Complementary Therapies for Diabetes: The Case for Chromium, Magnesium, and Antioxidants

doi:10.1016/j.arcmed.2005.01.004

Archives of Medical Research

Volume 36, Issue 3, May–June 2005, Pages 250-257

https://doi.org/10.1016/j.arcmed.2005.01.004 Get rights and content

A growing body of interest on the possible beneficial role of chromium, magnesium, and antioxidant supplements in the treatment of diabetes has contributed to debate about their value for reaching metabolic control and to prevent chronic complications in diabetic subjects. In this article we use a systematic approach focused on clinically based evidence from clinical trials regarding the benefits of chromium, magnesium, and antioxidant supplements as complementary therapies in type 2 diabetes.

Chromium, magnesium, and antioxidants are essential elements involved in the action of insulin and energetic metabolism, without serious adverse effects. However, at present there is insufficient clinically based evidence and its routine use in the treatment of type 2 diabetes is still controversial.

Because the most frequent origin of deficiencies in micronutrients is an inadequate diet, health care providers should invest more effort on nutrition counseling rather than focusing on micronutrient supplementation in order to reach metabolic control of their patients.

Results from long-term trials are needed in order to assess the safety and beneficial role of chromium, magnesium, and antioxidant supplements as complementary therapies in the management of type 2 diabetes.

Introduction

As dietary supplements are widely used not only by the general public but also by diabetic patients 1, 2, 3, a growing interest in its beneficial role has contributed to debate regarding the value of “alternative therapeutics” in the treatment of diabetes (4). Use of “alternative therapies” closely mirrors cultural preferences and individual circumstances that must be taken into account by health care providers in order to attain the best metabolic control for their patients. In this regard, the American Diabetes Association (ADA) issued a Position Statement regarding the “Unproven Therapies” that might be provided to patients (5). Among these, trace elements such as chromium and magnesium, as well as the antioxidants, are the most widely used.

Because the background of micronutrient deficiencies is an inappropriate diet, more than an alternative therapy, the adequate intake of foods rich in chromium, magnesium, and antioxidants should be considered as part of the nutritional support that must be counseled to diabetic patients. Because these essential micronutrients are enhanced by insulin action (6), it should be expected that an adequate daily dietary intake exerts a beneficial role in the metabolic control of subjects with type 2 diabetes. Because the long-term success of dietary intervention usually is poor (7), strategies for reaching the required micronutrient intake, such as oral supplementation, are of particular interest in the management of diabetes.

According to the ADA Position Statement (5) that recommends that the use of adjuvant therapies must be based on evidence emerged from clinical research, in this article we will present a systematic approach regarding the benefits of chromium, magnesium, and antioxidant supplements, focusing on clinical trial-based evidence, in the management of type 2 diabetes.

Section snippets

Chromium

Trivalent chromium (Cr³⁺) is an essential trace element (1) required for the maintenance of normal glucose (8) and fat metabolism (9). Because chromium potentiates the action of insulin, it was named from its recognition in the late 1950s (10) as the glucose tolerance factor term that emphasizes its importance in glucose metabolism.

Chromium is present in many foods, especially in liver, Brewer's yeast, American cheese, wheat germ, vegetables such as carrots, potatoes, broccoli, and spinach, and

Magnesium

Magnesium, the second most abundant intracellular cation (33), is an essential cofactor of high-energy phosphate-bound enzymatic pathways 34, 35 involved in the energetic metabolism, synthesis of protein, and modulation of glucose transport across cell membranes.

Hypomagnesemia, commonly due to insufficient magnesium intake and/or increased magnesium loss (36), is strongly related to metabolic syndrome (37) and has been associated with the development of type 2 diabetes (38), high blood

Antioxidants

There is a great body of evidence showing that hyperglycemia is the primary risk factor associated with development of both micro- and macrovascular complications 72, 73. Among the biochemical pathways through which hyperglycemia produces its deleterious effects is the production of free reactive oxygen species (ROS) 74, 75, 76. Thus, oxidative stress, defined as a persistent imbalance between the excessive production of ROS and/or defects in antioxidant defense, has been implicated in the

Conclusions

Although chromium, magnesium, and antioxidants are essential elements involved in the action of insulin and energetic metabolism, without serious adverse effects, there is insufficient clinically based evidence. Its routine use in the treatment of type 2 diabetes is still controversial. In general, dietary supplements are inexpensive and easily accessible to the public and because of this, they are frequently used inappropriately.

