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Posted by TerryPaulaHoffman on 23 Jul 2016 at 01:14 GMT

As a follow-up comment to this article, physicians need to scrutinize their patients’ daily diet.
In October 2002, with a family history of cardiovascular disease, my normal-ranged blood pressure jumped to 150/100 and my LDL (‘bad cholesterol’) doubled. My doctor-prescribed atorvastatin and candesartan effectively reduced both back to normal. Twenty-five years ago, I began my Mediterranean Diet Lifestyle, until morphing it into the DASH Diet in October 2002. Since then, I’ve had annual lab tests, including fasting serum-glucose, also remaining normal (about 90), until November 2014; it jumped to 101.

Already being slender, active, and a nonsmoker, as lifestyle changes, I increased my daily exercise by 10% to 15%, bought a FITBITTM, reduced my daily fresh fruit portion-size, and sprinkled a total-daily teaspoonful of cassia cinnamon[1], such as on my morning oatmeal, evening tea, and sliced apple.[2][3][4] Six months later, when retested, my serum-glucose-level dropped to 86.

After an extensive search of evidenced-based peer-reviewed studies, some trial-results suggested (although, not all) up to 3% to 5% decrease in fasting blood-glucose-levels, when consuming a daily teaspoonful of cassia cinnamon.[5][6][7] However, in larger daily amounts of cassia, the coumarin it contains can cause liver toxicity, such as interfering with its cytochrome P450 enzymes (limiting their ability to metabolize molecules, including drugs deemed toxic to the body), particularly if taking a statin or over 100 other medications.[8][9][10][11][12][13] My annual liver-function-tests (LFT) were always normal, until November 2015 (after eating for about 10 months, 1 teaspoon of cassia cinnamon daily); suddenly my LFT-results were very high.

My doctor-ordered ANA (Antinuclear Antibody) Test and Complete Abdominal Ultrasound were both negative; he wanted me to get a Bone Scan (not a DEXA scan). I asked if maybe my high LFT-results were caused by toxic effects from too much cinnamon[11] and if I could retake the LFT in three months? My doctor agreed. I did; my LFT dropped to its previous results and my Complete Metabolic Panel was also all normal. Even my glucose was 84.

It’s common practice to ask patients to bring a list of all medications and supplements to their scheduled doctor’s appointment. It might be beneficial to strongly encourage patients to write down a week-long list, in real-time or as close as possible, everything eaten, including daily-used herbs and spices, such as: a daily glass of pomegranate, grapefruit, or cranberry juice. It would also be helpful if a medical/healthcare journal create a tear-out or downloadable-page describing red-flagged foods, which might cause dangerous side-effects or drug-interactions.

It’s not uncommon for diabetics to eat cinnamon daily, or someone with frequent bladder infections to drink cranberry juice every day, but how many would think to tell their doctor, and how many physicians ask their patients what they eat?

[1] Busko M. Will a Spoonful of Cinnamon Help the Diabetes Meds Go Down? Medscape Medical News. September 09, 2013. [Requires free registration.]

[2] Allen RW, Schwartzman E, Baker WL, Coleman CI, Phung OJ. Cinnamon Use in Type 2 Diabetes: an Updated Systematic Review and Meta-analysis. Ann Fam Med. 2013 Sep-Oct;11(5):452-9.

[3] Akilen R, Tsiami A, Devendra D, Robinson N. Glycated Haemoglobin and Blood Pressure-lowering Effect of Cinnamon in Multi-ethnic Type 2 Diabetic Patients in the UK: a Randomized, Placebo-controlled, Double-blind Clinical Trial. Diabetic Medicine 2010 Oct;27(10):1159-1167. http://onlinelibrary.wile...

[4] Howard ME and White ND. Potential Benefits of Cinnamon in Type 2 Diabetes. Medscape. Am J Lifestyle Med. 2013;7(1):23-26. [Requires free registration.]

[5] Aubrey A. Cinnamon Can Help Lower Blood Sugar, But One Variety May Be Best. NPR – The Salt –Eating and Health. December 30, 2013.

[6] Davis PA and Yokoyama W. Cinnamon Intake Lowers Fasting Blood Glucose: Meta-analysis. J Med Food. 2011 Sep;14(9):884-9. http://www.ncbi.nlm.nih.g...

[7] Hlebowicz J, Hlebowicz A, Lindstedt S, Bjorgell O, Hoglund P, Holst JJ, Darwiche G, and Almer LO. Effects of 1 and 3 g Cinnamon on Gastric Emptying, Satiety, and Postprandial Blood Glucose, Insulin, Glucose-dependent Insulinotropic Polypeptide, Glucagon-like Peptide 1, and Ghrelin Concentrations in Healthy Subjects. Am J Clin Nutr 2009 Mar;89(3):815–21. and

[8] Lu T, Sheng H, Wu J, Cheng Y, Zhu J, Chen Y. Cinnamon Extract Improves Fasting Blood Glucose and Glycosylated Hemoglobin Level in Chinese Patients with Type 2 Diabetes. Nutr Res. 2012 Jun;32(6):408-12

[9] Kimura Y, Ito H, Hatano T. Effects of Mace and Nutmeg on Human Cytochrome P450 3A4 and 2C9 Activity. Biol Pharm Bull. 2010;33(12):1977-82. https://www.jstage.jst.go... and https://www.jstage.jst.go...

[10] Abraham K, Pfister M, Wöhrlin F, Lampen A. Relative Bioavailability of Coumarin from Cinnamon and Cinnamon-containing Foods Compared to Isolated Coumarin: a Four-way Crossover Study in Human Volunteers. Mol Nutr Food Res. 2011 Apr;55(4):644-53. http://onlinelibrary.wile...

[11] Fotland TO, Paulsen JE, Sanner T, Alexander J, Husøy T. Risk Assessment of Coumarin Using the Bench Mark Dose (BMD) Approach: Children in Norway which Regularly Eat Oatmeal Porridge with Cinnamon May Exceed the TDI for Coumarin with Several Folds. Food Chem Toxicol. 2012 Mar;50(3-4):903-12. http://www.sciencedirect....

[12] Wang YH, Avula B, Nanayakkara NP, Zhao J, Khan IA. Cassia Cinnamon as a Source of Coumarin in Cinnamon-flavored Food and Food Supplements in the United States. J Agric Food Chem. 2013 May 8;61(18):4470-6

[13] Lungarini S, Aureli F, Coni E. Coumarin and Cinnamaldehyde in Cinnamon Marketed in Italy: A Natural Chemical Hazard. Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2008 Nov;25(11):1297-305.

No competing interests declared.


TerryPaulaHoffman replied to TerryPaulaHoffman on 05 May 2019 at 19:51 GMT

Please note: two of my reference-links have changed:

[4] Howard ME and White ND. Potential Benefits of Cinnamon in Type 2 Diabetes. Medscape. Am J Lifestyle Med. 2013;7(1):23-26.

[8] Lu T, Sheng H, Wu J, Cheng Y, Zhu J, Chen Y. Cinnamon Extract Improves Fasting Blood Glucose and Glycosylated Hemoglobin Level in Chinese Patients with Type 2 Diabetes. Nutr Res. 2012 Jun;32(6):408-12

-Terry Paula Hoffman

No competing interests declared.