Cinnamon for Diabetes

Many try cinnamon for diabetes, but does it work and is it safe?

Cinnamon for Diabetes Introduction:

Many use cinnamon for diabetes, but it is unclear to many how safe it is and how well it works. Cinnamon is a potent anti-oxidant spice and supplement which has been used for diabetes, muscle spasms, vomiting, diarrhea, infections, infertility, the common cold, and loss of appetite. Cinnamon is a spice that contains health promoting anti-oxidants and coumarin, which is a chemical that can damage the liver in high doses. Some studies suggest that the daily tolerable intake of cinnamon by adults and children may be reached fairly easily. However, cinnamon is also associated with a number of health benefits. There are two main types of cinnamon: Ceylon cinnamon and Cassia cinnamon or Chinese cinnamon. Research suggests that Cassia cinnamon may damage the liver making Ceylon the better option for eating and supplementation purposes. Cinnamon is a potent anti-oxidant which may be used to help treat diabetes, muscle spasms, vomiting, diarrhea, infections, infertility, the common cold, and loss of appetite.

Different Types of Cinnamon for Diabetes Mellitus

There are 2 types of cinnamon available (2), Cassia cinnamon (Cinnamomum cassia), and Ceylon cinnamon (Cinnamomum verum or Cinnamomum zeylanicum) (3). Cinnamomum aromaticum is the name for Cassia cinnamon from Saigon, Vietnam. Cassia cinnamon is produced in China, Vietnam or Indonesia, is less expensive, has a stronger in flavor, and is more readily available. Ceylon cinnamon is produced in Sri Lanka, and has a mild flavor compared to Cassia cinnamon.

Animal studies have noted that both species of cinnamon have similar hypoglycemic action in animal studies (2). However, Wickenberg J. et al (7) performed a study in which 6 grams of Ceylon cinnamon was given to 10 subjects with signs of early diabetes. These subjects were tested with an oral glucose tolerance test with frequent testing of glucose and insulin levels. The subjects did not have any improvement on glucose levels or insulin response. There was no improvement of glycemic index either.

Cassia cinnamon for diabetes may improve glucose control. Allen, Robert W et al (1) performed a meta-analysis and systematic review on clinical trials which included use of cinnamon for diabetes mellitus. The study examined 10 randomized controlled trials with 543 subjects at doses of cinnamon between a range of 120 mg and 6000 mg per day taken for 5-18 weeks. The following statistically significant results were found by the authors with a 95% confidence interval. Reduction of fasting blood glucose levels by 8.67-40.52 mg/dL (average 24,59 mg/dL), lower total cholesterol by 1.44-29.76 mg/dL, lower LDL 1.63-17.21 mg/dL, lower triglycerides by 10.91-48.27 mg/dL, and increase in HDL 1.09-2.24 mg/dL. A large variation of dosing was used and substantial variation of results was seen. 2 of the trials reviewed by the author showed 1-1.2 grams of cinnamon per day resulted in an increase in fasting blood glucose, increase in glycosylated hemoglobin (HbAIC), and a few trials even showed some worsening of lipid parameters. A dose of cinnamon of 1-6 grams per day reported a decrease of fasting blood glucose in 6 trials, and most showed improvements of lipid parameters. In thIS meta-analysis, there was no significant change in HbA1C.

In a comparison between cinnamon, cardamom, saffron, and ginger supplementation for diabetes control, cinnamon was the only one in this group which improved fasting blood glucose (6).

Sahib AS (8) performed a randomized placebo controlled trial on uncontrolled diabetes mellitus type 2 subjects. This study found that 1 gram of Cassia cinnamon significantly reduced fasting blood glucose by about 10% after 6 weeks and by about 17% after 12 weeks. HgbA1C improved but was not significant when compared to baseline. Additionally, cinnamon improved antioxidant status with a significant increased in glutathione over baseline.

According to Qin, B et al (9), cinnamon and the components of cinnamon is able to improve insulin resistance, lower blood glucose, and improve inflammation, and has a possible role in the prevention of diabetes and metabolic syndrome.

