Manuka Honey

• How It Works

  Manuka honey (MH) helps prevent infections and promotes wound healing when used externally.

  MH can help fight bacterial infections and has been used in dressings to promote wound healing. Methylglyoxal, a compound present in MH, is thought to have bacteriostatic effects. In vitro and animal studies have shown that MH has anti-inflammatory and anti-ulcer effects. Small studies in humans suggest its benefits against gingivitis and inflamed nasal sinuses. But it was found ineffective in improving oral mucositis following radiation in head and neck cancer patients. Larger studies are needed.

• Purported Uses
  • Wound dressings
    Small studies suggest the value of MH in wound healing.
  • Antibiotics
    Topical use of MH was shown to be effective against bacteria.
  • Fungal infections
    Clinical trials have not been conducted.
  • High cholesterol
    MH was ineffective in lowering cholesterol.
  • Diabetes
    Clinical trials are lacking. Excessive use of honey may cause increase in blood sugar levels.
  • Gastrointestinal tract problems
    Clinical trials have not been able to confirm if MH has a significant effect on the levels of beneficial bacteria in the gut.
  • Infections
    Case studies and anecdotal reports have described MH as being effective in treating infected wounds that were non-responsive to standard treatment.
  • Cancer prevention/treatment
    Clinical trials are lacking.
  • Radiation-induced oral mucositis
    Clinical trials did not find any benefit of MH in reducing radiation-induced oral mucositis, but one study found that it reduced bacterial infections.
  • Oral health
    One small study suggested regular consumption of MH to be effective in reducing buildup of plaque and gingivitis. Large-scale studies are needed.
• Patient Warnings

  Although MH has antibacterial effects, patients should not self-medicate with honey products. Any infection should be examined by a physician or a qualified healthcare professional for proper care.

• Side Effects
  • The sugar content in honey may raise the blood glucose level of diabetics.
  • In rodents, a 50% concentration of MH applied to the ear following a surgical procedure of the eardrum resulting in inflammation leading to facial paralysis and hearing loss.
• Clinical Summary

  Manuka honey (MH) is collected from beehives around the Manuka (Leptospermum scoparium) bush that is indigenous to Australia and New Zealand. It has been used as food and as a topical treatment for wounds, burns and ulcers. Studies done in vitro and in animal models show that MH has antibacterial ^{(1) (25) (26)}, anti-inflammatory ^(9) (27), antioxidant and anti-ulcer ⁽²⁷⁾ effects. Methylglyoxal, one of the constituents, is the major bactericidal factor ⁽²¹⁾. MH was also found effective against several antibiotic-resistant bacteria ^{(28) (29) (30)}, and may potentially be useful against rapidly increasing antibiotic resistance.

  Small studies suggest its utility against gingivitis ⁽²⁾, chronic rhinosinusitis ⁽³²⁾, as an adjunct in the management of corneal oedema ⁽²⁴⁾, and as an adjunctive oral hygiene agent in children ⁽³³⁾. However, randomized trials did not find MH to be more effective compared to standard treatments against catheter-associated bacterial infections ⁽⁶⁾, in healing venous leg ulcers ⁽²⁰⁾ or eyelid surgical wounds ⁽³¹⁾. MH has also been used to increase levels of beneficial bacteria and relieve gastrointestinal problems, but was not found useful in healthy subjects ⁽⁷⁾. It also did not reduce cholesterol levels in subjects with hypercholesterolemia ⁽⁸⁾.

  The anticancer potential of MH has not been investigated yet. But it was ineffective in alleviating radiation-induced oral mucositis in randomized trials involving patients with head and neck cancer ^(19) (22), although one study reported a reduction in bacterial infections ⁽²²⁾. Larger studies are needed to determine the therapeutic value of MH.

• Purported Uses
  • Wound healing
  • Infections
  • Diabetes
  • GI problems
  • Cancer
  • Oral health
• Mechanism of Action

  Flavonoids present in MH demonstrated anti-inflammatory, antimicrobial, and anticancer properties ⁽¹³⁾. Methylglyoxal, a phytochemical, is the major bactericidal factor and also promotes free radical generation ^(14) (21). MH was shown to reduce the motility of Pseudomonas aeruginosa, a gram negative bacterium and an opportunistic pathogen, by suppressing genes associated with its flagella, thereby reducing its virulence ⁽³⁴⁾. It also inhibited the formation of biofilm, a complex polysaccharide structure produced by some bacteria such as Clostridium dificile, which confers on them resistance to antibiotics ⁽³⁰⁾. The anti-ulcer effects of MH are likely by increasing gastric mucosal levels of glutathione peroxidase and superoxide dismutase; and by reducing inflammatory cytokines including tumor necrosis factor (TNF-alpha), Interleukins 1-beta and 6 ⁽²⁷⁾.

