RESEARCH ARTICLE
Open Access
Abstract
Background: In traditional medicine Cinnamon is considered a remedy for respiratory, digestive and
gynaecological ailments. In-vitro and in-vivo studies from different parts of the world have demonstrated numerous
beneficial medicinal effects of Cinnamomum zeylanicum (CZ). This paper aims to systematically review the scientific
literature and provide a comprehensive summary on the potential medicinal benefits of CZ.
Methods: A comprehensive systematic review was conducted in the following databases; PubMed, Web of Science,
SciVerse Scopus for studies published before 31st December 2012. The following keywords were used:
Cinnamomum zeylanicum, Ceylon cinnamon, True cinnamon and Sri Lankan cinnamon. To obtain additional
data a manual search was performed using the reference lists of included articles.
Results: The literature search identified the following number of articles in the respective databases; PubMed=54,
Web of Science=76 and SciVerse Scopus=591. Thirteen additional articles were identified by searching reference
lists. After removing duplicates the total number of articles included in the present review is 70. The beneficial
health effects of CZ identified were; a) anti-microbial and anti-parasitic activity, b) lowering of blood glucose, blood
pressure and serum cholesterol, c) anti-oxidant and free-radical scavenging properties, d) inhibition of tau
aggregation and filament formation (hallmarks of Alzheimers disease), e) inhibitory effects on osteoclastogenesis,
f) anti-secretagogue and anti-gastric ulcer effects, g) anti-nociceptive and anti-inflammatory activity, h) wound
healing properties and i) hepato-protective effects. The studies reported minimal toxic and adverse effects.
Conclusions: The available in-vitro and in-vivo evidence suggests that CZ has many beneficial health effects.
However, since data on humans are sparse, randomized controlled trials in humans will be necessary to determine
whether these effects have public health implications.
Keywords: Cinnamomum zeylanicum, True cinnamon, Ceylon cinnamon, Medicinal properties, Health benefits
Background
Cinnamon is a common spice used by different cultures
around the world for several centuries. It is obtained from
the inner bark of trees from the genus Cinnamomum, a
tropical evergreen plant that has two main varieties;
Cinnamomum zeylanicum (CZ) and Cinnamon cassia
(CC) (also known as Cinnamomum aromaticum/Chinese
cinnamon). In addition to its culinary uses, in native Ayurvedic medicine Cinnamon is considered a remedy for respiratory, digestive and gynaecological ailments. Almost
* Correspondence: priyanga.ranasinghe@gmail.com
1
Department of Pharmacology, Faculty of Medicine, University of Colombo,
Colombo, Sri Lanka
Full list of author information is available at the end of the article
2013 Ranasinghe et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the
Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is properly cited.
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Methods
A systematic review of published studies reporting the medicinal effects of CZ was undertaken in accordance with
the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement guidelines (Additional
file 2) [13]. A comprehensive search of the literature
was conducted in the following databases; PubMed (U.S.
National Library of Medicine, USA), Web of Science
[v.5.3] (Thomson Reuters, USA), SciVerse Scopus
(Elsevier Properties S.A, USA) for studies published before 31st December 2012. We used the following medical subject headings and keywords: Cinnamomum
zeylanicum, Ceylon cinnamon, True cinnamon and
Sri Lankan cinnamon. Results were limited to studies
in English, while conference proceedings and commentaries were excluded.
In the second stage the total hits obtained from
searching the databases using the above search criteria
was pooled together and duplicate articles were removed. The remaining articles were initially screened by
reading the title and thereafter the abstracts. Studies
not satisfying the inclusion criteria were excluded at
these stages. The remaining articles were screened in the
final stage by reading the full-text and those not meeting
inclusion criteria were excluded. To obtain additional
data a manual search was performed using the reference
lists of included articles. Wherever possible forward citations of the studies retrieved during the literature search
was traced and screened for possible inclusion. This
search process was conducted independently by two reviewers (PR and SP) and the final group of articles to be
included in the review was determined after an iterative
consensus process.
Results
Literature search
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Organism(s) tested
Main outcomes
Candida albicans
Human rota-virus
Acinetobacter spp.
