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Vol. 61, No. 1, March 2016
Leading article
THE CEYLON
MEDICAL JOURNAL
Established 1887
The Official Publication of the
Sri Lanka Medical Association
Volume 61, No.1, March 2016
Quarterly ISSN 0009–0875
Editors Emeritus
Chris G Uragoda MD, FRCP
Colvin Goonaratna FRCP, PhD
Janaka de Silva DPhil, FRCP
Editors
Anuruddha Abeygunasekera MS, FRCS
Varuni De Silva MBBS, MD
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A Pathmeswaran MBBS, MD
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Samath Dharmaratne MSc, MD
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Prasad Katulanda MD, Dphil
Sarath Lekamwasam MD, PhD
Senaka Rajapakse MD, FRCP
Udaya K Ranawaka MD, FRCP
Chandu de Silva MBBS, MD
Sisira Siribaddana MD, FRCP
International Advisory Board
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London, UK
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Karachi, Pakistan
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Helsinki, Finland
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New Delhi, India
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Health benefits of Ceylon cinnamon
(Cinnamomum zeylanicum): a summary
of the current evidence
Introduction
Cinnamon is obtained from the inner bark of trees from the genus
Cinnamomum. There are two main varieties of cinnamon; Cinnamomum
zeylanicum (CZ) and Cinnamon cassia (CC). CC is also known as Cinnamomum
aromaticum/Chinese cinnamon. In addition to its culinary uses, in Ayurvedic
medicine cinnamon is considered a remedy for respiratory, digestive and
gynaecological ailments. Different parts of the plant (bark, leaves and root)
possess the same array of hydrocarbons in varying proportions. The primary
constituents being cinnamaldehyde (bark), eugenol (leaf) and camphor
(root) [1].
CZ, also known as Ceylon cinnamon or ‘true cinnamon’ is indigenous to
Sri Lanka and southern parts of India [2]. One important difference between
CC and CZ is their coumarin content [3]. Coumarins are plant compounds that
possess strong anticoagulant, carcinogenic and hepato-toxic properties. The
levels of coumarins in CC appear to be very high and could pose health risks
if consumed regularly in higher quantities, whereas CZ contains hardly any
coumarin [4]. Hence, although CC has also demonstrated health benefits,
numerous health agencies have advocated against the regular use of CC.
However, regular use of CZ has not shown to carry such risks.
In vitro and in vivo studies in animals and humans from different parts of
the world have demonstrated numerous beneficial health effects of CZ, such
as anti-inflammatory properties, anti-microbial activity, reducing cardiovascular
disease, boosting cognitive function and reducing risk of colonic cancer [5].
The current level of evidence is summarised in Table 1 and described further
in the following sections.
In vitro and in vivo effects on blood pressure, glycaemic control and lipids
Two systematic reviews in the effects of CZ extracts on diabetes
demonstrate numerous beneficial effects in animal models [6, 7]. In vitro CZ
has demonstrated potential for; reducing post-prandial intestinal glucose
absorption by inhibiting the activity of pancreatic α-amylase and α-
glucosidase, stimulating cellular glucose uptake by membrane translocation
of GLUT-4, stimulating glucose metabolism and glycogen synthesis,
inhibiting gluconeogenesis by effects on key regulatory enzymes and
stimulating insulin release and potentiating insulin receptor activity [6].
