Scientific Name

Cinnamomum zeylanicum, Cinnamomum aromaticum, Cinnamomum loureiroi,

Cinnamomum burmannii
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Common Name

Cassia

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Clinical Summary

Cinnamon refers to several plants that belong to the genus Cinnamomum, native to Southeast
Asia. The bark, rich in essential oil, is used as a flavoring agent and as a spice. Medicinal
uses include appetite stimulation, treatment of arthritis, inflammation, and dyspepsia. In
traditional Chinese medicine, cinnamon is used with other herbs in decoctions for cold. In
vitro studies have demonstrated that cinnamon has antioxidant (1) (2), anti-inflammatory (3),
immunomodulatory (4) (5), antimicrobial (6) and antitumor (7) properties. It has been studied in
clinical trials for type 2 diabetes but results are conflicting (8) (9) (10) (11). However, conclusions
from a meta-analysis suggest benefits of cinnamon and cinnamon extract in improving fasting
blood glucose in patients with type 2 diabetes (12).

Use of cinnamon flavored products has been associated with oral adverse effects (13) (14) (15)
(16)
. Certain cinnamon products are high in coumarin (18) (17) content that can cause
hepatotoxicity (19) and can also interact with other drugs (20).

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Food Sources

Cinnamon spice

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Purported Uses

 Diabetes
 Stomach ulcers
 Inflammation
 Arthritis

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Constituents

 Volatile oils: Cinnamaldehyde, Eugenol, Trans-cinnamic acid

 Phenolic Compounds: Tannins, Catechins, Proanthocyanidins
 Monoterpenes and Sesquiterpenes
(21)

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Mechanism of Action
Cinnamon extract inhibits NFkappaB and AP1 leading to apoptosis (7). It also has
antiangiogenic activity by inhibiting vascular endothelial growth factor (VEGF) (22).
Compounds isolated from Cinnamon mimicked the action of insulin by activating the insulin
receptors (23). Cinnamon has been demonstrated to inhibit hepatic HMG-CoA reductase
activity (24) and reduce levels of blood lipids in animals and humans (10).
Hydroxycinnamaldehyde, a compound present in cinnamon, exhibits anti-inflammatory
activity by inhibiting nitric oxide production via inhibition of NF-kappaB (3). Cinnamon
extract binds to estrogen-receptor beta and has a direct stimulatory effect on bone formation
(25)
. The n-hexane extract of cinnamon has antiestrogenic activity (26).

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Contraindications

 Patients taking blood glucose lowering or blood-thinning medications should use

cinnamon extract with caution.
 Cinnamon was shown to have both estrogenic and antiestrogenic activities in vitro (24)
(25)
. Patients with hormone sensitive disease should use caution.

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Adverse Reactions

 Plasma cell gingivitis (PCG) and stomatitis were shown to be associated with the use
of oral cinnamon products including toothpaste and chewing gum (13) (15) (16) (27).
 Occupation allergy has been reported with use of cinnamon (28).
 Use of vaginal suppositories containing cinnamon oil resulted in allergic contact
dermatitis in an 18-year-old woman (29)

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Herb-Drug Interactions

 Cinnamon inhibits cytochrome P450 2C9 and 3A4 activities and may increase the
blood levels of substrate drugs (31).
 Cinnamon extract may have an additive effect with blood glucose-lowering
medications.
 In theory, cinnamon may interact with blood-thinning medications due to the presence
of coumarin.

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Herb Lab Interactions

 Cinnamon may lower blood glucose and cholesterol levels but the evidence in support
of this is mixed (8) (10).
 Theoretically, cinnamon may increase prothrombin time (30).

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Literature Summary and Critique

Mang B, Wolter M, Schmitt B, et al. Effects of a cinnamon extract on plasma glucose,

HbA, and serum lipids in diabetes mellitus type 2. Eur J Clin Invest 2006;36(5):340-4.In
this double-blind, placebo-controlled trial, 79 type 2 diabetic patients were randomized to
either receive either one gram aqueous cinnamon extract or a placebo capsule three times a
day for four months. Only patients being treated with diet or oral antidiabetic medications
were recruited. Sixty-five patients completed the study. A significantly higher reduction in
fasting plasma glucose was demonstrated in the cinnamon group (10.3%) versus the placebo
group (3.4%). But no significant differences were noted in HbA1C, LDL, HDL, total
cholesterol or triglyceride levels. There was a significant correlation between the reduction of
plasma glucose and baseline concentrations suggesting that patients with higher initial plasma
glucose levels benefitted more from the cinnamon extract. No adverse effects were reported.
The authors conclude that cinnamon extract may be of moderate benefit in reducing plasma
glucose in type 2 diabetics with poor glycemic control.

