Honey – the new hope or the new hype?

How is honey made? Producing honey is hard work: a bee makes just a twelfth of a teaspoon in her lifetime. Female foraging worker bees collect nectar from flowers. When she finds a good source she returns to the hive and tells the others where it is by doing a ‘waggle dance’ positioning the flower in relation to the sun and the hive. Nectar is transferred to hive bees who ingest and regurgitate it from their ‘honey stomach’ repeatedly adding enzymes to break down the sugar (sucrose) in it into fructose and glucose. Another enzyme uses glucose to make hydrogen peroxide, which makes honey acidic. The bees ingest and regurgitate the honey until it is partially digested. So honey is actually bee vomit! It is left to dry in the honeycomb then sealed in with beeswax as a food supply for the winter. When honey is taken for humans, bees may be fed syrup made from white sugar and water – not really a fair swap!

Honey is a mixture of carbohydrates, proteins, amino acids (the building blocks of proteins), enzymes, vitamins, minerals, antioxidants and other compounds. The properties and components of honey vary greatly depending on locality and the types of flowers available to the bees that make it. Most supermarket honey is processed; filtered to remove pollen and/or heat-treated to keep it in liquid form and destroy pathogens. This diminishes certain properties in honey such as enzyme activity.

The nutritional content of honey

Per 100g	Honey	Golden syrup	Black treacle (molasses)	Maple syrup	White sugar
Energy (kcal)	318	298	257	262	394
Carbohydrate (g)	76.4	79.0	67.2	67.2	105.0
Glucose (g)	34.6	23.1	17.4	3.1	0
Fructose (g)	41.8	23.0	16.7	1.1	0
Sucrose (g)	Tr	32.8	32.7	56.5	105.0
Fibre (g)	0	0	Tr	0	0
Sodium (mg)	11	270	180	9	5
Potassium (mg)	51	58	1760	200	5
Calcium (mg)	5	16	550	67	(10)
Iron (mg)	0.4	0.4	21.3	1.2	(0.2)
Zinc (mg)	0.9	(0.1)	0.8	4.2	(0.1)
Vitamin C (mg)	0	0	0	0	0
Vitamin B6 (ug)	N	Tr	Tr	Tr	0

Tr: trace amount

N: No reliable information

( ): estimated value

Know your sugars!

Sucrose is made up of glucose and fructose joined together. All three sugars may taste similar in fruit, honey and sweets but fructose is broken down in the body in a completely different way as it is not regulated and can be harmful to cells and increase fat production. This is why fructose has been linked to metabolic syndrome, a combination of medical problems that increase the risk of cardiovascular disease and diabetes.

Around 30-35 per cent of people suffer from fructose malabsorption. In the same way that lactose intolerant people suffer when bacteria in their guts digest lactose from their diet, fructose digested by gut bacteria leads to gas, bloating, cramping and diarrhoea. Eating glucose with fructose may improve fructose absorption; people may tolerate grapefruits or bananas, which contain similar amounts, but apples may not be tolerated because they contain higher levels of fructose. Honey contains more fructose than glucose and malabsorption after ordinary doses of honey is frequent in healthy adults and can lead to a range of abdominal complaints and laxative effects.

IBS  

Fructose malabsorption often occurs in people with irritable bowel syndrome (IBS), and high-fructose foods can trigger symptoms. Fructose intake is restricted in the low FODMAP diet, often recommended for IBS patients (FODMAP stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides And Polyols – short chain carbohydrates that are poorly absorbed in the small intestine). One study found that 74% of people with IBS benefitted from avoiding high-fructose fruits, certain dried fruits, fruit juice, high fructose corn syrup, sucrose and honey. Maple syrup contains mostly sucrose with a small amount of glucose and an even smaller amount of fructose (see table above), so is safe in moderation on the low FODMAP diet.

