Natural Standard® Patient Monograph, Copyright © 2014 (www.naturalstandard.com). All Rights Reserved. Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

Background

Honey is a sweet fluid made by honeybees from the nectar of flowers. It is generally safe, but there have been reports of certain toxic types of honey made from plants from the Rhododendron genus and others.

Honey is easy for the body to absorb and use. It contains about 70-80 percent sugar. The rest is water, minerals, and some protein, acids, and other substances. Honey has been used for wounds, skin problems, and various diseases of the stomach and intestines.

The antibacterial effects of honey are well-known. Research has been done on the role of honey in long-term wound management, as well as the treatment of ulcers, burns, Fournier's gangrene (a life-threatening bacterial infection), and diabetes. However, more high-quality studies are needed to make firm conclusions on the use of honey.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

For diabetes, natural unprocessed honey has been taken by mouth in the following doses: 1 gram per kilogram daily for two weeks, then increased to 1.5 gram per kilogram daily for two weeks, then increased to 2 grams per kilogram for two weeks, and finally increased to 2.5 grams per kilogram for another two weeks. A dose of 0.5 milliliters per kilogram of Egyptian clover honey has been taken by mouth daily for 12 weeks.

For exercise performance, 8.8 milliliters per kilogram of a honey-sweetened drink (containing 110 milligrams of sodium per 240 milliliters), was taken by mouth 30 minutes before exercise and at the 10-minute halftime.

For dry mouth caused by radiation treatment, 5 milliliters of honey from wildflowers has been swished in the mouth for five minutes, then swallowed.

For malnutrition, 2 milliliters per kilogram of unprocessed polyfloral honey from Egypt has been diluted in water and taken by mouth daily in two divided doses, together with standard treatment, for two weeks.

For memory, 20 grams of tualang honey (Agro Mas) has been taken by mouth daily for 16 weeks.

For mouth sores caused by radiation treatment, 20 milliliters of honey rinse has been swished in the mouth for up to two minutes, then slowly swallowed, in the following regimens: 15 minutes before and 15 minutes after treatment, and six hours after radiation or at bedtime for up to seven weeks; or four times daily for four weeks of radiation treatment, plus two weeks afterward. Honey rinse has also been swished and spit out 15 minutes before and after radiation therapy, and at bedtime, for up to six weeks. A dose of 20 milliliters of Camellia sinensis honey has been applied to the irradiated areas for 15 minutes before treatment, 15 minutes after treatment, and 6 hours after treatment. Filtered honey or honey gauze (HoneySoft®) has been applied to the skin until healing.

For pneumonia, honey-thick liquid has been taken by mouth for three months.

For surgery, one teaspoon (5 milliliters) of honey has been taken by mouth every hour while awake for 14 days in combination with antibiotics and acetaminophen.

For wounds with pus-buildup, honey has been applied to the affected area, then covered with a honey dressing.

For burns, honey has been applied to the skin directly in doses of 15-30 milliliters every 1-2 days, and covered with a dry, sterile gauze or bandage. Honey has been applied to the skin as a dressing made from gauze filled with honey, and left in place for up to 25 days. Natural honey has been applied to burn wounds twice daily until complete healing.

For skin inflammation and dandruff, a diluted solution of honey and 90 percent warm water has been applied to the scalp for 2-3 minutes, then left for three hours.

For diabetic foot ulcers, a clean, non-sterile pure honey dressing has been applied to the skin daily, then covered with a sterile gauze and bandaged for 7-36 days. Non-sterile gauze filled with clover honey has been applied to the skin for up to three months or until the ulcer has healed.

For Fournier's gangrene, 15-30 milliliters of unprocessed honey has been applied to affected areas.

For high cholesterol, 70-75 grams of honey, sometimes dissolved in 250 milliliters of tap water, has been applied to the skin once daily for 14-30 days.

For catheter-related infections, 3 milliliters of Medihoney has been applied to the skin with each dressing change (three times weekly) until removal of the catheter.

For leg ulcers, 5 grams per 20 centimeters squared of Manuka honey dressing has been applied to the affected area weekly for four weeks. A calcium alginate dressing filled with Manuka honey has been applied for 12 weeks. A dose of 20 milliliters of unprocessed honey has been applied to each wound with each dressing, changed every two days, and given for up to five weeks or until the ulcer heals.

For parasites, a honey-soaked gauze dressing has been applied twice daily for up to six weeks.

For wounds after surgery, crude Yemini honey has been applied twelve times, once every hour, after initial washing.

