Effect of Honey on Human Health

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1		Celia Rodriguez-Pérez	--	4148	2023-07-19 08:37:51	\|
2	format	Jason Zhu	Meta information modification	4148	2023-07-20 10:43:47	\|

This entry is adapted from the peer-reviewed paper 10.3390/nu15133056

Honey is a nutritious, healthy, and natural food, to which antioxidant, anti-inflammatory, and antimicrobial properties have been attributed, mainly due to its content of phenolic compounds. More beneficial effects of honey intake than no or negative effects on different cardiovascular and metabolic risk factors, glucose tolerance, mucositis caused by chemo-radiotherapy, cough in children and wound healing, among others have been observed. Although the number of studies conducted to date is limited and the different investigations are not standardized, beneficial effects of honey intake have been observed, especially when its intake replaces the intake of other sweeteners. Therefore, honey could be a safe adjuvant to be administered to people aged more than 1 year old alongside drugs currently used for certain diseases. However, it should not be forgotten that honey is a high sugar food, and it should be consumed occasionally and with moderation. More studies are necessary to establish more specific recommendations on honey consumption.

honey health clinical trials cough cancer

1. Introduction

Honey is a natural substance produced by honey bees (Apis mellifera). They collect flower nectar, plant secretions or excretions of plant-sucking insects from plants and transform it into honey ^[1]. Worldwide, 1779.6 metric tons of honey are produced, and the market value of honey is expected to grow by 2028 ^[2]. China produces almost 28% of the world’s honey, followed by Turkey (5.9%), Iran (4.5%), the United States (4.1%), and India (3.5%) ^[3]. The main exporters of honey are China, New Zealand, Argentina, Germany, Ukraine, India, and Spain while the United States, Germany, Japan, France, the United Kingdom, Italy, and China lead the import ^[3].

Honey is considered a nutritious, healthy, and natural food, whose composition is highly variable depending on its botanical and geographical origin ^[4]. It is mainly composed of a mixture of different sugars (80–85%), water 15–17%, and proteins (0.1–0.4%) ^[5], but it also contains enzymes, organic acids, vitamins, minerals, and phenolic compounds to a lesser extent, which contribute greatly to its sensory and functional characteristics ^[5]. The color can range from white to brown and is largely determined by the presence of phenolic compounds and minerals ^[5]. Honey is classified according to its botanical origin as monofloral—when it is produced from the nectar or honeydew of a single botanical species or if its presence is predominant and multifloral—when it comes from more than one botanical species ^[6]. Antioxidant, anti-inflammatory, antibacterial, and antiviral properties have been linked to honey intake which has contributed to increasing the interest in this food ^[4]. Despite the fact that bioactive compounds implicated in those effects have not been fully elucidated, the beneficial effects of honey on human health have been attributed to its content of phenolic compounds ^[7]. Phenolic compounds are synthesized by plants under normal and stress conditions ^[8] and have several functions, such as attracting insects for pollination and protecting against pathogens and ultraviolet radiation, among others ^[9]. They are characterized for having one or more aromatic rings with one or more hydroxyl groups. Its content varies depending on the variety, origin, agronomic and storage conditions, harvest time, and climate ^[10]. In fact, recent research reported that values of total phenolic content (TPC) from different honeys ranged between 0.65 ± 0.42 and 84.17 ± 30.40 mg/100 g ^[11]. Among them, the majority of the characteristics are flavonoids and phenolic acids.

