Chromium

Chromium is a natural essential mineral belonging to the supplement class.

Chromium is also known as crocoite and chromate.

Chromium is an essential mineral that is required for

A deficiency of chromium leads to chromium deficiency which is characterized by symptoms like disorientation, numbness or discomfort in the hands, feet, or face, glucose intolerance, and elevated blood sugar.

Chromium is found primarily in grain products, grapes, broccoli, nuts, spices, meat, brewer’s yeast, beer, and wine.

Chromium is absorbed by the digestive system, distributed throughout the body's tissues, metabolised by the liver, and mostly excreted through the urine.

The common side effects of chromium include gastrointestinal effects like abdominal cramps, diarrhoea and nausea.

Chromium is available in capsules, tablets, powders, and liquids.

Biochemical action of Chromium

Chromium belonging to the supplement class helps enhance insulin sensitivity, potentially promoting glucose uptake and cell metabolism. Chromium acts via the insulin signalling pathway.

Hexavalent chromium (chromium (VI) and trivalent chromium (chromium (III) are the two valence states of chromium that are most prevalent in nature. The hexavalent form is dangerous and typically spreads through industrial exposure. Orally, frequently as a result of industrial water contamination, it has been classified as a severe carcinogen for both people and animals. Trivalent chromium is an essential element to human health and is approved as a supplement. Overall, trivalent chromium is safe for humans, and hexavalent chromium is a toxic form of chromium.

Most of chromium's primary functions are eventually associated with its contribution to glycaemic regulation and its secondary benefit as antioxidant system.

Cofactor: Chromium is a crucial trace mineral to metabolise carbohydrates, lipids, proteins, and corticosteroids.

Improves blood sugar control: Trivalent chromium is a crucial trace element for healthy carbohydrate metabolism and insulin sensitivity, promoting insulin's capacity to carry glucose into cells.

Lipid-lowering activity: Chromium supplementation has the potential to slightly raise HDL cholesterol while lowering triglyceride, total, and LDL cholesterol levels.

Chromium is available in capsules, tablets, powders, and liquids.

• Tablets/capsules: To be swallowed whole with water/liquid, as applicable.
• Powders: To be swallowed with water/liquid or may be eaten directly, as applicable.
• Liquids: Liquids should be taken by mouth or parenterally, as applicable.

Chromium can be used as a supplement when the amount of chromium taken from the diet is insufficient.

Chromium supplement helps maintain proper carbohydrate and lipid metabolism at a molecular level.

Adequate oral intake of chromium supplements might help enhance the effects of insulin and lower glucose levels.

Vitamins and natural supplements should not replace a balanced diet.

This product is not intended to diagnose, treat or prevent any disease(s).

Chromium may be useful as a supplement for the following health benefits:

• Prevention and treatment in deficiency states: Chromium supplementation is utilised in situations where there is a risk of deficiency, such as those with long-term corticosteroid use, patients who have signs of decreased insulin sensitivity, persons who consume a lot of sugar, or those who are suspected of being deficient after an extensive clinical history has been met.
• Immunomodulation: Chromium has immunostimulatory and immunosuppressive effects on the immune system, shown by its effects on T- and B-lymphocytes, macrophages, and cytokine production.
• Diabetes: Studies examined if increasing chromium intakes could lower the incidence of impaired glucose tolerance since chromium can enhance the effect of insulin.
• Polycystic ovary syndrome (PCOS): A common endocrine condition that affects women of reproductive age is PCOS. Infertility, obesity, dyslipidemia, hyperandrogenism, and increased risks of type 2 diabetes and cardiovascular disease are some of its key features. Studies examined chromium supplements in persons with PCOS to assist in maintaining glycemic control and lower lipid levels because insulin resistance is frequently a critical factor in PCOS.
• Obesity: It has been suggested that chromium supplementation may benefit body composition, including lowering fat and increasing lean body mass. Chromium plays an integral role in regulating glucose and lipid metabolism.
• Hypoglycaemia: Supplementing with chromium significantly improved the ability of insulin to attach to receptors and red blood cells and reduced the symptoms of hypoglycemia.
• Atypical depression: By stimulating and increasing the release of norepinephrine, another neurotransmitter that controls mood, chromium could potentially help depression. Its mode of action could be connected to the downregulation of 5HT2A.
• Bone density protection: It has been hypothesised that chromium's regulation of insulin may increase bone density by preventing bone resorption while stimulating osteoblasts to produce collagen.