Manuka mania

Manuka honey is produced from nectar from the Manuka bush (Leptospermum scoparium) in New Zealand and Australia. Because Manuka honey is so expensive, there is widespread evidence of a ‘honey crime wave’ of counterfeit or adulterated products being sold as Manuka honey. The UK Food Standards Agency (FSA) says that UK testing has identified non-compliance in around a third of tested samples. In other words, one in three jars of Manuka honey ain’t what it says on the tin! The FSA has raised concerns over honey diluted with corn syrup or with cheaper imports from abroad. In 2015, EU-wide testing identified high levels of noncompliance around sugar content and botanical origin. Nearly half of all honey sold in Britain is imported and much of it contains blends. Imported honey is usually much cheaper, less traceable and often not Fair Trade.  

What lies beneath?

In 2002, Britain, the EU and the US banned all honey imports from China when samples of its honey were found to be contaminated with the antibiotic chloramphenicol, which can lead to life-threatening anaemia and may also be linked to cancer.  

Honey is unsafe for children under one

Botulism is a life-threatening condition caused by toxins produced by Clostridium botulinum bacteria. These toxins attack the nervous system and cause paralysis. Most people will make a full recovery with treatment, but the paralysis can spread to the muscles that control breathing if it’s not treated quickly. This is fatal in around 5-10% of cases. In low oxygen conditions, C. botulinum bacteria form protective spores which can exist in the soil, air, dust and raw agricultural products like honey. The NHS says that you should avoid giving honey to babies less than 12 months old because of C. botulinum spores.

Mad honey

Many plants of the Ericaceae plant family (the heath or heather family including cranberry, blueberry, huckleberry and rhododendron plants), contain a neurotoxin called grayanotoxin. This can be transferred into honey if bees collect it in the nectar. Honey containing grayanotoxin is called Mad Honey, Miel Fou, Crazy Honey, Toxic Honey or Deli Bal and it is said that it can enhance focus, concentration and energy while providing a euphoric feeling with a bit of dizziness – similar to being drunk.  

Mad honey was used as a weapon of war in 67 BC, when King Mithridates’ army left chunks of ‘mad honeycomb’ in the path of the Roman enemy, who ate it up, became disorientated and were promptly slain. More recently grayanotoxin was the poison used by the chief antagonist Lord Blackwood to feign his death in the 2009 film Sherlock Holmes.

Mad honey is widely used in indigenous medicine for the treatment of high blood pressure and sexual dysfunction. But it can cause low blood pressure and heartbeat irregularities. A recent study described how a 55-year-old woman was admitted to hospital with chest tightness and pain after she ate three tablespoons of honey at breakfast. She was suffering weakness, dizziness and cold shivers and was diagnosed with a heart attack! Another study reported how a 60‐year‐old man was brought to the emergency department with dizziness after eating a few spoonfuls of honey. While he was being treated, his heartbeat slowed then stopped and he ended up having a pacemaker fitted.  

Mad honey intoxication is one of the most common food intoxications in people in Turkey. From 1981 to 2014, 1,199 cases were reported. Mild cases can cause dizziness, weakness, excessive perspiration, hypersalivation, nausea, vomiting and ‘pins and needles’. Severe intoxication can lead to life-threatening cardiac complications including slow or irregular heartbeat. Most known cases are restricted to Turkey and the Black Sea region but others have been found worldwide as mad honey is currently sold online.  

Can honey ease a cough?

Cochrane Reviews are internationally recognised as the highest standard in evidence-based health care, often referred to as the gold standard. For chronic cough and acute cough, a 2009 Cochrane review found no evidence for or against the use of honey. They said that lozenges or honey are not recommended when managing very young children as lozenges are a potential choking hazard and honey can cause infant botulism!

A 2014 Cochrane review found that honey may be better for the relief of a cough in children than no treatment, a placebo or diphenhydramine (an antihistamine used to treat allergies and symptoms of the common cold – used in Benadryl), but honey was no better than dextromethorphan (a cough suppressant used in many over-the-counter cold and cough medicines including Benylin). They said there is no strong evidence for or against the use of honey. However, a number of children in the honey group experienced adverse events including nervousness, insomnia and hyperactivity.

A couple of small studies (both funded by Honey Boards) suggested that honey may work better than certain cough medicines in easing a cough. The methodologies of these studies has been questioned including inadequate description of randomisation and allocation, no blinding, exclusion of patients who deviated from the protocol, substitution of clinician ratings in place of parent or child ratings, funding by the Honey Board and uncertain clinical significance, plus there was no consistency in adverse events between the trials.

