Posted by SLS on September 14, 2006, at 7:08:25
In reply to Re: Success using chromium for carb cravings?, posted by redbeach on September 13, 2006, at 16:26:33
> have you any links to these studies
>
> Redbeach
>
>
> > Several studies indicate that chromium picolinate at 600 micrograms reduces carbohydrate cravings in atypical depression.
> >
> > Any comments?
> >
> >
> > - Scott
>
>----------------------------------------------------------
Chromium Supplementation May Reduce Carbohydrate Cravings of Atypical Depression CMENews Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEdComplete author affiliations and disclosures, and other CME information, are available at the end of this activity.
Release Date: October 6, 2005; Valid for credit through October 6, 2006
Credits Available
Physicians - up to 0.25 AMA PRA Category 1 Credit(s)TM for physiciansAll other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation.
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--------------------------------------------------------------------------------Oct. 6, 2005 — Chromium supplementation may be effective for the carbohydrate cravings of atypical depression, according to the results of a double-blind, randomized trial published in the September issue of the Journal of Psychiatric Practice.
"For years, the link between depression, insulin sensitivity, and the value of dietary chromium picolinate [CrPic] has been hinted at in small studies and this trial may bring us closer to understanding the connection," lead author John P. Docherty, MD, from Comprehensive NeuroScience Inc., and Weill Medical College of Cornell University in New York, NY, says in a news release. "These results suggest that the use of chromium picolinate may be beneficial for patients with atypical depression who also have severe carbohydrate craving."
In this multicenter, eight-week replication study, 113 adult outpatients with atypical depression were randomized in a 2:1 ratio to receive 600 μg per day of elemental chromium as CrPic or placebo. The main outcome measures were the 29-item Hamilton Depression Rating Scale (HAM-D-29) and the Clinical Global Impressions Improvement Scale (CGI-I).
Of the 113 randomized patients, 110 patients (70 CrPic, 40 placebo) received at least one dose of study medication and completed at least one efficacy evaluation. Of these 110 patients constituting the intent-to-treat (ITT) population, 75 (50 CrPic, 25 placebo) took at least 80% of study drug with no significant protocol deviations and were therefore evaluable. Mean age in the evaluable population was 46 years; 69% were female, 81% were white, and mean body mass index (BMI) was 29.7 kg per m2.
In both the ITT and evaluable populations, the primary end points did not differ significantly between the CrPic and placebo groups. During treatment, total HAM-D-29 scores improved significantly from baseline in both groups (P < .0001). However, in the evaluable population, the CrPic group had significant improvements from baseline vs the placebo group on four HAM-D-29 items: appetite increase, increased eating, carbohydrate craving, and diurnal variation of feelings.
For the subset of 41 patients in the ITT population with high carbohydrate craving (26 CrPic, 15 placebo; mean BMI, 31.1 kg/m2), those receiving CrPic had significantly greater response on total HAM-D-29 scores than did those receiving placebo (65% vs 33%; P < .05). Those receiving CrPic also had significantly greater improvements on the following HAM-D-29 items: appetite increase, increased eating, carbohydrate craving, and genital symptoms such as libido. Chromium supplementation was well-tolerated.
Study limitations were lack of a placebo run-in period, no requirement for minimum duration or severity of depression, and enrollment of patients with major depression, dysthymia, or depression NOS.
The authors conclude that the main effect of chromium was on carbohydrate craving and appetite regulation in patients with depression, and that 600 μg of elemental chromium may benefit patients with atypical depression and severe carbohydrate craving. However, they recommend further studies to evaluate chromium in patients with depression specifically selected for symptoms of increased appetite and carbohydrate craving and to determine whether a higher dose of chromium would have an effect on mood.
"These findings also suggest that physicians and mental health professionals should be alert to patients who report carbohydrate craving as it may signal the possible presence of a more serious underlying medical condition, such as atypical depression," Dr. Docherty says. "The use of antidepressants, mood stabilizers, and antipsychotics that are commonly prescribed to treat depression can often worsen carbohydrate cravings. A treatment that effectively reduces carbohydrate cravings and has a favorable tolerability and side-effect profile would be a very useful contribution to improve overall health outcomes."
Nutrition 21, Inc,. which markets CrPic as an ingredient and as a finished product, funded this study and employs two of its authors.
J Psychiatr Pract. 2005;11:302-314
Learning Objectives for This Educational Activity
Upon completion of this activity, participants will be able to:
List clinical features of atypical depression.
