Mel Anhang 3

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[Stefan Bogdanov]

Honey in traditional Chinese medicine

Honey was mentioned as medicine by Shen Nang, some 2000 BC. In the“52 prescription book,. 3th century BC includes a prescription including honey.

According to Chinese medicine honey has a balanced character (neither Yin nor Yang) and acts according to the principles of the Earth element, entering the lung, spleen and large

intestine channels. There are many original prescriptions and medical indications which contain honey

Christopher Gussa, a TCM practioner: “Honey is known as Feng Mi and has the ability to nourish yin energy and strengthen the spleen. Apart from its widely recognized nutritional value,

honey is the Chinese people's favorite as a "neutral" food with medicinal properties.In the "Compendium of Materia Medica," the TCM classic by pharmacist Li Shizhen in the Ming

Dynasty (1368-1644), "Honey can help dispel pathogenic heat, clear away toxins, relieve pain and combat dehydration." Li Shizhen showed that eating honey regularly resulted in clear sight

and rosy cheeks. He also wrote that eating honey every morning can help prevent constipation and it is a good choice for those who suffer chronic coughing.

TCM also shows that due to honey's affinity for the stomach and spleen it can greatly enhance the effect of many of the super-tonics such as He Shou Wu”

According to the Fundamentals of Chinese Medicine honey has following properties

“balanced, sweet, non-toxic.Enters the lung, spleen and the large intestine meridian channels.Supllements the center and moistens the lung.Relieves pain and resolves toxin. . . . . Treats cough

due to lung dryness; constipation due to dryness of the intestines; stomach pain; deep source nasal congestion, mouth sores, scalds and burns”

Sui Wan summirises: “Honey has been used in traditional Chinese Medicine to treat many diseases for more than two thousands years.In Traditional Chinese Medication, honey is a combination

used with bee venom, propolis, royal jelly, pollen and other herbal medications in medical treatment.In addition, the following diseases are good indications for using honey.

I) Infectious Diseases: Bacterial Infections:

A. Infections caused by gram-positive bacteria, e.g.Streptococcal infections- Pharyngitis, Enterococcal infections, Pneumococcal infections; Staphyloccus Aureus infections,

B. Infections caused by gram-negative bacteria, e.g.Meningococcal infections- Meningococcal meningitis. , Salmonellae infections-Typhoid fever, Salmonella Gastro-enteritis., Shigella infections.

II) Gastrointestinal Diseases:

A. Gastritis, B. Peptic ulcer Disease, C. Celiac Disease, D. Antibiotic-Associated Colitis. E. Inflammatory Bowel Diseases.

III) Allergic and Immunologic Disorders:

A. Allergic Rhinitis B. Rheumatoid arthritis, C. Systemic Lupus Erythematous(SLE), D. Ankylosing spondylitis, E. Multiple Sclerosis.

IV) Traumatic wounds: traumatic and surgical wounds managements”

Honey in Ayurveda Medicine

Honey has a long tradition in traditional ayurveda medicine. This topic has been reviewed by according to D Ramanathan, director of the Sitaram Ayurveda Pharmacy Limited & Specialty Hospital,

Thrissur on the role honey plays in ayurvedic treatment: “Honey known as madhu in ayurvedic scriptures is one of the most important medicines used in ayurveda. In ayurveda, honey is used for

both internal and external applications. It is mainly used for the treatment of eye diseases, cough, thirst, phlegm, hiccups, blood in vomit, leprosy, diabetes, obesity, worm infestation, vomiting,

asthma, diarrhoea and healing wounds. It is also used as a natural preservative and sweetener in manyayurvedic preparations.It is also used as a vehicle along with some medicines to improve its

efficacy or to mitigate the side effects of the other medicines it is mixed with. It is also known to mitigate the increased kapha dosha. (Kapha dosha is the ayurvedic category for body constitutions- those with kapha dosha are of larger proportions with robust frame.)

It should also be kept in mind that fresh honey helps to increase body mass while old honey produces constipation and decreases

body mass. Honey should not be heated or consumed warm as it causes toxic effect. Cold honey should always be preferred.

According to ayurveda, there are eight different types of honey:

1. Makshikam: Used in the treatment of eye diseases, hepatitis, piles, asthma, cough and tuberculosis

Collected by bees of moderate size. Color yellowish brown, light and cold in nature.

2. Bhraamaram: Used in the treatment when blood is vomited/bleeding disorders.

Collected by large bees and sticky in nature

3. Kshoudram: Used in the treatment of diabetes. Collected by bees of moderate size. Color yellowish brown and cold in nature

Dissolves Kapha/Diabetes.

4. Pauthikam: Used in the treatment of diabetes and urinary infection

Collected by very large black bees from nectar of poisonous flowers.

Increases Vata, causes gout and burning in the chest.

Sedative/hypnotic, promotes wound healing/reduces fat.

Urinary tract infections, tumors, ulcers, wounds, diabetes.

5. Chathram: Used in the treatment of worm infestation, when blood is vomited and diabetes

Collected in Himalayan region.

Honey heavy and cool in nature and useful in gout,

6. Aardhyam: Effective for eye diseases, cough and anaemia

Causes arthritis.

7. Ouddalakam: Increases taste and swarasudhi. Used in the treatment of leprosy and poisoning cases

Modulation of voice.

