Cinnamon has gained attention as a potential natural remedy for fatty liver disease, with some research suggesting it may offer modest metabolic benefits. Fatty liver disease, particularly non-alcoholic fatty liver disease (NAFLD), affects approximately one in three UK adults and is closely linked to obesity, type 2 diabetes, and metabolic syndrome. Whilst small studies indicate that cinnamon supplementation might improve liver enzyme levels and insulin sensitivity, the evidence remains preliminary. NICE does not recommend cinnamon as a treatment for fatty liver, and it should never replace proven lifestyle interventions such as weight loss, dietary modification, and physical activity. This article examines the current evidence, safe usage, and the role of cinnamon within comprehensive fatty liver management.

What Is Fatty Liver Disease and How Common Is It in the UK?

Fatty liver disease, medically termed hepatic steatosis, occurs when excess fat accumulates in liver cells. The condition exists in two main forms: non-alcoholic fatty liver disease (NAFLD), which develops in people who drink little or no alcohol, and alcoholic fatty liver disease (AFLD), caused by excessive alcohol consumption. NAFLD has become the most common chronic liver condition in the UK, affecting approximately one in three adults to some degree.

The prevalence of NAFLD in the UK has risen substantially over recent decades, closely mirroring increases in obesity and type 2 diabetes. Current estimates from the NHS and British Liver Trust suggest that between 25% and 30% of the UK population may have some degree of fatty liver, though many remain undiagnosed as the condition often causes no symptoms in its early stages and liver enzyme tests (ALT, AST) may be normal. The condition is particularly common among people with metabolic syndrome, which includes a cluster of risk factors such as central obesity, insulin resistance, high blood pressure, and abnormal cholesterol levels.

In most cases, simple fatty liver (steatosis) is relatively benign and reversible with lifestyle modifications. However, in approximately 20% of people with NAFLD, the condition can progress to non-alcoholic steatohepatitis (NASH), where inflammation and liver cell damage occur alongside fat accumulation. NASH carries a significant risk of advancing to liver fibrosis, cirrhosis, and even hepatocellular carcinoma. NAFLD and NASH represent an increasing cause of advanced liver disease and liver transplantation in the UK.

Key risk factors for developing fatty liver disease include:

• Obesity, particularly excess abdominal fat

• Type 2 diabetes or prediabetes

• High cholesterol and triglycerides

• Metabolic syndrome

• Rapid weight loss or poor nutrition

• Certain medications (corticosteroids, amiodarone, tamoxifen, methotrexate, valproate, some chemotherapy agents)

Early detection through routine blood tests or imaging studies such as ultrasound can identify fatty liver before significant damage occurs. NICE guidance (NG49) recommends that people with suspected NAFLD should have their risk of advanced fibrosis assessed in primary care using the FIB-4 score. Those at low risk can be reassured and managed with lifestyle advice in primary care. People with indeterminate risk should have an Enhanced Liver Fibrosis (ELF) blood test, and those at high risk or with abnormal results should be referred to a hepatology specialist for further assessment and monitoring.

Can Cinnamon Help With Fatty Liver? What the Evidence Shows

Cinnamon, derived from the bark of Cinnamomum trees, has been investigated for potential metabolic benefits, including effects on liver health. The spice contains bioactive compounds such as cinnamaldehyde, cinnamic acid, and polyphenols that demonstrate anti-inflammatory and antioxidant properties in laboratory studies. These mechanisms have prompted researchers to explore whether cinnamon supplementation might benefit people with fatty liver disease.

Several small-scale clinical trials have examined cinnamon's effects on NAFLD markers. A systematic review and meta-analysis of randomised controlled trials published in 2020 analysed multiple studies and found that cinnamon supplementation (typically 1.5–3 grams daily for 8–12 weeks) was associated with modest improvements in liver enzyme levels (ALT and AST) and some metabolic parameters in people with NAFLD. Participants in these studies also showed improvements in fasting blood glucose, insulin sensitivity, and lipid profiles—all factors closely linked to fatty liver progression.

However, the evidence remains preliminary and limited. Most studies have been small, short-term, and conducted in specific populations, making it difficult to draw definitive conclusions. The mechanisms by which cinnamon might benefit liver health are thought to include improved insulin sensitivity, reduced oxidative stress, and decreased inflammatory markers, but these effects have not been conclusively demonstrated in large-scale human trials. Importantly, NICE does not recommend cinnamon as a treatment for fatty liver disease, and there is no official guidance from the MHRA or other UK regulatory bodies supporting its use for this indication.

It is crucial to understand that cinnamon should not be considered a substitute for evidence-based medical management. Whilst the spice may offer supportive benefits as part of an overall healthy diet, it cannot reverse established liver damage or replace the need for weight loss, dietary modification, and management of underlying metabolic conditions. The quality and type of cinnamon used in studies (Ceylon versus Cassia varieties) also varies, with Cassia cinnamon containing significantly higher levels of coumarin, a compound that can be hepatotoxic in large amounts. The European Food Safety Authority (EFSA) has set a tolerable daily intake (TDI) for coumarin of 0.1 mg per kilogram of body weight per day.

Patients considering cinnamon supplementation should discuss this with their GP or hepatologist, particularly if they are taking medications for diabetes (especially insulin or sulfonylureas, which may increase the risk of hypoglycaemia) or anticoagulants such as warfarin, as cinnamon may affect INR levels and require closer monitoring.

