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Review

A Comprehensive Review of the Effect of Honey on Human Health

by
Marta Palma-Morales
1,2,
Jesús R. Huertas
1,3 and
Celia Rodríguez-Pérez
1,2,4,*
1
Biomedical Research Centre, Institute of Nutrition and Food Technology (INYTA) ‘José Mataix’, University of Granada, Avda. del Conocimiento s/n, 18071 Granada, Spain
2
Department of Nutrition and Food Science, Faculty of Pharmacy, University of Granada, Cartuja Campus, 18011 Granada, Spain
3
Primary Care Promotion of Maternal, Child and Women’s Health for Prevention of Adult Chronic Diseases Network (RD21/0012/0008), Institute of Health Carlos III, 28029 Madrid, Spain
4
Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
*
Author to whom correspondence should be addressed.
Nutrients 2023, 15(13), 3056; https://doi.org/10.3390/nu15133056
Submission received: 22 June 2023 / Revised: 4 July 2023 / Accepted: 5 July 2023 / Published: 6 July 2023
(This article belongs to the Section Clinical Nutrition)

Highlights

  • Honey from sources like clover, thyme, buckwheat, and manuka has shown positive effects on health.
  • Honey improves metabolic and cardiovascular health by enhancing insulin sensitivity, reducing blood glucose, improving the lipid profile, and reducing oxidative stress with the help of their bioactive compounds.
  • Honey promotes intestinal health and wound healing and helps manage oral mucositis in cancer patients, as well as the symptoms in children with upper respiratory infections (URTIs).
  • More robust studies, taking into account honey types, dosages, and trial methods, are needed to establish clear guidelines for the therapeutic use of honey.

Abstract

:
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. The aim of this review is to analyze the available evidence of the effect of honey on humans. Forty-eight clinical trials published between 1985 and 2022 were analyzed, with a total of 3655 subjects. 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. In addition, honey could be a safe adjuvant to be administered alongside drugs used for certain diseases.

Graphical Abstract

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. In this regard, Figure 1 shows the main phenolic compounds characterized in honey. Phenolic compounds, in addition to being considered as bioactive compounds, can act as biomarkers of honey origin or adulteration [1].
Considering the interesting properties that have traditionally been attributed to honey intake and the fact that most of the studies supporting those properties have been carried out in vitro or in animal models, the aim of this review is to analyze the available evidence of the effect of honey on humans. In this paper, the effects of honey on human health are presented from a comprehensive approach, including the clinical trials published from 1985 to the present.

2. Materials and Methods

The US National Library of Medicine National Institutes of health (PubMed) and Web of Science databases have been employed for conducting literature searches from 1985 to 2022 to achieve an overview of all the available evidence regarding the effects of honey on human health. Different combinations of the following keywords were used: Honey, health, diabetes, metabolic cardiovascular syndrome, obesity, cancer, upper respiratory infections, and antimicrobial. In PubMed, we used the following search equation strategy: “honey” [All Fields] AND (“health” [All Fields] OR “diabetes” [All Fields] OR “metabolic cardiovascular syndrome” [All Fields] OR “obesity” [All Fields] OR “cancer” [All Fields] OR “upper respiratory infections” [All Fields] OR “antimicrobial” [All Fields]). When we used PubMed, we included Medical Subject heading (MeSH) terms to increase the power of the search. In addition, 4613 results were obtained, then filtered by “full text” (4348 results), “clinical trial” (131 results), and “English language” (130 results). The search equation used in Web of Science was: Honey AND (health OR diabetes OR metabolic cardiovascular syndrome OR obesity OR cancer OR upper respiratory infections OR antimicrobial). Moreover, 734 results were obtained, then filtered by “open access” (375 results), “article” (301 results), and “English language” (299 results).
The main criteria of PICO (Population, Intervention, Comparison, Outcome) were followed to frame and answer the clinical-related question. In this regard, the population included humans (healthy subjects, subjects who are overweight or obese, diabetes, cancer, wounds, infections, and inflammation), the intervention was treatment with different types of honey, oral or topical, without combining it with other substances, and the comparison was made between honey and other sugar sweeteners. The outcome was cardiovascular, anticancer, antidiabetic, antimicrobial and antiviral, anti-obesity and antioxidant effects.
The inclusion criteria were the following: (1) Clinical trials with honey; (2) food and nutrition-related studies; (3) studies written in English. The exclusion criteria were: (1) Review articles; (2) studies written in languages other than English; (3) studies without controls; (4) studies without full access. Once the articles were selected based on reading the title, abstract, and full text, duplicates were removed and the quality of the clinical trials was assessed based on the PEDro scale (https://pedro.org.au/spanish/resources/pedro-scale/ (accessed on 21 June 2023)), which evaluates the infernal validity as well as the statistical information to establish that the results are interpretable. Then, the results were classified according to the different health effects attributed to honey, i.e., effect on healthy subjects, subjects who are overweight or obese, diabetes, cancer, abscesses, wounds, blepharitis, rhinoconjuntivitis, children with upper respiratory tract infections (URTIs) or gastroenteritis, and women with vulvovaginal candidiasis and dysmenorrhoea. Those data have been summarized in different tables along the text and a narrative review of the main outcomes has been included.

