Ever wonder why Winnie the Pooh loves honey so much?
Is it just a comfort food?
Or does honey have actual proven health benefits, too?
Honey has been used in the treatment of a wide range of disorders including eye diseases, asthma, cough, sleep disturbances, throat infections, digestive disorders, eczema, skin ulcers, and wounds.
Before we base our opinion on honey on that very biased honey lover from the Hundred Acres Forest (who incidentally also loves Heffalumps and is a self-confessed "Bear of Very Little Brain"), let's look at the scientific data for ourselves.
What is Raw Honey?
Honey is a delicious sweet sticky fluid - on this point, I totally agree with Winnie.
It comes from the nectar of flowering plants.
Humankind has enjoyed honey since antiquity and there are even paintings depicting honey dating back over 8000 years.
There are hundreds of different types of honey. That being said, not all honey is created equally. Think of those highly processed squeezy plastic jars of honey (usually shaped like a bear) and compare that to honey slowly dripping from the original honeycomb. In general, darker honey contains higher levels of vitamins and trace mineral (have you ever seen dark honey in the plastic squeezy bear type of honey?)
The quality of honey varies with its origins, handling, processing, transportation, and storage.
Honey can be processed to help extend shelf-life, reduce spoilage, and improve its appearance (1). These processes can include filtration to further remove any impurities and make the honey look nice for shoppers. Ultrafiltration involves even more intensive filtration to make the honey super smooth but logically this can also remove some of the natural components (and possibly some of the benefits) of honey.
Honey can be pasteurized or can undergo thermal processing to remove microorganisms such as yeast. Finally, manufacturing processes can involve adding sweeteners and flavors (Seriously, do we think that we can improve on nature?)
A popular brand of honey (made by a leading pharmacy chain) contains (per 100gm):
- Energy 375 kcal
- Protein 2.5 g
- Fat 7.5 gm
- Carbohydrate 80gm
- Fiber 0
- Sugar 47.5 gm
- Calcium 20 mg (2).
But that’s not all. You also get extra goodies.
Please excuse the shouty capitals letters - they come from the manufacturer and not me where the honey is labeled as containing the following:
"CORN SYRUP, SUGAR, NONFAT MILK, HYDROGENATED COCONUT OIL, ALMONDS, AND LESS THAN 2% OF HONEY, SALT, EGG WHITES, CANOLA AND/OR SAFFLOWER AND/OR PALM OIL, MODIFIED SOY PROTEIN, NATURAL FLAVOR, TBHQ AND CITRIC ACID (TO PRESERVE FRESHNESS)."
Ah, "TO PRESERVE FRESHNESS" is supposed to somehow justify adding corn syrup to honey, I suppose.
Raw honey refers to unadulterated honey that comes from the bees. It may be filtered to remove beeswax and dead bees but otherwise is just as nature designed it.
A sample brand of raw honey contains (per 100gms):
- Energy 286 kcal
- Protein 0 g
- Fat 0
- Carbohydrate 80gm
- Fiber 0
- Sugar 76.19 gm
- Calcium 0 mg (3).
A 2015 review paper on honey listed all of the possible health benefits of honey (big long list of a multitude of health benefits) and advocated the use of the term "SMIF" (Synergistic Multiple Ingredients Factor) to describe the many ways that honey can improve our health and well-being (4).
There are over 10,000 honey products for sale on Amazon. These products range in price from $0.31 per ounce to $107 per ounce. We will next explore what makes for this wide range on price later in this article (hint - manuka honey).
This is honey produced by the bees that pollinate the manuka shrub (Heptospernium Scoparium).
Methylglyoxal is found in varying amounts in all honey. The concentration of this methylglyoxal in honey is scored using a special scoring system known as the Unique Manuka Factor (UMF). Ratings of 10 or more UMF are considered to be medicinal.
Need I mention that the cost of honey increases with an increasing UMF score?
The manuka honey flowers have a high concentration of dihydroxyacetone which is, in turn, converted into methylglyoxal and is considered to be the most medicinal of the honey (5).
Is There any Research?
