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Effect of Cinnamon on Diabetes

Mariana Kalenichenko

University of North Florida

FOS 4041

April 3rd, 2018

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Introduction

Since the very beginning of times, humans have been using the plants around

them for various uses. Whether for food, material, aromatic purposes, or as medical

treatment, humans used every discovery to take advantage of its benefits in order that it

could be put into place for practical use. Cinnamon was one of these discoveries that

was found to be useful for a variety of uses, including medicinal. Although native to Sri

Lanka, this plant has made its way to be likewise as popular among surrounding

countries over time and folklore medicine shows it’s commonality repeatedly. 1

Beginning from the Old Testament as treatment for digestion illnesses and respiratory

tract illnesses as well as for covering up odor at funerals, then Egyptians began using it

for embalming mummies, leading into its growth to spurt out to cover a variety of

illnesses like chronic bronchitis, frigidity, eye inflammation, vaginitis, neuralgia,

rheumatism, etc. Originating from the Lauraceae plant family, this spice can be

extracted from almost every part of the tree including leaves, bark, flowers, fruits, and

the roots. Depending on from where it is extracted, the spice is known to be used for

different purposes. Alcohol extract from the bark has traditionally been used for liver

protection from fat infiltration, essential oils from the leaves have been used for its

antimicrobial properties, ethanolic extract from the bark have been used for its anti-

inflammatory properties, and most relative here is that the aqueous extract of cinnamon

has traditionally been used to increase glucose metabolism. This is crucial because

glucose metabolism holds significant importance in diseases like diabetes. This

widespread disease is characterized by high levels of blood glucose, otherwise known

as blood sugar. This blood glucose is the body’s primary source of energy and comes
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from the food that is consumed.2 The hormone insulin is responsible for taking glucose

from the blood into the cells through absorption in order for the body to be able to utilize

the energy. However, when insulin is not able to perform its job then glucose can’t get

into the cells leading to a buildup of glucose in the blood, thus higher than normal blood

sugar levels, which lead to health problems such as diabetes. There are two types of

this disease including a type 1 diabetic who is physically not able to produce insulin at

all and a type 2 diabetic who is not able to make or use the insulin well enough due to

external factors, which are many times preventable. It is with type 2 diabetes that recent

researchers claim cinnamon may have a significant influence in benefitting patients.

Botanical Composition

To start off, various parts of the tree which cinnamon comes from, called C.

verum, is composed of different amounts of resinous chemical components.3 The

leaves are found to be 70-95% eugenol, bark is 65-80% cinnamaldehyde, root bark is

60% camphor, fruit of the tree is 42-54% trans-cinnamyl acetate , where the buds are

78% terpene hydrocarbons and about 27% alpha-Bergamotene, then finally the flowers

consist of about 42% (E)-cinnamyl acetate and about 8% of trans-alpha-bergamotene.

As cinnamon ages, some of the substances within the product are known to increase in

quantity such as cinnamaldehyde, cinnamate, and cinnamic acid. Another property

cinnamaldehyde is recognized for is the signature spicy taste of cinnamon, as well as its

distinctive fragrance. Concerning nutritional value, extensive studies have gathered a

collection of micro and macronutrient information. Per 100 grams of a stick of cinnamon

there is approximately 10 g water, 4 g protein, 1.2 g total fat, 53.1 g fiber, 28.1 g
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carbohydrate, 243 Kcal, 9.33 μg vitamin A, 112 μg beta-carotene, 2.32 mg vitamin E,

1.33 mg vitamin B3 niacin, 6 μg vitamin B9 folate, and 2.8 mg of vitamin C.1 Thereby,

primary macronutrient is carbohydrate with the largest vitamin proportion being vitamin

E and C. Additional minerals found include 7 mg of iron, 2.6 mg zinc, 20 mg

manganese, 85.5 mg magnesium, 135 mg potassium, 42 mg phosphorus, and 84 mg

calcium which is all per 100 grams of cinnamon.4 Thus, major minerals contained within

are potassium, magnesium, and calcium. According to the Faculty of Agriculture at the