  In addition, MH honey was shown to enhance the effects of antioxidants in animal studies ⁽¹⁵⁾ as well as promote wound healing by modulating production of cytokines ⁽⁴⁾ and by lowering pH on wound surfaces ^(5) (16). Some products MH list its antibacterial potency by a Unique Manuka Factor (UMF), which is equal to the inhibitory potential of a phenolic solution of same strength ⁽⁷⁾. However, the clinical relevance of this measurement is unclear.

• Contraindications

  Individuals allergic to honey should avoid this product.

• Adverse Reactions

   

  • May increase blood glucose levels.
  • In a rodent model, a 50% concentration of MH applied to the ear following myringotomy caused severe inflammation leading to facial paralysis, vestibulotoxicity, and hearing loss ⁽²³⁾.

   

• Herb-Drug Interactions

  Chemotherapy: Theoretically, MH may interfere with certain chemotherapeutic agents due to its antioxidant effects.

• Herb Lab Interactions

  The sugar in MH may raise the blood glucose level in diabetics.

• References

  1. Cooper RA, Molan PC, Harding KG. Antibacterial activity of honey against strains of Staphylococcus aureus from infected wounds. J R Soc Med. Jun 1999;92(6):283-285.

  2. English HK, Pack AR, Molan PC. The effects of manuka honey on plaque and gingivitis: a pilot study. J Int Acad Periodontol. Apr 2004;6(2):63-67.

  3. Cooper RA, Molan PC, Harding KG. The sensitivity to honey of Gram-positive cocci of clinical significance isolated from wounds. J Appl Microbiol. 2002;93(5):857-863.

  4. Tonks AJ, Cooper RA, Jones KP, Blair S, Parton J, Tonks A. Honey stimulates inflammatory cytokine production from monocytes. Cytokine. Mar 7 2003;21(5):242-247.

  5. Gethin GT, Cowman S, Conroy RM. The impact of Manuka honey dressings on the surface pH of chronic wounds. Int Wound J. Jun 2008;5(2):185-194.”

  6. Johnson DW, van Eps C, Mudge DW, et al. Randomized, controlled trial of topical exit-site application of honey (Medihoney) versus mupirocin for the prevention of catheter-associated infections in hemodialysis patients. J Am Soc Nephrol. May 2005;16(5):1456-1462.

  7. Wallace A, Eady S, Miles M, et al. Demonstrating the safety of manuka honey UMF 20+in a human clinical trial with healthy individuals. Br J Nutr. Apr 2010;103(7):1023-1028.

  8. Munstedt K, Hoffmann S, Hauenschild A, Bulte M, von Georgi R, Hackethal A.Effect of honey on serum cholesterol and lipid values. J Med Food. Jun 2009;12(3):624-628.

  9. Prakash A, Medhi B, Avti PK, Saikia UN, Pandhi P, Khanduja KL. Effect of different doses of Manuka honey in experimentally induced inflammatory bowel disease in rats. Phytother Res. Nov 2008;22(11):1511-1519.

  10. Adams CJ, Manley-Harris M, Molan PC. The origin of methylglyoxal in New Zealand manuka (Leptospermum scoparium) honey. Carbohydr Res. May 26 2009;344(8):1050-1053.

  11. Weston RJ, Mitchell KR, Allen KL. Antibacterial phenolic components of New Zealand manuka honey. Food Chemistry. 1999;64(3):295-301.

  12. Yao L, Datta N, Tomás-Barberán FA, Ferreres F, Martos I, Singanusong R. Flavonoids, phenolic acids and abscisic acid in Australian and New Zealand Leptospermum honeys. Food Chemistry. 2003;81(2):159-168.

  13. Lopez-Lazaro M. Flavonoids as anticancer agents: structure-activity relationship study. Curr Med Chem Anticancer Agents. Nov 2002;2(6):691-714.

  14. Kalapos MP. The tandem of free radicals and methylglyoxal. Chem Biol Interact. Feb 15 2008;171(3):251-271.

  15. Medhi B, Prakash A, Avti PK, Saikia UN, Pandhi P, Khanduja KL. Effect of Manuka honey and sulfasalazine in combination to promote antioxidant defense system in experimentally induced ulcerative colitis model in rats. Indian J Exp Biol. Aug 2008;46(8):583-590.