8. Daalam: It increases digestion and helps in the treatment of cough, vomiting (can cause it) and diabetes.

We prescribe a particular brand called Samskritha Madhu (meaning cultured or purified honey) which is made by most of the authentic ayurvedic manufacturing units according

to ayurvedic scriptures. In ayurveda the bee species that are most preferred- are they Italian species (that are kept in boxes) or Indian species (that are found in the wild).

As far as Ayurveda is concerned our acharyas (= Weisen) who made this system of medicine utilized Indian honey and tested the wild honey, hence any ayurvedic physician will prefer

the Indian wild honey.

Honey in traditional medicine

Acacia, liquid and mild;

Sweetener for people with Diabetis Type II.Improved digestions.Applied at diseases of stomach, intestines, liver and kidney

Buckwheat, dark and strong

High antioxidant activity, improves digestions, to be taken by pregnant women and when nursing

Eucalyptus, dark and strong

Against infections and diseases of respiratory organs and urinary passages. Increases immunity

Calluna, dark and strong

High antioxidant activity.Invigorating at fatigue and convalesence; against problems with kidney urinary bladder

Chestnut, dark and strong

Improves blood circulation; against anaemia and infections of kidney urinary bladder

Clover, light und mild sedative

Lavendel, aromatic

Treatment of wounds, burns, insect stings, infections or respiritory organs and depressions

Linden, strong, aromatic

Diaphoretic, diuretic, palliative, apetising; against cold, flu, cough, sinusitis, headache, sleeplessness and anxiety.

Manuka, Dark and strong

High antibacterial activity, against infections and for wound healing

Dandelion, aromatic

Hemo-protective, against gastric, intestine, liver, kidney and gall bladder diseases

Citrus, light and mild

Indigestion and sleeplessness

Rape, mild

Sedative, relaxing

Rosmarine, mild

Hemo-protective; against gastric, intestine, liver diseases

Sunflower, mild spasmolytic in asthma cases, gastric, intestine colic

Fir, honeydew, dark and strong

High antioxidant activity.Against infections of respiratory organs

Thyme, dark and strong

Against infections of respiratory organs; wound treatment

Unifloral honeys are used in folk medicine for different purposes. The applications given in the table below remain to be confirmed by experimental science. Indeed, in most scientifically

conducted clinical studies the botanical origin of the honey was not determined. On the other hand, the antibacterial and the antioxidant activity of honey depends strongly on the botanical origin.

The table below has been compiled from them. At present there is no scientific explanation of many of the claimed effects.

HONEY AND WOUND CARE: AN OVERVIEW

By Keith Cutting, with some additions by S. Bogdano

After Ostomy Wound Management

Until the first part of the 20^th century, honey dressings were part of everyday wound care practice. With the advent of antibiotics in the 1930s and 1940s, views changed and honey was consigned to items of historical interest. Misuse of antibiotics, the emergence of resistant bacteria, and increasing interest in therapeutic honey have provided an opportunity for honey to be re-established as a broad-spectrum, antibacterial agent that is non-toxic to human tissue.

Despite lack of promotional support from large corporations, interest in the use of honey in wound management has increased in recent years. However, a clinical profile in wound care commensurate

with other modalities has not been achieved despite offering similar indications of use and an increase in research activity and clinical reports. It is observed that

“The therapeutic potential of uncontaminated, pure honey is grossly underutilized”

Clinicians need reassurance that any health-related agent is safe and meets its stated therapeutic purpose.

Therefore, it is important to emphasize that although natural in origin, the honey used in wound care should be of medical-grade standard and not sourced from honey destined for the supermarket shelf. Medical grade honey is filtered, gamma-irradiated, and produced under carefully controlled standards of hygiene to ensure that a standardized honey is produced

Therapeutic benefit of honey in wound care The therapeutic properties of honey are variable and depend on the type of honey used.

Manuka (the Maori name for the New Zealand tea tree/bush Leptospermum scoparium) or Leptospermum is honey derived from the tea tree; the former is the more widely used term.In a review of the literature, Moore showed that Manuka honey has “very special healing properties” and described it as “the best natural antibiotic in the world.”

Medical grade Manuka honey is prepared purely for medical use and controlled by a rigorous set of systems and standards.These exacting standards apply to the leptospermum honey distributed in US (Medihoney™, Derma Sciences, Princeton, NJ). This product is a blend of L.scoparium (Manuka) and L. polygalifolium known as Jelly Bush.

A systematic review of honey as a wound dressing noting the dearth of good evidence on topical wound agents contradicts Molan’s literature review of the evidence (17 randomized, controlled trials

involving 1,965 participants and five clinical trials involving 97 participants, plus numerous case studies) - supports the use of honey as a wound dressing and underscores clinician failure to recognize that evidence. Molan’s research reviews also addressed the range of honey’s therapeutic activities:

Bioactivity of honey Suggested Rationale

Prevention of cross-contamination Viscosity of honey provides a protective barrier

Provides a moist wound healing environment Osmolarity draws fluid from underlying tissues

Dressings do not adhere to wound surface.

Tissue does not grow into dressings The viscous nature of honey provides an interface between wound bed and dressing

Promotes drainage from wound Osmotic outflow sluices the wound bed

Removes malodor Bacterial preference for sugar instead of protein (amino acids) means lactic acid is produced in place

of malodorous compounds

Promotes autolytic debridement Facilitates the autolytic action of proteases

Stimulates healing Stimulation of cytokine production

Anti-inflammatory Number of inflammatory cells reduced in honey-treated wounds

Prevents cutaneous inflammation by honey flovonoids

Managing infection Antiseptic properties found to be effective against a range of microbes including multi-resistant

strains Increases immune reaction

Effect of lipopolysacharides and apalbumine 1 and 2

Promotes pain relief and epitelisation Analgetic effect of honey

Regulates oxidative stress in the wound Inhibition of reactive oxygen species production by activating polymorphonuclear neutrophils

Inhibits adhesion of bacteria in wound Antiadhesive properties against wound pathogens

Wound bed preparation may be viewed as management of the wound in order to accelerate endogenous healing.

