Cassia cinnamon
| Summary | |
|---|---|
| Binomial | Cinnamomum cassia (L.) J.Presl |
| Family | Lauraceae |
| Common names | Cassia cinnamon, Chinese cinnamon, cassia, gui (Chinese, the generic name), rou gui (Chinese, the bark), gui zhi (Chinese, the twig), dar-cini (Persian and Urdu, shared with Ceylon), qirfa (Arabic, shared with Ceylon); the synonymic binomial Cinnamomum aromaticum Nees appears in some older literature |
| Native range | southern China and northern Vietnam (Guangxi and Guangdong provinces are the principal historical and modern production areas); cultivated widely throughout southeast Asia, with related Cinnamomum loureirii (Saigon cinnamon, Vietnam) and Cinnamomum burmannii (Indonesian cinnamon, Java and Sumatra) frequently traded under the generic "cassia" or "cinnamon" name and supplying the majority of American grocery-store cinnamon |
| Cultivars / varieties | grade-based: Vietnamese cassia (C. loureirii, technically a distinct species) is often the highest-cinnamaldehyde and most pungent product; Chinese cassia (C. cassia proper) is the traditional TCM source; Indonesian cassia (C. burmannii, also a distinct species, also frequently sold as "cassia") is the lower-priced commodity cinnamon dominating American retail. The species distinctions matter for coumarin content (which varies among the three) and for cinnamaldehyde concentration, but the three are routinely sold interchangeably under the "cassia" or "cinnamon" name in the American market |
| Parts used | inner bark (rou gui, the TCM and culinary form, the characteristic hollow tube quill); young twig (gui zhi, the TCM surface-resolving form); the leaf is less used than in C. verum; root bark, camphor-rich, used historically |
| Cultivation | subtropical evergreen tree to 10 to 15 m at full size, maintained as coppice or semi-coppice for bark production; bark stripping is mechanically and chemically similar to the Ceylon practice but produces the characteristic single-layer thick rigid quill rather than the multi-layered brittle Ceylon scroll |
| Pharmacy | |
| Preparations | bark powder 1 to 4 g daily for digestive carminative use (with the coumarin-content caveat below); bark essential oil 0.05 to 0.2 mL daily, diluted, never undiluted on skin or mucosa; rou gui (bark) 2 to 5 g per day in TCM decoction; gui zhi (twig) 3 to 10 g per day in TCM decoction; tincture 1:5 in 70 percent alcohol, 2 to 4 mL three times daily; aqueous extract for some glycemic-effect supplement formulations |
| Pregnancy | culinary doses safe; therapeutic-dose supplementation, essential oil, and chronic high-coumarin intake caution |
| Legal status | unscheduled; GRAS for culinary use; widely sold worldwide as culinary spice and as dietary supplement; this is the cinnamon dominant in the American supermarket and the principal "cinnamon" of commercial baked goods |
| Pharmacology | |
| Active constituents | cinnamaldehyde 75 to 90 percent of bark essential oil (higher than verum's 65 to 80 percent, accounting for cassia's more pungent flavor); eugenol below 1 percent of bark essential oil (contrasting with verum's 5 to 10 percent); coumarin 0.4 to 4 percent of bark dry weight (the load-bearing safety distinction; verum carries trace amounts below 0.004 percent); cinnamyl acetate, cinnamic acid and derivatives; proanthocyanidins (type A doubly-linked oligomers); MHCP (methylhydroxychalcone polymer, the proposed insulin-mimetic, identified primarily in cassia) |
| Mechanism (summary) | cinnamaldehyde TRPA1 ion-channel agonism produces the characteristic warming-and-pungent sensation and contributes to carminative effect through smooth-muscle modulation; cinnamaldehyde broad-spectrum antimicrobial effect via membrane disruption and thiol-disulfide exchange; MHCP enhancement of insulin-receptor autophosphorylation and downstream glycogen-synthase signaling provides the mechanistic rationale for the glycemic effect documented in type 2 diabetes trials, most of which used cassia rather than Ceylon; the coumarin fraction is metabolized hepatically via CYP2A6 with substantial individual-variable production of the 3-hydroxycoumarin minor pathway that accounts for the rare-but-real chronic-intake hepatotoxicity in heavy users |
