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Honey

View 263 Products Containing: Honey

View 5 Canadian Licensed Products Containing: Honey

Scienti c Name
Apis mellifera (honey bee).
Family: Apidae.

Background
Honey is a sweet, viscid uid produced by honeybees (Apis mellifera) from the nectar of owers. It is generally safe, but there have
been numerous reports of certain types of honey produced from the nectar of owering plants from the genus Rhododendron, and
others, that have toxic effects in humans and in animals.
Also known as: Buckwheat Honey, Chestnut Honey, Clari ed Honey, Honig, Jellybush Honey, Madhu, Manuka Honey, Mel, Miel,
Miel Blanc, Miel Clari , Miel de Chtaignier, Miel de Manuka, Miel de Sarrasin, Miel Filtr, Puri ed Honey, Strained Honey.
CAUTION: See separate listings for Apitherapy, Bee Pollen, Bee Venom, and Royal Jelly.
History

People Use This For

Orally, honey is used for cough, asthma, and allergic rhinitis. It is also used orally for diarrhea and gastric ulcer associated with
Helicobacter pylori (H. pylori). Honey is also used orally as a source of carbohydrate during vigorous exercise.
Topically, honey is used for wound healing, burns, diabetic foot ulcers, and for treating cataracts and postherpetic corneal opacities.
It is also used topically for sunburn and to prevent surgical tumor implantation.
In foods, honey is used as a sweetening agent.
In manufacturing, honey is used as a fragrance and a moisturizer in soaps and cosmetics.

Safety
LIKELY SAFE ...when used orally and appropriately. Honey consumption is typically safe in adults and children over one year old
(13160, 14319). The concern about botulism pertains to infants and young children and not to adults (13160). ...when used topically
and appropriately. A speci c commercially available wound dressing containing manuka honey (Medihoney) is an FDA-approved
medical device (16353, 16355, 16357, 16362, 16369, 16371). Some evidence suggests other honey preparations can also be used
safely when applied to the skin (395, 396, 397, 398, 399, 7847, 7849, 13133, 14317)(16358, 16372).
LIKELY UNSAFE ...when honey produced from the nectar of Rhododendrons is used orally. This type of honey contains grayanotoxin,
which may lead to cardiovascular symptoms, such as hypotension, chest pain, bradycardia, syncope, asystole, various types of heart
block, atrial brillation, myocardial infarction, as well as other cardiac arrhythmias (12220, 19908, 55119, 55122, 55125, 55126,
55129, 55141, 55142, 55157)(55163, 55170, 55171, 55180, 55183, 55190, 55224, 55233, 55234, 55239)(55248, 55260, 55261,
55280, 55281).
CHILDREN: LIKELY SAFE ...when used orally and appropriately, short-term. Single doses of honey have been safely used in children
aged one year and older (15910, 17299, 55210, 55244, 55253). POSSIBLY UNSAFE ...when used orally in infants or young children.
Ingestion of raw honey contaminated with Clostridium botulinum spores can cause botulism poisoning in infants or young children
under 12 months of age (13160, 55067, 55290). This is not a danger for older children or adults.
PREGNANCY AND LACTATION: LIKELY SAFE ...when consumed in food amounts. The concern about botulism pertains to infants
and young children and not to adults or pregnant women (13160). There is insuf cient reliable information available about the
safety of honey when used for medicinal purposes in women who are pregnant or breast-feeding.

Effectiveness

See detailed evidence summary

POSSIBLY EFFECTIVE
Burns. Honey applied directly in gauze applications seems to improve formation of granulation tissue and speed healing time in
partial thickness burns. It appears to compare favorably with silver sulfadiazine and moisture permeable polyurethane dressing
(OpSite) (395, 396, 397, 398, 399, 14317, 55175, 55200, 55204, 55264). Surgical intervention with tangential excision and skin
grafting appears to be more effective than honey for moderate burns (7848). However, poor study design limits the reliability of
these ndings.
Cough. Clinical research shows that taking honey 2.5-10 mL (0.5-2 teaspoons) at bedtime can signi cantly reduce nighttime cough
frequency and severity, and improve sleep compared to placebo in children ages 2 years and older with upper respiratory infections
(15910, 55244, 55253). Honey also appears to be at least as effective or more effective than the cough suppressant
dextromethorphan in typical over-the-counter doses and the antihistamine diphenhydramine (15910, 17299).

