Australian Health Today - - Con­tents -

Dr Shona Blair and Dr Nu­ral Cokcetin are sci­en­tists who have been in­ves­ti­gat­ing the medic­i­nal prop­er­ties of honey for years. They are fas­ci­nated by bees and their sweet honey

and how they are so im­por­tant for our well­be­ing.

Honey is much more than just a sweet toast-top­per - it lit­er­ally saves lives and limbs. This is be­cause honey kills su­per-bugs and other germs that are caus­ing life-threat­en­ing in­fec­tions in hos­pi­tals and in the com­mu­nity, even ones like the deadly Golden Staph.

Su­per-bugs are germs that cause in­fec­tions that are no­to­ri­ously dif­fi­cult to treat be­cause they have be­come re­sis­tant to the usual an­tibi­otic med­i­ca­tions that used to kill them. In some cases the in­fec­tion can progress to com­pli­ca­tions like gan­grene and may lead to am­pu­ta­tion or even death. Honey has medic­i­nal prop­er­ties that kill su­per-bugs and erad­i­cate these life-threat­en­ing in­fec­tions, even when con­ven­tional med­i­ca­tions have failed.

But it’s not just any old honey. It is all about the flow­ers that bees visit to col­lect nec­tar that they turn into de­li­cious, and po­ten­tially life-sav­ing, honey. One of the most fa­mous ex­am­ples of a pow­er­ful medic­i­nal honey is manuka (Lep­tosper­mum sco­par­ium) from New Zealand.

Pro­fes­sor Peter Molan (New Zealand) dis­cov­ered the un­usual ac­tiv­ity of manuka honey in the 1980s and he showed that it was ef­fec­tive against a wide range of dif­fer­ent in­fec­tion-caus­ing germs. Since Pro­fes­sor Molan’s dis­cov­ery, and all of the re­search he and other sci­en­tists have con­ducted on New Zealand’s manuka since, the de­mand and price of this honey have grown con­sid­er­ably.

How­ever, although Aus­tralia is home to the largest di­ver­sity of Lep­tosper­mum plants in the world (we have more than 80 species com­pared to NZ’s one!), Aus­tralia’s medic­i­nal honey re­search and in­dus­try is in its in­fancy com­pared to New Zealand’s.

Why the sci­en­tific in­ter­est in medic­i­nal honey?

Honey has been used as a medicine through­out the his­tory of the hu­man race. Con­di­tions tra­di­tion­ally treated with honey range from dis­eases of the gut and res­pi­ra­tory sys­tems to burns, bites, wounds and eye in­fec­tions.

In many dif­fer­ent cul­tures honey has been es­pe­cially per­sis­tent as a wound dress­ing. This is un­doubt­edly be­cause it shows sig­nif­i­cant an­timi­cro­bial, or germkilling, ac­tiv­ity.

Although it was used ex­ten­sively through­out the his­tory of medicine, honey largely fell from favour from the 1940s, with the ad­vent of highly ac­tive an­tibi­otic med­i­ca­tions. After the in­tro­duc­tion of these in­cred­i­bly im­por­tant and life-sav­ing drugs, mod­ern western medicine largely dis­missed medic­i­nal honey as a “worth­less but harm­less sub­stance”.

How­ever, one of the scari­est threats to hu­man health right now is the huge in­crease of an­tibi­oti­cre­sis­tant bac­te­ria

(or an­tibi­otic-re­sis­tant germs). Some germs that cause se­ri­ous in­fec­tions are be­com­ing re­sis­tant to most avail­able an­tibi­otics. A few ter­ri­fy­ing types are now re­sis­tant to all of the an­tibi­otics we cur­rently have.

