Erev Rosh Hoshonoh
Jaocb Schor, ND, FABNO
September 28, 2011
For a number of years now I have been in the habit of writing a Rosh Hoshonoh newsletter for this mailing list in which I talk about honey. Honey, along with fresh apples, or better said, the taste of these two foods signify this holiday in my mind.
There is far more being published about the medicinal uses of honey these days so I will not pretend that all of the interesting studies published over the past year will be mentioned. In fact, this review will focus only on human clinical trials.
In October 2010 an article appeared in the International Wound Journal comparing honey versus silver sulphadiazine for healing burns. Malik et al recruited 150 patients at their burn center in Wah Cantt, Pakistan, from May 2007 to February 2008. These patients had partial-thickness burns covering less than 40% of body surface area. The researchers compared the results of using topical honey with those of silver sulphadiazine (SSD]. Each patient had one burn site treated with honey and one treated with topical SSD, randomly. The rate of new skin formation was faster in the areas treated with honey taking about 13 days compared to almos 16 days (13·47 days ± 4·06 versus 15·62 ± 4·40 days, respectively: P < 0·0001). The honey treated sites healed completely in less than 21 days versus 24 days for the sites treated with SSD. Six patients had positive culture for Pseudomonas aeroginsa in honey-treated site, whereas 27 patients had positive culture in SSD-treated site. The results clearly showed greater efficacy of honey over SSD cream for treating superficial and partial-thickness burns.
In November 2010 Shoma et al reported that topical honey is useful in healing the radiation burns resulting from radiation therapy for breast cancer. They compared the effect of treating women undergoing breast radiation with the drug pentoxifylline (PTX) or a combination of this drug and topical honey was more effective than standard treatments. They treated 150 women, 50 with standard therapy, 50 with PTX (400 mg bid) and 50 with PTX (same dose) plus topical honey.
“The addition of honey was associated with marked pain relieving effect and rescue of proper motion. …. honey was associated with shorter duration of treatment as 74% of group C patients completely recovered after 12 weeks, compared to only 54% and 36% of groups B and A in order.”
Throat Burns: aka Head and Neck Mucositis
In December 2010 a study appeared in the International Journal of Oral and Maxillofacial Surgery that confirmed what earlier studies have suggested about the benefit of using honey to prevent the mouth sores that are typical after effects the radiation treatments used to treat head and neck cancer. The authors claim that using honey reduced the risk of getting mucositis by approximately 93% (RR=0.067].
A May 2011 study in the Journal of Medicinal Foods told us that honey was a useful addition to the standard treatments in use to treat protein energy malnutrition (PEM). This was a randomized controlled trial. Thirty infants with PEM were involved in the study along with 20 healthy infants who served as controls
The researchers monitored something called the “50% complement hemolytic activity” (CH50) in patients with PEM. This is considered a measurement of immune system function. Before nutritional rehabilitation, the CH50 was lower in the PEM infants compared with the healthy infants. After rehabilitation treatment, the CH50 increased in both groups. The rise of CH50 was significantly more in the honey group compared with the placebo. This may lower the risk these infants have of acquiring infection.
From Finland, the land of birch trees comes a study on the effect of birch pollen honey on birch pollen allergies. Forty-four patients with diagnosed birch pollen allergy ate either birch pollen honey (BPH) or or regular honey (RH) daily from November 2008 to March 2009. Seventeen patients (on their usual allergy medication served as the control group. From April to May, all the patients recorded daily allergy symptoms. Those patients who ate the birch pollen honey reported a 60% reduction in their total allergy scores, had twice as many days where they didn’t notice any symptoms and had a 70% reduction in days they described as severe. They used half the antihistamines as the control group.