For itching, a honey barrier cream has been applied to skin folds twice daily for 21 days.

For skin ulcers, multi-layer pressure bandages have been used over honey-filled dressings on the skin. Medihoney and manuka honey dressings have been applied to the skin for eight weeks.

For wound management, honey-filled dressings have been applied to the skin in doses of 20 milliliters of honey on a dressing pad. The following dressings have been applied to the skin: Activon Tulle, which is filled with 20-25 grams of Manuka honey, changed every 2-3 days for four weeks; sterile gauze dipped in unprocessed, undiluted honey; Honey-Soft, applied to wounds for up to 28 weeks; monofloral aloe honey, used on clean wounds once daily until healing; a manuka honey-filled alginate dressing applied twice weekly until healing; and Medihoney™ Antibacterial Wound Gel™, applied daily beginning 10 days after surgery.

For type 2 diabetes and high blood pressure, a 10 milliliter aqueous honey solution has been breathed deeply through the nose for up to 10 minutes. Honey solutions with 30-90 grams of natural, unprocessed honey with 250 milliliters of water have been inhaled.

For sinus infections, 2 milliliters of Manuka honey solution has been sprayed in the nostril once daily in the evening for 30 days.

For eye surgery, 25 percent honey eye drops have been used in the eyes five times daily for seven days before and five days after surgery in addition to Efflumidex®.

Children (under 18 years old)

For cough, 10 grams of eucalyptus honey, Labiatae honey, and citrus honey, and 17 milligrams per milliliter of buckwheat honey have been taken by mouth in single doses up to 30 minutes before bed. A dose of 2.5 milliliters of natural honey has been used as a single dose before bed.

For stomach flu, unprocessed, multifloral honey has been dissolved in oral rehydration solution (ORS) (5 milliliters per 100 milliliters of ORS) and taken by mouth within two hours of preparation.

For malnutrition, 2 milliliters per kilogram of pure, unprocessed multifloral honey solution (7.2 kilocalories per kilogram) plus standard treatment has been taken by mouth daily in two divided doses for two weeks.

For mouth sores caused by radiation treatment, 0.5-15 grams per kilogram of honey has been applied to affected areas three times daily for up to 10 days.

For infected wounds after surgery in newborns, 5-10 milliliters of unprocessed honey has been applied to the wound and covered with a sterile gauze dressing, which have been changed twice daily.

For wound healing, crude, undiluted honey-soaked gauze has been applied to wounds twice daily until healing.

Evidence

These uses have been tested in humans or animals.  Safety and effectiveness have not always been proven.  Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Key to grades

A
Strong scientific evidence for this use
B
Good scientific evidence for this use
C
Unclear scientific evidence for this use
D
Fair scientific evidence against this use (it may not work)
F
Strong scientific evidence against this use (it likely does not work)

Grading rationale

Evidence gradeCondition to which grade level applies
C

Allergies (rhinoconjunctivitis)

There is a lack of evidence on the use of honey for the treatment of allergy symptoms of the eyes and nose. Results are conflicting, with some studies reporting a lack of benefit, while others suggest that honey may reduce redness, swelling, and pus discharge. More high-quality research is needed before a firm conclusion may be made.
C

Burns

Honey has been used to heal burns and prevent infection for thousands of years. It has been used as a wound cover in studies on treating burns and is found in many licensed medical products. There is evidence to support the benefit of honey in healing and sterilizing infected wounds. Promising results show that honey may reduce burn-healing time. However, many studies were conducted by the same researchers, who compared honey dressings to other treatments such as potato. More evidence is needed in this area.
C

Chemotherapy side effects (low white blood cell count)

Honey used together with chemotherapy may be a promising and inexpensive way to prevent low white blood cell count caused by chemotherapy. However, more studies are needed before a conclusion may be made.
C

Cough

Honey may be an inexpensive treatment for cough in children with upper respiratory tract infections (URIs). Although honey may have few side effects, there are conflicting reports. The use of honey may cause cavities, hyperactivity, sleep problems, bacterial infection, or effects on the heart. High-quality research is needed before a conclusion may be made.
C

Diabetes

Honey has been proposed as a potential sugar substitute. Studies report that honey may blood sugar levels, although conflicting results have been found. Further high-quality studies are needed before a conclusion may be made.
C

Diabetic foot ulcers

Honey applied to the skin may be a cost-effective treatment for diabetic foot ulcers, due to its antibacterial and tissue-healing properties. However, further high-quality research is needed before a conclusion may be made.
C