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Diabetes. Limited clinical evidence suggests that, compared to control, consuming 1-2.5 grams or 0.5 mL per kilogram of honey daily
for 8-12 weeks modestly decreases fasting blood glucose, glycosylated hemoglobin (HbA1C), cholesterol levels, and weight in
patients with diabetes (55182, 55263).
Radiation mucositis. In a meta-analysis of three trials, the overall risk of developing radiation-induced oral mucositis was about 80%
lower for the honey treatment group as compared to the control group (55241). Other clinical research shows that 20 mL of honey
or a honey gauze (HoneySoft) used topically reduces the severity and progression of mucositis, ulceration, bacteria colonization,
painful dysphagia, and weight loss associated with radiation therapy for head and neck cancers (16352, 55105, 55133, 55137,
55202, 55245, 55265). However, some contradictory research shows no bene t for reducing symptoms (55219).
Wound healing. Several small clinical trials and case reports describe the use of honey or honey-impregnated dressings for various
types of wounds, including post-surgical wounds, chronic leg ulcers, abscesses, burns, abrasions, lacerations, and skin graft donor
sites. Honey seems to improve granulation and epithelialization, reduce odors and purulent exudate, help clean the wound, increase
eradication of infection, reduce pain, and decrease time to healing (7847, 7849, 14317, 16354, 16355, 16357, 16358, 16360,
16362, 16369)(16372, 16374, 55068, 55109, 55121, 55130, 55144, 55147). In a meta-analysis of two trials, honey was found to
result in quicker wound healing in partial thickness burns compared to control and lack signi cant differences when compared to an
active control such as silver sulfadiazine and paraf n gauze (55264).
In some reports, wounds healed with honey after failing previous treatments (16369, 16371).
Honey applied directly to wounds appears to be comparable to hydrogels such as carboxymethylcellulose, povidone iodine, and
hypochlorite solutions (16355, 16358, 16360, 16376, 55235). Honey dressings also appear to be comparable to hydrocolloid
dressings, paraf n gauze, nanocrystalline silver, and saline-soaked gauze (16358, 16360, 16372, 55101). However, poor study
design limits the reliability of some of these ndings. Trials cannot be directly compared due to variation in wound type and severity,
patient characteristics, honey type and processing, dressing techniques, treatment duration, and concomitant use of antibiotics.
Adequate blinding is also dif cult to achieve due to the distinctive properties and smell of honey (16360). Many of the clinical trials
used manuka honey, which is derived from the nectar of Leptospermum scoparium and is gamma irradiated to inactivate bacterial
spores (16355, 16357, 16362, 16369, 16371). Some other trials used unprocessed honey (16358, 16372).
POSSIBLY INEFFECTIVE
Leishmania lesions. Limited clinical evidence suggests that using honey-soaked gauze twice daily for 6 weeks on leishmania lesions
in addition to a glucantime injection results in a smaller cure rate (51.1 vs. 71.1%) compared to a glucantime injection alone (55118).
INSUFFICIENT RELIABLE EVIDENCE to RATE
Allergic rhinitis (hayfever). Preliminary clinical research suggests that consuming honey one tablespoon daily, in addition to
standard treatment, does not signi cantly improve allergy symptoms (14319, 55216).
Athletic performance. Some preliminary clinical evidence suggests that honey might normalize blood sugar following exercise and
improve performance when given during exercise (7851).
Catheter-related infections. Preliminary clinical research suggests that manuka honey (Medihoney) applied three times weekly to
the exit sites of tunneled, cuffed central venous hemodialysis catheters is as effective as mupirocin ointment in reducing the
incidence of catheter-associated infections and bacteremias. It may also be associated with less development of bacterial resistance
than mupirocin (16361). A small study also reported that manuka honey had similar ef cacy to povidone iodine for dialysis catheter
site care (16375).
Diabetic foot ulcers. Anecdotal reports suggest that applying topical raw honey can speed healing of otherwise non-healing diabetic
foot ulcers, even in the presence methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE),
and Pseudomonas infection. In one report, previously non-healing ulceration completely healed after applying supermarket honey
under dressings for 6-12 months and lower-limb amputation was prevented (13133). In a small clinical trial, the group receiving
honey dressings experienced less pain but did not have any differences in healing rates when compared to regular dressings
(19739).
Eye surgery. A small clinical trial reported that there were no signi cant differences in the amount of isolated bacteria between the
0.3% o oxacin eye drops (Uni ox) and 25% honey eye drops (Abies spp. sterilized by gamma-irradiation) administered ve times
daily for seven days before and ve days after eye surgery (55247).
Fournier's gangrene. Preliminary clinical research has shown unclear results about whether honey dressings given adjunct to
antibiotics aid in the treatment of Fournier's gangrene (55106, 55293, 55295, 55315).
Gingivitis. Preliminary research suggests that chewable leather made from Manuka honey slightly improves plaque and bleeding
status compared to sugarless chewing gum (55091).
Hemorrhoids. Preliminary research suggests that a mixture containing honey, olive oil, and beeswax relieves pain, bleeding, and
itching from hemorrhoids and anal ssures (34100).
Herpes simplex. Preliminary research suggests that using a gauze soaked with honey four times daily to lesion until it healed,
improved symptoms and healing time of labial herpes but not genital herpes (55095).
Hyperlipidemia. One clinical study shows that taking honey 75 grams daily for 14 days decreases in low-density lipoprotein (LDL)
cholesterol in women with high cholesterol; however comparisons between the honey and the placebo groups were not made
(55173). In another clinical study, taking honey 70 grams daily for 30 days did not have signi cant effects on blood lipid levels in
overweight patients with normal cholesterol levels (55136). Other preliminary research shows that honey with pollen and a prespeci ed diet decreases total cholesterol and LDL cholesterol levels in people with dyslipidemia (55232).
Infectious diarrhea. One clinical study shows that adding honey to oral rehydration solution (ORS) helps decrease vomiting,
diarrhea, and recovery time in children and infants with gastroenteritis (55194) while another study shows a no additional bene cial
effects from adding honey to ORS (55273).
Infertility. Preliminary clinical research suggests that intravaginal applications of a combination mixture consisting of Egyptian bee
honey and royal jelly resulted in more pregnancies when compared to standard intrauterine insemination (IUI) (23 vs. 7 pregnancies
respectively) (55131). Since all unsuccessful couples were crossed over to the alternative treatment in 2 months, the causality of the
pregnancy success was unclear.
Malnutrition. Preliminary clinical evidence suggests that honey improves weight and other biomarkers in infants and children with
protein-energy malnutrition (PEM) (55196, 55210).

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Pruritus (itching). Preliminary evidence shows that a honey barrier cream used on the skin for 21 days had less pruritus complaints
than zinc oxide ointment in people with intertrigo (55258).
More evidence is needed to rate honey for these uses.