Cinnamtannin B1 has been identified as the potential active compound
DOI: http://doi.org/10.4038/cmj.v61i1.8251
2Ceylon Medical Journal
Leading article
Table 1. Summary of current evidence
Effects on blood glucose In vitro Reducing intestinal glucose absorption and stimulating cellular glucose uptake
Stimulating glycolysis and glycogensis, and inhibiting gluconeogenesis
Stimulating insulin release and potentiating insulin receptor activity
In vivo (animals) Reducing FBG and HbA1c, and increasing insulin levels
Effects on cholesterol In vivo (animals) Reducing LDL cholesterol and increasing HDL cholesterol
Effects on blood pressure In vivo (animals) Reduction in blood pressure
Anti-oxidant properties In vitro Reduced oxidative stress and free radical scavenging activity
In vivo (humans) Reduced oxidative stress and lipid peroxidation
Activity against micro- In vitro Bactericidal and fungicidal
organisms Anti-bacterial activity (Salmonella enteritidis, oral cavity anaerobic bacteria)
In vivo Anti-fungal activity (Candida)
Anti-parasitic activity (Cryptosporidium parvum)
Others In vitro Inhibiting tau aggregation and filament formation (Alzheimer’s disease)
Stimulation of collagen synthesis in dermal fibroblasts (anti-ageing skin
treatment)
Inhibition of osteoclastogenesis (osteoporosis)
In vivo (animals) Reducing nephropathy and neuropathy (diabetes)
Reduced acid secretion and increased mucus secretion of stomach
(peptic ulcer disease)
Anti-inflammatory, analgesic and wound healing activity
Hepato-protective activity
responsible for these effects [6]. The beneficial effects
of CZ observed with in vivo animal models include;
attenuation of weight loss associated with diabetes,
reduction of fasting blood glucose (FBG), reducing LDL
and increasing HDL cholesterol, reducing HbA1c and
increasing circulating insulin levels [6]. In addition CZ
also showed beneficial effects against diabetic neuropathy
and nephropathy in animal models [6].
Effects of CZ extracts (CZA) on mean arterial blood
pressure (BP) of normotensive rats (NR), salt-loaded
hypertensive rats (SLHR), L-NAME hypertensive rats
(LNHR) and spontaneously hypertensive rats (SHR)
have been studied [8]. Immediately after intravenous
administration, a significant drop in BP was shown in NTR,
SLHR and LNHR in a dose dependent manner and the
drop in BP was not dose dependent in SHR [8]. These
observations indicate that CZ could have potential health
benefits in diseases such as diabetes mellitus and
hypertension.
In-vitro and in-vivo anti-oxidant properties
The volatile oils of CZ have 55.9% and 66.9%
antioxidant activity at 100 and 200 ppm concentration,
respectively [9]. The dried fruit extracts of CZ with ethyl
acetate, acetone, methanol and water exhibited
antioxidant activity in the order of water > methanol
> acetone > ethyl acetate [10]. The etheric (0.69 mg),
methanolic (0.88 mg) and aqueous (0.44 mg) cinnamon
extracts, inhibited the oxidative process in 68%, 95.5%
and 87.5% respectively [11]. CZ bark extracts were found
to be potent in free radical scavenging activity especially
against DPPH (2,2-diphenyl-1-picrylhydrazyl) radicals and
ABTS (2,2-azino-bis-3-ethylbenzthiazoline-6-sulphonic
acid) radical cations, while the hydroxyl and superoxide
radicals were also scavenged by the tested compounds
[12]. Similarly CZ has 65.3% of anti-oxidant activity and
strong free radical scavenging activity [13].
Operating room personnel who consumed tea with
CZ (100 mg/ 300 ml) daily for 10 days had their blood
samples analysed for biomarkers of oxidative stress
including lipid peroxidation level (LPO), total antioxidant
power (TAP) and total thiol molecules (TTM).
Consumption of cinnamon induced a significant reduction
in plasma LPO [14]. Treatment of 54 healthy volunteers
with CZ 100 mg/ 30ml of tea daily was significantly effective
in the reduction of lipid peroxidation and increasing TAP
and TTM in comparison with controls [15]. The extent of
increase in plasma TBARS (thiobarbituric acid reactive
substances) and TAP in the CZ group was significantly
higher than in those given only regular tea [15]. Hence,
CZ has the potential of reducing the oxidative stress
associated with diseases such as diabetes, and the
potential to reduce oxidative stress associated
complications of these diseases.
3
Vol. 61, No. 1, March 2016
Leading article
In vitro and in vivo anti-microbial properties
CZ has shown potential for in-vitro anti-microbial
action against a wide variety of gram positive
(Staphylococcus aureus, Streptococcus pneumoniae and
Streptococcus pyogenes), gram negative (Escherichia
coli, Haemophilus Influenzae, Helicobacter pylori,
Klebsiella pneumoniae, Pseudomonas aeruginosa and
Salmonella typhi) and anaerobic bacteria (Clostridium
difficile and Clostridium perfringens) [6]. It has also
demonstrated in-vitro anti-microbial activity against
Mycobacterium tuberculosis. In addition there seems to
be activity against numerous fungi of Aspergillus spp.
and Candida spp. CZ has demonstrated activity against
the human rotavirus too [6].
