Health Care Professional Information

Common Name

Chromium III, chromium picolinate, niacin-bound chromium, chromium chloride

Clinical Summary

Chromium is a trace element that is necessary for glucose, insulin, and lipid metabolism in humans (1) (9). Most people consume adequate amounts through their diet and deficiency is rare. Chromium is marketed as a dietary supplement for diabetes, weight loss, and to improve muscle mass. Trivalent chromium from yeast extract is sometimes referred to as Glucose Tolerance Factor (GTF) in over-the-counter products. Chromium supplementation with biotin may help to improve glycemic control in type 2 diabetics (4) (5) (6). However, many clinical studies failed to demonstrate a beneficial effect of chromium on glucose metabolism, weight loss, or muscle mass improvement (3) (7) (8) (9) (10) (11) (12) (13) (14). One study did show that chromium picolinate may increase satiety (15). Due to lack of clinical evidence, the FDA has stated that chromium picolinate does not reduce the risk of insulin resistance or type-2 diabetes (16). A small clinical study reported that chromium picolinate supplementation in elderly patients with early memory decline improved cerebral and memory function (17).

Chromium is poorly absorbed following oral administration, but the salt forms (e.g., chromium picolinate, niacin-bound chromium, and chromium chloride) appear to have better bioavailability. Adverse effects are rare but can include renal failure (18) (19), rhabdomyolysis (20), liver damage (21), and dermatitis (22).

Food Sources

Liver, American cheese, brewer's yeast, wheat germ, meat, fish, fruits, whole grains, brown sugar, alfalfa, and animal fats
(1)

Purported Uses
  • Diabetes
  • Strength and stamina
  • Weight gain
  • Weight loss
Constituents
  • Trivalent chromium
  • Salt formed with picolinic acid, niacin, amino acids, or chloride
  • GTF or Glucose Tolerance Factor is extracted from yeast and frequently combined with chromium in commercial products.
Mechanism of Action

Chromium is an essential trace element involved with glucose and lipid metabolism, circulating insulin levels, and the peripheral activity of insulin (1). In vitro and in vivo studies suggest that chromium potentiates the activity of insulin (23). This is thought to occur via enhanced intracellular tyrosine kinase activity that results from an interaction between chromium, low molecular weight chromium-binding substance, and activated cell surface insulin receptors (2).

Pharmacokinetics

Absorption:
The bioavailability of trivalent chromium is relatively low, ranging from 0.4 to 2.5% of the orally administered dose. Chromium picolinate, trivalent chromium bound to picolinic acid, has a bioavailability of approximately 3%.
Distribution:
Trivalent chromium binds to transferrin and albumin. It distributes throughout the body, but appears to concentrate in the kidney, liver, soft tissue, and spleen. Chromium fits a three compartment pharmacokinetic model.
Excretion:
The biological half-life for urinary excretion of chromium ranges from 0.97-1.51 days. Unabsorbed chromium is excreted in the feces while absorbed chromium is primarily eliminated renally.

Contraindications

Patients with liver or renal insufficiency may have increased susceptibility to adverse effects (24).

Adverse Reactions

Rare: Hepatic toxicity (21)
Case reports: Two cases of renal failure (18) (19); one case of acute generalized exanthematous pustulosis, characterized by erythematous lesions, fever, edema, leukocytosis, and eosinophilia (22); one report of rhabdomyolysis in a patient taking chromium picolinate in addition to other dietary supplements (20).

Herb-Drug Interactions

Sulfonylureas / Insulin: Theoretically, chromium may have additive hypoglycemic effects.

Herb Lab Interactions
Literature Summary and Critique

Several clinical trials have evaluated the efficacy of chromium supplementation for weight loss and muscle mass. Most trials had small sample sizes and conclusive data is lacking. To date, no study definitively supports the use of chromium supplements for weight loss or improvements in muscle mass.