Dosing & Administration

Adult
Oral:
Diabetes mellitus: Natural unprocessed honey (multi oral origin collected in Iran) has been taken as the following
regimen: 1g/kg daily the rst two weeks, 1.5g/kg daily for the second two weeks, 2g/kg daily for the third two weeks,
and 2.5g/kg daily the last two weeks for a total treatment course of eight weeks (55182). 0.5mL/kg of Egyptian clover
honey has been taken daily for 12 weeks (55263).
Exercise performance: 8.8mL/kg of a honey-sweetened drink, including 110mg sodium per 240mL, was consumed 30
minutes prior to exercise and at the 10-minute halftime (55189).
Irradiation-induced xerostomia: 5mL of honey from wild owers administered to patients to swish for ve minutes and
swallow has been studied (55063).
Malnutrition: 2mL/kg of pure and unprocessed poly oral honey (from Egypt) diluted in water has been used in
combination with conventional nutritional rehabilitation (CNR) daily in two divided doses for two weeks (55196).
Memory: 20g of tualang honey (Agro Mas) was taken daily for 16 weeks (55230).
Mucositis (radiation): 20mL of honey rinse was placed topically on the oral mucosa (then slowly swallowed after
allowing it to spread to the oral and pharyngeal mucosa) 15 minutes prior to radiation treatment, 15 minutes after
radiation treatment, and six hours after radiation or at bedtime for up to seven weeks (55241, 55133, 55137). 20mL of
manuka honey mouth rinse (rinse then slowly swallowed) has been used four times daily for four weeks of radiotherapy
plus two weeks following treatment (total duration: 42 days) (55219). 20mL of honey has been swished for two
minutes then spit out 15 minutes before radiation therapy, 15 minutes after radiation therapy, and at bed time while
undergoing chemoradiation ( ve days of the week) for up to six weeks (55265, 55202).
Pneumonia: Honey-thick liquid was taken in a head-neutral position (dosing information was lacking) for three months
(55134).
Surgical uses: One teaspoon (5mL) of honey (average daily dose of honey used was 9.3 teaspoons) has been taken
every hour while awake for 14 days in combination with antibiotics and acetaminophen (55109).
Topical:
Abscesses, cavities and depression wounds: In one study, the wound bed was completely lled with honey, and then
covered with a honey impregnated dressing (14318).
Burns: Honey has been applied directly or as a dressing made from gauze impregnated with honey. The dressings have
been left in place for up to 25 days, with wound inspection every two days. When used directly, 15-30mL of honey has
been applied every one to two days, and covered with a dry sterile gauze and bandage (399, 398, 395, 396, 55175).
Natural honey (Langnese) was applied to burn wounds twice daily for as long as long as it took the wounds to heal
completely (55200).
Dermatitis and dandruff: A diluted solution of honey and warm water containing 90% water is rubbed gently into the
scalp for 2-3 minutes and then left on scalp for three hours for chronic seborrheic dermatitis and dandruff (55070).
Diabetic foot ulcers: Clean nonsterile pure honey dressing was applied daily and then covered with a sterile gauze and
bandaged for 7-36 days (55154). Non-sterile gauze saturated with clover honey was applied based on the individuals
exudate quantity for up to three months or until ulcer had healed (55199).
Fournier's gangrene: 15-30mL of unprocessed honey per ulcer has been used (55293).
Hypercholesterolemia: 75g of honey has been used once daily for 14 days (55173). 70g of natural unprocessed honey
dissolved in 250mL tap water has been used once daily for up to 30 days (55136).
Infection (catheter-related): 3mL Medihoney (standardized antibacterial honey) was applied topically to exit sites with
each dressing change (thrice weekly) until removal of the catheter (16361).
Leg ulcers: 5g/20cm2 Manuka honey dressing (Woundcare 18+; Comvita, Te Puke, New Zealand) was applied weekly
for four weeks (55147, 55144). Manuka honey (ApiNate UMF12+; Comvita New Zealand, Te Puke, New Zealand)
impregnated calcium alginate dressing was changed each time the compression bandaging was changed based on
clinical need and was administered for 12 weeks (55130). 20mL of unprocessed, unpasteurized honey per 10cm
10cm wound was applied with each dressing, changed every two days and administered until the pressure ulcer healed
completely or up to ve weeks (16354).
Parasite infection (Leishmaniasis): Honey-soaked gauze dressing was applied twice daily for up to six weeks (55118).
Postoperative wounds: Twelve hourly applications of crude Yemini honey after initial washing has been used for
postoperative wound management (55061).
Pruritis: Honey barrier cream has been applied to skin folds twice daily for 21 days (55258).
Mucositis (radiation): 20mL of Camellia sinensis honey has been applied to the irradiated areas for 15 minutes prior to
radiotherapy, 15 minutes after radiotherapy and 6 hours post radiotherapy (16352). Honey was ltered and supplied as
raw or pure honey to the patients. Honey gauze (HoneySoft) has been used until skin toxicity resolved (55105).
Skin ulcers: Multi-layer pressure bandages should be used over the honey impregnated dressings (14318). Medihoney
dressings have also been used using honey and low-adherent, sterile, contact layer on top of a sterile dressing pad,
roughly 20g of honey to a 10 X 10 cm dressing (55092). Manuka honey has been used in one study in a leg ulcer
dressing for eight weeks (55297).
Wound management: For honey impregnated dressings, typically 20mL of honey (25-30g) is used on a 10cm X 10cm
absorbent dressing pad (14318). Frequency of dressing changes is dependent on how rapidly the honey is diluted by
the wounds exudate. Advancis Medical Ltd produces a sterilized, non-adherent dressing called Activon Tulle, which is
impregnated with 20-25g of Manuka honey (16374). Another means to attain a honey impregnated dressing is to dip
sterile gauze in unprocessed and undiluted honey (398). A honey-medicated dressing, Honey-Soft, has been applied to
wounds for up to 28 weeks (55081). Mono oral aloe honey was applied to cleaned wounds once daily until the wound
was considered to be healed (16358). Manuka honey-impregnated alginate dressing (ApiMed, Cambridge, New
Zealand) has been applied twice weekly until complete healing occurred (55101) and Manuka honey (Algivon/Activon
Tulle UMF 12+, AdvaNordic Medical Group A/S, Soroe, Denmark) bandages were changed every 2-3 days for four
weeks (55235, 55229). Honey dressings were applied on either an acute or chronic wound and gauze was changed
either daily or weekly until wound healed (55264). Antibacterial honey (Medihoney Antibacterial Wound Gel) was
applied daily to suture lines following surgery and was applied to free ap wounds beginning 10 days after surgery
(55225).
Inhalation:
Type 2 diabetes mellitus and hypertension: 10mL aqueous honey solution of 60% wt/v, patient was told to breathe
deeply through the nose for a maximum of 10 minutes (55086). Honey solutions with 30-90g of natural unprocessed
honey of an unspeci ed type with 250mL of water have also been studied (55090, 55090).