3. Results

Forty-eight articles published in 42 different journals were analyzed, with a total of 3655 subjects with 29.51 ± 21.51 years of age, of whom 1990 consumed or were treated with honey. Of the 3655 subjects, at least 1803 were women (two studies did not specify). The studies included different population groups (healthy subjects, overweight or obese subjects, diabetic subjects, subjects with cancer, children, etc.) and included more than 30 different types of honey. Although it is not a systematic review, the results of the PEDro scale regarding the quality of the articles were in the range of 6–10, with articles scoring 6 or higher being considered of good methodological quality.

3.1. Cardiovascular and Metabolic Risk Factors

Table 1 shows the studies found on the effects of honey on different cardiovascular or metabolic risk factors in different population groups, i.e., healthy, overweight or obese, diabetic and hyperlipidemic subjects.

3.1.1. 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.

3.1.2. 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.

3.1.3. 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.

3.1.4. 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.

3.2. Glucose Tolerance

Table 2 shows glucose tolerance compared with honey intake versus other sugar solutions, using an oral glucose tolerance test.

3.2.1. 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].

3.2.2. 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.
Table 2. Effects of honey on glucose tolerance.
Table 2. Effects of honey on glucose tolerance.
HoneyDoseTest DurationSubjectsPhysiological ParameterEffectReferences
Basswood (linden) honey75 g vs. glucose-fructose120 minHealthy men
27.7 years
Increase in BGL[23]
AUC for glucosea
Increase in BILa
Increase in C-peptide
Natural honey75 g vs. dextrose180 minHealthy subjects
25–42 years
Increase in BGL[21]
Increase in BILa
Increase in C-peptidea
70 g vs. glucoseType II diabetic patientsIncrease in BGLa
Sue Bee honey (clover honey) 100% pure75 g honey vs. glucose120 minType II diabetic patients
50 ± 9.7 years
Increase in BGLa[24]
Unprocessed Egyptian clover honey supplied by a beekeeper2.3 g/kg120 minHealthy subjects and type I diabetic patients
10.02 years
Increase in BGLa[25]
Increase in C-peptidea
BGL: blood glucose level; BIL: blood insulin level; AUC: areas under the concentration–time curve; ↑: increase; ↓: decrease. a Significantly different (p < 0.05) from the control groups.

3.3. Appetite and Food Intake

The results of studies on the effects of honey consumption on appetite and energy intake are shown in Table 3.

3.3.1. 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].

3.3.2. 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.

3.4. Alcohol Metabolism

In terms of the effect of honey on alcohol metabolism (Table 4), 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.

3.5. Cancer

Table 5 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 5. Effects of honey on cancer patients.
Table 5. Effects of honey on cancer patients.
HoneyDoseDurationSubjectsPhysiological ParameterEffectReference
Natural Baran-Baghro honey from Iran1:20 honey:water
Mouthwash
4 wAcute myeloid leukemia patients receiving chemotherapy
>18 years
Mucositis severity↓ *,a[29]
Body weight↑ *,a
Pure and filtered thyme honey1:5
honey:water
Mouthwash
6 mHead and neck cancer patients receiving radiotherapy
61.53 years
Mucositis severity↓ *,a[30]
Weight lossa
Global health↑ *,a
Life quality↑ *,a
Western Ghats forests honey20 mL
Mouthwash
6 wOral carcinoma patients receiving radiotherapy
>18 years
Mucositis severitya[31]
Pure and filtered natural clover honey20 mL pure honey
Rinse + swallow
7 wHead and neck cancer patients receiving chemotherapy 48.20 ± 15.63 yearsMucositis severitya[32]
Candida colonizationa
Pure natural honey from Thymus and Astragale in the Albroz mountains in northern Iran20 mL pure honey
Rinse + swallow
6 wHead and neck cancer patients receiving radiotherapy
57.0 ± 12.0 years
Mucositis severity↓ *,a[33]
Weight lossa
Tea plant honey from Cameron Highland of peninsular Malaysia20 mL pure honey
Rinse + swallow
7 wHead and neck cancer patients receiving radiotherapy
14–89 years
Mucositis severitya[34]
Body weighta
Pure and filtered thyme honey1:5
honey:water
Rinse + swallow
6 wHead and neck cancer patients receiving radiotherapy or chemotherapy or surgery
61.53 ± 13.50 years
Xerostomia levela[35]
Quality lifea
Paina
Dysphagiaa
Irradiated organic manuka honey5 mL
Rinse + swallow
6 wHead and neck cancer patients receiving radiotherapyMucositis severity[36]
Active manuka honey20 mL (98% honey)
Rinse + swallow
6 wHead 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 Governorate0.5 g/kg/d
Rinse + swallow
10 dLymphoblastic leukaemia patients receiving chemotherapy
6.9 ± 3.8 years
Mucositis recovery timea[38]
Turkish Flower honey from the highlands of Zonguldak Province, in the Western Black Sea Region of Turkey3.70–30.96 g
Rinse + swallow
21 dChildren treated in a paediatric intensive care unit (PICU)
7.25 years
Mucositis severity↓ *,a[39]
Life-Mel honey from Express Honey, Tzuf Globus, Israel5 g/d5 dCancer patients with neutropenia
57 years
Neutrophil level↑ *[40]
Haemoglobin level
Thrombocytes level
Egyptian unprocessed clover honey collected from Al Mahala-Gharbia Governorate2.5 g/kg twice weeklyCrossover
Two 12 w periods
Children with acute lymphoblastic leukemia
5.4 ± 2.4 years
Febrile neutropenia episodesa[41]
Number of patients admitted in hospital
Duration of hospital stay
Haemoglobin levela
d: day; w: week; ↑: increase; ↓: decrease. * Significant differences (p < 0.05) within group between baseline and the end. a Significantly different (p < 0.05) from the control group.