The bio-activity of honey aligns closely with the concept of wound bed preparation. The physiology of healing in acute wounds is a carefully controlled series of events that ensures healing progresses in a timely fashion.However, in chronic wounds this orderly sequence is disrupted and the repair process is delayed.If wound bed preparation is to be successful, the impediments to healing must be recognized and addressed, implying appropriate management of exudate, devitalized tissue, and associated bioburden. The appropriate application of honey dressings offers a way forward in managing potential

wound-related barriers to healing.

Exudate

A clinical study by Al-Waili and Saloom compared honey with topical antiseptics in 50 patients with postoperative abdominal wound infections; Ahmed et al non-randomizes study of 60 patients with chronic surgical or trauma wounds; and Betts and Molan’s in vivo pilot study reported that honey helps reduce the amount of wound exudate. This is most likely a consequence of honey’s anti-inflammatory properties.Inflammation - increased vessel permeability increases fluid movement into soft tissue, subsequently increasing surface exudate. A decrease in inflammatory cells has been found (histologically) in animal models following application of honey in full-thickness burns. Similar findings have been reported in animal studies comparing ampicillin and nitrofuazone in treating infection of full-thickness wounds.

The anti-inflammatory activity of honey also has been documented in clinical studies of human burn wounds and in “in vitro studies.

The potential consequences of effectively managing inflammation include rapid reduction of pain, edema, and exudate; additionally, hypertrophic scarring is minimized by avoiding protracted inflammation that may result in fibrosis. It follows that reducing inflammation lessens exudate production and dressing change frequency, which may conserve resources in terms of dressings used, staff time, and unnecessary disturbance of the patient and the wound bed.

Devitalized tissue

It has been established that dressings that create the type of moist wound environment that honey provides facilitate the process of autolytic debridement. The osmotic pull of honey draws lymph from the deeper tissues and constantly bathes the wound bed. Lymph fluid contains proteases that contribute to the debriding activity of honey.In addition, the constant sluicing of the wound bed is believed to help remove foreign body (dirt and grit) contamination .

Molan has suggested the most likely explanation for honey’s debriding activity involves the conversion of inactive plasminogen to plasmin, an enzyme that breaks down the fibrin that tethers slough and eschar to the wound bed. Stephen-Haynes who presented the results of three patient case studies and an additional five patients who benefited from management of wound malodor, attests to the clinical impact of honey in debridement. Malodor is known to occur in a variety of wounds in conjunction with slough and necrotic tissue; it is a particular concern when managing fungating lesions.

Malodorous substances such as ammonia and sulphur compounds are produced when bacteria metabolize protein. Because honey provides bacteria an alternative source of energy (glucose), these noxious compounds are no longer produced and wound malodor is avoided.

Maceration

Macerated periwound skin can be a problem in some wounds and is often related to the dressing used. The osmotic action of honey, previously mentioned, has been shown in previous reviews of the literature to reduce the risk of maceration - honey draws moisture rather than donates it. Thus, periwound skin is protected from overhydration.

Bioburden

Honey has been shown in clinical observations to have the ability to manage wound infection in situations where conventional antimicrobial (antibiotics/antiseptics) have failed. Honey also has been found to be effective in vitro against a range of multiresistant organisms including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE), and other multiresistant Gram-negative organisms including Pseudomonas aeruginosa. Other in vitro studies involving different micro-organisms also have demonstrated honey’s effectiveness against antibiotic-resistant bacteria.

George and Cutting specifically identified honey’s antibacterial activity. The binding of water can be added to these antibacterial properties:

• The high sugar content/low water activity provides osmotic action

• Acidic pH (3. 2 to 4. 5) inhibits bacterial growth

• Glucose oxidase enzyme helps produce hydrogen peroxide

• Plant-derived factors (present in some honeys and not specifically identified).

The antibacterial action most likely reaches below the wound surface. Although topical honey manages superficial bacteria (bactericidal in action rather than bacteriostatic) it also has been shown in vitro to

provide prompt clearance of deep-seated infection and boils with unbroken skin, suggesting that honey’s antibacterial activity may diffuse through the skin to deeper tissues.

Cooper et al performed sensitivity testing of 17 strains of P. aeruginosa isolated from infected burns using two honeys with different types of antibacterial activity; Wahdan compared the antibacterial activity of a sugar solution and honey on 21 types of bacteria and two types of fungi.

Some commercial honey preparations used in wound healing:

In recent years, attention has turned to the potential role of biofilms in wound infection. A biofilm may be described as a bacterial community living within a self- produced extracellular polysaccharide (EPS) matrix.

The EPS protects the bacterial community from antimicrobial and phagocytic onslaught.Lately, in vitro evidence has indicated that honey is an effective agent for preventing biofilm formation. In an in

vitro study it was found that laboratory-grown Pseudomonal biofilms were disrupted following application of Manuka honey.

These findings are particularly encouraging when considering the emergence of antimicrobial-resistant bacteria. No evidence has yet been presented that bacterial resistance to honey has occurred - it is

highly unlikely that bacteria will select for resistance to honey because bacteria rely on sugar as a source of food.

