Vol. 61, No. 1, March 2016
The Official Publication of the
Sri Lanka Medical Association
Volume 61, No.1, March 2016
Quarterly ISSN 0009–0875
Chris G Uragoda MD, FRCP
Colvin Goonaratna FRCP, PhD
Janaka de Silva DPhil, FRCP
Anuruddha Abeygunasekera MS, FRCS
Varuni De Silva MBBS, MD
A Pathmeswaran MBBS, MD
B J C Perera MD, FRCPCH
Shalini Sri Ranganathan MD, PhD
Carukshi Arambepola MBBS, MD
Samath Dharmaratne MSc, MD
Tiran Dias MD, MRCOG
Ranil Fernando FRCS, PhD
Malik Goonewardene MS, FRCOG
Renuka Jayatissa MD, MSc
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
S Arulkumaran FRCOG, PhD
Zulfiqar Ahmed Bhutta FRCPCH, PhD
Andrew Dawson FRACP
Barbara Gastel MD, MPH
Kalle Hoppu MD, PhD
David Lallo MD, FRCP
Ian Pearce BMBS, FRCS
Peush Sahni MS, PhD
New Delhi, India
Anita KM Zaidi MMBS, SM
Rikaz Sheriff MBBS MSc
Health benefits of Ceylon cinnamon
(Cinnamomum zeylanicum): a summary
of the current evidence
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
CZ, also known as Ceylon cinnamon or ‘true cinnamon’ is indigenous to
Sri Lanka and southern parts of India . One important difference between
CC and CZ is their coumarin content . 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 . 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 .
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 .
Cinnamtannin B1 has been identified as the potential active compound
Ceylon Medical Journal
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
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
responsible for these effects . 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 . In addition CZ
also showed beneficial effects against diabetic neuropathy
and nephropathy in animal models .
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 . 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 . These
observations indicate that CZ could have potential health
benefits in diseases such as diabetes mellitus and
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 . 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 . 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 . CZ bark extracts were found
to be potent in free radical scavenging activity especially
against DPPH (2,2-diphenyl-1-picrylhydrazyl) radicals and
acid) radical cations, while the hydroxyl and superoxide
radicals were also scavenged by the tested compounds
. Similarly CZ has 65.3% of anti-oxidant activity and
strong free radical scavenging activity .
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 . 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 . 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 . 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.
Vol. 61, No. 1, March 2016
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) . 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 .
Administration of CZ oil is beneficial in protecting
susceptible hosts against opportunistic zoonotic parasites
such as Cryptosporidium parvum . 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 . 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 (H
salivary anaerobes has been investigated . Significant
reductions in total salivary anaerobes and H
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 . 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 . CZ extracts facilitate
collagen biosynthesis in human dermal fibroblasts .
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 . CZ extracts have also
exhibited strong inhibitory effects on osteoclastogenesis
. 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 .
Other in vivo effects in animals
CZ is known to have anti-secretagogue and anti-
gastric ulcer effects . 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 . CZ extracts at
100 and 200 mg/ kg doses significantly reduced the extent
of the diarrhoea (71.7% and 80.4%) in test animals .
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 . These effects have been confirmed by
other authors . CZ has wound healing properties.
Topical CZ containing ointments accelerated the wound
healing process and specifically increased epithelialisation
. Oral CZ increased the wound breaking strength,
granulation tissue breaking strength and hydroxyproline
content in wister rates .
CZ has hepato-protective effects in a study where
liver injury was induced in rats by carbon tetrachloride
) . 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 . Water-based extract from CZ was a potent
inhibitor of VEGFR2 kinase (vascular endothelial growth
factor receptor) activity which is involved in angiogenesis
. 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 .
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.
Ceylon Medical Journal
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Vol. 61, No. 1, March 2016
P Ranasinghe and P Galappaththy, Department of Pharmacology, Faculty of Medicine, University of Colombo,
Correspondence: e-mail: email@example.com.
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