Coumarin Content of Cinnamon for Diabetes Mellitus:

Sixty samples of ground cinnamon (12 brands) bought in the Czech Republic were analyzed for their courmarin content. Coumarin is a naturally occurring substance found in a wide variety of plants which is known to cause liver toxicity. Cinnamon has been determined to be the main source of coumarin in the human diet. As a control and for comparison researchers analyzed a sample imported directly from Sri Lanka. All 60 samples of cinnamon from the Czech Republic contained coumarin in a range from 2,650 to 7,017 mg per kilogram.  The coumarin content of a sample from Sri Lanka was below the limit of detection confirming its origin from Cinnamomum verum or the Ceylon variety. According to Druera, http://www.srilankacinnamon.com, Ceylon cinnamon is native to Sri Lanka which exports 85% of the world’s Ceylon cinnamon. (3)

Tolerable Daily Intake of Coumarin:

Abraham K, et al examined the tolerable daily intake (TDI) of coumarin, a naturally occurring substance found in a wide variety of plants (tonka bean, cinnamon, vanilla) with hepatotoxic (causing damage to the liver) and carcinogenic (cancer causing) properties. An analysis of clinical data on hepatoxicity from patients treated with coumarin determined a tolerable daily intake to be 0.1mg/kg. The authors suggested that dietary exposure to coumarin in Cassia cinnamon is concerning. Data in this study suggests that Cassia (Chinese) cinnamon may cause hepatotoxicity. Abraham K, et al determined the tolerable daily intake of coumarin to be 0.1 mg per kg of body weight. For a person weighing 80 kg, about 176 lbs, would have a tolerable daily intake of approximately 8 mg of coumarin. (4)

Coumarin in cinnamon is present in amounts from 2.65 to 7.02 mg per gram (3). Sproll et al. expressed in a study that a child may reach the tolerable daily intake of Cassia cinnamon by eating 3-4 cinnamon cookies, and an adult, by eating 10 cookies (5).

Summary: Cinnamon for Diabetes

• Cassia cinnamon at a dose of up to 1 gram daily appears safe when taken up to 18 weeks in those without liver disease. Cassia cinnamon appears to improve fasting blood glucose in diabetes mellitus type 2, improves antioxidant status, and may modestly improve the lipid profile.

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• A meta-analysis and systematic review by Allen, Robert W et al revealed the following statistically significant results of cinnamon taken at a dose of 120 mg to 6000 mg per day for 5-18 weeks over placebo. A dose of 1-6 grams per day showed a decrease of fasting blood glucose in 6 trials, and most showed improvements of lipid parameters. 2 of the trials showed 1-1.2 grams of cinnamon per day decreased fasting blood glucose and HcA1C. Overall results of the meta-analysis showed (1):
  • Reduction of fasting blood glucose 8.67-40.52 mg/dL (average 24.59 mg/dL).
  • Lower total cholesterol by 1.44-29.76 mg/dL.
  • Lower LDL 1.63-17.21 mg/dL.
  • Lower triglycerides by 10.91-48.27 mg/dL.
  • Increase in HDL 1.09-2.24 mg/dL.
  • No significant change in HbA1C.
  • In a comparison between cinnamon, cardamom, saffron, and ginger supplementation for diabetes control, cinnamon was the only one in this group which improved fasting blood glucose (6).

• Sahib AS (8) found that 1 gram of Cassia cinnamon significantly reduced fasting blood glucose by about 10% after 6 weeks and by about 17% after 12 weeks. HgbA1C improved but was not significant when compared to baseline. Additionally, cinnamon improved antioxidant status with a significant increased in glutathione over baseline.

• According to Qin, B et al (9), cinnamon and the components of cinnamon is able to improve insulin resistance, lower blood glucose, and improve inflammation, and has a possible role in the prevention of diabetes and metabolic syndrome.