Administration of CZ oil is beneficial in protecting
susceptible hosts against opportunistic zoonotic parasites
such as Cryptosporidium parvum [16]. Two infants who
were chronic carriers of Salmonella enteritidis and received
short term (10 days) administration of grounded CZ bark
had consistently negative stool cultures with neither
clinical nor microbiological relapses [17,18]. Activity of
CZ against fluconazole resistant and susceptible Candida
were studied in HIV infected patients having pseudo-
membranous candidiasis, where three patients out of five
showed improvements in oral candidiasis [19]. The effects
of sugared chewing gum containing cinnamic aldehyde
and natural flavours from CZ on the short-term germ-killing
effect on total and hydrogen sulphide (H2S)-producing
salivary anaerobes has been investigated [20]. Significant
reductions in total salivary anaerobes and H2S-producing
salivary anaerobes were observed 20 minutes after
participants chewed the gum.
Other in vitro effects
An aqueous extract of CZ is known to inhibit tau
aggregation and filament formation in the brain, which are
hallmarks of Alzheimer’s disease [21]. The extract also
promotes complete disassembly of recombinant tau
filaments and cause substantial alteration of the
morphology of paired-helical filaments isolated from brains
of those with Alzheimer’s disease, although it was not
deleterious to the normal cellular function of tau. An A-
linked proanthocyanidin trimer molecule isolated from the
CZ extract has shown to contain a significant proportion
of this inhibitory activity [21]. CZ extracts facilitate
collagen biosynthesis in human dermal fibroblasts [22].
CZ extract up-regulated both mRNA and protein ex-
pression levels of type I collagen without cytotoxicity,
cinnamaldehyde was the major active component
promoting the expression of collagen by HPLC and NMR
analysis. This suggests that CZ extracts might be useful
in anti-aging treatment of skin [22]. CZ extracts have also
exhibited strong inhibitory effects on osteoclastogenesis
[23]. CZ dose-dependently inhibited osteoclast-like cell
formation at concentrations of 12.5-50 μg/ ml without
affecting cell viability. This finding raises prospects for
the development of a novel approach in the treatment of
osteopenic diseases [23].
Other in vivo effects in animals
CZ is known to have anti-secretagogue and anti-
gastric ulcer effects [24]. CZ suspension pre-treatment
decreased the basal gastric acid secretion in pylorus
ligated rats and effectively inhibited gastric haemorrhagic
lesions induced by 80% ethanol, 0.2M NaOH, and 25%
NaCl. It also showed anti-ulcer activity against
indomethacin. CZ treatment replenished the gastric wall
mucus secretion reduced by ethanol [24]. CZ extracts at
100 and 200 mg/ kg doses significantly reduced the extent
of the diarrhoea (71.7% and 80.4%) in test animals [25].
In a study using two animal models for the
investigation of the anti-nociceptive and anti-inflammatory
effects of CZ and selected plants, CZ induced a dose-
dependent analgesic protective effect against both thermal
stimuli. Furthermore, CZ showed an anti-inflammatory
effect against chronic inflammation of cotton pellet
granulomata [26]. These effects have been confirmed by
other authors [27]. CZ has wound healing properties.
Topical CZ containing ointments accelerated the wound
healing process and specifically increased epithelialisation
[28]. Oral CZ increased the wound breaking strength,
granulation tissue breaking strength and hydroxyproline
content in wister rates [29].
CZ has hepato-protective effects in a study where
liver injury was induced in rats by carbon tetrachloride
(CCl4) [30]. Administration of CZ extracts (0.01, 0.05 and
0.1 g/kg) for 28 days significantly reduced the serum levels
of liver enzymes. In addition, treatment with CZ increased
the levels of superoxide dismutase and catalase enzymes
in rats [30]. Water-based extract from CZ was a potent
inhibitor of VEGFR2 kinase (vascular endothelial growth
factor receptor) activity which is involved in angiogenesis
[31]. As a result, CZ inhibited VEGF-induced endothelial
cell proliferation, migration and tube formation in vitro,
sprout formation from aortic ring ex vivo and tumour-
induced blood vessel formation in vivo [31].
