Honey and its Anti-Inflammatory, Anti-Bacterial and Anti-Oxidant Properties

Abstract

Honey mainly consists of sugars and water. Apart from sugars, honey also contains several vitamins, especially B complex and vitamin C, together with a lot of minerals. Some of the vitamins found in honey include ascorbic acid, pantothenic acid, niacin and riboflavin; while minerals such as calcium, copper, iron, magnesium, manganese, phosphorus, potassium and zinc are also present. Honey has been used for its healing, nutritional and therapeutic properties since ancient times. Its antibacterial potentials even against multi-drug resistant bacteria, such as Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacterbaumanni have been proved. Honey is well known for its anti-inflammatory and antioxidant capacities, which may be useful for the prevention of chronic inflammatory process like atherosclerosis, diabetes mellitus and cardiovascular diseases. The antibacterial, anti-inflammatory and antioxidant properties of honey will be reviewed here.

Full text

General Medicine: Open Access
Vallianou et al., General Med 2014, 2:1
http://dx.doi.org/10.4172/2327-5146.1000132
Open Access
Review Article
Volume 2 • Issue 1 • 1000132
General Med
ISSN: 2327-5146 GMO, an open access journal
Honey and its Anti-Inflammatory, Anti-Bacterial and Anti-Oxidant
Properties
Natalia G Vallianou1*, Penny Gounari1, Alexandros Skourtis1, John Panagos1 and Christos Kazazis2
1Evangelismos General Hospital, Athens, Greece
2Island of Samos, Internist, Athens, Greece
Abstract
Honey mainly consists of sugars and water. Apart from sugars, honey also contains several vitamins, especially
B complex and vitamin C, together with a lot of minerals. Some of the vitamins found in honey include ascorbic
acid, pantothenic acid, niacin and riboavin; while minerals such as calcium, copper, iron, magnesium, manganese,
phosphorus, potassium and zinc are also present. Honey has been used for its healing, nutritional and therapeutic
properties since ancient times. Its antibacterial potentials even against multi-drug resistant bacteria, such as
Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacterbaumanni have been proved. Honey is
well known for its anti-inammatory and antioxidant capacities, which may be useful for the prevention of chronic
inammatory process like atherosclerosis, diabetes mellitus and cardiovascular diseases. The antibacterial, anti-
inammatory and antioxidant properties of honey will be reviewed here.
*Corresponding author: Natalia G Vallianou, Evangelismos General Hospital,
5 Pyramidonstr, 190 05, Municipality of Marathon, Athens, Greece, Tel:
+302294092359; E-mail: natalia.vallianou@hotmail.com
Received January 06, 2014; Accepted January 20, 2014; Published February
03, 2014
Citation: Vallianou NG, Gounari P, Skourtis A, Panagos J, Kazazis C (2014) Honey
and its Anti-Inammatory, Anti-Bacterial and Anti-Oxidant Properties. General Med
2: 132. doi: 10.4172/2327-5146.1000132
Copyright: © 2014 Vallianou NG, et al. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the
original author and source are credited.
Keywords: Honey; Inammation; Anti-bacterial properties
Introduction
Ηoney mainly consists of sugars and water. Sugars in honey
comprises predominantly of monosaccharides and oligosaccharides.
e most abundant sugar in honey is fructose, while sugars in it are
sweeter and give more energy than articial sweeteners [1-3]. Apart
from sugars, honey also contains several vitamins, especially B complex
and vitamin C, together with a lot of minerals. Some of the vitamins
found in honey include ascorbic acid, pantothenic acid, niacin and
riboavin; while minerals such as calcium, copper, iron, magnesium,
manganese, phosphorus, potassium and zinc are also present [4].
Honey contains at least 181 constituents [2,5]. e other constituents
of honey are amino acids, antibiotic-rich inhibine, proteins and phenol
antioxidants [6]. It also contains other bioactive substances such as
phenolic constituents, avonoids, organic acids, carotenoid-derived
compounds, nitric oxide (NO) metabolites, amino acids and proteins
[7,8]. Evidence indicates that some varieties of honey contain kynurenic
acid (a tryptophan metabolite with neuroactive activity) which may
contribute to its antimicrobial properties [9]. e presence of enzymes
such as glucose oxidase, diastase, invertase, phosphatase, catalase and
peroxidase has also been documented in honey [10].
Anti-Bacterial and would Healing Activity
e medicinal importance of honey has been known since ancient
times and its antimicrobial property as well as wound-healing activities
was well-known long ago. e rst written reference for honey was a
Sumerian tablet writing dating back to 2100-2000 BC, which mentioned
honey’s use as a drug and an ointment. Aristotle (384-322 BC), when
discussing dierent honeys, referred to pale honey as being “good as
a salve for sore eyes and wounds” [11]. e healing property of honey
is due to the fact that it oers anti-bacterial activity, maintains a moist
wound condition, and its high viscosity helps to provide a protective
barrier to prevent infection. Its immune-modulatory property is
relevant to wound repair, too [12].
Nowadays, with the presence of multi-drug or pan-drug-resistant
microbes, alternative anti-microbial strategies are urgently needed.
is need has led to a re-evaluation of the therapeutic use of ancient
remedies, such as plants and plant-based products, including honey [13-
15]. e antimicrobial activity in most honeys is due to the enzymatic
production of hydrogen peroxide [13]. However, another kind of honey,
called non-peroxide honey (e.g. manuka honey), displays signicant
anti-bacterial eects even when the hydrogen peroxide activity is
blocked. Its mechanism may be related to the low pH level of honey
and its high sugar content (high osmolarity) that is enough to hinder
the growth of microbes. Honey traditionally has an acidic pH, between
3.2 and 4.5, which is low to be inhibitory for many bacteria [15,16]. e
anti-bacterial property of honey is also derived from the osmotic eect
of its high sugar content and low moisture content, along with its acidic
properties of gluconic acid and the antiseptic properties of its H2O2
[17]. A recent study examining the antimicrobial properties of honey
in vitro found that H2O2, methylglyoxal and an antimicrobial peptide,
bee defensin-1, are distinct mechanisms involved in the bactericidal
activity of honey [18]. e medical grade honeys have potent in vitro
bactericidal activity against antibiotic-resistant bacteria causing several
life-threatening infections to humans. Nevertheless, there is a large
variation in the antimicrobial activity of some natural honeys, which
is due to temporal variation in sources of nectar. us, identication
and characterization of the active principles may provide valuable
information on the quality and possible therapeutic potential of honeys.
Currently, many researchers have reported the anti-bacterial
activity of honey and found that natural unheated honey has some
broad-spectrum antibacterial activity when tested against pathogenic
bacteria, oral bacteria as well as food spoilage bacteria [12,19]. At
present a number of honeys are sold with standardized levels of
anti-bacterial activity. e Leptospermum scoparium honey, the best
known of the honeys, has been reported to have an inhibitory eect
on around 60 species of bacteria, including aerobes and anaerobes,
gram-positives and gram-negatives [20]. Manuka honey is produced
from the manuka bush (Leptospermum scoparium) indigenous to New
Zealand and Australia. Exceptionally high concentrations of the anti-