There are just 10,000 publications on honey and just 250 clinical trials. There are just 148 papers on raw honey and 3 clinical trials.
To put this into context, here are 470,000 papers on sugar which include 2500 clinical trials. We will use data on both raw and regular honey in this article - if we stuck to "raw honey" (honestly, no pun intended), there would be very little to say.
Does Raw Honey Help Heal Wounds and Ulcers?
Medicinal grade honey can be used for wounds and burns (6). An enzyme which is added by the bees to the honey results in the formation of small amounts of hydrogen peroxide which can kill bacteria.
A 2015 systematic review published by researchers from Sweden looked at the effects of honey compared to silver on burns. The review analyzed data from six randomized controlled trial studies and concluded that honey was statistically more efficacious for wound healing than silver (7).
Greek wound specialists looked at manuka impregnated dressings in 63 patients with diabetic foot ulcers (8). They compared the conventional dressings to manuka dressings over a 16-week period. They found that healing time and time to sterilization of the ulcers was significantly faster in the manuka group.
There is evidence to support honey for the treatment of wounds. I have to add something here. We are talking about medicinal grade honey, and not a scoop of your breakfast honey complete with toast crumbs. You would not believe how often we see patients with badly infected ulcers who tried a home remedy with honey straight from the kitchen table.
Does Raw Honey Counter Pollen Allergies?
Finnish investigators looked at the effect of pre-seasonal use of birch pollen honey (birch pollen added to honey) versus regular honey on symptoms and medication use during birch pollen season (9). A total of 44 women with birch pollen allergy were randomized to receive birch pollen honey or raw honey for 6 months. The control group was made up of 17 women who took their usual allergy medication.
During the birch pollen season of 2009, patients receiving either of the honey pollen products reported a statistically significant reduction in symptoms severity and days with symptoms. The usage of anti-histamines was statistically significantly lower in the birch pollen honey arm as opposed to the raw honey arm of the study.
The authors concluded that their results were just preliminary but suggested that pre-seasonal use of honey and especially birch pollen honey resulted in significantly better control of pollen symptoms as compared to conventional medication.
Now let's travel to Malaysia where investigators studied the complementary effect of ingestion of a high dose of honey, in addition to standard medications, on allergic rhinitis in 40 patients (10). This study used a high dose of honey - 1 g per kg of body weight. To put this into context, 1 tablespoon of honey = 20gms. The study lasted four weeks and during this time all patients received antihistamine therapy.
They found statistically significant improvements in symptoms such as sneezing, runny nose, eye itch in the honey arm of the study. These benefits lasted for one month after the study ended which also meant for one month after the discontinuation of their antihistamines.
How could honey help with allergic conditions? The study proposes three possible mechanisms:
- immune suppression
- tolerance i.e. constant low dose exposure to allergens can induce tolerance which means that the body gets used to the allergen and stops reacting to the allergens. (This is why some children with nut allergies take tiny amounts of nut every day - of course, this is done under very careful medical supervision).
There is some evidence to support a role for honey in the management of allergic conditions.
Does Raw Honey Promote Restful Sleep?
A number of blogs claim that honey can promote restful sleep. They base this on unsubstantiated theories and reference newspaper articles to back up their claims. As always, we will do our own research.
An Iranian study which is about to be published next month looked at 68 hospitalized patients with acute coronary syndrome in the coronary care unit (11). Patients were randomized to either a milk-honey mixture twice a day for three days or routine care. A statistically significant improvement in sleep quality was noted between the two groups in favor of the milk-honey drink.
Apart from this study, there are other publications which indirectly link honey with sleep via its action as a nocturnal cough suppressant. Having a child with a stubborn, unrelenting barking cough can destroy sleep for the child and entire family and so is a really valid research question.
A cohort of 105 children with respiratory tract infections were given either a single dose of buckwheat honey, honey-flavored dextromethorphan (standard cough syrup) or no treatment administered 30 minutes prior to bedtime (12). The study metrics were cough frequency, cough severity, bothersome nature of cough, and child and parent sleep quality.
