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American Journal of Clinical Nutrition, Vol. 85, No. 6, 1552-1556, June 2007
© 2007 American Society for Nutrition

ORIGINAL RESEARCH COMMUNICATION

Effect of cinnamon on postprandial blood glucose, gastric emptying, and satiety in healthy subjects1,2,3

Joanna Hlebowicz, Gassan Darwiche, Ola Björgell and Lars-Olof Almér

1 From the Departments of Medicine (JH, GD, and L-OA) and Radiology (OB), Malmö University Hospital, University of Lund, Lund, Sweden

2 Supported by grants from the Malmö Diabetes Association.

3 Address reprint requests to J Hlebowicz, Department of Medicine, Malmö University Hospital, Ingång 35, 205 02 Malmö, Sweden. E-mail: joanna.hlebowicz{at}skane.se.


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Background: Previous studies of patients with type 2 diabetes showed that cinnamon lowers fasting serum glucose, triacylglycerol, and LDL- and total cholesterol concentrations.

Objective: We aimed to study the effect of cinnamon on the rate of gastric emptying, the postprandial blood glucose response, and satiety in healthy subjects.

Design: The gastric emptying rate (GER) was measured by using standardized real-time ultrasonography. Fourteen healthy subjects were assessed by using a crossover trial. The subjects were examined after an 8-h fast if they had normal fasting blood glucose concentrations. GER was calculated as the percentage change in the antral cross-sectional area 15–90 min after ingestion of 300 g rice pudding (GER1) or 300 g rice pudding and 6 g cinnamon (GER2).

Results: The median value of GER1 was 37%, and that of GER2 was 34.5%. The addition of cinnamon to the rice pudding significantly delayed gastric emptying and lowered the postprandial glucose response (P < 0.05 for both). The reduction in the postprandial blood glucose concentration was much more noticeable and pronounced than was the lowering of the GER. The effect of cinnamon on satiety was not significant.

Conclusions: The intake of 6 g cinnamon with rice pudding reduces postprandial blood glucose and delays gastric emptying without affecting satiety. Inclusion of cinnamon in the diet lowers the postprandial glucose response, a change that is at least partially explained by a delayed GER.

Key Words: Gastric emptying • blood glucose • healthy subjects • cinnamon • diabetes • satiety


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Around the world, the incidence of type 2 diabetes mellitus is increasing rapidly. Changing the diet helps to prevent development of type 2 diabetes and to control blood glucose concentrations. Traditional herbs and spices also can be used to control blood glucose concentrations. Allspice, cinnamon, bay leaf, cloves, nutmeg, witch hazel, oregano, and black and green tea have been shown to have an insulin-like biological activity (1). Of these substances, cinnamon has been shown to have the highest bioactivity (1). A water-soluble polyphenol typ-A polymer from cinnamon has been isolated and shown in vitro to have insulin-like activity as well as an antioxidant effect (2). Cinnamon has been shown to reduce fasting serum glucose, triacylglycerol, and total and LDL-cholesterol concentrations in patients with type 2 diabetes when it is added to the diet for 40 d in doses of 1, 3, or 6 g (3). The same study showed that, after the consumption of cinnamon for 40 d, the serum concentrations of glucose and triacylglycerol remained lower, even after a 20-d washout period (3), which indicated that it is not necessary to consume cinnamon every day (3).

The effect of cinnamon on gastric emptying has not previously been studied. Gastric emptying, along with other factors, regulates the postprandial blood glucose response, and a delay in the gastric emptying rate (GER) leads to a lower postprandial blood glucose concentration. Therefore, this study was designed to determine whether there is a delay in gastric emptying that affects postprandial blood glucose concentrations and satiety in healthy subjects after cinnamon consumption.


   SUBJECTS AND METHODS
TOP
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
RESULTS
 DISCUSSION
 REFERENCES
 
Fourteen healthy subjects [8 M, 6 F; x ± SD age: 25.6 ± 4.8 y (range: 20–38 y); body mass index (BMI; in kg/m2): 22.6 ± 2.2 (range: 18.4–26.0)] without symptoms or a history of gastrointestinal disease, abdominal surgery, or diabetes mellitus were included in the crossover study. The subjects had no connective tissue disease or cerebrovascular or endocrine disease, and only the 4 women who took birth control medication were receiving any drugs. Two subjects were smokers and 2 were snuff users. All subjects were recruited from the population in southern Sweden.

