Patient handout for Chromium
Chromium
Chromium
SCIENTIFIC NAME
Chromium; Cr; atomic number 24
FAMILY

+ Other Common Names

  • Acétate de Chrome, Chélate de Chrome, Chelated Chromium, Chlorure Chromique, Chlorure de Chrome, Chrome, Chrome III, Chrome 3+, Chrome Chélaté, Chrome FTG, Chrome Facteur de Tolérance au Glucose, Chrome Trivalent, Chromic Chloride, Chromium Acetate, Chromium Ascorbate, Chromium Chelate, Chromium Chloride, Chromium Nicotinate, Chromium Picolinate, Chromium Polynicotinate, Chromium Proteinate, Chromium Trichloride, Chromium Tripicolinate, Chromium III, Chromium III Picolinate, Chromium 3+, Cr III, Cr3+, Cromo, Cromo Quelado, Glucose Tolerance Factor-Cr, GTF, GTF Chromium, GTF-Cr, Kali Bichromicum, Nicotinate de Chrome, Numéro Atomique 24, Picolinate de Chrome, Picolinate de Chrome III, Polynicotinate de Chrome, Potassium Bichromate, Protéinate de Chrome, Quelato de Cromo, Trichlorure de Chrome, Tripicolinate de Chrome, Trivalent Chromium.

Overview

Chromium is a trace mineral. It exists in two forms: trivalent and hexavalent states. Trivalent chromium (Cr III), the form found in foods and supplements, is biologically active and safe (42626). The other form of chromium, hexavalent chromium (Cr VI), is a known toxin that can cause skin problems and lung cancer following long-term occupational exposure (9141,42572,42648). Unless otherwise noted, the information in this monograph pertains only to trivalent chromium.

Safety

LIKELY SAFE ...when used orally and appropriately in medicinal amounts, short-term. Chromium has been safely used in doses up to 1000 mcg daily for up to 6 months (1934,5039,5040,6858,6859,6860,6861,6862,6867,6868)(7135,7137,10309,13053,14325,14440,17224,90057,90061)(90063,94234,95095,95096,95097,98687); however, most of these studies have used chromium doses in a range of 150-600 mcg. The Food and Drug Administration (FDA) and Institute of Medicine (IOM) evaluations of the safety of chromium suggest that it is safe when used in doses of 200 mcg daily for up to 6 months (13241,13242).

POSSIBLY SAFE ...when used orally and appropriately in medicinal amounts, long-term. Chromium has been safely used in a small number of studies at doses of 200-1000 mcg daily for up to 2 years (7060,7135,42618,42628,42666,110605,110607,110609). However, the Food and Drug Administration (FDA) and Institute of Medicine (IOM) evaluations of the safety of chromium suggest that it is safe when used in doses of 200 mcg daily for up to 6 months (13241,13242).

CHILDREN: LIKELY SAFE ...when used orally and appropriately in amounts not exceeding the daily adequate intake (AI) levels by age: 0-6 months, 0.2 mcg; 7-12 months, 5.5 mcg; 1-3 years, 11 mcg; 4-8 years, 15 mcg; males 9-13 years, 25 mcg; males 14-18 years, 35 mcg; females 9-13 years, 21 mcg; females 14-18 years, 24 mcg (7135). POSSIBLY SAFE...when used orally and appropriately in amounts exceeding AI levels. Chromium 400 mcg daily has been used safely for up to 6 weeks (42680).

PREGNANCY: LIKELY SAFE ...when used orally and appropriately in amounts not exceeding adequate intake (AI) levels. The AI for pregnancy is 28 mcg daily for those 14-18 years of age and 30 mcg daily for those 19-50 years of age (7135). POSSIBLY SAFE ...when used orally in amounts exceeding the adequate intake (AI) levels. There is some evidence that patients with gestational diabetes can safely use chromium in doses of 4-8 mcg/kg (1953); however, patients should not take chromium supplements during pregnancy without medical supervision.

LACTATION: LIKELY SAFE ...when used orally and appropriately in amounts not exceeding adequate intake (AI) levels. The AI for lactation is 44 mcg daily for those 14-18 years of age and 45 mcg daily for those 19-50 years of age (7135). Chromium supplements do not seem to increase normal chromium concentration in human breast milk (1937). There is insufficient reliable information available about the safety of chromium when used in higher amounts while breast-feeding.

+ Adverse Effects

General: Orally, chromium is generally well tolerated.

Most Common Adverse Effects:

Orally: Gastrointestinal irritation, headaches, insomnia, irritability, mood changes.

Serious Adverse Effects (Rare):

Orally: Rare cases of kidney and liver damage, rhabdomyolysis, and thrombocytopenia have been reported.
  • + Dermatologic

    Orally, chromium-containing supplements may cause acute generalized exanthematous pustulosis (42561), skin rashes (42679), and urticaria (17224). Also, chromium picolinate or chromium chloride may cause systemic contact dermatitis when taken orally, especially in patients with contact allergy to chromium (6624,90058). In one clinical study, a patient taking chromium nicotinate 50 mcg daily reported itchy palms that improved after the intervention was discontinued. It is unclear of this effect was due to the chromium or another factor (95096).

    Topically, hexavalent chromium, which can be present in some cement, leather products, or contaminated soil, may cause allergic contact dermatitis (42645,42789,90060,90064,110606).

    A case of lichen planus has been reported for a patient following long-term occupational exposure to chromium (42688).
  • + Endocrine

    Orally, cases of hypoglycemia have been reported for patients taking chromium picolinate 200-1000 mcg daily alone or 200-300 mcg two or three times weekly in combination with insulin (42672,42783). Chromium picolinate has also been associated with weight gain in young females who do not exercise and in those following a weight-lifting program (1938).
  • + Gastrointestinal

    Orally, chromium in the form of chromium picolinate, chromium polynicotinate, chromium-containing brewer's yeast, or chromium-containing milk powder may cause nausea, vomiting, diarrhea, decreased appetite, constipation, flatulence, or gastrointestinal upset (14325,42594,42607,42622,42643,42679).

