Dr Rupy: Honey is apparently antibacterial, improves wound healing, prevents viral illnesses, treats coughs, and is good for gut health. But if honey is basically sugar, and sugar is just sugar, how on earth is this substance healthy? We're going to dive into it, but I want to go into some of the origins and traditional uses of honey just to give you some context of how long this has been used for by a number of different civilisations across the world. So, it's been used for thousands of years and evidence for its consumption has been found dating back to the neolithic age. It's been used in ancient times, including Egyptians, Romans, Mayans, Chinese, and people used it as one of the only sweeteners that was available back in the time. So they used it as part of religious rituals and for medicinal purposes, like healing wounds and burns and against lung diseases. So there is this long historical context of using honey as a medicine. There's even some scriptures that show digestive effects as well, so treating diarrhoea and constipation, potentially because of antimicrobial effects. You'll see it mentioned as a medicine in various texts, so in Egyptian papyri dating, you know, 2000 BC, in Hindu scripture, in Hippocrates, loads of people have been raving about honey. It's not just your favourite health influencers online. Let's dive into the actual product of honey. So, it's produced from the nectar of flowering plants. Plants basically produce this nectar to entice bees and so they spread their pollen to other areas so they get to grow. Bees suck up the nectar in their honey sacs where the bee's enzymes, including one called invertase, break down the complex sugars, sucrose, into much simpler sugars, glucose and fructose. I've put a little diagram of what exactly that looks like so you can see clearly that the glucose and fructose structure is a lot simpler than sucrose. It's basically just broken up by damaging that glycosidic bond in the middle there. Honey bees make honey basically to store up as food for the larvae and other members of their colony to survive during the winter months. So for them, it's a really important food. It is the food and it is medicine for them. So, we've established that honey is basically just sugar, just by looking at the chemical composition right there. It's in the form of glucose and fructose, and if you've heard anyone talk about glucose and fructose online, you will know that those are the devil. It's not basically what I think, but essentially the excess consumption of glucose and fructose is net bad for us. So why on earth are there any health benefits? And is there any robust scientific evidence backing up these anecdotal claims that I'm sure you've heard of? So let's look at the actual constituents by looking at this other diagram that looks at the minerals and enzymes and the other polyphenols that you find. So, honey is 80% sugar. So what I just described there, sucrose, fructose and glucose, that's 80% of what honey is. 17%, so the vast minority, is just water. But then there's a really interesting 3%, and that's a treasure trove of vitamins, minerals, polyphenols. And these constituents are why researchers are investigating these potential health-promoting effects. It's basically down to this 3% of honey. And depending on the type and the quality of honey that you'll find, you'll get different amounts of these constituents. So minerals and vitamins, that's around 0.2 to 0.5% of honey in its dry weight. And the specific ones are potassium, sodium, vitamin C and B vitamins. So the B vitamins like thiamine, riboflavin, niacin. I just want to point out here, you should not be consuming honey to get those ingredients specifically, those micronutrients, because you'll find potassium, vitamin C in things like dark green leafy vegetables, pulses, you'll find lots of different B vitamins in whole grains, you'll also find them in small amounts in nuts and seeds. So don't think about honey as sources of those minerals and vitamins. It's just interesting that that 3% contains a tiny fraction that has those micronutrients. It also contains enzymes, so I mentioned invertase before, and also has glucose oxidase and diastase, and these come from the nectar, the bees, or the microorganisms in honey as well. We don't actually know what the effects of those enzymes are, but a few methods to develop a quality ranking for honey look specifically to measure some of these enzymes like diastase. And that is meant to be a quality indicator of honey, but we don't actually know what those enzymes do. So it's kind of hard to determine quality if you're looking at an enzyme that we don't particularly understand what it does, but that is a quality ranking system that you might see online. And we're going to talk a bit about where there is this huge confusion, it's a bit of a murky world with determining the quality of honey later on in this episode as well. So the general sort of thinking by some of these quality measures is where the quality is high, you also find high amounts of enzymes like diastase, for example. Another fraction of this tiny, tiny 3% are phenolic acids or polyphenols. So you'll find things like p-coumaric, gallic acid, caffeic and ferulic acid and other flavonoids as well. So let's zoom into this pie chart that I was just talking about. This is basically honey composition and you'll see here that it is largely sugars. You've got sucrose, you've got dextrose here, you've got a big fraction which is water. This is basically what is in honey. And if you look at the next, sorry, if you if you're listening to this on the podcast, I'm just describing a pie chart that basically says exactly what I just stated. 