Cassia Cinnamon, Canela de Cassia, Canela Molida, Canelle, Cannelle Bâtarde, Cannelle Cassia, Cannelle de Ceylan, Cannelle de Chine, Cannelle de Cochinchine, Cannelle de Padang, Cannelle de Saigon, Cannelier Casse, Canton Cassia, Casse, Casse Odorante, Cassia, Cassia Aromaticum, Cassia Bark, Bastard Cinnamon, Cassia Lignea, Chinese Cinnamon, Cinnamomi Cassiae Cortex, Cinnamomum, Cinnamon, Cinnamon Essential Oil, Cinnamon Flos, Cinnamoni Cortex, Cinnamonomi Cortex, Cortex Cinnamomi, Écorce de Cassia, False Cinnamon, Fausse Cannelle, Gui Zhi, Huile Essentielle de Cannelle, Keishi, Laurier des Indes, Nees, Ramulus Cinnamomi, Rou Gui, Sthula Tvak, Taja, Zimbluten.
Scientific Name:
Cinnamomum aromaticum, synonyms Cinnamomum cassia, and Cinnamomum ramulus. Family: Lauraceae.
People Use This For:
Orally, cassia cinnamon is used for type 2 diabetes, gas (flatulence), muscle and gastrointestinal spasms, preventing nausea and vomiting, diarrhea, infections, the common cold, and loss of appetite. It is also used for impotence, enuresis, rheumatic conditions, testicle hernia, menopausal symptoms, amenorrhea, and as an abortifacient. Cassia cinnamon is also used orally for angina, kidney disorders, hypertension, cramps, cancer, and as a blood purifier. Topically, cassia cinnamon is used in suntan lotions, nasal sprays, mouthwashes, gargles, toothpaste, and as a counterirritant in liniments. In food and beverages, cassia cinnamon is used as a flavoring agent.
Safety:
LIKELY SAFE ...when used orally and appropriately. Cassia cinnamon has been safely used in clinical trials lasting up to 4 months (8, 13, 20). Cassia cinnamon has Generally Recognized as Safe (GRAS) status in the US (1). POSSIBLY UNSAFE ...when used orally in high doses, long-term. Some cassia cinnamon products contain high levels of coumarin. Coumarin can cause hepatotoxicity in animal models (14). In humans, very high doses of coumarin from 50-7000 mg/day can result in hepatotoxicity that resolves when coumarin is discontinued (17). In most cases, ingestion of cassia cinnamon won't provide a high enough amount of coumarin to cause significant toxicity; however, in especially sensitive people, such as those with liver disease, prolonged ingestion of large amounts of cassia cinnamon might exacerbate the condition. PREGNANCY AND LACTATION: There is insufficient reliable information available about the safety of cassia cinnamon when used in medicinal amounts during pregnancy and breast-feeding; avoid using.
Effectiveness:
INSUFFICIENT RELIABLE EVIDENCE to RATE
Diabetes. There is contradictory evidence about the effectiveness of cassia cinnamon for treating type 1 or type 2 diabetes. Initial clinical research showed that taking cassia cinnamon 1, 3, or 6 grams daily for 40 days lowered fasting serum glucose by 18% to 29%, triglycerides by 23% to 30%, low-density lipoprotein (LDL) cholesterol by 7% to 27%, and total cholesterol by 12% to 26% in patients with type 2 diabetes (8). Another clinical trial shows that patients taking a specific cinnamon product (Cinnamon 500 mg, Puritan's Pride) 1 gram daily for 90 days significantly reduces hemoglobin A1C (HbA1C) by about 0.83% (19). However, three other clinical studies found no significant effect on blood glucose, HbA1C, cholesterol, or triglycerides when cassia cinnamon was used in doses of 1-3 grams daily up to 4 months (13, 18, 20). A meta-analysis of cassia cinnamon studies suggests that overall taking cassia cinnamon does not significantly reduce fasting blood glucose, HbA1C, or lipid levels in patients with type 1 or type 2 diabetes (18). More evidence is needed to rate cassia cinnamon for this use.