But, one of the most ex­cit­ing things about the an­timi­cro­bial ac­tiv­ity of honey is that it works against a very wide range of germs that cause in­fec­tions, and it is just as ef­fec­tive against an­tibi­otic-re­sis­tant ones as it is against those that are still sen­si­tive to these drugs. So, it is far from “worth­less”!

not just any honey

Aris­to­tle pre­scribed honey for a va­ri­ety of con­di­tions. How­ever, it was not just any old honey for any old thing. He spec­i­fied the re­gion and sea­son for the col­lec­tion of medic­i­nal honey. In fact, many of the an­cient peo­ples who used honey medic­i­nally, pre­scribed hon­eys col­lected from spe­cific lo­ca­tions, sea­sons or flow­ers for spe­cific med­i­cal con­di­tions. What Aris­to­tle and many other an­cient peo­ples ap­pre­ci­ated is that the flo­ral source of a honey will af­fect the level of its an­timi­cro­bial ac­tiv­ity (although it is un­likely that they would have phrased it that way them­selves!).

A com­mon mod­ern mis­con­cep­tion is that honey is a stan­dard prod­uct. How­ever, the aroma, taste and colour, as well as the an­timi­cro­bial ac­tiv­ity of honey will vary greatly, depend­ing on which flow­ers the bees visit to col­lect the nec­tar they turn into honey.

All hon­eys pos­sess some level of an­timi­cro­bial ac­tiv­ity, but some are up to 100 times more ef­fec­tive than oth­ers!

How does medic­i­nal honey work?

Honey is an in­cred­i­bly com­plex sub­stance, with well over 100 com­po­nents in­clud­ing many dif­fer­ent sim­ple and com­plex sug­ars, amino acids and other sub­stances. The Eu­ro­pean honey bee (Apis mel­lif­era) is the one most com­monly em­ployed by peo­ple for honey pro­duc­tion, which usu­ally comes from the nec­tar of flow­ers.

As a con­se­quence of the many dif­fer­ent types of flowering plants that can be used to pro­duce honey, there is a huge dif­fer­ence in hon­eys and their germ-killing abil­ity.

Cer­tain hon­eys have pow­er­ful ac­tiv­ity against the germs that cause in­fec­tions, even against su­per-bugs like Golden Staph. This an­timi­cro­bial ac­tiv­ity is due to four main fac­tors:

• High su­gar con­tent (about 80%)

- All of the su­gar mol­e­cules in honey bind so tightly to any wa­ter mol­e­cules present that the wa­ter is not avail­able for the germs to use, so the honey is too “dry” for them to grow.

- But even when honey be­comes di­luted it is more pow­er­ful than just equiv­a­lent su­gar so­lu­tions.

• Acid­ity (low pH)

- The typ­i­cal pH ranges from 3.2 to 4.5, which is too low for the growth of most germs that cause in­fec­tion

• Hy­dro­gen per­ox­ide

- When bees are mak­ing honey they add a va­ri­ety

of things to the nec­tar, and one of these is an enzyme called glu­cose ox­i­dase.

- When honey is mixed with wa­ter this enzyme pro­duces hy­dro­gen per­ox­ide (like bleach), and this is toxic to germs.

- This is the main fac­tor re­spon­si­ble for the an­timi­cro­bial ef­fect in most hon­eys with sig­nif­i­cant ac­tiv­ity.

- But the level varies greatly from honey to honey – jar­rah honey from Western Aus­tralia is an ex­am­ple of a honey with very high lev­els of an­timi­cro­bial ac­tiv­ity due to hy­dro­gen per­ox­ide pro­duc­tion.

• Flo­ral fac­tors

- Some hon­eys have ex­cep­tional an­timi­cro­bial ac­tiv­ity that is not due to hy­dro­gen per­ox­ide – the most fa­mous ex­am­ple is cer­tain Lep­tosper­mum hon­eys from New Zealand and Aus­tralia (a.k.a. manuka or jelly bush).

- Even once the hy­dro­gen per­ox­ide is neu­tralised, sig­nif­i­cant ac­tiv­ity re­mains, so this type of ac­tiv­ity was dubbed “non-per­ox­ide ac­tiv­ity” (NPA). - Although the spe­cial prop­er­ties of manuka were dis­cov­ered in the 1980s it wasn’t un­til 2008 that sci­en­tists found that methyl­gly­oxyl (MGO) is re­spon­si­ble for much of the un­usual ac­tiv­ity of manuka honey.