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Sinusitis (rhinosinusitis): 2mL of Manuka honey solution has been sprayed in the nostril once daily in the evening for
30 days (55216).
Ophthalmic:
Surgical uses: 25% honey eye drops have been taken ve times daily for seven days before and ve days after eye
surgery in addition to Ef umidex (55247).

Children
Oral:
Cough: 10g of eucalyptus honey, Labiatae honey, and citrus honey (55253) and 17mg (per 5mL) of buckwheat honey
(15910) have been used as one-time doses up to 30 minutes prior to sleep. 2.5mL of natural honey (isolated from a
village in Yazd, Iran) has been used as a one-time dose before sleep (55244, 17299).
Gastroenteritis (infantile): Unprocessed multi oral honey (Al Mahala, Gharbia Governorate, Egypt) was dissolved in
oral rehydration solution (ORS) (5mL per 100mL ORS) and consumed within two hours of preparation (55194).
Malnutrition: 2mL/kg of pure, unprocessed multi oral honey (Al Mahala, Gharbia Governorate, Egypt) solution
(7.2kcal/kg) plus conventional nutritional rehabilitation has been used daily in two divided doses for two weeks
(55210).
Topical:
Mucositis (radiation): 0.5g/kg honey (maximum dose 15g) has been used topically three times daily for up to 10 days
(55245).
Neonatal post-operative infected wounds: 5-10mL of commercial, unprocessed, non-pasteurized and non-irradiated
honey applied locally to the wound and covered with a sterile gauze dressing. Dressing were changed twice daily
(55302).
Wound healing: Crude undiluted honey soaked gauze was packed into wounds twice daily until wound closure
(16376).

Standardization & Formulation

Manuka honey is especially prized for its antibacterial properties. This unidenti ed component is referred to as the
"Unique Manuka Factor" (UMF), which rates the honey by its antibacterial activity (55091). A UMF rating of six would
be equivalent to the antiseptic potency of a 6% solution of phenol.
Honey used in one clinical trial had a pH of 6.5, glucose 321mmol/l and speci c gravity of 1.003 (55154) and in another,
poly- oral honey made from owers from Europe and Central and South America contained 17.3% water, 42.1%
fructose, 34.0% glucose, 24.9 diastase number, and 13.2 parts per million hydroxymethylfurfural (55173). Nonirradiated and non-heated Egyptian clover honey used in clinical trials was collected from El Mahala, Gharbia
Governorate, Egypt and had a 3.7 pH, 18.8% moisture content, and 78.4g/100g carbohydrate content (55263, 55245).
In a clinical trial, all of the honey used was from Thymus and Astragale, located in the Alborz mountains of northern
Iran and the honey's organoleptic, microbial, and physicochemical content was analyzed by the Drug and Food Control
Laboratory of the Ministry of Health of Iran in order to maintain consistency of intervention throughout the study
(55133).
Unprocessed and unpasteurized honey used in a clinical trial reported to have with a minimum inhibitory
concentration (MIC) of 3.8% (16354). In other clinical trials, honey was extracted from the nectar of the plant Trifolium
alexandrenum and was supplied in a raw form (55137). Liquid viscosity was determined to be 3000 centipoise for the
honey-thick liquid (55134). An intranasal honey solution was standardized to 50% honey and 50% saline in which
Medihoney, or active Leptospermum (Manuka) honey, from Derma Sciences Inc. in Toronto, Ontario was used (55216).
A honeydew honey was derived from Abies spp. and was sterilized by gamma-irradiation (55247). In additional clinical
trials, honey treatment was a blend of honey from Australian and New Zealand Leptospermum sp. that had been
gamma irradiated (55225), was supplied without heating or gamma irradiation and negative for Clostridum botulinum
spores (55196)
However, a widely accepted method of standardization for honey preparations is lacking.