The most frequent origin of micronutrient deficiencies is an

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Diabetes mellitus is an ancient disease that continues to pose huge challenges to health and healthcare costs with its increasing global incidence and prevalence calling for novel therapeutic approaches to contain the epidemic. Intense research efforts have elucidated the critical role of oxidative stress in the etiopathogenesis of this disease and thus a focus on the potential therapeutic benefits of antioxidants. Endogenous and exogenous antioxidants have shown promising results in several studies with occasional equivocal outcomes, which we attribute to the delicate homeostatic environment (prooxidant versus antioxidant) for the therapeutic intervention. The plant flavonoid antioxidant, quercetin, has been successfully tested in several in vitro, in vivo, and human studies. In our most recent, quercetin combined synergistically with the antidiabetic drug, pioglitazone, to reverse endothelial dysfunction in diabetic rats. This and other similar studies make quercetin a molecule of special interest in the race to contain the scourge of diabetes mellitus.
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The prevalence of metabolic syndrome (MetS) has been increasing rapidly worldwide. The activities of zinc, magnesium and chromium have a potential association with MetS; therefore, we investigated the effects of zinc, magnesium and chromium supplements on metabolic risk factors in adults with MetS. In this double-blind, placebo controlled randomised study, 32 adults with MetS were included in the zinc, magnesium, and chromium-administered group (n = 16) or the placebo group (n = 16) and received either 300 mg magnesium, 600 μg chromium and 36 mg zinc per day or placebo over a 24-week period. The primary endpoint was the change in the MetS components, including serum glucose, triglyceride and high-density lipoprotein cholesterol levels, blood pressure and waist circumference. Data were analysed using repeated-measures analysis of variance. The metabolic risk factors did not change post-intervention, but the serum C-reactive protein level decreased in the mineral-supplemented group compared with that in the placebo group. Further studies with stricter inclusion criteria are needed to better evaluate the potential for zinc, magnesium and chromium to improve metabolic risk in adults with MetS.
Investigation of chemical modifiers for the determination of cadmium and chromium in fish oil and lipoid matrices using HR-CS GF AAS and a simple ‘dilute-and-shoot’ approach
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This work presents simple and reliable methods for the determination of Cd and Cr in fish oil and lipoid samples by high-resolution continuum source graphite furnace atomic absorption spectrometry (HR-CS GF AAS). Only a simple dilution using 1-propanol was adopted as sample preparation for the determination of Cd and Cr in order to reduce the high viscosity of the lipoid samples. Pt was employed as permanent chemical modifier and Pd was used as chemical modifier in solution, added over the sample for the determination of Cd for a better performance and sensitivity. Cr was determined without a chemical modifier. The accuracy of the proposed methods was evaluated by comparison with microwave-assisted digested samples and determination by HR-CS GF AAS, showing good agreement between 2% and 13% for both elements without statistical difference (confidence interval of 95%). The limits of detection for Cd and Cr were 0.5 pg and 7 pg, respectively, corresponding to 0.15 ng g^− 1 and 2 ng g^− 1, respectively. The developed methods can be described as clean, fast and accurate, which did not require any sample pre-treatment stages, such as digestion or matrix oxidation, and could be extended to different lipoid matrices, demonstrating their robustness.
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Citation Excerpt :
Chromium is an essential element present in many foods, requires about of 30–40 μg/day. In the absence of well-balanced diet, chromium deficiency appears frequently, hence supplementation of chromium through diet plays an important role in protecting our body from disorders such as diabetes, infertility and cardiovascular complications [9,10]. Due to the low absorption rate of chromium in its salts form, the pharmaceutical and dietary supplement market is growing fast by offering various chemical forms of chromium compounds.
Present study was designed to evaluate the effect of chromium-d-phenylalanine complex (Cr (d-phe)₃) on indomethacin-induced inflammatory bowel disease (IBD) in rats.
Adult Wistar rats were pretreated with vehicle/Cr (d-phe)₃ (30, 60 and 90 μg/kg, p.o.) for 11 days. On day 8 and 9, after one h of the above mentioned treatment, indomethacin (7.5 mg/kg/day, s.c.) was administered to induce IBD. On day 12, blood samples were collected from animals for lactate dehydrogenase (LDH) estimation and ileum was isolated for macroscopic scoring, biochemical estimation (lipid peroxidation, reduced glutathione and myeloperoxidase activity) and histopathological study.
Administration of indomethacin significantly altered the serum LDH, macroscopic and microscopic appearance and biochemical parameters in ileum tissue. Cr (d-phe)₃, at all the tested doses, caused a significant reversal of changes induced by indomethacin.
Present study demonstrates the protective effect of Cr (d-phe)₃ against indomethacin-induced IBD in rats. The observed protective effect might be attributed to the antioxidant and anti-inflammatory properties of Cr (d-phe)₃.
Speciation of chromium in bread and breakfast cereals
2017, Food Chemistry
Citation Excerpt :
Over-exposure to Cr(VI) through consumption of Cr(VI) contaminated food could result in gastrointestinal and neurological effects, cancer, abdominal pains, vomiting and hemorrhage (ATSDR, 1998). Chromium(III) plays a number of important physiological functions in human bodies through its involvement in carbohydrates, lipids and protein metabolisms (Guerrero-Romero & Rodriguez-Moran, 2005; Jomova & Valko, 2011). The effects of Cr(III) on insulin action are illustrated in Fig. 1.
Bread and breakfast cereals are a major constituents of the human diet, yet their Cr(VI) content is not known. Chromium(VI) was determined in these products by high resolution continuum source atomic absorption spectrometer (HR-CS AAS) after leaching Cr(VI) with 0.10 mol L⁻¹ Na₂CO₃.
The results showed that 33–73% of total Cr (58.17 ± 5.12 μg kg⁻¹–156.1 ± 6.66 μg kg⁻¹) in bread exist as Cr(VI) and the highest total Cr content was found in brown bread. It was shown that Cr(III) is oxidized to Cr(VI) during toasting of bread.
Chromium(VI) content in breakfast cereals ranged between 20.4 ± 4 μg kg⁻¹ and 470.4 ± 68 μg kg⁻¹. Therefore, it can be concluded that bread and breakfast cereals contains Cr(VI) which does not exceed maximum acceptable concentration (MAC) of 0.003 mg kg⁻¹bw⁻¹ day⁻¹ through daily consumption of half a bowl (65 g) of breakfast cereal and four slices of toasted (122 g) or untoasted bread (160 g).

