Modern Research on Cinnamon
by Dr. Robert Keith Wallace
Since we were children, we have been familiar with the pleasant taste and smell of cinnamon—in pastries, cereal, and hot drinks, not to mention toothpaste and mouth wash. Cinnamon comes from the bark of several different types of cinnamon trees, and its characteristic flavor is due to the aromatic essential oils contained in the bark. In common use today, it was once scarce and more costly than gold; wars were even fought over it. In addition to its use as a household spice, for thousands of years it has been highly regarded as a medicinal herb in India, China, the Middle East, and other parts of the world.
Ayurveda makes use of the warming property of cinnamon, which pacifies both Vata and Kapha. Its tastes are sweet, pungent or spicy, as well as astringent or drying. It helps increase Agni, our vital digestive fire, and it is useful for the treatment of many different conditions, including indigestion, flatulence, colic, abdominal pain, diarrhoea, cold, cough, sore throat, sinus congestion, bronchitis, headache, reproductive disorders in both men and women.
Beside besides being a popular spice and medicinal herb, cinnamon has other uses. In Egypt, it was also used as embalming oil, and it is mentioned in the Bible as both a holy anointing oil and as an incense, and in Greece, it was an offering to the Gods. The ancient roman nobleman, Pliny, writes that cinnamon was costly and Emperor Nero is said to have burned a year’s worth of Romec’s supply of cinnamon at the funeral for his wife in 65 AD.
For a long time the source of cinnamon was a mystery to the Western world, although many believed that it came from Arabia since Arab traders brought the spice by overland trade routes to Alexandria in Egypt. It was introduced to Europe by Venetian traders who held a monopoly on the spice. When these trade routes were eventually disrupted due to wars, the Europeans had to search for other sources. In the sixteenth century, Portugese traders sailed to Ceylon, or Sri Lanka, and established a fort that allowed them to maintain a monoply on the cinnamon trade for another hundred years. The Portuguese monopoly was then broken by the Dutch, and the Dutch monopoly was broken by the British. As different varieties of cinnamon came to be accepted, the financial security of the cinnamon monopoly became less important.
The type of cinnamon that is most familiar to Europe, England, Mexico, and South America, is called true cinnamon or Ceylon cinnamon, and is from the tree Cinnamomum verum or C. verum or C. zeylanicum, primarily found in Sri Lanka. In North America, however, the type of cinnamon with which we are most familiar is from the tree Cinnamomum cassia or C. cassia, and is commonly called cassia or Chinese cassia. One can easily distiquinsh between these two varieties of cinnamon by the hardness of the cinnamon sticks, which are, in fact, strips of bark that have curled up. Cassia is hard and difficult to break, and comes the outer bark of C. cassia trees. True cinnamon is soft and brittle, and come from the inner bark of C. verum. Cassia’s flavour is thought to be coarser and less delicate than that of Ceylon and for that reason is less expensive. Sri Lanka still produces 80-90% of the world’s supply of C. verum, although it is also cultivated on a commercial scale in the Seychelles and in Madagascar. Two other close relatives to C. cassia, are Saigon or Vietnamese cinnamon (or cassia), C. loureiroi, and Indonesian cinnamon or cassia, C. burmannii. Indonesian cassia has the lowest oil content and is the least expensive, but became popular during the Vietnam war due to the shortage of Vietnamese cassia.
One of the most remarkable findings on cinnamon is its ability to balance blood sugar or blood glucose. Balancing blood sugar is esssential for general health, and when it becomes disrupted, as is the case in diabetes, many health problems arise.