- It has since been es­tab­lished that MGO comes from a nat­u­rally oc­cur­ring com­pound in the nec­tar of flow­ers of some Lep­tosper­mum species na­tive to New Zealand and Aus­tralia.

Honey kills su­per-bugs

Medic­i­nal honey is a very pow­er­ful wound dress­ing be­cause it pro­motes wound heal­ing, and it kills su­per-bugs.

Many dif­fer­ent types of germs are sen­si­tive to the an­timi­cro­bial ac­tiv­ity of honey, just a few ex­am­ples in­clude:

• Methi­cillin-re­sis­tant Sta­phy­lo­coc­cus au­reus - a.k.a. MRSA or Golden Staph.

• Strep­to­coc­cus pyo­genes - a.k.a. “flesh eat­ing” bac­te­ria.

• Pseu­domonas species - many of these cause very nasty in­fec­tions, par­tic­u­larly in burns pa­tients.

Honey and wound heal­ing

Wound heal­ing is a com­pli­cated process that is not com­pletely un­der­stood, and it is a bal­ance be­tween cre­at­ing an en­vi­ron­ment for new healthy tis­sues to grow and heal, while try­ing not to cre­ate one that en­ables germs to grow and cause in­fec­tions.

In­fec­tions slow down heal­ing, cause more pain and scar­ring, and can be­come life threat­ing. How­ever, our re­pair­ing tis­sues and germs both do best in warm, moist en­vi­ron­ments. Un­like other top­i­cal wound dress­ings, honey helps to main­tain a moist en­vi­ron­ment for our cells to re­gen­er­ate, while also killing the bac­te­ria that could lead to in­fec­tion.

There are nu­mer­ous re­ports of the suc­cess­ful use of honey in mod­ern medicine, and these in­clude the treat­ment of:

• Su­per-bug in­fected wounds, like Golden Staph in­fec­tions

• Burns

• In­fected sur­gi­cal wounds

• Leg ul­cers and pres­sure sores

• Trau­matic in­juries and chronic wounds

• Meningo­coc­cal le­sions

• Side ef­fects from ra­dio­ther­apy

Honey has var­i­ous prop­er­ties that help wounds to heal, and these in­clude:

• Main­tain­ing a moist en­vi­ron­ment (which is es­sen­tial for good heal­ing)

• Pro­mot­ing healthy tis­sue re­growth

• Anti-in­flam­ma­tory ac­tiv­ity

• Scar re­duc­tion

• Pre­vent­ing ban­dages and other dress­ings from

stick­ing to wound beds

• Re­duc­tion of wound smell

• Pow­er­ful an­timi­cro­bial ac­tiv­ity – while be­ing non­toxic to hu­man cells.

so which honey should i buy…?

This de­pends on why you want the honey. If it is for gen­eral daily use as a food or tonic, there is no need to buy the more ac­tive (and also rarer and there­fore more ex­pen­sive) types.

How­ever, if honey is to be used as a wound dress­ing, it should be one with a high level of an­timi­cro­bial ac­tiv­ity, and it should be ster­ile. The best way to en­sure this is to check that it is honey specif­i­cally for wound care, and that the wound care

prod­uct ei­ther has a CE mark or it is reg­is­tered with the Aus­tralian Ther­a­peu­tic Goods Ad­min­is­tra­tion as a wound-care prod­uct (there will be an AUST L num­ber vis­i­ble on the pack­ag­ing). You can ask your chemist to or­der reg­is­tered honey-based wound care prod­ucts.

what do the dif­fer­ent ‘rat­ings’ used on medic­i­nal honey mean?