80% different types of sugars and 17% water and a very, very small fraction. The next table that I'm describing for the audio guys, but also for you guys on YouTube, are the phenolic acids. So this is basically the different types of phenolic acids that you find in honey and flavonoids as well. And you might recognise some of these. So caffeic acid, chlorogenic acid, you'll find these in coffee and tea in varying amounts. And on the flavonoid side, you've got quercetin, kaempferol, apigenin, you find that in things like parsley and apple and onions. They're really, really common flavonoids that have been well recognised as having some beneficial effects. But considering that there's such a small amount of all these different elements in honey, it begs the question, can honey be an important source of nutrients? Can we actually consider honey to be an important source of all those different nutrients, the micronutrients, the polyphenols, etc? My personal opinion is no, and that's for three reasons. The first being the most obvious, low amounts. It's really, really hard to get a significant amount of those particular compounds without consuming a bucket load of honey. So to have sufficient quantities to have noticeable health effects, my sort of skepticism detector is going off the scale here. I just don't, I can't get my head round those small amounts having a demonstrable impact. The second reason is bioavailability. We're not actually quite sure how well our bodies can actually utilise these compounds in honey. In other words, their bioavailability remains unclear and can be influenced by lots of different factors, things like environmental variables, how you process the honey, interactions with other substances, like proteins or polyphenols, the chemical structures of those phenolic compounds and how our intestinal digestion via one's microbes can impact the ultimate level of those different polyphenols and whether they have a demonstrable health effect. And there's very limited research investigating the metabolism and absorption of honey polyphenols in humans. So it's still really up in the air. And the third thing is that not all honey types are the same. So depending on where the bees gather their nectar from, the honey can vary a lot. Different plants can give different types of honey, which can ultimately impact the nutrient quantity and quality. And this is sort of where the line for me kind of around determining quality honey is really blurred. I there's a lot of stuff online that you'll hear about, but there isn't much evidence to sort of underpin those particular benefits. But I want to be really frank. Despite my initial skepticism, the main therapeutic benefits and health-promoting properties of honey, which we're going to get into in a moment, are actually attributed to the presence of these small amounts of polyphenols. So despite me looking at it on face value and thinking this is not going to have any effect whatsoever, there are researchers, bona fide researchers who think that those small amounts, those small properties of honey are responsible for some of the health effects that we see in certain studies. Let's talk about those potential health benefits of honey. Again, research is really limited and it's really mixed, but there is some interesting evidence suggesting that honey intake can improve certain aspects of health. Number one, cardiometabolic health. So researchers at the University of Toronto recently found that honey intake improved key markers of metabolic health, including blood sugar, cholesterol levels, particularly if, and this is going to be going to sound like music to a lot of people's ears here, particularly if the honey is in its raw form and from a single floral source. So it's raw honey, single floral source, so just one type of tree like manuka, so manuka honey is something that a lot of people have heard about. The team conducted a meta-analysis of 18 clinical trials totalling over 1,000 participants, and overall honey intake beneficially reduced people's fasting blood sugar, which I can't, I just don't understand how that happens, but it reduced fasting blood glucose, blood sugar levels. It reduced total and LDL cholesterol. It reduced triglycerides and also a marker of fatty liver disease, something called ALT. It's a liver enzyme that we look for. We do liver enzyme tests, particularly if someone's on a hepatotoxic medication, for example. One of the one of the things can be elevated ALT in fatty liver disease. It also increased HDL cholesterol, which is a marker of good cardiovascular health as