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Cinnamon Offers Health Benefits but Also Carries Serious Risks

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For a spice that has a history going back over 4,000 years, you would think that there wouldn't be much controversy or confusion. Au contraire. The benefits and risks of cinnamon are making headlines these days like never before.

Just in the last week NPR ran two seemingly contradictory cinnamon stories:

"When Is Cinnamon Spice Not So Nice? The Great Danish Debate"

and

"Cinnamon Can Help Lower Blood Sugar, But One Variety May Be Best"

The Straight & Skinny on Cinnamon

Part of the confusion surrounding cinnamon involves what is and is not "true" cinnamon. Cinnamomum zeylanicum, also known as Cinnamomum verum, is native to Ceylon (Sri Lanka). China and Southeast Asia are the home of Cinnamomum cassia, a related species that has an equally long history. Ancient Egyptians included both forms of cinnamon in their embalming formula for mummifying pharaohs because of the spices' lovely aroma and preserving powers. The Bible refers to both cinnamon and cassia, which were used for aroma and flavor. Both types are derived from the bark of trees.

In modern times these two species are used interchangeably to flavor both sweet and savory dishes. What you find on the spice shelf in the supermarket is usually cassia cinnamon, because it is more readily available and cheaper than Ceylon cinnamon. The flavors are subtly different.

The more critical issue is whether they have the same medicinal properties and safety profile. Most of the research showing that cinnamon can lower blood sugar has utilized cassia cinnamon. The extracts that are sold in health food stores are also primarily derived from cassia cinnamon. But here's the rub. Cassia cinnamon from China, Vietnam or Indonesia contains coumarin. This compound is a natural component of the cassia spice. It is found in varying amounts in different brands. When consumed at high levels, coumarin can cause liver damage in susceptible people. That is why Danish regulators are cracking down on a beloved treat we know as cinnamon swirls (kanelsnegle in Danish).

Five years ago the European Union passed strict limitations on the amount of coumarin allowed in food. German bakers were the first to feel the pinch. Authorities warned about coumarin levels in traditional cinnamon Christmas cookies (Zimtsterne). Regulators found some brands of cookies had coumarin levels 20 times higher than permitted by law. The German trade organization complained that the levels were too strict, since people only consumed their star-shaped cookies during the holidays. More recently, the Danish Baker's Association has also complained:

"We must recognize that to get a cinnamon roll ... to taste like cinnamon, we have to use more than the very small amounts allowed, or it's the end of the cinnamon roll as we know it."

While European bakers and regulators argue over coumarin levels in cinnamon-containing baked goods, the FDA seemingly shrugs its shoulders. European regulators are far more concerned about coumarin than their American counterparts. As far as we can tell, there are no U.S. limits on the amount of coumarin permitted in cinnamon-flavored baked goods in the United States. Analysis of such foods has found coumarin in detectable levels.

We are not terribly worried about an occasional cinnamon roll or cookie. What does concern us, however, is the growing trend for people who are diagnosed with type 2 diabetes or prediabetes to regularly consume cassia cinnamon on their oatmeal or toast in order to lower blood sugar levels. A teaspoon of cassia cinnamon daily could pose serious risks.

You might assume that is not a likely problem for most people. Not so fast. A meta-analysis of clinical trials in the Journal of Medicinal Food (Sept., 2011) revealed that "cinnamon extract and/or cinnamon improves FBG [fasting blood glucose] in people with type 2 diabetes or prediabetes."

People love that sort of good news. It was reinforced more recently in the Annals of Family Medicine (Sept.-Oct., 2013). The authors concluded that, "Based on currently available literature, cinnamon may have a beneficial effect on fasting plasma glucose, LDL-C, HDL-C, and triglyceride levels in patients with type 2 diabetes." 

 

The Bad News About Cinnamon

Such studies create appealing headlines. People are told that cinnamon will not only lower blood sugar levels but also reduce bad LDL cholesterol and triglycerides and raise good HDL cholesterol. That might encourage some people to start consuming high doses of inexpensive cinnamon from their grocery shelves. One diabetes educator who was interviewed on NPR was quoted as saying cinnamon "is inexpensive," "and it tastes good."

That really worries us because regular consumption of inexpensive cassia cinnamon could lead to liver damage. Coumarin may also interact with other drugs including aspirin, NSAIDs (ibuprofen, naproxen, etc) and other anticoagulants such as warfarin (Coumadin), to name a few potential complications.

Over the years we have heard from many people that cinnamon helps control their blood glucose. Here are some stories from visitors to this website.

"I have been using Saigon cinnamon for about 2 months as a supplement to my diet and medication. I put it in coffee, cereal, or oatmeal (at least once daily in the morning).