Since the dis­cov­ery that manuka and some other hon­eys have sig­nif­i­cant medic­i­nal prop­er­ties there have been a num­ber of sys­tems used to de­scribe and rate the an­timi­cro­bial ac­tiv­ity. There is cur­rently a con­fus­ing ar­ray of la­bels and ter­mi­nol­ogy on dif­fer­ent hon­eys, like UMF® (Unique Manuka Fac­tor), NPA (Non-Per­ox­ide Ac­tiv­ity), MGO or MG (Methyl­gly­oxal), and Ac­tive + or TA (To­tal Ac­tiv­ity).

Un­for­tu­nately, this can be very con­fus­ing for peo­ple, but hope­fully un­der­stand­ing what the dif­fer­ent num­bers mean will help.

the npa or Umf®

The NPA or UMF® rat­ings are used to de­scribe the unique type of an­timi­cro­bial ac­tiv­ity ex­hib­ited by cer­tain Lep­tosper­mum hon­eys (a.k.a. manuka or jelly bush) from New Zealand and Aus­tralia. The lab tests used to gen­er­ate these rat­ings are called “bioas­says” be­cause they test the honey di­rectly against a bi­o­log­i­cal or­gan­ism (in this case, a germ re­lated to Golden Staph). Although the NPA and UMF® num­bers are gen­er­ated by the same type of lab tests and the rat­ings are equiv­a­lent to each other, the “Unique Manuka Fac­tor” (UMF®) is a trade­mark reg­is­tered by the UMF Honey As­so­ci­a­tion. UMF® is only avail­able for use un­der li­cense by pro­duc­ers of manuka honey from New Zealand. Some other ac­tive Lep­tosper­mum hon­eys from New Zealand and Aus­tralia (with sim­i­lar an­timi­cro­bial prop­er­ties to New Zealand manuka) are sold with the NPA rat­ings. So NPA and UMF® are di­rectly com­pa­ra­ble, and are equiv­a­lent of each other when tested by an ap­pro­pri­ate lab­o­ra­tory.

methyl­gloxal - mgo (or mg)

Since it was dis­cov­ered that methyl­gloxal (MGO) is re­spon­si­ble for much of the unique ac­tiv­ity in manuka honey, a num­ber of prod­ucts on the mar­ket are la­belled with a MGO (or MG) con­cen­tra­tion. This is a di­rect mea­sure of the amount of MGO in the honey and it is ex­pressed as parts per mil­lion (ppm) or mg/kg. The num­bers for this type of la­belling are usu­ally much higher than the NPA/UMF® rat­ings – although this doesn’t nec­es­sar­ily mean the hon­eys are more ac­tive.

There is a re­la­tion­ship be­tween MGO con­cen­tra­tion and the NPA/UMF® of a honey. How­ever, it is im­por­tant to re­mem­ber that the num­bers are de­rived from com­pletely dif­fer­ent types of tests, so they are not eas­ily com­pared. Con­sumers should be aware that as the MGO scale is a com­pletely dif­fer­ent one, a “higher” MGO might not be as ac­tive as a honey with a “lower” NPA/UMF® rat­ing.

As a rough guide:

NPA/UMF® 5+ = MGO 83+

NPA/UMF® 10+ = MGO 263+

NPA/UMF® 15+ = MGO 514+

NPA/UMF® 20+ = MGO 829+

But as there is more to the story of the medic­i­nal ac­tiv­ity of honey than the amount of MGO, just mea­sur­ing this does not nec­es­sar­ily give the full pic­ture of its medic­i­nal po­ten­tial.

to­tal ac­tiv­ity

To­tal ac­tiv­ity gen­er­ally refers to the ac­tiv­ity of a honey in its en­tirety. That is, it in­cludes all of the per­ox­ide ac­tiv­ity and any non-per­ox­ide ac­tiv­ity that might be present (but usu­ally to­tal ac­tiv­ity hon­eys don’t have much of the un­usual ac­tiv­ity we see in the manuka-type hon­eys). And the tests that are used to gen­er­ate these num­bers are sim­i­lar bioas­says to those used for NPA/UMF® rat­ings.

is raw bet­ter?