Now here’s a study you don’t want to try at home. In February 2011 Chang et al reported in the Journal Otolaryngolical Head and Neck Surgery on a double blinded randomized controlled clinical trial in which they used surgical sponges that had been soaked in honey while doing sinus surgery. Forty-eight patients with chronic rhinosinusitis undergoing sinus surgery were enrolled in this prospective study. Patients were randomized and blinded to receive a medication-soaked Merocel ‘spacer’ (either one of budesonide, gentamicin, or manuka honey) in one nostril and a nonmedicated spacer in the opposite side. There wasn’t a lot of difference between these treatments. All the patients hurt and were fairly miserable. But, “… there was a trend toward less pain for the manuka honey-soaked Merocel MMS.”
A study coming from the University of Wyoming attempted to explain why honey doesn’t seem to be linked to obesity the same way sugar consumption is. Fourteen women ate a breakfast that contained either 450 calories from sugar or from honey. Eating the honey delayed the postprandial ghrelin response and blunted the glucose response compared with the regular sugar-containing meal.
Finally there is a June 2011 study on using honey to treat allergic fungal rhinosinusitis. Chronic fungal infection of the sinuses and allergic reaction to these molds that live in the nose have been assumed to be to blame for chronic sinusitis ever since a Mayo study a decade or so ago. Treating these infections has been a challenge and many of our patients will agree that the topical treatments we have tried have been less than pleasant. In this study Thanboo et al from St. Paul's Sinus Centre, in Vancouver, BC had 34 patients with these allergic fungal sinusitis conditions spray one nostril with a 50/50 mixture of honey-saline solution once a day for a month. There was no significant improvement in the treated nostrils versus control untreated sides. However, the nine patients who did respond to the honey treatment relative to their control side responded very well. Those who responded, responded well. One has to wonder whether using the treatment more than once a day might have worked better.
A Sweet and Happy New Year:
Now that we’ve completed that little chore, let me take the opportunity to wish all of you a sweet and happy new year.
Int Wound J. 2010 Oct;7(5):413-7. doi: 10.1111/j.1742-481X.2010.00717.x.
Honey compared with silver sulphadiazine in the treatment of superficial partial-thickness burns.
Malik KI, Malik MA, Aslam A.
POF Hospital, Surgical Unit-1, Wah Cantt, Pakistan. email@example.com
Burn injury is associated with a high incidence of death and disability; yet, its management remains problematic and costly. We conducted this clinical study to evaluate the efficacy of honey in the treatment of superficial and partial-thickness burns covering less than 40% of body surface area and compared its results with those of silver sulphadiazine (SSD). In this randomised comparative clinical trial, carried out Burn Center of POF Hospital, Wah Cantt, Pakistan, from May 2007 to February 2008, 150 patients of all ages having similar types of superficial and partial-thickness burns at two sites on different parts of body were included. Each patient had one burn site treated with honey and one treated with topical SSD, randomly. The rate of re-epithelialization and healing of superficial and partial-thickness burns was significantly faster in the sites treated with honey than in the sites treated with SSD (13·47 ± 4·06 versus 15·62 ± 4·40 days, respectively: P < 0·0001). The site treated with honey healed completely in less than 21 days versus 24 days for the site treated with SSD. Six patients had positive culture for Pseudomonas aeroginsa in honey-treated site, whereas 27 patients had positive culture in SSD-treated site. The results clearly showed greater efficacy of honey over SSD cream for treating superficial and partial-thickness burns.
2010 The Authors. Journal Compilation © 2010 Blackwell Publishing Ltd and Medicalhelplines.com Inc.
PMID: 20649832 [PubMed - indexed for MEDLINE]
Curr Clin Pharmacol. 2010 Nov;5(4):251-6.
Pentoxifylline and local honey for radiation-induced burn following breast conservative surgery.
Shoma A, Eldars W, Noman N, Saad M, Elzahaf E, Abdalla M, Eldin DS, Zayed D, Shalaby A, Malek HA.
Algomhoria ST., Faculty of Medicine, Department of Surgery, Mansoura University Hospital, Elmansoura, Egypt. firstname.lastname@example.org
Breast-conserving therapy is currently the standard of management of breast cancer cases. Radiotherapy is an integral part of it; however, it has several complications. Radiation induced burn is a common complication of radiotherapy that requires more effective lines of management rather than the classically used ones. We investigated whether the addition of pentoxifylline (PTX) alone or in combination with topical honey is effective in its management compared to the standard measures.