    Long-term exposure to heavy metals, including chromium, has been associated with increased risk of gallbladder disease and cancer (42682,42704).
  • + Genitourinary

    Orally, chromium polynicotinate has been associated with disrupted menstrual cycles in patients taking the supplement to prevent weight gain during smoking cessation (42643).
  • + Hematologic

    Anemia, hemolysis, and thrombocytopenia were reported in a 33 year-old female taking chromium picolinate 1200-2400 mcg daily for 4-5 months (554). The patient received supportive care, blood product transfusions, and hemodialysis and was stabilized and discharged a few days later. Lab values were normal at a one-year follow-up.
  • + Hepatic

    Liver damage has been reported for a 33-year-old female taking chromium picolinate 1200 mcg daily for 4-5 months (554). Also, acute hepatitis has been reported in a patient taking chromium polynicotinate 200 mcg daily for 5 months (9141). Symptoms resolved when the product was discontinued. Two cases of hepatotoxicity have been reported in patients who took a specific combination product (Hydroxycut), which also contained chromium polynicotinate in addition to several herbs (13037).
  • + Musculoskeletal

    Acute rhabdomyolysis has been reported for a previously healthy 24-year-old female who ingested chromium picolinate 1200 mcg over a 48-hour time period (42786). Also, chromium polynicotinate has been associated with leg pain and paresthesia in patients taking the supplement to prevent weight gain during smoking cessation (42643).
  • + Neurologic/CNS

    Orally, chromium picolinate may cause headache, paresthesia, insomnia, dizziness, and vertigo (6860,10309,14325,42594). Vague cognitive symptoms, slowed thought processes, and difficulty driving occurred on three separate occasions in a healthy 35-year-old male after oral intake of chromium picolinate 200-400 mcg (42751). Transient increases in dreaming have been reported in three patients with dysthymia treated with chromium picolinate in combination with sertraline (2659). A specific combination product (Hydroxycut) containing chromium, caffeine, and ephedra has been associated with seizures (10307). But the most likely causative agent in this case is ephedra.
  • + Psychiatric

    Orally, chromium picolinate has been associated with irritability and mood changes in patients taking the supplement to lose weight, while chromium polynicotinate has been associated with agitation and mood changes in patients taking the supplement to prevent weight gain during smoking cessation (6860,42643).
  • + Renal

    Orally, chromium picolinate has been associated with at least one report of chronic interstitial nephritis and two reports of acute tubular necrosis (554,1951,14312). Laboratory evidence suggests that chromium does not cause kidney tissue damage even after long-term, high-dose exposure (7135); however, patient- or product-specific factors could potentially increase the risk of chromium-related kidney damage. More evidence is needed to determine what role, if any, chromium has in potentially causing kidney damage.

    Intravenously, chromium is associated with decreased glomerular filtration rate (GFR) in children who receive long-term chromium-containing total parenteral nutrition - TPN (11787). Topically, burns caused by chromic acid, a hexavalent form of chromium, have been associated with acute chromium poisoning with acute renal failure (42699). Early excision of affected skin and dialysis are performed to prevent systemic toxicity.
  • + Other

    Another form of chromium, called hexavalent chromium, is unsafe. This type of chromium is a by-product of some manufacturing processes. Chronic exposure can cause liver, kidney, or cardiac failure, pulmonary complications, anemia, and hemolysis (9141,11786,42572,42573,42699). Occupational inhalation of hexavalent chromium can cause ulceration of the nasal mucosa and perforation of the nasal septum, and has been associated with pneumoconiosis, allergic asthma, cough, shortness of breath, wheezing, and increased susceptibility to respiratory tract cancer and even stomach and germ cell cancers (42572,42573,42601,42610,42636,42667,42648,42601,42788,90056,90066). Although rare, cases of interstitial pneumonia associated with chromium inhalation have been reported. Symptoms resolved with corticosteroid treatment (42614).

+ Effectiveness

LIKELY EFFECTIVE
Chromium deficiency. Oral or parenteral chromium is effective for the treatment and prevention of chromium deficiency.
+ Details:  Taking chromium orally is effective for preventing and treating symptoms of chromium deficiency, including hyperglycemia, glycosuria, sudden weight loss, peripheral neuropathy, and confusion (7135).
POSSIBLY EFFECTIVE
Diabetes. Oral chromium seems to be modestly beneficial for improving glycemic control in diabetes, especially when used in doses greater than 200 mcg daily and in patients with poorly controlled diabetes. It is unclear if chromium helps to prevent the development of diabetes.
+ Details:  Epidemiological research has found that lower toenail chromium levels are associated with an increased risk of diabetes and cardiovascular disease (11908). In 2005, the US Food and Drug Administration (FDA) allowed a qualified health claim stating that chromium picolinate may reduce the risk of type 2 diabetes. However, the FDA has determined that any relationship between chromium picolinate and type 2 diabetes is highly uncertain and is based on limited scientific evidence (102362).