The subjects were examined between 0730 and 1000 after an 8-h fast. Smoking and snuff-taking were prohibited for 8 h before and during the test. Each subject was checked for a normal fasting blood glucose concentration on the day of the examination. If the subjects reported symptoms from the gastrointestinal tract (diarrhea or constipation) on the study day, the examination was postponed. The test meal consisted of 300 g rice pudding (Axa Goda Gröten Risgrynsgröt; Lantmännen AXA, Järna, Sweden) mixed with 6 g cinnamon (Santa Maria AB, Mölndal, Sweden). The total caloric value was 330 kcal: 10% of energy from protein (3 g), 58% of energy from carbohydrate (16 g), and 32% of energy from fat (4 g). The reference meal consisted of 300 g rice pudding (Axa Goda Gröten Risgrynsgröt). The meals were served in a random order and ingested within 5 min.

GER was estimated by using a previously described, standardized ultrasound method (4) The sonographic examination was performed with a 3.5-MHz abdominal transducer and an imaging system (Acuson 128 XP 10; Siemens Medical Solutions, Mountain View, CA). The measurements of the gastric antrum were performed by the same radiologist, who was blinded with respect to the meals. At each observation of the gastric antrum, the abdominal aorta and the left lobe of the liver were used as internal landmarks. The subjects were examined in a supine position, but, between examinations, they were seated. The measurements were taken 15 and 90 min after the end of meal consumption. Gastric emptying was expressed as the percentage change of the antral cross-sectional area from 15 to 90 min. At each examination, 3 measurements of the longitudinal (d1) and anteroposterior (d2) diameters were taken, and mean values were used to calculate the cross-sectional area of the gastric antrum by using the following equation:

Formula 1(1)
The GER was calculated by using the following equation:

Formula 2(2)
Finger-prick capillary blood samples were taken 15, 30, 45, 60, 90, and 120 min after the start of the meal to measure glucose. Blood glucose concentrations were measured with the HemoCue Glucose system (HemoCue AB, Ángelholm, Sweden). A validated satiety score scale was used according to the method of Hauber et al (5) on the basis of a scoring system with grades from –10 (extreme hunger) to 10 (extreme satiety). Satiety scores were estimated before the meal (0 min) and 15, 30, 45, 60, 90, and 120 min after the start of the meal by using scoring that was graded from 0 for extreme hunger to 20 for extreme satiety.

All subjects provided written informed consent. The study was approved by the Ethics Committee at Lund University and performed according to the Helsinki Declaration.

Median values and quartiles (q1 and q3) are presented for the antral cross-sectional areas and the GER. The areas under the curves (AUCs) of each subject were measured for blood glucose and satiety by using GRAPH PAD PRISM software (version 4; GraphPad, San Diego, CA). The AUC was calculated above zero. The AUC values are presented as means ± SEMs. All statistical calculations were performed with SPSS for WINDOWS software (version 14.0; SPSS Institute, Chicago, IL). Significant differences in GER, gastric antral cross-sectional areas, and AUCs were evaluated with the use of Wilcoxon's t test. P < 0.05 was considered significant.


   RESULTS
TOP
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
DISCUSSION
 REFERENCES
 
Postprandial blood glucose response
Ingestion of rice pudding with cinnamon resulted in a significantly (P < 0.05) lower blood glucose response in the postprandial phase (15, 30, and 45 min) than did the reference meal (Figure 1Go). The blood glucose AUCs at 0–30, 0–45, 0–60, 0–90, and 0–120 min were significantly (P < 0.05) lower after ingestion of rice pudding with cinnamon than after ingestion of the reference meal (Table 1Go). However, the AUCs at 0–15 min did not differ significantly between the test and reference meals (Table 1Go).