METHODS AND MATERIALS:
In this prospective study, patients were randomly allocated into three groups each of 50 cases. Group A received standard burn treatment (control group). Group B received additionally 400 mg PTX twice daily. Group C received the same treatment as Group B with adding topical purified honey ointment. Patients were assessed initially and subsequently after 4 and 12 weeks, for projected coetaneous surface area (PCSA) of burn, pain severity, limitation of movement and exudation.
There was a striking regression of the mean PCSAs of lesions among groups B and C at 12 weeks, with reduction rates (86±61%) and (76±58%) respectively (p<0.0001***). The addition of honey was associated with marked pain relieving effect and rescue of proper motion. Finally, honey was associated with shorter duration of treatment as 74% of group C patients completely recovered after 12 weeks, compared to only 54% and 36% of groups B and A in order.
Combination of PTX and honey is an ideal measure for treatment of radiation-induced burn following breast conservative surgery.
Int J Oral Maxillofac Surg. 2010 Dec;39(12):1181-5. Epub 2010 Sep 15.
Effect of topical honey on limitation of radiation-induced oral mucositis: an intervention study.
Khanal B, Baliga M, Uppal N.
Department of Oral Surgery, People's Dental College, Kathmandu, Nepal.
Radiation therapy for oral carcinoma is therapeutically useful in dose of at least 6000 cGy but causes mucositis that severely interferes with oral function. The literature indicates that honey appears to promote wound healing, so the authors investigated whether its anti-inflammatory properties might limit the severity of radiation-induced oral mucositis. A single-blinded, randomized, controlled clinical trial was carried out to compare the mucositis-limiting qualities of honey with lignocaine. A visual assessment scale permitted scoring of degrees of mucositis and statistical evaluation of the results was performed using the χ(2) test. Only 1 of 20 patients in the honey group developed intolerable oral mucositis compared with the lignocaine group, indicating that honey is strongly protective (RR=0.067) against the development of mucositis. The proportion of patients with intolerable oral mucositis was lower in the honey group and this was statistically significant (p=0.000). Honey applied topically to the oral mucosa of patients undergoing radiation therapy appears to provide a distinct benefit by limiting the severity of mucositis. Honey is readily available, affordable and well accepted by patients making it useful for improving the quality of life in irradiated patients.
Copyright © 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
J Med Food. 2011 May;14(5):551-5. Epub 2010 Dec 27.
Effect of honey on 50% complement hemolytic activity in infants with protein energy malnutrition: a randomized controlled pilot study.
Abdulrhman MA, Nassar MF, Mostafa HW, El-Khayat ZA, Abu El Naga MW.
Faculty of Medicine, Ain Shams University, Cairo, Egypt. email@example.com
Protein energy malnutrition (PEM) is associated with a significant impairment of cell-mediated immunity and complement system, which may be responsible for the high incidence of infections among these patients. This study was designed to examine the effect of honey, as a natural substance, on the 50% complement hemolytic activity (CH50) in patients with PEM. Thirty patients with PEM and 20 healthy infants serving as controls participated in this study. The patients were randomized to receive either honey (group 1) or placebo (group 2), in addition to conventional nutritional rehabilitation therapy. Measurements of weight, midarm circumference, skin fold thickness, serum albumin, and CH50 were done for all patients before and after 2 weeks of rehabilitation. Before nutritional rehabilitation, the CH50 was significantly lower in the PEM groups compared with the control. However, after rehabilitation, the CH50 increased significantly in both PEM groups, compared with the pre-interventional state and with the controls. Moreover, the rise of CH50 was significantly more in the honey group compared with the placebo. On the other hand, the improvement in the anthropometric measures and serum albumin did not differ significantly between the honey and placebo groups after rehabilitation. Thus honey supplementation in patients with PEM increased the level of CH50. Whether this would have an effect on the frequency and severity of infections in patients with PEM needs further studies.