3.6. Cough and Gastroenteritis in Infants

Table 6 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].

3.7. Antimicrobial and Wound Healing Effects

Studies on the antimicrobial and wound healing effects of honey are described in Table 7. 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. Similar results were reported by Moghazy et al. [54] who observed a significant improvement in healing and healing time of diabetic foot ulcers after treatment with pure Egyptian honey dressings; however, no control group was used in this study. On the contrary, Shukrimi et al. [55] observed no significant effect with clean non-sterile honey treatment compared to povidone iodine.
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 6. Effects of honey on cough and gastroenteritis in children.
Table 6. Effects of honey on cough and gastroenteritis in children.
HoneyDoseDurationSubjectsPhysiological ParameterEffectReferences
Buckwheat honeyChildren aged 2 to 5 (1/2 teaspoon), 6 to 11 (1 teaspoon), 12 to 18 (2 teaspoons)
Single dose
1 dChildren with upper URTIs
5.02 ± 3.99 years
Cough frequencya[42]
Combined symptom scorea
Bothersome cough
Cough severity
Sleep quality
Parents’ sleep quality
Iranian natural honey from Kafi-Abad, Yazd2.5 mL
Single dose
1 dChildren with URTIs
3.15 ± 0.93 years
Cough frequencya[43]
Cough severitya
Sleep qualitya
Parents’ sleep qualitya
Eucalyptus, citrus or Labiatae honey10 g
Single dose
1 dChildren with URTIs
2.4 years
Cough frequencya[44]
Combined symptom scorea
Bothersome cougha
Cough severitya
Sleep qualitya
Parents’ sleep qualitya
Nairobi dark honeyChildren aged 1 to 2 (2.5 mL), 2 to 6 (5 mL), 6 to 12 (7.5 mL)
Three times daily
5 dChildren with a common cold
1–12 years
Cough frequencya[45]
Combined symptom scorea
Bothersome cougha
Cough severitya
Cough durationa
Sleep qualitya
Parents’ sleep qualitya
Two kinds of Iranian honey: Kimia honey and Golha honeyChildren aged 1 to 6 (2.5 mL), 7 to 12 (5 mL),
Two doses
2 dChildren with URTIs
3.5 ± 1.6 years
Cough frequencyb[46]
Combined standard scorea
Bothersome cougha
Sleep qualityb
Parents’ sleep qualitya
Acacia honey3 mL
Single dose
2 dChildren with URTIs
2.5 years
Cough frequency[47]
Combined symptom score
Bothersome cough
Cough severity
Cough duration
Sleep quality
Pure honey50 mL/L of rehydration solution vs. 50 mL/L of glucoseDuration of gastroenteritis Children with gastroenteritis
1.39 ± 1.82 years
Bacterial gastroenteritis recovery time a[48]
d: day; URTIs: upper respiratory tract infections; ↑: increase; ↓: decrease. a Significantly different (p < 0.05) from the control group. b Significantly different (p < 0.05) for one type of honey.
Table 7. Effects of honey on wounds.
Table 7. Effects of honey on wounds.
HoneyDoseDurationSubjectsPhysiological ParameterEffectReferences
Multifloral processed honey1:1
honey:water
Mouthrinse
10 mL twice a day
5 dHealthy subjects
20–24 years
Tooth plaque↓ *[49]
Iranian honey from Chaharmahal and Bakhtiari region70:30
honey:neutral cream
5 g/d
7 dWomen with vulvovaginal candidiasis
34.3 ± 8.6 years
Inflammation↓ *[50]
Discharge↓ *
Itching↓ *
Natural raw honeyHoney-soaked gauze vs. medical solution21 dChildren with pyomyositis abcesses
4.5 ± 4.0 years
Wound healinga[51]
Duration of hospital staya
Iranian honey from Qamsar region30% honey cream
1 knuckle/d
14 dNulliparous women with episiotomy wound
24.7 ± 4.0 years
Dischargea[52]
Wound healinga
Pain
Beri-irradiated honey collected from Karak, PakistanOnce or twice daily or every 48 h4 mPatients with diabetic foot ulcers
54 years
Wound healinga[53]
Wound healing timea
Pure raw untreated clover honey supplied by the Firm of Faculty of Agriculture, Alexandria UniversityHoney-soaked gauze3 mPatients with diabetic foot ulcers
52.3 years
Ulcer size↓ *[54]
Ulcer grade↓ *
Ulcer stage↓ *
Inflammation↓ *
Discharge↓ *
Wound healing↑ *
Clean non-sterile pure honey packed by Barnes for Honey Cooperation of AustraliaOnce daily36 dPatients with diabetic foot ulcers
31–51 years
Wound healing time[55]
Discharge
Edema
d: day; m: month; ↑: increase; ↓: decrease. * Significant differences (p < 0.05) within group between baseline and the end. a Significantly different (p < 0.05) from the control group.