well, as well as some markers of inflammation. So that for me is a bit astounding if you just read the abstract, but we don't just read the abstract, we go into a little bit more detail. The the dose, the median daily dose of honey in these trials was 40 grams, which is about two tablespoons of honey, which is a lot, which is more than the recommended allowance that the WHO recommends for added sugar in a 24-hour period. So that's a lot of sugar. And the participants were also shown to follow a healthy dietary pattern with added sugars accounting for less than 10% of their total calorie intake. So that 40 grams was within that 10% or less of daily caloric intake. So that for me is pretty astounding. And that was in a paper that was published in 2023, so relatively recently. On the face of it, I, you know, I'm still a bit skeptical, but that disproves some of my some of my skepticism, despite the face value of what honey is. The second thing is cough and upper respiratory tract infections. Everyone's had that experience of having lemon and honey mixed with hot water, maybe a clove mixed in there for a bit of flavour and some of those extra antibacterial benefits when you're ill, you're under the weather. So there was a study looking at this. It was a systematic review without a meta-analysis of randomised control trials, and researchers concluded that honey may be more effective than cough medication or no treatment in relieving symptoms in children with acute cough. And these results are actually in line with a Cochrane review. So Cochrane is a big organisation, they're very well regarded to have the most up-to-date and the most rigorous reviews. They showed that giving honey to children for up to three days was more effective in relieving cough symptoms compared to placebo or salbutamol. Salbutamol is a spray that we give asthmatics, but also you can give it to children who have viral-induced wheeze, so wheeziness because of some receptors that overacted, over-activated and can cause constriction of your airways. But, big butt here, the evidence was graded as low quality by the reviewers at Cochrane because of methodological flaws like small sample size. A lot of these were unblinded. I mean, it's quite hard to blind honey unless you're using like a sugar syrup and something that resembles honey. And they also looked at things like parent-reported outcome measurements rather than objective outcomes. So an objective outcome in the form of, let's say, a cough or a viral-induced wheeze might be a little at-home test that we use to demonstrate just how constricted your airways are by blowing into a flow machine that basically measures the amount of air that you can express in a single breath. So they just looked at, you know, they just basically asked the parents, do you think your kid is doing better or worse? And they just said, oh yeah, it's a bit better or pretty much most of the same. So bottom line is we need more high quality, large randomised control trials to generalise these findings. But there are some positive results with honey. And the the the attributes of that may be its antimicrobial effects. We'll get into some of the potential explanations a little bit later. The third thing is brain health. So another emerging area of honey research is looking at brain health and healthy ageing. But most studies are looking at animals. There is one small human study conducted in 2020 on 80 people diagnosed with schizophrenia, and they found that Tualang honey supplementation improved total learning performance across domains in immediate memory. Now, I had to look up Tualang honey. I've never come across this before, but I looked on Amazon, and if you look at this on YouTube, Tualang black honey, 280 grams, and I'll just describe what I'm seeing for the folks listening to this. It is a very dark, licorice-looking honey, and it is 66 pounds, down from 70, but still 66 pounds. That's almost $100 for a small tub of honey. So, I mean, that that's an impressive price tag, and I'm sure it's a very good quality honey, but for not as robust studies, I don't know whether I'd be investing in that. And Tualang is a particular area in Southeast Asia, or that's where you find this particular honey from a Tualang plant, I imagine. They've also got some various quality indicators there, but as we'll get to, the quality indicators, I don't think are that robust either. It's kind of, it's all very murky, finger in the air kind of stuff. But, and here's a big butt, before you start loading up your online shopping baskets full of honey, there's a big caveat, okay? So we've seen very little human evidence supporting this. In 2015, there were researchers at the US Department of Agriculture that compared the consumption of honey and sucrose and high fructose corn syrup, and they found no difference in metabolic effects such as glycemic response, lipid metabolism, and inflammation, suggesting that honey was not more beneficial than other sweeteners for glucose homeostasis. So glucose homeostasis, big funky word for glucose stabilising effect, so the balance of glucose in the blood. A caveat to that though, I would