Research on the use of chromium for the TREATMENT of type 2 diabetes is conflicting but seems to show modest benefit in some patients. Many small clinical studies show that taking chromium orally decreases fasting blood glucose, postprandial glucose, insulin, and glycated hemoglobin (HbA1C) levels, and increases insulin sensitivity (6867,7137,12390,15169,14440,42628,42638,95097,103745). However, other small clinical studies show that chromium is no better than placebo for improving glycemic indices in patients with diabetes (7060,14325,42679,42707,90059,103746,103749). Some of these studies may not have been adequately powered and some had a high risk of bias. Furthermore, these studies had high heterogeneity related to study population and size, chromium supplementation duration, formulation, and dose, and accepted standards of diabetes care. Multiple meta-analyses pooling results of these small clinical trials also show mixed results (90055,90063,95098,105026,110610). The most recent and comprehensive meta-analyses show that chromium picolinate lowers HbA1C by about 0.6%; while it is unclear if chromium yeast, chromium dinicocysteinate, or chromium with biotin or other natural ingredients are beneficial. Chromium seems to be most beneficial in doses of greater than 200 mcg taken for 12 weeks or longer, and in patients with poorly controlled diabetes with a baseline HbA1C of 8% or greater (90063,105026). There is also speculation that chromium might primarily benefit patients with low chromium levels; however, there has not been an analysis specifically evaluating this population (6867,7058,13725,14325,95098).

Some research suggests that chromium might also modestly improve lipid levels in patients with type 2 diabetes (1934,6867,95098). A meta-analysis of randomized clinical trials including patients with type 2 diabetes shows that taking chromium 42-1000 mcg orally daily for 5-26 weeks decreases triglyceride levels by 7 mg/dL and increases high-density lipoprotein cholesterol levels by 2 mg/dL when compared with control. Taking chromium did not affect low-density lipoprotein cholesterol levels. However, the validity of these results is limited by high heterogeneity (110605). In addition, some meta-analyses have failed to demonstrate any effects of chromium on lipid levels (110610). A meta-analysis of randomized clinical trials including patients with type 2 diabetes shows that taking chromium 200-1000 mcg orally daily for 8-25 weeks lowers diastolic blood pressure by 2 mmHg, but not systolic blood pressure or body mass index, when compared with placebo (110607).

Preliminary clinical research shows that chromium picolinate might improve metabolic parameters in patients with other forms of diabetes as well. This includes those with type 1 diabetes (1935), diabetes secondary to corticosteroid use (5039,42829), and gestational diabetes (42817).
POSSIBLY INEFFECTIVE
Hypertension. Meta-analyses of small clinical trials suggest that oral chromium does not lower blood pressure by a clinically meaningful amount.
+ Details:  A meta-analysis of randomized clinical trials in adults with different metabolic disorders shows that taking chromium 42-1000 mcg orally daily for 12-24 weeks does not lower systolic or diastolic blood pressure when compared with placebo (110609). A meta-analysis of randomized clinical trials in adults with different chronic disorders shows that taking chromium 42-1000 mcg orally daily for 4-25 weeks lowers systolic and diastolic blood pressure by 3 mmHg and 1 mmHg, respectively, when compared with placebo. However, the validity of this meta-analysis is limited by high heterogeneity (110604). Another meta-analysis of randomized clinical trials including patients with type 2 diabetes shows that taking chromium 200-1000 mcg orally daily for 8-25 weeks lowers diastolic blood pressure by 2 mmHg, but not systolic blood pressure, when compared with placebo (110607). In addition, the validity of these results is limited by inclusion of patients with and without hypertension at baseline (110604,110607,110609).
Impaired glucose tolerance (Prediabetes). Oral chromium does not seem to improve glycemic indices in patients with prediabetes.
+ Details:  Some clinical research shows that adults with impaired glucose tolerance do not have improved glycemic parameters or insulin sensitivity after taking chromium picolinate 500-1000 mcg daily for up to 6 months when compared with placebo (13053,42670). Likewise, a small clinical study in elderly patients with impaired glucose tolerance shows that chromium supplements do not improve glucose tolerance or triglyceride or cholesterol levels when compared with placebo (13722). Finally, a preliminary clinical study in overweight or obese adults with prediabetes shows that taking two capsules of a combination product containing chromium, cinnamon, and carnosine (Glycabiane, PiLeJe) daily for 4 months decreases fasting plasma glucose by approximately 4 mg/dL when compared with placebo, but does not improve fasting plasma insulin, measures of insulin sensitivity or resistance, or glycated hemoglobin (HbA1C) (94234). The small effect on fasting plasma glucose is clinically insignificant and may be due to the other ingredients in this product.
Schizophrenia. Oral chromium does not seem to improve psychological measures in patients with schizophrenia.
+ Details:  Clinical research in patients with schizophrenia shows that taking chromium polynicotinate 400 mcg daily for 3 months does not affect weight or mental status when compared with placebo (42613).
INSUFFICIENT RELIABLE EVIDENCE to RATE
Antiretroviral-induced insulin resistance. It is unclear if oral chromium is beneficial for preventing antiretroviral-induced insulin resistance.
+ Details:  Preliminary clinical research in HIV patients treated with highly active antiretroviral therapy (HAART) shows that taking chromium nicotinate 200 mcg or chromium picolinate 1000 mcg daily for 8-16 weeks may help decrease insulin resistance and increase glucose disposal when compared to baseline (42630,42662). The validity of this finding is limited by the lack of a control group.
Athletic performance. It is unclear if chromium enhances athletic performance, although some research suggests that it may improve body composition when used in conjunction with exercise.
+ Details:  One large clinical study shows taking chromium 400 mcg daily, in conjunction with resistance training, can increase weight loss, body fat loss, and lean body mass when compared with placebo and resistance training (6868). However, other, very small clinical studies show that adding chromium picolinate or chromium chloride 177-400 mcg daily to a weight-training program does not improve body composition when compared with weight-training alone (6860,6861,6862,42747). These studies may not have been adequately powered to detect a difference in outcomes.
Atypical depression. It is unclear if oral chromium is beneficial in patients with atypical depression.
+ Details:  Preliminary clinical research in patients with atypical depression shows that taking chromium picolinate 400 mcg daily for 2 weeks followed by 600 mcg daily for an additional 6 weeks improves response and remission rates when compared with placebo (10309). However, other clinical research shows that taking elemental chromium 400 mcg in the form of chromium picolinate daily for 2 weeks followed by 600 mcg daily for an additional 6 weeks does not improve most symptoms of atypical depression, although appetite and sexual drive may improve, when compared with placebo (42600).
Beta blocker-induced dyslipidemia. It is unclear if oral chromium is beneficial in patients with dyslipidemia due to beta-blocker use.
+ Details:  One small clinical study in patients who take beta-blockers shows that taking glucose tolerance factor (GTF)-chromium 600 mcg daily for 2 months increases high-density lipoprotein (HDL) cholesterol levels by 16%, but does not affect other lipid parameters, when compared with placebo (5040).
Binge eating disorder. It is unclear if oral chromium is beneficial in patients with binge eating disorder.
+ Details:  One small clinical study in overweight adults with binge eating disorder shows that taking chromium picolinate 600 or 1000 mcg by mouth daily for 6 months does not affect binge eating frequency, body weight, or depressive symptoms when compared with placebo (90057).
Bipolar disorder. It is unclear if oral chromium is beneficial in patients with treatment-resistant bipolar disorder.
+ Details:  Preliminary clinical research in patients with treatment-resistant, rapid-cycling bipolar disorder shows that taking chromium chloride (Hypo-A Chrom, Hypo-A GmbH) 600-800 mcg daily for up to 2 years can decrease the frequency of affective episodes by approximately three episodes annually when compared to baseline (42618). The validity of this finding is limited by the lack of a control group.
Cognitive impairment. It is unclear if oral chromium prevents cognitive impairment.
+ Details:  Some clinical research shows that taking chromium picolinate standardized to contain elemental chromium 1000 mcg daily for 12 weeks does not improve memory or depression in elderly patients with mild cognitive impairment when compared with placebo. However, results from neuroimaging scans suggest that chromium increases the activity of certain regions of the brain during memory tasks when compared with placebo (42666).
Hyperlipidemia. Small clinical studies suggest that oral chromium may modestly reduce lipid levels in patients with hyperlipidemia.
+ Details:  One small clinical study in patients with atherosclerotic disease shows that taking chromium 250 mcg as chromium chloride daily for 7-16 months decreases triglycerides and increases high-density lipoprotein (HDL) cholesterol, but not other lipid parameters, when compared with placebo (7060). Other small clinical studies in adults with hyperlipidemia show that taking chromium picolinate 200 mcg daily for 6 weeks, chromium polynicotinate 200 mcg twice daily, or brewer's yeast containing 48 mcg elemental chromium daily for 6-8 weeks decrease total and low-density lipoprotein (LDL) cholesterol when compared to baseline (37178,42585,42710). The validity of this finding is limited by the lack of comparison with a control group.