3.8. Other Effects

Table 8 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 [56]. 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 [57]. 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 [58]. Wallace et al. [59] 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. [60] also observed no effect of Astragalus honey consumption on symptoms of dysmenorrhoea in female students with an average age of 22.

4. Discussion

According to the results of the present review, it appears that honey from clover, basswood, citrus, thyme, tea plant, flowers, buckwheat, eucalyptus, Labiatae, and Manuka has beneficial effects on certain parameters, such as cardiovascular risk factors, satiety, glucose tolerance, mucositis symptoms in cancer patients, URTIs symptoms in children, wound healing, etc.
It has been demonstrated that honey consumption can influence plasma lipid, glucose, and insulin levels through different biochemical mechanisms. The decrease in blood glucose may be due to the fact that honey has a stimulatory effect on insulin secretion and improves insulin sensitivity [13]. Honey also increases the production of hydrogen peroxide, which has similar effects to insulin [61]. In addition, it is possible that honey consumption stimulates nitric oxide synthase [62] and the increase in nitric oxide (NO), in turn, stimulates insulin release [63] since it contains NO metabolites. It has also been reported that honey consumption decreases plasma levels of some prostaglandins [62,64] that inhibit insulin secretion [13], constituting another pathway of increased insulin release. Moreover, honey contains zinc and copper, which play an important role in insulin and glucose metabolism [21,65]. The high fructose content of honey may also decrease the hyperglycemic glucose response by stimulating glucokinase to deliver glucose to the liver [15]. However, long-term glucose consumption can have negative effects on digestion, absorption, hormone levels, appetite, and liver metabolism, which can lead to the development of insulin resistance, obesity, and cardiovascular disease [66]. These negative effects have not been observed with honey consumption; therefore, it is believed that other components of honey, such as antioxidants (e.g., phenolic compounds and some vitamins), may contribute to the reduction in the negative effects produced by fructose consumption [19]. In addition, some characteristic flavonoids of honey, i.e., apigenin, luteolin, galangin-3-methyl ether, kaempferol, naringenin, rutin, quercetin, and myricetin have shown significant reductions in blood glucose levels and beneficial effects on dyslipidemia in animals [67,68,69,70]. This may be due to the inhibitory effect of flavonoids on mammalian alpha-amylase [71,72,73], which catalyzes the hydrolysis of the alpha-glycosidic bonds of high molecular weight polysaccharides releasing glucose and maltose. In addition, available data show that phenolic compounds from honey are bioavailable and increase the antioxidant activity of plasma [42,44]. The antioxidant activity of the phenolic compounds is attributed to their capacity to eliminate free radicals by donating hydrogen atoms, electrons or metallic cations, due to their structure (number and positions of the hydroxyl groups and the nature of the substitutions in the aromatic rings) and due to their binding to organic acids and sugars [1]. On the other hand, phenolic compounds promote the maintenance and recovery of the balance of the intestinal microbiota since they can stimulate the secretion of antioxidant enzymes, such as superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione reductase (GR), and peroxiredoxins that block reactive oxygen species (ROS) or stimulate endogenous defense system [1].
Its content of antioxidants, such as beta-carotene, vitamin C, and uric acid and its mineral content, such as copper, manganese, selenium, and zinc may also be responsible for the effects on blood lipids [19]. These elements may increase the catabolism of fats, leading to a decrease in serum lipid levels [19]. In addition, these antioxidants decrease oxidized LDL [13]. Among vitamins, honey contains niacin, which strongly inhibits lipolysis in adipose tissue, leading to a decrease in hepatic TG synthesis, and thus plasma TG levels [13]. TG synthesis is necessary for the synthesis of VLDL from which LDL in blood plasma is derived. It is therefore believed that niacin can also lower plasma LDL and total cholesterol levels [13]. On the other hand, insulin can stimulate protein lipase, increasing lipid metabolism, which results in a decrease in serum lipid levels [13,74]. The increase in HDL associated with honey consumption may be due to the fact that HDLs obtain cholesterol from cell membranes and other lipoproteins, such as LDL and transport it to the liver. As honey consumption decreases LDL, less HDL would be used to transport cholesterol to the liver, which may increase serum HDL levels [13], although further studies are needed to confirm this mechanism. In addition, the niacin content of honey may be responsible for the increase in HDL levels [13]. Concerning phenolic compounds, the cardioprotective effect of flavonoids has been widely demonstrated through the reduction in blood platelet activity, the prevention of LDL oxidation, and the improvement of coronary vasodilation [7].
Plasma concentrations of C-peptide effectively reflect endogenous insulin secretion; therefore, it is considered a good marker of insulin secretion. Increases in C-peptide levels following honey consumption in both healthy and diabetic subjects demonstrate that honey may stimulate both healthy and diseased pancreatic beta cells. It is thought that due to its anti-inflammatory [62], antioxidant [75], antiviral and probiotic [76] properties, honey may contribute to the healing of diseased beta cells [25]. On the other hand, Panero et al. [77] observed that higher levels of C-peptide in type I diabetic patients confer a statistically significant protective effect against the development of microvascular complications. Furthermore, due to the Lactobacillus and Bifidobacterium involved in its production, honey is considered a fermented and, consequently, probiotic product, which could reduce inflammation and intestinal permeability, and change the composition of the intestinal flora, these factors being implicated in the pathogenesis of type I diabetes mellitus [78]. Moreover, the antidiabetic and hypoglycemic capacity of honey can be attributed to its antioxidant ability (thanks to its phenolic compound content), as the pathogenesis of diabetes mellitus appears to be closely associated with the presence of oxidative stress and ROS [7].