Cassia cinnamon is the dried inner bark of Cinnamomum cassia (L.) J.Presl, a subtropical evergreen tree of the Lauraceae native to southern China and northern Vietnam and one of the foundational warming herbs of traditional Chinese medicine. The species is the cinnamon of the East Asian materia medica, the principal "cinnamon" of the American supermarket and of commercial baked goods, and the higher-coumarin twin of the Ceylon cinnamon (Cinnamomum verum) with which it is routinely confused in commerce and clinical conversation. Cassia bark is documented in Chinese sources from the Han dynasty onward and appears in the foundational Chinese materia medica the Shennong Bencao Jing (compiled in the early centuries of the common era from older oral tradition) under the entry gui, which is the generic Chinese name for the cinnamon-family barks and twigs. The two principal TCM preparations of the bark are rou gui (the older, thick, ground-floor bark used as the chief warming-yang herb of the Chinese pharmacopoeia, indicated for kidney-yang deficiency, mingmen-fire weakness, and cold-pattern lumbar and abdominal pain) and gui zhi (the young twig used in surface-resolving formulas for early-stage external wind-cold patterns); the two are distinct in clinical use within TCM despite arising from the same plant. The cassia of Western commerce and clinical research is most often the bark, marketed under the generic "cinnamon" or "cassia" name without species discrimination from the related Cinnamomum loureirii (Saigon cinnamon, Vietnam) and Cinnamomum burmannii (Indonesian cinnamon, Java), both of which are botanically distinct species but commercially interchangeable with C. cassia in the modern global cinnamon supply. The principal safety distinction from Ceylon cinnamon is the coumarin content: cassia bark contains 0.4 to 4 percent coumarin by dry weight, against trace amounts in Ceylon, and chronic high dietary intake of cassia (heavy supplementation, large cinnamon-rich baked-goods consumption, or social-media "cinnamon challenge" levels) can exceed the European Food Safety Authority tolerable daily intake of 0.1 mg per kg body weight and produce hepatotoxicity in susceptible individuals.
History and traditional use
The Chinese tradition is the historical centroid of cassia cinnamon. The bark and twig are documented from the Han dynasty onward and appear in the foundational Chinese materia medica the Shennong Bencao Jing (compiled in the first or second century CE from older oral tradition) under the entry gui, classed in the upper grade of medicines (the rejuvenative tonics, used long-term without harm).[1] The clinical use of cassia in TCM was systematized by Zhang Zhongjing in his Shang Han Lun ("Treatise on Cold Damage Disorders") of about 220 CE, the foundational Chinese clinical text on febrile and external-pathogen disease.[2] Zhang opened the Shang Han Lun with the formula Gui Zhi Tang (cassia twig, peony root, jujube, ginger, licorice), the foundational surface-resolving formula for early-stage external wind-cold disorder, and paired it with Ma Huang Tang (ephedra, cassia twig, almond, licorice) for the warming-and-dispersing pattern; the two formulas anchor the entire TCM tradition of treating cold-pattern external invasion and remain in routine modern use.
The TCM clinical separation of rou gui (the bark) from gui zhi (the twig) is the defining preparation distinction for this herb. Rou gui is the chief warming yang herb of the Chinese materia medica: it is indicated for kidney-yang deficiency (a syndrome encompassing chronic cold extremities, low back and knee weakness, impotence, polyuria, and exhaustion), for mingmen-fire weakness (the "gate of life" digestive-fire deficiency presenting as cold abdominal pain, chronic diarrhea, and edema), and for cold-pattern menstrual disorders including amenorrhea and dysmenorrhea with clear copious discharge.[3] Gui zhi is the surface-resolving twig: it warms the meridians, dispels wind, and is the principal ingredient of the foundational Han dynasty Shang Han Lun formulas Gui Zhi Tang and its many derivative formulas (the gui zhi family of about thirty Shang Han Lun formulas, modified for specific clinical patterns); modern Chinese herbal practice uses gui zhi as a routine ingredient in the early-stage cold-and-wind treatment of upper respiratory and musculoskeletal complaint.