Exercise performance

Research suggests that honey may lack significant effect on exercise performance. Further research is needed before a conclusion may be made.
C

Fournier's gangrene (a life-threatening bacterial infection)

Honey has been studied for the treatment of Fournier's gangrene. However, it is often used with antibiotics, and the effects of honey alone are unclear. More research in this area is needed to reach a firm conclusion.
C

Gastroenteritis (stomach flu)

Honey has been studied in children with the stomach flu, with limited benefit reported. Evidence is limited and more research is needed before a conclusion may be made.
C

Gum disease

Early evidence suggests that honey may help treat plaque and gum disease. More studies are needed to support these findings.
C

Hemorrhoids

Early studies report that a combination therapy containing honey may help reduce bleeding, pain and itching in people with hemorrhoids. However, more high-quality research is needed before a conclusion may be made.
C

Herpes

Early research has found that honey may be effective in treating herpes of the mouth (cold sores and fever blisters), but not herpes of the genitals. More research is needed in this area to draw a conclusion.
C

High blood pressure

Early study suggests that honey may benefit people who have high blood pressure. However, more studies are necessary to confirm these findings.
C

High cholesterol

Evidence is lacking to support the use of honey for high cholesterol. More studies are needed before a conclusion may be made.
C

Infection (catheter-related)

Evidence is mixed on the use of honey to treat catheter-related infections. More high-quality studies are needed before a conclusion may be made.
C

Infertility

Early research has found promising results with a honey-containing combination treatment for infertility. However, further research is needed before a conclusion may be made.
C

Itching

Early research suggests that honey barrier cream may help treat itching and increase comfort. However, more studies are needed before a conclusion may be made.
C

Leg ulcers

Studies have found little to no benefit of honey dressings on leg ulcers. More research is needed to determine the effects of honey on the treatment of ulcers.
C

Malnutrition

Early evidence has found positive effects of honey in terms of increasing weight and the passage of food through the stomach. However, more research is needed before a conclusion may be made.
C

Memory

Early research found that tualang honey may help some aspects of memory in women undergoing menopause. Further research is needed before a conclusion may be made.
C

Mouth sores (caused by radiation treatment)

Honey treatment appears to be promising for preventing mouth sores caused by radiation treatment in people with cancer. However, results are conflicting. Better quality studies are needed before a firm conclusion may be made.
C

Parasites

Early studies found a lack of strong evidence to support the use of honey for parasite infections. Higher quality research is needed before a conclusion may be made.
C

Pneumonia

Early research found a lack of benefit of honey for the treatment of pneumonia. Further studies are needed before a conclusion may be made.
C

Sinus infection

Early research showed a lack of effect of honey in people with fungal-induced sinus infections. Further study is needed before a firm conclusion may be made.
C

Skin graft healing (split thickness)

Currently, there is a lack of evidence on the use of honey for the treatment of split-thickness skin graft. Although early research suggests a shorter healing time, more studies are needed to make a firm conclusion.
C

Skin inflammation (dandruff)

There is limited evidence to support the use of honey in the treatment of dandruff. More research is needed before a conclusion may be made.
C

Surgery

Honey used together with antibiotics and acetaminophen may help improve healing after surgery. However, more research is needed to confirm these promising early results.
C

Ulcers

Honey has been studied for various types of ulcers, including breast ulcers. Honey may reduce pain, odor, and wound size. However, more studies are needed before a firm conclusion may be made.
C

Wound healing

Honey has been commonly used for wound management and the promotion of healing. It has also been used to treat antibiotic-resistant bacteria. Much research has been done on various types of honey, including medical grade honey, on different types of wounds. These types of wounds include long-term ulcers, wounds after surgery, and burns. More high-quality research is needed.

Uses based on tradition or theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Acidosis (too much acid in the body fluids), antacid, anti-aging, antifungal, anti-inflammatory, antimicrobial, antioxidant, antitumor, antiviral, asthma, atopic dermatitis (disorder causing scaly, itchy rashes), boils, cancer prevention, cataracts, coronary artery disease, dehydration, dental cavities, dental procedures (used during surgery), diarrhea, digestion, energy, expectorant (promotes mucus), eye disorders, eye infections/inflammation, fever, fistula (abnormal connection between organs), food uses, herpes virus (causing eye clouding), H. pylori, immune function, infections, inflammation, leprosy, liver protection, pain, sexual performance, skin care, skin disorders, skin conditions, psoriasis (long-term skin disorder), respiratory infections, septicemia (bacterial infection of the blood), sores (pressure sores), stomach disorders, swelling, tinea corporis (a skin infection caused by fungi), tinea cruris (fungal infection of the skin of the groin), tooth disease, vasculitis (blood vessel inflammation).