On the other hand, although the role of honey in weight loss is still unclear and more studies are needed to clarify how honey consumption may affect body composition, honey consumption has been associated with increased serum levels of antioxidants, such as vitamin C, β-carotene, uric acid and glutathione reductase, and the total phenolic content which results from phenolic antioxidants in the honey [56]. These compounds appear to increase diet-induced thermogenesis, and thus may be related to the weight loss associated with honey consumption versus other sweeteners [79].
Despite the fact that the mechanism of action of honey on oral mucositis is not well established, it may be due to the analgesic [80], antimicrobial [81], and wound-healing [82] properties that have been attributed to this food. In addition, qualities, such as high viscosity, high osmolarity, and low pH level of honey enhance its bacterial and fungal inhibitory activity [80]. On the one hand, since honey contains a characteristic sweetness [80] as well as ascorbic, citric, and malic acids [35], it increases salivation, and thus promotes repair and healing of the oral mucosa. On the other hand, weight loss is very common in cancer patients and has negative effects, such as increased risk of infection and reduced quality of life, treatment responses, and survival [83]. The positive effect of honey on body weight in cancer patients may be due to its positive effects on mucositis, as this results in increased oral food intake [84]. The positive effect of honey against neutropenia could be associated with its antioxidant [40], antimicrobial, and immunomodulatory [41] properties. Another hypothesis is that honey could increase levels of granulocyte colony stimulating factor (G-CSF) [41], which induces neutrophil production [85] by increasing TNF-α and IL-1. The evidence seems to indicate that honey is quite beneficial for cancer patients, although more standardized and longer-term studies are needed to confirm these effects.
The positive effect of honey on cough may be due to its antioxidant, antimicrobial [42,43], anti-inflammatory, and antiviral effects [46]. In addition, some of the studies used dark honey [42,44], which tends to have a higher content of phenolic compounds that have been related to the antioxidant properties of honey [42,46], and thus may have contributed to the positive effects observed. As honey is a sweet substance that increases salivation and mucus secretion from the respiratory tract, it may have a demulcent effect on the pharynx and larynx, and thus reduces dry and unproductive cough [86]. In addition, these secretions can improve mucociliary clearance in the airways through expectoration [86]. On the other hand, the anatomical relationship between the nerve fibers that initiate coughing and the nerve fibers that taste sweetness may lead to an interaction between the two and favor antitussive effects [86]. Therefore, there appears to be benefits with the addition of honey to conventional treatment. It is worth mentioning that children under 1 year of age should not consume honey due to the high risk of developing botulism [87,88].
Table 9 presents a summary of the most significant effects of honey on human health found in this review. Doses of 70 g/d seem to have beneficial effects on cardiovascular risk factors in healthy subjects as well as in hyperlipidemic subjects; however, beneficial effects have been observed with doses of 20 g/d and above in diabetic subjects. In addition, glucose tolerance is better after consumption of honey than other sugar solutions in both diabetic and healthy subjects. Supplementation with clover honey has been shown to have satiating effects. Doses of 1–1.25 g/kg of honey reduce intoxication time after alcohol ingestion. In patients with leukemia and head and neck cancer, improvements in mucositis and decreases in weight loss have been observed when using solutions of different types of honey (forest, thyme, clover, and tea tree honey) for rinses or mouthwashes with ingestion. However, Manuka honey does not seem to be recommended for these patients. Improvements in URTI symptoms have also been observed in children after ingestion of 2.5–10 g of different types of honey. There also seems to be an acceleration in wound healing and a decrease in wound secretion with the application of honey creams in pyomyositis abscesses in children, episiotomy wounds, and diabetic foot ulcers, although these effects do not outweigh conventional treatments.
Based on the available data, the average ingestion dose used is estimated to be 40.71 ± 30.59 g/day or 1.38 ± 0.59 g/kg/day, and the topical dose 12.50 ± 10.61 g, with the average duration of the studies being 8.5 ± 8.9 weeks. It should be noted that the included studies involve small samples, lack a standardized protocol, and differ in types of honey, doses used, duration of interventions and population groups (e.g., healthy subjects, overweight or obese subjects, diabetics, cancer patients, etc.), which makes it difficult to compare results and establish specific recommendations. Therefore, despite the promising positive effects of honey intake (Table 9), more evidence including the same type of honey, dosage, and trial protocols is necessary to establish a real cause and effect relationship between honey intake and the described healthy effects. In fact, as early as 2010, the European Food Safety Authority (EFSA) issued a report concluding that honey was not sufficiently characterized in relation to the claimed effects, i.e., “respiratory health through presence of antioxidant phytochemicals”, “the unique composition and ratio of effective substances adds energy to the human body”, and “it stimulates the whole metabolism and the immune system” [89].