Cross-contamination

Use of honey dressings may help prevent cross contamination. This is and will remain an important issue in healthcare. The viscous nature of honey is believed to provide a physical barrier that helps safeguard patients by preventing cross contamination.

Dressing wounds with honey

All dressings must be used in accordance with the manufacturer’s instructions. This helps endorse the maxim do no harm and ensure that the full benefit of the product is realized.

Because of its fluid and viscous nature, honey can be difficult to apply. This is particularly true when profuse exudate is present, diluting the honey. Experience has shown that use of the appropriate honey vehicle, including a secondary dressing, can sometimes circumvent this problem:

• Honey liquid or gel dispensed from a tube:

Applied directly onto wound or onto appropriate dressing before application

• Absorbent alginate dressing with honey:

Can be applied to most acute/chronic wounds including infected or sloughy wounds

• Honey in a hydrocolloid-like sheet:

Should be selected according to the exudate level of the wound

Allergy

Before honey is applied to a wound, the patient should be asked routinely if he/she is allergic to honey or bee products, including bee stings. It is advisable not to proceed with a honey-containing dressing if the answer is affirmative.

Discomfort

Occasionally, some patients report transient stinging on application of honey. The discomfort often disappears in a short period of time or after the first few applications.Analgesia is required only in those rare circumstances when pain may persist. In a review paper, Molan noted that patient response to honey applied to open wounds was reported as soothing, pain-relieving, and non-irritating, and demonstrated no adverse effects.

Conclusion

The resurgence of interest in honey as a modern wound dressing offers opportunities for both patients and clinicians. Recent additions to the honey product range of dressings indicate commercial confidence in the future of therapeutic honey. The wheel has turned full circle and honey is being re-established as a valuable agent in modern wound care management. Its advantages -providing a moist environment, debriding, deodorizing, antibacterial, anti-inflammatory capabilities- are factors that have been shown to facilitate healing. These advantages have been experienced by patients and clinicians in Europe and Australia and are now available to patients in N. America. Use of any medical device must be based on clinical justification and available evidence about product safety and effectiveness. Continued research is needed to increase our understanding about the role of honey in a variety of wounds and its effect on healing compared to other treatment modalities.

HONEY FOR WOUND HEALING UNDER HOME CONDITIONS

Besides scientifically based use of honey in wound care in hospitals (see next section), honey can also be used under home conditions, as it was used for many centuries. Although sterilised honey is only used in hospitals, raw honey can also be used under home conditions without any risk, as no adverse effects have been reported. Indeed, Prof. Descotte lectured in several Apitherapy conferences that his team has used raw honey routinely for wound care in hundreds of cases in the hospital of Limoge, France.

Honey applied in wound healing in a Swiss hospital

Wound at the treatment beginning

A painful and infected wound on the left leg. The fracture was stabilised with plates and screws. After several operations the blood circulation of the leg was diminished and sores were built because of the prolonged bed lying.

The wound treatment with conventional means was not successful.

The patient agreed to make a honey treatment. After only 5 days of treatment the wound condition was significantly improved. New tissues were built and the bacterial inflammation has diminished significantly.

After two months the wound was completely closed. The cicatrise is almost invisible and he skin is healthy, tender and elastic at the same time.

Application of honey for wound healing under home conditions, after

It is not necessary to disinfect wound because honey will disinfect it

1. Apply honey as much honey on a gauze or clean cotton cloth as it is necessary to cover wound fully. Gauze and cloth need not be sterile.

2. Abscesses, cavity or deep wounds need more honey to adequately penetrate deep into the wound tissues. The wound bed should be filled with honey before applying the honey dressing pad.

3. Change bandage once a day. When doing it, wound need not be cleaned from honey. Honey is „dissolved“ in the wound or sticks to the gauze.

4. When changing the bandage remove hornification at the border of the wound with a pincette. This can be done under running water or with a soft tooth brush. Cell debris, which were not removed will not disturb healing process.

5. After cleaning, wound should be padded with as much gauze as is needed for drawing the wound liquid.

6. If wound is infected by yeast or it heals badly, a mixture of honey-betadine 1:1 can be used.

ORAL HEALTH

There is much debate whether honey is harmful to teeth. Some reports show a cariogenic effect of honey, while others claim that the effect of honey isless cariogenic effect that sucrose. Due to its antibacterial activity honey ingestion inhibits the growth of bacteria, that cause caries and might have a carioprotective effect. It was shown to have an anti-plaque effect in vitro and in-vivo (tests with volunteers). It was also shown that Manuca honey, a very potent antimicrobial honey, has a positive effect against dental plaque development and gingivitis and thus can be used in the place of refined sugar in the manufacture of candy.

According to electron microscopic studies ingestion of honey does not cause erosion of tooth enamel as observed after drinking of fruit juice (pH 3. 5). Ten minutes after consumption of fruit juice tooth

erosion was seen, while 30 minutes after honey ingestion the erosion was only very weak. This effect can be explained only partially by the calcium, phosphorus and fluoride levels of honey, other colloidal honey components have to be also responsible.

