Are there any health benefits of honey ?

What is Honey ?

Honey is a sweet, viscous food substance stored in honeycombs by the bees Apis indica, Apis mellifera, Apis dorsata (Rock Bee) and other species of Apis of family Apidae and some related insects ¹⁾. Honey is produced by bees collecting nectar for use as sugars consumed to support metabolism of muscle activity during foraging or to be stored as a long-term food supply. Nectar is a thin, easily spoiled sweet liquid that is changed (“ripened”) by the honey bee to a stable, high-density, high-energy food. During foraging, bees access part of the nectar collected to support metabolic activity of flight muscles, with the majority of collected nectar destined for regurgitation, digestion, and storage as honey. In cold weather or when other food sources are scarce, adult and larval bees use stored honey as food. Bees produce honey from the sugary secretions of plants (floral nectar) or other insects (aphid honeydew) through regurgitation, enzymatic activity, and water evaporation, and store it in wax structures called honeycombs ²⁾, ³⁾. Honey is the only sweetener obtained from animal source ⁴⁾.

Honey is collected from wild bee colonies, or from hives of domesticated bees, a practice known as beekeeping. And honey is often named according to the geographical location where the honey is produced, the floral source of the honey or the trees on which the hives are found ⁵⁾.

Honey, the sweet liquid produced by honeybees, is composed of about 40% fructose, in contrast to the 50% fructose in table sugar and 40-90% fructose in high-fructose corn syrup ⁶⁾.

Honey does have more calories per teaspoon (5 ml or 4 grams) than table sugar, with 21 calories per teaspoon in honey vs. 16 in table sugar.

The typical composition of honey is: Fructose (40-50%), Glucose (32-37%) and sucrose (1.2%) in water (13-20%).

One 1980 study found that mixed floral honey from several United States regions typically contains:

• Fructose: 38.2%
• Glucose: 31.3%
• Maltose: 7.1%
• Sucrose: 1.3%
• Water: 17.2%
• Higher sugars: 1.5%
• Ash: 0.2%
• Other/undetermined: 3.2%

Although honey is a high carbohydrate food, its glycemic index varies within a wide range from 32 to 85, depending on the botanical source. Honey also contains small amounts of proteins, enzymes, amino acids, minerals, trace elements, vitamins, aroma compounds and polyphenols ⁷⁾.

Because of its unique composition and chemical properties, honey is suitable for long-term storage and the key to honey preservation is limiting access to humidity. In its cured state, honey has a sufficiently high sugar content to inhibit fermentation. If exposed to moist air, its hydrophilic properties pull moisture into the honey, eventually diluting it to the point that fermentation can begin.

Dextrose (glucose), a major sugar in honey, can spontaneously crystallize from any honeys in the form of its monohydrate. This sometimes occurs when the moisture level in honey is allowed to drop below a certain level.

Honey is one of the oldest natural sweeteners; honey is sweeter than sugar. Depending on the plant source, honey can have a range of flavors, from dark and
strongly flavored, to light and mildly flavored. Colors of honey form a continuous range from very pale yellow through ambers to a darkish red amber to nearly black ⁸⁾. The flavor and aroma of honey vary even more than the color. Although there seems to be a characteristic “honey flavor,” almost an infinite number of aroma and flavor variations can exist. As with color, the variations appear to be governed by the floral source. In general, light-colored honey is mild in flavor and a darker honey has a more pronounced flavor. Exceptions to the rule sometimes endow a light honey with very definite specific flavors. Since flavor and aroma judgments are personal, individual preference will vary, but with the tremendous variety available, everyone should be able to find a favorite honey ⁹⁾. The variations are almost entirely due to the plant source of the honey, although climate may modify the color somewhat through the darkening action of heat. Traditionally honey has been use in food has been as sweetening agent several aspects of its use indicate that honey also functions as food preservative ¹⁰⁾. Honey also contains tiny amounts of several compounds thought to function as antioxidants, including chrysin, pinobanksin, Vitamin C, catalase, and pinocembrin ¹¹⁾.

Honey has also been used as an antiseptic and applied to burns and wounds. It is a common ingredient in several cough mixtures, Cough drops and used in the preparation of creams, lotions, soft drinks and candies ¹²⁾, ¹³⁾.

