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Sources and physiological effects

Dietary sources
Chromium (ancient Greek “chroma“, color) is a trace element that owes its name to the beautifully colored chrome salts. In food, chromium is present in both organic and inorganic form, although the organic form (chromium picolinate) is slightly more bioavailable than the inorganic form. In addition to the bioavailability of the form of chromium, the chromium content of food varies greatly depending on the soil. This can make nutritional panels about the chromium content of foods less meaningful. Significant amounts of easily absorbable chromium are found primarily in calf's liver, brewer's yeast, wheat germ, but also in wholemeal products and in meat. Fruit and many vegetables are generally considered to be low in chromium. Industrial processing can also have an unfavorable effect on the chromium content of food products. For example, the processing of grain and molasses to highly purified starch and sugar products leads to the loss of up to 90% of the chromium it contains.
Physiological effects
Carbohydrate metabolism	Glucose tolerance control Intensification of insulin effect by activation of chromodulin
Protein metabolism	Co-factor in the metabolism of glycine and serine

EFSA Health Claims

Health Claims		EFSA Opinion
Chromium	Contributes to the normal metabolism of macronutrients Contributes to maintenance of normal blood sugar levels

Recommended intake

D-A-CH Reference values for the intake of chromium (Reference values EFSA and NHI )
	Age	Chrome (µg/d)
Infants (months)
	0-4	1 - 10
	4-12	20 - 40
Children (years)
	1-4	20 - 60
	4-7	20 - 80
	7-10	20 - 100
	10-13	20 - 100
	13-15	20 - 100
Teenagers/adults (years)		Women	Men
	15-19	30 - 100	30 - 100
	19-25	30 - 100	30 - 100
	25-51	30 - 100	30 - 100
	51-65	30 - 100	30 - 100
	> 65	30 - 100	30 - 100
Pregnancy	N/A
Breastfeeding	N/A
Increased needs	Carbohydrate- and fat-rich diets, competitive sports (losses through sweat), diabetes mellitus, etc;

Recommended intake according to the food labelling regulations
(=100 % daily value)		40 µg
Nutrient safety
UL	Long-term daily intake, for which no negative effects on health are to be expected	250 µg/d (according to WHO)
NOAEL	Maximum intake, with no observed adverse effect	1000 µg/d
Safety	The EFSA has been working on the safety of chromium.

Detailed information

Chromium and diabetes mellitus

For therapeutic use, chromium is primarily applied in the treatment of diabetes mellitus. Diabetics excrete more chromium (chromuria), which manifests itself in low plasma values. For example, the amount of chromium excreted in urine in diabetics are 100 % higher than those of a healthy person, while plasma values are reduced by 33 % (1). Chromium is an active component of the glucose tolerance factor, which can only be formed in the presence of sufficient trivalent chromium. The glucose tolerance factor controls the binding of insulin to the specific receptors of the cell membranes. This improves glucose utilization and optimizes insulin action (2). However, chromium (like zinc) can also interact with the receptors directly. This is done by stimulating a phosphorylation reaction, similar to that caused by insulin. Chromium (and zinc) is therefore referred to as an insulin-mimetic (3). Chromium supplementation of 200–1000 µg per day can improve insulin receptor binding, cellular glucose utilization (4) and blood fat levels in diabetics. Insulin resistance (5), fasting glucose levels (6), insulin and HbA1c levels are significantly reduced (1)(6). A common consequence of type 2 diabetes mellitus is an increased triglyceride and cholesterol level. Chromium can aid in this instance via insulin metabolism. A change in the cholesterol content of the cell membranes influences the amount of circulating cholesterol, which is an explanation for the cholesterol-lowering properties of chromium (7). In clinical trials, cholesterol and triglyceride levels in serum were significantly reduced in diabetics with a daily substitution of 50 µg chromium or more (8).

Chromium and competitive sports

Chromium supplementation is used in competitive athletes due to their high glucose turnover and an equally increased chromium excretion. However, an anabolic effect does not seem to exist (9). Studies also found no increase in muscle strength or a change in the distribution of body fat (10). Nevertheless, an adequate chromium intake is of particular importance for the athlete's physical performance, since a latent chromium deficiency can lead to limited energy utilization.

Reference values

Substrate	Parameters	Reference value	Description
Blood	serum	0.05 - 0.15 µg/l
	whole blood	0.12 - 0.34 µg/l
Urine	24-h-urine	<0.5 µg/l
Interpretation
Low value		Note on chrome deficiency. Parenteral nutrition, stress and infections. In diabetics, this indicates poor control.
High value		Acute or chronic chromium poisoning, terminal renal failure
Note on interpretation of results
Inaccurate results may be contamination of the sample by introduction of chromium from metal cannula during sampling.

Nutrigenetics
Determined nutrient deficiencies and their influence on the genes, related to the diseases associated with them

Affected gene location	Activity of the affected gene location	Associated disease	Nutrient
Insulin-regulating genes	reduced	DMT2 (11)(12)	Chromium deficiency

Deficiency symptoms

Impact on	Symtoms
Carbohydrate metabolism	Deterioration of glucose tolerance Increase of insulin resistance
Fat metabolism	Increase in total cholesterol Reduction of HDL cholesterol
Nerve system	Neuropathies, ataxias

Indications

Effect	Indication	Dosage
Physiological effects at a low intake	Prevention of  type 2 diabetes	200 µg/d
	To cover an increased demand and to improve an chromium deficiency, especially in the case of competitive athletes and older people	200 µg/d





Pharmacological effects at a high intake	Therapeutic support for type 2 diabetes	200 - 1000 µg/d

Administration

General mode of administration
When	Chromium should be taken between meals (60 minutes before) as other micronutrients and food components can interfere with absorption.
Side effects
No side effects are known to date.
Contraindications
No contraindications are known to date.