say, and that was published in the Journal of Nutrition in 2015. A caveat to that is honey is not all honey. What do I mean by that? There are many different types of honeys out there, including fake honey. And actually, we're going to do another episode, probably just for YouTube, where I'm going to try different types of raw honey. I might even convince myself to buy that Tualang honey, just to try it for your sake, so you don't need to invest in it yourself. I might save a lot of people money. And depending on the quality of the honey, you may see different effects. So if you remember back to that study that we just talked about earlier, they looked at single floral honey that was raw in its form. That study that I just mentioned that didn't show a difference in glycemic response, lipid metabolism, and inflammation, I very much doubt that they looked at specifically raw honey. So it's just a big caveat to my own caveat. Should you be having honey every single day? I personally think there will be a lot of drawbacks that could negate any potential benefits of honey. Honey is a complex substance. It's not a uniform product. Its composition and thus the potential benefits vary massively depending on factors like floral source. So the type of plants that are that the bees feed on to produce the honey itself. Different flowers have different phytochemical properties, which therefore influences the presence and concentration of these different bioactive compounds, the the honey polyphenols, the flavonoids. And so depending on what flowers the bees have visited, the honey can turn out very different. So I accept that there is going to be a huge amount of variation depending on the quality of the honey. And then that also goes into the geographical region. So it's not just the different types of flowers that the bees are feeding on, but in different regions around the world that have different climates and soils, that will also influence the flowers available for the bees, and then also variations in the honey composition. So everyone's heard of manuka honey, and if you've been to your local supermarket, you'll notice that it's under lock and key now, because a little jar is as expensive as some whiskeys. And, you know, to be fair to the manufacturers, it's a it's a very, the manufacturers, the bees, the bottlers of manuka, it is a very rare type of honey and it does command a higher price tag for that reason. There is clear evidence for antibacterial properties attributed to the presence of methylglyoxal. It's a compound that's derived from the nectar of the manuka tree, and that has been shown to to have some benefits as well. To the point that we actually use honey in medicinal environments as well. So after you've had an injury, a laceration, or using plastics as well, to improve wound healing and to reduce the likelihood of a subsequent infection as a result of bacteria that live normally on the surface of our skin, we sometimes apply a concentrated high antibacterial honey via a little tube. And this is very expensive, but that is something that we use in medicine. So I do not doubt that it has antibacterial effects when applied topically, whether or not that translates to cardiovascular health benefits, anti-inflammatory benefits, and cough, cold and flu benefits is quite hard to say, but you know, it might be worth a try. But if you are going to invest in it, try and go for a high quality one. And we're going to do an episode describing how you can choose a quality one as well. The processing and storage method will also have an impact on the end product as well. So techniques like filtration, pasteurisation, exposure to heat, this is all going to affect the levels of enzymes as well as vitamins and other heat-sensitive components in honey that may have an impact on the end quality of the product as well. So that processing and storage method is something to be wary of. And like I said, we're going to do an episode where I'm going to compare a whole bunch of different ones and we're going to be looking for the processing and storage methods as one of the markers of quality ourselves. Because of this huge amount of variability in the composition of honey, there aren't any uniform standards. This is to say we don't know which type of honey and how much could be beneficial, aside from the pharmaceutical grade honey that we use in medicine. I haven't come across a real good standard of grading that can give the consumer confidence that you are getting a really high quality product that is, you know, reflective of a price tag, like, you know, 60, 70 pounds for a for a jar. There are some regional methods and regional specific standards. So you've probably come across the UMF or the unique manuka factor, almost said that wrong, unique manuka factor rating, but there's no comprehensive standardisation across all honey types. And the studies, like you've heard, use different types of honey. They use different dosages, the outcomes measured are very different. So it's very hard to consistently compare and evaluate the beneficial effects of different honeys to draw conclusions from as well. So overall, the