Cinnamon: A systematic review of adverse events.

Cinnamon, from the genus Cinnamomum and Lauraceae family, has been used as a popular spice for thousands of years around the world. Many studies have shown therapeutic effects of cinnamon including its antimicrobial, antiviral, antifungal, antioxidant, antitumor, antihypertensive, antilipemic, antidiabetic, gastroprotective, and immunomodulatory effects. Due to popular use of cinnamon and several human reports on adverse events associated with short or long term use of cinnamon, we aimed to systematically review its human reports of adverse event. Databases including Medline, Scopus, Science Direct, Embase, PubMed Central and Google scholar were searched using the key words "cinnamon" or "cinnamomum" for clinical trials, case reports and case series. Also spontaneous reports about adverse effects of cinnamon were collected from five national and international spontaneous reporting schemes. Thirty eight clinical trials were found, five of them reported adverse events. Twenty case reports and seven case series, as well as, spontaneous reports including 160 adverse events were also included. The most frequent adverse events were gastrointestinal disorders and allergic reactions which were self-limiting in the majority of cases. The available data suggests that despite the safety of cinnamon use as a spice and/or flavoring agent, its use may be associated with significant adverse effects in medicinal uses with larger doses or longer duration of use and should be clinically monitored.

Maternal cinnamon intake during lactation led to visceral obesity and hepatic metabolic dysfunction in the adult male offspring.

PURPOSE: Studies with foods, known to promote health benefits in addition to the nutritive value, show that their consumption by pregnant and/or lactating females could induce negative outcomes to the offspring. It is well characterized that cinnamon intake promotes benefits to energy homeostasis. The present study aimed to analyze the effects of the consumption of an aqueous extract of cinnamon by lactating female rats on the endocrine-metabolic outcomes in the adult offspring. METHODS: Lactating dams (Wistar rats) were supplemented with cinnamon aqueous extract (400 mg/kg body weight/day) for the entire lactating period. The male adult offspring were evaluated at 180 days old (CinLac). RESULTS: The offspring presented visceral obesity (P = 0.001), hyperleptinemia (P = 0.002), and hyperinsulinemia (P = 0.016). In the liver, CinLac exhibited reduced p-IRß (P = 0.018) suggesting insulin resistance. However, phosphorylation of IRS1 (P = 0.041) and AKT (P = 0.050) were increased. JAK2 (P = 0.030) and p-STAT3 (P = 0.015) expressions were higher, suggesting that the activation of IRS1/AKT in the CinLac group could have resulted from the increased activation of leptin signaling. Although we observed no changes in the gluconeogenic pathway, the CinLac group exhibited lower hepatic glycogen content (P = 0.005) accompanied by increased p-GSK3ß (P = 0.011). In addition, the CinLac group showed increased hepatic triacylglycerol content (P = 0.049) and a mild steatosis (P = 0.001), accompanied by reduced PPARα mRNA expression (P = 0.005). CONCLUSION: We conclude that maternal intake of aqueous extract of cinnamon induces long-term molecular, metabolic, and hormonal changes in the adult progeny, including visceral obesity, higher lipid accumulation, and lower glycogen content in the liver.

Cinnamon and Cassia Nomenclature Confusion: A Challenge to the Applicability of Clinical Data.

Several Cinnamomum species' barks are generally labeled as cinnamon, although only Cinnamomum verum carries the common name of true cinnamon. Cassia, a common name for a related species, is rarely used on labels; instead, various cassia types may also be labeled "cinnamon." Confusion of true cinnamon and cassia spices in foods generally does not present a risk to health, except possibly at the highest intake levels. However, clinical studies with Cinnamomum investigational products have been published that inadequately describe or lack botanical identification information. The results of such studies are confounded by an inability to determine which species was responsible for the observed effects. Due to differences in the quality and composition of various Cinnamomum species, safety and efficacy data are not generalizable or transferable. Pharmacopeial monographs for characterizing the identity, composition, purity, quality, and strength of Cinnamomum investigational products should be applied to remove the ambiguity of cinnamon.

Antidiabetic, antihyperlipidemic and antioxidant influences of the spice cinnamon ( Cinnamomum zeylanicumon ) in experimental rats

ABSTRACT The present study investigates the effect of cinnamon (Cinnamomum zeylanicumon) powder supplementation on glucose levels, lipid profiles, and oxidative stress parameters in alloxan-induced diabetic rats. Diabetes was induced in adult male Wistar rats via a single subcutaneous alloxan injection (15 mg/kg). Cinnamon powder was mixed with the standard feed of the rats in an amount of 5% for 28 consecutive days. Serum concentrations of total cholesterol (TC) and triglycerides (TG) were assayed at the end of the experimental period in all investigated groups. Anti-oxidative enzymes such as glutathione peroxidase (GPx), catalase (CAT) and superoxide dismutase (SOD) were sought in the serum and pancreas. Alloxan caused the fasting blood sugar level to increase. The administration of cinnamon blocked the increase of blood glucose. There was also a significant difference in the TG and TC levels between control and treated diabetic rats. In diabetic rats, cinnamon treatment restored the activities of SOD, CAT and GPx. These findings suggested that cinnamon has an anti-hyperglycemic effect, improves lipid profiles, and protect against damage induced by oxidative stress in the diabetic state.