Raw honey contains small amounts of enzymes, minerals and vitamins. It’s also said that consuming local honey can help build up your immunity to common allergens in your area – by introducing your body to the bee pollen.

Honey Sugars

Honey is essentially a highly concentrated water solution of two sugars, glucose and fructose, with small amounts of at least 22 other more complex sugars. Honey solids is 95 to 99.9 percent sugars and the identity of these sugars has been studied for many years. Sugars are classified according to their size or the complexity of the molecules of which they are made. Dextrose (glucose) and levulose (fructose), the main sugars in honey, are simple sugars, or monosaccharides, and are the building blocks for the more complex honey sugars. Dextrose and levulose account for about 85 percent of the solids in honey.

Until the middle of this century, the sugars of honey were thought to be a simple mixture of glucose, fructose, sucrose (table sugar), and an ill-defined carbohydrate material called “honey dextrin.” With the advent of new methods for separating and analyzing sugars, workers in Europe, the United States, and Japan have identified many sugars in honey after separating them from the complex honey mixture. This task has been accomplished using a variety of physical and chemical methods.

Glucose and fructose are still by far the major sugars in honey, but 22 others have been found. All of these sugars are more complex than the monosaccharides, glucose and fructose. Ten disaccharides have been identified: sucrose, maltose, isomaltose, maltulose, nigerose, turanose, kojibiose, laminaribiose, a, B-trehalose, and gentiobiose. Ten trisaccharides are present: melezitose, 3-a-isomaltosylglucose, maltotriose, l-kestose, panose, isomaltotriose, erlose, theanderose, centose, and isopanose. Two more complex sugars, isomaltotetraose and isomaltopentaose, have been identified. Most of these sugars are present in quite small quantities.

Most of these sugars do not occur in nectar, but are formed either as a result of enzymes added by the honeybee during the ripening of honey or by chemical action in the concentrated, somewhat acid sugar mixture we know as honey.

Honey Enzymes

One of the characteristics that sets honey apart from all other sweetening agents is the presence of enzymes. These arise from the bee, pollen, nectar, or even yeasts or micro-organisms in the honey. Those most prominent are added by the bee during the conversion of nectar to honey. Enzymes are complex protein materials that under mild conditions bring about chemical changes, which may be very difficult to accomplish in a chemical laboratory without their aid. The changes that enzymes bring about throughout nature are essential to life.

Some of the most important honey enzymes are invertase, diastase, and glucose oxidase.

Invertase, also known as sucrase or saccharase splits sucrose into its constitutent simple sugars, glucose and fructose. Other more complex sugars have been found recently to form in small amounts during this action and in part explain the complexity of the minor sugars of honey. Although the work of invertase is completed when honey is ripened, the enzyme remains in the honey and retains its activity for some time. Even so, the sucrose content of honey never reaches zero. Since the enzyme also synthesizes sucrose, perhaps the final low value for the sucrose content of honey represents an equilibrium between splitting and forming sucrose.

Diastase (amylase) digests starch to simpler compounds but no starch is found in nectar. What its function is in honey is not clear. Diastase appears to be present in varying amounts in nearly all honey and it can be measured. It has probably had the greatest attention in the past, because it has been used as a measure of honey quality in several European countries.

Glucose oxidase converts dextrose to a related material, a gulconolactone, which in turn forms gluconic acid, the principal acid in honey. Since this enzyme previously was shown to be in the pharyngeal gland of the honey bee, this is probably the source. Here, as with other enzymes, the amount varies in different honeys. In addition to gluconolactone, glucose oxidase forms hydrogen peroxide during its action on dextrose, which has been shown to be the basis of the heat-sensitive antibacterial activity of honey. The hydrogen peroxide has been described as the main compound responsible by the antibacterial activity of honeys ¹⁴⁾. The hydrogen peroxide is a potent antimicrobial agent, produced mainly during glucose oxidation catalyzed by the action of the bee enzyme, glucose oxidase, which is introduced into honey during nectar harvesting by bees. The hydrogen peroxide concentration in honey is determined by the rate of its production by glucose oxidase and its destruction by catalases. Thus, the hydrogen peroxide levels in different honeys may differ considerably from honey to honey. The hydrogen peroxide content in honey is about 900-fold lower than the concentration commonly used for disinfecting medical equipments ¹⁵⁾.