5. Conclusions

To date, a limited number of studies have been carried out. Along with a lack of standardized research, the variety of methodology used, as well as differences in the duration of the interventions, the age of the subjects, and their physiological or pathological conditions is difficult to compare between them. The type of honey and the doses used in the different studies also vary widely, which does not allow the beneficial effects to be attributed to a specific honey nor a specific dose. However, despite being halfway between consideration as a functional food or a harmful food due to its high sugar content, more beneficial effects of honey intake have been observed than no or negative effects, especially when its intake replaces the intake of other sweeteners. The main beneficial effects have been observed on cardiovascular health in healthy, diabetic, and hyperlipidaemic subjects on glucose tolerance in healthy and diabetic subjects, on mucositis in cancer patients, on URTIs in children, and on wound healing. 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.

Author Contributions

Conceptualization, C.R.-P. and J.R.H.; methodology, M.P.-M.; validation, C.R.-P. and J.R.H.; investigation, M.P.-M.; resources, C.R.-P. and J.R.H.; writing—original draft preparation, M.P.-M.; writing—review and editing, M.P.-M., J.R.H., C.R.-P., C.R.-P., and J.R.H. All authors have read and agreed to the published version of the manuscript.

Funding

Contract for young research personnel financed by the Programa Operativo de Empleo Juvenil (Youth Employment Program), and contract to the Junta de Andalucía-Consejería de Universidad, Investigación e Innovación Research Project: P21_00777 M.P.-M.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.

Acknowledgments

NUTRACMIEL research project (CDTI-FEDER).

Conflicts of Interest

The authors declare no conflict of interest.

