Will chromium help Alzheimer's disease?

Q: I just finished reading your book, Lifting Depression: The Chromium Connection, and came away thinking that there may also be a link between chromium deficiency, insulin resistance, and Alzheimer's.

My 81-year-old father has just been diagnosed with Alzheimer's, and I noticed over the last 10-15 years that he developed a much stronger craving for sugary foods and carbohydrates. Diabetes runs in the family.

I found an article that links impaired insulin functioning in the brain and Alzheimer's disease.

I am thinking of suggesting that he take chromium supplements in the hopes that the progress of his disease will be milder.

Does this strategy sound reasonable to you?

A: You are so kind to write. You are forward-thinking and I appreciate that. I'll give you my short and long answers.

I don't know whether chromium will slow the progression of your father's illness. There is some evidence that is consistent with your presumption that chromium supplementation might delay or prevent the development of Alzheimer's. You mention one of the articles that suggests a link between impaired insulin functioning (diabetes) and Alzheimer's. I do think that you and members of your family should consider adopting measures that increase the sensitivity of the body to insulin. They include supplementing your diets with Chromax chromium picolinate, getting more exercise, and losing weight.

Here is the long answer: I think I understand your reasoning, but I want to make sure that I do. You think your father might have insulin resistance and that insulin resistance might be a factor in causing his Alzheimer's disease. You base this on three observations: 1) diabetes runs in your family, 2) your father craves carbohydrates, and 3) his carbohydrate craving increased during recent years when his Alzheimer's disease was developing. Since chromium reduces carb cravings and increases sensitivity of the body to insulin, you think chromium might slow the progression of your father's illness.

Alzheimer's disease and insulin resistance
There are several pieces of data that support your idea. You mentioned one of the studies, namely an article that links Alzheimer's and diabetes. I am familiar with the article you cited. I remember reading it with great excitement. For those who haven't read it, I'll summarize it here.

Dr. Suzanne de la Monte, M.D., M.P.H, a professor of pathology at Brown Medical School and her fellow researchers, conducted postmortem examinations of brain tissue of people who had Alzheimer's disease. They found that there was a reduced level of insulin and its related proteins in the hippocampus, which is the part of the brain involved in memory.

In a related study, the researchers conducted an experiment in rats in which insulin action is blocked due to a defective gene. They found that brain cell growth was interrupted.

Dr. de la Monte was awarded the Alzheimer's Medal for her original work.

Diabetes Increases Risk of Developing Alzheimer's Disease

There is another article that I think you'll find most interesting and perhaps helpful. It's large study that found that a group of people with diabetes had a 65% greater risk of developing Alzheimer's than a group without diabetes.

I find the above study both hopeful and alarming. Hopeful in that it suggests measures that might prevent the development of diabetes and Alzheimer's. It's alarming, however, because the rate of obesity and type 2 diabetes is reaching epidemic proportions, which suggest the occurrence of Alzheimer's might increase faster than currently feared.

Let's look at the study in more detail. Dr. Zoe Arvanitakis, M.D. and Dr.David Bennett, M.D., and colleagues at the Rush University Medical Center in Chicago studied 824 Catholic nuns and priests. At the beginning of the study none had any sign of Alzheimer's, but 127 of them had diabetes. Over a period of five years, 151 developed Alzheimer's disease. This is a much higher rate than would be expected in those who don't have diabetes. The study was funded by the National Institute on Aging (NIA) at the National Institutes of Health.

How might diabetes increase the risk of developing Alzheimer's disease? Neurons (brain cells) must have glucose to function normally. In people with diabetes, insufficient glucose enters cells. Over time this blood-sugar deficit in neurons might contribute to the development of Alzheimer's disease.

Same Drug May Treat Diabetes and Alzheimer's Disease

Rosiglitazone (pronounced ROH-see-GLIT-a-zohn)or Avandia (trade name) is a drug proven to be useful in the treatment of diabetes. It's too early to known for certain, but it may also be effective in Alzheimer's disease. There is an excellent newspaper article on the topic. This early finding has been published in the The Pharmacogenetics Journal.