"I have found that a sprinkle of cinnamon daily keeps my blood sugar from spiking. I still must maintain a diet of low carbs and no sugar, but my glucose remains at fairly constant levels (between 70 and 140) whereas without cinnamon it would spike sometimes as high as 230 for no apparent reason. Also, my A1C has dropped to 6.1 from the low 8s during this time." Jim


"I sprinkle a little cinnamon on my oatmeal in the AM for my psoriatic arthritis. Sometimes I even add it to my plain low fat yogurt as well." Kathleen


"Ooh Boy! I'm starting to worry. I've been taking an overdose of cinnamon for the better part of a month 2 heaping tablespoons per day. Now I have pains in the kidney area, just slightly. Have I damaged my liver? If so does it recover with cessation of the cinnamon?" A.P.


We advised A.P. to stop consuming cassia cinnamon. Hopefully her liver will recover, if in fact it was harmed.


The Good News About Cinnamon

True cinnamon or Ceylon cinnamon appears to have substantially lower levels of coumarin. Although it costs more, it does have a nice flavor and should be safer than cassia cinnamon. Here is a question we received about the effectiveness of Ceylon cinnamon:

"I understand that Saigon cassia cinnamon contains coumarin which can be toxic and has been linked to liver damage in some people. Aren't diet and exercise are safer options for controlling blood sugar? And the Ceylon cinnamon is safer, but I can't locate scientific evidence showing that it reduces blood sugar readings."

PEOPLE'S PHARMACY RESPONSE: For a long time, there weren't any studies showing that Ceylon cinnamon was helpful. But that has been changing: 


http://www.ncbi.nlm.nih.gov/pubmed/22518078 (This is a rat study)


http://www.ncbi.nlm.nih.gov/pubmed/23297571 (This one in mice, but the cinnamaldehyde compound used is present in Ceylon cinnamon)

http://www.ncbi.nlm.nih.gov/pubmed/22671971http://www.ncbi.nlm.nih.gov/pubmed/21150113 (rats and tissue culture)

"My question is similar to the one above; is cassia cinnamon the only type known to aid blood sugar control?" John

 PEOPLES'S PHARMACY RESPONSE to John: At one time we would have said yes without hesitation. However, as more research accumulates, this answer has become less clear. Some studies indicate that Cinnamomum zeylanicum (Ceylon cinnamon) is also effective: 

 

The Cinnamon Solution

"In 2007, I read on the People's Pharmacy website that we could pour boiling water on the cassia cinnamon using a paper coffee filter as a way of extracting the coumarin. Per that article, 'The active compound in cinnamon is water soluble but coumarin is not, so you get the benefit without the worry.'" Grace


Grace got it right. The active ingredient in cinnamon that helps lower blood sugar is water soluble. Using the technique she describes above can be helpful. Some people have complained, though, that it is too much trouble, or that putting cinnamon in the coffee filter creates a terrible mess or that they just plain do not like the taste of cinnamon in their coffee. There is another solution.

Health food stores now sell cinnamon extracts that have been purified so that there is no coumarin. One such brand of water-soluble cinnamon extract is Cinnulin PF. A visitor to this site offered the following:

"I became 'pre-diabetic' after being prescribed masses of prednisone for many months.  I had allergic reactions to generic metformin [went into convulsions with first dose] and started researching cinnamon and other supplements. I found an interesting fact about the cinnamon: If taken in the high volumes necessary to help with the glucose insensitivity, a secondary 'chemical' in the cinnamon can cause harm to the liver and kidneys.

"This property, however is NOT water soluble while the beneficial components ARE; so I then found Cinnulin PF and found that this preparation extracted by a water process contains none of the problem component and all of the benefits. I began using Cinnulin PF [along with other foods] and no longer am 'pre-diabetic'." L.D.


If you would like to learn more about the pros and cons of cinnamon as well as other foods for good health, we recommend our book, Favorite Foods from The People's Pharmacy: Mother Nature's Medicine. You will get the straight and skinny on almonds, beets, blueberries, cherries, ginger, grape juice, green tea, hot peppers, mustard and pomegranates to name just a few of our favorite foods. Always remember, though, that too much of a good thing, even an otherwise healthy food, can sometimes pose problems. That is the lesson of cinnamon.

Here is a link to Favorite Foods and all our other publications

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22 Comments

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I have been brewing 1/4 teaspoon of ordinary cinnamon cassia with my coffee. I do not recall where I got the 1/4 tsp dosage but I read it somewhere. The question now is whether this is safe, and, if so, is this amount sufficient to influence blood sugar positively. (I use an old-fashioned Farberware electric percolator with a paper disk to capture the volatile oils of the coffee).

Any thoughts? Should I switch to Cinnulin capsules?