2. Cardiovascular and Metabolic Risk Factors

2.1. Healthy Subjects

Several authors have associated honey consumption with improvements of lipid profile in healthy subjects. In this regard, a supplementation with 70 g/day of honey for 6 weeks significantly improved the lipid profile of young men (18–30 years) compared to subjects supplemented with sucrose ^[12]. Specifically, triglycerides (TG), total cholesterol (TC), and low-density lipoproteins (LDL) levels decreased, and high-density lipoprotein (HDL) levels increased between the beginning and end of the study. Those differences were also significant compared to the control group. A significant improvement in lipid profile were also demonstrated in a study conducted on young Pakistani men (20.13 ± 0.14 y) ^[13]. In the experimental group supplemented with 70 g/day of natural, unprocessed honey purchased from Ilyas Traders, Charsadda, Khyber Pakhtunkhwa, (Pakistan) for 4 weeks, a significant decrease in total and LDL cholesterol levels was observed, while the HDL level increased significantly. However, changes in fasting blood glucose (FBG) and TG levels were not significant. When the two groups were compared, the increase in FBG in the experimental group was significantly lower than in the control group, the decrease in TG, TC, and LDL levels and the increase in HDL level in the experimental group were also significant compared to the control group. In addition, oral glucose tolerance (OGT) was significantly higher after honey consumption than after glucose consumption. Contrarily, Al-Tamimi et al. ^[14] showed no significant effects on lipid profile or basal insulin when supplemented with 1.5 g/kg/day of a mixture of four types of clover honey obtained from Golden Heritage Foods, Smitty Bee Honey, Millers Honey Company, and Marshall’s Farm Natural Honey, for 1 month in healthy subjects aged 24–57 years. Interestingly, honey consumption did not produce the negative responses in TG levels that sucrose intake did, and thus suggests that the substitution of sucrose with natural honey may be beneficial. These results seem to indicate that supplementation for 6 weeks has a greater effect than for 4 weeks.

2.2. Overweight or Obese Subjects

Yaghoobi et al. ^[15] conducted a study on overweight/obese subjects in which the experimental group consumed 70 g/day of Iranian natural honey and the control group consumed the same amount of sucrose for a month. Honey consumption resulted in a significant reduction in body mass index (BMI) and FBG. Moreover, honey significantly reduced serum TG and C-reactive protein (CRP) in subjects with elevated variables. There was also a slight reduction in body weight (BW) and body fat (BF), but these findings were not significant. In addition, the intake of honey allowed for a significant reduction in TG and CRP levels in subjects with high baseline values while it non-significantly reduced total cholesterol, LDL, TG, and CRP levels and increased HDL cholesterol in subjects with normal baseline values. In another study carried out on a group of obese prepubertal girls (10 ± 0.34 y) who had a dietary treatment, the intake of 15 g/day of wild flowers-forest-thyme honey (experimental group) or jam (control) showed similar results ^[16]. The decrease in BMI was greater in the experimental group but not in a significant way. HDL levels increased in the experimental group while it decreased in the control group. TG decreased in both groups which is greater in the experimental group; however, this difference was not significant. Raatz et al. ^[17] also found no significant differences in a trial conducted on overweight/obese subjects aged 35–55 years who had normal or impaired glucose tolerance. Subjects were supplemented with 50 g of Dutch Gold Honey (honey from different floral sources and geographic origin), sucrose, or corn syrup for 2 weeks. No changes in BW were observed throughout the trial, or in glucose and insulin concentrations during the glucose tolerance test. Systolic blood pressure (SBP) was unchanged while diastolic blood pressure (DBP) was significantly reduced between pre- and post-treatment in subjects supplemented with sucrose or syrup, indifferently of their glycaemic status. No significant changes in cholesterol levels were observed in either group, but TG levels increased significantly between pre- and post-treatment in sucrose-supplemented subjects. These results suggest that doses of 15 and 50 g/day are insufficient to produce significant improvements in cardiovascular risk factors. On the other hand, the intervention seems to be more effective in subjects with altered baseline values.

2.3. Diabetic Subjects

Wahab et al. ^[18] carried out a study on healthy and diabetic post-menopausal women that showed that the intake of 20 g/day of Tualang sterilized honey supplied by Federal Agricultural Marketing Authorities (FAMA) (Malaysia) for 12 months had significant effects on lowering DBP and FBG. However, it had no significant effects on blood lipid profile, BMI, body composition, and waist circumference. In another study performed with type II diabetic subjects (57.2 ± 8.4 years), the experimental group was supplemented with increasing doses of Iranian natural unprocessed honey collected from Samans kandeh, Neka, Sari City, for 8 weeks, starting with 1.0 g/kg/day and increasing by 0.5 g/kg/day every 2 weeks until reaching 2.5 g/kg/day; while the control group was not supplemented with any substance. After 8 weeks of honey consumption, there were significant reductions in BW, TC, LDL, and TG, as well as a significant increase in HDL levels. There was also a decrease in FBG levels, although this was not significant. However, glycosylated hemoglobin (HbA1c) levels increased significantly in the honey-consuming group ^[19].

