Dr. Noam Diamant
The numerous health benefits of honey have been known for centuries but is honey also helpful for healing inflammation and supporting gut health of IBD patients?
Honey is a natural product of honey bees, that is, originates from floral nectars and other plant secretions. It is rich in carbohydrates, proteins, vitamins, trace elements, enzymes, and polyphenolic compounds. In recent years numerous scientific studies have shown that honey possesses various important properties, such as wound healing, antibacterial, antioxidant and anti-inflammatory effects. Lately, studies focused on patients with Chrohn’s and ulcerative colitis (UC) which are inflammatory bowel diseases (IBD), shed light on the potential of honey to support the healing process of this patient population.
What is honey and what does it contain?
Honey is a supersaturated, semi-solid natural product that is prepared by bees from the nectar of different flowers and plants. It is a healthy, natural, energy producing and easily digestible food. More than 181 substances are found in raw natural honey. It contains a blend of vitamins, minerals, enzymes, antioxidants, protein, carbohydrate, lipids and polyphenolic compounds such as flavonoids. The presence of such a variety of active compounds provides the basis for the combined anti-microbial, anti-oxidant and anti-inflammatory properties of honey. However, the composition and properties of honey depend on the weather and geographical conditions under which it is produced. Therefore, a complete understanding of the medicinal properties of honey is a complicated ongoing scientific endeavor.
What are the medicinal properties of honey?
Ancient civilizations considered honey a god gifted prestigious product. The use of honey as a medicine started at least six thousand years ago. The earliest written records on papyri and Sumerian clay tablets clearly demonstrate that honey was used, by the Egyptians as a medicine, before 1900–1250 BC.
Prior to the appearance of present-day drugs, honey was conventionally used for treating many diseases. It has broad spectrum anti-biotic, anti-viral and anti-fungal activities, as well as potent anti-oxidant, anti-inflammatory and anti-cancerous activities.
In particular, honey has a long history of use as an anti-inflammatory substance. The ancient Greek physician and pharmacologist Pedanius Dioscorides used honey to treat sunburns and spots on the face, as well as to heal inflammation of the throat and tonsils.
In the modern era, there have been numerous observations of honey applied to inflamed wounds and burns resulting in reduced edema and exudate, providing a soothing effect, and minimizing scarring.
In clinical trials on burns comparing honey with silver sulfadiazine, honey showed decreased levels of the marker for inflammation, decreased levels of malondialdehyde, and a reduced number of inflammatory cells present in biopsy samples.
The numerous reports of anti-inflammatory activity in experimental wounds and burns of animal models, prove that honey has a direct anti-inflammatory activity; the decrease in inflammation is not simply a secondary effect of the antibacterial activity of honey’s removing of inflammation-causing bacteria.
It has been reported, that honey inhibited the production of the inflammatory cytokine TNF-α, inhibited enzymes involved in inflammation such as, cyclooxygenase-1 and cyclooxygenase-2. It also decreased the amount of potent inflammatory compounds including prostaglandins such as PGE2 (prostaglandin E2), PGF2a (prostaglandin F2a) and thromboxane B2 in plasma.
Honey also has remarkable reactive oxygen species (ROS) scavenging activities which might be due to the phenolic content and the lipid metabolism-enhancing effect of honey. This beneficial effect of honey has the ability to counteract the oxidative damage and protect organs and tissues.
Why is honey good for wound healing?
Honey has long been documented as having wound healing properties. The risk of wound infection increases as local conditions favor bacterial invasion and growth. As a dressing on wounds, honey provides a moist healing environment, rapidly clears infection, deodorizes, and reduces inflammation, edema, and exudation. It increases the rate of healing by stimulation of angiogenesis, granulation, and epithelialization.
It is now widely agreed and proven that honey is not just sugar syrup with certain physical properties that make it suitable as a wound dressing material, but that it is a biologic wound dressing with multiple bioactive components that can expedite the healing process.
Can honey positively affect the human microbiome?
The microbiome (also known as microbiota) is a relatively new term that describes a community of microorganisms (such as bacteria, fungi, and viruses) that inhabit a particular environment and specifically, the collection of microorganisms living in or on the human body.
It is estimated that the human body harbors about 100 trillion bacteria and other microbes which means we contain about 10 microorganism cells for each one of our human cells. The majority of these microorganisms reside within the gut which, in the past decade, promoted researchers to inspect the involvement of the gut microbiome in IBD. It is now known that IBD is indeed associated with a gut microbial dysbiosis (i.e. changes in the balance between beneficial to harmful bacteria), including an expansion of facultative anaerobic bacteria of the family Enterobacteriaceae.
Advances in DNA sequencing enabled researchers to entangle the gut microbiota in human health and IBD and beyond the gut bacterial microbiota, expanding insights into other types of bugs. Viruses and fungi such as Candida albicans were also revealed to be increased in IBD.