The Mediterranean tradition documented cassia (Greek kasia, Hebrew qiddah) as a distinct trade good alongside true cinnamon (kinnamomon, qinnamon) from the earliest written records onward. The Hebrew Bible lists qiddah as a constituent of the holy anointing oil prescribed in Exodus thirty (alongside qinnamon, myrrh, and calamus) and as one of the trade cargoes of the merchants of Tyre in the prophecy of Ezekiel; the Hebrew distinction between the two cinnamons predates the formal botanical separation of the species by more than two thousand years. Dioscorides in book one of his De Materia Medica of about 60 CE devoted separate entries to kinnamomon and kasia, listing both as warming, digestive, and emmenagogue, but ranking kinnamomon as the more valuable.[4] Pliny the Elder in book twelve of his Naturalis Historia gave both spices extended treatment and noted (correctly) that the Mediterranean trade in cassia was substantially larger by volume than the trade in true cinnamon, an indication that even in the Roman period the cheaper, more abundant cassia was the workhorse cinnamon of everyday commerce.[5]
The Islamic and Persian medical traditions documented cassia within the same Dar-Cini and qirfa entries as Ceylon cinnamon, without (initially) distinguishing the two species; the practical Unani distinction between the higher-grade darchini-yi-suluqi (Sri Lankan, Ceylon) and inferior grades implicitly distinguished cassia as the cheaper and lower-grade product. The Avicennan indications (chronic cough, asthmatic complaints, dyspepsia, vomiting, weak constitution) apply to both species; cassia in the medieval Islamic pharmacopoeia was the cheaper and more available form for routine clinical use, while Ceylon was reserved for higher-grade prescription.
The European reception of cassia was the inverse of the Ceylon trade in scale and clinical prestige. Cassia was the cheaper alternative throughout the medieval and early modern European pharmacopoeial tradition; the Continental tradition (German, French, Dutch) more often accepted cassia where the British tradition preferred Ceylon. The American market, which developed in the nineteenth century outside the British colonial trade network for Ceylon, settled on cassia as the dominant cinnamon for both culinary and clinical use, and the modern American grocery-store "cinnamon" is overwhelmingly C. cassia or one of its related species (C. loureirii, C. burmannii) rather than C. verum.
The modern Western pharmacopoeial tradition recognizes cassia cinnamon (Cinnamomi cassiae cortex) separately from Ceylon, with the coumarin content as the principal safety distinction. The European Medicines Agency Committee on Herbal Medicinal Products issued a separate monograph for Cinnamomum cassia bark, with a specific coumarin-intake warning that the verum monograph does not carry.[6] The German Federal Institute for Risk Assessment issued a 2012 statement on coumarin in cinnamon foods, noting that the EFSA tolerable daily intake of 0.1 mg coumarin per kg body weight is regularly exceeded by chronic high consumption of cassia-containing foods (heavy use of powdered cinnamon in oatmeal and baked goods, supplement use) and recommending Ceylon as the safer choice for chronic high-intake users.[7] A small literature of case reports documents hepatotoxicity from chronic high-dose cassia supplementation in susceptible individuals, with onset typically over weeks to months of multi-gram daily intake and resolution on discontinuation; the reports are rare in absolute terms relative to the magnitude of cassia consumption worldwide, but the case-report literature is reproducible enough to constitute a real safety signal and is the empirical basis for the EMA and BfR coumarin warnings.[8]
The contemporary controlled-trial literature on cinnamon for type 2 diabetes is dominated by cassia rather than Ceylon, with most trial populations receiving Chinese or Indonesian cassia bark powder or extract. Meta-analyses have produced positive findings (modest reductions in fasting glucose), null findings, and intermediate findings; the most-cited recent meta-analysis (Allen 2013) reported modest improvements in fasting plasma glucose, total cholesterol, LDL, and triglycerides with cinnamon supplementation in patients with type 2 diabetes, with substantial between-study heterogeneity.[9] Where observational and short-trial evidence has supported the glycemic-effect claim, larger and more recent randomized trials have tended toward modest or null effect; the role of cassia in type 2 diabetes management is a useful adjunctive at best, not a primary intervention, and the choice between cassia and Ceylon for chronic supplementation should weigh the modestly stronger cassia evidence against cassia's coumarin hepatotoxicity concern.