Stomatitis and other oral lesions

Stomatitis is inflammation of the mouth mucose. Aphthous stomatitis, as well as other oral lesions like recurrent herpes labialis, recurrent intraoral herpes, atrophic/erosive oral lichen planus, oral candidiasis and oral psoriasis can be successfully treated with honey. Honey significantly speeded resolution of the inflammatory and ulcerative oral lesions. It significantly lowered the pain ensation and reduced the duration of some lesions and increased the number of pain free days. To treat the conditions listed above, smear the individual ulcers, boils or aphthae with honey - or simply trickle a good spoonful of honey in your mouth and then swirl it around the mouth, in order to reach as many sores as possible.(It will become runny, but honey does penetrate the tissues very quickly; and it seems it is

precisely when diluted that its curative power is activated. )

Against halitosis (malodor)

Manuka and acacia honey have been successfully used against halitosis (malodor)

Summarising the different findings, it can be concluded that honey is probably not as cariogenic as other sugars and in some cases can be also carioprotective (from strong antibacterial honey).

However, for safety reasons, after consumption of honey it is advised to clean the teeth.

OTHER EXTERNAL APPLICATIONS

Besides the application in wounds and burns honey has also other external applications:

Honey against eye diseases

Since ancient times honey has been used for the treatment of eye disorders. This topic is reviewed by Molan, 2001, see there the original references : Aristotle has written in his Historia Animalium

that “honey is good as a salve for sore eyes”.

It has also been used by traditional Indian medicine and in Mali. In the Rangarya Medical College of India it has been used to treat corneal eye ulcers, treatments of plepharitis (inflammation of he eye-lids) catarrhal conjunctivitis and keratitits. Honey is also successful in various ailments of the cornea. The use of honey in Russia has been reviewed: undiluted or 20 - 50% water solutions being being applied to the eye under the lower eye lid against chemical and thermal burns of the eye, conjunctivitis and infections of the cornea. The healing effect of honey is explained by its anti-inflammatory, antibacterial and

antifungal actions of honey.

There are reports on the successful treatment by honey of keratitis, conjunctivitis and blepharitis in Egypt.

The positive effect in keratitis to reducing the levels of angiogenic factors (VEGF and TGF-beta), inflammatory cytokines (IL-12) and chemokines (CC chemokine receptor 5(CCR-5).

Another explanation of the healing effect of honey in eye diseases is a irritation effect, triggering healing processes of the eye.

Stingless bee honey has been traditionally used by the Mayas against cataract.

Against catheter infection

Topical medihoney can be successfully use against catheter infections

Against virus action on lips and genitals:

Apply honey on gauze auf critical point and change once a day

Against boils and furuncles

Mix liquid honey and flour 1:1, add a little water and brush with it affected area. Cover with gauze and leave it overnight.

Against muscle cramps

Cover affected area with honey, cover with gauze or cloth and fix it with adhesive plaster. Cover with a warm wool cloth. Leave at least 2 hours.

Against bruises and contusions

Mix honey and olive oil 1:1 and cover with mixture affected area.Cover with gauze and leave for 4-6 hours.

Enhances post tonsilitis inflammation healing

Tualang honey from Malaysia enhances post tonsilitis inflammation healing process

Honey and cosmetics

A recent review summarises the used in honey in cosmetics.In cosmetic formulations, it exerts emollient, humectant, soothing, and hair conditioning effects, keeps the skin juvenile and retards wrinkle formation, regulates pH and prevents pathogen infections. Honey-based cosmetic products include lip ointments, cleansing milks, hydrating creams, after sun, tonic lotions, shampoos, and conditioners.

The used amounts range between 1 and 10%, but concentrations up to 70% can be reached by mixing with oils, gel, and emulsifiers, or polymer entrapment. Intermediate-moisture, dried, and chemically modified honeys are also used. Mechanisms of action on skin cells are deeply conditioned by the botanical sources and include antioxidant activity, the induction of cytokines and matrix metalloproteinase expression, as well as epithelial-mesenchymal transition in wounded epidermis

SIDE EFFECTS OF CANCER TREATMENTS

Most of the cancer research has been done in animal models (see chapter 7).The use of honey in clinical cancer treatments has been reviewed in 2008 by Bardy 26 and in 2009 by Orsolic

Clinical and animal studies have shown that honey reduces the secretion of gastric acid. Additionally, gastric ulcers have been successfully treated by the use of honey as a dietary supplement.

An 80% recovery rate of 600 gastric ulcer patients treated with oral administration of honey has been reported. Radiological examination showed that ulcers disappeared in 59% of patients receiving honey.

Laxative effects and constipation

In certain cases, consumption of relatively large amounts of honey (50 to 100 g) can lead to a mild laxative effect in individual with insufficient absorption of honey fructose.

Fructose is less readily absorbed in the intestinal tract than fructose together with glucose. The mild laxative properties of honey are used for the treatment of constipation in Eastern Europe, China

and the Near East.

However one should not give honey against constipation of infants younger than 1 year old because of the children botulism risk.

Against acute gastroenteritis in children

A clinical study of honey treatment in infantile gastroenteritis was reported by Haffejee and Moosa. They found that by replacing the glucose (111 mmol/l) in the standard electrolyte-containing oral rehydration solution recommended by the World Health Organisation/UNICEF as well as the solution of electrolyte composition 48 mmol/l sodium, 28 mmol/l potassium, 76 mmol/l chloride ions,

with 50 ml/l honey, the mean recovery times of patients (aged 8 days to 11 years) were significantly reduced. Honey was found to shorten the duration of diarrhoea in patients with bacterial gastroenteritis caused by organisms such as Salmonella, Shigella and E.coli. They recommended that honey was a safe substitute for glucose as long as it provided 111 mmol/l each of glucose and fructose.