Krikorian R, et al. Improved cognitive-cerebral function in older adults with chromium supplementation. Nutr Neurosci. 2010 Jun;13(3):116-22.
This randomized, double-blind, placebo-controlled study investigated the effect of chromium supplementation on cerebral and memory function in elderly patients with early cognitive decline. The study enrolled 26 elderly patients who were randomized to receive either chromium picolinate (n=15, mean age=72.2) or placebo (n=11, mean age=69.8) for 12 weeks. The California Verbal Learning Test (CVLT) was used to assess memory and the Geriatric Depression Scale was used for the evaluation of depression prior to treatment initiation and during the final week of treatment. Functional magnetic resonance imaging (fMRI) scans were also performed on a subset of subjects (n=13). Although chromium picolinate supplementation did not enhance learning rate and retention, semantic interference on learning (p<0.01) was significantly reduced, and trends in improvement for recall (P<0.07), and recognition memory tasks (p<0.09) were observed. In addition, the fMRI scans identified increased activity in the patients receiving chromium picolinate supplementation in the right thalamic, right temporal, right posterior parietal, and bifrontal regions. No effect on depressive symptoms was detected (p=0.22). The investigators stated that these findings suggest that chromium picolinate can enhance cognitive inhibitory control and cerebral function in older adults who have early memory decline and are at risk for neurodegeneration.

Anton SD, Morrison CD, Cefalu WT, et al. Effects of chromium picolinate on food intake and satiety. Diabetes Technol Ther. Oct 2008;10(5):405-412.
This randomized, double-blind, placebo-controlled trial evaluated the effect of chromium picolinate on food intake by healthy, overweight adult women (n=42) with carbohydrate cravings. The subjects received either chromium picolinate or placebo for 8 weeks. Food intake at breakfast, lunch, and dinner was directly measured at baseline, week 1, and week 8. The results of this study demonstrated that the group receiving chromium picolinate (n=21) experienced significantly reduced food intake (P<0.0001), hunger level (P<0.05), and fat cravings (P<0.0001) compared to the subjects receiving placebo (n=19). A trend toward weight loss was also observed in this group (P=0.08). No adverse events related to chromium picolinate supplementation were observed. The authors concluded that chromium picolinate plays a role in food intake regulation.

Wang ZQ, et al. Phenotype of subjects with type 2 diabetes mellitus may determine clinical response to chromium supplementation. Metabolism. Dec 2007;56(12):1652-165.
Because the effects of chromium supplementation in patients with type 2 diabetes have been inconsistent, the aim of this study was to determine if metabolic or clinical characteristics influenced the patient's response to chromium. In this randomized, double-blind, placebo-controlled study, baseline measures, including insulin sensitivity, were taken after which 73 patients received either chromium picolinate (1000 ìg/day) or placebo. After 6 months, study parameters were again measured and any relationship between the baseline characteristics and changes in insulin sensitivity were determined. Baseline insulin resistance was the only characteristic associated with response to chromium. However, because baseline insulin resistance accounted for approximately 40% of the variance in response to chromium, further studies are required to identify other factors that may influence response to chromium.

Anderson RA, et al. Elevated intakes of supplemental chromium improve glucose and insulin variable in individuals with type 2 diabetes. Diabetes 1997;46:1786-91.
A prospective, double-blind, randomized evaluation of chromium supplementation in type 2 diabetic patients ages 35-65 years. A total of 180 patients were randomized to 4 months of placebo, 100 mcg chromium twice daily, or 500 mcg chromium twice daily. Primary outcomes measured were change in fasting glucose, hemoglobin A1c, fasting insulin, and 2 hour post prandial glucose levels. The authors report that patients receiving 500 mcg chromium twice daily had statistically significant lower fasting glucose and 2 hour post prandial glucose levels at 2 and 4 months. Both treatment groups had significantly lower fasting and 2 hours post prandial insulin levels at 2 and 4 months, and hemoglobin A1c levels at four months decreased by 1-2 grams per deciliter in each treatment group. The authors did not publish actual baseline values and the statistical methods used are questionable. No adverse events were reported. The long-term effect and withdrawal of chromium supplementation is not addressed.