Mamdouh et al. ^[20] conducted a randomized crossover study on type I diabetic children. In the intervention period, the children were supplemented with 0.5 mL/kg/day of non-heated and non-irradiated Egyptian clover honey supplied by a beekeeper for 12 weeks. In the first period, statistically significant decreases in subscapular skinfold, FBG, post-prandial serum glucose, TC, HDL, and TG along with significant increases in fasting C-peptide and post-prandial C-peptide were observed in the intervention group compared to baseline. In the control group, no significant differences in any of the aforementioned parameters were observed. In the second period, significant reductions in midarm circumference, triceps skinfold, and fasting C-peptide were observed in the control group, while TC and LDL cholesterol increased significantly. On the contrary, significant decreases were observed in BMI, triceps skinfold, fasting serum glucose, HbA1C, total and LDL cholesterol, and TG in the intervention group. In addition, there were significant increases in fasting as well as post-prandial C-peptide and HDL.

Similarly, longer interventions with larger amounts of honey seem to have a greater effect on factors related to heart and vascular health in diabetic subjects.

2.4. Subjects with Hyperlipidemia

Al-Waili NS et al. ^[21] conducted a study on a group of healthy subjects (25–48 years) and a group of patients with hypercholesterolaemia or hypertriglyceridaemia (35–55 years). Consumption of 75 g of natural honey for 15 days significantly reduced total cholesterol and CRP levels in patients with hyperlipidemia, as well as LDL levels but not significantly. However, the reduction in TC, LDL, TG, CRP, homocysteine, and FBG levels was not significant in healthy subjects. The control groups were supplemented with 75 g of artificial honey (honey–glucose mixture), which caused an increase in total and LDL cholesterol and CRP levels ^[21]. These results do not agree with those obtained by Munsted K et al. ^[22], who showed that consumption of the same amount of honey during the same period in subjects with hypercholesterolemia aged 35–87 years reduced TC and HDL levels, and increased LDL and TG levels. However, when differentiating between both sexes, it was observed that the LDL value increased in women in the control group supplemented with a sugar solution, but not in those supplemented with honey.

3. Glucose Tolerance

3.1. Healthy Subjects

A study on healthy men showed significantly lower increases in the concentration-time curve (AUC) profiles for glucose and a lower increase in plasma insulin after consumption of basswood (linden) honey compared to the other sugar solutions ^[23]. They have also documented significantly lower increases in plasma insulin and C-peptide after consumption of natural or clover honey versus other sugar solutions in healthy subjects ^[21].

3.2. Diabetic Subjects

Significantly lower increases in blood glucose levels have been observed in subjects with type II diabetes after ingestion of natural honey ^[21] and clover honey ^[21]^[24] compared to the other sugar solutions. A study carried out with healthy and type I diabetic subjects also showed a significantly lower increase in blood glucose levels following Egyptian clover honey consumption, and a significantly higher increase in C-peptide levels ^[25].

These results indicate that replacing sugar with honey could be beneficial for both healthy and diabetic patients.

4. Appetite and Food Intake

4.1. Healthy Subjects

In a study conducted by Al-Tamimi et al. ^[14] on healthy subjects aged 24–57 years, the intake of 1.5 g/kg/day of a mixture of four types of clover honey promoted a significantly lower intake of energy, carbohydrates, and sugars compared to the sucrose-supplemented group. The inclusion of 42.7 g of pure clover honey in a 440 kcal meal showed a significant reduction in post-prandial blood glucose while lactate increased in healthy women aged 18–40 years that consumed the honey meal versus those who received a meal including 35.5 g of sucrose ^[26]. A similar pattern was observed for insulin, but the effect was not significant. The decrease in ghrelin, however, showed no significant difference between the two meals. Both post-prandial peptide YY and leptin levels did not change significantly over time and did not differ according to treatment; however, the AUC for peptide YY was significantly higher after the honey meal. Hunger and satiety were assessed, and participants received a free-choice meal 240 min after the test meal was consumed. Post-prandial satiety scores were significantly higher after the honey meal versus the sucrose one at 60 min. It could be that clover honey is satiating. In addition, the AUC for hunger during the 240 min following ingestion of the test meal tended to be lower with the honey meal than with the sucrose meal. Regarding meal-induced thermogenesis, there were no significant differences between the two groups and the same trend was found for energy and macronutrient intake in the free-choice meal between the two groups ^[26].