Botany and identification
Cinnamomum cassia is a subtropical evergreen tree of the Lauraceae reaching 10 to 15 m at full size in undisturbed cultivation, maintained as coppice in commercial bark production. The leaves are opposite, oblong to elliptic, 10 to 18 cm long, with five (occasionally three) prominent palmate-pinnate veins running from the base to near the leaf apex; the five-vein pattern is one of the diagnostic distinctions from C. verum, which characteristically has three (occasionally five). The bark of mature trunks is grey-brown, deeply fissured; the medicinally used bark is the harder, thicker inner bark of coppice shoots, scraped of the outer corky layer and dried to form the characteristic single-layer thick rigid quill (a hollow tube rather than the multi-layered brittle scroll of Ceylon). The bark color is darker reddish-brown than the light tan of Ceylon. The flowers are small, greenish-yellow, in lax panicles; the fruit is a small drupe 1 to 2 cm long. The young twigs (gui zhi in TCM preparation) are slender, brown, and cinnamaldehyde-aromatic. Distinguished from Cinnamomum verum in whole-stick or whole-leaf material by the five-vs-three leaf venation, the single-layer-vs-multi-layer quill structure, the darker red-brown color, and the harder rigid texture; these distinctions hold for whole material and are lost in ground powder, where chemical or spectroscopic distinction (cinnamaldehyde-eugenol-coumarin ratio profiling) is required. Distinguished from Cinnamomum loureirii (Saigon cinnamon, the related Vietnamese species often sold interchangeably) by smaller leaf size and somewhat lower cinnamaldehyde content; from Cinnamomum burmannii (Indonesian cinnamon, the principal cassia of the American grocery supply) by leaf morphology and a different terpene profile.
Active constituents
The principal medicinally active constituents of cassia bark are the volatile oil (1 to 2 percent of dry bark by weight, lower than Ceylon's 3 to 4 percent) and the proanthocyanidin polyphenol fraction. The volatile oil composition is the principal pharmacognostic distinction from Ceylon: cassia bark oil contains cinnamaldehyde at 75 to 90 percent of the oil (higher than Ceylon's 65 to 80 percent, accounting for cassia's more pungent and more one-note flavor), eugenol at less than 1 percent (against Ceylon's 5 to 10 percent), and coumarin at 0.4 to 4 percent of bark dry weight (against trace amounts in Ceylon, typically below 0.004 percent).[10] The Wang 2013 quantitative analysis of US-market cinnamon samples established the cassia-coumarin levels at 7 to 12 mg per gram of cassia powder (the higher end of the range for Chinese cassia, the lower end for Indonesian cassia), against undetectable or sub-milligram-per-gram coumarin levels in Ceylon samples; the analytical distinction is the practical fingerprint by which the two species are separated in modern quality control and the empirical basis of the chronic-intake hepatotoxicity concern.
Cassia bark oil also contains smaller amounts of cinnamyl acetate, cinnamic acid, benzaldehyde, salicylaldehyde, and trace eugenol; the overall aromatic profile is sharper and more cinnamaldehyde-dominant than Ceylon's more complex sweet-warm bouquet.
The non-volatile fraction includes proanthocyanidins (the type A doubly-linked oligomers characteristic of Cinnamomum, contributing to antioxidant and astringent activity), MHCP (methylhydroxychalcone polymer, identified at higher concentrations in cassia than in Ceylon and proposed as the principal insulin-mimetic constituent), and a range of cinnamic acid derivatives.
Preparations
The traditional Chinese forms are the rou gui (the bark, used in TCM decoction at 2 to 5 g per day, with the highest grades reserved for specific tonic formulations) and gui zhi (the twig, used in TCM decoction at 3 to 10 g per day, with Gui Zhi Tang the foundational Shang Han Lun formula). The Western therapeutic forms are the bark powder (1 to 4 g daily, with the coumarin-content caveat constraining the upper limit in chronic high-intake users); the bark essential oil (steam-distilled, 0.05 to 0.2 mL daily, diluted; never undiluted on skin or mucosa, and never as a primary medicinal route in chronic use because of the concentrated coumarin and cinnamaldehyde irritation); the tincture (1:5 in 70 percent alcohol, 2 to 4 mL three times daily); and the aqueous extract (used in some glycemic-effect supplement formulations to concentrate the polyphenol and MHCP fraction while reducing the essential-oil and coumarin content).