A meta-analysis of small heterogeneous clinical studies in patients mostly without hyperlipidemia shows that taking chromium orally does not affect lipid levels when compared with placebo (105029). A meta-analysis of randomized clinical trials including patients with type 2 diabetes shows that taking chromium 42-1000 mcg orally daily for 5-26 weeks modestly improves triglyceride and HDL cholesterol levels, but not LDL cholesterol levels, when compared with control. However, the validity of these results is limited by high heterogeneity and inclusion of patients with and without hyperlipidemia (110605). In addition, some meta-analyses have failed to demonstrate any effects of chromium on lipid levels in adults with diabetes (110610).

Limited research has tested high-dose chromium in children. One small clinical study in children with hypercholesterolemia shows that taking chromium polynicotinate 400-600 mcg with glucomannan 1000-1500 mg twice daily for 8 weeks reduces total and LDL cholesterol when compared to baseline (90061). It is unclear if this effect is due to chromium, glucomannan, or the combination. Finally, chromium does not seem to reduce lipid levels in people without hyperlipidemia.
Hypoglycemia. It is unclear if oral chromium helps to reverse or prevent hypoglycemia.
+ Details:  One very small clinical study in patients with reactive hypoglycemia shows that taking chromium chloride 200 mcg daily for 3 months increases blood glucose levels and improves insulin binding and hypoglycemic symptoms following an oral glucose load (6859). Another small clinical study in patients with symptomatic hypoglycemia shows that taking chromium yeast (Biochrome, Pharma-Nord) 125 mcg daily for 3 months improves symptoms, including chilliness, trembling, and disorientation, when compared with baseline (42711). The validity of this finding is limited by the lack of a control group.
Metabolic syndrome. It is unclear if oral chromium is beneficial in patients with metabolic syndrome.
+ Details:  One small clinical study in patients with metabolic syndrome shows that taking a particular chromium picolinate product (Chromax, Nutrition 21) 500 mcg twice daily for 16 weeks does not affect weight, waist circumference, insulin sensitivity, glycated hemoglobin (HbA1C), or lipid levels when compared with placebo (42654).
Myocardial infarction (MI). It is unclear if oral chromium helps to prevent MI.
+ Details:  Epidemiological research has found that low toenail chromium concentrations are associated with an increased risk of MI (13728). However, toenail chromium concentrations might not be a reliable predictor of body stores of chromium. There is also no reliable research showing that chromium supplements can prevent MI.
Nonalcoholic fatty liver disease (NAFLD). It is unclear if oral chromium slows NAFLD progression.
+ Details:  One small clinical study in patients with NAFLD shows that taking chromium picolinate 200 mcg two times daily after meals for 12 weeks does not affect liver enzyme levels or body weight when compared with placebo (105027).
Obesity. Although some research suggests that oral chromium may increase weight loss, this increase in weight loss is not likely to be considered clinically relevant.
+ Details:  Meta-analyses of clinical studies in overweight or obese adults show that taking chromium picolinate 200-1000 mcg daily for 12-16 weeks might result in a cumulative weight loss of about 0.5-1 kg when compared with placebo (90062,90065). However, this small reduction in weight is unlikely to be considered clinically significant. Furthermore, certain small clinical studies in healthy, overweight or obese adults and children show that taking oral chromium 200-1000 mcg daily for 6-24 weeks does not reduce weight when compared with control (6860,13727,17224,42680). Some of these studies may not have been adequately powered to detect a smaller effect.