In conclusion, the available in-vitro and in-vivo
evidence suggests that CZ has anti-microbial, anti-
parasitic, anti-oxidant, free radical scavenging and wound
healing properties. In addition, CZ may lower blood
glucose, serum cholesterol and blood pressure, suggesting
beneficial cardiovascular and metabolic effects. However,
most studies have been conducted using animal models.
Future studies are necessary to determine whether these
effects are reproducible in humans, their public health
implications and their safety.
Conflicts of interests
There are no conflicts of interest.
4Ceylon Medical Journal
Leading article
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5
Vol. 61, No. 1, March 2016
Leading article
P Ranasinghe and P Galappaththy, Department of Pharmacology, Faculty of Medicine, University of Colombo,
Sri Lanka.
Correspondence: e-mail: priyanga.ranasinghe@gmail.com.
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... In view of the above, it is undeniable that, for greater efficacy in the treatment of chronic diseases, to know how to choose foods according to the above-mentioned principle. To this end, a number of plant food matrices, taken individually or in combination, for their macro and trace nutrients contents have been studied by many authors (Dobroslavić et al., 2022;Ranasinghe & Galappaththy, 2016;Siriken et al., 2018). These include Ceylon cinnamon, Laurus nobilis leaves, and Curcuma longa rhizome. ...
... Cinnamon is native to Sri Lanka. It is a spice that also contains numerous biological activities (antioxidant, antidiabetic, antimicrobial, anticancer, etc.) (Ranasinghe & Galappaththy, 2016). All these matrices have varying contents of macronutrients (proteins, carbohydrates, lipids), fiber (cellulose, hemicellulose), bioactive compounds (polyphenols, flavonoids, tannins, etc.) and minerals (iron, zinc, copper, calcium, potassium, phosphorus, magnesium etc.) (Ranasinghe & Galappaththy, 2016;Siriken et al., 2018;Suriyagoda et al., 2021). ...
... It is a spice that also contains numerous biological activities (antioxidant, antidiabetic, antimicrobial, anticancer, etc.) (Ranasinghe & Galappaththy, 2016). All these matrices have varying contents of macronutrients (proteins, carbohydrates, lipids), fiber (cellulose, hemicellulose), bioactive compounds (polyphenols, flavonoids, tannins, etc.) and minerals (iron, zinc, copper, calcium, potassium, phosphorus, magnesium etc.) (Ranasinghe & Galappaththy, 2016;Siriken et al., 2018;Suriyagoda et al., 2021). Compared with the literature, these plant food matrices are mainly valued for their biological activities. ...
... It can also be used to lower blood sugar in diabetics and as a skin antiseptic. [2][3][4][5][6] It is often known that spices have therapeutic, antibacterial, and antioxidant qualities in addition to adding flavour and strong stimulation. Owing to their numerous potential benefits, spices are a great way to preserve food and help extend its shelf life by preventing rancidity through their antioxidant activity. ...
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Cinnamomum zeylanicum, commonly known as Dalchini or cinnamon, is a revered botanical species in Indian traditional medicine owing to its diverse therapeutic properties. This study presents a comprehensive botanical and pharmacognostic evaluation of zeylanicum bark aimed at understanding its medicinal potential and ensuring quality control measures. Botanical evaluation involved morphological characterization, including macroscopic and microscopic features, to identify the distinctive traits of zeylanicum bark. Additionally, physicochemical characteristics include total ash and acid-insoluble ash, moisture content, and water-soluble and alcohol-soluble extractive values were determined according to standard procedures. Pharmacognostic evaluation encompassed the determination of phytochemical constituents using various chemical tests. Primary and secondary metabolites, including tannins, alkaloids, flavonoids, phenols, and terpenoids, are present and investigated, providing insights into the chemical composition of zeylanicum bark. The research's conclusions add to establishing quality control parameters for zeylanicum bark, ensuring its authenticity, purity, and efficacy in traditional medicine formulations. Moreover, the detailed pharmacognostic analysis provides valuable information for further exploration of its therapeutic potential and pharmacological applications in modern healthcare practices.
... Cinnamon is produced within the inner bark of the tree; it is available as more or less broken bark rolls, or as powder of yellow or orange color. Numerous studies have shown that cinnamon has anti-inflammatory, antimicrobial, antiparasitic, antioxidant, anti-tumor, anticholesterol, immuno-modulatory and wound healing properties (3)(4)(5). Cinnamon has a beneficial effect on glucose metabolism by a mechanism similar to that of insulin. Several studies have shown that cinnamon is effective in reducing blood glucose concentrations in people with diabetes. ...
