Honey and coffee
Jacob Schor, ND, FABNO
June 20, 2014
Here’s a trick that you will want to remember next winter when those colds and coughs make our lives miserable. The second in a series of clinical trials using a cough syrup made from honey and instant coffee suggests this innocuous sonunding mixture will actually work better than taking oral steroids in treating those lingering coughs that go on and on once we are otherwise recovered from upper respiratory infections.
Hard to believe I know. Here are the details.
I read about this in a study published last year by Mohammad-Ali Raeessi and colleagues from Tehran, Iran  . They wrote about the a double-blind randomized controlled trial, which they conducted from 2008 to 2011 to compare the effectiveness of three treatments for reducing severity of persistent coughs that followed upper respiratory infections. These are the chronic coughs that may start with a cold or flu but that linger long after you think you are better.
They enrolled a total of 97 adults, who had experienced these persistent post-infectious coughs for more than three weeks. People who had other reasons for having a chronic cough, who had any systemic disease, who were smokers, or individuals who had any abnormal results on routine lab tests were all excluded from the study. Mean age of participants was 40 and mean duration of illness 2.9 months.
The subjects were divided into three groups to given one of three regimens to take three times a day for a week. The three ‘treatments were prepared as pastes that all looked and tasted similar. The study participants dissolved a tablespoon of this paste stuff in warm water and drank it three times a day.
Group one’s paste delivered about 21 grams of honey and about 3 grams of Nestle instant coffee per dose.
Group two’s mixture delivered 13.3 mg of the steroid prednisolone per dose.
Group three received 25 gm guaifenesin in each dose
All products were prepared and packaged by pharmacists to have similar appearance, flavor and packaging.
The cough frequency of each participant was evaluated before treatment began and one week after treatment was completed using a specially designed and validated questionnaire that was completed by physicians who interviewed and evaluated the patients. The questionnaire graded coughs on a scale of 0 (low) to 3+ (high).
The people in the three groups were similar in respect in all variables including age and cough frequency at the start of the study. Changes in cough frequency before and after the treatment period were significant for the honey/coffee group and the steroid group. No significant change was detected in the control group. The difference in cough frequency before and after treatment was not significantly different between the steroid and control groups. The decrease in cough frequency for the honey-coffee group was statistically significant and significantly greater than in the steroid or control groups.
The numbers speak for themselves:
Frequency of cough Honey-coffee group Steroid group control group
Before treatment 2.9 3.0 2.8
After treatment 0.2 2.4 2.7
This is pretty nifty. A mixture of honey and instant coffee was significantly more effective at relieving persistent cough than steroids or placebo. This treatment is safe, effective, pleasant tasting, inexpensive and uses natural food ingredients. What more could we ask for?
The use of honey for medicine dates back far into prehistory. In Iran, where this current stuy was performed, use of honey in traditional medicine goes back thousands of years to ancient Persia where mixtures of honey cooked with vinegar, known as oxymel, were used for a variety of medicinal purposes and also as the base for hundreds of specific herbal compounds .
This is the second study by these same authors using honey and coffee to treat persistent cough. In their earlier paper, published in 2009, they compared the effect of instant coffee or honey individually and then in combination on a group of 84 subjects with persistent cough. The combination of coffee and honey together was significantly superior in reducing persistent cough than either ingredient alone .
2009 study: cough frequency scores
coffee honey coffee + honey
before treatment: 30 3.0 3.0
1.8 1.4 0.4
A number of mechanisms have been suggested to explain honey’s medicinal action on these coughs including it’s acidity, osmolality, and hydrogen peroxide production  . Honey reduces prostaglandin synthesis in the area of application, increases nitric oxide levels and has antioxidant effect  .
In a rabbit model of asthma, aerosolized honey “… resulted in structural changes of the epithelium, mucosa, and submucosal regions of the airway ... [and] reduced the number of airway inflammatory cells present in bronchoalveolar lavage fluid and inhibited the goblet cell hyperplasia.” 
It has been suggested that any material that tastes sweet will reduce cough  . This effect may be simply due to the high osmolality of honey as it stimulates the salivation reflex and hypersecretion of airway mucus, which in turn improves mucociliary clearance in the pharynx and reduces cough.
A 2012 double-blinded randomized control trial from Israel reported that just honey alone was significantly superior to other treatments for night-time coughs in children  . The Journal of Family Practice described these results as a ‘game changer’ in clinical practice  .
Although a March 2012 Cochrane review, in their hallmark cautious style, allowed only that “Honey may be better than 'no treatment' …..”  , honey is starting to look like something we should employ more often in practice. Particularly, it would seem, in combination with coffee. Why does the combination work so well? We are not really sure.
In 2011 Nosá?ová et al identified an arabinogalactan-protein extract from instant coffee that does have an anti-tussive effect  . There have been suggestions that coffee or the caffeine in it might act as a bronchodilator and so improve the cough. Yet, the small amount of caffeine used in these studies is probably not adequate to cause bronchodilation  .
Whatever the case, the combination of the two, coffee and honey, appears to be more effective than either alone and certainly worth a try.
500 gram honey (about one pound)
70 grams of instant coffee (about 2.5 ounces dry weight, or 13 TB or 6.5 oz liquid measure)
2 Tb honey
3 gm instant coffee (about one serving)
Three times a day, or about every 8 hours, mix 1 tablespoon of this honey mixture in a cup of warm water and drink it.
[Note: Some of you will ask whether decaffeinated coffee work? We don’t know; it is unclear whether the caffeine is essential or not. I’m thinking that when I try this, I’ll use caffeinated coffee during the day and switch to decafe for the last dose at night.]
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 Raeessi MA, Aslani J, Gharaie H, Karimi Zarchi AA, Raeessi N, Assari S.
Honey with Coffee: A new finding in the treatment of Persistent Post infectious Cough
Iranian Journal of Otorhinolaryngology No.2, Vol. 23, Serial No.63, Spring-2011
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