Because the nerve fibres that initiate a cough and those that taste sweetness are located close together, it has been suggested that honey can induce an interaction between the fibres that suppresses the cough. All sweet substances can have a sedative effect on cough receptors so maple syrup could be a better alternative. Many websites recommend maple syrup in place of honey for the relief of coughs in infants.

Honey can be used to treat colds.

It’s been proposed that the high acidity, osmolality (high-sugar/low-water) and hydrogen peroxide in honey may be why it might help fight a cold. Sweet substances, such as honey and other syrups, stimulate saliva which may improve clearance in the airways and lead to a soothing effect resulting in reduced cough. However, if other sweet substances do this then maple syrup would be a better alternative. Until more research is done, it remains unclear if and how honey might help more than other syrups.  

Can honey help you sleep? 

It has been suggested that honey can help you sleep because it supplies the liver with energy which is stored as glycogen which supplies energy to restore the body during sleep. If you eat enough carbohydrates, this will happen anyway without bedtime honey! The government say starchy food is an important part of a healthy diet and should make up just over a third of the food we eat. Choose higher-fibre, wholegrain varieties such as wholewheat pasta, brown rice and wholemeal bread. Another claim is that honey contributes to melatonin being released in the brain which is an important sleep hormone. This is not supported by any scientific studies. Apart from some anecdotal evidence, there is little evidence to suggest that honey can help you sleep.

Three studies (two funded by local honey boards) found that honey at bedtime worked better than no treatment, cough medicine or a placebo at reducing the symptoms of coughing children. All this means is that relief from coughing helps children sleep – other sweet syrups have the same effect. Honey is unsafe for children younger than one because of the risk of botulism and has the potential to cause tooth decay if it is given nightly.    

Can honey combat hay fever?

It’s suggested that the small amount of local pollen in unfiltered honey can act in a similar way to a vaccine and desensitise the allergic reaction. This is nonsense and there’s no evidence to support it. In trials comparing locally-produced, unfiltered honey, with nationally-produced, filtered honey and honey-flavoured corn syrup there was no difference between the three in reducing hay-fever symptoms. The pollen in honey is mostly heavy, flower pollen that doesn’t cause hay fever. The pollen that causes hay-fever is much lighter and comes from grasses and trees that bees don’t tend to visit.  

Can honey help boost cognitive abilities?   

One single study suggests that Tualang honey (a wild rainforest honey from Malaysia) could help improve some aspects of memory in a group of postmenopausal women. The authors could offer no plausible mechanism by which this might work other than suggesting that honey might help improve concentration and overall well-being. A Booja-booja chocolate or does that for me! 

Can honey prevent stomach ulcers?

The bug thought to cause stomach ulcers (Helicobacter pylori) is found in the stomachs of many people. Only in some does it cause inflammation, peptic ulcers or gastric cancer. In tests in the laboratory, Manuka honey exhibits antimicrobial activity against H. pylori and one study found that people who ate this honey once or more times a week were less likely to be infected. However, in the only clinical trial to date, 12 people were given a tablespoon of Manuka honey four times a day for two weeks and at the end of the treatment, they all remained positive for H. pylori. It may work in the Petri dish but it doesn’t appear to be effective in people.  

Can honey help athletes replace energy and improve performance?

Sports drinks containing sugar can help prevent dehydration, improve performance and protect against a drop in blood glucose levels. There is no evidence that honey works better than sugar. One small study looked at the effect of Acacia honey in 10 male runners in their early twenties. Results showed that the honey drink improved running compared to water – it’s not clear why plain water was the control and not sugar and water! It’s a bit like the study that found meat provided more nutrients then vegetable oil! The authors acknowledged their oversight saying another drink containing carbohydrate should have been used for comparison purposes. There is no evidence that honey offers any advantage over sugar as the provider of carbohydrate in an energy drink. Fructose (found in substantial quantities in honey) can produce deleterious effects on the cardiovascular system, increasing blood pressure and producing adverse metabolic effects such as insulin resistance. You are better off sticking to orange juice, sugar and water with a small sprinkle of salt! 