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References

1. Kim SH, Hyun SH, Choung SY. Antioxidative effects of Cinnamomi cassiae and
Rhodiola rosea extracts in liver of diabetic mice. Biofactors. 2006;26(3):209-219.
2. Lin CC, Wu SJ, Chang CH, et al. Antioxidant activity of Cinnamomum cassia.
Phytother Res. Aug 2003;17(7):726-730.
3. Lee SH, Lee SY, Son DJ, et al. Inhibitory effect of 2'-hydroxycinnamaldehyde on
nitric oxide production through inhibition of NF-kappa B activation in RAW 264.7
cells. Biochem Pharmacol. Mar 1 2005;69(5):791-799.
4. Reddy AM, Seo JH, Ryu SY, et al. Cinnamaldehyde and 2-methoxycinnamaldehyde
as NF-kappaB inhibitors from Cinnamomum cassia. Planta Med. Sep
2004;70(9):823-827.
5. Koh WS, Yoon SY, Kwon BM, et al. Cinnamaldehyde inhibits lymphocyte
proliferation and modulates T-cell differentiation. Int J Immunopharmacol. Nov
1998;20(11):643-660.
6. Shahverdi AR, Monsef-Esfahani HR, Tavasoli F, et al. Trans-cinnamaldehyde from
Cinnamomum zeylanicum bark essential oil reduces the clindamycin resistance of
Clostridium difficile in vitro. J Food Sci. Jan 2007;72(1):S055-058.
7. Kwon HK, Hwang JS, So JS, et al. Cinnamon extract induces tumor cell death
through inhibition of NFkappaB and AP1. BMC Cancer. 2010;10:392.
8. Blevins SM, Leyva MJ, Brown J, et al. Effect of cinnamon on glucose and lipid levels
in non insulin-dependent type 2 diabetes. Diabetes Care. Sep 2007;30(9):2236-2237.
9. Khan A, Safdar M, Ali Khan MM, et al. Cinnamon improves glucose and lipids of
people with type 2 diabetes. Diabetes Care. Dec 2003;26(12):3215-3218.
10. Mang B, Wolters M, Schmitt B, et al. Effects of a cinnamon extract on plasma
glucose, HbA, and serum lipids in diabetes mellitus type 2. Eur J Clin Invest. May
2006;36(5):340-344.
11. Vanschoonbeek K, Thomassen BJ, Senden JM, et al. Cinnamon supplementation does
not improve glycemic control in postmenopausal type 2 diabetes patients. J Nutr. Apr
2006;136(4):977-980.
12. Davis PA, Yokoyama W. Cinnamon intake lowers fasting blood glucose: meta-
analysis. J Med Food. Sep 2011;14(9):884-889.
13. Anil S. Plasma cell gingivitis among herbal toothpaste users: a report of three cases. J
Contemp Dent Pract. 2007;8(4):60-66.
14. Endo H, Rees TD. Clinical features of cinnamon-induced contact stomatitis. Compend
Contin Educ Dent. Jul 2006;27(7):403-409; quiz 410, 421.
15. Endo H, Rees TD. Cinnamon products as a possible etiologic factor in orofacial
granulomatosis. Med Oral Patol Oral Cir Bucal. Oct 2007;12(6):E440-444.
16. Kind F, Scherer K, Bircher AJ. Allergic contact stomatitis to cinnamon in chewing
gum mistaken as facial angioedema. Allergy. Feb 2010;65(2):276-277.
17. Lungarini S, Aureli F, Coni E. Coumarin and cinnamaldehyde in cinnamon marketed
in Italy: a natural chemical hazard? Food Addit Contam Part A Chem Anal Control
Expo Risk Assess. Nov 2008;25(11):1297-1305.
18. Woehrlin F, Fry H, Abraham K, et al. Quantification of flavoring constituents in
cinnamon: high variation of coumarin in cassia bark from the German retail market
and in authentic samples from indonesia. J Agric Food Chem. Oct 13
2010;58(19):10568-10575.
19. Abraham K, Wohrlin F, Lindtner O, et al. Toxicology and risk assessment of
coumarin: focus on human data. Mol Nutr Food Res. Feb 2010;54(2):228-239.
20. Federal Institute for Risk Assessment. Selected Questions about coumarin in
cinnamon and other foods. http://www.bfr.bund.de/cd/8487. Accessed February 18,
2008.
21. Dugoua JJ, Seely D, Perri D, et al. From type 2 diabetes to antioxidant activity: a
systematic review of the safety and efficacy of common and cassia cinnamon bark.
Can J Physiol Pharmacol. Sep 2007;85(9):837-847.
22. Lu J, Zhang K, Nam S, et al. Novel angiogenesis inhibitory activity in cinnamon
extract blocks VEGFR2 kinase and downstream signaling. Carcinogenesis. Mar
2010;31(3):481-488.
23. Jarvill-Taylor KJ, Anderson RA, Graves DJ. A hydroxychalcone derived from
cinnamon functions as a mimetic for insulin in 3T3-L1 adipocytes. J Am Coll Nutr.
Aug 2001;20(4):327-336.
24. Lee JS, Jeon SM, Park EM, et al. Cinnamate supplementation enhances hepatic lipid
metabolism and antioxidant defense systems in high cholesterol-fed rats. J Med Food.
Fall 2003;6(3):183-191.
25. Lee KH, Choi EM. Stimulatory effects of extract prepared from the bark of
Cinnamomum cassia blume on the function of osteoblastic MC3T3-E1 cells.
Phytother Res. Nov 2006;20(11):952-960.
26. Kim IG, Kang SC, Kim KC, et al. Screening of estrogenic and antiestrogenic
activities from medicinal plants. Environ Toxicol Pharmacol. Jan 2008;25(1):75-82.
27. Siqueira AS, Santos CC, Cristino MR, et al. Intraoral contact mucositis induced by
cinnamon-flavored chewing gum—a case report. Quintessence Int. Oct
2009;40(9):719-721.
28. Guarneri F. Occupational allergy to cinnamal in a baker. Contact Dermatitis. Nov
2010;63(5):294.
29. Lauriola MM, De Bitonto A, Sena P. Allergic contact dermatitis due to cinnamon oil
in galenic vaginal suppositories. Acta Derm Venereol. Mar 2010;90(2):187-188.
30. Chase CK, McQueen CE. Cinnamon in diabetes mellitus. Am J Health Syst Pharm.
May 15 2007;64(10):1033-1035.
31. Kimura Y, Ito H, Hatano T. Effects of mace and nutmeg on human cytochrome P450
3A4 and 2C9 activity. Biol Pharm Bull. 2010;33(12):1977-82.