Dosage (Inside MSKCC Only)
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References
  1. Porter DJ, Raymond LW, Anastasio GD. Chromium: friend or foe? Arch Fam Med 1999;8:386-90.
  2. Vincent JB. The biochemistry of chromium. J Nutr 2000;130:715-8.
  3. Christopher H. Bailey. Improved Meta-Analytic Methods Show No Effect of Chromium Supplements on Fasting Glucose. Biological Trace Element Research, 2013; 157 (1):1-8.
  4. Anderson RA, et al. Elevated intakes of supplemental chromium improve glucose and insulin variable in individuals with type 2 diabetes. Diabetes 1997;46:1786-91.
  5. Albarracin CA, Fuqua BC, Evans JL, Goldfine ID. Chromium picolinate and biotin combination improves glucose metabolism in treated, uncontrolled overweight to obese patients with type 2 diabetes. Diabetes Metab Res Rev. Jan-Feb 2008;24(1):41-51.
  6. Wang ZQ, Qin J, Martin J, et al. Phenotype of subjects with type 2 diabetes mellitus may determine clinical response to chromium supplementation.Metabolism. Dec 2007;56(12):1652-1655.
  7. Campbell WW, et al. Effects of resistance training and chromium picolinate on body composition and skeletal muscle in older men. J Appl Physiol 1999;86:29-39.
  8. Clancy SP, et al. Effects of chromium picolinate supplementation on body composition, strength, and urinary chromium loss in football players. Int J Sport Nutr 1994;4:142-53.
  9. Grant KE, et al. Chromium and exercise training: Effect on obese women. Med Sci Sports Exercise 1997;29:992-8.
  10. Lukaski HC, et al. Chromium supplementation and resistance training: effects on body composition, strength, and trace element status of men. Am J Clin Nutr 1996;63:954-65.
  11. Pasman WJ, et al. The effectiveness of long-term supplementation of carbohydrate, chromium, fibre and caffeine on weight maintenance. Int J Obes Rel Metab Dis 1997;21:1143-51.
  12. Volpe SL, et al. Effect of chromium supplementation and exercise on body composition, resting metabolic rate and selected biochemical parameters in moderately obese women following an exercise program. J Am Coll Nutr 2001;20:293-306.
  13. Ali A, Ma Y, Reynolds J, et al. Chromium effects on glucose tolerance and insulin sensitivity in persons at risk for diabetes mellitus. Endocr Pract. 2011 Jan-Feb;17(1):16-25.
  14. Iqbal N, Cardillo S, Volger S, et al. Chromium picolinate does not improve key features of metabolic syndrome in obese nondiabetic adults. Metab Syndr Relat Disord. 2009 Apr;7(2):143-50.
  15. Anton SD, Morrison CD, Cefalu WT, et al. Effects of chromium picolinate on food intake and satiety. Diabetes Technol Ther. Oct 2008;10(5):405-412.
  16. Letter from FDA. Chromium picolinate and Insulin resistance. Accessed December 8, 2009.
  17. Krikorian R, Eliassen JC, Boespflug EL, et al. Improved cognitive-cerebral function in older adults with chromium supplementation. Nutr Neurosci. 2010 Jun;13(3):116-22.
  18. Cerulli J, et al. Chromium picolinate toxicity. Ann Pharmacother 1998; 32:428-31.
  19. Wasser WG, Feldman NS, D'Agati VD. Chronic renal failure after ingestion of over-the-counter chromium picolinate. Ann Int Med 1997;126:410.
  20. Martin WR, Fuller RE. Suspected chromium picolinate-induced rhabdomyolysis. Pharmacotherapy 1998;18:860-2.
  21. Jeejeebhoy KN. The role of chromium in nutrition and therapeutics and as a potential toxin. Nutr Rev 1999;57:329-35.
  22. Young PC, et al. Acute generalized exanthematous pustulosis induced by chromium picolinate. J Am Acad Dermatol 1999;41:820-3.
  23. Cefalu WT, et al. Oral chromium picolinate improves carbohydrate and lipid metabolism and enhances skeletal muscle Glut-4 translocation in obese, hyperinsulinemic (JCR-LA corpulent) rats. J Nutr 2002 ;132:1107-14.
  24. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington: National Academy Press; 2001.