Chromium supplementation may be administered orally or parenterally.

• Orally: Chromium supplements are available as tablets, capsules and powders that can be taken orally. It is best to take just before or after a meal.
• Parenterally: Chromium supplements are generally taken by mouth, but some patients may have to be administered intravenously.

The dosage and duration of treatment should be as per the clinical judgment of the treating healthcare professional).

Vitamins and natural supplements should not replace a balanced diet

This product is not intended to diagnose, treat or prevent any disease(s).

Chromium is generally present in multivitamin/mineral supplements in doses of 35 to 120 mcg. Supplements containing only chromium like tablets and capsules are also available, and most of them provide 200 mcg to 500 mcg of chromium; however, some go as high as 1,000 mcg.

Chromium is available in capsules, tablets, powders, and liquids.

Chromium should be used as supplement support for maintaining strong bones along with appropriate dietary restrictions.

• Limit drinks that contain high sugar or carbohydrates, as these substances could hinder chromium absorption.
• Avoid food that contains oxalate, such as seeds, legumes, grains and berries.
• Avoid alcoholic beverages.
• Stay within your daily calorie needs.

The dietary restriction should be individualized as per patient requirements.

Recommended Daily Allowance (RDA)

The RDA is 35 μg/day and 25 μg/day for young men and women, respectively.

Upper Tolerable Intake (UTL):

No UTL is set for chromium, as data concerning adverse effects is insufficient.

Chromium supplementation may be contraindicated in the following conditions:

• Hypersensitivity; sensitive to chromate or leather contact allergy
• Chronic kidney disease
• Liver disease.
• Hypermagnesemia
• History of heart block or cardiovascular disease.
• Insulin sensitivity or diabetes.

Chromium supplements should be cautiously used in behavioural or psychiatric disorders such as depression, anxiety, or schizophrenia, as it may worsen it.

For individuals on hemodialysis, chromium from supplements might need to be absorbed better in people.

Magnesium should be used cautiously in individuals with extensive heart block (a form of cardiac rhythm abnormality) since it might further reduce the heart rate.

Chromium supplements should be given cautiously to individuals with gastrointestinal disorders, as high doses may cause diarrhoea or other digestive issues.

Caution is advised when consuming alcohol with chromium.

It is excreted in breastmilk; Safe to use during breastfeeding.

Safe to use during pregnancy.

Limit the consumption of foods and beverages rich in carbohydrates, such as quinoa, grains, potatoes and alcoholic beverages, as these substances could hinder Chromium absorption.

Chromium is generally well-tolerated.

The adverse reactions related to chromium can be categorized as-

• Common: Stomach discomfort, headaches, skin reactions or irritations.
• Less Common: Dizziness, vomiting, insomnia, mood changes or irritability.
• Rare: Allergic reactions, kidney problems and liver function abnormalities.

The clinically relevant drug interactions of Chromium are briefly summarized here:

• Corticosteroids: It has been demonstrated that chromium supplementation can help people recover from steroid-induced diabetes mellitus. Corticosteroids increase urine losses of chromium. As a result, a positive interaction could be possible.
• Hypoglycaemic medicines: Chromium might reduce the need for hypoglycemic medications. Although there may be a positive interaction, this combination should be taken cautiously, and a healthcare provider should monitor and adjust the drug requirements.
• Lipid-lowering medicines: Since lipid-lowering effects have been shown in several clinical investigations, additive effects are theoretically possible. Observe patients who are using this combination and monitor their medication needs.
• Hormone replacement therapy (HRT): Trivalent chromium supplementation of 17-beta-oestradiol may increase IL-6 inhibition in animal models and appears to improve the chromium status of women on HRT. It is still being determined if this will change the needed amount of chromium.

The common side of chromium includes the following:

• Upset stomach
• Headaches
• Insomnia
• Mood changes
• Liver or kidney damage.
• Skin reactions

The use of chromium should be prudent in the following group of special populations.

• Pregnancy:

Pregnancy Category: C. Safe during pregnancy, but when taken in high doses, use with caution if the benefits outweigh the risks.