Figure 1
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  		FIGURE 1. Mean (± SEM) incremental blood glucose concentrations in 14 healthy subjects after ingestion of meals consisting of rice pudding with ({blacksquare}) and without ({blacktriangleup}) cinnamon. {Delta}, change. *Significantly different from the response to rice pudding with cinnamon, P < 0.05.

 

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  		TABLE 1 Postprandial blood glucose areas under the curve (AUCs) in healthy subjects after ingestion of meals consisting of rice pudding with or without added cinnamon1

 
Gastric emptying rate
The median values of the antral cross-sectional area after the ingestion of the cinnamon meal were 595 ± 234 mm2 (range: 283–1181 mm2; q1 = 458 mm2, q3 = 809 mm2) and 372 ± 366 mm2 (range: 83–1525 mm2; q1 = 282 mm2, q3 = 593 mm2) 15 and 90 min, respectively, after the end of the study meal. In the same subjects, the median values of the antral cross-sectional area after the ingestion of the reference meal were 531 ± 386 mm2 (range: 262–1626 mm2; q1 = 319 mm2, q3 = 891 mm2) and 317 ± 338 mm2 (range: 50–1389 mm2; q1 = 195 mm2, q3 = 546 mm2) 15 and 90 min, respectively, after the end of the meal. The median gastric antral cross-sectional areas were significantly (P < 0.05) larger 90 min after ingestion of rice pudding with added cinnamon than 90 min after ingestion of rice pudding. There were no significant differences between gastric antral cross-sectional areas at 15 min. The median value of GER after the cinnamon meal was estimated at 34.5% (range: –29% to 74%; q1 = 7%, q3 = 52%) (Figure 2Go), whereas that after the reference meal was estimated at 37.0% (range: 15–87%; q1 = 28.8%, q3 = 54%) (Figure 2Go). The ingestion of cinnamon resulted in significantly (P < 0.05) lower GERs.


Figure 2
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  		FIGURE 2. Gastric emptying of rice pudding with and without cinnamon, estimated as the gastric emptying rate (GER), in 14 healthy subjects. The median, minimum (Min), and maximum (Max) values and the values of the first (q1) and third (q3) quartiles are shown. Values of P < 0.05 (Wilcoxon's t test) were considered significant.

 
Satiety
Ingestion of rice pudding with cinnamon did not result in significantly longer satiety (15, 30, 45, 60, 90, and 120 min) than that seen with the reference meal of rice pudding (Figure 3Go). The AUCs at 0–15, 0–30, 0–45, 0–60, 0–90, and 0–120 min for satiety were not significantly longer after ingestion of rice pudding with cinnamon than after ingestion of rice pudding only (Table 2Go).


Figure 3
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  		FIGURE 3. Mean (± SEM) incremental satiety scores in 14 healthy subjects after ingestion of meals consisting of rice pudding with ({blacksquare}) and without ({blacktriangleup}) cinnamon. {Delta}, change. There were no significant differences between the mean incremental satiety scores.

 

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  		TABLE 2 Satiety score areas under the curve (AUCs) in healthy subjects after ingestion of meals consisting of rice pudding with or without cinnamon1

 

   DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
REFERENCES
 
This study shows that ingestion of 6 g cinnamon reduces postprandial blood glucose concentrations and GER in healthy subjects. This finding could indicate that the reduction in the postprandial blood glucose response seen after the ingestion of cinnamon could be partly explained by an accompanying reduction in gastric emptying, because the rate of gastric emptying acts as a major factor in blood glucose homeostasis in normal subjects by controlling the delivery of carbohydrate to the small intestine (6, 7). However, the reduction in the blood glucose concentrations, unexpectedly, was much more noticeable and pronounced in the present study than was the lowering of the GER. Therefore, it should be assumed that the change in GER itself could not be the only reason for the lower blood glucose response after the addition of cinnamon to the meal. In fact, cinnamon has been shown to improve insulin receptor function by activating insulin receptor PI 3-kinase and inhibiting tyrosine phosphates (8). Cinnamon has also been shown to stimulate the insulin receptor activity by increasing the concentrations of the phosphorylated intracellular protein IRS-1 and increasing the binding to PI 3-kinase, which leads to enhanced cellular glucose uptake (9). It has been shown that cinnamon prevents the development of insulin resistance in rats fed a high-fructose diet by enhancing the insulin signaling, possibly via the nitric oxide pathway in skeletal muscle (10). Essential oils composed of pumpkinseed oil, extra virgin olive oil, oregano, cinnamon, fenugreek, cumin, fennel, myrtle, allspice, and ginger lowered blood glucose concentrations and increased insulin sensitivity in rats (11). There was no significant difference in the concentrations of circulating insulin after the intake of the different essential oils (11). A new study shows that rats given cinnamon and then administered a glucose tolerance test had decreased blood glucose concentrations (12). The same study shows that cinnamon has a direct antidiabetic effect by increasing insulin concentrations in plasma (12).

