Honey may relieve hot flashes in breast cancer patients
February 14, 2016
Jacob Schor, ND, FABNO
Here’s a sweet study. Last summer, Karsten Münstedt and colleagues in Germany published a study on bee pollen and honey to alleviate hot flashes and other menopausal symptoms in breast cancer patients, that is in women taking adjuvant medications to block estrogen effect. In other words they were taking either tamoxifen or one of the aromatase inhibitor drugs such as Aromasin or Femara. Such treatments cause serious hot flashes.
This study was a prospective, randomized, crossover trial in breast cancer patients receiving anti-hormonal treatment
A total of 46 patients were recruited for the study but only 31 completed both the whole thing; the majority dropped out during the pollen phase because they found the taste of the pollen mixture intolerable. Mean age of participants was 60.8 years.
All participants had completed surgery for breast cancer and had been on anti-hormonal therapy for at least 3 months prior to the study. Exclusion criteria included distant metastases, pregnancy, allergy to bee pollen and/or honey, concomitant disease, psychiatric disease, use of other treatments for menopause symptoms or an inability to read German.
The treatment was simple: Patients received one tablespoon a day of either a mixture of pollen and honey (pollen group) or pure honey (honey group) for two weeks. After a washout period when they received no treatment, the participants received the alternate treatment for an additional two weeks.
Menopausal complaints were assessed using the Schneider and Heinemann Menopause Rating Scale (MRS). Blood samples were collected at each stage of the study and tested for triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and estradiol.
All participants reported significant improvements during the study, 68.3% of those while receiving honey and 70.9% of the patients while receiving pollen. The differences between groups were not significant; both honey and pollen relieved menopausal symptoms caused by adjuvant treatment of breast cancer. These improvements were noted 3-4 days after initiation of treatment regardless of whether patients received tamoxifen or an aromatase inhibitor, or were in the honey or the pollen groups. Patients receiving pollen and taking tamoxifen showed a trend toward higher rates of improvement (86.7 vs. 58.8%) but this difference was not significant. No differences in serum cholesterol, triglycerides of estradiol were seen. Patients taking aromatase inhibitors experienced significantly more improvement of symptoms in comparison to patients treated with tamoxifen. There was also a trend toward an increase in estradiol levels by honey in patients receiving aromatase inhibitors. 
This is wild. Giving plain honey was supposed to be the placebo so the effect of pollen could be measured. But plain honey seemed to work as well as the active pollen mixture. And both seem to work better than anything else short of Premarin. This is probably too good to be true.
Yet here’s where we are now.
Suggesting to patients complaining of menopausal symptoms secondary to adjuvant treatment of breast cancer that they try taking a tablespoon of honey once a day for a week or so as a clinical experiment sounds almost too simple, but it is certainly worth a try.
Finding ways to relieve menopausal symptoms is clinically important as many breast cancer patients will discontinue treatment rather than experience the discomfort of hot flashes. The Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial reported discontinuation rates of 14.3% for tamoxifen and 11.1% for anastrozole  . Providing relief may increase compliance with these currently accepted therapies.
In the past we have advocated for a range of alternative supplements to relieve menopausal symptoms, including vitamin E, soy, black cohosh, flax and red clover. Questions have remained about the safety of those that employ phytoestrogens and whether they may stimulate breast cancer growth. Chi et al’s 2013 meta-analysis of soy and breast cancer suggests that at least in the case of soy, these estrogens are protective  .
Several papers have reported that pollen extracts were useful in treating hotflashes but this may be the first to suggest that even plain honey was useful. In this case honey was used as a placebo to compare the active pollen and honey mixture against. [4, 5]
While some placebo effect was possible, the researchers suggest that the improvements seen greatly exceeded the 25% response rate what would have been predicted from placebo effect  .
Tualang honey, a rare form of wild honey produced by Asian honeybees from jungle floral nectars, may have an estrogenic effect  . The “common” honey used in this menopausal study, and the kind we eat, is produced by European honeybees, (Apis mellifera). Tualang honey is produced by Apis dorsata bees that nest in Tualang trees. This Tualang honey has in fact been suggested as a means to prevent osteoporosis . So although, for unknown reasons, the Tualang honey may somehow stimulate estrogen production, at this point there is no reason to think that common table honey does the same. It is unfortunate that Tualang honey is not yet readily available to our patients. It has been reported Tualang honey augments the effect of tamoxifen against breast cancer cells and so might be helpful if consumed.
