Honey

Scientific Name(s):Honey, clarified as strained honey, mel

Common Name(s): Honey , purified honey , miel blanc (French), honig (German)

Uses

Honey has been used as remedy for hundreds of ills, including as a gargle and as topical treatment for sores and wounds. Modern research lends support for this use in statistical findings and in isolation of antimicrobial and antifungal compounds. Most of the antibacterial activities of honey are lost after heating or prolonged exposure to sunlight. There has been successful use of honey in treating Helicobacter pylori , burns, wound disruption in cesarean-section patients, senile cataracts, and corneal opacities.

Dosing

Honey is a common food, and there are no dose restrictions on its use. It has been used topically on surgical dressings. 1

Contraindications

Use with great caution in infant formulations.

Pregnancy/Lactation

Generally recognized as safe or used as food. Safety and efficacy for dosages above those in foods is unproven and should be avoided.

Interactions

None well documented.

Adverse Reactions

Some people may have allergic reactions to pollen in honey.

Toxicology

Contaminated honey containing botulism spores can poison infants. Honey made from the nector of poisonous plants can be poisonous.

Botany

Honey is a bee-concentrated and processed product of nectar from the flowers of numerous plants. This saccharine secretion is deposited in honeycombs by bees ( Apis mellifera L., Fam. Apidae ). The most desired and flavorful honeys come from the nectar of such flowers as the white clover blossom, raspberry blossom, and basswood flower. 2 Purified honey is prepared by melting honey at a moderate temperature, skimming off any impurities, and diluting with water to a density of 1.35 to 1.36 g/mL at 20°C.

History

The honey used for flavoring medicinals was first known historically as a flavored sweetening agent and was once the official honey of the National Formulary. Its use dates back to ancient times, with Egyptian medical texts (c. between 2600 and 2200 BC) mentioning honey in at least 900 remedies. 3 Almost all early cultures universally hailed honey for its sweetening and nutritional qualities, as well as its topical healing properties for sores, wounds, and skin ulcers. During wartime it was used on wounds as an antiseptic by the ancient Egyptians, Asyrians, Greeks, Romans, Chinese, and even by the Germans as late as World War I.

The 1811 edition of The Edinburgh New Dispensatory states, “From the earliest ages, honey has been employed as a medicine . . . it forms an excellent gargle and facilitates the expectoration of viscid phlegm; and is sometimes employed as an emollient application to abscesses, and as a detergent to ulcers.” 3 It has consistently appeared in modern use for the same purposes by the laity and medical profession. Today, bees are commonly kept in Europe, the Americas, Africa, and Asia; at least 300,000 tons of honey are produced annually. Honey is used directly as a sweetener or fermented into a sweet-tasting mead, cyser, or metheglin. 4

Chemistry

Bees and other insects extract a thin, aqueous fluid (nectar) from the nectaries of various flowers. The composition of the nectar varies, but certain flowers offer distinct flavors to the different honeys. Some honeys can be poisonous if the nectar is obtained from poisonous plants (eg, mountain laurel, jimson weed, azalea, rhododendron 5 ). When taken in by the bee, the nectar is modified by the secretions from glands in the head and thorax so that levulose, dextrose, and sucrose are formed. The color of honey varies. Honey is a thick, syrup-like liquid ranging in color from light yellow to golden brown. It is translucent when fresh, but darkens to opacity when old and can become granular through the crystallization of dextrose. Generally, honey has a characteristic odor and a sweet, faintly acrid taste. Honey is naturally mildly acidic. While honey varies in composition, its principle constituents are a mixture of dextrose and levulose in almost equal amounts ranging from 65% to 80% of one or the other. Sucrose ranges from 0.5% to up to 8%; dextrin from 1% to up to 10%. 2

There have been numerous reports on an antimicrobial honey distillate fraction and related antifungal compounds. 6 , 7 , 8 , 9 These studies have shown that the activity is not simply due to the high sugar content. Thus far, the active antimicrobial principles have not been fully identified.

Uses and Pharmacology

Today, as in earlier times, honey is used as an ingredient in various cough preparations. It is also used to induce sleep, cure diarrhea, and treat asthma. 3

Wound healing effects
Animal data

Research reveals no animal data regarding the use of honey in wound healing.