The RDA for Chromium in pregnant women is 29-30 mcg/day.

• Paediatrics: Chromium supplements are essential for children with conditions that impair their ability to process glucose, such as obesity, diabetes, or low blood sugar.

Chromium supplements are the best way to help children get enough chromium daily.

The RDA for Chromium in paediatrics ranges from 0.2-35 mcg/day.

Dosage Adjustment for Paediatric Patients

There are no specific dosage adjustments provided.

• Geriatrics: Studies suggest that supplementation with brewer's yeast or inorganic Cr improves glucose tolerance and lowers cholesterol levels in older adults.

The RDA for chromium in geriatrics is 20-30 mcg/day.

• Lactating mothers: When consumed more than RDI, chromium may enter the breast milk and harm a breastfeeding infant, so it is advised to use it cautiously.

The RDA for chromium in lactating mothers is 44-45 mcg/day.

Dosage Adjustment in Kidney Impairment

There are no specific dosage adjustments provided.

Dosage Adjustment in Hepatic Impairment

There are no specific dosage adjustments provided.

Dosage Adjustment for Adult Patients

Diabetes Mellitus, Type 2

200-1000 mcg/day PO in divided doses

Beta Blocker-Related Low HDL Cholesterol

200 mcg PO TID

Hyperglycemia, Corticosteroid-Induced

200 mcg PO TID, OR

400 mcg PO qDay

Hypoglycemia, Prevention

200 mcg PO qDay

Dysthymic Disorder

200 mcg PO qDay-BID

The physician should be vigilant about the knowledge pertaining to identifying and treating overdosage of chromium. Overdosing on chromium supplements may cause diarrhoea, nausea, vomiting, and abdominal cramps.

There is no specific antidote or treatment for excessive intake of supplemental chromium. Calcium should be terminated immediately, followed by increased fluid intake if an overdose occurs. Supportive treatment should also be given, along with addressing any symptoms that persist or worsen. Physical therapy might be added if necessary.

Chromium is most frequently found in the oxidation states of +3 (III) and +6 (VI). Chromium III is the stable form most often found in food because it exists in reducing chemicals. An oligopeptide called chromodulin reacts to insulin-mediated chromic ion flow by binding these ions. When chromodulin is metal-saturated, it can bind to an insulin-stimulated insulin receptor and cause it to tyrosine kinase. This shows that chromodulin functions as an element of an auto-amplification mechanism for insulin signalling. Chromium from mobility pools is probably transported to insulin-sensitive cells via the metal transport protein transferrin. On the other hand, chromium from supplements like chromium picolinate uniquely penetrates cells. To release the chromium from the picolinate, the chromic centre must be reduced, which can produce harmful hydroxyl radicals.

Kinetic profile:

• Absorption: The trace mineral chromium is predominantly absorbed in the small intestine. The absorption of the trivalent form is greater than that of the hexavalent state. It enters the body, attaches to transferrin, and distributes to other tissues via circulation.
• Distribution: It accumulates in the liver, spleen, and bone, with the most significant amounts found in the kidneys and adipose tissue.
• Metabolism: Chromium is metabolised into an active form that enhances biological activity. This active form is assumed to combine chromium and an organic molecule. It has been suggested that this functional form contributes to increased glucose and insulin sensitivity.
• Elimination: Chromium is mostly excreted through the urine, and the kidneys are essential for the body's elimination of excess chromium. Chromium may also be passed in small amounts through faeces and sweating.

1. Braun L, Cohen M. October 1, 2014.Herbs and Natural Supplements; 4th Edition Vol-2. Australia. Elsevier.
2. https://www.ncbi.nlm.nih.gov/books/NBK222329/
3. https://ods.od.nih.gov/factsheets/Chromium-HealthProfessional/
4. https://ods.od.nih.gov/factsheets/Chromium-Consumer/
5. https://www.ncbi.nlm.nih.gov/books/NBK582150/
6. https://www.fssai.gov.in/upload/advisories/2021/07/60f1798019f94Direction_RDA_16_07_2021.pdf

7. National Institute of Nutrition. 2011. Dietary guidelines for Indians; 2nd Edition. Hyderabad. India