Interactions

Drug interactions
NSAIDs (e.g. diclofenac, ibuprofen)	Increase absorption, decrease excretion.
Beta-blockers (e.g. atenolol, bisprolol)	Higher chromium levels improve HDL cholesterol while taking beta-blockers.
Antidiabetics (insulin, metformin, glimepiride)	Chromium can increase the blood sugar lowering effect of antidiabetics.
Corticosteroids (e.g. dexamethasone, methylprednisolone)	Enhance the elimination of chromium.
Nutrient interactions
Trace elements	Calcium, iron and zinc impair chromium absorption.

Description and related substances

Description

Trace mineral
Symbol: Cr
Ion: Cr³⁺

Related substances

3-valent chromium compounds:

Chrom(III)-Chlorid, Chrom(III)-Sulfat, Chrom(III)-Lactat, Chrom(III)-Nitrat

Organic compounds:

Chrompicolinat

6-valent chromium compounds:

are toxic and not allowed

References

1) Morris, B. et al. 1999. Chromium Homeostasis in Patients with Type II (NIDDM) Diabetes. Journal of Trace Elements in Medicine and Biology 13, Nr. 1-2: 57–61. doi:10.1016/s0946-672x(99)80024-8.
2) Gröber U. 2002. Orthomolekulare Medizin. Ein Leitfaden für Apotheker und Ärzte.
3) Miranda, E. R. et al. 2004. Effect of Chromium and Zinc on Insulin Signaling in Skeletal Muscle Cells. Biological Trace Element Research 101, Nr. 1: 19–36. doi:10.1385/bter:101:1:19.
4) Abdollahi, M. et al. 2013. Effect of Chromium on Glucose and Lipid Profiles in Patients with Type 2 Diabetes; A Meta-analysis Review of Randomized Trials. Journal of Pharmacy & Pharmaceutical Sciences 16, Nr. 1: 99. doi:10.18433/j3g022.
5) Jain, S. K. et al. 2012. Effect of chromium dinicocysteinate supplementation on circulating levels of insulin, TNF-α, oxidative stress, and insulin resistance in type 2 diabetic subjects: Randomized, double-blind, placebo-controlled study. Molecular Nutrition & Food Research 56, Nr. 8 (June): 1333–1341. doi:10.1002/mnfr.201100719.
6) Racek, J. et al. 2013. Effect of Chromium-Enriched Yeast on Fasting Plasma Glucose, Glycated Haemoglobin and Serum Lipid Levels in Patients with Type 2 Diabetes Mellitus Treated with Insulin. Biological Trace Element Research 155, Nr. 1 (July): 1–4. doi:10.1007/s12011-013-9758-9.
7) Chen, G. et al. 2006. Chromium Activates Glucose Transporter 4 Trafficking and Enhances Insulin-Stimulated Glucose Transport in 3T3-L1 Adipocytes via a Cholesterol-Dependent Mechanism. Molecular Endocrinology 20, Nr.4:857–870. doi:10.1210/me.2005-0255.
8) Sharafetdinov, K. et al. 2004. Effect of food diet supplements with chromium on the clinical and metabolic parameters in type 2 diabetic patients. Vopr Pitan. 73(5):17-20.
9) Lefavi, R. G. et al. 1992. Efficacy of Chromium Supplementation in Athletes; Emphasis on Anabolism. International Journal of Sport Nutrition 2, Nr.2:111–122. doi:10.1123/ijsn.2.2.111.
10) Vincent, J. B. 2003. The Potential Value and Toxicity of Chromium Picolinate as a Nutritional Supplement, Weight Loss Agent and Muscle Development Agent. Sports Medicine 33, Nr.3:213–230. doi:10.2165/00007256-200333030-00004.
11) Zhang, Q. et al. 2017. Dietary chromium restriction of pregnant mice changes the methylation status of hepatic genes involved with insulin signaling in adult male offspring. PLoS One. 12:e0169889.
12) Zhang, H. et al. 2014. Maternal vitamin D deficiency during pregnancy results in insulin resistance in rat offspring, which is associated with inflammation and Iκbα methylation. Diabetologia. 57:2165-2172.

References Interactions
Stargrove, M. B. et al. Herb, Nutrient and Drug Interactions: Clinical Implications and Therapeutic Strategies, 1. Auflage. St. Louis, Missouri: Elsevier Health Sciences, 2008.
Gröber, U. Mikronährstoffe: Metabolic Tuning –Prävention –Therapie, 3. Auflage. Stuttgart: WVG Wissenschaftliche Verlagsgesellschaft Stuttgart, 2011.
Gröber, U. Arzneimittel und Mikronährstoffe: Medikationsorientierte Supplementierung, 3. aktualisierte und erweiterte Auflage. Stuttgart: WVG Wissenschaftliche Verlagsgesellschaft Stuttgart, 2014.