Active Manuka Honey Research. (Article 4).

Therapeutic uses of Honey in Ayurveda.

The FAO Codex Alimentarius Commission defines honey as ‘the natural sweet substance produced by honeybees from the nectar of flowers or from secretions coming from living organisms feeding on plants, that bees gather, transform and combine with specific ingredients, store and leave to ripen in the combs of the hive.’

Article 4: Selection Of Honey For Use On Wounds.

Honey is one of the oldest known medicines that has continued to be used up to present times in folk-medicine. Its use has been "rediscovered" in later times by the medical profession, especially for dressing wounds. The numerous reports of the effectiveness of honey in wound management, including reports of several randomised controlled trials, have recently been reviewed, rapid clearance of infection from the treated wounds being a commonly recorded observation.

In Ayurveda honey is called as "Madhu". Its qualities are explained as follows. “It has sweetness (madhura rasa) with added astringent as end taste (Kashaya anu rasa). It is heavy (guru guna), dry (ruksha) and cold (sheeta). Its effect on doshas is as follows: It aggravates vata, scrapes kapha and normalizes pitta and rakta. It promotes healing process.”

In almost all of these reports honey is referred to generically, there being no indication given of any awareness of the variability that generally is found in natural products. Yet the ancient physicians were aware of differences in the therapeutic value of the honeys available to them: Aristotle (384-322 BC), discussing differences in honeys, referred to pale honey being "good as a salve for sore eyes and wounds"; and Dioscorides (c.50 AD) stated that a pale yellow honey from Attica was the best, being "good for all rotten and hollow ulcers".

Various ingredients of honey have helped it to become not only a sweet liquid but also a natural product with high nutritional and medicinal value. The medicinal quality, taste, texture, color, aroma of honey differs according to the geographical area and the species of plants from which it has been collected.

Any honey can be expected to suppress infection in wounds because of its high sugar content, but dressings of sugar on a wound have to be changed more frequently than honey dressings do to maintain an osmolarity that is inhibitory to bacteria, as honey has additional antibacterial components. Since microbiological studies have shown more than one hundred-fold differences in the potency of the antibacterial activity of various honey, best results would be expected if a honey with a high level of antibacterial activity were used in the management of infected wounds.

Eight types of honey are described in Ayurveda depending on the type of bee which collects it. They are Pouttika, Bhramara, Kshoudra, Makshika, Chatra, Arghya, Oudalaka and Dala.

Other therapeutic properties of honey besides its antibacterial activity are also likely to vary. An anti-inflammatory action and a stimulatory effect on angiogenesis and on the growth of granulation tissue and epithelial cells have been observed clinically and in histological studies.

Pouttika: This honey is collected by very large bees from the nectar of poisonous flowers. It increases vata, causes gout and burning sensation in chest. It is also sedative and reduces fat.

The components responsible for these effects have not been identified, but the anti-inflammatory action may be due to antioxidants, the level of which varies in honey. The stimulation of tissue growth may be a trophic effect, as nutrification of wounds is known to hasten the healing process: the level of the wide range of micronutrients that occur in honey also varies.

Bhramara: This honey is collected by large bees and Sticky in nature.

Until research is carried out to ascertain the components of honey responsible for all of its therapeutic effects it will not be possible to fully standardise honey to obtain optimal effectiveness in wound management.

Kshoudra: (Honey collected by medium sized honey bees ) light and cold in nature. Dissolves Kapha.

However, where an antiseptic wound dressing is required then standardisation for this effect is possible. Several brands of honey with standardised levels of antibacterial activity are commercially available in Australia and New Zealand, but even where these are not available it is possible to assay the level of antibacterial activity of locally available honey by a simple procedure in a microbiology laboratory.

Makshika: (Honey collected by small honey bees) very light and dry natured. Useful in Vata-Kapha diseases and kapha diseases.

The antibacterial activity of honey is due primarily to hydrogen peroxide generated by the action of an enzyme that the bees add to the nectar, but there are some floral sources that provide additional antibacterial components.

Chatra: Heavy and cold in nature useful in gout, Leucoderma (Shwitra).

The body tissues and serum contain an enzyme, catalase, that breaks down hydrogen peroxide - how much of the honey antibacterial activity is lost through this is not known.

Arghya: Good for eyes but causes arthritis.

The antibacterial components that come from the nectar are not broken down by this enzyme.

Oudalaka: Useful in skin diseases, and helps in modulation of voice.

Until comparative clinical trials are carried out to determine which type of antibacterial activity is the more effective, it may be best to use manuka honey, as this contains hydrogen peroxide activity as well as the component that comes from the nectar.