Int Arch Allergy Immunol. 2011;155(2):160-6. Epub 2010 Dec 23.
Birch pollen honey for birch pollen allergy--a randomized controlled pilot study.
Saarinen K, Jantunen J, Haahtela T.
South Karelia Allergy and Environment Institute, Lappeenranta, Finland. firstname.lastname@example.org
Only a few randomized controlled trials have been carried out to evaluate various complementary treatments for allergic disorders. This study assessed the effects of the preseasonal use of birch pollen honey (BPH; birch pollen added to honey) or regular honey (RH) on symptoms and medication during birch pollen season.
Forty-four patients (59% female, mean age 33 years) with physician-diagnosed birch pollen allergy consumed either BPH or RH daily in incremental amounts from November 2008 to March 2009. Seventeen patients (53% female, mean age 36 years) on their usual allergy medication served as the control group. From April to May, patients recorded daily rhinoconjunctival and other symptoms and their use of medication. Fifty patients completed the study.
During birch pollen season in 2009, BPH patients reported a 60% lower total symptom score (p < 0.01), twice as many asymptomatic days (p < 0.01), and 70% fewer days with severe symptoms (p < 0.001), and they used 50% less antihistamines (p < 0.001) compared to the control group. The differences between the BPH and RH groups were not significant. However, the BPH patients used less antihistamines than did the RH patients (p < 0.05).
Patients who preseasonally used BPH had significantly better control of their symptoms than did those on conventional medication only, and they had marginally better control compared to those on RH. The results should be regarded as preliminary, but they indicate that BPH could serve as a complementary therapy for birch pollen allergy.
Copyright © 2010 S. Karger AG, Basel.
J Otolaryngol Head Neck Surg. 2011 Feb;40 Suppl 1:S14-9.
Double-blinded, randomized, controlled trial of medicated versus nonmedicated merocel sponges for functional endoscopic sinus surgery.
Chang EH, Alandejani T, Akbari E, Ostry A, Javer A.
St. Paul's Sinus Centre, ENT Clinic, St. Paul's Hospital, 1081 Burrard Street, Vancouver, V6Z1Y6. email@example.com
This study aimed to compare differences between medicated and nonmedicated Merocel middle meatal spacers (MMSs) on sinonasal mucosal healing (histopathologic and endoscopic difference), patient discomfort, and pain on removal of the MMS following functional endoscopic sinus surgery.
Forty-eight patients with chronic rhinosinusitis undergoing bilateral functional endoscopic sinus surgery were enrolled in a prospective study. Patients were randomized and blinded to receive a medication-soaked Merocel MMS (either one of budesonide, gentamicin, or manuka honey) in one nostril and a nonmedicated Merocel MMS in the contralateral side. Patients were seen on postoperative day 7 and were asked to complete a visual analogue score to report the level of discomfort from nasal packing on each side. Under endoscopic visualization, biopsies of mucosa were taken from both middle meati and assessed by a blinded pathologist to determine the level of mucosal inflammation on a scale of 0 to 4.
The budesonide-soaked Merocel MMS showed a trend toward reduced mucosal inflammation when compared to the control Merocel MMS, but the results were not statistically significant. There was no statistically significant difference in the degree of discomfort and pain on the removal of the packings between the medication-soaked Merocel MMS and the nonmedicated Merocel MMS, although there was a trend toward less pain for the manuka honey-soaked Merocel MMS.
Although our study failed to show any significant benefit from the addition of medication to the Merocel MMS, further studies with different compounds are recommended to determine whether a medicated MMS could indeed be a superior alternative to the standard MMS.
J Am Coll Nutr. 2010 Oct;29(5):482-93.
Effect of honey versus sucrose on appetite, appetite-regulating hormones, and postmeal thermogenesis.
Larson-Meyer DE, Willis KS, Willis LM, Austin KJ, Hart AM, Breton AB, Alexander BM.
