ARE CHROMIUM OR MILK THISTLE USEFUL FOR WEIGHT LOSS?
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Episode 284:
Show Notes
This episode features Dr Mary Barson and Dr Lucy Burns discussing two popular metabolic health supplements: chromium and milk thistle, and whether they're effective for weight loss and metabolic health.
Foundation First Philosophy
Supplements should never replace fundamental lifestyle practices including real food, movement, quality sleep, stress management, and proper circadian rhythms. The doctors use a Christmas tree analogy: supplements are like baubles that should only be added after the tree (basic health practices) is firmly in place.
Chromium Analysis
Chromium is an essential trace mineral that enhances insulin action and improves insulin sensitivity, particularly relevant for people with type 2 diabetes who may have chromium deficiency. The safe form (Chromium 3/trivalent chromium) is found in meat, eggs, nuts, and greens, though processed foods lose this mineral. Studies show statistically significant but not clinically meaningful results: approximately 0.5-1 kg weight loss over several months, far below the 5% body weight loss needed for clinical significance. The supplement carries potential risks including mild side effects (headaches, nausea) and theoretical concerns about converting to toxic forms. The doctors place chromium on their "nay list" due to lack of strong benefits and potential harm.
Milk Thistle Evaluation
Milk thistle is a Mediterranean herb traditionally used for liver protection, containing antioxidant plant phytonutrients that have anti-inflammatory effects. While animal studies show small improvements in fasting glucose and insulin resistance, there's no strong human evidence for weight loss. The supplement is generally well-tolerated with low risk, though supplement quality varies greatly in the unregulated industry. It may be supportive but definitely not transformative for metabolic health.
The Six S's for Success
The doctors recommend focusing on six fundamental pillars: Sustenance (real food, low carb, adequate protein, minimal processing), Sleep (addressing underlying sleep issues), Stress management (developing skills, not escapism), Strength training and movement (for metabolic and mental health), Sunlight (morning exposure, reduced artificial evening light), and Social connection (quality relationships providing support and validation).
Episode 284:
Transcript
Dr Mary Barson (0:04) Hello, my lovely friends. I am Dr Mary Barson.
Dr Lucy Burns (0:09) And I'm Dr Lucy Burns. We are doctors and weight management and metabolic health experts.
Both (0:16) And this is the Real Health and Weight Loss podcast!
Dr Lucy Burns (0:21) Good morning, gorgeous friend. How are you this morning? Dr Lucy here with the, well, I was gonna say effervescent Dr Mary, but she does have a cold because, you know, we are human, human. And humans get sick, even humans that look after themselves, because they are exposed to the germs of children.
Dr Mary Barson (00:41) So that's true. Bless those little Petri dishes that we call kids. I have a little Petri dish in daycare. Yes, I have a cold. It's amazing. I can feel prodigiously sorry for myself in this particular circumstance. But I'm rallying. I'm here. Apologise to everyone. I sound a bit coldy. But what can you do?
Dr Lucy Burns (01:02) Nothing is the answer. Well, no, that's not true. That's not true. In an ideal world, of course, you'd rest and, you know, but, you know, you've got—you not only that, the Petri dish still needs to be fed and put to bed and bathed and all sorts of things.
Dr Mary Barson (01:17) Demanding little Petri dishes. Yeah.
Dr Lucy Burns (01:19) Yeah. Life goes on. Life goes on. So today we have another episode in the supplement series. And it's particularly relevant because we see a lot around supplements on social media. We get lots of emails about supplements because people are looking for, I guess, that extra little boost to their wellness, their longevity, their metabolic health program. And we are going to talk about a really common supplement, but I guess we want to scaffold it with the fact that supplements do not replace the basics.
Dr Mary Barson (01:56) No, they could sometimes support, not always, but sometimes, but they're never a substitute for real food, for movement, for getting good sleep, for managing your stress, for working on your circadian rhythms. That's the really important stuff. That's like, you know, that has to be the foundation. And there are times when supplements do help a bit, help a bit with those things.
Dr Lucy Burns (02:21) Indeed. Indeed. So today we're talking about a supplement called Chromium. And I think we're even going to give a nod to milk thistle. So two popular supplements in the metabolic space. And we thought we'd unpack, you know, are they a yay or a nay from us?