Indeed, honeys with a high concentration of hydrogen peroxide have higher antibacterial activity. However, honey is a complex chemical milieu composed of over 100 different compounds (including antioxidants and traces of transition metals), which can interact with the hydrogen peroxide, affecting the oxidizing activity of the honey. Consequently, this interaction may result in increase or decrease of the antimicrobial activity of honey ¹⁶⁾.

Other enzymes are reported to be present in honey, including catalase and an acid phosphatase. All the honey enzymes can be destroyed or weakened by heat.

Honey Proteins and Amino Acids

It will be noted in table 2 that the amount of nitrogen in honey is low. Recent work has shown that only 40 to 65 percent of the total nitrogen in honey is in protein, and some nitrogen resides in substances other than proteins, namely the amino acids. Of the 8 to 11 proteins found in various honeys, 4 are common to all and appear to originate in the bee, rather than the nectar. Little is known of many proteins in honey, except that the enzymes fall into this class.

The presence of proteins causes honey to have a lower surface tension than it would have otherwise, which produces a marked tendency to foam and form scum and encourages formation of fine air bubbles. Beekeepers familiar with buckwheat honey know how readily it tends to foam and produce surface scum, which is largely due to its relatively high protein content.

The amino acids are simple compounds obtained when proteins are broken down by chemical or digestive processes. They are the “building blocks” of the proteins. Several of them are essential to life and must be obtained in the diet. The quantity of free amino acids in honey is small and of no nutritional significance. Breakthroughs in the separation and analysis of minute quantities of material (chromatography) have revealed that various honeys contain 11 to 21 free amino acids. Proline, glutamic acid, alanine, phenylalanine, tyrosine, leucine, and isoleucine are the most common, with proline predominating.

Amino acids are known to react slowly, or more rapidly by heating, with sugars to produce yellow or brown materials. Part of the darkening of honey with age or heating may be due to this.

Honey Acids

The flavor of honey results from the blending of many “notes,” not the least being a slight tartness or acidity. The acids of honey account for less than 0.5 percent of the solids, but this level contributes not only to the flavor, but is in part responsible for the excellent stability of honey against microorganisms. Several acids have been found in honey, gluconic acid being the major one. It arises from dextrose through the action of an enzyme called glucose oxidase. Other acids in honey are formic, acetic, butyric, lactic, oxalic, succinic, tartaric, maleic, pyruvic, pyroglutamic, a-ketoglutaric, glycollic, citric, malic, 2- or 3-phosphoglyceric acid, a– or B-glycerophosphate, and glucose 6-phosphate.

Honey Nutrition Content

Table 1. 100% Raw Honey

[Source: United States Department of Agriculture, Agriculture Research Service. USDA Food Composition Databases. ¹⁷⁾]

Note: Raw honey is as it exists in the beehive or as obtained by extraction, settling, or straining, without adding heat (although some honey that has been “minimally processed” is often labeled as raw honey). Raw honey contains some pollen and may contain small particles of wax.

Table 2. Honey Nutritional Content

[Source: United States Department of Agriculture, Agriculture Research Service. USDA Food Composition Databases. ¹⁸⁾]

Table 3. Organic Honey Nutritional Content

[Source: United States Department of Agriculture, Agriculture Research Service. USDA Food Composition Databases. ¹⁹⁾]

Table 4. Clover Honey Nutritional Content

[Source: United States Department of Agriculture, Agriculture Research Service. USDA Food Composition Databases. ²⁰⁾]