Mechanism of Action:
The applicable parts of cassia cinnamon are the bark and flower. Cinnamaldehyde is found in the volatile oil fraction of cassia cinnamon. The volatile oil from cassia cinnamon bark contains about 67% to 83% cinnamaldehyde (16). Cinnamaldehyde seems to have antibacterial activity (2). It may also have immunomodulating, anti-tumor, and antioxidant activity (3, 4, 5, 7). Polyphenolic polymers such as hydroxychalcone found in cassia cinnamon seem to potentiate insulin action. These compounds seem to increase phosphorylation of the insulin receptor, which increases insulin sensitivity. Increased insulin sensitivity may improve blood glucose control and lipid levels. Cinnamon extracts also seem to activate glycogen synthetase and increase glucose uptake (7, 8, 9, 11). Research in animal models suggests that cassia cinnamon stimulates a baseline insulin release, but does not seem to lower baseline glucose levels; however, during a glucose tolerance test, cassia cinnamon seems to stimulate insulin release and also significantly lowers blood glucose. Cassia cinnamon does not seem to lower blood glucose levels as much as the prescription drug glibenclamide. Cassia cinnamon (Cinnamomum cassia) does seem to have a greater insulin-stimulating effect than cinnamon bark (Cinnamomum zeylanicum (12). Cassia cinnamon contains a wide range of coumarin concentrations from 0.004% to 1.2% (14, 15, 16). Cassia cinnamon contains higher concentrations of coumarin compared to cinnamon bark (Cinnamomum zeylanicum). The presence of coumarin and other compounds can be used to distinguish cassia cinnamon from Cinnamomum zeylanicum (15).
Adverse Reactions:
Orally, cassia cinnamon appears to be well-tolerated. No significant side effects have been reported in clinical trials (8, 13). There is some concern about the safety of ingesting large amounts of cassia cinnamon due to its coumarin content. Coumarin can cause hepatotoxicity in animal models (14). In humans, very high doses of coumarin from 50-7000 mg/ day can result in hepatotoxicity that resolves when coumarin is discontinued (17). In most cases, ingestion of cassia cinnamon won't provide a high enough amount of coumarin to cause significant toxicity; however, in especially sensitive people, such as those with liver disease, prolonged ingestion of large amounts of cassia cinnamon might exacerbate the condition. Topically, allergic skin reactions and stomatitis from toothpaste flavored with cassia cinnamon have been reported (9, 10).
Interactions with Herbs & Supplements:
HEPATOTOXIC HERBS AND SUPPLEMENTS: There is some concern that ingesting large amounts of cassia cinnamon might cause hepatotoxicity in some people. Cassia cinnamon contains coumarin which can cause hepatotoxicity in animal models (14). In humans, very high doses of coumarin, from 50-7000 mg/ day, can result in hepatotoxicity that resolves when coumarin is discontinued (17). Lower amounts might also cause liver problems in susceptible people such as those with pre-existing liver disease. Theoretically, concomitant use with other potentially hepatotoxic products might increase the risk of developing liver damage. Some of these products include androstenedione, chaparral, comfrey, DHEA, germander, kava, niacin, pennyroyal oil, red yeast, and others. HERBS AND SUPPLEMENTS WITH HYPOGLYCEMIC POTENTIAL: Cassia cinnamon might lower blood glucose levels (8). Theoretically, it might have additive effects when used with other herbs and supplements that also lower glucose levels. This might increase the risk of hypoglycemia in some patients. Some herbs and supplements with hypoglycemic effects include alpha-lipoic acid, bitter melon, chromium, devil's claw, fenugreek, garlic, guar gum, horse chestnut, Panax ginseng, psyllium, Siberian ginseng, and others.
Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate • Occurrence = Possible • Level of Evidence = B
Cassia cinnamon may lower blood glucose levels, and have additive effects in patients treated with antidiabetic agents; use with caution (8). Dose adjustments to diabetes medications might be necessary. Some antidiabetes drugs include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, metformin (Glucophage), pioglitazone (Actos), rosiglitazone (Avandia), and others.