Dala: Dry and reduces vomiting.

Because the enzyme in honey that produces hydrogen peroxide is destroyed by heating and exposure to light, unpasteurised honey should be used, and it should be stored in a cool place and protected from light.

• As it contains sugars which are quickly absorbed by our digestive system and converted into energy, this can be used as instant energizer.
• As it is hygroscopic it speeds up healing, growth of healing tissue and dries it up.
• Honey acts as a sedative and is very useful in bed wetting disorders.
• Honey is very good anti-oxidant which restores the damaged skin and gives soft, young looks.
• Honey has antibacterial properties due to its acidic nature and enzymically produced hydrogen peroxide.
• Constant use of honey strengthens the white blood corpuscles to fight bacteria and viral diseases.

If it is necessary to warm honey to liquefy it, it should be heated to no more than 37°C. If it is considered necessary to sterlise honey, this can be done by gamma-irradiation without loss of antibacterial activity. Gamma-irradiated manuka honey is available commercially. (In none of the clinical reports of use of honey on wounds was the honey used sterilised.No case of infection resulting from the use of honey has been reported.)

Manuka honey can have a uniquely high level of an antibacterial component from nectar that is not broken down by catalase. This antibacterial component is particularly effective against Staphylococcus aureus.

• Honey is very good for eyes and eye sight.
• It quenches thirst.
• Dissolves kapha.
• Reduces effects of poison.
• Stops hiccups.
• It is very useful in urinary tract disorders, worm infestations, bronchial asthma, cough, diarrhea and nausea -vomiting.
• Cleanse the wounds.
• It heals wounds.
• Helps in quick healing of deep wounds.
• Initiates growth of healthy granulation tissue.
• Honey which is newly collected from bee hive increases body weight and is a mild laxative.
• Honey which is stored and is old helps in metabolism of fat and scrapes Kapha... [read more]

Like all honeys, manuka honeys vary very much in their potency. A 'UMF' rating ('Unique Manuka Factor', equivalent to the % phenol with the same activity against Staphylococcus aureus) is being used by producers of manuka honey to show the potency of this antibacterial component, as more than half of the manuka honey on sale does not have any significant amount of this component present.

Some practical considerations are:

• Ensure that there is an even coverage of the wound surface with honey. Honey can be made fluid by stirring or warming. Cavities may be filled by pouring in fluidised honey, or more conveniently by using honey packed in squeeze-tubes. (Gamma-irradiated manuka honey in tubes is available commercially.)
  
  
• Spread honey on the dressing pad rather than on the ulcer - it is much easier to do and causes less discomfort for the patient.
  
  
• The amount of honey needed depends on the amount of fluid exuding from the wound - the benefits of honey on wound tissues will be reduced if honey becomes diluted a lot: typically, 20 ml of honey is used on a 10 cm X 10 cm dressing.
  
  
• Cover with absorbent secondary dressings to prevent honey oozing out from the dressing. Change the dressings more frequently if the honey is being diluted a lot - otherwise change every day or two.
  
  

Active Manuka Honey Research. (Article 3).

Honey 'weapon against superbugs'.

Scientists claim to have discovered that honey can be used as a natural remedy to hospital infection "superbugs" which are resistant to strong antibiotics.

Article 3: Case Report - The use of honey in healing a recalcitrant surgical wound.

Ancient civilizations used honey to heal wounds. Despite the rediscovery of honey by modern physicians its use in conventional medicine, unlike in complementary medicine, remains limited.

The research team from Cardiff University and the University of Waikato in New Zealand believes the combination of honey's high sugar content and its syrupy texture would act as a natural barrier to bacteria entering wounds.

Much anecdotal evidence, some clinical observations, some animal models and some randomised controlled trials support the efficacy of honey in managing wounds, but few detailed descriptions of the use of honey in healing difficult surgical wounds have previously been published.

The tests could have a major impact on the way hospitals tackle outbreaks of bugs, such as MRSA, which have infected 3,000 patients so far this year.

Case Report.

In March 1999 a 38 year old female with a non-healing surgical wound of 36 months duration in her left axilla requested treatment with honey.

Earlier this year, scientists from the University of Illinois at Urbana-Champaign published research showing honey contained antioxidants, which are beneficial in lowering cholesterol.

She had been suffering with Hidradenitis Suppurativa(HS) in the left axilla since the age of sixteen, when she underwent an incision and drainage of an abscess in this area. Her right axilla, inframammary folds and groin were unaffected and the patient was otherwise fit and healthy.