Adverse Effects

Report an Adverse Reaction to Honey

General: In general, honey is well tolerated in the recommended does and for daily
consumption, and reported adverse effects have been mild in nature (15910, 55244). In addition, honey has been reported as being
more tolerable than common sugars and sweeteners (55252). However, there are reported cases of honey intoxication documented
in the literature as an adverse effect of consuming toxic honey also known as 'mad honey' which is produced from the nectar of
certain owering plants such as those of the genus Rhododendron. The symptoms of honey intoxication vary from case to case.
Incidents of weakness and sweating from honey intoxication have been reported (55171). In an animal study with anesthetized
albino rats injected intraperitoneally with toxic honey, the rats exhibited dose-dependent hypotension, bradycardia and respiratory
rate depression. Honey intoxication occurred in 15 persons following consumption of wasp honey containing atropine (55305).
There is a concern with some third world countries that the topical use of honey on deep leprotic ulcers may increase the risk of
maggot infestation in the wound by house ies and bluebottle ies (55146). Topically, honey may cause excessive dryness of wounds,
which may delay healing. This may be treated by applying saline packs as needed (55279).

Cardiovascular
Dermatologic
Endocrine
Gastrointestinal
Genitourinary
Hematologic
Musculoskeletal
Neurologic/CNS
Ocular/Otic
Pulmonary/Respiratory
Other
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Toxicology
Toxicity data for honey are limited, and due to variability in preparation methods, safety, or toxicity of one preparation may
not be applicable to other preparations. There are certain honeys from the nectar of owering plants from the genus
Rhododendron that have been known to cause honey intoxication, an adverse event that may be very serious depending on
the amount of toxic honey consumed. The symptoms of honey intoxication vary from case to case. It has been found that toxic
honey contains grayanotoxins, sodium channel blockers that cause a constant state of nerve and muscle depolarization
(55166).
Hepatotoxic alkaloids, which are known to occur in tansy ragwort (Senecio jacobaea L.), are also present in honey produced
from the nectar of the Rhododendron genus (55292). These alkaloids, which include senecionine, seneciphylline, jacoline,
jaconine, jacobine, and jacozine, are potentially carcinogenic, mutagenic, and teratogenic and may pose health hazards to the
human consumer. Pyrrolizidine alkaloid-containing plants used to produce honey may present a health hazard to humans,
particularly infants and fetuses, although further investigation is warranted (55074).

Interactions with Drugs

ANTICOAGULANT/ANTIPLATELETDRUGS
Interaction Rating =ModerateBe cautious with this combination.
Severity=Moderate Occurrence=Possible Level of Evidence = D

In vitro, honey inhibits platelet aggregation and increases the time to clotting (20352). Theoretically, honey might increase the risk
of bleeding when used concomitantly with anticoagulant or antiplatelet drugs. Some of these drugs include aspirin; clopidogrel
(Plavix); nonsteroidal anti-in ammatory drugs (NSAIDs) such as diclofenac (Voltaren, Cata am, others), ibuprofen (Advil, Motrin,
others), naproxen (Anaprox, Naprosyn, others); dalteparin (Fragmin); enoxaparin (Lovenox); heparin; warfarin (Coumadin); and
others.
CYTOCHROMEP4503A4(CYP3A4)SUBSTRATES
Interaction Rating =MinorBe watchful with this combination.
Severity=Mild Occurrence=Possible Level of Evidence = B

Some clinical research shows that honey induces CYP3A4 (55116). However, other clinical studies found no effect on CYP3A4
activity (55208). Different honey preparations may have different effects on CYP3A4. Use caution in patients taking CYP3A4
substrates. Some of these drugs include some calcium channel blockers (diltiazem, nicardipine, verapamil), chemotherapeutic
agents (etoposide, paclitaxel, vinblastine, vincristine, vindesine), antifungals (ketoconazole, itraconazole), glucocorticoids, cisapride
(Propulsid), alfentanil (Alfenta), fentanyl (Sublimaze), losartan (Cozaar), uoxetine (Prozac), midazolam (Versed), omeprazole
(Prilosec), ondansetron (Zofran), propranolol (Inderal), fexofenadine (Allegra), and numerous others.
PHENYTOIN(Dilantin)
Interaction Rating =ModerateBe cautious with this combination.
Severity=Moderate Occurrence=Possible Level of Evidence = D

In an animal model, the rate and extent of absorption of phenytoin was increased by honey (20352). Theoretically, honey might
increase therapeutic exposure to phenytoin.

Interactions with Herbs & Supplements

ANTICOAGULANT/ANTIPLATELET HERBS AND SUPPLEMENTS: In vitro, honey inhibits platelet aggregation and increases the
time to clotting (20352). Theoretically, honey might increase the risk of bleeding when used concomitantly with other herbs and
supplements that have anticoagulant or antiplatelet effects. Some other herbs and supplements that affect platelet aggregation
include angelica, clove, danshen, garlic, ginger, ginkgo, glucosamine, Panax ginseng, and others.

Interactions with Foods

None known.

Interactions with Lab Tests

None known.

Interactions with Diseases

POLLEN ALLERGIES: Honey may cause allergic reactions in people with pollen allergies (6).

Mechanism of Action
Constituents: Pure honey is a semi-translucent concentrated mixture of glucose, fructose, proteins, fatty acids, minerals,
vitamins and water (16374). Its therapeutic properties are believed to include promoting rapid wound healing, reducing
edema and in ammation, debriding necrotic tissue and stimulating tissue regeneration. Research has shown honey to be an
effective antibacterial agent, including against antibiotic-resistant strains of bacteria. The pH of honey is characteristically
between 3.2 and 4.5. Honey is a super-concentrated sugar solution with a low percentage of water, which means that it has a
signi cant osmotic effect. In addition, hydrogen peroxide, an oxidizing agent, is present in honey and is released by the action
of enzyme glucose oxidase. Some types of honey contain phytochemicals, including avonoids and phenolic acids.
Honey consists of phenolic constituents such as quercetin, caffeic acid, caffeic acid phenethyl ester (CAPE), chrysin, acacetin,
pinocembrin, pinobanksin, apigenin, kaempferol, and galangin (55223, 55174) and of the secondary plant constituents
pyrrolizidine alkaloids (PAs), which in food PAs are regulated (55187). Reviews have described methods to differentiate oral
honeys from arti cial honeys (55236). Honey also is composed of proteins, enzymes, amino acids, minerals, trace elements,
vitamins, oligosaccharides, aroma compounds and polyphenols (55158, 55240).

