Chromium picolinate may enhance insulin sensitivity

VICUS.COM (31 July 2000) -- Recently, it was reported that 833 individuals living in China with type 2 diabetes were treated with chromium in the form of chromium picolinate.

Side effects associated with chromium picolinate supplementation

Most studies of chromium picolinate supplementation reveal no side effects except gastrointestinal intolerance with dosages of 50 to 200 micrograms/day for less than one month. However, anecdotal reports of serious adverse effects, including anemia, cognitive impairment, chromosome damage and interstitial nephritis, have been reported with chromium picolinate ingestion in increased dosages and/or durations.

Source: Armsey TD, Green GA. Nutrition supplements: science vs. hype. The Physician and Sportsmedicine. 1997 Jun; 25(6). Available at URL:
http://www.physsportsmed.com/
issues/1997/06jun/armsey.htm

Chromium picolinate, the organic form of chromium, is a trace element that is a popular weight-loss supplement.

The study subjects were reported to have experienced improved control of blood glucose levels, which was accompanied by long-term improvements in their symptoms of diabetes (Cheng, et al., 1999).

These findings are significant in light of the fact that type 2 diabetes is poised to become one of the major challenges to public health in the 21st century.

The growing problem of type 2 diabetes

Speaking during the 60th scientific session of the American Diabetes Association meeting in San Antonio, Texas, in June, Paul Zimmet, Ph.D., the founder of the International Diabetes Institute in Melbourne, Australia, summarized the extent of the problem:

By 2010, 230 million people in the world will have diabetes, almost twice as many as today.
Atherosclerosis is the most common complication of type 2 diabetes, and coronary artery disease, cerebrovascular disease and peripheral vascular disease are two to five times more common in people with this condition.
Obesity is a risk factor for type 2 diabetes, and more than 60% of the adult population of the United States is either overweight (body mass index [BMI] of 25-29.9 kg/m²) or obese (BMI >30 kg/m²), with more than 20% of adults falling into the latter category.
Type 2 diabetes is now being diagnosed in younger population groups. Most cases in the 1960s were diagnosed in people older than age 65, while today diagnoses in persons age 35 and older is not unusual.

Insulin resistance

During a recent interview, James Gavin III, M.D., Ph.D., senior scientific officer at the Howard Hughes Medical Institute in Chevy Chase, Md., described type 2 diabetes as one disease with two major problems.

"The first problem is insulin resistance in peripheral tissues. The second is a progressive insulin deficiency that is due to the failure of insulin-secreting beta-cells in the pancreas."

Early in the disease, according to Gavin, "although it is possible to find qualitative defects in beta-cell function, the predominant problem in most people with type 2 diabetes is clinical insulin resistance" (Eriksson, et al., 1989).

Recognition of the importance of insulin resistance during the earliest stages of type 2 diabetes has led to the development of drugs known as insulin sensitizers. The most successful member of this group is metformin (Glucophage), which works predominantly on liver cells. The other class, the thiazolidinediones, works predominantly on peripheral muscle and fat tissues.

Both classes of drugs control elevations in blood glucose; both are also expensive and have side effects that limit their use in certain patients.

Chromium picolinate

Chromium is an essential element required for normal carbohydrate and lipid metabolism. The proposed mechanism of action of chromium in the regulation of insulin is related to an increase in the number and sensitivity of insulin receptors on cell membranes. Among people with diabetes, the response to chromium supplementation is related to the degree of glucose intolerance (Anderson, 1998).

Food sources
of chromium:

• Whole grains
• Brewer's yeast
• Wheat germ
• Liver
• Broccoli
• Prunes
• Nuts
• Cheese
• Fortified cereals

Source: Pelletier KR. The Best Alternative Medicine. What Works? What Does Not? New York (NY): Simon & Schuster; 2000.

The effect can be substantial, as demonstrated in another study of 180 men and women in China (Anderson, et al., 1997). The addition of 500 or 1,000 µg/day of chromium picolinate to their diabetes treatment regimen resulted in improvement in a range of monitoring parameters, including fasting and two-hour blood glucose values plus a decrease in plasma cholesterol.

Perhaps the finding of greatest interest was the decrease in hemoglobin A1c levels after four months (thus signifying increased glycemic control), from greater than 9% pretreatment to less than 8% and less than 7% in the 500 and 1,000 µg/day treatment groups, respectively. This would be considered an optimal response with any diabetes drug regimen and was accomplished without an increase in the body mass index (BMI). Furthermore, treatment with chromium picolinate was well-tolerated.

Comment

Although many studies of chromium picolinate in patients with type 2 diabetes have reported benefits, other studies have not come to the same conclusion.

Furthermore, it should be mentioned that the researches that found chromium picolinate to be useful in the treatment of diabetes have not concluded that it should be used to the exclusion of other established diabetes treatments. Rather, the contribution of this trace element when administered in "therapeutic" doses is as an adjunct to enhance insulin sensitivity at receptor sites of peripheral tissues.

As such, adjustments in other drug therapy may be needed to achieve optimal diabetes control with minimal side effects. Patients should consult their health-care professionals before adding chromium picolinate to their diabetes treatment. .

John Russo Jr., PharmD, is senior vice president of medical communications at Vicus.com. He is a pharmacist and medical writer with more than 20 years of experience in medical education.

References:

Amato P, Morales AJ, Yen SS. Effects of chromium picolinate supplementation on insulin sensitivity, serum lipids and body composition in healthy, nonobese, older men and women. J Gerontol A Biol Sci Med Sci. 2000 May; 55(5):M260-3.

Anderson RA. Chromium, glucose intolerance and diabetes. J Am Coll Nutr. 1998 Dec; 17(6):548-55.

Anderson RA, Cheng N, Bryden NA, et al. Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes. Diabetes. 1997 Nov; 46(11):1786-91.

Cheng N, Zhu X, Shi H, et al. Follow-up survey of people in China with type 2 diabetes mellitus consuming supplemental chromium. Journal of Trace Elements in Experimental Medicine. 1999; 12(2):55-60.

Eriksson J, Franssila-Kallunki A, Ekstrand A, et al. Early metabolic defects in persons at increased risk for non-insulin dependent diabetes mellitus. N Engl J Med. 1989 Aug 10; 321(6):337-43.

Howard Hughes Medical Institute http://www.hhmi.org/

International Diabetes Institute http://www.idi.org.au/

Jeejeebhoy KN. The role of chromium in nutrition and therapeutics and as a potential toxin. Nutr Rev. 1999 Nov; 57(11):329-35.

McCarty MF. Toward practical prevention of type 2 diabetes. Med Hypotheses. 2000 May; 54(5):786-93.