The high sugar content of honey means that it could be used to promote sodium and water absorption from the bowel.

In a later study in Egypthoney added to oral rehydration solution promoted rehydration of the body and sped recovery from vomiting and diarrhea.

Against alcohol abuse

Positive effects of honey on ethanol intoxication such as disappearance in blood increase and of ethanol elimination rate has also been confirmed in studies with humans.

Ingestion of both honey (2 g/kg body weight) and fructose, prevented the ethanol-induced transformation of erythrocytes of mice

Animal experiments have shown that the administration of a honey solution via a tube in the stomach of rabbits prior to them being administered with 0.5 g ethanol per kg body weight, accelerated alcoholic oxidation. Honey administered subcutaneously or orally before oral administration of ethanol affords protection against gastric damage and reverses changes in pH induced by ethanol

A controlled clinical trial demonstrated the use of fructose in the treatment of acute alcoholic intoxication. A small but significant increase occurred in the rate of fall of blood-ethanol levels and it

was concluded that fructose may be beneficial in shortening the duration of alcoholic intoxication.

Treatment of reflux oesophagus and heartburn

Honey has high density, high viscosity, and low surface tension, and therefore, can stay longer in the oesophagus as a coating on the mucus membrane, and can be used against reflux oesophagus and against heartburn

Hepatitis and liver health

A positive effect of honey on hepatitis A patients was found after ingestion of clover and rape honey, causing a decrease of alanine aminotranferase activity (by 9 – 13x) and of bilirubin production by

2.1 to 2.6 times.

Honey for good digestion

Supplementation of honey in concentration of 2, 4, 6 and 8 g/100 g to protein fed to rats improved the protein and lipid digestibility.

The anti gastric ulcer and anti-gastritis effect of honey can be explained by its antibacterial and anti-inflammatory action, as well as with its inhibitory effect on the acidity of the gastric juice. The positive

effect of honey on nutrition function is also due to its prebiotic effect.

CARDIOVASCULAR HEALTH

The effects of ingestion of 75 g of natural honey by humans compared to the same amount of artificial honey (fructose plus glucose) or glucose on plasma glucose, plasma insulin, cholesterol, triglycerides

(TG), blood lipids, C-reactive proteins and homocysteine, most of them being risk factors for cardiovascular diseases were studied in humans. Elevation of insulin and C-reactive protein was significantly higher after dextrose than after honey.

Dextrose reduced cholesterol and low-density lipoprotein-cholesterol (LDL-C).Artificial honey slightly decreased cholesterol and LDL-C and elevated TG. Honey reduced cholesterol, LDL-C, and TG and slightly elevated high-density lipoprotein-cholesterol (HDL-C).In patients with hyperlipidemia, artificial honey increased LDL-C, while honey decreased LDL-C.

A similar study has been recently carried out in normal and overweight persons carrying a higher risk for a cardiovascular disease. These patients were given 70 g honey for 30 days. Results showed that honey caused a mild reduction in body weight (1.3%) and body fat (1.1%).Honey reduced total cholesterol (3%), LDL-C (5.8), triacylglycerole (11%), FBG (4.2%), and CRP (3.2%), and increased

HDL-C (3.3%) in subjects with normal values, while in patients with elevated variables, honey caused reduction in total cholesterol by 3.3%, LDL-C by 4.3%, triacylglycerole by 19%, and CRP by 3.3%

(p < 0. 05).The conclusion of the authors is that consumption of natural honey reduces cardio vascular risk factors, particularly in subjects with elevated risk factors, and it does not increase body weight

in overweight or obese subjects. Honey decreases also platelet aggregation and blood coagulation

The above cited studies suggest small effects of honey on arteriosclerosis risk factors such as cholesterol, LDL-c and TG, the first studies being carried out with only 9 patients.

In a study with 30 persons and 30 controls it was shown that no significant decrease of cholesterol HDL and TG was encountered after ingestion of 75 g honey daily for a period of 14 days.

While there were no effects in men, in women HDL values were increased in the controls having ingested sucrose, while in the honeygroup no increase was encountered, pointing out that honey has a positive effects in women.

The effect of honey intake on the blood risk factors was tested in diabetes 2 patients (controls with no intake).Body weight, total cholesterol, low-density lipoprotein-cholesterol and triglyceride decreased, while and high-density lipoprotein-cholesterol ratio increased significantly.

Honey can contain nitric oxide (NO) metabolites which are known cardiovascular disease risk indicators.

Increased levels of nitric oxides in honey could have a protecting function in cardiovascular diseases. Total nitrite concentration in different biological fluids from humans, including saliva, plasma, and urine was measured after ingestion by humans of 80 g of honey. Salivary, plasma and urinary NO metabolites concentrations showed a tendency to increase.

Different honey types contained various concentrations of NO metabolites, darker or fresh honeys containing more NO metabolites than light or stored honey. After heating, NO metabolites decreased in all the kinds of honey.

The cardiovascular effects of honey can be explained by its antioxidant and anti-inflammatory effects.

HONEY AGAINST COUGH

Small doses of honey, 1 to 2 tablespoonsintake has been found to influence favourably cough and also sleep of children.

The dose of honey used was ½ tsp for 2-5 year olds, 1 teaspoon for the 6 - 11 year-olds and 2 tsp for 12 to 18 year-olds. Buckwheat honey was chosen in this study because of its high antioxidant properties. The same study shows that honey is more effective than a chemical anti cough syrup.

