The following article was taken from the Spring 2000 Issue, Vol. 7, No. 1

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Establishing Honey as a Recognized Medicine

by P. C. Molan

Honey is starting to be accepted as a reputable and effective therapeutic agent by both practitioners of conventional medicine and the general public. This has been a consequence of increasing public awareness of both good clinical results from the use of honey for therapy and rational explanations for its therapeutic actions. To further establish the status of honey as a medicine, there must be a combination of written and laboratory research to obtain evidence and explanations for its therapeutic effectiveness, and medical practitioners and the general public must be educated about the results of this research. Increasingly the medical profession requires evidence-based decisions on therapeutic options.

There are many reports in medical literature of honey being used effectively as a dressing for wounds, burns, and skin ulcers: inflammation, swelling, and pain are quickly reduced; malodor is reduced; shedding of dead tissue is induced so that surgical removal is unnecessary; healing occurs rapidly with minimal scarring and no need for skin grafting; and infection clears quickly. Honey also creates a moist environment that promotes the growth of new skin tissue. Although a moist environment also favors the growth of infecting bacteria, the antimicrobial properties of honey prevent infection. Unlike other antiseptics, however, honey is not harmful to tissues, and actually speeds up the growth of new tissue to heal the wound.

Most practitioners have not been aware of a marked variation in the potency of antimicrobial activity of honey. It varies mainly because of differences in the amount of hydrogen peroxide generated, but sometimes because of additional antimicrobial components from specific plant sources. Honey from manuka (Leptospermum scoparium), for example, has an exceptionally high level of plant-derived antibacterial activity; the most common wound-infecting species of bacteria, Staphylococcus aureus, has been found to be particularly sensitive to it.

All common wound-infecting species of bacteria have been tested as sensitive to both types of antibacterial activity in honey, chemical and anaerobic. Clearing bacterial infection from a wound is essential to allow the healing process to occur. Recent tests carried out in collaboration with the Central Public Health Laboratory in London, UK, on many strains of multi-antibiotic-resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Acinetobacter baumarii have shown that these bacteria have no resistance to honey. (These "superbugs" are a serious clinical problem because infections by them often cannot be treated at all with antibiotics.)

Honeys selected for mid-range levels of antibacterial activity have been used in all tests done to determine the sensitivity of wound-infecting bacteria species to honey. These honeys have tested as being ten to fifty times more active than necessary to completely suppress the growth of the bacteria tested. Although this may suggest that other less potent honeys would be suitable for use on wounds, it should be taken into account that honey is diluted by serum exuding from wounds, and that the depth of penetration to an effective level of antibacterial activity depends upon the strength of the surface activity.

Hydrogen peroxide generated in honey is responsible for some of the other therapeutic effects observed in wound treatment. It stimulates growth of the cells responsible for replacing damaged tissue and has an insulin-like effect on cells that should be beneficial to the healing process, since insulin aids healing when applied to wounds. Hydrogen peroxide also stimulates the development of new blood vessels, a key first step in tissue regeneration. It serves as a messenger between different types of cells active in the body's immune system response to infection and activates protein-digesting enzymes in tissues involved in the healing process. Although hydrogen peroxide is generally an inflammatory substance, the enzymatic generation in honey produces only low levels of the chemical. Antioxidants in honey also prevent the formation of free radicals, which are responsible for the inflammatory effect. They are the likely explanation of the anti-inflammatory action of honey.

The acidity of honey and its content of sugars and other nutrients are also important to the healing process. Acidification of a wound prevents ammonia produced by bacterial metabolism from harming body tissues. It also promotes healing by increasing oxygen release from the blood's hemoglobin, oxygenation of the tissues being essential for growth of new tissue.

Nutrient supply is another important factor for growth of new tissue, usually limited because of damage from injury or infection to the underlying circulation. Honey supplies the cells with a wide range of vitamins, amino acids, and minerals, and supplies white blood cells with the glucose necessary for their "respiratory burst" that enables them to destroy bacteria. Furthermore, it supplies nutrients to the cells by drawing serum through the tissue by osmosis, induced by the high sugar content of honey. This is what creates the moist environment, preventing deformity that would occur if the re-growth were forced down by a dry scab on the surface.

Honey creates a film of liquid between the tissues and the dressing that allows the dressing to be lifted off painlessly and without tearing the newly grown cells. By reducing swelling in the surrounding inflamed tissue, honey also reduces a primary cause of pain. The sugar content of honey eliminates the unpleasant odor associated with major burns and skin ulcers as well, since, instead of using amino acids from the serum and dead cells, thus producing foul smelling amines and sulfur compounds, the infecting bacteria use sugar from the honey.

Research is being done on other traditional therapeutic uses of honey--for peptic ulcers, diarrhea, eye infections, and throat infections--to find evidence for their effectiveness. Reports from clinical trials have found honey to be effective in the treatment of peptic ulcers and diarrhea, and a clinical report about the use of honey for treatment of eye infections indicates that the treatment is effective for these infections as well. Laboratory research has demonstrated that the bacteria causing these infections are sensitive to the antibacterial action of honey. Laboratory research has been carried out to establish a rational basis for clinical trials using honey as a treatment for fungal infections of the skin, protection of dental health, and treatment of mastitis in dairy cows and goats. In all of these, it has been found that the microorganisms involved are sufficiently sensitive to the antimicrobial action of honey to expect a good therapeutic effect. Clinical trials are currently underway to measure the effectiveness of honey as a treatment for mastitis in dairy cattle and persistently non-healing wounds, eczema, and eye infections in humans.