Chromium deficiency

# Overview
Chromium deficiency is a disorder that results from an insufficient dietary intake of chromium.  It occurs rarely in developed nations.

# Use of chromium in the body
Trivalent chromium is an essential trace metal and is required for the proper metabolism of sugar in humans.  In contrast, hexavalent chromium is very toxic and mutagenic.
Trivalent chromium has been found to be the key constituent in the so-called glucose tolerance factor (GTF). GTF is a metalloprotein complex that is formed when the oligopeptide chromodulin, which consists of the four amino acid residues aspartate, cysteine, glutamate, and glycine, is bonded with four chromic trivalent (Cr3+) ions. Recent studies suggest that this metalloprotein plays an important role in insulin receptor activity by enhancing the efficiency of insulin.

# Dietary Guidelines
The dietary guidelines for adequate daily chromium intake were lowered from 50-200 g for an adult to 30- 35 g (adult male) and to 20-25 g (adult female).
Approximately 2% of chromium of ingested chromium(III) is absorbed, with the remainder being excreted in the feces.  Vitamin C and niacin may enhance the uptake of chromium from the intestinal tract.  After absorption, this trace mineral is stored in the liver, bone, and spleen for later use in the body.
The amount of chromium in the body can be decreased as a result of a diet high in simple sugars and/or high in fats, if an infection is present in the body, if the person is pregnant or lactating, and/or if the person is partaking in acute exercise.  The body excretes the specified amount of chromium out of the body through the process of urination.  Because of the high excretion rates and the very low absorption rates of chromium, toxicity is uncommon, even with the use of chromium supplements.

# Diagnosis

## Diagnosis Critera

## Symptoms and History
If a person is deficient in chromium they may experience one or more of a wide variety of symptoms.  These may include: increased blood cholesterol, problems with sugar metabolism, fatigue, an increased accumulation of plaque in the aorta, increased blood pressure, anxiety, impaired physical growth in the young, slower healing time after surgery or injury, atherosclerosis, decreased glucose tolerance, and possibly decreased fertility and longevity.

# Treatment
Chromium picolinate is the most commonly used synthetic supplement to correct imbalances in glucose metabolism due to chromium deficiency.  This complex enters the cells in the body through a different mechanism compared to how trivalent chromium found naturally in food does and for this reason the safety or this supplement is debatable.  For chromium to be used in the cells it must be released from chromium picolinate, in a process in which there is a reduction in the chromic center.  This process can possibly lead to the formation unsafe hydroxyl radicals.   Although it has been debated whether or not supplementation should be given regularly, studies have shown that chromium picolinate may be effective when given to patients receiving total parenteral nutrition (TPN), and as a result it is added regularly to TPN solutions.
Trivalent chromium is found in a wide range of foods, each of which can be used to supply the correct amount of chromium needed in the diet, thus treating any possible deficiency.  The foods include: egg yolks, whole-grain products, high-bran breakfast cereals, coffee, nuts, green beans, broccoli, meat, brewers yeast, and some brands of wine and beer.

# Further reading
John B. Vincent. (2000). The Biochemistry of Chromium. The Journal of Nutrition,130: 715- 718.
William T. Cefalu and Frank B. Hu. (2004).  Role of Chromium in Human Health and in Diabetes.  Diabetes Care,27:2741-2751.
Journal of the American College of Nutrition, Vol 4, Issue 1 107-120, Copyright  1985 by American College of Nutrition