4.2. Diabetic Subjects

Contrarily, although the trend appears to be positive in healthy subjects, Bahrami et al. ^[19] reported no significant differences in diabetic patients after supplementation with Iranian natural honey for 8 weeks in energy intake or protein, fat, carbohydrate or sugar intake.

5. Alcohol Metabolism

In terms of the effect of honey on alcohol metabolism, the inclusion of freshly harvested Nigerian citrus (Citrus sinensis Osbeck) honey from the delta region of the River Niger along with alcohol intake has shown a significant decrease in the degree and time of intoxication in healthy adults ^[27]^[28]. Therefore, honey could be a promising anti-intoxication agent. However, in men, the consumption of alcohol and honey seems to cause a significant increase in TG levels ^[28]. As a result, further studies would be necessary to establish recommendations.

6. Cancer

Table 1 displays different studies conducted on cancer patients to test the effect of honey intake on various cancer-related complications, such as mucositis, weight loss, and xerostomia. In this regard, mouth washing with a solution of natural Baran-Baghro honey from Iran in water (1:20, v/v) for 4 weeks significantly reduced the severity of mucositis in adult patients with myeloid leukemia undergoing chemotherapy and significantly increased the patients’ body weight ^[29]. The same results were shown in another study carried out on patients with head and neck cancer receiving radiotherapy, who were treated with mouthwashes of a solution of pure and filtered thyme honey in water (1:5, v/v) for 6 months. In this case, it significantly reduced the severity of mucositis and weight loss, and significantly increased overall health and quality of life in the experimental group ^[30]. In agreement, Khanal et al. ^[31] reported a significant reduction in mucositis in adult patients with oral carcinoma, the mouth rinse was performed with 20 mL of Western Ghats Forest honey for 6 weeks. In other studies, involving adult patients with head and neck cancer receiving chemo-radiotherapy, the treatment consisted of smearing 20 mL of honey all over the mouth and swallowing it slowly. Treatments with clover honey, thyme, and astragalus honey or tea plant honey significantly reduced the severity of mucositis ^[32]^[33]^[34]. In addition, thyme and astragalus honey and tea plant honey significantly reduced weight loss in cancer patients ^[33]^[34], and clover honey significantly reduced Candida colonization, which is the most common clinical infection of the oropharynx in patients receiving radiotherapy ^[32]. In another study carried out with patients with head and neck cancer aged 61 years on average who are receiving radiotherapy, chemotherapy or surgery, patients in the experimental group were given a solution of pure filtered thyme honey in water (1:5, v/v) to swish around in their mouth and swallow slowly. There were significant reductions in the level of xerostomia, pain, and dysphagia compared to the control group as well as a significant increase in patients’ quality of life measured by a Quality of Life scales containing 15 items (Dirix XQ) ^[35]. However, the same treatment with Manuka honey in the same type of patients did not produce significant changes in the severity ^[36]^[37] or duration of mucositis ^[37]. Moreover, the Manuka honey was not well tolerated by patients. Studies in pediatric patients also showed a significant reduction in the severity of mucositis using treatments with Egyptian clover honey ^[38] or Turkish flower honey ^[39].

A study conducted on adult cancer patients with neutropenia showed a significant improvement in neutrophil levels when supplementing these patients with 5 g/day of Life-Mel honey for 5 days ^[40]. Similarly, a significant reduction in febrile neutropenia episodes with the supplementation of 2.5 g/kg twice a week of Egyptian clover honey in a study in pediatric patients was observed. In addition, the intervention group significantly improved their hemoglobin levels compared to the control group ^[41].

