Sciences Institute of Medicine recommends daily chromium intake of 35 μg for men and 25 μg for women. This recommendation is based on studies which show that nearly all individuals who consume this amount of chromium have no signs of deficiency.
Chromium supplementation is also advised for those receiving nutrition via feeding tubes or intravenous feeding. Current guidelines suggest a minimum of 35 µg per day for those on tube feeding and 10 to 15 µg per day for those on intravenous feeding. These doses have been used safely for a long time. However, there is some controversy over chromium supplementation, as the best dosage has yet to be determined.
When a lack of chromium is suspected due to insulin resistance, healthcare professionals recommend a dosage of 200 to 250 µg per day for 2 weeks via intravenous feeding. After 2 weeks of supplementation, insulin resistance should be reassessed. Please note that these recommendations apply only to critically ill patients with insulin resistance, not to patients with diabetes or obesity.
It’s important to note that the chromium in intravenous feeding solutions enters the bloodstream directly, while only about 0.5% of chromium from food is absorbed. Treating chromium deficiency often involves giving doses that are 100 to 1000 times higher than what someone typically gets from food. This raises questions about whether the symptoms of chromium deficiency are caused solely by the deficiency, and if chromium truly plays a crucial role in normal bodily functions.
Interestingly, taking chromium supplements can reduce inflammatory markers, according to a recent analysis of multiple studies. This analysis found a reduction in two key inflammatory markers, C-reactive protein and tumor necrosis factor-α, in patients with type 2 diabetes, obesity, and women with polycystic ovarian syndrome. However, the effectiveness of supplements on inflammation can’t be confirmed definitively due to the differences in the participant groups and metabolic processes studied in these trials.
The use of chromium supplements beyond the recommended intake for people with no chromium deficiency is generally discouraged. Similarly, there’s little support for taking chromium supplements to manage high blood sugar and abnormal levels of blood fats unless you are in critical condition with severe insulin resistance and high blood sugar. Additionally, evidence suggests chromium doesn’t significantly help in maintaining a healthy body weight or blood cholesterol levels.
Despite some studies showing a slight reduction in blood pressure in patients taking chromium supplements, more reliable, large-scale studies are needed to definitively confirm these findings.
What else can Chromium Deficiency be?
When a doctor suspects someone might have a chromium deficiency, they also need to consider several other health problems that may cause similar symptoms. These health problems often result in the body’s resistance to insulin (a hormone that helps control blood sugar) and intolerance to glucose (a type of sugar), making it harder for the body to process sugar properly. The main conditions that can cause these symptoms include:
- Obesity
- Metabolic syndrome (a group of conditions including high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels)
- Type 2 diabetes
- Lipodystrophy (a medical condition characterized by abnormal or degenerative conditions of the body’s fat tissue)
- Use of glucocorticoids (a type of steroid hormone)
- Pregnancy
- Type A and Type B insulin resistance (severe forms of insulin resistance)
New-onset diabetes may need to be considered since it’s a common cause of insulin resistance. Other conditions like certain issues with the pancreas, including obstruction or inherent dysfunction, may cause similar symptoms. Most often though, obesity and metabolic syndrome are the root of the problem. These should be ruled out before a deficiency in chromium is concluded as the cause of these symptoms.
What to expect with Chromium Deficiency
There isn’t a lot of data available, but people with chromium deficiency are generally believed to have good outcomes. There are no known reports of illness or death directly related to chromium deficiency either in medical practice or in the literature.
Possible Complications When Diagnosed with Chromium Deficiency
Despite the fact that well-nourished people typically do not show any specific signs of low chromium intake, there are certain complications associated with chromium deficiency. For instance, it could lead to higher blood sugar levels in the body.
Some reports suggest a link between chromium deficiency and an increased inflammation state in the body, as well as potential heightened risk for heart-related conditions. However, there isn’t enough scientific evidence to directly associate these health complications with chromium deficiency.
There have been clinical studies investigating the connection between chromium deficiency and metabolic syndrome, a group of conditions that increase the risk of heart disease, stroke, and diabetes type 2. However, while these studies showed some correlation, they were limited by the small number of participants and the diverse profiles of the individuals involved, making it difficult to prove a cause-and-effect relationship. The US National Institutes of Health (NIH) has stated, based on the currently available clinical data, that there are no benefits of chromium supplementation for those with metabolic syndrome.
Chromium deficiency is also thought to be connected to neurocognitive diseases. This belief is based on the knowledge that insulin resistance, which can be influenced by chromium levels, plays a role in changes seen in diseases like Alzheimer’s. In fact, one study conducted in 2010 found that chromium supplementation had a positive effect on learning, memory tasks, and recall in older adults with mild cognitive impairment. However, a review in 2018 by Cochrane, an international organisation that reviews health research, maintained that the quality of the data supporting this idea is too low to make any firm conclusions.
- Chromium deficiency could increase blood sugar levels in the body
- Increased risk of inflammation
- Potentially increased risk of heart-related conditions
- Some evidence of connection to metabolic syndrome
- Possible association with neurocognitive diseases
When it comes to trivalent chromium supplementation specifically, complications are quite rare, most likely because our bodies cannot easily convert this type of chromium into a toxic form. However, there have been individual cases where taking high doses orally, between 600 and 2400 micrograms per day, resulted in kidney and liver failure. This is less likely to happen overall because the chromium is not easily absorbed by the body in this way. Consequently, no upper limit for safe intake of this form of chromium has been established.
There have never been any reported instances of chromium toxicity in adults who have received long-term total parenteral nutrition (TPN), which includes recommended doses of chromium supplementation. However, the toxic effects of chromium on the kidneys may be greater in children, and thus, guidelines recommend not including chromium supplementation in TPN for kids, or severely reducing the dose.
Reports haven’t shown any detrimental effects to human embryos from trivalent chromium supplementation. However, a recent mouse study using in vitro fertilization found that the chromium did have toxic effects on the embryos, especially during the pre-implantation stage.
- Trivalent chromium supplementation complications are rare
- Possible reports of kidney and liver failure with high doses
- No established upper limit for safe intake
- No reported cases of toxicity in adults receiving long-term TPN
- Children may be more susceptible to kidney effects
- Research indicates potential toxicity to mouse embryos
Preventing Chromium Deficiency
There’s typically no need to take extra steps to prevent a lack of chromium, which is a nutrient found in many different foods. In fact, the average adult’s regular diet often provides enough chromium, no additional supplementation needed. However, some individuals – such as those who rely on nutrition delivered through a vein (total parenteral nutrition), those with conditions like short bowel syndrome, malnutrition, severe burn injuries, or trauma – may need extra chromium and should be monitored for signs of deficiency.
It’s important for people to understand the actual effectiveness of chromium supplementation, especially as it’s often marketed for certain health conditions. For example, some advertising suggests that taking extra chromium can help lose weight, increase lean body muscle, control blood sugar in people with diabetes, and even prevent diabetes in people at risk. However, medical professionals need to remind their patients that there’s little clinical proof to support these claims. In fact, any weight loss from chromium supplementation is usually minimal and may not significantly impact health. Current medical advice typically recommends against routine use of chromium for people who are overweight or obese.