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Anticalculus effects: In laboratory research, certain types of honey inhibited the formation of amorphous calcium phosphate
precipitates, in which the authors suggested may have anticalculus properties useful in toothpastes and mouthwash (55155)
and compared to chlorhexidine gluconate mouthrinse, honey exhibited antibacterial effects against oral microorganisms
(55242).
Anticoagulant and antiplatelet effects: In vitro, natural honey exhibited inhibitory effects on platelet aggregation and blood
coagulation proteins in which higher concentrations of honey samples elevated whole blood clotting time, showed moderate
inhibition of platelet aggregation (IC(50) 5-7.5%), and signi cantly prolonged aPTT, PT, and TT (p>0.005) (55222).
Anti-glycemic effects: It has been suggested that the hypoglycemic effects of honey are due to fructose, one of the main
constituents, which with glucose may synergistically enhance intestinal fructose absorption and/or stimulate insulin secretion
in the gastrointestinal tract and pancreas (55243). While other reviews suggest another constituent, oligosaccharides, to
have a role in honey's antidiabetic effects (55240).
Honey produced a signi cantly less postprandial hyperglycemia than sucrose and glucose in normal volunteers and insulindependent diabetes mellitus patients (55268). Honey has also been shown to decrease fasting blood sugar in healthy subjects
(55090, 55087) and decrease hyperglycemia in diabetic humans and rats (55243, 55240). In overweight individuals, honey
signi cantly decreased FBG by 4.2% (96.2 44.2 vs. 92.2 39.2; p=0.04, respectively) in individuals with normal values
(55136).
In human research, compared to baseline, honey signi cantly reduced fasting blood sugar (153.3 43.9 to 124.3 37.5mg/dL,
p<0.01) and signi cantly increased HbA1c (7.1 1.2% to 7.7 1.5%, p<0.01) (55182). In human research, compared to the
control, honey signi cantly improved mean fasting serum glucose fasting C-peptide, two hour postprandial C-peptide (PCP),
and HbA1C (55263).
Fructose-to-glucose ratios and glycemic index vary in honeys depending on the botanical origin and composition. In healthy
participants, statistically signi cant differences between glycemic index and fructose-to-glucose ratios was lacking with
various types of honey (clover, buckwheat, cotton, and tupelo) (55104). Con icting data was reported with certain German
honey varieties with glycemic index and insulinemic response in which the authors suggested certain honey varieties may be a
suitable option for individuals with impaired glucose tolerance (55179). In healthy participants, statistically signi cant
differences were observed with natural honey compared to simulated honey and D-glucose, in stabilizing physiological
glycemic response and lowering glucose response (p<0.005) (55151).
In healthy participants, compared with a glucose-fructose solution, basswood honey resulted in lower serum insulin, serum
glucose, and C-peptide concentrations (55150), while rapeseed honey increased fructose serum levels and C-peptide levels
and acacia honey increased C-peptide levels (55201).
In pregnant women, honey ingestion provided carbohydrates which improved anaerobic performance during labor and lacked
an effect on glucose level in the mother (55127).
Anti-in ammatory properties: There is histological evidence of reduced numbers of in ammatory cells present in wounds
dressed with honey due to an anti-in ammatory component of honey (55078) while in other review the wound healing effect
following topical application of honey may be due to in ammatory cytokine release in surrounding tissue cells, such as
monocytes and macrophages (55209). The antioxidant content of honey may contribute to prevention of in ammation, as
oxidative species formed from hydrogen peroxide are responsible for the activation of the transcription factor NF-kB. In vitro,
buckwheat honey decreased reactive oxygen species (ROS) which were activated by human polymorphonuclear neutrophils
(55138). In human research, honey also caused a signi cant reduction between pre- and post-treatment in C- reactive protein
(CRP) by 3.3% (6.3 4.2 vs. 6.1 4.1; p=0.008, respectively) in subjects who had elevated values (55136). In human research,
plasma IL-1ra increased signi cantly posttest for the honey-sweetened drink (25.8%) (55189).
Antilipemic effects: Honey reduced cholesterol, low-density lipoprotein-cholesterol, and plasma triglycerides in healthy and
hyperlipidemic subjects (55090), although in other human research lacked an effect on total cholesterol, LDL, HDG, and
triglycerides (55173). In human research, honey also caused a signi cant reduction between pre- and post-treatment in