University of Ruhuna is Sri Lanka, processing of these trees are many times done by

hand after the rainy season if labeled as premium.5 After harvesting occurs, the stems

are removed of knots, scraped with hand tools, rubbed, peeled of the outer layer, dried

in the shade for several hours depending on bark moisture, then packed into a quill

ready for export. Approximately 57% of the cinnamon exported from this country comes

as a result of this manufacturing process into the United States of America. Also,

cinnamon is found to contain significant amounts of components such as the

antioxidants epicatechin, catechin, and quercetin which is an immunity booster and aids

in allergies.6 This was something people noticed long ago, but recently the phenolic

composition and antioxidant properties have sparked the curiosity of researchers to

seek out what else this spice can be used for considering the traditional uses for

digestion, anti-inflammation, antimicrobial, and anti carcinogenic properties.

Health Implications Regarding Type II Diabetics

Now as tradition sparked the curiosity of modern researchers, the amount of

studies have expanded significantly regarding the established properties of cinnamon.

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In vitro, current evidence shows this spice to reduce intestinal glucose absorption by

inhibiting the activity of pancreatic α-amylase and α- glucosidase, while stimulating

cellular glucose uptake by membrane translocation of GLUT4 .7 Also, it stimulates

additional processes like glycolysis and glycogenolysis by activating release of insulin,

key regulating enzymes of these processes and potentiating insulin receptor activity,

while inhibiting gluconeogenesis to promote homeostasis in glucose levels. In vivo

animal models cinnamon reduces fasting blood glucose (FBG), HbA1c, and LDL

cholesterol, while increasing HDL cholesterol. HbA1c is glycated hemoglobin which is

tested to find the average blood glucose concentration over the period of three months,

thus a reduction found among diabetic patients is a good thing, as are the other

findings. These findings were associated with the species Cinnamomum zeylanicum

which originates from Sri Lanka. Other studies compared the previously stated species

with another called Cinnamomum cassia, which is native to China. Researcher

Medagama found both species to potentially be beneficial for people diagnosed with

type 2 diabetes to consume as an add-on therapy option.8 However although her

studies included animal studies for both species, they did not include human studies for

C. zeylanicum. Nevertheless since the high content of coumarin in C. cassia has been

previously linked with liver damage, claim is that C. zeylanicum is still the safer and

better option. Another study conducted by researchers Anderson et. al. isolated and

characterized complexes that stimulated insulin activity within several cinnamon species

that could be involved in the alleviation, prevention, or control of glucose intolerance

and diabetes.9 They did this by isolating water-soluble polyphenol polymers that show

antioxidant properties and are thought to increase insulin-dependence in vitro glucose

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metabolism by about twenty times, then examining them by nuclear magnetic

resonance and mass spectroscopy. Results revealed these polymers having synergistic

benefits to diabetic therapy, while lessening or slowing diabetes complications by

preventing polyunsaturated fatty acid peroxidation which can directly interfere with

insulin binding action. There was also a significant reduction found among the human

study with fasting blood glucose levels by 18-29%, triglycerides by 23-30%, total

cholesterol by 12-26%, and specifically LDL by 7-27%. Even after the therapy was

removed, levels started rising again but did not rise as much as to reach prestudy

levels. However, other studies do not show as promising of results such as the one

conducted by Mirfeizi et. al. where they studied the effects of two seperate herbal

treatments, cinnamon and caucasian whortleberry, on blood glucose control, lipid profile

and body mass index (BMI).10 Researchers found no significant changes when

comparing the control group with the one receiving cinnamon regarding blood glucose

levels, insulin sensitivity or their overall lipid profile. However, the cinnamon group did

experience a significant change of BMI values, concluding cinnamon could be a

beneficial add-on to traditional diabetic medication but not a substitution.

Modern Applications

Applying the research into present day treatment for type II diabetes with

cinnamon could seem beneficial and some people already market the product as being

a remedy for such. Researcher Medagama took these claims to review the evidence as

a complementary therapy to integrative medicine and found successful but inconclusive

results due to the time frame of which the study was conducted.11 Cinnamon therapy
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influenced many pathways and processes responsible for improving plasma glucose

levels in both human and animal studies. These human studies were tested using either

the species Cinnamomum Cassia, Cinnamomum aromaticum, or cinnamomum

burmanii whereas only the animal studies here were conducted with C. zeylanicum.