Interaction Rating = Moderate Be cautious with this combination. Severity = High • Occurrence = Possible • Level of Evidence = D There is some concern that ingesting large amounts of cassia cinnamon might cause hepatotoxicity in some people. Cassia cinnamon contains coumarin which can cause hepatotoxicity in animal models (14). In humans, very high doses of coumarin from 50-7000 mg/day can result in hepatotoxicity that resolves when coumarin is discontinued (17). Lower amounts might also cause liver problems in susceptible people, such as those with pre-existing liver disease. Theoretically, concomitant use with other potentially hepatotoxic drugs might increase the risk of developing liver damage. Some of these drugs include acarbose (Precose, Prandase), amiodarone (Cordarone), atorvastatin (Lipitor), azathioprine (Imuran), carbamazepine (Tegretol), cerivastatin (Baycol), diclofenac (Voltaren), felbamate (Felbatol), fenofibrate (Tricor), fluvastatin (Lescol), gemfibrozil (Lopid), isoniazid, itraconazole, (Sporanox), ketoconazole (Nizoral), leflunomide (Arava), lovastatin (Mevacor), methotrexate (Rheumatrex), nevirapine (Viramune), niacin, nitrofurantoin (Macrodantin), pioglitazone (Actos), pravastatin (Pravachol), pyrazinamide, rifampin (Rifadin), ritonavir (Norvir), rosiglitazone (Avandia), simvastatin (Zocor), tacrine (Cognex), tamoxifen, terbinafine (Lamisil), valproic acid, and zileuton (Zyflo).
Interactions with Foods:
None known.
Interactions with Lab Tests:
BLOOD GLUCOSE: Cassia cinnamon might lower blood glucose levels and test results in some patients (8). LIVER FUNCTION TESTS: There is some concern that ingesting large amounts of cassia cinnamon might increase liver enzymes and cause hepatotoxicity in some people. Cassia cinnamon contains coumarin which can cause hepatotoxicity in animal models (14). In humans, very high doses of coumarin from 50-7000 mg/day can result in hepatotoxicity that resolves when coumarin is discontinued (17). Lower amounts might also cause liver problem in susceptible people such as those with pre-existing liver disease.
Interactions with Diseases or Conditions:
DIABETES: Cassia cinnamon might lower blood glucose in patients with type 2 diabetes (8). Tell patients with diabetes to use cassia cinnamon products cautiously and monitor blood glucose levels very closely. Dose adjustments to diabetes medications might be necessary. LIVER DISEASE: There is some concern that ingesting large amounts of cassia cinnamon might cause hepatotoxicity in susceptible people. Cassia cinnamon contains coumarin which can cause hepatotoxicity in animal models (14). In otherwise healthy humans, very high doses of coumarin from 50-7000 mg/day can result in hepatotoxicity that resolves when coumarin is discontinued (17). Lower amounts cassia cinnamon might exacerbate liver function in people with existing liver disease. SURGERY: Cassia cinnamon might affect blood glucose levels. Theoretically, cassia cinnamon might interfere with blood glucose control during and after surgical procedures. Tell patients to discontinue cassia cinnamon at least 2 weeks before elective surgical procedures.
Dosage/Administration:
ORAL: For type 1 or type 2 diabetes, 1 to 6 grams (1 teaspoon = 4.75 grams) of
cassia cinnamon daily for up to 4 months have been used. (8, 13, 18, 19).
Editor's Comments:
There are a lot of different types of cinnamon. Cinnamomum verum (Ceylon cinnamon) is the type used most commonly in the Western world. Cinnamomum aromaticum (Cassia cinnamon or Chinese cinnamon) is also commonly used. In many cases, the cinnamon spice purchased in food stores contains a combination of these different types of cinnamon. So far, only cassia cinnamon has been shown to have any effect on blood glucose in humans. However, Cinnamomum verum also contains the hydroxychalcone polymer thought to be responsible for lowering blood sugar (5).