Chrmoium deficiency may damage brain cells and nerves outside the brain

The two earliest reports on severe chomium deficiency reported involvment of the brain and nerves in the body. I discussed these cases at some length in Lifting Depression: The Chromium Connection. Briefly, Dr. Khursheed Jeejeebhoy, professor of gastroenterology at the Toronto General Hospital in Canada, was taking care of a patient who required feeding through her veins of a mixture of nutrients, called TPN, that was later found to be chromium deficient. Her ability to “burn” or metabolize glucose became impaired with the result that her blood sugar rose to abnormally high levels. In addition, her legs tingled, she lost sensation in her legs (peripheral sensory neuropathy), and her gait became unsteady (ataxia). After chromium was added to her nutrient mixture, her nerve problem disappeared. Dr. Jeejeebhoy reported on this case in 1977 in an article titled, "Chromium deficiency, glucose intolerance, and neuropathy reversed by chromium supplementation in a patient receiving long-term total parenteral nutrition."

A similar observation was made in the second case report. Dr. Herbert Freund, M.D., a surgeon at the Massachusetts General Hospital in Boston, had a 45-year-old woman patient whose also was being fed through her veins. After a few months, she became confused (encephalopathy). Dr. Freund added chromium to his patient's TPN mixture and her confusion disappeared within three days.

Both case reports suggested that chromium is necessary for normal functioning of the nervous system, but this lead was not followed up until I discovered the role of chromium in mood regulation.

What To Do?
Should a person wait for more evidence of a connection between diabetes and Alzheimer's disease before adopting measures that hopefully will decrease the risk of diabetes. "No," is my answer. there is enough evidence linking impaired insulin functioning and Alzheimer's to justify dietary supplementation with chromium, which incrases the senstivity of the body to insulin.

If your hunch -- that chromium may help with Alzheimer's disease by increasing sensitivity of the body to insulin -- is shown to be correct 20 or 30 years from now, supplementing your diet and that of other family members with Chromax chromium picolinate, getting more exercise and shedding a few pounds would prove to be of great preventive value. Even if future research shows that chromium does not have any effect in preventing Alzheimer's, the family history of diabetes and carb craving are good reasons for chromium supplementation of your diet and that of your family members.

Your question is very perceptive and I'm grateful to you for writing to me. Please let me know whether chromium reduces your father's craving for carbs and if it seems to slow the progression of his Alzheimer's disease.

Gratefully,

Malcolm McLeod

Is chromium picolinate safe?

Q: My concern about adding chromium picolinate to my diet, as with any metal, is toxicity. Laboratory studies have suggested that [chromium picolinate] could damage genetic material in animal cells. Might this cause cancer?

A: Thank you for raising these important issues. I'll take this opportunity to respond to these concerns at some length. First I'll address the question of heavy metal toxicity and, then, I'll point to the safety of Chromax® chromium picolinate.

Heavy metal toxicity
Chromium exists in many forms. Two common forms are trivalent chromium and hexavalent chromium. Trivalent chromium, which includes chromium picolinate, is safe and essential for normal functioning of the human body. Hexavalent chromium is a form of chromium that is produced in industrial processes and which is toxic at high levels.

Trivalent chromium and hexavalent chromium are as different as chlorine gas is from sodium chloride (table salt). Table salt and chlorine gas both contain the element chlorine, but in different chemical states. Chlorine gas is toxic and sodium chloride is used to season food.

Does chromium cause chromosomal damage?
The short answer is: both the U.S. Food and Drug Administration (FDA) and the U.K. Food Standards Agency (FSA) have acknowledged the safety of chromium picolinate.

Here’s the long answer: The tests that raised questions about chromium picolinate's safety are outdated and have been disproved by recent experiments.

In 1995, Diane Stearns, Ph.D., reported on results that suggested that chromium picolinate damaged DNA and might, therefore, increase the risk of cancer. Dr. Stearns extracted cells from the ovaries of Chinese hamsters and put them in Petri dishes, to which she added a mixture of trivalent chromium picolinate, chromium chloride, and picolinic acid. Then she examined the cells and found that the chromosomes in some of them had been damaged.

The Stearns’ study is of limited scientific applicability for at least four reasons:

1) The experiment was not conducted in living animals. Rather it was performed in a Petri dish. It was a so-called "test-tube" experiment. The result of test-tube experiments cannot be reliably extrapolated to humans.

2) The cells in the Petri dishes were treated with very high concentrations of chromium.

3) The type of chromium picolinate that most people take -- the type that is readily found on the shelves of grocery, pharmacy and health-food stores -- was not used. Rather, Sterns used chromium picolinate made in a laboratory.

4) The experiment was not conducted in accordance with internationally accepted guidelines.

As a result of the Stearns’ study, Dr. Richard Anderson, a lead researcher and chromium expert at the U.S. Department of Agriculture (USDA), decided to evaluate chromium's safety in living animals by supplementing rats' diets with large amounts of chromium picolinate. The results of his study found no toxicity. Based on his review of the Stearns’ study and on his results, Dr. Anderson concluded that the Stearns’ study was "extremely questionable."

