Product POINTERS
Honey: Ancient cure or modern alternative?
By Liza G. Ovington, PhD, CWS
President
Ovington & Associates Inc.
Ft. Lauderdale, FL
Early Egyptians were the first to use honey as a component (along with animal fats and vegetable fibers) in the topical treatment of wounds as evidenced from their writings in the Smith papyrus (1650 BC).
Why did the Egyptians choose honey? For one thing, the combination of honey and animal fat may have prevented the bandages from drying out and adhering to the wound. Perhaps more importantly, the honey could have been used for its antibacterial effects. The Egyptians may have known this empirically, but today we know scientifically that honey is antibacterial.
The antibacterial effects of honey are both physical and chemical. Honey has a very high osmotic pressure and will draw water from another source, such as tissues or bacteria cells. When it draws the water out of bacteria, it kills them. The antibacterial properties of honey have been compared to those of saturated sugar solutions with comparable osmotic pressures. It was found that the saturated sugar solutions exhibited less antibacterial activity than natural honey, indicating that there was more going on than just removing water from bacteria.
From a chemical standpoint, honey contains a number of ingredients that possess antibacterial activity. One such ingredient is a particular enzyme called glucose oxidase. This enzyme produces hydrogen peroxide, which kills bacteria when it breaks down to form oxygen radicals. The levels of hydrogen peroxide produced are not sufficient to damage tissues.
Propolis found in honey
Honey also contains non-peroxide ingredients that are antibacterial. The presence of such ingredients has been confirmed by treating honey with catalase to remove hydrogen peroxide and finding that it retained antibacterial activity. Many of the specific ingredients in honey that are responsible for this retained antibacterial effect have not yet been identified. One that has been identified is propolis, a material used by bees to repair their hives. Propolis has been shown to contain an antibacterial substance called galangine, which is used as a food preservative.
Highly variable substance
It is important to note that honey is a highly variable material, like most plant derived products. The chemical composition of honey depends on the types of flowers from which it is made. Antibacterial effects may, therefore, vary between different types of honey.
Researchers at the University of Waikato in New Zealand have studied the antibacterial and wound-healing properties of a specific type of honey made from the flowers of the New Zealand tea tree (Manuka).
In one published study, researchers at Waikato compared the antibacterial properties of 345 samples of unpasteurized honey from 26 types of flowers. The honeys were tested for activity against the common wound pathogen, Staph aureus, using the antiseptic phenol as a reference. They found that the antibacterial levels of the honeys ranged anywhere from 58% to 2% of the antibacterial activity of phenol.
The highest antibacterial levels were found in honeys derived from the flowers of Manuka tree. When the honeys were treated with catalase to knock out the hydrogen peroxide effects, only the Manuka honeys and one other type retained significant antibacterial effects.
Honey is not sterile
Honey has not been well- or widely accepted in the modern medical community as an antibacterial agent or for wound healing. Aside from the inherent variability of honey due to the flower sources, a particular concern is that honey is not a sterile product and could contain spores or certain types of bacteria.
While unlikely that spores and bacteria would grow in the honey, they have been known to survive in the honey, and if the water content is raised (as when the honey is diluted by the fluids drawn from the wound), the spores/bacteria may then proliferate in the wound. Sterilization of honey by heat treatment or filtration could destroy contaminants, but heat also destroys the antibacterial ingredients, and filtration is impractical because honey is too viscous. However, sterilization by gamma irradiation has been shown to preserve the antibacterial activity of honey.
There have been a handful of randomized controlled trials of honey as a burn wound healing agent by Subrahmanyam et al of the Dr. Vaishampayan Memorial Medical College in India. In 1993, gauze impregnated with honey was compared to a transparent film dressing in the treatment of partial thickness burns. Forty-six patients were randomized, and it was found that the patients treated with the honey healed in an average of 10.8 days while those treated with the film dressing healed in an average of 15.3 days.
In 1996, 50 patients with partial thickness burns were randomized to treatment with either honey-impregnated gauze or boiled potato skins. The patients treated with honey had a mean healing time of 10.4 days while the patients treated with boiled potato skins had a mean healing time of 16.2 days. (Boiled potato skins may seem to be an unusual treatment, but they have been found to maintain a moist environment and commonly are used in India for treatment.)
The most recent randomized controlled trial by Subrahmanyam compared honey gauze to a more modern burn dressing — silver sulfadiazine (SSD) — in 50 patients with partial thickness burn wounds. One hundred percent of the honey treated wounds showed epithelization by day 21 post-treatment compared to only 84% in the SSD-treated patients. Better control of infection also was noted in the honey-treated group. The same research group also noted better pain relief, lower incidence of hypertrophic scar, and contracture with honey compared to SSD in an earlier burn wound study.
While honey may seem like an ancient remedy to many of us in the United States, it could potentially be considered a viable alternative agent for healing (especially in underdeveloped countries) with further randomized trials and proper treatment protocols coupled with appropriate selection and sterilization of the honey used.
Suggested reading
1. Allen KL, Molan PC, Reid GM. A survey of the antibacterial activity of some New Zealand honeys. J Pharm Pharmacol 1991; 43(12):817-822.
2. Willix DJ, Molan PC, Harfoot CG. A comparison of the sensitivity of wound-infecting species of bacteria to the antibacterial activity of manuka honey and other honey. J Appl Bacteriol 1992; 73(5):388-394.
3. Molan PC, Allen KL. The effect of gamma irradiation on the antibacterial activity of honey. J Pharm Pharmacol 1996; 48(11):1,206-1,209.
4. Subrahmanyam M. Honey impregnated gauze versus polyurethane film in the treatment of burns: a prospective randomized study. Br J Plast Surg 1993; 46(4):322-323.
5. Subrahmanyam M. Honey dressing versus boiled potato peel in the treatment of burns: a prospective randomized study. Burns 1996; 22(6):491-493.
6. Subrahmanyam M. A prospective randomized clinical and histological study of superficial burn wound healing with honey and silver sulfadiazine. Burns 1998; 24(2):157-161.
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