  16. Gethin G, Cowman S. Bacteriological changes in sloughy venous leg ulcers treated with manuka honey or hydrogel: an RCT. J Wound Care. Jun 2008;17(6):241-244, 246-247.

  17. Timm M, Bartelt S, Hansen EW. Immunomodulatory effects of honey cannot be distinguished from endotoxin. Cytokine. Apr 2008;42(1):113-120.

  18. Cooper RA, Jenkins L, Henriques AF, Duggan RS, Burton NF. Absence of bacterial resistance to medical-grade manuka honey. Eur J Clin Microbiol Infect Dis. Jun 13 2010.

  19. Hawley P, Hovan A, McGahan CE, Saunders D. A randomized placebo-controlled trial of manuka honey for radiation-induced oral mucositis. Support Care Cancer. 2014 Mar;22(3):751-61.

  20. Jull A, Walker N, Parag V, et al. Randomized clinical trial of honey-impregnated dressings for venous leg ulcers. Br J Surg. 2008 Feb;95(2):175-82.

  21. Kwakman PH, Te Velde AA, de Boer L, Vandenbroucke-Grauls CM, Zaat SA. Two major medicinal honeys have different mechanisms of bactericidal activity. PLoS One. 2011 Mar 4;6(3):e17709.

  22. Bardy J, Molassiotis A, Ryder WD, et al. A double-blind, placebo-controlled, randomised trial of active manuka honey and standard oral care for radiation-induced oral mucositis. Br J Oral Maxillofac Surg. 2012 Apr;50(3):221-6.

  23. Aron M, Victoria Akinpelu O, Dorion D, Daniel S. Otologic safety of manuka honey.J Otolaryngol Head Neck Surg. 2012 Apr;41 Suppl 1:S21-30.

  24. Albietz JM, Lenton LM. Standardised antibacterial Manuka honey in the management of persistent post-operative corneal oedema: a case series.Clin Exp Optom. 2015 Sep;98(5):464-72.

  25. Kumar ND, Kalluru RS, Ahmed S, et al. Comparison of the Antibacterial Efficacy of Manuka Honey Against E.faecalis and E.coli – An In vitro Study. J Clin Diagn Res. 2014 Aug;8(8):ZC29-31.

  26. Schmidlin PR, English H, Duncan W, Belibasakis GN, Thurnheer T. Antibacterial potential of Manuka honey against three oral bacteria in vitro. Swiss Dent J. 2014;124(9):922-4.

  27. Almasaudi SB, El-Shitany NA, Abbas AT, et al. Antioxidant, Anti-inflammatory, and Antiulcer Potential of Manuka Honey against Gastric Ulcer in Rats. Oxid Med Cell Longev. 2016;2016:3643824.

  28. Hillitt KL, Jenkins RE, B Spiller O, Beeton ML. Antimicrobial activity of Manuka honey against antibiotic resistant strains of the cell wall free bacteria Ureaplasma parvum and Ureaplasma urealyticum. Lett Appl Microbiol. 2016 Dec 19. doi: 10.1111/lam.12707. [Epub ahead of print]

  29. Jenkins R, Wootton M, Howe R, Cooper R. A demonstration of the susceptibility of clinical isolates obtained from cystic fibrosis patients to manuka honey. Arch Microbiol. 2015 May;197(4):597-601.

  30. Hammond EN, Donkor ES, Brown CA. Biofilm formation of Clostridium difficile and susceptibility to Manuka honey. BMC Complement Altern Med. 2014 Sep 3;14:329.

  31. Malhotra R, Ziahosseini K, Poitelea C, Litwin A, Sagili S. Effect of Manuka Honey on Eyelid Wound Healing: A Randomized Controlled Trial. Ophthal Plast Reconstr Surg. 2016 Jul 13. [Epub ahead of print]

  32. Lee VS, Humphreys IM, Purcell PL, Davis GE. Manuka honey sinus irrigation for the treatment of chronic rhinosinusitis: a randomized controlled trial. Int Forum Allergy Rhinol. 2016 Dec 9. doi: 10.1002/alr.21898. [Epub ahead of print]

  33. Rupesh S, Winnier JJ, Nayak UA, Rao AP, Reddy NV, Peter J. Evaluation of the effects of manuka honey on salivary levels of mutans streptococci in children: a pilot study. J Indian Soc Pedod Prev Dent. 2014 Jul-Sep;32(3):212-9.

  34. Roberts AE, Maddocks SE, Cooper RA. Manuka honey reduces the motility of Pseudomonas aeruginosa by suppression of flagella-associated genes. J Antimicrob Chemother. 2015 Mar;70(3):716-25.