Clinical data

A review of literature from 1984 to March 2001 found at least 25 scientific articles verifying honey's wound and topical ulcer healing powers. A representative sample of these include articles on honey for wounds, ulcers, and skin graft preservation; 10 an analysis of 40 cases where honey was used on wounds and showed a positive (88% healing) effect; 11 honey and its healing properties for leg ulcers; 12 the successful use of honey for superficial wounds and ulcers; 13 honey as a wound-healing agent with antibacterial activity; 14 and the use of honey in wound management. 15

Antibacterial effects

Potent antibacterial peptides (apidaecins and abaecin) have been isolated and characterized in the honeybee ( Apis mellifera ) itself, 16 , 17 and a new potent antibacterial protein named royalisin has been found in the royal jelly of the honeybee. 18

The antibacterial activity in diluted honey with the right pH (range 3.2 to 5) is attributed to hydrogen peroxide (H 2 O 2 ), an enzymatic byproduct of the formation of gluconic acid from glucose. However, most of the antibacterial activities of honey are lost after heating or prolonged exposure to sunlight. 19 , 20 Honeydew honey from the conifer forests of the mountainous regions of central Europe and honey from manuka ( Leptospermum scoparium ) in New Zealand have been found to have high antibacterial activity.

Animal data

Manuka honey has a high level of activity against a variety of bacteria including Staphylococcus aureus and epidermis , Streptococcus pyogenes , and Enterobacteriaceae. 21 , 22 , 23 , 24 Active manuka honey (and its Australian equivalent) is the only honey commercially available that is tested for its antibacterial activity. It contains an additional antibacterial component found only in honey produced from Leptospermum plants called the “Unique Manuka Factor (UMF).” 25

Clinical data

Manuka honey was found to be a safe alternative topical antibiotic when compared with povidone iodine for the prophylaxis of dialysis catheter-related sepsis. 26

Other uses

A number of related activities and unique medical applications include the following: The successful use of honey for treating Helicobacter pylori , the gastric ulcer causative agent; 27 , 28 , 29 effectiveness in treating burns; 30 , 31 , 32 usefulness in managing abdominal wound disruption in 15 patients after cesarean section; 33 use in treating senile cataracts 34 and postherpetic opacities of the cornea; 35 and moderate antitumor and pronounced antimetastic effects in rat and mice tumors. 36 A recent study showed that the application of commercial honey to surgical wounds in mice impeded subsequent tumor implantation. 37

Dosage

Honey is a common food, and there are no dose restrictions on its use. It has been used topically on surgical dressings. 1

Pregnancy/Lactation

Generally recognized as safe or used as food. Safety and efficacy for dosages above those in foods is unproven and should be avoided.

Interactions

None well documented.

Adverse Reactions

Some people may have allergic reactions to pollen in honey.

Toxicology

Generally, honey is considered safe as a sweet food product, a gargle and cough-soothing agent, and a topical product for minor sores and wounds. However, medical reports indicate that honey can be harmful when fed to infants because some batches contain spores of Clostridium botulinum , which can multiply in the intestines and result in botulism poisoning. 38 , 39 Infant botulism is seen most commonly in 2- to 3-month old infants after ingestion of botulinal spores that colonize in the GI tract as well as toxin production in vivo. Infant botulism is not produced by ingestion of preformed toxin, as is the case in foodborne botulism. Clinical symptoms include constipation followed by neuromuscular paralysis (starting with the cranial nerves, then proceeding to the peripheral and respiratory musculature). Cases are frequently related to ingestion of honey, house dust, and soil contaminated with Clostridium botulinum . Intense management under hospital emergency conditions and trivalent antitoxin are recommended, although use of the latter in infant botulism has not been adequately investigated. 40