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• Cinnamon adverse reactions and interactions:
  • Cassia cinnamon contains coumarin which may result in liver toxicity (1,4), and should be avoided in doses over 1 gram daily.
  • Ceylon cinnamon has undetectable levels of coumarin (3). Animal studies have suggested that Ceylon cinnamon may have similar hypoglycemic action to Cassia cinnamon (2), but a human study showed that Ceylon cinnamon had no improvement on glucose levels, insulin response, and glycemic index.
  • Allen, Robert W et al (1) found that 10 trials reviewed did not report any significant adverse effects, but animal studies with Cassia cinnamon showed liver toxicity, lowering of platelet counts, increase risk of bleeding, and allergic reactions. Potential interactions with cinnamon include medications which affect platelets and anticoagulants. Caution is advised when taking Cassia cinnamon with compromised liver function.
  • Cassia cinnamon contains about 2.65 to 7.02 mg per gram of coumarin, a substance which may damage the liver, and therefore intake of Ceylon cinnamon is preferred instead because it’s coumarin content was found to be below detectable limits (3). However, Ceylon cinnamon is unlikely to improve diabetes control.
  • Abraham K, et al determined the tolerable daily intake of coumarin to be 0.1 mg per kg of body weight, and for a person weighing 80 kg, about 176 lbs, their tolerable daily intake of coumarin is approximately 8 mg (4). This data supports that Cassia cinnamon at a dose of 1 gram daily is likely safe, but doses over 1 gram may risk liver toxicity.
  • Sproll et al. expressed in a study that a child may reach the tolerable daily intake of Cassia cinnamon by eating 3-4 cinnamon cookies and that an adult might be able to reach the tolerable daily intake by eating 10 cookies (5).

Read More: How to Prevent Diabetes

References: Cinnamon for Diabetes

1.Allen, Robert W., Emmanuelle Schwartzman, William L. Baker, Craig I. Coleman, and Olivia J. Phung. Cinnamon Use in Type 2 Diabetes: An Updated Systematic Review and Meta-Analysis. Ann Fam Med September/October 2013, vol. 11 no. 5, 452-459. http://www.ncbi.nlm.nih.gov/pubmed/24019277

2.Bandara T, Uluwaduge I, Jansz ER. Bioactivity of cinnamon with special emphasis on diabetes mellitus: a review. Int J Food Sci Nutr. 2012 May;63(3):380-6. http://www.ncbi.nlm.nih.gov/pubmed/22007625

3.Blahová J, Svobodová Z. Assessment of coumarin levels in ground cinnamon available in the Czech retail market. ScientificWorldJournal. 2012;2012:263851. http://www.ncbi.nlm.nih.gov/pubmed/22761548

4.Abraham K, Wöhrlin F, Lindtner O, Heinemeyer G, Lampen A. Toxicology and risk assessment of coumarin: focus on human data. Mol Nutr Food Res. 2010 Feb;54(2):228-39. http://www.ncbi.nlm.nih.gov/pubmed/20024932

5.Sproll C, Ruge W, Andlauer C, Godelmann R, Lachenmeier DW. HPLC analysis and safety assessment of coumarin in foods. Food Chemistry. 2008;109(2):462–469. http://www.sciencedirect.com/science/article/pii/S0308814608000381

6. Azimi P, Ghiasvand R, Feizi A, Hariri M, Abbasi B.Effects of Cinnamon, Cardamom, Saffron, and Ginger Consumption on Markers of Glycemic Control, Lipid Profile, Oxidative Stress, and Inflammation in Type 2 Diabetes Patients. Rev Diabet Stud. 2014 Fall-Winter;11(3-4):258-66. http://www.ncbi.nlm.nih.gov/pubmed/26177486

7.Wickenberg J, Lindstedt S, Berntorp K, Nilsson J, Hlebowicz J. Ceylon cinnamon does not affect postprandial plasma glucose or insulin in subjects with impaired glucose tolerance. Br J Nutr. 2012 Jun;107(12):1845-9. http://www.ncbi.nlm.nih.gov/pubmed/21929834

8.Sahib AS. Anti-diabetic and antioxidant effect of cinnamon in poorly controlled type-2 diabetic Iraqi patients: A randomized, placebo-controlled clinical trial. J Intercult Ethnopharmacol. 2016 Feb 21;5(2):108-13. http://www.ncbi.nlm.nih.gov/pubmed/27104030

9.Qin B, Panickar KS, Anderson RA. Cinnamon: potential role in the prevention of insulin resistance, metabolic syndrome, and type 2 diabetes. J Diabetes Sci Technol. 2010 May 1;4(3):685-93. http://www.ncbi.nlm.nih.gov/pubmed/20513336]