Cinnamon Sugar Scrub Dermatitis: "Natural" Is Not Always Best.

Children are at risk of developing allergic contact dermatitis to fragrances. Personal hygiene products, even those labeled hypoallergenic or considered all natural, may be a significant source of fragrance exposure in this population.

Cinnamon spice and everything not nice: many features of intraoral allergy to cinnamic aldehyde.

Intraoral allergic contact dermatitis (ACD) is an uncommonly reported entity. The most commonly implicated allergens are metals that are incorporated into dental appliances. Intraoral ACD to nonmetal allergens is even less frequently described. Cinnamic aldehyde is widely used as a flavoring agent in foods and dentifrices. However, intraoral ACD to cinnamon flavoring agents has only been sporadically reported. In these cases, a variety of sources have been implicated, including candy, chewing gum, mouthwash, lip sunscreen, cinnamon toast, volatile oils, and toothpaste. The clinical presentation of intraoral ACD reactions varies greatly, and as a result, clinicians often do not recognize the diagnosis. Furthermore, because patients are typically unable to provide a list of putative allergens, a high degree of clinical suspicion is required to make the correct diagnosis. We describe several patients with intraoral ACD caused by cinnamon and review the literature associated with this condition.

Do cinnamon supplements cause acute hepatitis?

BACKGROUND: The use of herbal medications to treat various diseases is on the rise. Cinnamon has been reported to improve glycolated hemoglobin and serum glucose levels. When patients consider the benefit of such substances, they are often not aware of potential adverse effects and drug interactions. Cinnamon, via coumarin, can cause liver toxicity. Therefore, its concomitant use with hepatotoxic drugs should be avoided. CASE REPORT: A 73-year-old woman was seen in the Emergency Department complaining of abdominal pain associated with vomiting and diarrhea after she started taking cinnamon supplements for about 1 week. The patient had been taking statin for coronary artery disease for many months. The laboratory workup and imaging studies confirmed the diagnosis of hepatitis. The detail workup did not reveal any specific cause. Cinnamon and statin were held. A few weeks after discharge, the statin was resumed without any further complications. This led to a diagnosis of cinnamon-statin combination-induced hepatitis. CONCLUSIONS: A combination of cinnamon supplement and statin can cause hepatitis, and it should be discouraged.

[Cinnamon rolls are not associated with admission for toxic or alcoholic hepatitis in a Danish liver referral centre].

INTRODUCTION: Cinnamon contains cumarin, which may be toxic to the liver. EU-regulations standardardize the amount of cinnamon in pastry including cinnamon rolls. The aim of the study was to investigate if cinnamon intake from pastry was associated with toxic or alcoholic hepatitis. RESULTS: We registered 58 patients with toxic hepatitis, 38 (66%) women and 20 (34%) men with a median age of 51 (range: 32-80) and 53 (range: 18-78) years, respectively. A total of 22 patients had primarily cholestasis and 36 had hepatitis biochemically. The duration of toxic liver disease from admission to normalization of liver enzymes was similar in the two groups (3.5 ± 3.5 vs 3.6 ± 3.5 months). Toxic hepatitis was most often caused by drugs e.g. NSAID (n = 15; 26%), antibiotics (n = 9; 16%), alternative medicine (n = 7; 12%) and Antabuse (n = 5; 9%). We registered eight patients admitted with severe alcoholic hepatitis, five men and three women, median age of 60 (range: 34-67) years. Alcoholic hepatitis was associated with high alcohol intake. None of the patients with toxic or alcoholic hepatitis reported of excessive intake of cinnamon rolls and there was no evidence of cinnamon added to alcohol of alternative medicine products. CONCLUSION: Intake of cinnamon from cinnamon rolls is not associated with admission for toxic or alcoholic hepatitis. However, for the diagnosis of toxic liver diseases including alcohol it is very important to have patient information regarding any new drugs, alternative medicine and alcohol intake. Further, other causes of liver diseases should be excluded. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Atividade antifúngica de produtos naturais indicados por raizeiros para tratamento de candidíase oral / Actividad antifúngica de productos naturales indicados por vendedores de hierbas (raizeiros) para el tratamiento de la candidiasis oral / Antifungal activity of natural products indicated by herb sellers (raizeiros) for the treatment of oral candidiasis

