Chromium

Common Names: Chromium chloride, Chromium picolinate, Chromium polypicolinate

Clinical Name: Chromium

Summary

Chromium

chemical name: Cr

forms: Chromium chloride, chromium picolinate, chromium polypicolinate, chromium-enriched yeast.

overview of interactions:
• nutritional synergy: Beta-adrenergic Blockers

• nutrient affecting drug performance: Insulin

• nutrient affecting drug performance: Lithium

chemistry/function: Chromium is an essential trace mineral required for normal sugar and fat metabolism. Organic chromium potentiates the action of insulin and is the active component of a substance called GTF (glucose tolerance factor), along with vitamin B3 and amino acids. Chromium occurs primarily in the trivalent and hexavalent forms; the form in higher organisms is trivalent. This mineral occurs throughout the body with highest concentrations in the liver, kidney, spleen and bone.

dietary sources: Meats, brewers yeast, oysters, liver, and potatoes are fairly high in chromium. Seafood, whole grains, cheeses, chicken, bran, fresh fruits and vegetables are intermediate in levels.

deficiency: The primary sign of chromium deficiency is impaired glucose tolerance characterized by elevated levels of blood sugar and circulating insulin. Long term deficiency results in elevated cholesterol and elevated triglycerides. Chromium deficiency was first recognized in parenterally fed long term patients.

proven or potential therapeutic uses: Diabetes mellitus, elevated cholesterol. hypoglycemia, obesity, Turner's syndrome.

maintenance dose: 50-200 mcg per day.
• The Estimated Safe and Adequate Daily Dietary Intake (ESADDI) for adults is 50 to 200 µg.
• Usual dietary intakes in the U.S. are about 25 µg per day for women and 33 µg per day for men.
• Breast-fed infants consume less than 1 µg per day and the ESADDI for infants is 10 to 40 µg per day.
• Many nutritional experts suggest that the current ESADDI for chromium needs to be reevaluated, especially for infants.

therapeutic dose: 300-900 mcg per day.

side effects: No side effects due to chromium supplementation have been reported at typical doses.

toxicity:
• Both solubility and oxidation state affect the potential for toxicity. Furthermore, the type of complex may impact toxicity. Trivalent chromium, the form in all chromium supplements, is extremely safe.
• Toxic effects are limited primarily to industrial exposure to hexavalent chromium, which is much more toxic than the trivalent form.
• There have been reports of toxic reactions to chromium picolinate at doses significantly higher than those typically used. In 1998 Cerulli et al reported the case of a 33-year-old woman suffering from toxicity secondary to ingestion of 1200-2400 microg/d of chromium picolinate, i.e., 6-12 times the recommended daily allowance, for 4-5 months. She had chromium plasma concentrations 2-3 times normal and presented with weight loss, anemia, thrombocytopenia, hemolysis, liver dysfunction, elevated bilirubin, and renal failure. Generally, doses of over 400 mcg per day should not be taken for extended periods of time without consulting a healthcare professional trained in nutritional therapies.
(Cerulli J, et al. Ann Pharmacother 1998 Apr;32(4):428-431.)



Interactions

nutritional synergy: Beta-adrenergic Blockers

• mechanism: Chromium can help reduce risks of cardiovascular disease by lowering overall cholesterol levels while increasing levels of HDL, the so-called “good” cholesterol.
(Riales R, Albrink MJ. Am J Clin Nutr 1981 Dec;34(12):2670-2678; Wang MM, et al. Nutr Res 1989;9:989-998.)

• research: Roeback et al conducted a randomized, controlled trial to determine the efficacy of glucose tolerance factor (GTF)-chromium for increasing serum levels of high-density lipoprotein (HDL) cholesterol in patients taking beta-blockers, mainly for hypertension. Using a total daily dose of 600 micrograms of biologically active chromium divided into three equal doses, they found that two months of chromium supplementation resulted in a clinically useful increase in HDL cholesterol levels in men taking beta-blockers.
(Roeback JR Jr, et al. Ann Intern Med 1991 Dec 15;115(12):917-924.)