A meta-analysis of randomized clinical trials including patients with type 2 diabetes shows that taking chromium 200-1000 mcg orally daily for 8-25 weeks does not lower body mass index when compared with placebo. However, the validity of these results is limited by inclusion of patients with and without obesity at baseline (110607).
Polycystic ovary syndrome (PCOS). It is unclear if oral chromium improves symptoms of PCOS.
+ Details:  One small clinical study in patients with PCOS shows that taking chromium picolinate 1000 mcg daily for 6 months along with diet and exercise counseling decreases body mass index and improves rates of ovulation and regular menstruation when compared with placebo (95094). Also, some clinical research shows that taking chromium picolinate (21st Century HealthCare, Inc. or Nature Made) 200 mcg daily orally for 8 weeks increases insulin sensitivity when compared with placebo (95095,98687). However, other preliminary clinical research shows that taking chromium picolinate 200 mcg daily for 4 months does not affect insulin sensitivity or improve ovulation rates (42603). Although chromium picolinate at doses of less than 1000 mcg might have very small effects on fasting glucose, these doses do not seem to have clinically beneficial effects on fasting glucose, pregnancy rate, or testosterone levels (95094,95095,98687).

A lower dose of chromium has also been studied in combination with carnitine. One small clinical study in overweight adults with PCOS shows that taking chromium picolinate 200 mcg daily with carnitine 1000 mg daily for 12 weeks modestly reduces fasting blood glucose, insulin resistance, and body weight, and slightly increases insulin sensitivity, when compared with placebo (103747). However, it is unclear if this benefit is clinically significant. Additionally, it is unclear if these effects are due to chromium, carnitine, or the combination. Carnitine has demonstrated clinical benefit when used alone in PCOS.
Turner syndrome. It is unclear if oral chromium is beneficial in patients with this condition.
+ Details:  A small clinical study shows that taking brewer's yeast 30 grams containing chromium 50 mcg daily for 8 weeks might improve abnormalities in glucose and lipid metabolism when compared with baseline in patients with Turner syndrome, a genetic disorder that has a high incidence of diabetes (13729). The validity of this finding is limited by the lack of a comparator group.
More evidence is needed to rate chromium for these uses.

Dosing & Administration

  • Adult

    Oral:

    General: There is insufficient information to establish safe and tolerable upper intake levels for chromium (7135). However, daily adequate intake (AI) levels for chromium have been established: males 19-50 years, 35 mcg; males 51 and older, 30 mcg; females 19-50 years, 25 mcg; females 51 and older, 20 mcg. During pregnancy: 14-18 years, 29 mcg; 19-50 years, 30 mcg. When lactating: 14-18 years, 44 mcg; 19-50 years, 45 mcg.

    Sometimes chromium amounts are listed in micromols. The conversion factor to mcg is: 1.92 micromol = 100 mcg (6867).

    Chromium has been used in various salt forms and at various doses. See Effectiveness section for condition-specific information.
  • Children

    Oral:

    General: There is insufficient information to establish safe and tolerable upper intake levels for chromium (7135). However, daily adequate intake (AI) levels for chromium have been established by age: 0-6 months, 0.2 mcg; 7-12 months, 5.5 mcg; 1-3 years, 11 mcg; 4-8 years, 15 mcg; males 9-13 years, 25 mcg; females 9-13 years, 21 mcg; males 14-18 years, 35 mcg; females 14-18 years, 24 mcg (6867,42580). See Effectiveness section for condition-specific information.
  • Standardization & Formulation

    Chromium chloride is the natural form of trivalent chromium (95098). The most common chromium salt used in supplements is the synthetic chromium picolinate. Other chromium salts used include chromium chloride and chromium polynicotinate (2659,95098). Chromium may also come in the form of brewer's yeast or chromium yeast (95098). Chromium picolinate is a complex of chromium and picolinic acid, which is a naturally occurring metabolic derivative of tryptophan. It contains 12.4% elemental trivalent chromium (2659,95094). Chromium polynicotinate is often referred to as niacin-bound chromium because it includes chromium bound to molecules of niacin (2659).

+ Interactions with Drugs

ANTIDIABETES DRUGS

Interaction RatingModerate Be cautious with this combination.
Severity = Moderate •  Occurrence = Possible •  Level of Evidence = A
Theoretically, chromium may have additive effects with antidiabetic agents and increase the risk of hypoglycemia.
+ Details
Some research shows that taking chromium might lower blood glucose levels, especially in patients with poorly controlled type 2 diabetes (7137,14440,15169,94234,95097,95098,98687).

ASPIRIN

Interaction RatingMinor Be watchful with this combination.
Severity = Insignificant •  Occurrence = Possible •  Level of Evidence = D
Theoretically, aspirin might increase chromium absorption.
+ Details
Animal research suggests that aspirin may increase chromium absorption and chromium levels in the blood (21055).