Type 1 diabetes occurs when the pancreas cannot produce enough insulin. Insulin is one of the key hormones that regulate blood sugar. It enables the sugar in the blood stream to be transported into the cells where it used for many essential biological functions. Type 2 diabetes results from the body’s ineffective use of insulin. One characteristic of Type 2 diabetes is a condition called insulin resistance. In this condition, cells and their surface receptors fail to respond to the normal action of the hormone insulin. They become resistant to insulin, with the result that the pancreas increases its production of insulin, which results in higher levels of blood sugar. In both Type 1 and 2 diabetes, overly high blood sugar results in damage to the heart, blood vessels, eyes, kidneys, and nerves
The symptoms of Type 2 diabetes are often less marked and as a consequence, the disorder may be diagnosed several years after onset, when complications have already arisen. Until recently, Type 2 diabetes was seen only in adults, but it is now also occurring in children. Approximately 90% of all diabetes is Type 2, so it poses the number one health threat worldwide, even though it is the easiest to treat since simple lifestyle measures, such as weight management, physical activity, diet, and avoidance of tobacco, have been shown to be effective in preventing or delaying its onset.
Over 350 million people all over the world have diabetes, and it is predicted that by 2040 it will affect over 550 million. In the United States alone, there are 25 million children and adults with diabetes, and some 80 million with prediabetes (2). Diabetes is the fourth or fifth leading cause of death in most developed countries and there is substantial evidence that we are about to experience a global diabetes epidemic (3).
Diabetes increases the risk of both heart disease and stroke. It also reduces blood flow and causes nerve damage in the feet, increasing the chance of foot ulcers, infection and the eventual need for limb amputation. It is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. It is among the leading causes of kidney failure. The overall risk of dying among people with diabetes is at least double the risk of those without diabetes.
Cinnamon and Diabetes
Different herbal supplements have been studied for their ability to regulate blood sugar and cinnamon has been found to be one of the most promising (4). A large number of laboratory and animal studies have demonstrated the effectiveness of cinnamon and its components on the regulation of blood sugar. These studies have also shown that cinnamon acts as a powerful insulin regulator and increases insulin sensitivity by making changes in insulin receptors. These and other attributes of cinnamon suggest its potential role in reversing the condition of insulin resistance, which may be the primary cause of type 2 diabetes (5-16).
Clinical studies on the role of cinnamon in diabetes show that cinnamon has a positive effect on lowering blood sugar levels, although there are some mixed results. Let us, therefore, briefly review the twelve clinical studies on patients with diabetes or related conditions.
The first of eight positive studies was conducted in Pakistan in 2003, and included 60 people with type 2 diabetes, 30 men and 30 women who were randomly divided into six groups. Groups 1, 2, and 3 consumed 1, 3, or 6 grams of cinnamon daily for 40 days, and groups 4, 5, and 6 were given placebo capsules for the same period of time. The results showed that the group taking the cinnamon reduced their mean fasting serum glucose, triglyceride, LDL cholesterol, and total cholesterol levels. There were no significant changes in the placebo groups. (17).
The second study was done in Germany in 2006 and was conducted on a total of 79 patients with diagnosed diabetes type 2. The patients were randomly assigned to take either a cinnamon extract or a placebo capsule three times a day for 4 months in a double-blind study. The amount of aqueous cinnamon extract corresponded to 3 grams of cinnamon powder per day. The fasting plasma glucose levels of the cinnamon group were significantly reduced compared to the placebo group. No significant differences were observed in measurements of HbA1c or lipids. HbA1c is a molecule that is made of the junction between hemoglobin and glucose and is used as a way of measuring blood glucose levels over time. The finding also suggested that the subjects with a higher initial plasma glucose level seem to benefit more from cinnamon intake. (18).
A third study conducted in the US and also published in 2006 examinedpatients with prediabetes and metabolic syndrome. Metabolic syndrome, also called insulin resistance or syndrome X, is characterized by obesity, high blood pressure, high triglycerides and impaired blood sugar levels. It is a risk factor for both heart disease and diabetes. In this study, 22 people were randomly assigned to supplement their diets with either a specially prepared form of cinnamon called Cinnulin PF® at 500 mg per day, or a placebo for 12 weeks. The findings showed that the group taking the cinnamon preparation reduced both fasting blood sugar and systolic blood pressure. The authors recommended the use of cinnamon in reducing risk factors associated with diabetes and cardiovascular diseases (19).