serum triacylglycerole by 19% (237 56 vs. 192 59; p=0.006, respectively) in individuals with elevated values (55136).
In human research, compared to baseline, honey signi cantly reduced total cholesterol (214.3 48.7 to 177.4 36.2mg/dL,
p<0.001), LDL-C (125.3 28.1 to 107.6 20.9mg/dL, p<0.001), ratio of LDL-C to HDL-C (2.2 0.60 to 1.6 0.20, p<0.001),
and triglyceride (190.0 70.1 to 148.0 80.4mg/dL, p<0.001), as well as signi cantly increased HDL-C (59.2 13.4 to 66.1
15.1mg/dL, p<0.01) (55182). In human research, compared to the control, honey signi cantly improved total cholesterol,
triglycerides, LDL cholesterol, and HDL cholesterol (55263).
Antimicrobial properties: Honey exhibits strong antibacterial properties (55176, 55242) via decreasing prostaglandin levels,
increasing nitric oxide levels, and exerting prebiotic effects (55227). Reviews have suggested phenolic compounds to also be a
factor for honey's antibacterial characteristics (55138).
Honey has been studied most frequently for its antimicrobial (antibacterial/antifungal) properties in the topical application in
the management of wound care (55301, 55286, 55188, 55096, 55135, 55071, 1261, 55077, 55287, 55072, 16355, 55300).
In laboratory research, undiluted, diluted, tualang, manuka, Greek, and Cypriot honey inhibits the growth of Pseudomonas
pyocyanea, Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus
uberis, Proteus mirabilis, coliform spp., Klebsiella species, Acinetobacter spp., Streptococcus faecalis, and Streptococcus
pyogenes (55288, 7849, 55120, 55259). According to a review, honey also exhibited activity against methicillin-resistant
Staphylococcus aureus (MRSA) and vancomycin resistant Enterococcus (VRE) and contains viable spores, including clostridia;
however antibacterial sensitivities are highly dependent on the botanical origin of the honey product (55176). In animal
research, topical application of honey plus Aloe vera gel on Klebsiella infected burn wounds exhibited signi cant activity
against Klebsiella pneumonia B5055 (p<0.001); although lacked additional effect when in combination with Klebsiella speci c
phage Kpn5 (30707).
This function of honey is attributed to its high osmolarity, acidity, and content of inhibines, such as hydrogen peroxide,
avonoids and the phenolic acids (55065). In addition, phytochemicals from the nectar of particular plants have been noted as
a potential mechanism behind honeys antimicrobial attributes (55097). The antibacterial effect of honey is based on the
concentration of hydrogen peroxide levels in the honey used (55083, 1261, 55259). Enzyme immunoassays have detected
varying amounts of tetracycline equivalents, streptomycin and sulfathiazole equivalents in honey (55062, 55094).
Antioxidant properties: Honey has been reported to have antioxidant properties (55174, 55138) and may ameliorate
oxidative stress in the management of chronic diseases (55246). Buckwheat honey containing phenolic antioxidants
increased the total plasma phenolic content, antioxidants and reducing capacities (16366). In vitro, buckwheat honey
decreased reactive oxygen species (ROS) which were activated by human polymorphonuclear neutrophils (55138) and in
other researched honey also reduced production of reactive oxygen species in cells stimulated by lipopolysaccharide (55078).
Honey increased antioxidant agents in healthy subjects (55087). It increased blood vitamin C concentration, beta-carotene,
uric acid and glutathione reductase.
In healthy participants, honey supplementation plus exercise increased seminal interleukin (IL) levels (IL-1beta, IL-6, IL-8),
tumor necrosis factor (TNF)-alpha, and malondialdehyde levels and signi cantly increased in seminal superoxide dismutase,
catalase, and total antioxidant capacity concentrations (p<0.008) (55220).
Antitumor activity: Honey has been studied for its antiproliferative properties (55174). In vivo, studies on C3H/He mice
exhibited a signi cant difference between honey-treated mice vs. control with regard to nal tumor volume (55082). In vitro
studies on bladder cancer cells showed that diluted honey affected their growth pattern. Apoptosis was shown by TUNEL
assay in bladder cancer cells, which suggests one of the ways by which honey induces cellular death.
Blood alcohol metabolism: Citrus honey seems to be a promising adjunct in the management of alcohol intoxication because
of its sugar (fructose and glucose) content (55099). The mechanism by which fructose promotes alcohol metabolism is
uncertain, but it has been hypothesized that the metabolism of fructose to sorbitol or glycerol in the presence of alcohol
utilizes NADH, and so offers the means of reoxidizing NADH to NAD+ which facilitates further alcohol metabolism.

