Cinnamon a Supplement for Prediabetes?

The spice lowered blood glucose in patients who were not on any other medication in a recent study

With Giulio Romeo MD

Cinnamon a supplement for prediabetes

For more than a decade, there have been studies attempting to determine whether using cinnamon can help people with diabetes control their blood sugar levels. Two review articles, from 2007 and 2019 respectively, found a few trials that can be considered substantive enough to lead to physicians considering cinnamon supplements to help control blood sugar in patients with type 2 diabetes

The reviews found cinnamon to be safe and well-tolerated, and one found a beneficial impact on blood pressure for those with type 2 diabetes or prediabetes. One review noted that high levels of coumarin – a substance which has been shown to potentially cause cancer and liver damage at high doses – present in cinnamon could be problematic. It is present in larger quantities in cassia, rather than Ceylon, or true, cinnamon. Most cinnamon purchased in the United States is cassia.

A new study on if cinnamon can lower blood sugar levels

But a new study is looking at the impact of cinnamon on those with prediabetes, in the hopes that it can reduce the risk of it developing into type 2. This is early work, says lead author Giulio Romeo MD, an endocrinologist at the Joslin Diabetes Center in Boston.

The new study included 54 patients in the placebo and cinnamon groups (51 completed the study – all in the cinnamon group and 24 in the placebo group), and it was time-limited to 12 weeks. Looking for a cheap, well-tolerated way to prevent patients with prediabetes from progressing to diabetes is “an unmet need,” Giulio says. Indeed, more than a third of the US population has prediabetes, many of them without knowing it. Depending on population demographics, it’s estimated that 3 to 11% of those patients will develop diabetes in any given year.

How can cinnamon lower blood sugar?

Romeo explains that cinnamon is thought to work by increasing glucose transporter type 4 membrane translocation, stimulating after-meal levels of glucagon-like peptide, inhibition of alpha glucosidase activity, and antioxidant properties.

Participants all had to have impaired fasting glucose, defined as fasting glucose between 100 and 125 mg/dl; a two hour plasma glucose level of 140 to 199 mg/dL based on 75-g oral glucose tolerance test; and HbA1c of 5.7% to 6.4%. They were initially screened after an overnight fast. Baseline tests included A1c, fasting plasma glucose, fasting insulin, fasting lipids, a comprehensive chemistry panel, and a standard 75g oral glucose tolerance test. Participants were randomized to take a 500 mg cinnamon capsule (using cassia, not true cinnamon, although Romeo says both products have the active ingredients that researchers believe impact blood sugar) or placebo three times daily over the course of the study. The cinnamon capsules contained 300 mg of cinnamon extract, and 200 mg of cinnamomum burmanii powder.

The participants were randomized within 2 weeks of having their baseline tests and were seen at week 6 and week 12 after randomization. A safety follow-up took place a week or two after the final visit. There was no additional coaching on lifestyle or diet changes that could positively impact blood sugar levels.

Fasting plasma glucose levels were similar in both groups at baseline, and similar after 6 weeks. But by 12 weeks, the people in the placebo group saw an increase in their baseline average, while the cinnamon group showed no significant difference.

Cinnamon caused a reduction in blood sugar after 12 weeks

Cinnamon resulted in a significant reduction in the area under the curve of plasma glucose during oral glucose tolerance tests by the 12-week mark. There was no change in the placebo group. And cinnamon resulted in a significant decrease in plasma glucose two hours after the oral glucose tolerance test at 12 weeks compared to baseline.

While the impact of cinnamon was modest, there is evidence that even small changes among those with prediabetes can be clinically meaningful. One study showed that mortality can decline by as much as 10% if patients can lower A1c by just 0.2% from a baseline of 5-6.9% (14).

There were no significant adverse events in either group, and none of the researchers could attribute any to the treatment.

Romeo notes that previous studies looked at patients with type 2 diabetes, many of whom were on other medications at the time. “Our study shows a positive impact on people who are not yet on any medication, potentially meaning they will never have to be,” he said.

"It is still unknown why some patients who are considered prediabetic end up progressing to diabetes and some don’t," Romeo says. There is speculation that people with impaired gastrointestinal tracts are more at risk, but testing for that is not routine practice. That makes getting to this patient population with simple and cheap ways to improve glucose levels a potential win in the absence of other known risk factors.

Treating cinnamon as a supplement, not a cure

“This isn’t meant to replace lifestyle changes,” says Romeo. If patients are already taking cinnamon, he tells them the verdict on it is still out, but it’s a safe supplement, and it may help.

Romeo says that those with liver damage or disease, or those who have had a reaction to cinnamon should not try the supplement. Coumarin, the element that can cause liver damage and possibly cancer, occurs at about 2.6 grams per teaspoon in cassia. Patients trying cinnamon as a supplement should be aware that the limit for a 130-pound person is about 7 mg of Coumarin per day.

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