A crescente resistência das leveduras pertencentes ao gênero Candida frente aos antifúngicos sintéticos, atualmente disponíveis no comércio, impulsiona a busca por novos compostos antifúngicos de origem vegetal. Assim, o propósito do presente estudo foi avaliar in vitro a atividade antifúngica dos decoctos de Schinus terebenthifolius Raddi (aroeira) Cinnamomum zeylanicum Breym (canela) e Punica granatum Linn (romã), vendidos por raizeiros em três feiras livres distintas (A, B e C), frente a três espécies de microorganismos do gênero Candida (C. albicans, C. tropicalis e C. krusei). O ensaio para determinação da atividade antifúngica dos produtos naturais foi realizado pelo método da difusão em meio sólido, em triplicata, onde discos de papel de filtro estéreis embebidos em 50 µL dos extratos foram colocados sobre o meio de cultura. Os resultados foram avaliados a partir da mensuração dos diâmetros dos halos de inibição de crescimento fúngico em milímetros (mm), sendo considerada a moda dos valores obtidos. Foi observada atividade antifúngica de S. terebenthifolius Raddi e de C. zeylanicum Breym sobre C. krusei. No entanto, diferenças foram identificadas entre os produtos obtidos nos diferentes locais. O decocto de Punica granatum Linn apresentou atividade antifúngica sobre as três cepas fúngicas utilizadas no estudo. Também foram verificadas diferenças entres os produtos obtidos nas feiras livres, sendo que apenas as amostras de Punica granatum Linn provenientes da feira A foram capazes de inibir o crescimento fúngico de todas as cepas analisadas. Desta forma, conclui-se que todos os produtos avaliados apresentam atividade antifúngica, havendo diferenças relacionadas aos locais de sua obtenção e sensibilidade das cepas ensaiadas(AU)

La resistencia cada vez mayor de levaduras del género candida a los antifúngicos sintéticos disponibles en la actualidad ha llevado a la búsqueda de nuevos compuestos antifúngicos de origen vegetal. El propósito de este estudio fue evaluar la actividad antifúngica in vitro de decocciones de Schinus terebenthifolius Raddi (pimentero brasileño),Cinnamomum zeylanicum Breym (canela) y Punica granatum Linn (granada) sobre tres especies del género Candida (C. albicans, C . tropicalis y C. krusei). Este material vegetal fue vendido por vendedores de hierbas (raizeiros) en tres ferias callejeras distintas (A, B y C). El ensayo para determinar la actividad antifúngica de los productos se realizó por triplicado. Se empleó el método de difusión en medio sólido, en el que discos de papel de filtro estériles fueron empapados en 50 µL de los extractos y colocados en medio de cultivo. Los datos fueron evaluados mediante la medición de los diámetros de los halos de inhibición del crecimiento fúngico, en milímetros, y se consideró la moda de los valores encontrados. Se observó actividad antifúngica de S. terebinthifolius Raddi y C. zeylanicum Breym contra C. krusei, pero fueron identificadas diferencias entre los productos obtenidos en diferentes lugares. La decocción de Punica granatum Linn presentó actividad antifúngica sobre las tres levaduras en estudio. Además, se encontraron diferencias entre los productos adquiridos en las ferias callejeras, pero sólo las muestras de Punica granatum Linn de la feria A fueron capaces de inhibir el crecimiento de hongos de todas las levaduras analizadas. Todos los productos evaluados mostraron actividad antifúngica, pero hubo diferencias en función de la localidad donde los productos fueron obtenidos y de la sensibilidad a las cepas ensayadas(AU)

An increasing resistance of Candida yeasts to the synthetic antifungals currently available has driven the search for new plant-derived antifungal compounds. In this respect, the present study aimed to evaluate the in vitro antifungal activity of decoctions from Schinus terebenthifolius Raddi (Brazilian pepper tree), Cinnamomum zeylanicum Breym (cinnamon) and Punica granatum Linn (pomegranate) against three species of Candida genus (C. albicans, C. tropicalis and C. krusei). Such plant material was sold by herb sellers in three distinct street fairs (A, B and C). The test to determine the products antifungal activity was performed in triplicate by means of the diffusion method on solid medium, in which sterile filter paper discs were soaked in 50 µL of the extracts and then placed on culture medium. Data were assessed by measuring the diameters of halos of fungal growth inhibition, in millimeters (mm), and it was considered the mode of the values found. Antifungal activity of S. terebinthifolius Raddi and C. zeylanicum Breym was observed against C. krusei, but were identified differences among the products obtained in different locations. Punica granatum Linn decoction presented antifungal activity on the three yeasts under study. Also, were found differences among the products acquired in the street fairs, but only the samples of Punica granatum Linn from fair A were able to inhibit fungal growth of all yeasts analyzed. Thus, it is concluded that all the products assessed showed antifungal activity, but differences were found depending on the location where these were obtained and on the sensitivity to the strains assayed(AU)

Contact dermatitis as an adverse reaction to some topically used European herbal medicinal products - part 1: Achillea millefolium-Curcuma longa.