Safety concerns involve the previously stated substance called coumarin, which may

induce liver damage with prolonged use. There are also controversial results with renal

function being affected with an increase of uric acid and blood urea in streptozotocin

induced diabetic rats, as well as spotted incidents with other studies showing side

effects on only a few subjects showing rashes, hives, nausea and one hypoglycaemic

seizure. Another study using C. zeylanicum reveals no chronic oral toxic effects, rather

a reduction in hemoglobin levels and a suicidal-sperm effect even though it increases

reproductive weight, sperm count and motility at the same time.12 Then in high doses,

this same species has record of possibly transferring tumorigenic effects. Results of

cinnamon with drug, herbs, food, etc. interactions are extensive. Many times cinnamon

treatment may provide an additive effect to whichever treatment the body is already

consuming such as with antifungals, antidiabetics, anti-inflammatories, antiretrovirals,

estrogens, analgesic herbs, phytoestrogens, and more. Cinnamon may alter the effects

of immunosuppressants, supplies synergistic antibacterial effects when paired with

clove and artemisia, and when paired with vitamin E it has been known to prevent

cinnamaldehyde-mediated apoptosis.

Conclusion
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Cinnamon has been suggested to help patients with type II diabetes mellitus

reach improved glycemic control, but unfortunately conclusions from meta-analyses are

mixed.13 Regarding application to dietetic practice, there are several factors involved

before taking action in commiting to a practical use of the information currently available

connecting cinnamon and diabetes. Patients diagnosed with type II diabetes may

certainly be affected beneficially by consuming cinnamon in addition to their prescribed

medication, however there is not enough evidence for a dietitian to recommend a

cinnamon treatment to completely substitute their prescribed diabetic medication , only if

it’s an addition. Due to the difference of doses influencing the results of glycemic levels

in various past studies, the recommended dose for any person should be adjusted

accordingly due to high doses increasing risk of producing harmful effects and too low

of doses not providing any significant results at all. More research is required in this

area, as well as what kind of cinnamon species to use. There are many available

species and researchers tend to study either a single species or only a small number of

different species. So although Cinnamomum zeylanicum revealed the most promising

results, there is still much research that should be done in the future to not only extend

our knowledge about this species, but also the others which could in fact provide

heightened benefits for diabetes patients specifically. Additional research areas to

correct and extend in the future include duration time of the study, as many of these

previously performed and examined were short time and long term effects of cinnamon

treatments for such patients could not be found. Overall, the product is an excellent

spice derived from the earth with seemingly endless benefits and attractive qualities for
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consumers that should be continued, but as dietetic professionals, there is not enough

evidence currently available to be able to recommend a patient a specific amount of

cinnamon for their diabetic condition due to mixed conclusions.

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Reference

1. Ribeiro-Santos R, Andrade M, Madella D, et al. Revisiting an ancient spice with

medicinal purposes: Cinnamon. Trends in Food Science & Technology.
2017:154-169. Revisiting an ancient spice with medicinal purposes: Cinnamon.
doi: 10.1016/j.tifs.2017.02.011.
2. National Institute of Diabetes and Digestive and Kidney Diseases. What is
diabetes? NIH Web site. https://www.niddk.nih.gov/health-
information/diabetes/overview/what-is-diabetes. Updated 2016. Accessed april 2,
2018.
3. Mollazadeh H, Hosseinzadeh H. Cinnamon effects on metabolic syndrome: A
review based on its mechanisms. Iranian Journal of Basic Medical Sciences.
2016;19(12):1258-1270. doi: 10.22038/ijbms.2016.7906.
4. Shumaila Gul and Mahpara Safdar, 2009. Proximate Composition and Mineral
Analysis of Cinnamon. Pakistan Journal of Nutrition, 8: 1456-1460.
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of Ruhuna Web site.
http://www.agri.ruh.ac.lk/Departments/Engineering/cinnamon/processing.htm.
Accessed Apr 2, 2018.
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