• nutritional support: Individuals taking beta-blockers should consult with their prescribing physician and/or a healthcare provider trained in nutritional therapies about the potential benefits of supplementing with chromium. Typical therapeutic dosages of chromium are in the range of 200-400 mcg per day.

nutrient affecting drug performance: Insulin

• mechanism: Chromium potentiates the action of insulin.
(Mertz W. Nutr Rev 1998 Jun;56(6):174-177.)

• nutritional synergy: Chromium's ability to enhance endogenous regulation of blood glucose levels, together with its potentiation of insulin, make it a valuable tool in stabilizing diabetic degeneration and eventually reducing dependence on insulin. However, consultation with the prescribing physician and close monitoring of blood glucose levels is recommended for any individual on insulin who is considering supplementation with chromium. Physicians experienced in nutritional therapy typically prescribe chromium at a dosage of 200 mcg, 1-2 times daily; chromium picolinate is the preferred form.

nutrient affecting drug performance: Lithium

• mechanism: Lithium carbonate has been found to reduce blood glucose levels in diabetics. Chromium potentiates the action of insulin. The combined effect of two substances with potential hypoglycemic action might present a significant risk for excessively low blood glucose levels.
(Hu M, et al. Biol Trace Elem Res 1997 Oct-Nov;60(1-2):131-137; Mertz W. Nutr Rev 1998 Jun;56(6):174-177.)

• nutritional synergy: Chromium's ability to enhance endogenous regulation of blood glucose levels, together with its potentiation of insulin, make it a valuable tool in stabilizing diabetic degeneration and eventually reducing dependence on insulin. However, consultation with the prescribing physician and close monitoring of blood glucose levels is recommended for any individual on lithium who is considering supplementation with chromium, especially if they have a history of hypoglycemia or have also been prescribed insulin. Physicians experienced in nutritional therapy typically prescribe chromium at a dosage of 200 mcg, 1-2 times daily; chromium picolinate is the preferred form.

Please read the disclaimer concerning the intent and limitations of the information provided here.
Do not rely solely on the information in this article.

The information presented in Interactions is for informational and educational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, case reports, and/or traditional usage with sources as cited in each topic. The results reported may not necessarily occur in all individuals and different individuals with the same medical conditions with the same symptoms will often require differing treatments. For many of the conditions discussed, treatment with conventional medical therapies, including prescription drugs or over-the-counter medications, is also available. Consult your physician, an appropriately trained healthcare practitioner, and/or pharmacist for any health concern or medical problem before using any herbal products or nutritional supplements or before making any changes in prescribed medications and/or before attempting to independently treat a medical condition using supplements, herbs, remedies, or other forms of self-care.


References

Anderson RA. Chromium, glucose tolerance, diabetes and lipid metabolism. J. Advancement Med. 1995; 8: 37-48.

Cerulli J, Grabe DW, Gauthier I, Malone M, McGoldrick MD. Chromium picolinate toxicity. Ann Pharmacother 1998 Apr;32(4):428-431.
Abtsract: OBJECTIVE: To describe a case of toxicity secondary to chronic ingestion of 6-12 times the recommended daily allowance of over-the-counter (OTC) chromium picolinate. CASE SUMMARY: A 33-year-old white woman presented with weight loss, anemia, thrombocytopenia, hemolysis, liver dysfunction (aminotransferase enzymes 15-20 times normal, total bilirubin 3 times normal), and renal failure (serum creatinine 5.3 mg/dL; blood urea nitrogen 152 mg/dL). She had ingested chromium picolinate 1200-2400 microg/d for the previous 4-5 months to enhance weight loss. The patient had chromium plasma concentrations 2-3 times normal. Thrombotic thrombocytopenic purpura and hemolytic uremic syndrome were ruled out by clinical findings, peripheral blood smears, and a bone marrow biopsy. The patient was managed with supportive measures and received blood product transfusions and hemodialysis. Hemolysis stabilized and liver function improved over 6 days. Liver function returned to normal prior to discharge. Renal function began to return on day 12 and her serum creatinine on discharge was 1.3 mg/dL. One year later, all laboratory values were within normal limits. DISCUSSION: Trivalent chromium is an essential trace element that is considered safe when ingested in normal quantities. Trivalent chromium compounds are used by patients to enhance weight loss, increase lean body mass, and/or improve glycemic control. Information regarding the toxicity of chromium picolinate is limited. CONCLUSIONS: Chromium supplements may cause serious renal impairment when ingested in excess. Medication histories should include attention to the use of OTC nutritional supplements often regarded as harmless by the public and lay media.