Department of Family and Consumer Sciences, University of Wyoming, Laramie, Wyoming 82071, USA. firstname.lastname@example.org
Increased per capita consumption of sweeteners may be responsible in part for the rising prevalence of obesity in the United States. Recent studies suggest that consumption of honey is not associated with this same obesogenic effect and may have beneficial effects neuro on body weight. The purpose of this study was to evaluate whether the meal-induced responses of ghrelin and peptide YY(3-36) (PYY(3-36)) and/or meal-induced thermogenesis differ following a honey- versus a sucrose-containing meal.
In a double-blind randomly assigned study, appetite hormones (ghrelin, PYY(3-36), leptin) and glycemic and thermic responses were evaluated following isoglucidic ∼450 kcal honey- or sucrose-containing breakfasts in 14 healthy, nonobese women (22 ± 3 y). Blood samples and hunger ratings were obtained at baseline and every 30 minutes for 240 minutes following the meal. Meal-induced thermogenesis was measured by indirect calorimetry. Ad libitum food intake was evaluated from a free-choice meal following the test meal.
Honey consumption delayed the postprandial ghrelin response (p = 0.037), enhanced the total PYY (p = 0.007) response, and blunted the glucose response (p = 0.039) compared with consumption of the sucrose-containing meal. Meal-induced insulin response, hunger ratings, thermogenesis, and subsequent ad libitum food intake, however, did not differ (p > 0.10) between diet treatments.
Alterations in meal-induced responses of ghrelin and PYY(3-36) but not meal-induced thermogenesis may be responsible in part for the potential "obesity protective" effect(s) of honey consumption. A blunted glycemic response may be beneficial for reducing glucose intolerance. Further research is required to determine if these findings hold true for obese individuals, for males, or with habitual consumption.
PMID: 21504975 [PubMed - indexed for MEDLINE]
J Otolaryngol Head Neck Surg. 2011 Jun 1;40(3):238-43.
Single-blind study of manuka honey in allergic fungal rhinosinusitis.
Thamboo A, Thamboo A, Philpott C, Javer A, Clark A.
St. Paul's Sinus Centre, ENT Clinic, St. Paul's Hospital, Vancouver, BC. email@example.com
Some patients continue to suffer from symptoms of sinusitis after maximal topical medical and surgical treatment for allergic fungal rhinosinusitis (AFRS). Manuka honey has well-documented antimicrobial and antifungal properties and is currently being used by physicians across the world for a wide variety of medical problems.
This study aimed to determine the effectiveness of Medihoney Antibacterial Medical Honey in patients who continue to suffer from AFRS resistant to conventional medical treatment after bilateral functional endoscopic sinus surgery and maximal postoperative medical management.
A randomized, single-blind, prospective study was conducted at a tertiary centre. Thirty-four patients with AFRS sprayed one nostril with 2 mL of a 50/50 mixture of honey-saline solution once a day at night for 30 days. Otherwise, patients continued with their regular nasal regimen in both nostrils. A 5-point improvement in our clinic's endoscopic grading system was considered significant. During their pre- and postassessment, patients' sinus cavities were cultured, and the patients filled out a Sino-Nasal Outcome Test (SNOT-22) questionnaire to assess subjective nasal symptoms.
As a group, the 34 patients who completed the study showed no significant improvement in the treated nostrils versus control nostrils (p ?=? 1.000). However, the nine patients who did respond to the honey treatment relative to their control side responded very well. A number of these patients had high IgE levels in their blood. The manuka honey did not appear to modify the culture results in the ethmoid cavities after 30 days of treatment, but patients who completed the SNOT-22 questionnaire indicated global improvement in their symptoms while receiving the honey spray (p ?=? .0220).
Overall, topical manuka honey application in AFRS, despite showing symptomatic benefits, did not demonstrate a global improvement in endoscopically staged disease, but specific patients did show significant positive responses. Further research is needed to determine the factors of the patients who responded well to the honey spray, which may correlate to high IgE levels.