A fourth study done, in France and published in 2009, looked at the effects of a dried aqueous extract of cinnamon on the antioxidant status of people with impaired fasting glucose who were overweight or obese. The study was a double-blind placebo-controlled trial in which 22 subjects were given capsules containing either a placebo or 250 mg of an aqueous extract of cinnamon (Cinnulin PF) two times per day for 12 weeks. Several plasma oxidative stress markers were significantly improved, and fasting blood glucose levels in the cinnamon group decreased. In the cinnamon group, impaired fasting glucose levels returned to normal physiological levels after 12 weeks (not 6 weeks) of supplementation, and there was a positive correlation between plasma glucose levels and oxidative stress markers. Impaired fasting glucose is a leading cause of oxidative stress and oxidative vascular complications in obesity, so the improvement of impaired fasting sugar levels in the cinnamon group suggests its role in helping patients with Type 2 diabetes (20).
A fifth study, published in 2009 in the US, was also a randomized and controlled clinical study. One hundred and nine Type 2 diabetic patients were assigned to either a treatment or a control group and studied over a three-month period. In the treatment group, participants were given cinnamon supplements of 1gram. The control group was not given a placebo since the researcher felt it would not be possible to create a placebo that was different enough from the distinctive taste of cinnamon. After three months of use it was found that there was a significant reduction in serum HbA1c, which again suggests cinnamon beneficial role in Type 2 diabetes (21).
A sixth study, published in 2010 in United Kingdom, conducted a randomized and placebo-controlled, double blind clinical trial with subjects of multiple ethnicities to determine the effects of cinnamon on blood pressure and HbA1c. Type 2 diabetic subjects were given 2 grams per day for 12 weeks, while the control group took placebo capsules. The findings showed a significant reduction in HbA1c, systolic and diastolic blood pressure in the group taking cinnamon. A significant reduction in fasting blood sugar levels were also found compared to the baseline in the cinnamon group (22).
A seventh study was done in China, and published in 2010, evaluated the effects of cinnamon in fasting plasma glucose–impaired participants. The 137 subjects were investigated in a double-blind, randomized, placebo-controlled trial. For 2 months, subjects received either a 250-mg placebo (baked wheat flour) capsule twice per day, or a 250-mg dried water-soluble cinnamon extract preparation capsule twice per day. The study showed a significant reduction in fasting blood glucose levels as compared to controls (21).
An eighth study, also done in China and published in 2012, investigated patients with Type 2 diabetes in a randomized, double-blinded clinical study measuring the effects of cinnamon extract on HbA1c and fasting blood glucose levels. There were 3 groups: placebo and low-dose and two groups taking cinnamon extract at 120 and 360 mg/day, respectively. Both HbA1c and fasting blood glucose levels were significantly reduced in patients in both the low-and-high-dose groups, whereas they were not changed in the placebo group. The blood triglyceride levels were also significantly reduced in the low-dose group. The blood levels of total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and liver transaminase, remained unchanged in the three groups (24).
The findings of these studies have been challenged by the results from four other clinical studies. In one study published in 2006 in Holland, twenty-five postmenopausal type 2 diabetic patients received either a supplement of 1.5 grams cinnamon or a placebo daily for 6 weeks. The researcher found no significant changes in fasting blood sugar, HbA1c or lipid levels (25). A second study conducted in Thailand and published in 2006, studied 60 Type 2 diabetic patients in a randomized placebo trial, using 1.5 gram per day of cinnamon cassia powder over a 12-week period. The findings reported no significant difference in reducing fasting plasma glucose, HbA1c, or lipid profile (26). The third study, conducted in the US and published in 2007, was a prospective, double-blind and placebo-controlled trial with 72 adolescent Type 1 diabetic patients. The subjects were given either a cinnamon supplement of 1 gram, or a placebo, daily for 90 days. The researchers reported that there were no significant differences in HbA1c levels after cinnamon intake in patients with Type 1 diabetes (27). The fourth study done in the US and published in 2007, found no change in glucose, HbA1c, or lipids in subjects taking 1 gram of cinnamon over 3 months as compared to controls taking a placebo (28).