Holt GA. Food and Drug Interactions. Chicago: Precept Press, 1998.

Hu M, Wu H, Chao C. Assisting effects of lithium on hypoglycemic treatment in patients with diabetes. Biol Trace Elem Res 1997 Oct-Nov;60(1-2):131-137.
Abstract: In this article, we report the assisting effect of lithium on hypoglycemic treatment in patients with diabetes. Thirty-eight diabetic patients, 15 male and 23 female, aged 20-70 yr, 33 noninsulin-dependent diabetes mellitus (NIDDM) patients, and 5 insulin-dependent diabetes mellitus (IDDM) patients, were recruited in this study. Fasting and 1-h postprandial blood glucose (BG) profiles were undertaken from three groups of patients with diabetes before and after short-term of treatment of lithium carbonate. Group I was treated with diet only, Group II with oral hypoglycemic agents (OHA), and Group III with insulin. The fasting blood glucose (FBG) level and 1-h postprandial blood glucose (1-h PBG) level before and after treatment of lithium were: Group I: FBG: 7.67 +/- 0.48 vs. 7.13 +/- 0.82; 1-h PBG 15.13 +/- 0.88 vs. 10.33 +/- 0.96; Group II: FBG: 8.84 +/- 0.67 vs. 6.04 +/- 0.57; 1-h PBG: 12.33 +/- 0.72 vs. 9.95 +/- 0.82; Group III: FBG: 10.87 +/- 0.83 vs. 6.83 +/- 0.79; 1-h PBG: 12.45 +/- 0.93 vs. 9.17 +/- 1.00 mmol/L, respectively. The FBG and PBG of all three groups decreased significantly after lithium treatment, except the FBG in Group I. These data suggest that combined with other therapy, lithium could improve glucose metabolism in most patients with diabetes. Our results suggest that lithium has an assisting hypoglycemic effect on antidiabetic treatment.

Mertz W. Interaction of chromium with insulin: a progress report. Nutr Rev 1998 Jun;56(6):174-177. (Review)

Pronsky Z. Powers and Moore's Food-Medications Interactions. Ninth Edition. Food-Medication Interactions. Pottstown, PA, 1991.

Riales R, Albrink MJ. Effect of chromium chloride supplementation on glucose tolerance and serum lipids including high-density lipoprotein of adult men. Am J Clin Nutr 1981 Dec;34(12):2670-2678.
Abstract: Chromium deficiency may cause insulin resistance, hyperinsulinemia, impaired glucose tolerance, and hyperlipidemia, recovered by chromium supplementation. The effect of chromium supplementation on serum lipids and glucose tolerance was tested in a double-blind 12-wk study of 23 healthy adult men aged 31 to 60 yr. Either 200 micrograms trivalent chromium in 5 ml water (Cr) or 5 ml plain water (W) was ingested daily 5 days each week. Half the subjects volunteered for glucose tolerance tests with insulin levels. At 12 wk high-density lipoprotein cholesterol increased in the Cr group from 35 to 39 mg/dl (p less than 0.05) but did not change in the water group (34 mg/dl). The largest increase in high-density lipoprotein cholesterol and decreases in insulin and glucose were found in those subjects having normal glucose levels together with elevated insulin levels at base-line. The data are thus consistent with the hypothesis that Cr supplementation raises high-density lipoprotein cholesterol and improves insulin sensitivity in those with evidence of insulin resistance but normal glucose tolerance.

Robinson C, Weigly E. Basic Nutrition and Diet Therapy. New York: MacMillan, 1984.

Roe DA. Diet and Drug Interactions. New York: Van Nostrand Reinhold, 1989.

Roe DA. Drug-induced Nutritional Deficiencies. 2nd ed. Westport, CT: Avi Publishing, 1985.

Roe DA. Risk factors in drug-induced nutritional deficiencies. In: Roe DA, Campbell T, eds. Drugs and Nutrients: The Interactive Effects. New York: Marcel Decker, 1984: 505-523.