Interactions

Interactions with Drugs

Honey may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

Honey may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. People taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

Honey may cause low blood pressure. Caution is advised in people taking drugs that lower blood pressure.

Honey may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be altered in the blood, and may cause altered effects or potentially serious adverse reactions. People using any medications should check the package insert, and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.

Honey may also interact with agents taken for the blood, agents taken for the heart, agents taken for the nervous system, agents taken for the skin, agents taken for the stomach or intestines, agents taken for the urinary tract, antibiotics, anticancer agents, antifungal agents, anti-inflammatory agents, anti-seizure agents, cholesterol-lowering agents, dental agents, ethanol, weight loss agents, and wound-healing agents.

Interactions with Herbs and Dietary Supplements

Honey may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

Honey may interfere with the way the body processes certain herbs or supplements using the liver's "cytochrome P450" enzyme system. As a result, the levels of other herbs or supplements may be altered in the blood. It may also alter the effects that other herbs or supplements possibly have on the P450 system.

Honey may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

Honey may cause low blood pressure. Caution is advised in people taking herbs or supplements that lower blood pressure.

Honey may also interact with antibacterials, anticancer herbs and supplements, antifungal herbs and supplements, anti-inflammatory herbs and supplements, antioxidants, anti-seizure herbs and supplements, cholesterol-lowering herbs and supplements, dental herbs and supplements, herbs and supplements taken for the blood, herbs and supplements taken for the heart, herbs and supplements taken for the nervous system, herbs and supplements taken for the skin, herbs and supplements taken for the stomach or intestines, herbs and supplements taken for the urinary tract, weight loss herbs and supplements, and wound-healing herbs and supplements.

Methodology

This information is based on a systematic review of scientific literature, and was peer-reviewed and edited by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Monograph methodology

Related terms

Acacia honey, adular, älskling, amour, andromedotoxin-containing honey, Apis mellifera (honey bee), apitherapy product, azaleas honey, bee products, blackberry honey, blueberry honey, borage honey, buckwheat honey, chou, cielo, citrus sinensis osbeck, clarified honey, clover honey, coisa doce, deli bal, endulzar, falar docemente, feng mi, flavonoids, grayanotoxin honey, hachimitsu, honeydew, honig, honing, honingkleur, honung, HY-1, iets beeldigs, jelly bush honey, kamahi honey, kanuka honey, lastig portret, lavender honey, Leptospermum honey, lief doen, liefje (aanspreekvorm), ling honey, ljuvhet, mad honey, madu, Manuka honey, mel, mel depuratum, melliferous products, miel, miel blanc, miele, mi vida, moeilijk probleem, mooi praten, mountain laurel honey, namorado, nectar, Nigerian citrus honey, nodding thistle honey, orange blossom honey, pasture honey, purified honey, rata honey, raw honey, rewarewa honey, rhododendron honey, schatz, smöra, sourwood honey, strained honey, sunflower honey, tala smickrande, tansy ragwort honey, Tasmanian leatherwood honey, tawari honey, tesoro, toppensak, toxic honey, tupelo honey, tutan bal, US IX, versuikeren, vipers bugloss honey, vleien, wild thyme honey, zoet maken.

Combination product examples: Hydromel (honey and water); mead (fermented honey with wine-grade yeast).

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Avoid in people with a known allergy or sensitivity to celery, pollen, or other bee-related allergies, and when honey made from plants in the Rhododendron genus is used, due to toxicity.

Allergic reactions have been reported after honey use, including asthma, cough, difficulty swallowing, hives, lip or tongue inflammation and itching, lung inflammation, shortness of breath, swelling under the skin, voice changes, and wheezing, as well as severe life-threatening reactions.

Side Effects and Warnings

Honey is likely safe when taken by mouth in food amounts, or when recommended doses are used. Honey is possibly safe when applied to the skin.

Honey may cause abnormal or absent heart rhythms, blurred vision, changes in taste, changes in white blood cell count, chest pain, diarrhea, double vision, drowsiness, faintness, fatigue, feeling of burning or tingling on the skin, fever, heart attack, honey intoxication (sweating or weakness when honey produced from Rhododendron plants is used), hyperactivity, impaired consciousness, increased saliva, lung problems, mild paralysis, musculoskeletal problems, minor scarring, nausea, nervousness, pain, seizures, sleep problems, sweating, tooth decay, upset stomach, urinary tract infections, vomiting, weight loss, and wound dryness or infection.