Honey was no better than cough syrup for any of the metrics. However, honey was significantly better than no treatment in terms of reducing the frequency of cough and sleep quality of the child but not for the sleep quality of the parents.
A study from Israel compared eucalyptus honey, citrus honey, or labiatae honey to placebo in 300 children under the age of five with nocturnal cough (13). Parents scored the cough and sleep quality of their children on the night before the intervention and on the night of the intervention.
The parents scored honey products higher than the placebo for symptomatic relief of their children's nocturnal cough and sleep difficulty.
One study shows that raw can promote restful sleep in hospitalized patients. Other studies suggest that honey can promote sleep by relieving night time cough.
Does Raw Honey Help in Weight Management?
A 2011 study compared the effect of 33 days of honey versus sucrose in male Sprague-Dawley rats (14). At the end of 33 days of a sweet life, the rats underwent excision of their epididymal fat pads (ouch ouch ouch). Bodyweight and epididymal fat gain were statistically significantly lower in the honey fed rats.
However, the results of the study did not pan out when tested in humans.
No, don't worry, these humans did not have epididymal fat pad analysis.
US researchers compared the effect of 3 nutritive sweeteners [honey, sucrose, and 55% high-fructose corn syrup] on blood parameters, body weight and blood pressure in 28 people with normal glucose tolerance and 27 with impaired glucose tolerance (15). Each study participant took each of the sweeteners for two weeks with a gap in between to allow for wash-out of the previous sweetener.
Overall, consumption of 50 gm of sugar resulted in higher increases in the glucose-intolerant group as compared to the glucose tolerant group (this makes sense). They found no difference in the increase in glucose among the different treatment arms.
Equally, there was no difference in weight among the three treatment arms which means that raw honey was no better for weight management than sucrose or high corn fructose. Hence using raw honey as a food swap instead of sucrose offers no benefits.
The caveat here is that this was a short-term study. While there may be no benefit in terms of weight for choosing honey over high fructose corn syrup, I think that there are lots of other reasons to prefer honey to corn syrup.
A really sub-optimal study compared the effect of a honey- or sucrose-containing breakfasts in 14 healthy, non-obese women (16).
The honey group had statistically significant improvements in their levels of hunger hormones which sounds very promising. But hunger ratings and subsequent food intake did not differ between diet treatments. So who cares what the hormone levels were?
There are no studies showing that raw honey helps in weight maintenance.
Does Raw Honey Reduce Risk Of Diabetes?
This is the million-dollar question. Honey seems to have some health benefits but how does that work in terms of sugar load and glycemic control?
Honey contains fructose and sucrose. Honey and sugar rank close together in the glycemic league table (honey at 62 and sugar at 64). This scoring system measures how easily the body converts carbohydrates into sugar,
A 2006 study showed no major differences between the glycemic index and fructose: sucrose ration of leading brands of honey (17).
The Raatz study mentioned above showed no difference between three sweeteners (honey, sucrose, and high-fructose corn syrup) on sugar control.
There is growing interest in the role of honey as an anti-diabetic agent (18).
Pakistani researchers compared 75 gm of honey to 30 gm of honey to 75 gm of glucose in 97 patients with type 2 diabetes.
The mean rise in blood sugar was 30mg/dl, 85mg/dl and 170mg/dl respectively for these three interventions (19). These differences were statistically significantly different. This supports the common use of low dose honey as a food swap for sugar in patients with diabetes. Even though the study authors do not explicitly say so, low dose honey is also a reasonable food swap for sugar for the general population.
A suite of Egyptian studies showed that honey, compared to sucrose, had a lower glycemic index in adults and children with diabetes as compared to controls (20, 21). This is where things get interesting. They also found a possible stimulatory effect on diseased pancreatic beta cells which raises the possibility of an anti-diabetic effect. At this stage, it is all very interesting but speculative.
Honey is probably a better food choice than sugar. There is interesting (but very, very, very preliminary) data to suggest that honey may (possibly, possibly maybe) have an anti-diabetic effect. However, this is totally unproven as of now. This does not mean that people with diabetes can binge on honey.