Pharmacokinetics
Cinnamaldehyde is rapidly absorbed from the gastrointestinal tract and rapidly oxidized to cinnamic acid and then conjugated to hippuric acid (the principal urinary metabolite); elimination of the cinnamaldehyde-derived metabolites is largely complete within 24 hours of administration. Coumarin (substantial in cassia at 0.4 to 4 percent of bark dry weight) is absorbed and metabolized hepatically via CYP2A6: approximately 90 percent is converted to 7-hydroxycoumarin (a detoxification pathway, excreted in urine), and approximately 1 to 6 percent via the minor pathway to 3-hydroxycoumarin (the hepatotoxic intermediate, which can produce hepatocyte mitochondrial damage on chronic high exposure). The CYP2A6 enzyme has substantial polymorphic variation in the human population, with poor-metabolizer genotypes diverting more coumarin through the 3-hydroxycoumarin pathway and accounting for the variable individual susceptibility to chronic cassia hepatotoxicity. The pharmacokinetic distinction is the empirical basis of the EFSA tolerable daily intake of 0.1 mg coumarin per kg body weight per day, set conservatively to protect the poor-metabolizer susceptible population.
Pharmacodynamics
Cinnamaldehyde is a TRPA1 ion-channel agonist, accounting for the warming-and-pungent sensation of cassia on the tongue and gut mucosa and contributing to the carminative effect through smooth-muscle modulation and gastric motility effect. Cinnamaldehyde and the cinnamic acid derivatives produce broad-spectrum antimicrobial effect against bacteria, fungi (including Candida species), and some viruses, mediated by membrane disruption and thiol-disulfide exchange with bacterial enzymes. The proanthocyanidins produce astringent gut-mucosa stabilization. The glycemic effect of cassia has been proposed to involve MHCP enhancement of insulin-receptor autophosphorylation and downstream glycogen-synthase signaling, with cassia having higher MHCP content than Ceylon and the modern T2DM trial literature accordingly weighted toward cassia; the trial-level glycemic effect is nevertheless modest, with substantial heterogeneity between studies and a trend toward null effect in larger and more recent trials. The coumarin pharmacology of cassia is the principal pharmacodynamic distinction from Ceylon: chronic high exposure produces hepatocyte mitochondrial dysfunction in susceptible CYP2A6-polymorphic individuals via the 3-hydroxycoumarin minor metabolic pathway, the mechanistic basis of the rare-but-real cassia hepatotoxicity case reports.
Experience
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Problems
Carminative and digestive aid for postprandial bloating, mild dyspepsia, and flatulence (the principal Commission E indication). Type 2 diabetes mellitus glycemic adjunct (the principal modern clinical indication, with most trial evidence from cassia rather than Ceylon; modest effect; not a primary intervention). TCM-specific indications: kidney-yang deficiency syndrome (rou gui), mingmen-fire weakness with cold abdominal pain or chronic diarrhea (rou gui), cold-pattern dysmenorrhea and amenorrhea (rou gui), early-stage external wind-cold disorder with chills and absent sweating (gui zhi in Gui Zhi Tang and Ma Huang Tang), warming-the-meridians for cold-pattern arthritis and musculoskeletal complaint (gui zhi). Mild antimicrobial and antifungal traditional use. Folk indications: warming for cold-pattern complaint, dysmenorrhea, and as a flavoring synergist in compound formulations.
Titration and dosing
Bark powder: 1 to 4 g daily (the upper end constrained in chronic high-intake users by the coumarin TDI of 0.1 mg/kg/day, which a 70 kg adult exceeds at approximately 2 g of cassia powder daily). Whole bark in decoction or infusion: 0.5 to 1 g per cup, three times daily. Bark essential oil: 0.05 to 0.2 mL daily, diluted; never undiluted; not recommended for chronic high-dose internal use because of cumulative coumarin exposure. Tincture 1:5 in 70 percent alcohol: 2 to 4 mL three times daily. TCM rou gui (bark): 2 to 5 g daily in compound formula. TCM gui zhi (twig): 3 to 10 g daily in compound formula. For glycemic-effect supplementation: 1 to 6 g of cassia daily has been the typical trial range; doses above 2 g daily approach or exceed the coumarin TDI threshold for a 70 kg adult and are best limited to short-course use (weeks to a few months) rather than indefinite supplementation, or substituted with Ceylon cinnamon for the chronic-use case.