After meal ingestion, the food initially remains in the proximal part of the stomach (fundus) (13) and is then delivered in portions to the distal stomach (eg, antrum) (14, 15). If there is a substantial inhibition of gastric emptying, one could expect a 90-min antral area wider than a 15-min antral area and thereby a negative GER, which was the case in 3 of the participants.

Prolonged postmeal satiety is in accordance with a reduced GER, because distension of the stomach is one factor that promotes a feeling of satiety. The data suggest slightly greater satiety at each timepoint after ingestion of cinnamon, but there were no significant differences in satiety, probably because of the low number of study subjects. Consequently, it is not clear why cinnamon ingestion did not result in a prolongation of postmeal satiety in the present study. An elevation of blood glucose concentrations, even including concentrations within the physiologic range, reduces the GER in healthy subjects (16), and hypoglycemia increases the GER (17, 18). It has also been shown that insulin-induced hypoglycemia increases botht he gastric emptying and the drinking capacity of meat soup in healthy volunteers (19). Accordingly, because the reduction in postprandial blood glucose concentrations was prominent, it may well have influenced the results of the GER, giving a less pronounced reduction in gastric emptying and less postmeal satiety than would otherwise be expected.

To prevent development of diabetes mellitus, the American Diabetes Association recommends a reduction in calories and consumption of dietary fiber and foods containing whole grains (20). Low-glycemic-index food that reduces postprandial hyperglycemia is recommended, but it is not clear whether it prevents diabetes mellitus (21-27). Glycemic index, glycemic load, and carbohydrate consumption are probably not associated with insulin sensitivity, insulin secretion, or adiposity (28). A low-glycemic-index diet can be recommended to control glycemia (29, 30). Patients with diabetes mellitus (type 2 or type 1) are recommended to have 60–70% of energy intake provided by carbohydrates and monosaturated fat (20). There are no recommendations for the intake of herbs, but they may be an important unexplored source of glycemia control in patients with diabetes mellitus type 2. In the present study, the rice pudding with added cinnamon was well tolerated, and none of the subjects reported any discomfort or postprandial nausea. The question of whether cinnamon could be a cause of contact stomatitis was discussed previously (31). However, only a few cases were reported during past years, and this possibility should be evaluated in the future. Whether a continuous daily intake of cinnamon can be recommended also should be further evaluated. The present study was designed to determine the mechanism of cinnamon's effect on postprandial blood glucose concentrations and on gastric emptying.

The present study shows that the presence of cinnamon in a semisolid meal reduces postprandial glucose responses in healthy subjects and that the cause of this reduction could at least partly be a delayed GER. Further investigation of the effect of cinnamon on the insulin resistance in patients with type 2 diabetes mellitus is needed.


   ACKNOWLEDGMENTS
 
The authors' responsibilities were as follows—JH: the design of the study, recruitment of subjects, performance of statistical calculations and creation of the graphs, and drafting of the manuscript; GD: the design of the study, performance of the statistical calculations and creation of the graphs, securing study funding, and drafting of the manuscript; OB: the design of the study and performance of the ultrasound examinations; and LOA: the design of the study and drafting of the manuscript. All authors read and approved the final manuscript. None of the authors had any personal or financial conflict of interest.


   REFERENCES
TOP
 ABSTRACT
 INTRODUCTION
 SUBJECTS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 

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Received for publication July 12, 2006. Accepted for publication January 24, 2007.




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