Nutritional Medicine , Separating Fact from Fiction
Update on the FODMAP Diet and lack of evidence for its use
Update on the FODMAP Diet and lack of evidence for its use
Diabetes is a disease in which the blood glucose levels are above normal. People with diabetes have a hard time converting food to energy in the form of glucose. Metabolic syndrome is a disease that can be related to diabetes and is manifested by:
Fasting hyperglycemia — diabetes mellitus type 2 or impaired fasting glucose, impaired glucose tolerance, or insulin resistance;
High blood pressure;
Central obesity (also known as visceral, male-pattern or apple-shaped adiposity), overweight with fat deposits mainly around the waist;
Decreased HDL cholesterol;
The study done by Ziegenfuss, 2006, showed a reduction in fasting blood sugar, blood pressure in both men and women with the metabolic syndrome and suggests that this spice can reduce risk factors associated with diabetes and cardiovascular disease prevalent in the metabolic syndrome. A similar study done by Preuss, 2006, showed that treatment with cinnamon spice lowered blood pressure, blood glucose and other parameters associated with metabolic syndrome.
Cinnamon has been shown to lower the blood sugar in both pre-diabetes, type 2 diabetes and to have a favorable profile on those with metabolic syndrome according to these sources: Preuss, 2006; Sabash, 2006; Mang, 2006; Pham, 2007; Hiebowicz, 2007; Safdar, 2004; Ziegenfuss, 2006; and Flatt, 2007.
Then, there is the meta-analysis done by Hartford Hospital (Reuters, 2008) that says cinnamon does not lower a person’s risk of heart disease by helping them control their glucose or blood lipids. Doses in this study were 1-6 grams per day and used the everyday cinnamon spice that you would find in your spice cabinet. This study concluded that there was no difference in blood sugar, HBA1C or lipid parameters.
The studies have been inconsistent as to which form of cinnamon is more effective at bringing blood sugar down with some studies using capsules and other studies adding it directly to food. One study cited the successful use of cinnamon tea after meals and chewing on cinnamon bark (sticks) after meals (Safdar, 2004) to lower blood sugar. This particular study used 1-3 grams of cinnamon in food to bring down blood sugar to significantly lower values which were time sensitive. In other words, the longer the cinnamon was consumed, the better the blood sugar was. There was also some evidence in this study that cinnamon was potentiating the effects of insulin in the metabolism of carbohydrates making the insulin more efficient in the body.
A cautionary note was placed in one of the articles stating that before you start loading up on cinnamon powders, seasonings and bark to consider that some of the active ingredients in cinnamon may be rendered ineffective by contact with saliva and its lack of solubility in water can result in a build –up of the spice in the body. Cinnamon capsules with the water soluble extract can be purchased in the equivalent of ¼ - ½ tsp twice per day (Flatt, 2007). Lack of consistency in cinnamon delivery may account for some of the inconsistencies in results with some studies showing only a lowering of 10% and others showing a lowering of blood glucose of about 20%.
Effective dosages and lengths of studies have led to controversial outcomes. Some studies say that the cinnamon does and some say it doesn’t affect HbA1C, a way of measuring long term glucose control. This again, I believe relates to the dosage and length of time the study was done. HbA1C is an average measurement of blood glucose over 3 months.
It is also important to note that cinnamon has absolutely no effect on Type I diabetes according to Altschuler (2007).There were no significant differences in A1C, total daily insulin intake or number of hypoglycemic episodes between the cinnamon group and placebo group. More study in Type 1 diabetics is needed.
Studies done by Subash, 2007, showed a reduction in lipids with cinnamon supplementation that has been found to be inconsistent in the literature. This study showed a reduction in HbA1c, total cholesterol, triglycerides while increasing the good cholesterol, HDL. Studies done by Mang, 2006, and Dogoua, 2007 found no change in A1C or lipid profiles.
More recent studies have shown that a 5 g dose of cinnamon reduced peak blood sugars in sedentary, obese women, but no effects on insulin sensitivity or insulin resistance were observed. Cinnamon tea was found in a 2015 study to lower postprandial blood sugar in nondiabetic adults.