Can honey help soothe a hangover?

Just ahead of Christmas in 2010 The Royal Society of Chemistry issued a press release saying that toast with honey is the ideal way to combat a hangover. Dr John Emsley of the Royal Society said that the fructose in the honey – which is also found in golden syrup – can help the body break down alcohol into harmless by-products. The reason hangovers are so painful is that alcohol is first broken down into acetaldehyde, a substance which is toxic to the body. This is then converted – using fructose – into acetic acid which is then broken down into carbon dioxide which we breathe out. A 2005 study tested honey and alcohol in 50 volunteers and found that it did help break down and eliminate alcohol. However, it also reduced intoxication time and increased blood pressure and triglycerides (fats and sugar combined in the blood – not good!). Honey is no magic bullet – it might just be that drinking booze less is the answer!

Can honey help you lose weight?

We are advised to eat less sugar. However, controversy exists over whether all sugars are the same. It has been suggested that the sugar in honey behaves differently and that it can actually help you lose weight. There is no scientific evidence for this. A study comparing honey, sucrose and a high-fructose corn syrup found all three had the same effects on measures of glycaemia, lipid metabolism and inflammation. There was no difference.

Can honey reduce the risk of cancer?

There is no evidence that honey can be used to treat cancer and to suggest it can is dangerous. Sure, honey contains antioxidants but so do all fruit and vegetables which don’t have the high-sugar content honey has. High-sugar intake is linked to an increased risk for cancer, diabetes, obesity and a host of other health problems. Common sense tells us that you would be better of getting your antioxidants from red cabbage and sweet potato then large amounts of honey!!  

Can honey cure worms?

No – there is no evidence that honey can be used to treat worms.

SKIN COMPLAINTS

Can honey soothe eczema?

It appears not. In a single-blind randomised controlled trial of medical-grade Kanuka honey results showed no evidence of efficacy and the authors concluded that application of medical-grade Kanuka honey does not appear to be effective in the management of eczema.

Can you treat acne with honey?

There’s no evidence that honey can help combat acne. One trial investigating the effect of medical-grade Kanuka honey on acne found no evidence that it was more effective than the use of antibacterial soap.   

Can honey help some scalp conditions; dermatitis, dandruff and general itchiness?

A limited number of studies have reported that rubbing honey into the scalp can help treat dermatitis and dandruff. This effect may be due to antifungal properties some honeys have; however, this varies depending on where the honey is from and how it has been produced.   Interestingly, a number of studies found that propolis (or bee glue – a resinous mixture of bee saliva and beeswax with exudate from tree buds, sap flow, or other botanical sources used as a sealant in the hive) and propolis-enriched honey, may actually cause dermatitis in some people.

Antibacterial action

There is some evidence that medical grade Manuka honey (standardised and irradiated to kill C. botulinum spores) can combat infection of wounds and even kill antibiotic-resistant bacteria such as MRSA. However, much of this activity is attributed to its acidic and hygroscopic properties (the high-sugar/low-water content makes it draw moisture out of the environment so it dehydrates bacteria). If you ate a bowl of sugar and vomited it up, the sugary, acidic gloop would undoubtedly have the same effect! This is missing the point; antibiotic resistant bacteria are a problem of our own making. The overuse of antibiotics in animal farming and the grim environment of factory farms have provided an ideal breeding ground for bacteria (and viruses). Honey is not going to make these dangerous superbugs go away.  

Conclusion

Like coconut oil, honey is presented as a cure-all functional food that can be used to treat all manner of ailments. The nutritional claims for it are not supported by scientific evidence and there is not a single claim approved under European law. Instead of searching for another animal to exploit isn’t it about time we accepted there are no magic bullets. If you want to be healthy, you have to eat healthily, exercise regularly and lead a healthy lifestyle. 

“It might be time, although this is none of WHO’s business really, but the bottom line is that humans have to think about how they treat their animals and how they farm them, how they market them – basically the whole relationship between the animal kingdom and the human kingdom is coming under stress.”

WHO spokesman for the Western Pacific region, Peter Cordingly