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Review articleComplementary Therapies for Diabetes: The Case for Chromium, Magnesium, and Antioxidants

Introduction

Section snippets

Chromium

Magnesium

Antioxidants

Conclusions

Metabolism

J Nutr

J Nutr

Am J Clin Nutr

Nutr Res

Diabetes Res Clin Pract

J Nutr

Am J Hypertens

J Diabetes Complicat

Arch Med Res

J Med

Diabetes Res Clin Pract

Biochim Biophys Acta

Am J Clin Nutr

Diabetes Metab

Biochem Biophys Res Commun

Am J Clin Nutr

J Am Diet Assoc

Am J Clin Nutr

Diab Res Clin Pract

Free Radic Biol Med

Free Radic Biol Med

Free Radic Biol Med

Trends in alternative medicine use in the United States, 1990–1997. Results of a follow-up national survey

JAMA

Systematic review of herbs and dietary supplements for glycemic control in diabetes

Diabetes Care

Interactions between complementary therapies or nutrition supplements and conventional medications

Diabetes Spectrum

Chromium. Friend or foe

Arch Fam Med

Unproven therapies (Position Statement)

Diabetes Care

Micronutrients as nutriceutical interventions in diabetes mellitus

J Am Coll Nutr

Nutrition recommendations and principles for people with diabetes mellitus

Diabetes Care

Chromium research from a distance. From 1959 to 1980

J Am Coll Nutr

A glucose tolerance factor and its differentiation from factor 3

Arch Biochem Biophys

Select vitamins and minerals in the management of diabetes

Diabetes Spectrum

Chromium, glucose intolerance and diabetes

J Am Coll Nutr

Mechanisms of chromium action. Low-molecular-weight chromium-binding substance

J Am Coll Nutr

Elevated intakes of supplemental chromium improve glucose and insulin variables in individuals with type 2 diabetes

Diabetes

Interaction of chromium with insulin. A progress report

Nutr Rev

Chromium oligopeptide activates insulin receptor tyrosine kinase activity

Biochemistry

Potential antioxidant effects of zinc and chromium supplementation in people with type 2 diabetes mellitus

J Am Coll Nutr

Clinical use of the trace element chromium (III) in the treatment of diabetes mellitus

J Trace Elem Exp Med

Beneficial effect of chromium supplementation on serum triglyceride levels in NIDDM

Diabetes Care

Effect of chromium nicotinic acid supplementation on selected cardiovascular disease risk factors

Biol Trace Elem Res

Chromium supplementation in impaired glucose tolerance of elderly. Effect on blood glucose, plasma insulin, C-peptide, and lipid levels

Br J Nutr

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

Chromium picolinate and type 2 diabetes

Am J Clin Nutr

Nutrition principles and recommendations in diabetes

Diabetes Care

Role of chromium in human health and in diabetes

Diabetes Care

Is chromium a trace essential element?

BioFactors

Review article
Complementary Therapies for Diabetes: The Case for Chromium, Magnesium, and Antioxidants