Bibliography

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2. Osol A, et al. The Dispensatory of the United States of America . 25th ed. Philadelphia: Lippincott, 1960.
3. Carper J. The Food Pharmacy . New York: Bantam Books, 1988.
4. Klein R. The Green World: An Introduction to Plants and People . 2d ed. New York: Harper & Row, 1987.
5. Filler. Honey poisoning. BMJ 1999;319:1419.
6. Obaseiki-Ebor E, et al. In vitro evaluation of the anticandidiasis activity of honey distillate (HY-1) compared with that of some antimycotic agents. J Pharm Pharmacol 1984;36(4):283.
7. Radwan SS, et al. Experimental evidence for the occurrence in honey of specific substances active against microorganisms. Zentralbl Mikrobiol 1984;139(4):249.
8. Elbagoury EF, et al. Antibacterial action of natural honey on anaerobic bacteroides. Egyp Dent J 1993;39(1):381.
9. Efem SE, et al. The antimicrobial spectrum of honey and its clinical significance. Infection 1992;20(4):227.
10. Postmes T, et al. Honey for wounds, ulcers, and skin graft preservation [letter]. Lancet 1993;341(8847):756.
11. Ndayisaba G, et al. [Clinical and bacteriological outcome of wounds treated with honey. An analysis of a series of 40 cases.] Rev Chir Orthop 1993;79(2):111. French.
12. Bourne IH. Honey and healing of leg ulcers [letter; comment]. J R Soc Med 1991;84(11):693.
13. Greenwood D. Honey for superficial wounds and ulcers. Lancet 1993;341(8837):90.
14. Kolmos HJ. [Honey: A potential wound-healing agent with antibacterial activity.] Ugeskr Laeger 1993;155(42):3397. Danish.
15. Dunford C, et al. The use of honey in wound management. Nurs Stand 2000;15(11):63-8.
16. Casteels P, et al. Apidaecins: antibacterial peptides from honeybees. EMBO J 1989;8(8):2387.
17. Casteels P, et al. Isolation and characterization of abaecin, a major antibacterial response peptide in the honeybee ( Apis mellifera ). Eur J Biochem 1990;187(2):381.
18. Fugiwara S, et al. A potent antibacterial protein in royal jelly. Purification and determination of the primary structure of royalisin. J Biol Chem 1990;265(19):11333.
19. Krell R. The physiological effects of honey. In: Value-added Products from Beekeeping . Rome Food and Agriculture Organization of the United Nations;1996:Chap 2.
20. Waikato Honey Research Unit. Honey as an antimicrobial agent. Honey Research Unit-University of Waikato (Auckland, NZ).
21. Quadri K, et al. Manuka honey for central vein catheter exit site care. Semin Dial 1999;12(5):397-98.
22. Waikato Honey Research Unit. Activity of honey against wound-infecting bacteria (including “superbugs”). Honey Research Unit-University of Waikato (Auckland, NZ).
23. Allen KL, et al. The potential for using honey to treat wounds infected with MRSA and VRE. First World Wound Healing Congress,10-13Sep00, Melbourne, Australia.
24. Cooper R, et al. Antibacterial activity of honey against strains of Staphylococcus aureus from infected wounds. J R Soc Med 1999;92(6):283-85.
25. Waikato Honey Research Unit. What's special about active manuka honey? Honey Research Unit-University of Waikato (Auckland, NZ).
26. Quadri K, et al. A prospective randomized controlled trial of topical honey versus povidone iodine in the prevention of hemodialysis catheter related sepsis. J Am Soc Nephrol 1998;9:180A-181A.
27. al Somal N, et al. Susceptibility of Helicobacter pylori to the antibacterial activity of manuka honey. J R Soc Med 1994;87(1):9.
28. Ali A, et al. Inhibitory effect of natural honey on Helicobacter pylori . Trop Gastroenterol 1991;12(3):139.
29. Osato MS, et al. Osmotic effect of honey on growth and viability of Helicobacter pylori . Dig Dis Sci 1999;44(3):462-64.
30. Subrahmanyam M. Honey-impregnated gauze versus amniotic membrane in the treatment of burns. Burns 1994;20(4):331.
31. Subrahmanyam M. Honey-impregnated gauze versus polyurethane film (OpSite) in the treatment of burns — a prospective randomised study. Br J Plast Surg 1993;46(4):322.
32. Subrahmanyam M. Topical application of honey in treatment of burns. Br J Surg 1991;78(4):497.
33. Phuapradit W, et al. Topical application of honey in treatment of abdominal wound disruption. Aust N Z J Obstet Gynecol 1992;32(4):381.
34. Golychev VN. [Use of honey in conservative treatment of senile cataracts]. Vestn Oftalmol 1990;106(6):59. Russian.
35. Mozherenkov VP. Honey treatment of postherpetic opacities of the cornea. Oftalmol Zh 1984;3:188.
36. Gribel NV, et al. [The antitumor properties of honey]. Vopr Onkol 1990;36(6):704. Russian.
37. Hamzaoglu J, et al. Protective covering of surgical wounds with honey impedes tumor implantation. Arch Surg 2000;135(12):1414-17.
38. A case of infant botulism. Commun Dis Rep . CDR Wkly 1994;4(12):53.
39. Fenicia L, et al. A case of infant botulism associated with honey feeding in Italy. Eur J Epidemiol 1993;9(6):671.
40. Berkow R. The Merck Manual . 15th ed. Rahway, NJ; Merck Co. 1987.

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