You of­ten see the term “raw” used to de­scribe honey, and although this isn’t an of­fi­cial term it is gen­er­ally used to im­ply that the honey has not been heated or

fil­tered. There are some­times claims that raw honey is “more nu­tri­tious” or “bet­ter for you”. How­ever, in terms of eat­ing Aus­tralian honey, its mi­cronu­tri­ent pro­file is not overly af­fected by nor­mal com­mer­cial pro­cess­ing.

“Su­per­mar­ket” honey has usu­ally un­der­gone some heat­ing dur­ing fil­tra­tion and pack­ag­ing. Min­i­mally pro­cessed honey is gen­er­ally more ac­tive than pro­cessed va­ri­eties be­cause heat (and long-term ex­po­sure to light in clear jars) can de­stroy the enzyme re­spon­si­ble for the pro­duc­tion of hy­dro­gen per­ox­ide—the main fac­tor be­hind the an­timi­cro­bial prop­er­ties of most hon­eys. So, medic­i­nal hon­eys for wound care prod­ucts are usu­ally pro­cessed slightly dif­fer­ently to hon­eys that are for eat­ing.

Some­thing to keep in mind – you might hear lots of peo­ple say­ing “raw” honey is best and “su­per­mar­ket” honey is lower qual­ity. This might be the case in some other coun­tries, but in Aus­tralia we have strict food laws and our “su­per­mar­ket” honey is of a very high qual­ity - so long as it is Aus­tralian - al­ways check the small print of the la­bel and make sure that it is in­deed 100% Aus­tralian.

why the buzz for bees?

We know we need bees for honey and other hive prod­ucts like beeswax and propo­lis (a.k.a. bee glue). How­ever, bees play an even more im­por­tant role in keep­ing us healthy, be­cause of their es­sen­tial part in feed­ing us all. They are cru­cial due to the pol­li­na­tion ser­vices they pro­vide.

It is stag­ger­ing to think that there are around 100 crop species that pro­vide 90% of the world’s food, and bees pol­li­nate over 70 of these. It has been es­ti­mated that one in ev­ery three mouth­fuls of food con­sumed glob­ally is de­pen­dent on the pol­li­na­tion ser­vices of bees. In Aus­tralia al­most two thirds of our agri­cul­tural out­put ben­e­fits from honey bee pol­li­na­tion! Many fruits, veg­eta­bles, nuts and seeds need bees. Imag­ine your diet with­out them...

De­spite their es­sen­tial role in healthy food pro­duc­tion, honey bee pop­u­la­tions are de­clin­ing in many places around the world, and they face se­ri­ous, on­go­ing and com­plex threats.

Nec­tar and pollen are es­sen­tial food for bees, and poor nu­tri­tion can be ex­tremely detri­men­tal to their health. In Aus­tralia 70-80% of the honey pro­duced (and the pollen col­lected by bees for feed­ing their young) comes from na­tive species. So ac­cess to na­tive flowering plants is es­sen­tial to main­tain healthy honey bee pop­u­la­tions (and bee­keep­ing busi­nesses).

How­ever, the de­struc­tion of na­tive forests, im­pact of cli­mate change, in­creas­ing in­ci­dence and man­age­ment of bush­fires, in­creas­ing ur­ban­i­sa­tion, as well as gov­ern­ment pol­icy around ad­mis­sion to na­tive forests on pub­lic land, all mean that some bee­keep­ers are hav­ing dif­fi­culty ac­cess­ing ad­e­quate nec­tar and pollen flo­ral re­sources es­sen­tial for honey bee health and growth, and for the pro­duc­tion of hon­eys with medic­i­nal prop­er­ties.

We can sup­port Aus­tralian bees and bee­keep­ers by buy­ing Aus­tralian honey.

“We can sup­port Aus­tralian bees & bee­keep­ers by buy­ing Aus­tralian honey ”

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