Roeback JR Jr, Hla KM, Chambless LE, Fletcher RH. Effects of chromium supplementation on serum high-density lipoprotein cholesterol levels in men taking beta-blockers. A randomized, controlled trial. Ann Intern Med 1991 Dec 15;115(12):917-924.
Abstract: OBJECTIVE: To determine the efficacy of glucose tolerance factor (GTF)-chromium for increasing serum levels of high-density lipoprotein (HDL) cholesterol in patients taking beta-blockers. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Mixed primary and referral-based outpatient clinic at a university-affiliated VA Medical Center. PATIENTS: Referred sample of 72 men receiving beta-blockers, mainly for hypertension. Sixty-three patients (88%) completed the study. INTERVENTIONS: Current medications, including beta-blockers, were continued. During the 8-week treatment phase, patients in the chromium group received a total daily dose of 600 micrograms of biologically active chromium divided into three equal doses; control patients received a placebo of identical appearance and taste. MEASUREMENTS: Serum levels of total cholesterol and HDL cholesterol were measured. MAIN RESULTS: Mean baseline levels of HDL and total cholesterol (+/- SD) were 0.93 +/- 0.28 mmol/L and 6.0 +/- 1.0 mmol/L (36 +/- 11.1 mg/dL and 232 +/- 38.5 mg/dL), respectively. The difference between groups in adjusted mean change in HDL cholesterol levels, accounting for baseline HDL cholesterol levels, age, weight change, and baseline total cholesterol levels, was 0.15 mmol/L (5.8 mg/dL) (P = 0.01) with a 95% Cl showing that the treatment effect was greater than +0.04 mmol/L (+1.4 mg/dL). Mean total cholesterol, triglycerides and body weight did not change significantly during treatment for either group. Compliance as measured by pill count was 85%, and few side effects were reported. Two months after the end of treatment, the between-group difference in adjusted mean change from baseline to end of post-treatment follow-up was -0.003 mmol/L (-0.1 mg/dL). CONCLUSION: Two months of chromium supplementation resulted in a clinically useful increase in HDL cholesterol levels in men taking beta-blockers.

Sterns DM, Belbruno JJ, Wetterhahn KE. A prediction of chromium (III) accumulation in humans from chromium dietary supplements. FASEB J 1995;9:1650-1657.

Trovato A, Nuhlicek DN, Midtling JE. Drug-nutrient interactions. Am Family Phys 1991;44:1651-1658. (Review)

Wang MM. Fox EA. Stoecker BJ. Menendez CE. Chan SB. Serum cholesterol of adults supplemented with brewer’s yeast or chromium chloride. Nutr Res 1989;9:989-998.
Abstract: Serum glucose, insulin, total cholesterol, high density lipoprotein-cholesterol, triglycerides, urinary chromium and creatinine concentrations were assessed in 30 adults (Mean age = 52 yrs) with a mean total cholesterol concentration of 236 mg/dL. Three groups of 10 participants were supplemented with 9 g (15 ug chromium) brewer's yeast (BY), with 50 ug chromium as chromium chloride (CrCl3) or with placebo (control) for twelve weeks. Fasting blood samples were obtained at 0, 6, and 12 weeks. Serum total cholesterol declined significantly in the CrCl3 group (p < 0.005) and in the BY group (p < 0.05) compared with the control group. Initial mean urinary chromium/creatinine (ng/mg) concentration was 0.21 +/- 0.02; a value similar to that reported in recent literature. Elevated urinary chromium concentrations were found not to be associated with reduced serum cholesterol concentrations in the supplemented groups.

Wasser WG, Feldman NS. Chronic renal failure after ingestion of over-the-counter chromium picolinate. Ann Intern Med 1997;126:410. (Letter)

Werbach MR. Foundations of Nutritional Medicine. Tarzana, CA: Third Line Press, 1997. (Review).

Wolf LR. Adrenergic Blocker Toxicity, in Haddad L, Shannon MW, Winchester JF (eds): Clinical Management of Poisoning and Drug Overdose, 3rd ed. Pennsylvania: WB Sanders Co, 1998:1031-1040.