Dr Mary Barson (02:40) Indeed. Yes. It's a good one. So Chromium is an essential trace mineral. It's a little metal, basically, and we need it in tiny little amounts. And we also need to have the right form. So it's this mineral that our body uses in carbohydrate, fat and protein metabolism. In its biologically active form, which we could call trivalent Chromium, we can just call it Chromium 3. It's safe and it's useful, but people have probably heard that there are toxic types of Chromium out there, particularly hexavalent Chromium, Chromium 5. This is toxic and it's carcinogenic. So not all Chromiums are created equal. And so that's just a really important thing to know. We're not suggesting that people eat industrial toxins, but Chromium 3 is the one we're talking about here. And this is the one that is available in supplements. So we don't make it. We have to eat it. It's an essential nutrient that we need to get. And it is actually widely available in our food supply. This varies. It varies in terms of the soil quality, where you're sourcing your food. And if food has been heavily processed, it tends to lose a lot of its nutritional value, including losing trace minerals like Chromium. But you can find it in meat, eggs, nuts, greens, lots of things. So it's around. And we only need tiny little amounts of it. So for most of us, we are probably getting enough from our food. Interestingly, though, we have seen in the studies in the scientific research that people with type 2 diabetes may also have some Chromium deficiency. So that's a very specific group of people that is sort of different from the whole general population. And I think that's a really important thing with Chromium as we need to think about different populations, not everybody as a whole, but certain populations are likely to benefit more than others. So, okay, what does Chromium do? That was my question. That's a good question.
Dr Lucy Burns (04:46) I know. I'm very happy to have you, the biochemist, answering this for me.
Dr Mary Barson (04:50) Absolutely. So Chromium enhances the action of insulin. So it improves insulin. It lets insulin work better. And because it helps insulin work better, it therefore improves our insulin sensitivity. So it improves our glucose, our blood sugar control, and our insulin sensitivity. And this is especially important for people with insulin resistance or prediabetes. And so it has a role potentially in helping improve insulin resistance because of the way it can kind of boost the action of our insulin. And I mean, it sounds great on the basis of what I've just said, everybody might want to sort of jump out and start buying Chromium supplements straight away. But there's some really important nuance here in that the difference is small. So it helps a bit, but it is only a little bit. There are really quite small improvements in fasting glucose and insulin sensitivity for people with insulin resistance. And the studies show that there is weight loss. There is statistically significant weight loss looking at big randomised double-blind control trials of people who have been put on Chromium and people who were put on a placebo. But the weight loss was small. It was like about half a kilo, 500 grams over several months. And so although it was statistically significant, it's not clinically significant. So there's this tiny difference that it makes for people with insulin resistance. So it's by far, it's far from a magic bullet and definitely not a replacement.
Dr Lucy Burns (06:40) Could you just explain the difference between statistically significant and clinically significant?
Dr Mary Barson (06:46) Absolutely. So one is like in the world of maths and one is sort of in the real world, if you like. So when we do scientific studies, trying to ascertain if a particular intervention is going to have a particular effect, we get the two groups of people and we want them to be as similar as possible. So these studies, they've gotten people with type 2 diabetes and tried to make them as similar as possible and study these groups of people and looked at all the differences between them and, using maths, have compensated for all of the differences. Then one group gets Chromium, one group gets a placebo, and then we measure outcomes like blood sugar control, weight loss. Then measure all of these things really carefully with these two groups of people. And then we run all the data through computers and we look to see what shows up, what are the differences. And for something to be considered statistically significant, it means that just based on pure maths, it's unlikely that the difference between group A and group B is due to chance. It's likely that the difference between group A and group B is due to the intervention, in this case Chromium versus placebo. So the computer flags it as statistically significant. But that doesn't necessarily mean that in the real world it's actually going to make a big difference. So what happened with these groups of people is that on average, the people who took the Chromium lost about somewhere between half a kilo to one kilo of fat loss compared to the people who didn't. But that didn't actually make a big difference to their clinical health. Overall, it didn't make a big difference. So the Chromium did result in this tiny bit of weight loss, but didn't actually make any difference overall to their health, to their functioning. So that's the difference between statistically significant, but not clinically meaningful. Basically, for a weight loss intervention to be considered clinically meaningful, it needs to be probably at least 5% of body weight. And that's not that.