Table 5. Carbohydrate composition of honey types

Number of samples	Floral type	Glucose	Fructose	Sucrose	Maltose	Higher sugars
		Percent	Percent	Percent	Percent	Percent
23	Alfalfa	33.40	39.11	2.64	6.01	.89
25	Alfalfa-sweetclover	33.57	39.29	2.00	6.30	.91
5	Aster	31.33	37.55	.81	8.45	1.04
3	Basswood	31.59	37.88	1.20	6.86	1.44
3	Blackberry	25.94	37.64	1.27	11.33	2.50
5	Buckwheat	29.46	35.30	.78	7.63	2.27
4	Buckwheat, wild	30.50	39.72	.79	7.21	.83
26	“Clover“	32.22	37.84	1.44	6.60	1.39
3	Clover, alsike	30.72	39.18	1.40	7.46	1.55
3	Clover, crimson	30.87	38.21	.91	8.59	1.63
3	Clover, Hubam	33.42	38.69	.86	6.23	.74
10	Cotton	36.74	39.28	1.14	4.87	.50
3	Fireweed	30.72	39.81	1.28	7.12	2.06
6	Gallberry	30.15	39.85	.72	7.71	1.22
3	Goldenrod	33.15	39.57	.51	6.57	.59
2	Heartsease	32.98	37.23	1.95	5.71	.53
2	Holly	25.65	38.98	1.00	10.07	2.16
3	Honeydew, cedar	25.92	25.16	.68	6.20	9.61
5	Honeydew, oak	27.43	34.84	.84	10.45	2.16
2	Horsemint	33.63	37.37	1.01	5.53	.73
3	Locust, black	28.00	40.66	1.01	8.42	1.90
3	Loosestrife, purple	29.90	37.75	.62	8.13	2.35
3	Mesquite	36.90	40.41	.95	5.42	.35
4	Orange, California	32.01	39.08	2.68	6.26	1.23
13	Orange, Florida	31.96	38.91	2.60	7.29	1.40
4	Raspberry	28.54	34.46	.51	8.68	3.58
3	Sage	28.19	40.39	1.13	7.40	2.38
3	Sourwood	24.61	39.79	.92	11.79	2.44
4	Star-thistle	31.14	36.91	2.27	6.92	2.74
8	Sweetclover	30.97	37.95	1.41	7.75	1.40
3	Sweetelover, yellow	32.81	39.22	2.94	6.63	.97
4	Tulip tree	25.85	34.65	.69	11.57	2.96
5	Tupelo	25.95	43.27	1.21	7.97	1.11
7	Vetch	31.67	38.33	1.34	7.23	1.83
9	Vetch, hairy	30.64	38.20	2.03	7.81	2.08
12	White clover	30.71	38.36	1.03	7.32	1.56
		Percent	Percent	Percent	Percent	Percent

[Source ²¹⁾]

Health Benefits of Honey

The published literature indicates that honey has antimicrobial ²²⁾, anti-inflammatory ²³⁾, antioxidant ²⁴⁾, ²⁵⁾, ²⁶⁾, ²⁷⁾ and antimutagenic ²⁸⁾ properties, that it expedites wound healing ²⁹⁾, ³⁰⁾, ³¹⁾ and that it has antitumor ³²⁾, ³³⁾, ³⁴⁾ and antidiabetic effects.

The composition and physicochemical properties of honey are variable depending on its floral source ³⁵⁾.

A few notes of caution: because honey can carry small amounts of the botulism bacterium, health experts advise not giving it to children under 1 year of age ³⁶⁾. There also have been rare reports of certain types of honey having a toxic effect on humans and animals, specifically honey made from the nectar of Rhododendrons ³⁷⁾, but it is generally considered safe.

Honey as a topical treatment for acute and chronic wounds

In a Cochrane Review published in March 2015 that involve studies published up to October 2014, of the 26 studies reviewed involving 3,011 people where honey was compared with many different treatments on many different kinds of wounds ³⁸⁾. The review authors found the differences in wound types and comparators make it impossible to draw overall conclusions about the effects of honey on wound healing. The evidence for most comparisons is low or very low quality. This was largely because of problems with the design of some of the studies made their results unreliable and for many outcomes there was only a small amount of information available. In some cases the results of the studies varied considerably. However, there is high quality evidence that honey heals partial thickness burns around 4 to 5 days more quickly than conventional dressings ³⁹⁾. And there is moderate quality evidence that honey is more effective than antiseptic followed by gauze for healing wounds infected after surgical operations ⁴⁰⁾. The authors conclusion was that honey appears to heal partial thickness burns more quickly than conventional treatment (which included polyurethane film, paraffin gauze, soframycin-impregnated gauze, sterile linen and leaving the burns exposed) and infected post-operative wounds more quickly than antiseptics and gauze ⁴¹⁾. These finding on the benefits of honey in healing burn wounds more quickly and are more likely to heal compared with those treated with topical antibiotics, were further supported by their most recent review published 12 July 2017 ⁴²⁾.