As mentioned above, honey has the potential to eradicate bacteria and fungi. The question that therefore arises is does honey exert such properties in a specific manner which targets the right bugs? A look into research on this topic reveals a quite compelling set of findings with many studies revealing specific antibiotic properties of honey against harmful bacterial strains that are increased in IBD patients’ gut. It has been proven, that some varieties of honey have anti-fungal activities against some species of yeast including Candida albicans. As a result of these findings, the use of honey for supporting development and maintenance of a healthy gut microbiome in patients, has been rising in recent years.
For example, in 2018 the results of a clinical study that evaluated the effect of honey on diarrhea and fecal microbiota in critically ill tube-fed patients were published. These patients are admitted to the Intensive Care Unit (ICU), and Enteral Nutrition (EN) is the first choice for feeding support. However, it is often complicated by gastrointestinal side effects, such as diarrhea. The objective of this study was to evaluate the effect of honey in enteral diet during occurrence of diarrhea and fecal microbiota in critically ill patients. Patients in the honey group showed a significant increase in the frequency of bifidobacterium in comparison with the control group. In the honey group, there was a considerable reduction in diarrhea. A significant difference was found in length of ICU stay and sequential organ failure assessment score in favor of the honey group.
Another example is a 2017 publication of results of a randomized controlled trial that evaluated a medically-graded honey supplementation formula as a prebiotic for preterm infants. Enterobacter (“bad bug”) stool colonization decreased in the honey supplemented groups, whereas Bifidobacterium bifidum and lactobacilli (“good bacteria”) colony counts increased in the honey groups. Furthermore, it was shown that supplementation of milk formula with medically graded honey was associated with significant increase in weight and head circumference of preterm infants.
So, what about honey and IBD patients?
With this body of evidence of the medicinal properties of honey it is only logical to assume that it can be useful for the alleviation of Chrohn’s disease and Ulcerative Colitis. However, can honey maintain it’s beneficial properites when it is ingested and not applied topically as traditionally done in wounds and burns?
Initial evidence that honey remains potent when it is administered by ingestion came from many studies that evaluated the efficacy of honey in treating gastric ulcers. For example, in experimental rat model of gastric ulcer which was examined both microscopically and macroscopically, honey was shown to have a gastroprotective effect that was similar when compared to omeprazole, which is the standard of care for gastric ulcers.
Another study was carried out to evaluate the effect of honey on gastric mucosa in a rat model. The rats were randomly assigned into two groups, the control group and the honey-fed (test) group. After twenty-two weeks the rats were weighed and tested for gastric ulcers. The results showed that honey significantly reduced ulcer scores as well as caused scanty hemorrhage in the test group compared with increased ulcer scores and multiple hemorrhages in the control group.
These are two examples of many studies that were conducted on animal models that showed clear efficacy of honey in treating gastric ulcers thus proving that consumed honey remains active in the digestive system.
In humans, a cross-sectional study that was conducted on 62 subjects over 18 years. Honey consumption was assessed by a Food Frequency Questionnaire (FFQ) and correlated to cellular tests, showed a positive relation between honey consumption and positive effects on gastric cancer.
Another study evaluated the effect of honey added to oral rehydration solution for treatment of gastroenteritis in infants and children. One hundred infants and children with acute gastroenteritis were randomly assigned to one of two treatment groups, each consisting of 50 patients: Group I received ORS for rehydration (control), and Group II received ORS with honey. In the honey-treated group the frequencies of vomiting and diarrhea were significantly reduced compared to the control group. Also, the recovery time, defined as the number of hours from initiation of treatment to when normal soft stools are passed, with the patient showing normal hydration and satisfactory weight gain, was significantly shortened after honey ingestion. In conclusion, honey added to ORS promoted rehydration of the body and sped recovery from vomiting and diarrhea.
A large study in humans that focuses on the effect of honey on IBD is a complicated scientific task to undertake. Until such a study is performed, the above evidence of conditions that are similar to IBD and work done in animal models suggest that IBD can be another condition that benefits from honey consumption.
For example, in a study done in a mouse inflammatory model of colitis, honey administration was as effective as prednisolone. In another such study honey dose-dependently afforded protection against acetic acid-induced colonic damage. There was almost 100% protection with the highest dose (5 g/kg) was used, while glucose, fructose, sucrose, maltose mixture produced no significant protective effect. Also, honey prevented the depletion of the antioxidant enzymes, reduced glutathione and catalase, and restored the lipid peroxide malondialdehyde to normal levels. In yet another study in colitis mice, the effect of natural honey on induced colitis was assessed by the following parameters in colonic samples: tissue injury, inflammatory infiltration, interleukin-1 and -6, superoxide dismutase and reduced glutathione.
In addition, the expression of TNF alpha and other pro-inflammatory agents were examined. Compared to the control colitis group, the honey-treated group had significantly improved macroscopic and microscopic scores and exhibited the down-regulation of oxidative, inflammatory, and apoptotic markers. In addition, the role of honey in epithelial regeneration was clarified.
To summarize, there is a rapidly increasing number of studies that support the use of honey in aiding the healing process of IBD patients. This natural medicine, which is also tasty and nutritious should be included in the diet of health conscious IBD patients.
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