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Cytochrome P450 effects: In healthy participants, honey signi cantly increased in 24 hour urinary excretion of 6betahydroxycortisol in which the authors concluded that honey may induce CYP3A4 activity, although lacked an effect with
CYP2D6 and CYP2C19 (55116). In other human research with healthy participants, honey and arti cial honey lacked an
effect on CYP3A activity (55208).
Gastroprotective effects: In rats with gastric ulcers induced by acetylsalicylic acid, natural honey had comparable
gastroprotective effects in healing gastric ulcers to Nigella sativa and cimetidine (55212).
Hematologic effects: In human research, compared to baseline, the honey group signi cantly increased hemoglobin
(8.411.43 vs. 10.390.79g %, p<0.001), lymphocytes (52.939.12 vs. 57.535.27%, p<0.001), protein (5.110.77 vs.
6.300.36 g/dL, p<0.001), and albumin (2.500.68 vs. 3.700.30 g/dL, p<0.001) (55210). Complement hemolytic activity
(CH50) levels rose signi cantly for both the honey group (77.010.61 to 639.06121.43, p<0.01) and the molasses group
(70.88.72 to 287.9354.26, p<0.01); the rise in CH50 levels was signi cantly greater for the honey group as compared to
the molasses placebo group, the p value was unreported.
In vitro, medicinal honey (Activon), supermarket honey (Rowse), a honey-based ointment (Mesitran), and arti cial honey (70%
w/w sugar glucose/fructose) stimulated pseudotubule formation in the rat aortic ring assay with medicinal honey having
greater activity than supermarket activity, although lacking an af liation with the sugar content (55205). The authors
concluded that honey promotes angiogeneic activity in varying amounts depending on the dilution of the honey preparation
and active constituents
Hepatic effects: In human research, compared to baseline, honey increased glutamate pyruvate transaminase (GPT) levels
(23.2 6.4 to 30.8 6.2U/L, p<0.001) (55182).
Immunostimulant effects: In vitro experiments using monocytes with pasture honey and Manuka honey have shown a
signi cant decrease in reactive oxygen intermediate production and signi cant enhancement of tumor necrosis factor-alpha
(TNF-alpha) (55069). Further in vitro experiments using monocytes with pasture honey, Manuka honey and jelly bush honey
have shown that honey signi cantly increased TNF-alpha, interleukin (IL)-1beta and IL-6 release as well as induced
stimulation of in ammatory cytokines (55084). In addition, honey at concentrations as low as 0.1% has been found to
stimulate proliferation of peripheral blood B-lymphocytes and T-lymphocytes in cell culture and activate phagocytes from
blood (55078). The sugar in honey also provides substrates for glycolysis, the minor mechanism for energy production in
macrophages.
Solubility-reducing agent: Organic phosphate esters, reportedly present in honey, may be responsible for the reduction in
solubility of tricalcium phosphate or enamel (55275). However, degradation by salivary enzymes may explain the absence of a
solubility effect in incubations with saliva and enamel.
Weight loss/gain effects: In human research, honey caused a signi cant decrease in BMI by 1.14% between pre- and posttreatment (30.1 3.1 vs. 29.8 3.2; p=0.02, respectively) (55136). In human research, compared to baseline, honey
signi cantly reduced body weight (71.3 12.7 to 69.5 11.9kg, p<0.001) (55182). In human research, compared to baseline,
the honey group had signi cant increases in weight (Z score= -3.071.28 to -2.561.21, p<0.001), midarm circumference
(MAC) (69.4713.07 to 73.0912.75%, p<0.001), and skin fold thickness (SFT) (54.3012.99 vs. 63.3712.59%, p<0.001)
(55210).
In human research, compared with a sucrose-containing meal, honey signi cantly delayed the ghrelin response postprandially
(p=0.037), increased total PYY response (p=0.007), and blunted the glucose responses (p=0.039) (55215).
Wound cleansing properties: The osmotic nature of honey draws lymph into the wound, helping ush the wound of bacteria
and debris (16355).
Wound debridement properties: It is thought that the generation of hydrogen peroxide aids in the debridement of the wound
because of the Fenton reaction, where hydrogen peroxide reacts with ferrous ions yielding the hydroxyl radical (55080).
Therefore, wounds may not require surgical debridement after honey treatment.
Wound deodorizing properties: Honey is reported to have a powerful deodorizing action due to the rich provision of glucose
that the bacteria prefer over amino acids resulting in the formation of lactic acids and non-malodourous compounds (55064).
Wound healing properties: Moist honey wound dressings enable epithelialization to occur along the top surface of the
wound, rather than underneath the scab, as occurs in dry wounds (55080). In addition the layer of honey on a dressing
prevents the dressing from adhering to the wound, enabling the dressing to be changed without disrupting the partially
healed wound or causing pain to the patient. The hydrogen peroxide content of honey has been found to stimulate the
proliferation of broblasts (14318). It is also thought that the pH of honey, on average around 3.9, may help to create and
maintain optimal conditions for broblast activity (migration, proliferation, and organization of collagen) (55080). Honey is a
bioactive wound dressing that provides rapid wound healing, promotes the formation of clean healthy granulation tissue, and
hastens epithelialization (55078, 55209). In clinical research, unprocessed honey had signi cantly greater healing rates and
signi cant reduction in contracture formation compared to silver sulfadiazine (55175). According to some research, the
wound repair and wound healing properties of honey is suspected to be due to the activation of keratinocyte reepithelialization (55256), stimulating tissue growth, and minimizing scar formation (55214). In human research, compared to
the control group, participants treated with unprocessed and unpasteurized honey showed increased rates of wound healing
after one week (14.48 1.81 vs. 13.80 1.91, p<0.05), two weeks (14.00 2.12 vs. 11.08 2.53, p<0.05), three weeks (13.64
2.14 vs. 8.84 2.53, p<0.05), four weeks (13.32 2.11 vs. 7.02 2.50, p<0.05), and ve weeks (12.62 2.15 vs. 6.55 2.12,
p<0.001), a signi cantly greater reduction in ulcer size for pressure ulcers dressed with honey compared to the control group
(56% vs. 13% reductions, p<0.001), and a greater percentage of participants treated with honey showed complete wound
healing compared to those in the control group (20% vs. 0%, p<0.05) (16354).
In vitro, acacia, buckwheat, and manuka honeys activated cyclin-dependent and focal adhesion kinases and rasGAP SH3
binding protein, although epithelial-mesenchymal transition (EMT) induction varied among the honeys due to different
botanical origins (55256). In laboratory research, compared to silver dressing, honey-based products showed
cytocompatibility with tissue cell cultures (55192).

Pharmacokinetics
Honey is considered to be easily absorbed and utilized by the body. However literature review provides little evidence on the
absorption, distribution, metabolism or elimination of honey.

Evidence Table / Discussion

See detailed Evidence Summary

References
See Monograph References

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This monograph was last reviewed on 3/11/2013 and last updated on 2/14/2015. Monographs are reviewed at least once per year.
If you have comments or suggestions on something that should be reviewed or included, please tell the editors. For details about our
evidence-based approach, see our Editorial Principles and Process.

2016 Therapeutic Research Center

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