Forest, thyme, clover, and tea tree honeys appear to be very effective in improving mucositis symptoms in cancer patients undergoing radiotherapy and/or chemotherapy; however, Manuka honey does not produce improvements and is not well tolerated by these patients; therefore, it does not appear to be recommended.

Table 1. Effects of honey on cancer patients.

Honey	Dose	Duration	Subjects	Physiological Parameter	Effect	Reference
Natural Baran-Baghro honey from Iran	1:20 honey:water Mouthwash	4 w	Acute myeloid leukemia patients receiving chemotherapy >18 years	Mucositis severity	↓ *^,a	^[29]
Natural Baran-Baghro honey from Iran	1:20 honey:water Mouthwash	4 w		Body weight	↑ *^,a	^[29]
Pure and filtered thyme honey	1:5 honey:water Mouthwash	6 m	Head and neck cancer patients receiving radiotherapy 61.53 years	Mucositis severity	↓ *^,a	^[30]
				Weight loss	↓ ^a
				Global health	↑ *^,a
				Life quality	↑ *^,a
Western Ghats forests honey	20 mL Mouthwash	6 w	Oral carcinoma patients receiving radiotherapy >18 years	Mucositis severity	↓ ^a	^[31]
Pure and filtered natural clover honey	20 mL pure honey Rinse + swallow	7 w	Head and neck cancer patients receiving chemotherapy 48.20 ± 15.63 years	Mucositis severity	↓ ^a	^[32]
Pure and filtered natural clover honey	20 mL pure honey Rinse + swallow	7 w		Candida colonization	↓ ^a	^[32]
Pure natural honey from Thymus and Astragale in the Albroz mountains in northern Iran	20 mL pure honey Rinse + swallow	6 w	Head and neck cancer patients receiving radiotherapy 57.0 ± 12.0 years	Mucositis severity	↓ *^,a	^[33]
	20 mL pure honey Rinse + swallow	6 w		Weight loss	↓ ^a	^[33]
Tea plant honey from Cameron Highland of peninsular Malaysia	20 mL pure honey Rinse + swallow	7 w	Head and neck cancer patients receiving radiotherapy 14–89 years	Mucositis severity	↓ ^a	^[34]
	20 mL pure honey Rinse + swallow	7 w		Body weight	↑ ^a	^[34]
Pure and filtered thyme honey	1:5 honey:water Rinse + swallow	6 w	Head and neck cancer patients receiving radiotherapy or chemotherapy or surgery 61.53 ± 13.50 years	Xerostomia level	↓ ^a	^[35]
				Quality life	↑ ^a
				Pain	↓ ^a
				Dysphagia	↓ ^a
Irradiated organic manuka honey	5 mL Rinse + swallow	6 w	Head and neck cancer patients receiving radiotherapy	Mucositis severity	↓	^[36]
Active manuka honey	20 mL (98% honey) Rinse + swallow	6 w	Head and neck cancer patients receiving radiotherapy 38–85 years	Incidence of servere mucositis	↑	^[37]
				Mucositis severity	↓
				Mucositis duration	↓
Egyptian clover honey from El Mahala, Gharbia Governorate	0.5 g/kg/d Rinse + swallow	10 d	Lymphoblastic leukaemia patients receiving chemotherapy 6.9 ± 3.8 years	Mucositis recovery time	↓ ^a	^[38]
Turkish Flower honey from the highlands of Zonguldak Province, in the Western Black Sea Region of Turkey	3.70–30.96 g Rinse + swallow	21 d	Children treated in a paediatric intensive care unit (PICU) 7.25 years	Mucositis severity	↓ *^,a	^[39]
Life-Mel honey from Express Honey, Tzuf Globus, Israel	5 g/d	5 d	Cancer patients with neutropenia 57 years	Neutrophil level	↑ *	^[40]
				Haemoglobin level	↑
				Thrombocytes level	↑
Egyptian unprocessed clover honey collected from Al Mahala-Gharbia Governorate	2.5 g/kg twice weekly	Crossover Two 12 w periods	Children with acute lymphoblastic leukemia 5.4 ± 2.4 years	Febrile neutropenia episodes	↓ ^a	^[41]
				Number of patients admitted in hospital	↓
				Duration of hospital stay	↓
				Haemoglobin level	↑ ^a