evidence is limited, it's of low quality, a lot of them are unblinded, a lot of them are short-term. And for me, that just makes it hard to tell people like, you should definitely invest in this because it's going to have these miraculous effects. There's going to be a lot more bang that you can get for your buck using different types of products. And if it's a nice to have and if you want something to sweeten your tea that may have antibacterial effects, maybe then, but I think until then, we need better quality research and it's really, really hard to draw conclusions about the effects of honey on health until I've seen anything of that sort of quality, that sort of benefit. So to summarise, is honey healthy? I think it really depends on what you're comparing it to. First off, so honey has small amounts of vitamins, minerals, plant compounds that could be beneficial. So if you are going to swap table sugar for honey, as long as it's in the correct amount, I don't mind. I think that's something that I do. Secondly, second of all, I do want you to remember that honey is still sugar. We shouldn't be thinking about honey as a health food because it's mostly composed of sugar. And to get meaningful benefit from the compounds in honey, you need a large amount of the honey that comes packaged with the sugar. So I would say, as a rule, most of us need to be reducing our sugar intake, which you can also get from, you know, fruits and and berries and that kind of stuff. You want some natural sugars that combine with the fibres to mitigate the effect of those natural sugars. And if you want to sweeten foods, there are other ways in which you can use that, like cinnamon and spices, nutmeg, these are sweet spices. I don't think we should be having like huge amounts of honey. I think we should be using honey in the same way we use sugar, which is in small, very intentional doses. Number three, what dose do I actually use? So I would say I use a teaspoon at a time. I would always combine it with something that's protein and fibre rich. So if I'm thinking of a dessert, which would be baked oats with hemp seeds and frozen berries, I'd bake the frozen berries in the bottom. There's actually an app recipe, so if you go to the Doctor's Kitchen app, you'll be able to find this recipe. You bake the berries until they reduce a bit, add a little bit of honey, and then you top it with oats and nuts. I forget the total recipe now. And then a little bit more honey on top of that. That way you're using it responsibly, you're not using like a ton of sugar, and you still got that sweetness effect as well. You are baking it, so there is an argument to say that you're attenuating or removing the benefits of honey, particularly in raw raw honey, because it's got the enzymes and vitamin C that might be having the health benefits. But, you know, that's one way in which you can use it. The other way in which I would use it is with ginger tea, half or a teaspoon of honey, raw honey, mixed in with that hot water. That's something that I have when I'm feeling a bit under the weather or my voice has gone from podcasting too much. But those are the ways in which I would use it. But the number one takeaway from this is there are so many other foods that we get significant amounts of polyphenols from, whole fruits, vegetables, legumes, nuts and seeds. I would not put honey in the same category as that. It is an add-on. It might be something that you want to supplement with. It might be something you want to experiment with, particularly if you like your tea slightly sweeter, but I would use it in the context of like creating a clove rich anti-inflammatory drink with a bit of sweetener with raw honey. I wouldn't put it in the class of foods that I want to consume on a daily basis. I think you should be focusing on dark leafy vegetables, greens, nuts and seeds, berries. That's the mainstay and then obviously plant-based proteins and animal-based proteins. Honey is a nice add-on, but it's not something that I would say is a health food that everyone should be having every single day. Until I see a lot of evidence to suggest otherwise, that's going to be my position. I think it's a wonderful ingredient. You should still use it, but in moderation, and it's still in my mind classed as a sugar. If you think differently, let me know. I want to know in the comments on YouTube. This is where we're going to be diving a lot more into to find out our responses to these episodes. There isn't a way on Apple podcast or Spotify to really get real-time feedback about the quality of specific episodes. So if you're listening to this, then do jump onto YouTube, subscribe whilst you're there, it helps us out. It's completely free to you. Hit the notification bell and let us know in the comments what you think of this because I'd love to do another episode on different types of sweeteners if you think there are health benefits attributed to, it could be maple syrup, it could be coconut sugar. I'd love to do a little episode on that, but we're also going to do a taste test and help you choose a high quality raw honey if you want to invest in that too.