These results were confirmed with 3 honeys (eucalyptus, citrus and labiatae) for the improvement of sleep in children (1-5 year old) with upper respiratory tract infections.

A review of the conducted clinical trials in the literature by Oduwole et al. in 2012 made the following conclusions: Honey may be better than 'no treatment' and diphenhydramine in the symptomatic

relief of cough but not better than dextromethorphan. There is no strong evidence for or against the use of honey.

A double-blind randomised controlled trial was conducted from 2008 to 2011 in Iran.Included in the study were 97 adults who had experienced persistent post-infectious cough (PPC) for more than

3 weeks. The participants were distributed into three groups. A jam-like paste was prepared which consisted of honey plus coffee for the first group ('HC'), prednisolone for the second group (steroid, 'S'), and guaifenesin for the third group (control, 'C').The participants were told to dissolve a specified amount of their product in warm water and to drink the solution every eight hours for one week.

Honey plus coffee was found to be the most effective treatment modality for PPC. The recipe for the honey-coffee mixture : 500 g honey mixed with 700 g instant coffee powder.

The daily dose was 23.7 g of the mixture, taken 3x daily.

HONEY AND THE BRAIN

The neurological effects of honey have been recently reviewed. The review points out that different honey components, mostly polyphenols, have neurological effects on the brain. There is also direct evidence: according to the original references cited in this review honey has following effects:

1. Honey is reported to be an important component of Brahma rasayan, an Ayurvedic formulation that is prescribed to extend the lifespan and improve memory, intellect, concentration, and physical

strength

2. Postmenopausal women who received honey showed improvements in their immediate memory but not in immediate memory after interference or in delayed recall. It has been claimed for a long time that honey influences beneficially human sleep, but there were no experiments to prove the claims. Ingestion of one to two table spoons of buckwheat honey (10-20 g) by children of 6 to 18 years (6-11 years old- one table spoon, 12-18 yeas old 2 table spoons) improved also the sleep of coughing children.

According to a theoretical model for the influence of honey on sleep honeystabilizes blood sugar levels and contributes to the release of melatonin, the hormone required for recovery and rebuilding of body tissues during rest.

HONEY AGAINST DIABETES ?

A clinical trial in Egypt showed that that long-term consumption of honey might have positive effects on the metabolic derangements of type 1 diabetes.

THE EXPERIENCE IN RUSSIA

Ludyansky, a chief doctor in a big Russian hospital, with life-long practice in apitherapy, has summarised the apitherapy knowledge in his monograph “Apitherapia” (in Russian)

Ludyanski summarises the medical uses of honey in his hospital in the following table:

Treated disease Very good and good improvement No improvement

Alopecia 11 5

Geriatry 59 -

Impotency 21 6

Inflammation of the vagina 21 5

Neurasthenia 60 -

Pediatrics 47 12

Prostatitis 24 5

Radicultis 47 15

Stomatology 43 16

OTHER HEALTH ENHANCING EFFECTS

Influenza and common cold

An Iranian study claims that intake of 50 g of honey daily reduces the length of the common cold by two days.

The Ukranian doctors Frolov and Peresadin reported on a unique long term honey intake experiment. Frolov is the chair of the department of infectious diseases in the medical university of Luganska.

All members of the department took 3x daily, a total of 40-45 g of honey added to lukewarm tea. In the whole experiment 26 people took part in this unique experiment (n and number of years):

n 5 for 20 y; n 6 for 15 y; n 8 for 10 y; n 5 for 5 to 10 y. During the whole experiment no other prophylactic was used. During the last 8 years of the experiment the department was in close contact

with 40-60 patients with influenza and inflammation of the upper respiratory organs or with other infectious diseases like virus hepatitis, dysentery and even cholera. During the 20 year duration of

the experiment no department member had any of the described diseases. In the immunological blood test it was found that the skin and the blood had an increased bactericidal activity, combined with very low microbial counts on the skin, while there were no pathogens in the whole area of the upper respiratory organs. And there was a control group to this experiment: a medical department, which

was in close proximity of Frolov’s test group, which had influenza or sore throat 3 to 4 times a year.This shows that a long term honey intake increases the anti-infectious immunity.

Hay fever and allergic rhinitis

Another controversial possible application of honey is its use for preventing hay fever. Beekeepers claim that eating honey in the pre-vegetation season (i.e.during winter) will prevent or weaken hay fever

symptoms. A report by Croft presented evidence that daily ingestion during winter time of 10-20 g of honey resulted in improvements of hay fever symptoms in 16 out of 21 patients.

Münstedt and Kalder found a positive effect of honey ingestion by means of questionnaire filled out by 29 beekeepers.

A 2002 clinical trial did not confirm the positive effects of honey ingestions, but honey was taken during the hay fever season and not before it.

As hay fever is increasing in developed countries this issue should be faced with more clinical trials, carried out in a correct way. More research is necessary to clarify this possible effect of honey.

Ingestion of 1 g/kg weight Tualang honey for 4 weeks by allergic rhinitis patients, complemented by an antihistamine drug treatment resulted in a significant improvement of allergic rhinitis of the honey

supplemented group as compared to placebo (sugar plus antihistamine drug) treated controls.

Infertility

In a preliminary announcement at the 2^nd International Conference on the Medicinal Use of Honey in 2010 there is a preliminary announcement that intracervical injection of honey in women with chronic

endocervitis was of positive therapeutic value both in terms of clinical cure and fertility enhancement.