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... It was generally observed that tannins had higher accumulation in RF than either YF or PF (Table S4A,B). For example, cinnamtannin B2 was absent in the PF variety but had 13-fold lower accumulation in YF relative to RF. Cinnamon is known as a remedy for respiratory, digestive, and gynecological disorders, among others, as outlined in Ranasinghe and Galappaththy [61]. The highest accumulation of tannins in the RF variety may account for the higher TPC recorded in RF than the other three varieties ( Figure 2D). ...
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Microwave-assisted hydrodistillation (MAHD) method was employed to extract cinnamon oil and hydrosol (a byproduct). The total polyphenol content (TPC) of the cinnamon hydrosol (CH) was determined using the Folin-Ciocalteu method, and its antioxidant power was assessed through the DPPH radical reduction method. Gas chromatography was utilized to quantify the main bioactive compound (cinnamaldehyde). The disc agar diffusion method was applied to evaluate the inhibition of pathogenic microorganisms. To protect the bioactive compound, an encapsulation method involving cross-linking with calcium alginate was utilized. The capsules were examined using environmental scanning electron microscopy (ESEM). The TPC content was found to be 15.63 ± 0.21 mg gallic acid/g dry matter, and the DPPH radical inhibition rate was 84.26 ± 1.35%. CH exhibited a significant inhibitory effect against Escherichia coli, and a moderate inhibition effect against Shigella flexneri, Salmonella spp., Salmonella typhimurium, and Escherichia coli EPEC. Finally, successful encapsulation of CH was achieved using sodium alginate, resulting in bead sizes ranging between 1.75 and 2.75 mm.
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Introduction Contradictory claims about the efficacy of several medicinal plants to promote glycemic control in patients with type 2 diabetes mellitus (T2DM) have been explained by divergences in the administration form and by extrapolation of data obtained from healthy individuals. It is not known whether the antidiabetic effects of traditional herbal medicines are influenced by gelatin capsules. This randomized crossover trial aimed to evaluate the acute effect of a single dose of raw cinnamon consumed orally either dissolved in water as a beverage or as ordinary hard gelatin capsules on postprandial hyperglycemia (>140 mg/dL; >7.8 mmol/L) in T2DM patients elicited by a nutritionally-balanced meal providing 50 g of complex carbohydrates. Methods Fasting T2DM patients (n = 19) randomly ingested a standardized meal in five experimental sessions, one alone (Control) and the other after prior intake of 3 or 6 g of crude cinnamon in the form of hard gelatin capsules or powder dissolved in water. Blood glucose was measured at fasting and at 0.25, 0.5, 0.75, 1, 1.5 and 2 hours postprandially. After each breakfast, its palatability scores for visual appeal, smell and pleasantness of taste were assessed, as well as the taste intensity sweetness, saltiness, bitterness, sourness and creaminess. Results The intake of raw cinnamon dissolved in water, independently of the dose, decreased the meal-induced large glucose spike (peak-rise of +87 mg/dL and Δ1-hour glycemia of +79 mg/dL) and the hyperglycemic blood glucose peak. When cinnamon was taken as capsules, these anti-hyperglycemic effects were lost or significantly diminished. Raw cinnamon intake did not change time-to-peak or the 2-h post-meal glycaemia, but flattened the glycemic curve (lower iAUC) without changing the shape that is typical of T2DM patients. Conclusions This cinnamon’s antihyperglycemic action confirms its acarbose-like property to inhibit the activities of the carbohydrate-digesting enzymes α-amylases/α-glucosidases, which is in accordance with its exceptionally high content of raw insoluble fiber. The efficacy of using raw cinnamon as a diabetes treatment strategy seems to require its intake at a specific time before/concomitantly the main hyperglycemic daily meals. Trial registration: Registro Brasileiro de Ensaios Clínicos (ReBEC), number RBR-98tx28b.
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Anti-inflammatory and analgesic activity of the essential oil of Cinnamomum zeylanicum were studied and the results are discussed. It is found that the oil has significant anti-inflammatory and analgesic activity. The GC-MS data of the oil showed the presence of eugenol, β-caryophyllene, eugenyl acetate as major components along with nine minor components.
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