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Figure 1. Phenolic compounds characterized in honey.
Figure 1. Phenolic compounds characterized in honey.
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Table 1. Effects of honey on cardiovascular risk factors.
Table 1. Effects of honey on cardiovascular risk factors.
HoneyDoseDurationSubjectsPhysiological ParameterEffectReference
Natural honey70 g/d vs. sucrose6 wHealthy males
25.51 ± 1.63 years
TG↓ *,a[12]
TC↓ *,a
LDL↓ *,a
HDL↑ *,a
Natural, unprocessed honey purchased from Ilyas Traders, Charsadda, Khyber Pakhtunkhwa, PakistanDiet + 70 g/d vs. diet1 mHealthy Pakistani males
20.13 ± 0.14 years
Increase in FBGa[13]
TGa
TC↓ *,a
LDL↓ *,a
HDL↑ *,a
Mixture of four types of clover honey obtained from Golden Heritage Foods, Smitty Bee Honey, Millers Honey Company, and Marshall’s Farm Natural Honey1.5 g/kg/d honey vs. sucrose1 mHealthy subjects
32.9 ± 1.7 years
FBI=[14]
TC
LDL
HDL
Iranian natural honey70 g/d vs. sucrose1 mOverweight or obese subjects
42.6 ± 8.6 years
TGb[15]
TC
LDL
HDL
FBG↓ *
CRP b
BW
BF
BMI↓ *
Wild flowers-forest-thyme honey produced by AttikiDiet + 15 g/d vs. diet + marmelade6 mObese girls
10.55 ± 0.34 years
BMI[16]
TG
TC
LDL
HDL
OGT
Dutch Gold Honey (honey from different floral sources and geographic origin)50 g/d vs. sucrose or corn syrup2 wGlucose-tolerant with overweight or obesity 38.9 ± 3.6 yearsBW
BMI=[17]
SBP=
DBP=
TG↑ *
TC
LDL=
HDL=
FBG
FBI
Glucose-intolerant with overweight or obesity
52.1 ± 2.7 years
BW
BMI
SBP
DBP=
TG
TC
LDL
HDL
FBG
FBI
Tualang sterilized honey supplied by Federal Agricultural Marketing Authorities (FAMA), Malaysia20 g/d vs. honey cocktail12 mPost-menopausal healthy and diabetic women
58.1 ± 3.7 years
SBP[18]
DBPa
TC
LDL
HDL
TG
FBG a
BMI
BF
WC
Iranian natural unprocessed honey collected from Samans kandeh, Neka, Sari City1 g/kg/d first 2 w
1.5 g/kg/d second 2 w
2 g/kg/d third 2 w
2.5 g/kg/d last 2 w
8 wType II diabetes
57.2 ± 8.4 years
BW↓ *,a[19]
FBG
HbA1c↑ *
TG↓ *
TC↓ *
LDL↓ *
HDL↑ *
Unprocessed Egyptian clover honey supplied by a beekeeper0.5 mL/kg/d Crossover study
Two 12 w intervention periods
Type I diabetes
4.7 ± 4.28 years
SSFT ↓ *[20]
MC
TSFT
FBG↓ *
TG↓ *
TC↓ *
LDL↓ *
HDL↑ *
C-peptide↑ *
HbA1C↓ *
Natural honey75 g/d15 dHealthy subjectsFBG[21]
TG
TC
LDL
HDL
CRP
Patients with hyperlipidemiaTC↓ *
LDL
CRP↓ *
Mixed blossom honey from Europe, Central America, and South America75 g/d vs. sugar solution2 wSubjects with hypercholesterolemia
35–86 years
TG[22]
TC
LDL
HDL
d: day; w: week; m: month; TG: triglycerides; TC: total cholesterol; LDL: low-density lipoproteins; HDL: high-density lipoproteins; FBG: fasting blood glucose; FBI: fasting blood insulin; CRP: C-protein reactive; BW: body weight; BF: body fat; BMI: body mass index; OGT: oral glucose tolerance; SBP: systolic blood pressure; DBP: diastolic blood pressure; WC: waist circumference; HbA1c: glycosylated haemoglobin; SSFT: subscapular skin fold thickness; MC: midarm circumference; TSFT: triceps skin fold thickness; ↑: increase; ↓: decrease; =: unchanged. * Significant differences (p < 0.05) within group between baseline and the end. a Significantly different (p < 0.05) from the control groups. b Significantly different (p < 0.05) in subjects with elevated baseline variables.
Table 3. Effects of honey on appetite and food intake.
Table 3. Effects of honey on appetite and food intake.
HoneyDoseDurationSubjectsPhysiological ParameterEffectReference
Mixture of four types of clover honey obtained from Golden Heritage Foods, Smitty Bee Honey, Millers Honey Company, and Marshall’s Farm Natural Honey1.5 g/kg/d honey vs. sucrose1 mHealthy subjects
24–57 years
Increase in energy intakea[14]
Increase in carbohydrate intakea
Increase in sugar intakea
Pure clover honey42.7 g vs. 35.5 g of sucrose1 dHealthy women
21.8 ± 2.9 years
Increase in post-prandial glucosea
Increase in post-prandial insulin
Post-prandial leptin[26]
Post-prandial ghrelin
Post-prandial peptide YY
Hunger rate
Satiety ratea
Thermogenesis
Energy intake
Carbohydrate intake
Sugar intake
Iranian natural unprocessed honey collected from Samans kandeh, Neka, Sari City1 g/kg/d first 2 w
1.5 g/kg/d 2 w
2 g/kg/d 2 w
2.5 g/kg/d last 2 w