INSULIN

Interaction RatingModerate Be cautious with this combination.
Severity = Moderate •  Occurrence = Possible •  Level of Evidence = B
Theoretically, concomitant use of chromium and insulin might increase the risk of hypoglycemia.
+ Details
In clinical research, chromium has been shown to increase insulin sensitivity (1952,14440,95095),

LEVOTHYROXINE (Synthroid, others)

Interaction RatingModerate Be cautious with this combination.
Severity = Moderate •  Occurrence = Probable •  Level of Evidence = B
Chromium might bind levothyroxine in the intestinal tract and decrease levothyroxine absorption.
+ Details
Clinical research in healthy volunteers shows that taking chromium picolinate 1000 mcg with levothyroxine 1 mg decreases serum levels of levothyroxine by 17% when compared to taking levothyroxine alone (16012). Advise patients to take levothyroxine at least 30 minutes before or 3-4 hours after taking chromium.

NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs)

Interaction RatingMinor Be watchful with this combination.
Severity = Mild •  Occurrence = Possible •  Level of Evidence = D
NSAIDs might increase chromium levels in the body.
+ Details
Drugs that are prostaglandin inhibitors, such as NSAIDs, seem to increase chromium absorption and retention (7135).

+ Interactions with Supplements

CHROMIUM-CONTAINING HERBS AND SUPPLEMENTS: Concomitant use can increase chromium levels.
+ Details
Herbs that contain chromium can increase the risk of chromium toxicity when taken chronically in conjunction with chromium supplements (9141).
HERBS AND SUPPLEMENTS WITH HYPOGLYCEMIC POTENTIAL: Chromium might lower blood glucose levels.
+ Details
Theoretically, chromium might have additive effects when used with other herbs and supplements that also lower glucose levels, which may increase the risk of hypoglycemia (7137,14440,15169,94234,95097,95098,98687). See other products with hypoglycemic potential here.
IRON: Chromium might increase the risk of iron deficiency.
+ Details
Chromium competes with iron for binding to the transport protein, transferrin, and could predispose people to iron deficiency. This effect is unlikely to be clinically significant at usual supplemental doses of chromium (6861,6865,6866,95097).
VITAMIN C: Limited data suggests that vitamin C increases chromium absorption.
+ Details
When taken along with vitamin C 100 mg, the absorption of a chromium 1000 mcg dose approximately doubled (10600). Advise people to avoid taking large doses of chromium and vitamin C together. It is not known whether separating the doses by several hours will eliminate this interaction.
ZINC: Chromium and zinc might impact each other's absorption.
+ Details
Laboratory research suggests that chromium and zinc share a transport site in the intestine, and that each could reduce the absorption of the other (1950). This is not likely to be clinically significant at normal supplemental doses of zinc and chromium.

+ Interactions with Conditions

+ BEHAVIORAL AND PSYCHIATRIC DISORDERS

Theoretically, chromium picolinate preparations might affect behavioral and psychiatric conditions. Picolinic acid in chromium picolinate preparations can alter serotonin, dopamine, and norepinephrine metabolism in the central nervous system (1935).

+ CHROMATE/LEATHER CONTACT ALLERGY

Theoretically, chromium might trigger a reaction in people allergic to leather. Oral chromium supplements can cause allergic reactions in people with chromate or leather contact allergy, including dermatitis, erythema, and scaling on the extremities (6624).

+ KIDNEY DISEASE

Theoretically, chromium might exacerbate kidney disease. There are at least three reports of kidney damage in patients who took chromium picolinate (554,1951,14312). Advise patients with kidney dysfunction to avoid chromium supplements.

+ LIVER DISEASE

Theoretically, taking chromium polynicotinate might exacerbate symptoms in patients with existing liver disease. The chromium polynicotinate form of chromium has been linked to hepatotoxicity in at least three cases (9141,13037). Advise these patients to avoid chromium polynicotinate supplements.

Interactions with Lab Tests

None known.

+ Nutrient Depletion

SOME DRUGS CAN AFFECT CHROMIUM LEVELS:

ANTACIDS

Depletion RatingInsufficient Evidence to Rate Clinical significance is not known.
Antacids might decrease chromium levels by inhibiting the absorption of chromium.
+ Details

Antacids increase gastric pH, which might decrease chromium absorption due to formation of less soluble chromium salts (7135,21055,21059). However, the clinical significance of this is not clear.

CORTICOSTEROIDS

Depletion RatingModerate Depletion Monitor for depletion; a supplement is needed in some patients.
Corticosteroids increase chromium excretion and can lower chromium levels.
+ Details

Use of corticosteroids can increase urinary chromium excretion, which might lead to chromium deficiency and/or corticosteroid-induced hyperglycemia (5039,42829).

DIMERCAPTOSUCCINIC ACID (DMSA)

Depletion RatingModerate Depletion Monitor for depletion; a supplement is needed in some patients.
DMSA increases chromium excretion and might lower chromium levels.
+ Details

Use of DMSA can increase urinary excretion of chromium by up to 88% of the recommended daily allowance (RDA); however, this effect may not be clinically significant, as chromium excretion seems to normalize after nine doses of DMSA (21057).

H2-BLOCKERS

Depletion RatingInsufficient Evidence to Rate Clinical significance is not known.
H2-blockers might decrease chromium levels by inhibiting the absorption of chromium.
+ Details

H2-blockers increase the gastric pH, which might decrease chromium absorption due to formation of less soluble chromium salts (7135). However, the clinical significance of this is not clear.

PROTON PUMP INHIBITORS (PPIs)

Depletion RatingInsufficient Evidence to Rate Clinical significance is not known.
PPIs might decrease chromium levels by inhibiting chromium absorption.
+ Details

PPIs increase the gastric pH, which might decrease chromium absorption due to formation of less soluble chromium salts (7135). However, the clinical significance of this is not clear.

Overdose

Presentation

Acute chromium toxicity can cause vomiting, diarrhea, hemorrhage, and blood loss into the gastrointestinal tract resulting in cardiogenic shock (11786).