Helicobacter pylori
Among all the essential oils, the leaf and bark oils of CZ
showed the highest activity against all the fungi with
MIC values of 0.04 to 0.63 g L1
Country(s)
Agasthya AS, et al. [14]
India
Barattha MT, et al. [15]
UK, Italy, Portugal
Bayoub K, et al. [16]
Morocco
Bhatia M, et al. [17]
India
Carmo ES, et al. [18]
Brazil
Dubey RC, et al. [19]
India
Elumalai S, et al. [20]
India
Fabio A, et al. [21]
Italy
Ferhout H, et al. [22]
France
Gonalves JLS, et al. [23]
Brazil
Guerra FQS, et al. [24]
Brazil
Hosseininejad Z, et al. [25]
Iran
Jantan IB, et al. [26]
Malaysia
Jirovetz L, et al. [27]
Austria, Cameroon
Khan R, et al. [28]
India
Lima EO, et al. [29]
Brazil
Maidment C, et al. [30]
UK
Mandal S, et al. [31]
India
Mastura M, et al. [32]
Malaysia
Page 5 of 10
E. coli O157:H7
Clostridium difficile
Mycobacterium tuberculosis
A recent meta-analysis by Ranasinghe, et al. and a systematic review by Bandara et al., on the effects of CZ extracts
on diabetes demonstrates numerous beneficial effects both
in-vitro and in-vivo [51,52]. In-vitro CZ has demonstrated
a potential for; a) reducing post-prandial intestinal glucose
absorption by inhibiting the activity of enzymes involved
in carbohydrate metabolism (pancreatic amylase and
glucosidase), b) stimulating cellular glucose uptake by
membrane translocation of GLUT-4, c) stimulating glucose metabolism and glycogen synthesis, d) inhibiting
gluconeogenesis by effects on key regulatory enzymes and
f ) stimulating insulin release and potentiating insulin
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An aqueous extract of CZ is known to inhibit tau aggregation and filament formation, which are hallmarks of
Alzheimers disease [68]. The extract also promotes
complete disassembly of recombinant tau filaments and
cause substantial alteration of the morphology of pairedhelical filaments isolated from brains of those with
Alzheimers disease, however 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 [68]. Takasao, et al. [69] demonstrated that CZ
extracts facilitates collagen biosynthesis in human dermal
fibroblasts. CZ extract up-regulated both mRNA and
protein expression 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 [69]. CZ extracts
have also exhibited the strong inhibitory effects on
osteoclastogenesis [70]. CZ dose-dependently inhibited
osteoclast-like cell formation at concentrations of 12.550 g/ml without affecting cell viability. This finding raises
prospects for the development of a novel approach in the
treatment of osteopenic diseases [70].
Other in-vivo effects in animals
In-vivo studies in animals have also highlighted lack of significant toxic effects on liver and kidney, with a significantly high therapeutic window [51]. Domarack et al., [79]
administered CZ for two weeks to female mice and evaluated the effects on the viability of embryos of mice, number
of nuclei and the distribution of embryos according to nucleus number. Cinnamon significantly decreased the number of nuclei and the distribution of embryos according to
nucleus number was significantly altered and these changes
were attributed to the anti-proliferative effects of cinnamaldehyde [79]. However these findings have been contradicted by others who have demonstrated that CZ does
not have significant abortive or embryo toxic effects in animals [80]. Furthermore, Shah et al, showed that CZ induced a significant increase in reproductive organ weights,
sperm motility, sperm count and demonstrated no spermatotoxic effects in mice [81].
Chulasiri et al., demonstrated that petroleum ether
and chloroform extracts from CZ showed cytotoxic effects on KB (human mouth carcinoma cell line) and
L1210 cells (mouse lymphoid leukaemia cell line) [82].
The average ED50 from the first and second tests of the
petroleum ether extract on these tumour cells were 60
and 24 pg/ml respectively and of the chloroform extract
were 58 and 20 pg/ml respectively. Singh, et al. [83] investigated the cytotoxic effects of aqueous cinnamon extract
from the bark of CZ on human and mouse cell lines. The
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Discussion
The available in-vitro and in-vivo evidence suggests that
CZ has anti-microbial, anti-parasitic, anti-oxidant and
free radical scavenging properties. In addition CZ seems
to lower blood glucose, serum cholesterol and blood
pressure, suggesting beneficial cardiovascular effects.
The different parts of the CZ plant possess the same
array of hydrocarbons in varying proportions. This chemical diversity is likely to be the reason for the wide-variety
of medicinal benefits observed. It would also be interesting
to identify probable mechanisms that are responsible for
such a wide array of medicinal benefits. The mechanism
of action by which CZ reduces blood glucose has been
well studied in-vitro and in-vivo, it seems that CZ; a) reduces intestinal glucose absorption by inhibiting enzymes,
b) stimulates cellular glucose uptake, glycogen synthesis,
insulin release and potentiates insulin receptor activity
and c) inhibits gluconeogenesis by effects on key regulatory enzymes.