So, what is the bottom line? Studies suggest overall that cinnamon in a variety of forms lowers blood glucose, blood pressure and even has a positive effect on metabolic syndrome. It is a spice that can be used in cooking to achieve these results or taken in capsule form to delay the progression of pre-diabetes to diabetes and to slow down the progression of type 2 diabetes. It can be taken by several methods – use in foods, cinnamon capsules purchased in the store with the water soluble extract to equal ¼ to ½ tsp twice per day, or to use cinnamon sticks to make tea in hot water. To be safe, if using more than 1 teaspoon of cinnamon per day, first boil it in water then pour off the resulting watery solution for use using cheesecloth and discard the solid remainder (Flatt, 2007). This will get rid of some of the fat soluble and allergenic components that might be bothersome to some people. Whole cinnamon contains some bothersome volatile compounds and grinding up whole cinnamon to put in brewed coffee is another way to ingest cinnamon, especially in levels over 1 gram.
Keep in mind that the jury is still out as some studies say cinnamon does not affect blood glucose. The pharmacists from the study covered by Reuters in a 2008 press release stated that the pharmacists were quoted as saying “they would not recommend it use to patients”. However, the study also used type 1 diabetics in their sample, a potential sample contamination effect. All together there were 282 study participants in the meta-analysis of 5 studies that contained both type 1 and type 2 diabetics. As mentioned earlier doses administered ranged from 1 -6 grams of regular table cinnamon. Whether saliva inactivation might have been an interfering factor in any of these studies is not known, although a viable variable since the spice form was used in all studies looked at in the meta-analysis.
And, as you can see, we have been studying cinnamon for years with conflicting results. Cinnamon has a high level of polyphenols with an elevated antioxidant score. Any way you look at it, it is a healthy spice to use and as we continue to study it and particularly ECGC, more and more medicinal uses for this wonderful, tasty spice will be unearthed.
But, above all, work with your doctor and health professionals so that if your blood sugar comes down they can adjust your meds. Always involve your health care team in any approach you decide on taking to control your own health and don’t let alternative therapies take the place of taking your medication or making needed lifestyle changes. Every little bit helps – just keep your healthcare team involved.
Although the studies seem controversial, further studies with dosage and type of cinnamon standardized will be useful. Also, more human trials with cinnamon in a standardized dosage format and delivery systems are clearly needed and that is happening now.
The caveat seems to still be that everyone is different and what helps one person may not help another in the same manner. Target population in the studies need to be more diverse. Delivery systems need standardization (i.e. capsules, food, spice stick,) for study consistency across the board. Then, perhaps, we will be able to statistically determine if cinnamon can truly help us in the fight against high blood sugar and the ravages of diabetes.
Altschuler JA, Casella SJ, Mackenzie TA, et.al. 2007. The effect of cinnamon on A1C among adolescents with Type 1 Diabetes. Diabetes Care, 30(4):813-6.
Dugoua JJ, Seely D, Perri D, et. al. 2007. 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, 85(9):837-47.
Flatt, K. 2007. Type 2 Diabetes: Cinnamon Improves Blood Sugar Levels and Insulin Function. http://www.kflatthealthnews.com/2007/02/type-2-diabetes-cinnamon-improves-blood.html. Accessed 12/28/07.
Hiebowicz J, Darwiche G, Bjorgell O, et al. 2007. Effect of cinnamon on postprandial blood glucose, gastric emptying, and satiety in healthy subjects. Am J Clin Nutrition, 85 (6):1552-6.
Mang B, Wolters, et al, 2006. Effects of a cinnamon extract on plasma glucose, HBA, and serum lipids in diabetes mellitus type 2. Eur J Clin Invest, 36(5):340-4.
Pham AZ, Kourlas H. 2007. Cinnamon supplementation in patients with type 2 diabetes. Pharmacotherapy, 27(4):595-9.
Preuss, HG. 2006. Cinnamon May Reduce Systolic Blood Pressure and Help Regulate Glucose
Metabolism. Journal of the American College of Nutrition. 25(2):144-150.
Reuters. 2008. Cinnamon does not control blood sugar. From: Diabetes Care, January 2008. Assessed http://www.diabetes.org/diabetesnewsarticle.jsp?storyId=16729458&filename=200800108/r assessed 1/10/08
Sabash, BP, Prabuseenivasan S and S Ignacimuthu. 2007. Cinnamaldehyde – a potential antidiabetic agent. Phytomedicine, 14(1); 15-22.
Safdar, M, Khan A, Khattak, MMAK, and M Siddique. 2004. Effect of various doses of cinnamon on blood glucose in diabetic individuals. Pakistan Journal of Medicine, 3(5):268-272.
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Ziegenfuss, TN, Hofheins, JE, Mendel, RW. 2006. Effects of a water-soluble cinnamon extract on body composition and features of the metabolic syndrome in pre-diabetic men and women. Journal of the International Society of Sports Nutrition, 3:45-52.