In 2003, the U.K. Expert Group on Vitamins and Minerals (EVM) raised some initial questions about chromium picolinate’s safety based on the same Stearns’ data. When questions were later raised about some of Stearns’ findings and conclusions upon which the EVM concerns were based, the U.K. FSA conducted a review of chromium's safety. As part of their review, the agency requested a repeat of the Stearns’ tests that would be conducted according to internationally accepted guidelines and using commercially available Chromax® chromium picolinate, which was supplied by Nutrition 21. The repeat tests were conducted by Ron Slesinski, PhD, DABT, a senior scientist at ENVIRON Health Sciences. This study did not show any evidence of genetic damage in hamster ovary cells. Dr. Slesinski commented, "The new findings are consistent with many previous studies showing chromium picolinate is safe."

As a result of the demonstrated safety of chromium picolinate, the U.K.Committee on Mutagenicity (COM) issued an official opinion on December 13, 2004, stating that, based on the balance of the data, chromium should be regarded as not being genotoxic in vitro and that no further testing was advised. In addition, on the same day the FSA announced that consumers can feel confident that chromium picolinate is a safe nutritional supplement, revising earlier recommendations.

Based on the extensive safety dossier supporting Chromax® chromium picolinate, in 2005 Nutrition 21 received green lights for continued sale of Chromax® in 19 European Community (EC) countries through 2009. In addition, in August 2005, the U.S. Food and Drug Administration (FDA) allowed a qualified health claim for chromium picolinate which confirms that chromium picolinate is a safe nutritional supplement [under the requirements of 21 CFR 101.14(b)(3)(ii)].

In short, Chromax® chromium picolinate is one of the safest nutritional supplements.

I hope I have answered your questions fully.

Why do some people become chromium deficient?

Below in Italics is an e-mail I received:

Dear Dr. McLeod,

I wonder what causes the imbalance/deficiency in chromium in the first place. Most of us eat a relatively similar diet. Some people eat more healthily than others. But, as you mention in your book, it would be difficult to eat enough food with enough chromium in it to overcome such deficiencies as those that cause depression. But some people apparently manage to do just that.

I'm wondering if the body somehow rids itself of chromium under certain circumstances. And if so, what are those circumstances? Are they liver or kidney difficulties? In other words why do some people who probably eat a generally similar diet not have these deficiencies?

This all really interests me and I thank you so much for your answer to my question.

Best wishes and many, many thanks again,

Wendy

Here is my answer:

Dear Wendy.

Thank you for asking another excellent question. Chromium deficiency can occur due to inadequate intake and loss. There include advancing age, soil deficiency, removal of chromium during food processing, diets high in sugar, diets low in meat, stomach and intestinal disorders that interfere with absorption, antacids, drugs that decrease stomach acidity, corticsteroids, profuse sweating, and stress. I'll go into these in a little more detail.

Advancing age. A large study demonstrated "highly significant age-related decreases in chromium levels in 51,665 hair, sweat, and serum samples obtained from 40,872 patients..."


Soil deficiency. Exhaustive farming may have removed chromium from the soil.

Processing of foods. White bread and white sugar contain very little chromium. The process of making these foods removes chromium.

Diets high in sugar cause chromium excretion in urine.

Disorders of the stomach and intestines may reduce absorption of chromium.

Vegetarian diet. While healthy in many ways, diets that don't contain meat are low in chromium. Several patients, who are vegetarian, responded well to chromium supplementation.

Antacids. Antacids in the stomach may combine with chromium and interfere with its absorption. Joseph, a man I described in Lifting Depression: The Chromium Connection, had taken antacids for years. I wonder if that caused him to become chromium deficient.

Decrease in stomach acid. Drugs that decrease acid in the stomach may interfere with the absorption of chromium. Such acid-decreasing drugs include cimetidine, rantidine, and esomeprazole.

Corticosteroids. A study of 13 patients showed that administration of corticosteroids caused chromium loss. I wonder -- because chronic stress is associated with an increase in blood cortisol -- if chronic stress might deplete the body of chromium.

Exercise. Chronic, sustained exercise and sweating my decrease chromium in the body. Several of my patients, whose depression responded beautifully to chromium, had relapses after intense exercise on a hot day. Doubling chromium intake for 2-3 days corrected the problem.

A great deal more research needs to be conducted on the topic of chromium deficiency. Again, thank you for asking this excellent question.