At the same conference it was reported that honey has positive effect on the mechanical properties of the fetal membranes, may be through “collagen promoting action.

Against alcohol abuse

Positive effects of honey on ethanol intoxication such as disappearance in blood increase and of ethanol elimination rate has also been confirmed in studies with humans.

Ingestion of both honey (2 g/kg body weight) and fructose, prevented the ethanol-induced transformation of erythrocytes of mice

Hepatitis

A positive effect of honey on hepatitis a patients was found after ingestion of clover and rape honey, causing a decrease of alanine aminotranferase activity (by 9 – 13x) and of bilirubin production

by 2. 1 - 2. 6x.

Anaemia

Remy Chauvin reviews different early works carried out on 4-8 old infants. The dose given was one tea to one soup spoon in warm milk per day. The increase of blood haemoglobin was seen after one week of intake

These clinical results are confirmed by experiments by Haydak et al.with rats, placed on a diet with milk and poor in iron. Only dark honeys (calluna/fir) were capable of bringing blood haemoglobin values back to normal, while light honeys failed to do so.

Honey massage

Honey massage was developed in Tibet and Russia and is extensively described elsewhere

Both liquid and crystalline honeys can be used.

1-2 tea spoons of liquid honey are applied on the back. Massagist puts hands puts hands onto this area and unglues the palms. Easy at first, "ungluing" the hands becomes more difficult with every

move because the tension force increases. Massage lasts until the palms no longer stick to the massaged area, and the honey disappears from it. The actual duration depends on the type and quality of honey. Generally, honey massage lasts from 30 minutes.

ATTENTION TO THE TYPE OF HONEY

Due to different proportions of the possible sources, nectar +/o. honeydew coming from a great variety of plants, no honey is completely the same as another one. This variability could be a handicap,

given the market requirement for a consistent product, but when properly managed, it also could represent an opportunity for enhancing honey by offering to the consumer a number of typical products with special characteristics, according to the particular botanical origin. Indeed, unifloral honeys are regarded as a more valuable class of honey, and botanical denominations are widely employed on the

European market, often achieving higher prices than honey blends. Unifloral honeys have higher prices than blend honeys. In countries like France, Italy and Spain 30 to 50% of the marketed honey is unifloral. In non-European countries, with the exception of the Manuka New Zealand honey, unifloral honeys have a smaller importance.

Information on European honeys is compiled in the special Apidologie Issue 35 from 2004. In Europe there are more than 100 plant species that can give origin to unifloral honey, most of them having only a local importance.

Most biological and clinical studies reviewed above have been made with undetermined types of honeys and there are very few studies where comparisons have been done with different unifloral honeys. Here the fields will be reviewed where such studies have been carried out.

Unifloral honeys are used in folk medicine for different purposes. The applications given in the table below remain to be confirmed by experimental science.Indeed, in most scientifically conducted clinical studies the botanical origin of the honey was not determined. On the other hand, the antibacterial and the antioxidant activity of honey depends strongly on the botanical origin.

Health enhancing effects of different unifloral honey have been claimed in different practical apitherapy books.

The table below has been compiled from them. At present there is no scientific explanation of many of the claimed effects.

HOW TO EXPLAIN THE USE OF HONEY IN MEDICINE

Therapeutic and health enhancing use

Biological rationale

Honey in healing of burns and wounds

Antibacterial, anti-inflammatory, antioxidant, osmotic and analgesic effects

Therapy of digestive diseases like peptic ulcers and gastritis

Antibacterial and anti-inflammatory effects

Against children diarrhoea

Antibacterial and anti-inflammatory effects

Improvement of gut microbial health and of digestion

Prebiotic effect

Improvement of immune reaction of the body

Immunoactivating effect

Regular intake improves cardiovascular health

Lowering of blood risk factors and specific heart conditions as extracystoles, arrhythmia and tachicardia

Long term ingestion of honey can reduce the risk of human cancer

Anticancerogenic effects

Positive glycemic nutritional effect.

Can be used as a sweetener of people with diabetes type II and also probably type I

Some honeys have a low glycemic index: e.g. acacia honey. Other fructose rich honeys such as thyme, chestnut, heather and tupelo are good alternatives.

Use for the treatment of radiation-induced mucositis

Antibacterial and anti-inflammatory effects

Positive effect of honey ingestion on hepatitis A patients

Anti-inflammatory effect

Improvement of cough in children

Contact soothing effect, sweet substances, as a sweetener honey causes reflex salivation and increases airway secretions which may lubricate the airway and remove the trigger that causes a dry, nonproductive cough.

QUANTITY AND TIME OF HONEY INGESTION

The health enhancing effects in human adults, described in this report were mostly achieved after ingestion of 50 to 80 g of honey per day.

The health claims of honey which are reported below are valid for intakes of following amounts of honey:

• Adults: after ingestion of 50 to 80 g per day by adults,

• General (adults or infants):0. 8 g to 1.2 g honey per g human weight

The duration of honey ingestion for increase of physical performance and fitness is very fast, and takes place already 1 to 4 hours after intake.

The health effects reported in the different publications reported above were measured mostly after 2 to 3 weeks of daily honey ingestion.

Practical apitherapists suggest for health enhancing effects a daily honey ingestion for 1.5 to 2 months.

The normal daily allowance for carbohydrate sweeteners is 25 grams.Considering that the recommended amount of honey is quite high, intake of other sweeteners should be avoided.

A normal intake of about 20-25 g per day will rather have a long term health enhancing effect.

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