In addition to these clinical trials with patients with diabetes and related conditions, there have been six studies conducted on healthy volunteers to examine the effects of cinnamon. One of these studies found no change with cinnamon supplements while the other five all showed some type of change. The first study, published in 2008, studied eleven healthy subjects, in an 8-week, randomly assigned, crossover study that involved the ingestion of supplemental doses of cinnamon and turmeric for a 4 week periods. No significant changes were found in fasting plasma glucose or lipids in conjunction with the 4 week periods of either cinnamon or turmeric supplementation (29). The second study, published in 2009, recruited 27 healthy subjects to determine whether cinnamon, vinegar, or combination of both, lowered blood glucose levels. The subjects consumed a normal meal, or a normal meal supplemented with 4 grams cinnamon, 28 mM acetic acids, or combination of both. Blood glucose measurements were then made during the 2-hour period after the meal. These researchers reported a significant decrease in blood glucose level in the subjects who took the cinnamon and acetic acids 15 minutes post-ingestion (30).
In a third study published in 2009, subjects received either 3 grams of cinnamon or a placebo supplement, daily for 14 days. Oral glucose tolerance tests were performed during the study period. The results showed that the cinnamon supplement significantly decreased glucose response and improved insulin sensitivity with no difference in the insulin response.These effects were lost, however, within 2 days of ceasing cinnamon intake (31). The same authors had published an earlier study in 2007, which showed that 5 grams of cinnamon, ingested 12 hours before or in conjunction with an oral-glucose-tolerance test in healthy men, reduced the blood glucose response and improved insulin sensitivity, again with no difference in the insulin response (32).
Another two studies done in Sweden on healthy subjects studied the effects on cinnamon on postprandial (after a meal) blood glucose, gastric emptying, and satiety. The first of these studies was published in 2007 and involved giving subject rice pudding with and without a 6 gram sprinkling of cinnamon. They found that the cinnamon significantly lowered the post-meal levels of blood sugar as well as delaying gastric emptying, without affecting satiety in healthy individuals (33). This study was continued in 2009, looking at lower doses of cinnamon. The subjects were randomly assigned into three groups. Two treatment groups ate rice pudding with 1 or 3 grams of cinnamon, while the control group ate only rice pudding. Supplements with 1 or 3 grams of cinnamon had no significant effect on blood glucose level. However, the insulin response at 60 minutes was significantly decreased after the ingestion of rice pudding with 3 grams cinnamon. The findings also showed that ingestion of 3 grams of cinnamon reduced increased glucagon-like peptide 1(GLP-1) levels without significantly affecting glucose-dependent insulinotropic polypeptide (GIP), ghrelin, satiety, or gastric empting rate. These results indicate a relationship between the amount of cinnamon consumed and the decrease in insulin concentration. This research supports the previous finding that cinnamon stimulates insulin receptors. The different doses of cinnamon seem to have contributed to the differences in results (34).
Two related clinical studies looked at women with polycystic ovary syndrome and patients with early stage diabetic nephropathy. In the first study, published in 2007, women with polycystic ovary syndrome, without diabetes, were given a dietary supplement of 333 mg cinnamon extract, 3 times a day for 8 weeks. Results showed a decrease in both insulin resistance and fasting glucose concentrations (35). A second study looked at the ameliorative effect of the cinnamon oil from C. zeylanicum or C. verum upon early stage diabetic nephropathy. Histological studies of the kidney proved the protective effect of cinnamon oil by reducing the glomerular expansion, eradicating hyaline casts, and decreasing the tubular dilatations, and also showed that it confers dose-dependent, significant protection against alloxan-induced renal damage (36).
Two meta-analysis have been published with contradictory conclusions. The first, published in 2008, had only a few studies to analyse and came to the conclusion that cinnamon did not show any changes in measurements of HbA1c, glucose, or lipids (37). A second meta-analysis published in 2011, which included a larger and more recent number of studies, found that cinnamon intake, either as whole cinnamon or an extract of cinnamon, results in a statistically significant lowering in fasting blood glucose (38). In addition, there have been several review articles that also support the use of cinnamon in lower blood sugar in type 2 diabetes (39-41). It has been suggested that the reason for the discrepancies in some of the earlier studies might be due to: differences in prescribed anti-diabetic medication, the type of cinnamon or cinnamon extract administered, the duration of the study, or the initial level of blood sugar levels in the patients studied (22, 39, 40).