The Centre of Bio Medical Sciences in Cardiff has conducted tests on bacteria gathered from infected patients and from hospitals, which proved highly resistant to antibiotics.

Three wide excisions of chronic indurated, non-healing tissue from the left axilla were performed in 1991, 1996 and in 1997, but the wound had failed to heal following the surgical procedure performed in 1996. A wide range of dressings was applied between April 1997 and February 1999 with limited effect.

Project leader Dr Rose Cooper led the two-year research programme, using tests involving pasture honey and Manuka honey, from New Zealand, in treating ulcers and abscesses.

Progress to healing was complicated by recurrent wound infections and Staphylococcus aureus was isolated on five occasions in addition to a number of other organisms. Antimicrobial therapy included Co. Amoxiclav, ciprofloxacin, flucloxacillin, metronidazole, Flamazine (silver sulphadiazine) and Inadine (povidone-iodine).

They discovered the high sugar content slowed bacterial growth, while the honey's texture acted as a seal against outside infection of wounds.

The patient had limited abduction of her shoulder as a result of scarring, and complained of a painful wound. In an attempt to re-introduce healthy undamaged skin to the area and to improve the range of shoulder movements, further surgery was performed in November 1998: the scarred area was excised and covered by a rotational skin flap.

In its undiluted form, honey had the effect of killing off bacteria, which researchers believe could be linked to enzymes in the bees themselves or present in pollen.

Initially this resulted in improving the range of movement of the shoulder joint, but the distal end of the flap broke down three months later, and Staphylococcus aureus was again isolated. It was at this point (having endured four operations and 36 months of failure to heal) that honey was requested by the patient.

But the so-called discovery would not have been news to the ancient Greeks and Romans, who were aware of honey's health-giving properties.

At this time the infected wound measured 2.3 x 2 cm. Co. Amoxiclav was prescribed for 7 days in view of the appearance and previous bacteriology results and Combine dressings (Smith & Nephew) impregnated with 25-35g active manuka honey and sterilised by gamma radiation were applied to the wound and covered by absorbent pads to collect excess honey.

With the emergence of antibiotics in the 1950s as a means of killing off infection, centuries of knowledge were overridden by the need for modern drugs to tackle infections.

The manuka honey used had an activity rating of "UMF 13" i.e. it had a non-peroxide antibacterial component with activity against Staphylococcus aureus ATCC 25923 equivalent to that of 13% phenol. The patient was provided with honey dressings and instructed to redress the wound at 24 hour intervals, following showering.

But in recent years, the medical profession has become alarmed at the resistance of bugs to even the strongest antibiotics.

The wound was monitored and swabbed at weekly visits to clinic. One week after the treatment commenced the wound measured 1.7 x 1.3 cm, and no bacterial growth resulted from the wound swab.

Dr Cooper's research shows there may be grounds for further examination of honey's healing properties... [read more]

After a further week the wound measured 0.5 x 0.6 cm, and the patient reported loss of all pain and discomfort and demonstrated greatly improved mobility of the arm and shoulder. Healing occurred within one month of initiating the treatment, but discontinuation of the honey lead to immediate tightening of the scar and superficial splitting of the newly formed scar on three occasions. Each time re-application of the honey promoted rapid healing, softening of the scar and cessation of pain. Four months after the initial wound closure, the patient discontinued the honey dressings and maintained a flexible, healed scar with daily application of a barrier cream. The patient was discharged in October 1999.

Comment.

A noticeable improvement in the appearance of this long-standing wound was observed within a week of applying the honey-impregnated dressings. It became smaller, less inflamed, and the already healed, scarred area became softer to touch. Bacteria were inhibited within 7 days and the recurrent infections ceased. Honey dressings did not adhere to or irritate the wound, and were easily and painlessly renewed. The patient found the dressings convenient to use, and reported improvements in comfort and mobility, and significant loss of pain. The application of dressings impregnated with manuka honey to this recalcitrant wound promoted healing within a month, where management using conventional dressings had failed to achieve healing in 36 months. Although the mechanisms by which honey enhances healing are not yet characterised at a molecular level, the potent antibacterial properties of selected honeys have been demonstrated in vitro and in vivo Recurrent infections would have impaired healing in this patient, but the additional well documented vulnery properties of honey such as its anti-inflammatory action, debriding action 8 and its stimulatory effect on granulation and epithelialisation may have contributed to the healing effect. Randomised clinical trials with further patients, and laboratory studies on cellular effects are urgently needed to explore the healing properties of honey.