People's Pharmacy response: You may well have gotten the dose from our site. And this is safe, since you are consuming the coffee and not the grounds or the cinnamon powder.

I believe that I read in a previous article that cinnamon sticks are safe to use. We've been making a "tea" from the sticks and drinking about 1/2 cup a day. Is this safe?

People's Pharmacy response: Yes. Since coumarin is not water soluble and you are not eating the sticks, this is safe.

For 20 years I have been taking 1/2 t of cinnamon on my morning oatmeal. At the time I started eating it, cinnamon was claimed by health food gurus to lower cholesterol. Mine was borderline. In all those years it never became higher nor have I ever suffered liver malfunction. Enzymes are normal. It was warned that the 1/2 teaspoon should not be exceeded because cinnamon poisoning was a serious possibility.

No distinction was made between different cinnamon species nor were there findings yet that cinnamon could lower blood sugar. Eating 2 TABLESPOONS a day of anything which can be sprinkled on food, but is not food, seems excessive to me.

Have been using honey for arthritis and it worked pretty good, when I added cinnamon, I didn't sleep good at night.

I use "WATER EXTRACT" cinnamon. I read that water extract removes the coumarin. I find mine in the health food vitamin section of my grocery store.

It is a patented process. I also purchase water extract cinnamon capsules from a good vitamin catalogue store/on line.

You hit on 2 of, in my opinion, the most important points of using plants as medicines. 1) When ingesting a plant you are ingesting hundreds of chemicals, not just the one you are intending to ingest. When ingesting a prescribed drug you ingest one highly purified chemical. 2) We rarely, perhaps never, know all there is to know about a living organism whether plant or animal. e.g. People's Pharmacy says, "At one time we would have said yes without hesitation. However, as more research accumulates, …"

I am a retired family physician. I have seen many drugs introduced as a "drug of choice" for disease A only to find several years later the drug causes or aggravates disease B. The chemistry of the human body is so complex I doubt we will ever fully understand it. The incredible rate of discovery and new information in medicine is nothing short of amazing, but the most amazing to me is how much we much we do not know. Questioning as People's Pharmacy does is a vital part of keeping the health care system healthy. Acknowledging, analysing, and interpreting the data with the knowledge that the interpretation may change dramatically as new data is added (as People's Pharmacy does) is essential to understanding the complexities we are involved with.

Geoff

PEOPLE'S PHARMACY RESPONSE:

Dr. Geoff,

Thank you so very much for your kind comments above. You just made our year! We do strive to provide up-to-date health information that is balanced and useful. As you so thoughtfully point out, the data are constantly changing. Science is not static. Although some people become frustrated or even disillusioned with health information that changes, that is how we evolve.

Have a Happy New Year!

Joe & Terry

Can an entire bottle of cinnamon be put in coffee filter & have boiling water poured over it? Then just put the water in a bottle, retaining the good properties & throw out what is left in the filter? Just want to make sure I understand correctly.
Thanks

People's Pharmacy response: You could do this, but your resulting liquid would be so strong it would need dilution.

Would it be feasible/effective to use the coffee pot method to filter a couple of tablespoons of cassia cinnamon (without coffee,) and ingest a bit of the cinnamon water each day? Perhaps keep the cinnamon water in a jar in the fridge? If this would be effective, it would be an affordable option for supplementing with cinnamon.

People's Pharmacy response: This should be feasible.

No mention is made, in this article, about the use of cinnamon capsules. Any information on the pros and cons of taking one of these per day? I have seen some on the shelf that have 1000mg/2 capsules.

People's Pharmacy response: As long as the capsules are a water-soluble extract, they should be both safe and effective. Cinnulin PF is a standardized extract to look for.

I am not a diabetic, but have been taking Cinnamon Bark Powder Extract. Diabetes runs in my family. Have not had any side effects at all.

I am type 2 diabetic. My triglyceride level was at a dangerous 300 reading in July 2013. My cholesterol was 288, and my A1C was 8.2. Medication has not been working (Janumet and Trilipix).

I did extensive research on the Ceylon vs Cassia cinnamon before trying this. I have been taking 3/4 teaspoon of Ceylon cinnamon since August 2013 every day, mixed with 1 teaspoon of apple cider vinegar (just added in December) and 1 teaspoon of honey, and as of my December 2013 readings, my triglycerides are down to 121 - normal! My cholesterol, while still high, dropped to 260 and my A1C dropped to 6.5!

I know I don't eat right (I'm trying) and don't exercise (it's hard with my schedule) so I had to do something else to kick start. This has worked for me.

What amount is safe? Is any amount safe? I have taken 500mg every other day for about 6 months. Should I be concerned?

People's Pharmacy response: If you are taking a water-based extract, that is safe.