8 wType II diabetes
57.2 ± 8.4 years
Energy intake[19]
Energy from protein
Energy from carbohydrate
Energy from fat
Sugar intake
d: day; w: week; m: month; ↑: increase; ↓: decrease. a Significantly different (p < 0.05) from the control groups.
Table 4. Effects of honey on alcohol metabolism.
Table 4. Effects of honey on alcohol metabolism.
HoneyDoseDurationSubjectsPhysiological ParameterEffectReferences
Freshly harvested Nigerian citrus (Citrus sinensis Osbeck) honey from the delta region of the River Niger0.5 mL/kg of ethanol + 1 mL/kg of honey1 dHealthy subjects
25–35 years
Blood alcohol clearance rate↓ *[27]
Intoxication time↓ *
Intoxication degree
Freshly harvested Nigerian citrus (Citrus sinensis Osbeck) honey from the delta region of the River Niger0.5 g/kg of ethanol + 1.25 mL/kg of honey1 dHealthy men
23.6 ± 7.4 years
Intoxication time↓ *[28]
Intoxication degree↓ *
TG↑ *
Blood pressure
d: day; TG: Triglycerides; ↑: increase; ↓: decrease. * Significant differences (p < 0.05) within group between baseline and the end.
Table 8. Other health effects of honey.
Table 8. Other health effects of honey.
HoneyDoseDurationSubjectsPhysiological ParameterEffectReference
Low- and high- antioxidant buckwheat honey from the Dutch Gold company1.5 g/kg6 hHealthy subjects
25.55 ± 2.30 years
Plasma phenolic concentration↑ *[56]
Plasma antioxidant capacity↑ *
Plasma reducing capacity↑ *
Manuka honey from New ZealandManuka honey microemulsion cream
0.5–1 cm
Once a day
3 mPatients with blepharitis
60 ± 12 years
Dry eye symptomologya[57]
Tear film qualitya
Ocular surface qualitya
Microbial burdena
Local unpasteurized honey from Honeycomb Apiairies, Bristol and filtered pasteurized clover honey from Dutch Gold Honey Inc, Lancaster1 tablespoonful/d30 wPatients with allergic rhinoconjunctivitis
45.3 years
Symptoms of rhinoconjunctivitis=[58]
Multiflora honey and Manuka honey UMF 20+, both produced by Comvita New Zealand Ltd.20 g/dCrossover
4 w each period
Healthy subjects
42–64 years
IgE level[59]
Gut bacterial=
Astragalus honey made in Ashtian Region of Iran1.2 g/kg from the 15th day to the onset of menstruationCrossover
2 m each period
Female students with dysmenorrhea
22.01 ± 1.78 years
Pain=[60]
Amount of bleeding=
Satisfaction=
h: hour; d: day; w: week; m: month; ↑: increase; ↓: decrease; =: unchanged. * Significant differences (p < 0.05) within group between baseline and the end. a Significantly different (p < 0.05) from the control group.
Table 9. Main effects of honey on human health.
Table 9. Main effects of honey on human health.
ConditionSubjectsParameterEffectReferences
Cardiovascular risk factorsHealthy subjects
Diabetic subjects
Subjects with hyperlipidaemia
FBG[12,13,18,19,20,21]
TG
TC
LDL
HDL
Glucose toleranceHealthy subjects
Diabetic subjects
Increase in BGL[21,23,24,25]
Increase in BIL
Alcohol metabolismHealthy subjectsIntoxication time[27,28]
CancerPatients with acute myeloid leukaemia
Patients with head and neck cancer
Mucositis severity[29,30,31,32,33,34,39]
Body weight
URTIsChildren with URTIsCough frequency and severity[42,43,44,45,46]
Combined symptom score
Sleep quality
Parent’s sleep quality
WoundsChildren with pyomyositis abscesses
Women with episiotomy wound
Patients with diabetes
Wound healing[51,52,53,54]
Discharge
FBG: fasting blood glucose; TG: triglycerides; TC: total cholesterol; LDL: low-density lipoproteins; HDL: high-density lipoproteins; BGL: blood glucose level; BIL: blood insulin level; ↑: increase; ↓: decrease.
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Palma-Morales, M.; Huertas, J.R.; Rodríguez-Pérez, C. A Comprehensive Review of the Effect of Honey on Human Health. Nutrients 2023, 15, 3056. https://doi.org/10.3390/nu15133056

AMA Style

Palma-Morales M, Huertas JR, Rodríguez-Pérez C. A Comprehensive Review of the Effect of Honey on Human Health. Nutrients. 2023; 15(13):3056. https://doi.org/10.3390/nu15133056

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Palma-Morales, Marta, Jesús R. Huertas, and Celia Rodríguez-Pérez. 2023. "A Comprehensive Review of the Effect of Honey on Human Health" Nutrients 15, no. 13: 3056. https://doi.org/10.3390/nu15133056

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