Safe Ways to Use Cinnamon for Liver Support

For individuals interested in incorporating cinnamon as part of a liver-supportive dietary approach, safety and moderation are paramount. Culinary use of cinnamon—adding small amounts to porridge, smoothies, yoghurt, or using it in cooking—is generally safe for most people and provides a simple way to include the spice in a balanced diet. However, it is important to be aware that even culinary amounts of Cassia cinnamon may approach or exceed safe coumarin limits for some individuals, particularly children or smaller adults.

When considering cinnamon supplements, it is important to distinguish between the two main varieties: Ceylon cinnamon (Cinnamomum verum, also called "true cinnamon") and Cassia cinnamon (Cinnamomum cassia). Cassia cinnamon, which is more commonly available and less expensive, contains significantly higher levels of coumarin—typically 0.4–12 grams per kilogram, compared with only trace amounts (0.004–0.1 grams per kilogram) in Ceylon cinnamon. Regular consumption of high-dose Cassia cinnamon supplements may exceed the EFSA tolerable daily intake for coumarin (0.1 mg per kilogram of body weight per day) and pose a risk of liver damage. For this reason, Ceylon cinnamon is strongly preferred for supplementation due to its much lower coumarin content.

If choosing supplements, look for products that clearly specify Ceylon cinnamon and provide clear dosage information. Typical doses used in research studies range from 1 to 3 grams daily, but individuals should not exceed these amounts without medical supervision. Always purchase supplements from reputable manufacturers; in the UK, food supplements are regulated as foods and quality can vary. Choose products with third-party testing where possible. Food supplements must not make medicinal claims.

Important safety considerations include:

• Avoid high-dose supplementation during pregnancy and breastfeeding due to insufficient safety data

• Cinnamon may lower blood sugar levels—people with diabetes, particularly those taking insulin or sulfonylureas, should monitor glucose carefully for signs of hypoglycaemia and discuss use with their diabetes care team

• Cinnamon may affect INR levels in people taking warfarin or other anticoagulants; closer INR monitoring is advised when starting or stopping cinnamon supplements

• People with existing liver disease should consult their hepatologist before taking cinnamon supplements

• Discontinue use if any adverse effects occur, such as mouth sores, allergic reactions, or digestive upset

• Report any suspected side effects from supplements via the MHRA Yellow Card Scheme at yellowcard.mhra.gov.uk

It bears repeating that cinnamon, whether as a food or supplement, should be viewed as a complementary approach within a comprehensive lifestyle modification programme, not as a standalone treatment for fatty liver disease.

Medical Treatments and Lifestyle Changes for Fatty Liver

The cornerstone of managing fatty liver disease, particularly NAFLD, is lifestyle modification, which remains the only treatment approach with robust evidence for reversing hepatic steatosis and preventing disease progression. NICE guidance (NG49) emphasises that weight loss is the most effective intervention for people with NAFLD who are overweight or obese. Studies demonstrate that losing 7–10% of body weight can significantly reduce liver fat, improve liver enzyme levels, and even reverse early fibrosis in some cases.

Dietary recommendations for fatty liver management include:

• Adopting a Mediterranean-style diet rich in vegetables, fruits, whole grains, legumes, nuts, and olive oil

• Reducing intake of refined carbohydrates, added sugars, and sugar-sweetened beverages

• Limiting saturated fats and avoiding trans fats

• Moderating portion sizes to achieve gradual, sustainable weight loss

• Strictly limiting or eliminating alcohol consumption—the UK Chief Medical Officers advise that if you drink regularly, you should consume no more than 14 units per week spread over three or more days; many people with NAFLD should aim for further reduction or abstinence

• Increasing dietary fibre intake

Physical activity plays an equally important role. The UK Chief Medical Officers' Physical Activity Guidelines recommend at least 150 minutes of moderate-intensity aerobic exercise weekly (or 75 minutes of vigorous activity), combined with resistance training on two or more days. Exercise improves insulin sensitivity, reduces liver fat, and benefits cardiovascular health—crucial given that cardiovascular disease is the leading cause of death in people with NAFLD.

Currently, no medications are specifically licensed in the UK for treating NAFLD or NASH. However, managing associated conditions is essential. This includes optimising control of type 2 diabetes; NICE guidance (NG28) recommends agents such as metformin, GLP-1 receptor agonists, or SGLT2 inhibitors for diabetes and obesity management, which may have indirect liver benefits through weight loss and improved metabolic control. Other important measures include treating dyslipidaemia with statins when indicated and managing hypertension. Vitamin E supplementation has shown some benefit in non-diabetic adults with biopsy-proven NASH in research studies, though this should only be used under specialist supervision. People with chronic liver disease should also discuss vaccination against hepatitis A and B with their clinician where appropriate.

When to seek medical review:

• Persistent fatigue, abdominal discomfort, or unexplained weight loss

• Jaundice (yellowing of skin or eyes)

• Swelling of the abdomen or legs

• Confusion or altered mental state

• Easy bruising or bleeding

People with confirmed NAFLD should have regular monitoring according to their fibrosis risk. NICE NG49 recommends calculating the FIB-4 score in primary care using age, liver enzymes (ALT, AST), and platelet count. Those at low risk (typically FIB-4 <1.3 in people under 65 years) can be managed in primary care with lifestyle advice and repeat assessment every two to three years. Those with indeterminate risk should have an Enhanced Liver Fibrosis (ELF) blood test, and those at high risk (typically FIB-4 >2.67 in people under 65 years, with age-adjusted thresholds for older adults) or with abnormal ELF results should be referred to hepatology for specialist assessment. People with advanced fibrosis or cirrhosis require specialist hepatology input and surveillance for hepatocellular carcinoma and varices. The NHS provides access to specialist liver services through GP referral when indicated, ensuring that people with progressive disease receive appropriate multidisciplinary care.

Frequently Asked Questions