Honey may affect blood sugar levels. Caution is advised in people with diabetes or low blood sugar, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood sugar levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.

Honey may increase the risk of bleeding. Caution is advised in people with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

Honey may cause low blood pressure. Caution is advised in people taking drugs or herbs and supplements that lower blood pressure.

Honey may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system.

Use cautiously when the origin of the honey is unknown, due to possible toxicity.

Use cautiously in people who have heart conditions, nervous system disorders, and stomach or intestine conditions.

Use cautiously in people who are taking antibiotics, heart medications, nervous system agents, stomach or intestine medications, and weight loss agents.

Avoid in children under 12 months of age.

Avoid in people with known allergy or sensitivity to celery, pollen, or other bee-related allergies, and when honey made from plants in the Rhododendron genus is used, due to toxicity.

Note: Honey that is contaminated with the bacteria Clostridium botulinum may cause poisoning in infants and young children. However, this is not a danger for older children and adults.

Pregnancy and Breastfeeding

There is a lack of scientific evidence on the use of honey during pregnancy or breastfeeding. Honey may contain contaminants that may be harmful to pregnant or breastfeeding women, or to unborn babies.

Selected references

  1. Abdulrhman MM, El-Hefnawy MH, Aly RH, et al. Metabolic effects of honey in type 1 diabetes mellitus: a randomized crossover pilot study. J Med Food 2013;16(1):66-72.
  2. Anthimidou E and Mossialos D. Antibacterial activity of Greek and Cypriot honeys against Staphylococcus aureus and Pseudomonas aeruginosa in comparison to manuka honey. J Med Food 2013;16(1):42-47.
  3. Badrasawi MM, Shahar S, Abd Manaf Z, et al. Effect of Talbinah food consumption on depressive symptoms among elderly individuals in long term care facilities, randomized clinical trial. Clin Interv.Aging 2013;8:279-285.
  4. Bayram NA, Keles T, Durmaz T, et al. A rare cause of atrial fibrillation: mad honey intoxication. J Emerg.Med 2012;43(6):e389-e391.
  5. Chatzoulis G, Chatzoulis K, Spyridopoulos P, et al. Salvage of an infected titanium mesh in a large incisional ventral hernia using medicinal honey and vacuum-assisted closure: a case report and literature review. Hernia. 2012;16(4):475-479.
  6. Hind J, Divyak E, Zielinski J, et al. Comparison of standardized bariums with varying rheological parameters on swallowing kinematics in males. J Rehabil.Res Dev 2012;49(9):1399-1404.
  7. Jansen SA, Kleerekooper I, Hofman ZL, et al. Grayanotoxin poisoning: 'mad honey disease' and beyond. Cardiovasc.Toxicol. 2012;12(3):208-215.
  8. Jull AB, Walker N, and Deshpande S. Honey as a topical treatment for wounds. Cochrane.Database.Syst.Rev. 2013;2:CD005083.
  9. Karali Y, Demirkaya M, and Sevinir B. Use of complementary and alternative medicine in children with cancer: effect on survival. Pediatr.Hematol.Oncol 2012;29(4):335-344.
  10. Lennerz C, Jilek C, Semmler V, et al. Sinus arrest from mad honey disease. Ann.Intern.Med 11-20-2012;157(10):755-756.
  11. Oduwole O, Meremikwu MM, Oyo-Ita A, et al. Honey for acute cough in children. Cochrane.Database.Syst.Rev. 2012;3:CD007094.
  12. Oguzturk H, Ciftci O, Turtay MG, et al. Complete atrioventricular block caused by mad honey intoxication. Eur.Rev.Med Pharmacol Sci 2012;16(12):1748-1750.
  13. Sayin MR, Karabag T, Dogan SM, et al. Transient ST segment elevation and left bundle branch block caused by mad-honey poisoning. Wien Klin Wochenschr. 2012;124(7-8):278-281.
  14. Vlcekova P, Krutakova B, Takac P, et al. Alternative treatment of gluteofemoral fistulas using honey: a case report. Int Wound.J 2012;9(1):100-103.
  15. Wagner JB and Pine HS. Chronic cough in children. Pediatr.Clin North Am 2013;60(4):951-967.

This evidence-based monograph was prepared by The Natural Standard Research Collaboration

www.naturalstandard.com