The mechanism for the lipid lowering effects is not
clearly described in literature. The high dietary fibre content of CZ could result in reduced intestinal lipid absorption, and the high vitamin/anti-oxidant is likely to result in
increased lipid metabolism. Insulin plays a key role in lipid
metabolism and it is possible that increased serum Insulin
levels following CZ administration also contributes towards reducing lipid levels. The exact blood pressurelowering mechanism of cinnamon is still unknown and
new studies are needed to clarify this issue. The results of
studies in animals have indicated that cinnamon regulates
blood pressure levels through peripheral vasodilatation
[84]. This vasodilatation might be partially through Ca2+
channels blocking properties [57].
The phenolic constituents of CZ are likely to be responsible for the anti-oxidant and free radical scavenging activity observed. Cinnamon extracts are known to increase
Tristetraprolin mRNA and protein levels, Tristetraprolins
have anti-inflammatory effects due to destabilizing of proinflammatory mRNA [85]. This could be the reason for the
anti-inflammatory actions observed. The anti-microbial
action is considered to arise mainly from the potential of
hydrophobic essential oils to disrupt the bacterial cell
membrane and its structures which leads to ion leakage
[37]. Antibacterial assays of the column chromatography
fractions clearly indicated that cinnamaldehyde is the primary compound responsible for major antibacterial activity
[37]. Trans-cinnamaldehyde is also known to inhibits bacterial acetyl-CoA carboxylase [33].
Conclusions
The available in-vitro and in-vivo evidence suggests that
CZ has anti-microbial, anti-parasitic, anti-oxidant and free
radical scavenging properties. In addition CZ seems to
lower blood glucose, serum cholesterol and blood pressure, suggesting beneficial cardiovascular effects. However,
randomized controlled human trials will be necessary
to determine whether these effects have public health
implications.
Additional files
Additional file 1: A brief comparison of the two main varieties of
cinnamon (Cinnamomum zeylanicum and Cinnamomum cassia).
Additional file 2: PRISMA (Preferred Reporting Items for Systematic
reviews and Meta-Analyses) Checklist.
Competing interest
The authors declare that they have no competing interests.
Authors contributions
PR, GASP, PG, GRC and PK made substantial contribution to conception and
study design. PR and SP were involved in data collection. PR, SP, GASP and
GRC were involved in refining the study design, statistical analysis and
drafting the manuscript. PR, PG and PK critically revised the manuscript.
All authors read and approved the final manuscript.
Acknowledgement
The authors would like to thank the staff members of Department of
Pharmacology, Faculty of Medicine, University of Colombo for their support.
Author details
1
Department of Pharmacology, Faculty of Medicine, University of Colombo,
Colombo, Sri Lanka. 2Industrial Technology Institute, Colombo, Sri Lanka.
3
Department of Clinical Medicine, Faculty of Medicine, University of
Colombo, Colombo, Sri Lanka.
Received: 26 May 2013 Accepted: 17 October 2013
Published: 22 October 2013
Page 8 of 10
References
1. Shen Q, Chen F, Luo J: Comparison studies on chemical constituents of
essential oil from ramulus cinnamomi and cortex cinnamomi by GC-MS.
Zhong Yao Cai 2002, 25:257258.
2. Gruenwald J, Freder J, Armbruester N: Cinnamon and health. Crit Rev Food
Sci Nutr 2010, 50:822834.
3. Paranagama PA, Wimalasena S, Jayatilake GS, Jayawardena AL, Senanayake
UM, Mubarak AM: A comparison of essential oil constituents of bark, leaf
root and fruit of cinnamon (cinnamomum zeylanicum Blum), grown in
Sri Lanka. J Natl Sci Found Sri 2010, 29:147153.
4. Chericoni S, Prieto JM, Iacopini P, Cioni P, Morelli I: In vitro activity of the
essential oil of cinnamomum zeylanicum and eugenol in peroxynitriteinduced oxidative processes. Journal Agric Food Chem 2005, 53:47624765.
5. Singh G, Maurya S, DeLampasona MP, Catalan CA: A comparison of
chemical, antioxidant and antimicrobial studies of cinnamon leaf and
bark volatile oils, oleoresins and their constituents. Food Chem Toxicol
2007, 45:16501661.
6. Simic A, Sokovic MD, Ristic M, Grujic-Jovanovic S, Vukojevic J, Marin PD:
The chemical composition of some lauraceae essential oils and their
antifungal activities. Phytother Res 2004, 18:713717.
7. Usta J, Kreydiyyeh S, Barnabe P, Bou-Moughlabay Y, Nakkash-Chmaisse H:
Comparative study on the effect of cinnamon and clove extracts and
their main components on different types of ATPases. Hum Exp Toxicol
2003, 22:355362.