Dr Lucy Burns (08:52) Yeah. And it needs to be 5% that stays off. Yes. Which is interesting that it's actually not a huge amount in many respects. If you weigh 100 kilos and you lose 5 kilos of fat, again, we want to make sure it's not muscle mass that we're losing. But that does have, usually clinically helpful outcomes related to things like fatty liver disease, potentially insulin sensitivity, reduced leptin, so better knees, all sorts of better blood pressure, often improved sleep because of a reduction in sleep apnea. So there's a whole host of things that happen with a 5% reduction that then translates clinically. But I think one of the tricky things is that the media and supplement companies will use this word statistically significant, particularly to promote their product.
Dr Mary Barson (09:51) Oh, they might even just drop this statistically and say significant weight loss. It can be quite misleading. Absolutely. They can use the science to lie, to dress up the truth into something so it looks completely different from what it actually is. And they're quite skilled at this. Indeed. All right.
Dr Lucy Burns (10:10) So back to chromium.
Dr Mary Barson (10:12) Yes. Yes. Back to chromium. So yes, I mean, some slight benefits for people with type 2 diabetes, but interestingly, no consistent benefits for people without type 2 diabetes. So science has shown that we can't really tell if chromium is helpful or not helpful for people without type 2 diabetes. I think another really important aspect is to know about, you know, well, is this safe? Like what are the risks? I've talked about the potential benefits. What are the risks? I'd say it's generally safe, particularly if it's under 400 micrograms a day. Side effects that people sometimes report are pretty mild, things like headache, nausea, tummy upset. There are very rare reports in the literature of liver and kidney disease, but diving deeper into that, I found that it was actually unclear if chromium was the cause of that. And there also are some theoretical concerns that particularly if we're supplementing with chromium, we're taking higher doses than we would normally get from food. We're taking it in a way that our bodies are not used to getting it. You know, we're used to our bodies being designed to extract chromium from our food and use it that way, not designed to extract it from supplements. And it's a theoretical risk that we could turn the useful form of chromium into the toxic form inside ourselves. So it could potentially be carcinogenic or toxic. So that's another thing to just think about, which is all in all, when I'm looking at this, I would exercise caution. I think if you're going to use it, be cautious. And it's certainly not one that has made our yay list. We've got our yay list and our nay list. I think for now, chromium is probably on our nay list, but it's a watch-this-space situation. There's no strong evidence that it's helpful and potentially some evidence that it's harmful.
Dr Lucy Burns (12:02) Yeah, absolutely. And I think if we can go back to our analogy that we've used a fair few times, and it's probably helpful given it's Christmas time when this episode's coming out, is we think about the structure, so that you referred to earlier. And if we think about that as a Christmas tree, so it's a tree. And then what happens is our brain loves to go to the shiny objects, the baubles, the things like, you know, cold plungers, hot plungers. They're not bad, you know, supplements, collagen, anything that feels like it might make things a bit easier. Our brain is drawn to even recipes. None of these things are bad, but they're potentially not that useful if you don't have the structure in place. So the branches of the Christmas tree, in this case, our recommendations, particularly if you're insulin resistant, is to focus on real food, low in carbohydrate, and with a moderate amount of protein. And there's plenty of evidence for that, that is not just statistically significant, but clinically significant. I wouldn't bother taking chromium if your diet is still consistent of a high processed, you know, high carbohydrate, refined carbohydrate diet. It's not going to help.