Note that there was a trend toward increased estrogen levels in the honey group but this association did not reach significance. If this association proves real in the future it will no doubt trigger debate as to whether breast cancer patients should consume or abstain from honey.
While a rationale for a mechanism of action remains to be found for honey’s reported benefit, there is little reason to justify not attempting to employ it clinically. In this report honey worked better in women taking aromatase inhibitors and it took only 3-4 days of regular honey until improvement was felt. As the downsides of honey supplementation are negligible there is no reason to not try this in practice.
Mol Clin Oncol. 2015 Jul;3(4):869-874. Epub 2015 May 4.
Bee pollen and honey for the alleviation of hot flushes and other menopausal symptoms in breast cancer patients.
Münstedt K1, Voss B2, Kullmer U3, Schneider U2, Hübner J4.
Hot flushes, night sweats, pain during sexual intercourse, hair loss, forgetfulness, depression and sleeping disturbances are common problems among breast cancer patients undergoing antihormonal treatment. The aim of this study was to investigate whether bee pollen can alleviate menopausalsymptoms in patients receiving tamoxifen and aromatase inhibitors/inactivators. We compared a pollen-honey mixture with pure honey (placebo) in a prospective, randomized crossover trial in breast cancerpatients receiving antihormonal treatment. The menopausal complaints were assessed using theMenopause Rating Scale (MRS). A total of 46 patients were recruited; 68.3% (28/41) of the patientsreported an improvement in their symptoms while taking honey, compared with 70.9% (22/31) who reported an improvement with pollen (the difference was non-significant). The results were confirmed by significant improvements in the postmenopausal complaints in the two groups in a pre-post analysis in the MRS and its 3 subscales. This study provided evidence that honey and bee pollen may improve themenopausal symptoms of breast cancer patients on antihormonal treatment. Of note, honey, which was intended to be used as a placebo, produced similar effects as pollen and they both exceeded the extent of a placebo effect in this setting (~25%).
1. Münstedt K, Voss B, Kullmer U, Schneider U, Hübner J. Bee pollen and honey for the alleviation of hot flushes and other menopausal symptoms in breast cancer patients. Mol Clin Oncol. 2015 Jul;3(4):869-874.
2. Group: Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years' adjuvant treatment for breast cancer. Lancet. 2005;365:60–62
3. Chi F, Wu R, Zeng YC, Xing R, Liu Y, Xu ZG. Post-diagnosis soy food intake and breast cancer survival: A meta-analysis of cohort studies. Asian Pac J Cancer Prev.2013;14:2407–2412.
4. Hellström AC1, Muntzing J. The pollen extract Femal--a nonestrogenic alternative to hormone therapy in women with menopausal symptoms. Menopause. 2012 Jul;19(7):825-9.
5. Winther K1, Rein E, Hedman C. Femal, a herbal remedy made from pollen extracts, reduces hot flushes and improves quality of life in menopausal women: a randomized, placebo-controlled, parallel study. Climacteric. 2005 Jun;8(2):162-70.
6. Sloan JA, Loprinzi CL, Novotny PJ, Barton DL, Lavasseur BI, Windschitl H. Methodologic lessons learned from hot flash studies. J Clin Oncol. 2001;19:4280–4290.
7. Zaid SS, Sulaiman SA, Sirajudeen KN, Othman NH. The effects of Tualang honey on female reproductive organs, tibia bone and hormonal profile in ovariectomised rats--animal model for menopause. BMC Complement Altern Med. 2010 Dec 31;10:82.
8. Mohd Effendy N, Mohamed N, Muhammad N, Mohamad IN, Shuid AN. The effects of tualang honey on bone metabolism of postmenopausal women. Evid Based Complement Alternat Med. 2012;2012:938574.
9. Yaacob NS, Nengsih A, Norazmi MN. Tualang honey promotes apoptotic cell death induced by tamoxifen in breast cancer cell lines. Evid Based Complement Alternat Med. 2013;2013:989841.