8. Archer A: Determination of cinnamaldehyde, coumarin and cinnamyl
alcohol in cinnamon and cassia by high-performance liquid
chromatography. J Chromatogr 1988, 447:272276.
9. Bundesinstitut fr Risikobewertung: High daily intakes of cinnamon: health
risk cannot be ruled out, Book high daily intakes of cinnamon: health risk
cannot be ruled out. Germany: Bundesinstitut fr Risikobewertung; 2006.
10. Abraham K, Whrlin F, Lindtner O, Heinemeyer G, Lampen A: Toxicology
and risk assessment of coumarin: focus on human data. Mol Nutr Food
Res 2010, 54:22839.
11. European Food Safety Association: Coumarin in flavourings and other
food ingredients with flavouring properties. EFSA J 2008, 793:115.
12. Jayaprakasha GK, Rao LJ: Chemistry, biogenesis, and biological activities
of cinnamomum zeylanicum. Crit Rev Food Sci Nutr 2011, 51:547562.
13. Moher D, Liberati A, Tetzlaff J, Altman DG: Preferred reporting items for
systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009,
339:b2535.
14. Agasthya AS, Jayapal N, Naveenkumar E, Goud NR, Vijayanand J, Hemapriya
J: In vitro study of antimicrobial activity of the South Indian spices
against enteric pathogens. Asian J Microbiol, Biotechnol Environ Sci 2009,
11:173180.
15. Baratta MT, Dorman HJD, Deans SG, Figueiredo AC, Barroso JG, Ruberto G:
Antimicrobial and antioxidant properties of some commercial essential
oils. Flavour Fragr J 1998, 13:235244.
16. Bayoub K, Baibai T, Mountassif D, Retmane A, Soukri A: Antibacterial
activities of the crude ethanol extracts of medicinal plants against
listeria monocytogenes and some other pathogenic strains.
Afr J Biotechnol 2010, 9:42514258.
17. Bhatia M, Sharma A: Inactivation of candidia albicans in culture media by
eight spices native to Indian subcontinent. Intl J Pharm Sci Rev Res 2012,
16:125129.
18. Carmo ES, Lima EDO, De Souza EL, De Sousa FB: Effect of cinnamomum
zeylanicum blume essential oil on the growth and morphogenesis of
some potentially pathogenic aspergillus species. Braz J of Microbiol 2008,
39:9197.
19. Dubey RC, Rana A, Shukla RK: Antibacterial activity of essential oils of
some medicinal plants against certain human pathogens. Indian Drugs
2005, 42:443446.
20. Elumalai S, Kesavan R, Ramganesh S, Prakasam V, Murugasen R:
Comparative study on anti-microbial activities of bark oil extract from
cinnamomum cassia and cinnamomum zeylanicum. Biosci Biotechnol Res
Asia 2010, 7:251258.
21. Fabio A, Cermelli C, Fabio G, Nicoletti P, Quaglio P: Screening of the
antibacterial effects of a variety of essential oils on microorganisms
responsible for respiratory infections. Phytother Res 2007, 21:374377.
22. Ferhout H, Bohatier J, Guillot J, Chalchat JC: Antifungal activity of selected
essential oils, cinnamaldehyde and carvacrol against malassezia furfur
and candida albicans. J Essent Oil Res 1999, 11:119129.
23. Gonalves JLS, Lopes RC, Oliveira DB, Costa SS, Miranda MMFS, Romanos
MTV, Santos NSO, Wigg MD: In vitro anti-rotavirus activity of some
medicinal plants used in Brazil against diarrhea. J Ethnopharmacol 2005,
99:403407.
24. Guerra FQS, Mendes JM, de Sousa JP, Morais-Braga MFB, Santos BHC,
Coutinho HDM, Lima EDO: Increasing antibiotic activity against a
multidrug-resistant acinetobacter spp by essential oils of citrus limon
and cinnamomum zeylanicum. Nat Prod Res 2012, 26:22352238.
25. Hosseininejad Z, Moghadam SD, Ebrahimi F, Abdollahi M, Zahedi MJ,
Nazari M, Hayatbakhsh M, Adeli S, Sharififar F: In vitro screening of
selected Iranian medicinal plants against helicobacter pylori. Int J
Green Pharm 2011, 5:282285.
26. Jantan IB, Karim Moharam BA, Santhanam J, Jamal JA: Correlation between
chemical composition and antifungal activity of the essential oils of
eight cinnamomum species. Pharm Biol 2008, 46:406412.