Consumer Information

How It Works

Bottom Line: Chromium may help to regulate blood glucose in some people, but the long-term effects are unknown. There is no clear evidence to show that chromium supplementation is effective for improving glucose metabolism, losing weight, or building muscle mass.

Chromium is an element required by the body in very small amounts (0.025 mg a day). Adequate amounts are usually obtained in the diet from foods such as American cheese, meat, fish, fruits, and whole grains. Based on laboratory experiments, scientists think that chromium is involved in maintaining adequate levels of glucose, fats, and insulin activity in the body. Chromium may interact with insulin receptors and enhances the effects of insulin on cells, including improved glucose uptake. In theory, this could help patients with type 2 diabetes.

Chromium is sometimes combined with GTF (Glucose Tolerance Factor) in over-the-counter products. GTF is a yeast extract that helps with glucose metabolism in laboratory studies, but this effect has not been confirmed in humans.

Purported Uses
  • To treat diabetes
    Clinical trials produced conflicting results regarding chromium's ability to lower blood glucose, cholesterol, and triglycerides. According to the FDA, it is highly uncertain that chromium picolinate can reduce the risk of insulin resistance or type 2 diabetes.
  • To improve muscle mass
    Clinical trials do not support this use.
  • To improve weight loss
    Clinical trials do not support this use.
Research Evidence

Weight loss and muscle gain:
Several clinical trials have tested chromium supplements to see whether they are effective for losing weight and gaining muscle mass. However, most of these clinical trials were small and had mixed results. Right now, no clinical trial definitively supports the use of chromium supplements for weight loss or improvements in muscle mass.

Type 2 diabetes:
The use of chromium supplements for treating type 2 diabetes was tested in a randomized controlled trial. For four months, 180 patients took either 100 micrograms of chromium, 500 micrograms of chromium, or a placebo pill twice daily. Both of the groups taking chromium had lower fasting glucose and postprandial (after eating) blood glucose levels than the placebo group. This suggests that chromium is helpful in reducing blood glucose levels in patients with type 2 diabetes, but this study did not address the long-term effects of chromium, and what happens when it is discontinued in these patients.

According to the FDA, it is 'highly uncertain' that chromium picolinate reduces the risk of insulin resistance and type 2 diabetes.

Because studies about chromium supplementation in patients with type 2 diabetes have produced mixed results, researches wanted to see if certain characteristics of the patient (e.g., age, race, weight, etc.) influenced their response to chromium. At the beginning of the study, many characteristics (baseline characteristics) were measured in 73 patients with type 2 diabetes. These patients then received either chromium picolinate (1000 ìg/day) or placebo. After 6 months, the patient characteristics were again measured. The only characteristic that could predict if a patient would respond to chromium was insulin resistance at the beginning of the study. This suggests that patients with insulin resistance are more likely to benefit from chromium supplementation that those without it. However, larger studies are needed to identify other factors that may influence a patient's response to chromium.

Do Not Take If
  • You have liver or kidney problems.
  • You are taking sulfonylureas or insulin (in theory, chromium may lower your blood sugar even more. Diabetics may wish to check their blood glucose levels more often so that adjustments can be made to their therapy, if necessary. Ask your doctor.)
Side Effects
  • In rare cases, liver toxicity has occurred.
  • The following cases of very rare side effects have been reported:(1) Two people had kidney failure, (2) One patient developed acute generalized exanthematous pustulosis (red skin lesions, fever, edema, high white blood cell count, and elevated blood eosinophil levels), (3) One patient developed rhabdomyolysis (destruction of skeletal muscle) while taking chromium picolinate in addition to other dietary supplements (so whether chromium caused this condition is not clear).
Special Point
  • When taken by mouth, chromium is poorly absorbed through the gut into the bloodstream. The salt forms of chromium, such as chromium picolinate, niacin-bound chromium, and chromium chloride are more readily absorbed.
E-mail your questions and comments to aboutherbs@mskcc.org.