I’m a very sceptical person which often infuriates those who look at health care more holistically. If something sounds too good to be true, it probably is, my mind tells me.
Always felt dubious about the manuka honey craze which has shifted the price of a jar of this delicious, earthy honey from a few dollars to over $20 a jar - and $120 for the pure product.
(I know it’s fantastic for the economy of the North though, so feel guilty about my scepticism.)
This topic came up on our Facebook group when someone linked to Itzhak Brook MD’s much respected blog about head and neck cancer. Written by a laryngectomee, it contains heaps of useful info for HNC patients in general.
Here is the discussion point:
It’s a reference to a mega-analysis of research into honey (regular honey, not manuka) for radiation-induced oral mucositis, the agonising inflammation of the mucous membranes in the mouth during radiotherapy.
“But what about the teeth?” I thought. Honey is mostly sugar so wouldn’t it increase the risk of tooth decay in the radiated teeth? My little brother’s baby teeth rotted back in the 50s because my mother put honey on his dummy.
And the study Dr Brook referenced wasn’t enough for me. A lot of these studies have vague results and say “more evidence required”.
What I found out in this investigation is that manuka honey is probably effective for healing wounds on the body but is no good for wounds in the mouth. While it has interesting antibacterial qualities, there is one bug in the mouth, the one that causes most dental decay, that manuka honey can’t defeat.
Patients undergoing radiation treatment found a manuka honey mouthwash to be painful and ineffective in two of the studies I skimmed, one by a student at the Otago Dental School. A Saudi Arabian study, however, found it effective for children with oral mucositis.
I’ll share here what I discovered about the healing properties of manuka honey and then the trials using the honey with cancer patients going through treatment. I’ve emailed a scientist, an oral medicine specialist and the Otago Dental School but while I’m waiting for their replies, if any, I’ll rely on Dr Google.
In the beginning
The late Professor Peter Molan of Waikato University in New Zealand was the first to report the unusual activity of manuka honey, and began testing its action against a wide range of different bacterial species in the mid 1980s. Eventually he had to grade the honey to make sure people were getting the real deal.
He said that manuka honey usually has a Unique Manuka Factor (UMF) rating on the package which means it has been tested for antibacterial activity; the higher the UMF the greater the antibacterial effects.
All honey has antibacterial qualities and it has been used to treat wounds since the days of the ancient Egyptians. When applied to a wound, honey gives off the antiseptic peroxide, same chemical you find in the useful little tubes of Crystaderm. And remember the days when we peroxided our hair?
Here’s the scientific explanation. Honey contains an enzyme called glucose oxidase, which breaks down glucose sugars and generates hydrogen peroxide, a sort of natural bleaching agent. ... As a result, hydrogen peroxide is released slowly and acts as an antibacterial agent.
Special qualities of manuka honey
Manuka honey goes above and beyond your ordinary honeys though. It has an effect called Non Peroxide Activity. A high NPA rating means super healing power. However, an article in the Huffington Post expresses some doubt about the superiority of manuka product while our own Consumer magazine damped down expectations beyond wound healing.
Manuka honey can contain an unusual type of antibacterial activity at levels not found in other honeys. This antibacterial activity has only been demonstrated in medical-grade honey used as a topical antiseptic. There’s no hard evidence the honey has any antibacterial effect when eaten. (Consumer)
Manuka honey for wounds
Sounds as if clinical grade manuka honey is good for abscesses and other wounds but needs to be applied in a medical setting.
Manuka honey for oral mucositis
I found a couple of reports giving poor results.
Oral mucositis is an unavoidable side effect of radiation therapy to the head and neck which can compromise patient health and quality of life. This study investigates the effect of manuka honey on the extent of oral mucositis in head and neck patients in New Zealand. A total of 28 patients were recruited; 10 patients received standard care and 18 patients were given additional manuka honey. Honey was used three times a day, assessment included: extent of oral mucositis using a multi-site mucositis scoring system, weight and quality of life. The first six patients randomized to the honey arm, used undiluted honey and pulled out in the first week because of extreme nausea, vomiting and stinging sensations in the mouth. The next 12 honey patients used a honey mouthwash (diluted 1:3). Six of these patients completed the trial and four more completed the first 4 weeks of the trial. Eight control patients completed the trial. In contrast to previous studies in Malaysia, Egypt, Iran and India undiluted honey was not tolerated. Honey mouthwash did not affect the extent of oral mucositis.
Despite promising earlier reports, manuka honey was not tolerated well by our patients and, even when used as directed, did not have a significant impact on the severity of ROM (radiation-induced oral mucositis).
The following report seems to be the source of the above. It's an Otago Dental School study (for a Master's thesis).
The addition of manuka honey did not show any benefit and caused a large amount of discomfort with respect to taste and stinging.
The trial did not yield statistically significant results due to the small sample size and confounding factors but it did provide useful information about the tolerability of manuka honey in head and neck patients. The reports from trial patients can be used in future trials that involve honey application. Further research into ways to make manuka honey more tolerable to patients and improve patient compliance is warranted.
An International Journal of Dentistry explanation of why this honey might not be good for gum disease.
Medical-grade manuka honey (i.e., NPA > 20) is antimicrobial towards representative oral bacteria generally, and the gram-negative anaerobes associated with gingivitis are particularly sensitive. However, the relative resistance of cariogenic S. mutans in association with the high concentrations of fermentable carbohydrates in honey and the direct demineralisation of oral hard tissues caused by the low pH of honey mitigate against application as a subgingival sustained-release adjunct in the treatment of periodontal disease.
https://www.hindawi.com/journals/ijd/2017/9874535/ Internationa Joural of Densitisty
Here’s an extract from a pro-natural products webiste.
WHAT IS SO SPECIAL ABOUT MANUKA HONEY?
Honey is a natural antiobiotic, thanks to the presence of hydrogen peroxide. Even the ancient Egyptians slathered it on as a salve.
What sets manuka honey apart is its "non-peroxide activity" due to high levels of certain antibacterial compounds, among them methylglyoxal, or MGO, and leptosperin, which make it way more potent than what's in the average honey bear.
Studies have shown manuka honey not only attacks and kills germs, but prevents the formation of antibiotic-resistant superbugs, including Staphylococcus aureus, or MRSA.
Manuka honey has proven most effective in treating infected wounds, burns, eczema and other skin problems.
Here is an article from the honey business.
Doesn't look as if the study referenced by Dr Brooks stands up to closer scrutiny. Not for use in the mouth. However, as they say in just about every Cochrane report, "More research required".
I'd love to think of our lovely honey from the iconic manuka bush as a panacea. What a romantic, natural, heartwarmng thing that would be. How exotic for people from other countries. Behind a lot of natural health product fads though (Remember the green-lipped mussel?) there is often limited evidence.
And for manuka honey, you can't just take it from the nearest hive. It has to go through testing to make sure it is of clinical grade.
It sounds like a boon in a world where bacteria are becoming resistent to antibiotics - yes - but one for the scientists.