Effects
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Interactions
The clinically significant interactions of cassia cinnamon are dominated by the coumarin-hepatotoxicity and hypoglycemic-potentiation categories.
Coumarin chronic hepatotoxicity is the principal cassia-specific safety concern and the principal distinction from Ceylon cinnamon. Chronic dietary or supplemental cassia intake at multi-gram-per-day levels (heavy oatmeal-cinnamon consumption, large cassia-rich baked-goods intake, multi-gram-per-day cassia supplementation) regularly exceeds the EFSA tolerable daily intake of 0.1 mg coumarin per kg body weight in adults of average weight, with the higher exposures occurring among supplement users and among heavy culinary consumers. The empirical case-report literature documents rare-but-reproducible hepatotoxicity in susceptible individuals on chronic high-cassia exposure, with onset typically over weeks to months and resolution on discontinuation. The conservative recommendation for chronic supplementation is to limit cassia to short-course use (weeks to a few months) and substitute Ceylon cinnamon for indefinite or high-dose chronic use.
Modest hypoglycemic potentiation with insulin and oral antidiabetic medicines is the principal pharmacodynamic interaction; the effect is small at culinary doses, somewhat more substantial at therapeutic-dose supplementation, and the trial evidence is dominated by cassia studies.[11] Patients on antidiabetic regimens who add cassia supplementation should monitor for hypoglycemia, particularly during dose titration of the antidiabetic medicine.
The widely repeated concern that cinnamon (cassia or Ceylon) potentiates warfarin or other anticoagulants is mistaken about coumarin pharmacology: the coumarin of cinnamon is the parent 2H-1-benzopyran-2-one compound, not the 4-hydroxycoumarin (warfarin) class, and lacks direct anticoagulant activity. The cassia coumarin concern is hepatotoxicity at chronic high exposure, not anticoagulation. No specific anticoagulation-related preoperative discontinuation recommendation is necessary for cassia at culinary or routine supplementation doses; the hepatotoxicity concern operates on a different timescale (chronic, cumulative) and is addressed by dose-limiting rather than by perioperative discontinuation.
Contact dermatitis from cinnamaldehyde is the principal occupational concern, more common with cassia than Ceylon because of cassia's higher cinnamaldehyde concentration; this affects bakers, spice handlers, and food-industry workers more often than retail consumers.
Pregnancy and lactation
Culinary amounts of cassia cinnamon are considered safe in pregnancy and lactation, with a long historical record of routine use in essentially all cinnamon-using cultures. Therapeutic-dose supplementation (multi-gram daily for glycemic effect, or essential oil for any indication) and the cassia-coumarin chronic-intake concern apply in pregnancy as in the general population, with the additional consideration that fetal coumarin exposure has not been formally studied at the relevant intake levels; the conservative recommendation is to limit pregnant patients to culinary doses of cassia (or to substitute Ceylon at any chronic supplementation level) and to avoid concentrated cassia essential oil entirely in pregnancy.
Monitoring
For patients on insulin or oral antidiabetic medicines who add cassia supplementation at therapeutic dose, fasting glucose monitoring at baseline and at two to four weeks of regular supplementation is the conservative practice. For chronic high-intake cassia consumers (multi-gram daily cassia powder supplementation for indefinite duration, or comparable heavy dietary intake), liver function test monitoring at baseline and periodically (every six to twelve months) is reasonable, particularly in patients with pre-existing hepatic disease or concurrent hepatotoxic medicine use; substitution of Ceylon for cassia in chronic high-intake users is the preferable alternative to ongoing LFT surveillance.
Patient counseling
The most important counseling distinction for cinnamon is the species, and patients seeking cinnamon for chronic high-intake therapeutic use should generally choose Ceylon (Ceylon cinnamon) rather than cassia because of the coumarin-content difference. The cinnamon sold as a culinary spice in most American grocery stores and used in commercial baked goods is C. cassia or one of its related species (C. loureirii Saigon cinnamon, C. burmannii Indonesian cinnamon), not C. verum Ceylon cinnamon. The visual distinction between cassia and Ceylon is possible with whole sticks but lost in ground powder. Cassia is darker reddish-brown, composed of a single thick rigid layer rolled into a hollow tube, hard and resistant to crushing, with a strong, simple, pungent aroma; Ceylon is light tan, composed of many thin papery layers tightly rolled into a multi-quill scroll, brittle and easily crushed, with a delicate, complex, sweet aroma.
