The Rise of Medicinal Honey

More people are reaching for honey to treat scrapes and scratches instead of antibiotic ointments.

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Dec 11 2015, 6:25pm

Image: Pixabay

Honey can treat wounds, may kill antibiotic-resistant superbugs, and tastes great in tea. The antimicrobial effects of honey have been touted since before the Egyptians built the pyramids, but it's only within the past five to ten years that science has begun to support the folklore: honey heals.

While honey has been used as a natural remedy for millennia, its antibacterial and anti-inflammatory properties are increasingly embraced by conventional medicine, especially in light of recent studies suggesting honey can fight antibiotic-resistant strains of bacteria.

The Food and Drug Administration approved medicinal honey in 2008 for the treatment of burns and sores. The first FDA-approved product, Medihoney, is commonly used in clinical settings today. Since then there's been an uptick in over-the-counter medical grade honey-based topical ointments—products like Wound Honey, Manuka Health, and Manuka Guard.

Image: Screenshot of sponsored Google search results for medical grade honey.

For the most part, the medicinal honey companies on the market are sticking to treatments for which there's at least some medical evidence: scrapes, cuts, and minor burns. More people are reaching to honey for scrapes and scratches when previously they'd have reached for triple antibiotic ointments like Neosporin.

There's nothing to suggest that this is bad. Many health professionals believe that while more research is needed to give a conclusive answer, honey has been shown to help heal wounds, and at the least can't hurt. Generally speaking, medical grade honey doesn't cause harm especially when used with standard treatments of keeping a wound clean and covered.

What's more, triple antibiotic ointments may not be necessary for your average cut, and at least one study has linked their use to an increase in antibacterial resistant skin infections. This is where honey's healing potential gets especially exciting. Medical grade honey can work to heal stubborn infections that don't respond to conventional antibiotic treatments, and some studies have shown it can fight superbugs like the dreaded antibiotic resistant staph.

If it can be consistently harnessed, and with further research, honey could be a new, affordable treatment as antibiotics lose efficacy due to resistance.

Honey kills bacteria in a different way than antibiotics. At least three components contribute to honey's natural antimicrobial nature. One, its high sugar content. Sugar, like salt, is a desiccant—it essentially sucks bacteria or fungi dry, killing off pathogens.

Honey also naturally produces hydrogen peroxide. While honey is high in sugar, the nectar that bees harvest is not. At only 20 percent sugar, it's not sweet enough to stave off fungal infections as it dries into honey, so as the bee moves from flower to hive, the nectar is transported in a second stomach, called the honey sac. There it reacts with an enzyme that converts some of the nectar into hydrogen peroxide and gluconic acid, antimicrobials that inhibit bacterial and fungal growth. It's why honey doesn't spoil.

Lastly, honey has a low pH, like our skin does when it's healthy and intact. That pH rises when skin gets cut. When honey is applied to cuts it can lower a wound's pH while also providing a moisture barrier—a kind of sweet scab that some studies suggest can aid healing.

Manuka honey—drawn from nectar from New Zealand's manuka bush (Leptospermum), a form of tea tree—is an especially potent type of honey with exceptionally high antimicrobial properties. It's the basis of most medical grade honey products including Medihoney.

"It is actually honey," said Marci Turks from Derma Sciences clinical affairs department. Derma Sciences is the tissue regeneration company that, in addition to a traditional suite of wound care products, manufactures Medihoney. "It's not indicated for eating, but you could eat the stuff in the tube—it's 100% honey." (However, cautions Turks, the Medihoney gel includes a food-based thickener that makes it taste bad.)

Image: Medihoney wound gel

The difference between medical grade honey like Medihoney and dietary honeys we stick in our tea is that the former are sterilized, usually by a form of gamma radiation to ensure its not contaminated, that pathogens like botulism on't make it in. In other words, you probably don't want to rub the honey in your kitchen on an open wound.

And importantly, the antimicrobial properties in medical grade honey are standardized by comparing phenolic, antioxidant and chemical properties from batch to batch. Standardization is how you know that every time you pop an ibuprofen each pill will be as strong as the other ones. Honey used in FDA registered products are generally standardized to an equivalency of 12-16 percent phenolic acid.

The problem is that while honeys are often standardized within a given study, there's no standardization across studies. The antimicrobial properties vary widely across different kinds of honey, geographic regions, and the preparation of the product. This can make it difficult to study honey's efficacy as a treatment.

In a study, "You have to be more or less certain that the antimicrobial properties are the same in different batches," said Sebastian A. J. Zaat a researcher of medical microbiology at the Academic Medical Center in Amsterdam. This isn't always easy.

Zaat is part of a team that found that honey killed both antibiotic susceptible and resistant isolates of a variety of skin bacteria both in in vitrostudies, or studies on the cellular level, an on surface skin itself. But when Zaat's team moved to a clinical setting on catheter patients, who are prone to skin infections, the honey didn't decrease infection rates. Put honey in a petri dish with bacteria and it tends to kill them, but put honey on a wound and the results are less consistent.

After Zaat's team identified all of the antimicrobial properties of a local Dutch honey, they tried turning off those antimicrobial mechanisms in in other honeys, like New Zealand's manuka honey. They found that despite the inactivity of their known antimicrobial agents the honey still killed microbes. It's as if your cell phone kept working after you'd popped the battery out.

"One of the key things about honey in medicinal practices is there is variability [of the antimicrobial properties] of honey preparations," said Zaat.

This variation, the fact that different studies use different types honey, and that honey's sticky properties mean patients know they're receiving a honey-based treatment (making double blind studies difficult) makes assessing the efficacy of medicinal honey difficult. Scientists say we need more high-quality, randomized controlled studies with blinding to make firm conclusions about honey's medicinal uses.

Illustration courtesy of Michelle Schrad

Dr. Luke Holland, now at Oxford University Hospitals, was a medical student when he first saw honey being used in a hospital to bandage sores. It piqued his curiosity enough to conduct a 2015 review study of existing literature assessing the efficacy of medical grade honey in treating chronic venous leg ulcers, like the kind frequently found in diabetes patients.

Holland found only two studies met adequate scientific rigor, and they cancelled each other out —one found that honey helped, the other found that it didn't. "Maybe they're both right," Holland said, "because they used different methods." He noted his review only looks at one type of wound.

"I'm not saying that it doesn't work," Holland notes. "I'm saying that we don't know that it does work."

The ancient physicians of Egypt and Greece once prescribed honey without knowledge of its underlying medicinal principles. And yet, they knew that some honeys were better than others for medical use. For example, in 50 AD the Greek physician Dioscorides noted that 'a pale yellow honey from Attica was the best, being ‘good for all rotten and hollow ulcers.'

Two thousand years later, scientists are still just beginning to unlock honey's medicinal potential, a reminder of not only the long tail of science, but also the tendrils that connect so many modern medicines from pain relievers, like aspirin, to cancer drugs, like taxol, to their origins in nature. If successful at treating antibiotic resistance, this ancient natural treatment may be part of the solution to a major modern health crisis.