Honey for acute cough in children

In another Cochrane Review published in December 2014, the reviewers wanted to know if honey can reduce cough symptoms caused by bacteria and viruses in children ⁴³⁾. The small trials showed that honey it is not better than dextromethorphan (common over-the-counter cough suppressant cold medicine that works by suppressing the cough center of the brain) but may be better than ‘no treatment’ and placebo (a liquid that looks like and taste like honey, but is not honey) for cough relief. The evidence also showed that honey may be better than placebo in reducing worrying as a result of cough. However, it was no different to ‘no treatment’. Honey allowed children and parents to sleep moderately better at night than ‘no treatment’ ⁴⁴⁾.

Honey As a Natural Immune Booster

Honey stimulates inflammatory cytokine production from monocytes ⁴⁵⁾. Manuka, pasture, and jelly bush honey were found to significantly increase TNF-α, IL-1β, and IL-6 release from MM6 cells (and human monocytes) when compared with untreated and artificial honey-treated cells ⁴⁶⁾. A 5.8 kDa component of manuka honey was found to stimulate cytokine production from immune cells via TLR4 ⁴⁷⁾. Honey stimulates antibody production during primary and secondary immune responses against thymus-dependent and thymus-independent antigens in mice injected with sheep red blood cells and E. coli antigen ⁴⁸⁾. Consumption of 80 g daily of natural honey for 21 days showed that prostaglandin levels compared with normal subjects were elevated in patient with AIDS ⁴⁹⁾. Natural honey has been shown to decrease prostaglandin level, elevated NO production in patients with a long history of AIDS ⁵⁰⁾. It was reported that oral intake of honey augments antibody productions in primary and secondary immune responses against thymus-dependent and thymus-independent antigens ⁵¹⁾.

These studies suggest that daily consumption of honey improves one’s immune system.

Honey As Natural Anti-Inflammatory Agent

In routine everyday life, our cells may be injured by irritants from outside or within our bodies (by microbes or nonmicrobes). Cellular/molecular injuries result in inflammatory response, the body defense mechanisms in trying to rid of the irritants. In general inflammatory responses are beneficial and protective to us, but at times, inflammatory responses are detrimental to health. Honey is a potent anti-inflammatory agent. Infants suffering from diaper dermatitis improved significantly after topical application of a mixture containing honey, olive oil, and beeswax after 7 days ⁵²⁾. Honey provides significant symptom relief of cough in children with an upper respiratory tract infection (URTI) ⁵³⁾. It has been shown to be effective in management of dermatitis and Psoriasis vulgaris ⁵⁴⁾. Eight out of 10 patients with dermatitis and five of eight patients with psoriasis showed significant improvement after 2 weeks on honey-based ointment ⁵⁵⁾. Honey at dilutions of up to 1 : 8 reduced bacterial adherence from 25.6  ±  6.5 (control) to 6.7  ±  3.3 bacteria per epithelial cell in vitro ⁵⁶⁾. Volunteers who chewed “honey leather” showed that there were statistically highly significant reductions in mean plaque scores in the manuka honey group compared to the control group suggesting a potential therapeutic role for honey for gingivitis, periodontal disease ⁵⁷⁾, mouth ulcers, and other problems of oral health ⁵⁸⁾.

A case report of a patient who had chronic dystrophic epidermolysis bullosa for 20 years healed with honey impregnated dressing in 15 weeks ⁵⁹⁾ after conventional dressings and creams failed. This illustrates the usefulness of honey as an anti-inflammatory agent. Chronic inflammatory process has risk of cancer development.