7. Cough and Gastroenteritis in Infants

Table 1 shows different studies in pediatric patients with common cold or URTIs. Several studies have linked the consumption of different types of honey (Buckwheat honey, Iranian, eucalyptus, citrus, Labiatae and Nairobi dark honey) with significant reductions in frequency ^[42]^[43]^[44]^[45]^[46], bothersome ^[44]^[45]^[46], and severity ^[43]^[44]^[45] of nocturnal cough, as well as in the combined symptom score of URTIs ^[42]^[44]^[45]^[46]. Significant improvements in sleep quality have also been observed in children and parents ^[43]^[44]^[45]^[46]. Contrarily, a study in which children were supplemented with acacia honey for 2 days showed no significant differences with honey consumption versus placebo ^[47]. On the other hand, an early study carried out on children with gastroenteritis showed a significant reduction in recovery time from bacterial gastroenteritis by substituting pure honey for glucose in the oral rehydration solution ^[48].

8. Antimicrobial and Wound Healing Effects

Studies on the antimicrobial and wound healing effects of honey are described in Table 2. Rinses with a solution of multifloral processed honey in water (1:1, v/v) for 5 days significantly reduced dental plaque in healthy subjects, although a 0.2% chlorhexidine solution was found to be more effective ^[49]. Banaeian et al. ^[50] studied the influence of Iranian honey on vulvovaginal candidiasis, and they found significant reductions in inflammation, discharge, and itching after 8 days of treatment with a 70% honey cream. They concluded that although treatment with 1% clotrimazole was more effective, honey could be an alternative for the treatment of vulvovaginal candidiasis due to its wide availability and cost-effectiveness ^[50]. In a study conducted on children with pyomyositis abscesses, gauze soaked in natural raw honey, or a medical solution was applied to the wounds for 21 days. Honey significantly improved wound healing and reduced the duration of hospital stay ^[51]. Similarly, Lavaf et al. ^[52] demonstrated that a 30% Iranian honey cream significantly increased healing and reduced discharge from episiotomy wounds in nulliparous women. Several studies have tested the effect of honey dressings on patients with diabetic foot ulcers. Muhammad Imran et al. ^[53] in their study using Beri honey observed significant improvements in both wound healing and healing time in the experimental group compared to the control group treated with normal saline dressing.

Although honeys from different origins have been shown to have antimicrobial effects, they are not superior to pharmacological treatments, such as chlorhexidine, clotrimazole or povidone-iodine. However, due to their low cost, wide availability, and lack of side effects, honey could be an alternative to conventional treatments, although more research is needed.

Table 2. Effects of honey on cough and gastroenteritis in children.

Honey	Dose	Duration	Subjects	Physiological Parameter	Effect	References
Buckwheat honey	Children aged 2 to 5 (1/2 teaspoon), 6 to 11 (1 teaspoon), 12 to 18 (2 teaspoons) Single dose	1 d	Children with upper URTIs 5.02 ± 3.99 years	Cough frequency	↓ ^a	^[42]
				Combined symptom score	↓ ^a
				Bothersome cough	↓
				Cough severity	↓
				Sleep quality	↑
				Parents’ sleep quality	↑
Iranian natural honey from Kafi-Abad, Yazd	2.5 mL Single dose	1 d	Children with URTIs 3.15 ± 0.93 years	Cough frequency	↓ ^a	^[43]
				Cough severity	↓^a
				Sleep quality	↑ ^a
				Parents’ sleep quality	↑ ^a
Eucalyptus, citrus or Labiatae honey	10 g Single dose	1 d	Children with URTIs 2.4 years	Cough frequency	↓ ^a	^[44]
				Combined symptom score	↓ ^a
				Bothersome cough	↓ ^a
				Cough severity	↓ ^a
				Sleep quality	↑ ^a
				Parents’ sleep quality	↑ ^a
Nairobi dark honey	Children aged 1 to 2 (2.5 mL), 2 to 6 (5 mL), 6 to 12 (7.5 mL) Three times daily	5 d	Children with a common cold 1–12 years	Cough frequency	↓ ^a	^[45]
				Combined symptom score	↓ ^a
				Bothersome cough	↓ ^a
				Cough severity	↓ ^a
				Cough duration	↓ ^a
				Sleep quality	↑ ^a
				Parents’ sleep quality	↑ ^a
Two kinds of Iranian honey: Kimia honey and Golha honey	Children aged 1 to 6 (2.5 mL), 7 to 12 (5 mL), Two doses	2 d	Children with URTIs 3.5 ± 1.6 years	Cough frequency	↓ ^b	^[46]
				Combined standard score	↓ ^a
				Bothersome cough	↓ ^a
				Sleep quality	↑ ^b
				Parents’ sleep quality	↑ ^a
Acacia honey	3 mL Single dose	2 d	Children with URTIs 2.5 years	Cough frequency	↓	^[47]
				Combined symptom score	↓
				Bothersome cough	↓
				Cough severity	↓
				Cough duration	↑
				Sleep quality	↑
Pure honey	50 mL/L of rehydration solution vs. 50 mL/L of glucose	Duration of gastroenteritis	Children with gastroenteritis 1.39 ± 1.82 years	Bacterial gastroenteritis recovery time	↓ ^a	^[48]