Specific References: Cinnamon
1. lectronic Code of Federal Regulations. Title 21. Part 182 - E - Substances Generally Recognized As Safe. Available at: http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid= 786bafc6f6343634fbf79fcdca7061e1&rgn=div5&view= text&node=21:3.0.1.1.13&idno=21
2. Lee HS, Ahn YJ. Growth-Inhibiting Effects of Cinnamomum cassia Bark- Derived Materials on Human Intestinal Bacteria. J Agric Food Chem 1998;46:8-12.
3. Koh WS, Yoon SY, Kwon BM, et al. Cinnamaldehyde inhibits lymphocyte proliferation and modulates T-cell differentiation. Int J Immunopharmacol 1998;20:643-60.
4. Kwon BM, Lee SH, Choi SU, et al. Synthesis and in vitro cytotoxicity of cinnamaldehydes to human solid tumor cells. Arch Pharm Res 1998;21:147- 52.
5.Anderson RA, Broadhurst CL, Polansky MM, et al. Isolation and Characterization of Polyphenol Type-A Polymers from Cinnamon with Insulin- like Biological Activity. J Agric Food Chem 2004;52:65-70.
6. 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 2001;20:327-36.
7. Imparl-Radosevich J, Deas S, Polansky MM, et al. Regulation of PTP-1 and insulin receptor kinase by fractions from cinnamon: implications for cinnamon regulation of insulin signalling. Horm Res 1998;50:177-82.
8. 11347 Khan A, Safdar M, Ali Khan M, et al. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care 2003;26:3215-8.
9. De Benito V, Alzaga R. Occupational allergic contact dermatitis from cassia (Chinese cinnamon) as a flavouring agent in coffee. Contact Dermatitis 1999;40:165.
10.Drake TE, Maibach HI. Allergic contact dermatitis and stomatitis caused by a cinnamic aldehyde-flavored toothpaste. Arch Dermatol 1976;112:202-3.
11.Onderoglu S, Sozer S, Erbil KM, et al. The evaluation of long-term effcts of cinnamon bark and olive leaf on toxicity induced by streptozotocin administration to rats. J Pharm Pharmacol 1999;51:1305-12.
12. 3238 1 Verspohl EJ, Bauer K, Neddermann E. Antidiabetic effect of Cinnamomum cassia and Cinnamomum zeylanicum in vivo and in vitro. Phytother Res 2005;19:203-6.
13. Vanschoonbeek K, Thomassen BJ, Senden JM, et al. Cinnamon supplementation does not improve glycemic control in postmenopausal type 2 diabetes patients. J Nutr 2006;136:977-80.
14. ress release. Cinnamon capsules to reduce blood sugar are medicinal P products! Efficacy has not been scientifically proven - some products contain high levels of coumarin. Federal Institute of Risk Assessment (BfM), Germany, November 11, 2006. Available at: http://www.bfarm.de/nn_425226/ EN/press/press-releases/pm2006-14-en.html.
15.Miller KG, Poole CF, Pawloski TMP. Classification of the botanical origin of cinnamon by solid-phase microextraction and gas chromatography. Chromatographia 1996;42:639-46.
16.He ZD, Qiao CF, Han QB, et al. Authentication and quantitative analysis on the chemical profile of cassia bark (cortex cinnamomi) by high-pressure liquid chromatography. J Agric Food Chem 2005;53:2424-8.
17.Felter SP, Vassallo JD, Carlton BD, Daston GP. A safety assessment of coumarin taking into account species-specificity of toxicokinetics. Food Chem Toxicol 2006;44:462-75.
18.Baker WL, Gutierrez-Williams G, White CM, et al. Effect of cinnamon on glucose control and lipid parameters. Diabetes Care 2008;31:41-3.
19. Crawford P. Effectiveness of cinnamon for lowering hemoglobin A1C in patients with type 2 diabetes: a randomized, controlled trial. J Am Board Fam Med 2009;22:507-12.
20. 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 2007;30:2236- 7.