For patients consuming cinnamon at routine culinary levels (gram or fraction of gram per day, sprinkled on food), the coumarin exposure from cassia is unlikely to reach the tolerable daily intake threshold and species choice is not a clinical priority. For patients consuming cinnamon at therapeutic supplementation levels (multi-gram daily, particularly the powdered form in capsules) or at high dietary levels (large quantities in baked goods, daily heavy-cinnamon oatmeal, social-media "cinnamon challenge" of swallowed dry powder), the coumarin exposure from cassia can substantially exceed safe daily intake. The Ceylon species is the appropriate substitution for chronic high-intake users; cassia is the appropriate choice for short-course supplementation (weeks to a few months) and for routine culinary use where chronic exposure is moderate.
The social-media "cinnamon challenge" (swallowing a tablespoon of dry cinnamon powder) carries the acute risks of aspiration and aspiration pneumonia (dry cinnamon powder is highly aspirable and reaches the lower airways) and the cumulative-coumarin risk only with repeated practice; the acute aspiration danger is the more immediate concern. Cinnamon essential oil (either species) is concentrated and irritating; it should never be applied undiluted to skin or mucosa, and oral consumption of essential oil at more than a few drops daily can produce gastritis, oral mucositis, and (with chronic high-dose cassia oil specifically) hepatotoxicity. Cinnamon chewing-gum stomatitis is a recognized presentation of intra-oral mucosal hypersensitivity to high-concentration cinnamaldehyde, more common with cassia than Ceylon because of cassia's higher cinnamaldehyde content; presentations generally resolve on cessation. Contact dermatitis from cinnamon (especially the essential oil and especially cassia) is a regular occupational concern in spice-handling industries and culinary work.
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See also
Ceylon cinnamon, Cinnamomum verum, Ginger, Turmeric, Cardamom, Cloves, Star anise, Garlic
References
- ↑ Yang SZ (translator). The Divine Farmer's Materia Medica: A Translation of the Shen Nong Ben Cao Jing. Boulder, CO: Blue Poppy Press; 1998.
- ↑ Mitchell C, Ye F, Wiseman N. Shang Han Lun: On Cold Damage, Translation and Commentaries. Brookline, MA: Paradigm Publications; 1999.
- ↑ Bensky D, Clavey S, Stoger E. Chinese Herbal Medicine: Materia Medica, 3rd ed. Seattle: Eastland Press; 2004.
- ↑ Beck LY (translator). Pedanius Dioscorides of Anazarbus: De Materia Medica. Hildesheim: Olms-Weidmann; 2005 (translation of c. 60 CE original).
- ↑ Bostock J, Riley HT (translators). Pliny the Elder: The Natural History. London: Taylor and Francis; 1855.
- ↑ European Medicines Agency, Committee on Herbal Medicinal Products. Community herbal monograph on Cinnamomum cassia Blume, cortex. EMA/HMPC/513617/2010 (the monograph documents are available from the EMA website).
- ↑ Bundesinstitut für Risikobewertung (German Federal Institute for Risk Assessment). Updated Health Assessment of Coumarin in Cinnamon and Other Foods. BfR Opinion No 036/2006 (18 September 2006), with subsequent updates including the 2012 communication. Available from the BfR website.
- ↑ Brancheau D, Patel B, Zughaib M. Do cinnamon supplements cause acute hepatitis? The American Journal of Case Reports. 2015 Apr 29;16:250-254. PMID 25923145.
- ↑ Allen RW, Schwartzman E, Baker WL, Coleman CI, Phung OJ. Cinnamon use in type 2 diabetes: an updated systematic review and meta-analysis. Annals of Family Medicine. 2013 Sep-Oct;11(5):452-459. PMID 24019277.
- ↑ 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. Journal of Agricultural and Food Chemistry. 2013 May 8;61(18):4470-4476. PMID 23627682.
- ↑ Allen RW, Schwartzman E, Baker WL, Coleman CI, Phung OJ. Cinnamon use in type 2 diabetes: an updated systematic review and meta-analysis. Annals of Family Medicine. 2013 Sep-Oct;11(5):452-459. PMID 24019277.