9. Other Effects

Table 3 shows different effects of honey not discussed in the previous sections. A study carried out on healthy subjects showed that both low- and high-antioxidant buckwheat honey significantly increased plasma total phenolic concentration 2 h after consumption. However, this effect extended to 6 h only after consumption of high-antioxidant buckwheat honey. The same effect was observed on total plasma antioxidant capacity after consumption of these two honeys. Both honeys also increased total plasma reducing capacity 2 and 6 h after consumption ^[54]. A study on subjects with blepharitis showed a significant improvement in dryness of the eye, tear film quality, and ocular surface, as well as a decrease in microbial colonization in patients treated with a Manuka honey microemulsion cream for 3 months ^[55]. In contrast, the inclusion of 1 tablespoonful/d of natural Bristol honey or processed honey showed no improvement over placebo in the symptoms of allergic rhinoconjunctivitis ^[56]. Wallace et al. ^[57] found no significant change in IgE levels after consumption of 20 g of multifloral honey or manuka honey UMF 20+ for 4 weeks in healthy adults. There was also no effect on the number of intestinal bacteria of the Bacteroides, Bifidobacterium, Lactobacillus, Escherichia coli, and Clostridium groups. Farahani et al. ^[58] also observed no effect of Astragalus honey consumption on symptoms of dysmenorrhoea in female students with an average age of 22.

Table 3. Other health effects of honey.

Honey	Dose	Duration	Subjects	Physiological Parameter	Effect	Reference
Low- and high- antioxidant buckwheat honey from the Dutch Gold company	1.5 g/kg	6 h	Healthy subjects 25.55 ± 2.30 years	Plasma phenolic concentration	↑ *	^[54]
				Plasma antioxidant capacity	↑ *
				Plasma reducing capacity	↑ *
Manuka honey from New Zealand	Manuka honey microemulsion cream 0.5–1 cm Once a day	3 m	Patients with blepharitis 60 ± 12 years	Dry eye symptomology	↓ ^a	^[55]
				Tear film quality	↑ ^a
				Ocular surface quality	↑ ^a
				Microbial burden	↓ ^a
Local unpasteurized honey from Honeycomb Apiairies, Bristol and filtered pasteurized clover honey from Dutch Gold Honey Inc, Lancaster	1 tablespoonful/d	30 w	Patients with allergic rhinoconjunctivitis 45.3 years	Symptoms of rhinoconjunctivitis	=	^[56]
Multiflora honey and Manuka honey UMF 20+, both produced by Comvita New Zealand Ltd.	20 g/d	Crossover 4 w each period	Healthy subjects 42–64 years	IgE level	↑	^[57]
	20 g/d	Crossover 4 w each period	Healthy subjects 42–64 years	Gut bacterial	=	^[57]
Astragalus honey made in Ashtian Region of Iran	1.2 g/kg from the 15th day to the onset of menstruation	Crossover 2 m each period	Female students with dysmenorrhea 22.01 ± 1.78 years	Pain	=	^[58]
				Amount of bleeding	=
				Satisfaction	=

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