Compare the effect of eight weeks of CrPic vs placebo on atypical depression.
Clinical Context
Atypical depression is a common but frequently undiagnosed depressive disorder, affecting up to 42% of 19 million Americans with depression and is characterized by mood reactivity and two or more of the following symptoms: significant weight gain, hypersomnia, leaden paralysis, and a long-standing pattern of interpersonal rejection sensitivity. Clinical features also include carbohydrate cravings and unexplained fatigue. According to the current authors, patients with atypical depression are more likely to be overweight and to overeat and do not respond well to selective serotonin reuptake inhibitors. Chromium is an essential trace mineral whose main role is to work with insulin to metabolize carbohydrates, fats, and proteins. When bound to picolinic acid as CrPic, absorption is significantly improved. Previous case studies have suggested that chromium supplementation may lead to remission of dysthymic symptoms. The current authors propose a possible antidepressant effect of CrPic in atypical depression.The current study is a pilot, multisite, randomized, placebo-controlled, double-blind study examining the effect of eight weeks supplementation with 600 µg daily of CrPic in patients with atypical depression conducted at 10 commercial research centers.
Study Highlights
Inclusion criteria were patients aged 18 to 65 years who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, criteria for a major depressive episode or dysthymia, met criteria for atypical depression defined by the Columbia Atypical Depression Diagnostic Scale (ADDS), and who were not pregnant.
Exclusion criteria were any other Axis 1 psychiatric disorder, significant medical condition, electrocardiographic abnormality, attempted suicide within 1 year, nonresponse to 3 previous antidepressants, taking any form of chromium within 21 days, and taking psychotropic drugs.
113 patients were randomized in 2:1 ratio to receive either CrPic at 400 µg daily for 2 weeks followed by 600 µg daily for 6 weeks or matching placebo for 8 weeks. Medication was taken once daily in the morning before or after a meal.
A washout period for antidepressants was allowed.
Patients were seen for 6 visits, including a screening and baseline visit followed by visits every 2 weeks.
Primary outcomes were HAMD-D-29 score, including subcomponents of the Seasonal Affective Disorder 8 (SAD-8) scale, and the CGI-I scale. They also completed the 90-item Symptom Checklist (SCL-90).
Adverse events were monitored.
Efficacy was evaluated in the ITT population of 110 patients who took at least 1 study drug (70 CrPic and 40 placebo), and the evaluable population of 75 patients who took 80% of the medications (50 CrPic and 25 placebo).
Mean age was 46 years, three quarters were women, two thirds to three quarters were white, and mean BMI was 29.7 kg per m2.
Both the CrPic and placebo groups showed significant improvement in the HAM-D-29 score from baseline, but few patients showed complete remission.
Using a definition of "responder" of greater than 50% improvement in HAM-D-29 score and a CGI-I score of 1 or 2, the responder rate was 46% for CrPic vs 43% for placebo in the ITT group.
There were no statistically significant differences in weight change from baseline, total HAM-D-29 scores, individual items of the SAD-8 or the SCL-90, and ADDS between the groups.
There was a significant correlation between baseline severity of carbohydrate craving and improvement in the overall HAM-D-29 in the CrPic but not the placebo group in both the ITT and evaluable populations.
In the evaluable population, the CrPic group showed significant improvement vs baseline on four HAM-D-29 items: appetite increase, increased eating, carbohydrate craving, and diurnal variation of feelings.
In the subgroup of ITT patients with high carbohydrate craving (n = 41), mean age was 50 years, mean BMI was 31.5 kg per m2, and there were more black patients than whites (17% vs 8%, respectively, in the overall study population).
This subgroup had a significantly greater response to CrPic than to placebo on the total HAM-D-29 score (65% vs 33% response rate; P < .05) and on 4 HAM-D-29 items: increased carbohydrate craving, appetite increase, and increased eating and genital symptoms (libido).
Adverse events attributable to treatment were minimal and similar between groups.
Pearls for Practice
Atypical depression is a form of depressive disorder with mood reactivity and two or more one of the following symptoms: significant weight gain, hypersomnia, leaden paralysis, and a long-standing pattern of interpersonal rejection sensitivity. Clinical features also include carbohydrate cravings and unexplained fatigue.
Supplementation with eight weeks of CrPic vs placebo is associated with improvements in HAM-D-29 score and four symptoms related to weight gain in a subset of patients with high baseline carbohydrate craving.
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URL: http://www.dr-bob.org/babble/alter/20060817/msgs/685807.html