Does Raw Honey Boost the Immune System?
The following hodge-podge of low-quality studies sums up the current state of research in honey and the immune system.
Malaysian investigators have started a study looking at the effects of honey on inflammatory markers in smokers and non-smokers (22).
The study is still on-going and there is no interim data to go on.
Honey was compared to topical steroids and to triamcinolone (Orabase) for apthous mouth ulcers in 94 subjects (23).
Honey was statistically superior in terms of ulcer size and pain.
Medical grade honey was added to milk in 40 preterm infants but no impact was noted on immune parameters over 14 days of observation (24).
An older Swiss study looked at the effect of a drink containing herbal yeast, malt, honey, and orange juice in 16 ling-distance runners and found no benefits on immune markers (total and differential white blood cell counts, numbers of B- and T-cells and T-subpopulations, concanavalin-A-induced lymphocyte proliferation, serum levels of immunoglobulins, neopterin, IL-2 receptors, beta 2-microglobulin, complement factor b, c4 and c3c, and c1-inactivator) following a 21 km run (25).
There is no "medicinal grade" evidence to support a role for honey as immunotherapy.
Is Raw Honey Safe?
Even though honey has been shown to be of some benefit in allergic conditions, honey itself can trigger allergy and anaphylaxis (26).
A 2014 paper suggested that honey should not be considered to be a completely safe food (27). A compound called 5-hydroxymethylfurfural which is not present in raw honey can be formed during processing and is mutagenic and carcinogenic. The paper also reports that honey can be contaminated with lead, arsenic, mercury, and cadmium.
Extreme examples of honey toxicity nectar of Rhododendron ponticum which contains alkaloids that can be poisonous to humans and honey collected from Andromeda flowers contains grayanotoxins, which can cause paralysis of limbs in humans and eventually leads to death.
A 2015 paper reported 1199 cases of Rhododendron toxicity which presented as dizziness, nausea, fainting and the EKG abnormalities (28).
Honey should be avoided in children under the age of one. At this young age, their immune systems are not fully developed and these children are at risk of botulism from the spore of the bacteria, Clostridium botulinium.
Just today, the FDA issued a health alert reminding parents to avoid honey in children under the age of 1 following the hospitalization of four children with botulism. All four infants had used pacifiers containing honey which had come from Mexico (29).
Honey raises lots of interesting issues for us.
Firstly, while "honey" may have been shown to have some health benefits, there is a very real risk that some people will buy highly processed commercial brands of honey which may have been processed beyond the point where the honey can add any health benefits.
Secondly, I have seen many families apply honey to the wounds of their loved ones (especially in resource-poor countries where there might not be a burn or plastic surgery unit). Adding contaminated low UMF honey is likely to do more harm than good.
Thirdly, let's look at the issue of cough. The data is not incontrovertible but suggests that honey may help nocturnal cough.
Does the data have to be ironclad to justify using an intervention?
The answer to that question depends on a number of things.
Even as a hardcore HBS blogger, I think I would try honey next time that cough keeps me awake at night.
Here is my reasoning.
- There is some preliminary positive data.
- One person with a nighttime cough can cost an entire household a night's sleep.
- There are no great proven remedies for night time cough (of course, I would use antibiotics, inhalers, steroids if the family doctor recommended them) but I could still use honey as well.
- There are minimal risks.
- It is inexpensive.
If something might just work, does no harm, is inexpensive and if I am also following standard medical advice, then it would be reasonable to give it a try.
However, I would be totally opposed to trying honey as an alternative therapy in immune disorders or for cancer where the stakes are higher and there is no science to back it up.
Finally, sometimes in life, we overcomplicate things. Honey tastes delicious. Maybe that's reason enough to enjoy it.
Remember when Winnie the Pooh was having an off-day...
"'I don’t feel very much like Pooh today,' said Pooh.
'There there,' said Piglet. 'I’ll bring you tea and honey until you do.'"
Sounds like a good idea to me (though I do note that Piglet did not make any false claims about other health benefits- unlike some bloggers that I know).