This review focuses on contact dermatitis as an adverse effect of a selection of topically used herbal medicinal products for which the European Medicines Agency has completed an evaluation up to the end of November 2013 and for which a Community herbal monograph has been produced. Part 1: Achillea millefolium L.-Curcuma longa L.

Oral adverse reactions due to cinnamon-flavoured chewing gums consumption.

Cinnamon-flavoured products (toothpaste, chewing gum, food, candy and mouthwash) can cause oral adverse reactions; among these, the most common is contact stomatitis (cinnamon contact stomatitis, CCS). Signs and symptoms of contact allergic reactions affecting the oral mucosa can mimic other common oral disorders, making diagnosis difficult. As CCS may be more prevalent than believed and its clinical features can frequently determine misdiagnosis, we reviewed case reports and case series of oral adverse reactions due to cinnamon-containing chewing gums, emphasizing clinical aspects, diagnostic and management procedures. We also proposed an algorithm to perform a diagnosis of CCS as in the previous published literature the diagnostic approach was not based on a harmonized and shared evidence-based procedure. Moreover, as patients can refer to different specialists as dentists, dermatologists and allergists, a multidisciplinary approach is suggested.

Efecto combinado del aceite esencial de Cinnamomum zeylanicum blume y nistatina sobre cepas de Candida no-albicans / Combined effect of Cinnamomum zeylanicum blume essential oil and nystatin on strains of non-albicans Candida

Introduction: considering the emergence of resistant species of albicans and non-albicans Candida to agents therapeutically available as a result of the increased number of immunocompromised population and of the increasingly frequent use of prophylaxis and empirical treatment with antifungals, it's verified that there is a clear and emerging need to introduce new antimicrobials agents in the therapeutic arsenal. The purpose of this study was to evaluate the antifungal activity of essential oil of Cinnamomum zeylanicum Blume alone and combined with Nystatin on strains of C. tropicalis and C. krusei. Methods: this was an experimental research in laboratory. It was determined the Minimum Inhibitory Concentration, using the microdilution method, as well as the Fractional Inhibitory Concentration to determine the possible synergistic effects of the association. Strains of C. tropicalis ATCC 40147 and C. krusei ATCC 40042 were used in the tests. When assessed separately, C. zeylanicum essential oil and Nystatin presented Minimum Inhibitory Concentration of 312,5 µg/mL and 64 µg/mL, respectively, on both tested strains. Results: When combined, were found Minimum Inhibitory Concentration of 39 µg/mL and 32 µg/mL for the essential oil and for Nystatin, respectively. The Fractional Inhibitory Concentration value was 0,6024 for both tested strains, indicating additivity of the inhibitory effect on fungal growth. Conclusions: the results indicate that C. zeylanicum essential oil has antifungal activity against the strains of non-albicans Candida evaluated and that its association with Nystatin potentiates this effect(AU)

Introducción: es necesaria la introducción de nuevos agentes antimicrobianos por el surgimiento de especies de Candida albicans y no albicans resistentes a los agentes terapéuticos disponibles .El objetivo del estudio fue evaluar la actividad antifúngica del aceite esencial de Cinnamomum zeylanicum Blume aislado y asociado con nistatina sobre cepas Candida tropicalis y Candida krusei. Métodos: se realizó una investigación experimental de laboratorio. La concentración mínima inhibitoria fue determinada utilizando el método de microdilución, y la concentración inhibitoria fraccionada se usó para determinar los posibles efectos sinérgicos de la asociación. Para las pruebas fueron utilizadas las cepas de C. tropicalis ATCC 40147 y C. krusei ATCC 40042. Se usaron el aceite esencial de C. zeylanicum y nistatina. Cuando fueron evaluados por separado presentaron la concentración mínima inhibitoria de 312,5 µg/mL y de 64 µg/mL, respectivamente, sobre ambas cepas ensayadas. Resultados: una vez asociados, la concentración mínima inhibitoria fue de 39 µg/mL para el aceite esencial y de 32 µg/mL para la nistatina. El valor de la concentración inhibitoria fraccionada para ambas cepas probadas fue de 0,6024, lo que indica adicción del efecto inhibidor sobre el crecimiento de hongos. Conclusiones: los resultados indican que el aceite esencial de C. zeylanicum tiene actividad antifúngica frente a las cepas de Candida no albicans y que la asociación del mismo con la nistatina promueve la potenciación de este efecto(AU)