1. Cinnamon: Not Your Grandma’s Spice Anymore Christie Seibert, MD Primary Care Conference May 14, 2008

2. The Patient Susan is a 50 yo woman with type 1 diabetes Susan is a 50 yo woman with type 1 diabetes On insulin pump On insulin pump HbA1C = 6.0 HbA1C = 6.0 Computer Scientist Computer Scientist Emailed about internet claims about cinnamon use in diabetes Emailed about internet claims about cinnamon use in diabetes

3. Cinnamon (Cinnamomon cassia) Chromium (Cr) Chromium (Cr) –Chromium deficiency glucose intolerance glucose intolerance visceral obesity visceral obesity low HDL low HDL –Decreases cortisol concentrations in small human trials

4. Chromium Data Effects of supplemental Cr on lean body mass, glucose and insulin vary in reported studies Meta-analysis of human trials for weight loss: stat sig (-1.1 kg), not clinically sig Meta-analysis of human trials for weight loss: stat sig (-1.1 kg), not clinically sig Most pts are not marginally or overtly deficient in Cr Cr is “not the dominant factor”

5. Cinnamon (Cinnamomon cassia) Cinnamon Polyphenols Cinnamon Polyphenols – –Increases activation of insulin receptors increasing tyrosine phosphorylation activity – –Decreases inactivation of insulin receptors decreasing phosphatase activity –Increases glycogen synthease activity

6. The Data Khan et al: Diabetes Care, 2003 Done in Pakistan Done in Pakistan 60 people with type 2 diabetes 60 people with type 2 diabetes –30 men and 30 women –aged 52.2 +/- 6.32 years –Poorly controlled, many on sulfonylureas Divided randomly into six groups Divided randomly into six groups Groups 1, 2, and 3 took 1, 3, or 6 g of cinnamon daily, respectively Groups 1, 2, and 3 took 1, 3, or 6 g of cinnamon daily, respectively Groups 4, 5, and 6 were given placebo capsules Groups 4, 5, and 6 were given placebo capsules Duration = 40 days Duration = 40 days

7. Results Khan et al: Diabetes Care, 2003 1 g – 6g Daily Mean Fasting Glucose Decreased 18-29% TriglyceridesDecreased 23-30% LDL CholesterolDecreased 7-27% Khan et al, Diabetes Care. 2003 Dec; 26(12):3215-8

8. More Data Blevins et al. Diabetes Care. 2007 58 subjects 58 subjects –Avg age 58-63 –Baseline FBS 139, TG 144 –¾ of subjects taking Metformin 500mg cinnamon caps BID vs placebo 500mg cinnamon caps BID vs placebo Duration = 3 months Duration = 3 months No change in glucose, insulin or cholesterol No change in glucose, insulin or cholesterol Blevins et al. Diabetes Care. 2007 Sep;30(9):2236-7.

9. Bottom Line Mixed results Mixed results Cinnamon supplementation should not be used as a replacement for standard treatments. Cinnamon supplementation should not be used as a replacement for standard treatments. Cinnamon supplements have not consistently shown any adverse effects in trials. Cinnamon supplements have not consistently shown any adverse effects in trials. –Except for allergies to cinnamon (mouth sores)

10. Taking Cinnamon The capsule form may be more easily tolerated than the tablet. The capsule form may be more easily tolerated than the tablet. The cost is ~ $15/mo for a 500mg dose (amazon.com) The cost is ~ $15/mo for a 500mg dose (amazon.com) Extract in the studies was cinnulin PF (available from many supplement manufacturers) Extract in the studies was cinnulin PF (available from many supplement manufacturers)

11. Do NOT use raw cinnamon Do NOT use raw cinnamon –Raw cinnamon has some chemicals that may be harmful at high doses.

12. References Anderson R. Chromium and polyphenols from cinnamon improve insulin sensitivity, Proceedings of the Nutrition Society (2008), 67: 48-53 Cambridge University Press. Anderson R. Chromium and polyphenols from cinnamon improve insulin sensitivity, Proceedings of the Nutrition Society (2008), 67: 48-53 Cambridge University Press. Khan, A et al. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care (2003) 26, 3215–3218. Khan, A et al. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care (2003) 26, 3215–3218. Blevins S et al. Effect of Cinnamon on Glucose and Lipid Levels in Non–Insulin-Dependent Type 2 Diabetes. Diabetes Care (2007) Sep;30(9):2236-7. Blevins S et al. Effect of Cinnamon on Glucose and Lipid Levels in Non–Insulin-Dependent Type 2 Diabetes. Diabetes Care (2007) Sep;30(9):2236-7.