In regards to the different effects produced by different types of cinnamon, a recent study found that ingestion of C. zeylanicum or C. verum did not affect postprandial plasma glucose or insulin levels in human subjects. The authors point out that only C cassia may be helpful for type 2 diabetes (42). This goes against the recommendations by the Federal Institute for Risk Assessment in Europe, stating that C. cassia be replaced by C. zeylanicum because since C. cassia contains higher levels of coumarin. At high enough levels, coumarin has been shown to be toxic to the liver. It has also been suggested that the coumarin in cinnamon may interfere with anticoagulant drugs. Although coumarin itself has no anticoagulant properties, it is transformed into the natural anticoagulant dicoumarol by a number of species of fungi. There is, however, still debate on the actual effects of coumarin from C. cassia. It is suggested that the coumarin is not absorbed into the blood stream at high enough levelsto cause any problems.
In conclusion, we can see that there is very strong scientific evidence to support the effectiveness of cinnamon lowering blood glucose levels in type 2 diabetic patients. Further research, however, is necessary to determine which type of cinnamon or cinnamon extract is most effective.
Cinnamon and other Conditions
Cinnamon and the components contained in its essential oils (cinnamaldehyde, eugenol, and cinnxeylanine), have been shown to have strong antibacterial as well as antifungal properties (including the yeast Candida), as well as a role as a food preservative. (43-47). There are a large number of laboratory, animal, and clinical studies, which have shown that cinnamon and its components have a number of biological activities. These include: antiviral, antifungal, antiulcer, anti-inflammatory, antioxidant, anticardiovascuclar, antihypertensive, antithrombotic, anticancer, as well as immunodulatory and analgesic effects, and improvement in wound healing, in conditions of bronchoconstriction, and in central nervous sytem depression (41, 48-60).
Cinnamon and Neurological Disorders
Cinnamon has been suggested as a non-toxic means to stop the progression of multiple sclerosis. Studies conducted at Rush University Center show that sodium benzoate, which is a metabolite of cinnamon, can inhibit the activation of glial cells, which destroy the coating of surrounding nerve fibers, called the myelin sheath, in multiple sclerosis. Since glial cell activation may also be involved in other conditions such as Alzheimer’s and Parkinson’s disease, cinnamon may have potential applications in other neurological disorders (61). Another study conducted by scientists at the Agricultural Research Service, revealed that cinnamon extract might prevent brain cells from swelling, which is a factor in conditions such as brain trauma injuries and strokes (62). Finally, a recent study showed that a cinnamon extract inhibits the development of Alzheimer’s disease in an animal model (63).
Cinnamon and Cancer
A number of studies have shown that cinnamon possesses anticancer effects. In vitro and in vivo studies on melanoma show that cinnamon treatment strongly inhibits the expression of pro-angiogenic factors and master regulators of tumor progression, not only in melanoma cell lines, but also in an experimental melanoma model (64). In addition, cinnamon treatment increased the anti-tumor activities of immune cells by increasing the levels of cytolytic molecules and their cytotoxic activity (65). Another recent study has revealed that a cinnamon extract could act as a natural vascular endothelial growth factor (VEGF) inhibitor, which could potentially be useful in cancer prevention and/or treatment (66). Pharmacological experiments further suggest that cinnamaldehyde represents an experimental chemopreventive dietary factor targeting colorectal carcinogenesis (67).
Therapeutic Uses of Cinnamon
Research on cinnamon and its extracts are extremely promising, especially in the area of type 2 diabetes. The fact that there are some conflicting findings on type 2 diabetes indicates that further research is necessary to clarify which specific type of cinnamon should be used and what dose is most effective.
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Copyright: Dr. Robert Keith Wallace