Honey As Natural Antimicrobials

Everyday we are exposed to all kinds of microbial insults from bacteria, viruses, parasites, and fungi. Honey is a potent natural antimicrobial. The most common infections humans get are from staphylococcal infection. Antibacterial effect of honey is extensively studied. The antimicrobial activity of honey is attributed largely to osmolarity, pH, hydrogen peroxide production and the presence of other phytochemical components e.g. methylglyoxal ⁶⁰⁾. In vivo, such activity may occur due to a synergistic relationship between any of these components rather than a single entity. The bactericidal mechanism is through disturbance in cell division machinery ⁶¹⁾. The minimum inhibitory concentration for Staphylococcus aureus by A. mellifera honey ranged from 126.23 to 185.70 mg/ml ⁶²⁾. Honey is also effective against coagulase-negative staphylococci ⁶³⁾. Local application of raw honey on infected wounds reduced signs of acute inflammation ⁶⁴⁾, thus alleviating symptoms. Antimicrobial activity of honey is stronger in acidic media than in neutral or alkaline media ⁶⁵⁾. The potency of honey is comparable to some local antibiotics. Honey application into infective conjunctivitis reduced redness, swelling, pus discharge, and time for eradication of bacterial infections⁶⁶⁾. When honey is used together with antibiotics, gentamycin, it enhances anti-Staphylococcus aureus activity, by 22% ⁶⁷⁾. When honey is added to bacterial culture medium, the appearance of microbial growth on the culture plates is delayed ⁶⁸⁾. Mycobacteria did not grow in culture media containing 10% and 20% honey while it grew in culture media containing 5%, 2.5%, and 1% honey, suggesting that honey could be an ideal antimycobacterial agent ⁶⁹⁾ at certain concentrations.

Honey is also effective in killing hardy bacteria such as Pseudomonas aeruginosa and could lead to a new approach in treating refractory chronic rhinosinusitis ⁷⁰⁾. Daily consumption of honey reduces risk of chronic infections by microorganisms. Chronic infections have risk for cancer development.

The effectiveness of honey is best when used at room temperature. Heating honey to 80 degrees for 1 hour decreased antimicrobial activity of both new and stored honey. Storage of honey for 5 years decreased its antimicrobial activity, while ultraviolet light exposure increased its activity against some of microorganisms ⁷¹⁾.

Honey also has been shown to have antiviral properties. In a comparative study topical application of honey was found to be better than acyclovir treatment on patients with recurrent herpetic lesions ⁷²⁾. Two cases of labial herpes and one case of genital herpes remitted completely with the use of honey while none with acyclovir treatment ⁷³⁾.

What is Manuka Honey ?

Manuka honey is a monofloral honey produced by bees fed on the flowers of the New Zealand and/or Australian Manuka bush (Leptospermum scoparium) ⁷⁴⁾. Manuka honey contains a significant higher concentration of the 1,2-dicarbonyl compound methylglyoxal, which may account for its antibacterial activity; this agent may release small amounts of hydrogen peroxide which may also contribute to its antibacterial activity. The presence of methylglyoxal in manuka honey contributes to its uniqueness and has been termed the unique manuka factor (UMF®). To date there are many publications reporting both in vitro and in vivo on the therapeutic properties of manuka honey, which have confirmed its activity against a wide range of medically important bacteria including methicillin-resistant Staphylococcus aureus  ⁷⁵⁾, ⁷⁶⁾. As the potential role for honey as a topical agent to manage surgical site or wound infections is increasingly acknowledged ⁷⁷⁾, ⁷⁸⁾, ⁷⁹⁾, Manuka honey has also been reported to stimulate the formation of new blood capillaries and the growth of fibroblasts and epithelial cells when applied topically to wounds ⁸⁰⁾.

Table 6. 100% Raw Manuka Honey

[Source: United States Department of Agriculture, Agriculture Research Service. USDA Food Composition Databases. ⁸¹⁾]

Manuka Honey Benefits

Published data on Manuka honey indicate that it has numerous therapeutic properties against several ailments ⁸²⁾, ⁸³⁾, ⁸⁴⁾. Manuka honey is already extensively studied and characterised.

What is Clover Honey ?

As mentioned earlier, honey is named for the most prevalent source of nectar/pollen in the area where bees forage for their nectar. If the bees are mainly surrounded by a particular type of plant, it will typically have a taste that differentiates it from other honey varieties. Clover honey is honey that come from a majority of clover. Clover is simply the name of the flower the bees gathered the nectar to make the honey from. These plants are extremely abundant, concentrated in large patches, and when one is done producing nectar, the next one is in bloom. The clover flowers the nectar was gathered from can have an extraordinary effect on the flavor of the honey. Clover honey varies in color from very white to extra light amber and has a mild, delicate flavor. Most honeys sold in the supermarket are a clover honey or a blend.

Clover honey’s nutrient profile is highly variable, however, depending on whether the bees fed on other types of plants, whether the honey was processed and how long it was stored.