I use McCormick cinnamon-which kind is this? Can someone tell me? I have started using cinnamon and honey as my cholesterol is high.

People's Pharmacy response: We suspect that McCormick is using cassia cinnamon, as that is the usual spice.

What about Costco "Kirkland Saigon Cinnamon': Is that Ceylon or Cassia? The type of cinnamon is not indicated on the bottle label. Thanks

People's Pharmacy response: Saigon cinnamon is a fancy version of cassia cinnamon.

I certainly appreciate the potential concern about coumarin in Cinnamon. I would also like to point out a few questions that might strengthen the consideration of this.

1. what level of coumarin is in the plant? Plants contain hundreds of chemical constituents in small amounts (ppm) and what level of coumarin consumption is dangerous?
2. what quality of cinnamon are we talking about? Better grown, stored and fresher material will have more activity than old material. I would guess the stuff people are sprinkling on their toast is not the most potent version.
3. Can we extrapolate the research on C. verum to C. cassia? Sometimes different genus's are very similar and sometimes not. It would be important to look closely at both profiles before determining this. Or ask an expert like Dr James Duke or Mark Blumenthal.
4. I encourage you to look at Dr Dukes phytochemical database and you will see that coumarin exists in several common plant/food sources, including Zea mays (corn) at 2000 ppm

So you see it is a matter of amount and the beauty of plants is that there are many chemicals that help to ameliorate each other. This is why you see more side effects in isolated compounds than in whole plant sources of nutrients.

I hope this is helpful in some way.
Thanks for all the great education you share!

McCormick is Cassia cinnamon. It has to say Ceylon Cinnamon on the bottle. Frontier makes it - if there is a Whole Foods near you, they carry it.

This is really scary stuff here. My husband is a Type2 Diabetic and before we cottoned on to Cinnamon powder in bulk he was taking Cinnamon Capsules and see on the bottle that is IS Cassia bark.

Since then - about 2 years or so now, we've been buying the powder in 1lb lots from Vitacost and it comes from Star West Botanicals and is Organic, Kosher etc. The type is Cinnamomium Burmanii (Indonesia).

Is that the dreaded Cassia too? He has been having about a tablespoon on his morning breakfast concoction. Have to admit, it doesn't seem to be doing a huge amount for his blood sugar but he's 71 and desperate to keep off truckloads of medication. The pills he is on now would make for a scary bed-time story too! Mouse

I am confused, is Ceylon cinnamon ok? Everything in my pantry is cassia. I have some capsules from health food store that do not say water soluble.
I look forward to this newsletter each week and readers experiences, comments and questions.

People's Pharmacy response: Yes, Ceylon cinnamon is OK.

I find this article very interesting, esp. since I have read of anti-inflammatory benefits of curcumin in treatment of inflammatory bowel disease and in arthritis. Also, I see no mention of limiting the use of turmeric in foods since turmeric contains curcumin.

If curcumin poses risks it seems the risk is even greater for those using both cassia cinnamon and turmeric as seasonings, and possibly as dietary supplements. What is the level of curcumin that poses the risk?

People's Pharmacy response: Curcumin, a component of turmeric, is distinct from coumarin, sometimes a component of cassia cinnamon. Coumarin is the one we worry about, but people taking the anticoagulant warfarin have reported that turmeric/curcurmin may interact with the drug to make bleeding more likely.

I read all the info about water solubility and coffee filters, but have a question about adding cinnamon (cassia, if that's all I have) to loose tea leaves in a metal infuser positioned over/in a tea pot. Then pour hot/boiling water over the tea leaves/cinnamon, steep, and drink the resulting tea. Would the cinnamon dissolve in the hot water? No filter to strain it out. Just a metal infuser with small holes in it.

I plan to purchase Ceylon cinnamon next time I shop, but have "fancy Vietnamese" cinnamon in house now. Plus, I sometimes purchase Chai flavored loose tea, which has cinnamon, cardamon, etc in it. I want to be sure it's safe to steep this via the infuser and not get the coumarin. I realize this may seem similar to to the coffee brewing scenario, but I am intentionally drinking a lot of tea all day, so I want to be sure this would be safe without the paper filter that is present in the coffee examples. Thanks for your help.

Is Cinnamon tea safe? I have been drinking different brands from local stores and hit on this as my favorite taste hoping also to get the health benefits of cinnamon. Now I see there are risks as well. I drink at least 4 cups a day. Not sure if the concerns apply here.

I was putting a stick of cinnamon that I bought at an Indian grocery store, in with my coffee. Not sure what it was doing to my diabetes, but I did develop a a series of canker sores on my tongue. I have had a reaction to cinnamon flavored gum in the past. I was told that I was one of the 2% of the population allergic to the oil of cinnamon. just wanted to let people know of this.

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