Another form of chromium, called hexavalent chromium (CR VI), is 100 times more toxic than trivalent chromium. Industrial hexavalent chromium is considered cytotoxic and genotoxic (6863,42658,42663,42686,42693). It penetrates the cells easily (unlike trivalent chromium) and appears to induce oxidative damage to DNA (7326,42565,42749,42778).

Treatment

There is insufficient reliable information available about the treatment of overdose with chromium.

Commercial Products Containing: Chromium


Pharmacokinetics

Absorption: When ingested, most chromium is excreted unabsorbed in the feces. The small percentage that is absorbed, typically 0.4% to 2.5%, is rapidly excreted in the urine (7135). Approximately 0.5% to 2% of chromium is absorbed (42740,42725).

Adding the picolinate or nicotinate salt increases absorption, retention, and accumulation of chromium compared to inorganic salts such as chromium chloride (6861,6864,9141,95096,95098). Nicotinate may also have increased bioavailability over picolinate (95096). Some manufacturers suggest that chromium polynicotinate is better absorbed than chromium picolinate, but there is no scientific support for this claim.

Distribution: After absorption, chromium is bound to transferrin (6869). The distribution may occur across fast, medium, and slow compartments, with serum chromium not in equilibrium with tissue-organ stores (42811). Once absorbed, chromium concentrates in the kidney, heart, liver, brain, muscle, spleen, testes, epididymis, and lungs (6863).

Chromium retention decreases with aging, as found in a very large collection of hair, sweat, and serum samples (7058). It is unclear whether this is due to inadequate nutrition or normal physiology (42779).

Excretion: The small percentage of chromium that is absorbed is rapidly excreted in the urine (7135,42579). Stressors, such as elevated blood sugar, strenuous physical activity or work, infection, and emotional and physical trauma, may increase the excretion of chromium (37163,42721,42744,42748).

Mechanism of Action

General: Chromium (Cr) is a white, hard, brittle metal that is an essential trace element. The activity of chromium depends on its valance state. Metallic chromium, or chromium 0, has no activity. The other two common forms, chromium III (Cr III) and chromium VI (Cr VI), have different activities. Cr VI is typically used in chemical and welding industries and is carcinogenic to humans. Cr III is the form found in foods and supplements (13721).

Chromium is sometimes referred to as glucose tolerance factor (GTF), but GTF is actually a complex of molecules found in the body that includes chromium bound to single molecules of glycine, cysteine, glutamic acid, and two molecules of nicotinic acid. Chromium is thought to be the active component of the complex. Some dietary sources of chromium include canned foods (due to chromium leaching from the can), meats and animal fats, fish, brown sugar, coffee, tea, some spices, calf liver, whole wheat bread, rye bread, and brewer's yeast (7061).

Symptomatic chromium deficiency is rare. When it does occur, it is most often due to malnutrition, pregnancy, stress, or long-term use of chromium deficient total parenteral nutrition (TPN). Symptoms include severe glucose intolerance, weight loss, and metabolic encephalopathy (6863,13730). Although not yet confirmed, some researchers suspect that tissue levels of chromium might decline with age (6863).

Antidiabetes effects: People with diabetes may have lower chromium levels (7058,11908,13725). Low chromium levels are associated with impaired glucose, insulin, and lipid metabolism, and resultant increased cardiovascular risk (95097). Some athletes might also be at risk for low chromium levels since strenuous aerobic exercise seems to increase urinary excretion of chromium (6860,6861). However, exercise-induced losses seem to be less in those who regularly exercise (6862). People who strength train seem to have increased absorption of chromium (7136). It is difficult to measure chromium status to determine who might require supplementation. Blood chromium levels are not in equilibrium with chromium stores and, therefore, do not provide a good indicator of chromium status (6859). However, elevated blood chromium levels may indicate excessive chromium exposure (11786). Levels in the urine and hair do not reflect overall chromium status (6867). There is no reliable method available to diagnose chromium deficiency, other than observing the outcome following supplementation in patients suspected of being deficient (3859,6869). Symptoms of chromium deficiency can include impaired insulin function and glucose tolerance, leading to elevations in insulin and fasting hyperglycemia, impairments in growth, increased serum cholesterol and triglycerides, neuropathy, weight loss, decreased respiratory function, and nitrogen metabolism abnormalities (6863,6869,11786,95098).

Discovery of the role of chromium in insulin function occurred when patients on long-term TPN developed symptoms of diabetes that did not respond to insulin, but were reversed by chromium (6869,42641,42787). Because of the symptoms associated with chromium deficiency, researchers have speculated that chromium supplementation might be an effective treatment for diabetes. There is some evidence that patients with diabetes might have lower than normal levels of chromium due to increased chromium excretion (6858). However, patients with diabetes also seem to have increased gastrointestinal absorption of chromium. It's also theorized that patients with diabetes may not be able to adequately convert chromium from the diet to a usable form in the body (6867). Chromium seems to be transported to insulin-sensitive cells by transferrin, in response to increases in plasma insulin levels (6869). It is suspected to potentiate insulin by increasing receptor numbers and affinity, and increasing insulin binding to cells (6859,6867). Chromium increases insulin sensitivity through activation of signaling pathways involved with glucose transporter 4 (GLUT4), leading to translocation (95097). Chromium may also enhance the synthesis of insulin receptor mRNA as well as insulin-like growth factor receptors (95097). A single oral dose of chromium before a high carbohydrate meal seems to lessen postprandial hyperglycemia in healthy, young volunteers. This suggests chromium potentiates the effect of insulin (13726). Additionally, chromium picolinate has been shown to increase insulin sensitivity and stimulate insulin receptor sites in patients with type 2 diabetes (42554).