27. Jirovetz L, Buchbauer G, Ngassoum MB, Essia-Ngang JJ, Tatsadjieu LN,
Adjoudji O: Chemical composition and antibacterial activities of the
essential oils of plectranthus glandulosus and cinnamomum zeylanicum
from cameroon. Sci Pharm 2002, 70:9399.
28. Khan R, Islam B, Akram M, Shakil S, Ahmad A, Ali SM, Siddiqui M, Khan AU:
Antimicrobial activity of five herbal extracts against multi drug resistant
(MDR) strains of bacteria and fungus of clinical origin. Molecules 2009,
14:586597.
29. Lima EO, Gompertz OF, Giesbrecht AM, Paulo MQ: In-vitro antifungal
activity of essential oils obtained from officinal plants against
dermatophytes. Mycoses 1993, 36:333336.
30. Maidment C, Dyson A, Haysom I: A study into the antimicrobial effects of
cloves (syzgium aromaticum) and cinnamon (cinnamomum zeylanicum)
using disc-diffusion assay. Nutr Food Sci 2006, 36:225230.
31. Mandal S, Deb Mandal M, Saha K, Pal NK: In vitro antibacterial activity of
three Indian spices against methicillin- resistant staphylococcus aureus.
Oman Med J 2011, 26:319323.
32. Mastura M, Nor Azah MA, Khozirah S, Mawardi R, Manaf AA: Anticandidal
and antidermatophytic activity of cinnamomum species essential oils.
Cytobios 1999, 98:1723.
33. Meades G Jr, Henken RL, Waldrop GL, Rahman MM, Gilman SD, Kamatou GP,
Viljoen AM, Gibbons S: Constituents of cinnamon inhibit bacterial acetyl CoA
carboxylase. Planta Med 2010, 76:15701575.
34. Mishra AK, Mishra A, Bhargava A, Pandey AK: Antimicrobial activity of
essential oils from the leaves of cinnamomum spp. Natl Acad Sci Lett
2008, 31:341345.
35. Negi PS, Jayaprakasha GK, Rao LJ: Antibacterial activity of cinnamomum
zeylanicum fruit extracts. Sci Aliments 2007, 27:245250.
36. Noudeh GD, Sharififar F, Noodeh AD, Moshafi MH, Afzadi MA, Behravan E,
Aref M, Sakhtianchi R: Antitumor and antibacterial activity of four
fractions from heracleum persicum desf. And cinnamomum zeylanicum
blume. J Med Plants Res 2010, 4:21762180.
37. Rana IS, Singh A, Gwal R: In vitro study of antibacterial activity of
aromatic and medicinal plants essential oils with special reference to
cinnamon oil. Int J Pharm Pharm Sci 2011, 3:376380.
38. Senhaji O, Faid M, Kalalou I: Inactivation of escherichia coli O157:H7 by
essential oil from cinnamomum zeylanicum. Braz J Infect Dis 2007, 11:234236.
39. Shahverdi AR, Monsef-Esfahani HR, Tavasoli F, Zaheri A, Mirjani R: Transcinnamaldehyde from cinnamomum zeylanicum bark essential oil
reduces the clindamycin resistance of clostridium difficile in vitro.
J Food Sci 2007, 72:S055058.
40. Singh HB, Srivastava M, Singh AB, Srivastava AK: Cinnamon bark oil, a
potent fungitoxicant against fungi causing respiratory tract mycoses.
Allergyy 1995, 50:995999.
41. Sivakumar A, Jayaraman G: Anti-tuberculosis activity of commonly used
medicinal plants of south India. J Med Plants Res 2011, 5:68816884.
42. Tekwu EM, Askun T, Kuete V, Nkengfack AE, Nyasse B, Etoa FX, Beng VP:
Antibacterial activity of selected cameroonian dietary spices ethnomedically used against strains of mycobacterium tuberculosis.
J Ethnopharmacol 2012, 142:374382.
43. Unlu M, Ergene E, Unlu GV, Zeytinoglu HS, Vural N: Composition, antimicrobial
activity and in vitro cytotoxicity of essential oil from cinnamomum
zeylanicum blume (lauraceae). Food Chem Toxicol 2010, 48:32743280.
44. Abu El Ezz NMT, Khalil FAM, Shaapan RM: Therapeutic effect of onion (allium
cepa) and cinnamon (cinnamomum zeylanicum) oils on cryptosporidiosis
in experimentally infected mice. Global Vet 2011, 7:179183.
Page 9 of 10
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
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doi:10.1186/1472-6882-13-275
Cite this article as: Ranasinghe et al.: Medicinal properties of true
cinnamon (Cinnamomum zeylanicum): a systematic review. BMC
Complementary and Alternative Medicine 2013 13:275.