Dr Mary Barson (13:21) No, that's right. You have to get your tree out before you think about the baubles. Absolutely. Indeed. Like speaking of baubles, there is another little bauble that we will talk about. This is a question that has come up a bit in our community. So I thought that we would chat about milk thistle, the Silmarin plant. Yes. So this is another interesting one. It's milk thistle. It's a Mediterranean herb. And traditionally it's been used for liver protection, actually quite a long time. It's actually an old herb that humans have been using for a very, very, very long time. And modern studies do show that it does have some role in helping liver function. But lately, there's a bit of buzz around this as a potential weight loss supplement, for which there is not a lot of evidence. So it's unlikely to be harmful, particularly if you take it correctly. It's an antioxidant. So it's basically just a whole lot of plant phytonutrients, like these little nutrients that come from plants, and all of these different flavonoids. And together, they have quite a strong antioxidant effect. Like many plant foods do, many plants have got an antioxidant effect because of the special particular phytonutrients that are in plant foods. So because of this antioxidant effect, it's anti-inflammatory. And that's why they think that it probably helps support the liver regeneration due to its antioxidant and anti-inflammatory effect. Having said that, you can also get that effect from real food. So it's not like we all need to suddenly run out and go buy milk thistle. No. Yeah. There are some animal studies that show that it has some small improvements in fasting glucose and insulin resistance, but really no strong human evidence, and definitely no strong human evidence for weight loss. So it might be helpful, but it's definitely not going to replace good lifestyle changes. So it could be supportive, but definitely not transformative. And risks are pretty low. Generally, it's very well tolerated. It is a herb that doesn't seem to have many side effects for most people. Occasionally people can be allergic to it. It's in the daisy family. Some people develop allergies to daisies, but you can develop allergies to anything. Always with supplements, the quality can vary greatly depending on where you're buying it. It's hard to know exactly what you're getting. It's a wildly unregulated industry. It's a bit like the Wild West, the supplement industry. So that's another issue.
Dr Lucy Burns (16:00) Even more so now with the internet, and you can purchase from overseas where some countries have way less supervision than we do in Australia. But even in Australia, we've had issues over the years where suddenly it's clear that a company has not been putting into their supplements what they've got advertised on their bottle.
Dr Mary Barson (16:23) Absolutely. And it is actually quite frightening. So as much as possible, if you're going to go down the supplement route, try and choose reputable brands. But more than anything, make sure you put your Christmas tree up first. Just put the tree up. So you could potentially hang some baubles on there if you want to, some supplement baubles. But you can't just have a little pile of baubles sitting on the ground. That's not going to get you anywhere.
Dr Lucy Burns (16:50) No, absolutely. And a little acronym we have for the Christmas tree, the six S's for success. As a reminder, S1 is sustenance. So again, the foundation: real food, low carb, protein, minimal processing, not zero processing. Again, our bodies are clever. They can cope with some things. They just can't cope when they're overwhelmed with particularly ultra-processed foods. Looking at sleep, if you're not sleeping well, then we need to address the reasons why. It's all very well for us to go, oh yes, you need to sleep. Obviously, going to bed is helpful. But if sleep is a problem, then find out why and address it. Stress management, again, people think stress management is just running away to a deserted island. And sometimes it feels like we all want to do that. But actually, it's a skill set. We know that strength training and movement is really good, not just for your muscles, which are your metabolic organ, but also your mental health. Excellent for that. We know that sunlight, it doesn't have to be 4am as the sun is peeking up over the border, but sunlight is super helpful for us, particularly earlier in the morning, and less artificial light in the evenings. And then finally, often our whole purpose, our whole reason for being as a human is that we are social creatures. And what we want is quality social connection, not necessarily quantity, but quality, where you feel heard, validated, loved, supported. Those six things, they're the six S's. You know, there's extra S's that we pop in, you know, obviously want to avoid smoking. Maybe you'll need a supplement. Singing is good for you. So there's a few extra ones…
Dr Mary Barson (18:40) Very good for you. Pro singing, I am.
Dr Lucy Burns (18:44) Yes, very much so. But yeah, sort out the successes, my friends. And if you have trouble with implementing those successes, then that's where you need the help. So they're very basic, but basic doesn't mean easy to implement sometimes. Very true. Yeah. That's our favorite thing to do: to help people, first of all, get the correct knowledge and then turn that knowing into doing, so, you know, help with the implementation process.
Mary Barson (19:14) Six S's for success.
Dr Lucy Burns (19:16)Indeed. All right, my friends. Well, hopefully that's been helpful. I think both of those, you know, again, it's probably better to spend your dollars on real food than supplements for those two. And we will see you next week with another episode of the Real Health and Weight Loss podcast. Bye for now.
Dr Mary Barson (19:31) Bye.
Dr Lucy Burns (19:35) The information shared on the Real Health and Weight Loss Podcast, including show notes and links, provides general information only. It is not a substitute, nor is it intended to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.