Other clinical research shows that chromium dinicocysteinate can reduce insulin resistance by reducing oxidative stress and blood levels of tumor necrosis factor (TNF)-alpha and insulin in patients with type 2 diabetes (42707). However, chromium picolinate does not appear to have these effects. In animal models, a chromium-containing peptide called chromodulin has been identified, which potentiates the actions of insulin at its receptors, including activation of receptor tyrosine kinase activity (6869). Additionally, in laboratory study, chromium activated trafficking of glucose transporter-4 and increased insulin-stimulated glucose transport through a cholesterol-dependent mechanism (42602). In patients with diabetes, these actions seem to translate into decreased insulin resistance, improved glucose tolerance, and lower blood glucose levels (6862). Researchers are interested in chromium for treatment of obesity and metabolic syndrome (syndrome X) due to its potential effects on lipids and body composition.

Some clinical research shows that chromium might reduce oxidative stress and inflammation, and thereby some of the adverse effects and complications of diabetes (13724). A meta-analysis of clinical studies in adults, most of whom have diabetes, shows that chromium supplementation is associated with modest reductions in high-sensitivity C-reactive protein and TNF-alpha when compared with control (105030). But the clinical significance of this is not known.

Clinical research suggests that adding 100 mg of nicotinic acid 200 mcg of chromium chloride significantly improves glucose metabolism (11687); the effects of chromium may be augmented by nicotinic acid.

Antioxidant effects: Chromium is considered to have antioxidant effects (13724,42785). In human research, chromium dinicocysteinate supplementation significantly lowered protein carbonyl levels, a marker of protein oxidation, from baseline in diabetic patients (42707). Another study in diabetic patients reported an improvement in plasma thiobarbituric acid reactive substances (TBARS) (30863). In patients with polycystic ovary syndrome, chromium lowered levels of malondialdehyde (98687). A meta-analysis of patients with diabetes and other chronic disorders shows that taking chromium 400-1000 mcg orally daily for 8-24 weeks improves some markers of oxidative stress, such as malondialdehyde levels, when compared with control; however other markers, such as glutathione and superoxide dismutase levels, were not improved (110608). Some clinical research also shows that chromium might reduce oxidative stress in patients with diabetes; however, in patients without diabetes, chromium might act as a pro-oxidant (13724).

Bone-resorption effects: In vitro evidence suggests that chromium extract may increase the release of bone-resorbing cytokines by peripheral blood mononuclear cells. Thus, when used as an alloying element in metallic implants, chromium may increase tissue damage and bone resorption surrounding a metallic implant (42784).

Immunomodulating effects: In vitro evidence suggests that chromium extract reduces cell proliferation and inhibits interleukin (IL)-2-dependent response of peripheral blood mononuclear cells exposed to phytohemagglutinin. Thus, when used as an alloying element in metallic implants, chromium may reduce lymphocyte-mediated immune response to an infection that develops in tissue surrounding a metallic implant (42784).

Genetic effects: Although laboratory studies have shown that trivalent chromium compounds can produce chromosome or DNA oxidative damage, human studies have not demonstrated these findings (42790). On the other hand, hexavalent chromium penetrates the cells easily (unlike trivalent chromium) and appears to induce oxidative damage to DNA (7326,42565,42749,42778).

Growth effects: There is interest in using chromium to enhance muscle protein synthesis. In the presence of sufficient essential amino acids or protein, insulin stimulates muscle protein synthesis. With low amounts of essential amino acids, insulin inhibits protein breakdown and has minimal effects on the rate of muscle protein synthesis. Therefore, it has been speculated that an improvement in insulin signaling combined with adequate doses of essential amino acids, could affect muscle protein synthesis (95099). Chromium is hypothesized to increase muscle mass by increasing amino acid uptake into muscle cells via potentiation of insulin activity (6862,42813). Laboratory research suggests that chromium picolinate increases internalization of insulin and increases leucine uptake in muscle cells. Because of its effects on glucose transporter 4 (GLUT-4) translocation, and its ability to increase insulin response through the AMPK pathway, chromium has been used in clinical research to improve muscle protein synthesis. In one small clinical study in healthy young adults, taking a suboptimal dose of whey protein isolate (BiPro USA) 6 grams and a combination product containing chromium picolinate/histidinate and amylopectin (Velositol, Nutrition 21, LLC) 2 grams, followed by acute resistance exercise, significantly increased the muscle fractional synthesis rate compared to whey protein alone (95099).

Also, evidence from animal research suggests that chromium supplementation can increase growth rate in mice and rats (42733).

Lipid effects: Chromium inhibits the hepatic enzyme 3-hydroxy-3-methyl-glutaryl-CoA reductase leading to interference of cholesterol metabolism (95097).

Neurologic effects: It is theorized that chromium might enhance glucose utilization in the brain and stimulate norepinephrine release (2659). There is also interest in using chromium as an adjunct to antidepressant medications in people with depression. Preliminary clinical research suggests that chromium decreases endocrine responses to serotonin receptor stimulation, which could produce antidepressant activity (8929). A case series of adults with persistent depressive disorder shows that chromium supplementation might improve response to antidepressants, such as sertraline and amitriptyline, in patients with inadequate response (2659). However, clinical research in patients with atypical depression has yielded conflicting results (10309,42600).

Weight loss effects: Clinical research shows that ingestion of chromium picolinate reduces fat cravings, food intake, and hunger, which may lead to weight loss (42634). Chromium may induce these effects by affecting the brain's hunger receptors. Some research suggests that chromium might sensitize insulin-sensitive glucoreceptors in the brain, resulting in appetite suppression, activation of the sympathetic nervous system, stimulation of thermogenesis, and down-regulation of insulin secretion (6170,6860).

Classifications


References

See Monograph References


Monographs are reviewed on a regular schedule. See our Editorial Principles and Process for details. The literature evaluated in this monograph is current through 5/31/2023. This monograph was last modified on 5/7/2023. If you have comments or suggestions, please tell the editors.