Citation: Vallianou NG, Gounari P, Skourtis A, Panagos J, Kazazis C (2014) Honey and its Anti-Inammatory, Anti-Bacterial and Anti-Oxidant
Properties. General Med 2: 132. doi: 10.4172/2327-5146.1000132
Page 2 of 5
Volume 2 • Issue 1 • 1000132
General Med
ISSN: 2327-5146 GMO, an open access journal
bacterial compound methylglyoxal have been found in manuka honey,
but the exact contribution of this and possible other compounds to the
bactericidal activity of manuka honey remains largely unknown [21,22].
In a report testing anti-bacterial activity of two dierent honeys, aer
24 hours of incubation, both honeys killed all tested bacteria, including
methicillin-resistant Staphylococcus aureus (MRSA), but manuka honey
retained activity up to higher dilutions than RS honey (unprocessed
Revamil source usually from the Netherlands honey). Bee defensin-1
and H2O2 were the major factors involved in rapid bactericidal activity
of RS honey. ese factors were absent in manuka honey, but this honey
contained 44-fold higher concentrations of methylglyoxal than RS
honey. Methylglyoxal was a major bactericidal factor in manuka honey,
but aer neutralization of this compound, manuka honey retained
bactericidal activity due to several unknown factors. RS and manuka
honey have highly distinct compositions of bactericidal factors,
resulting in large dierences in bactericidal activity [23].
ere are several reports that Tualang honey has variable broad-
spectrum activities against many dierent kinds of gram positive and
enteric bacteria [24-26]. Unlike glucose oxidase, the antibacterial
properties from Leptospermum spp. honeys are light- and heat-stable.
Natural honey of other sources can vary as much as 100-fold in the
potency of their antibacterial activities, which is due to hydrogen peroxide.
In addition, honey is hygroscopic, which means that it can draw moisture
out of the environment and dehydrate bacteria, and its high sugar content
and low level pH can also prevent the microbes from growth.
Most deaths in severely burn-injured patients are due to burn
wound sepsis or complications due to inhalation injury. Currently,
the emerging antimicrobial resistance trends in burn wound bacterial
pathogens are a serious challenge [27]. us, honey with eective
antimicrobial properties against antibiotic-resistant organisms such as
MRSA (methicillin-resistastant Staphylococcus aureus), vancomycin-
resistant Enterococcus spp (VRE) and multiple-resistant Gram-negative
rods such as Pseudomonas aeruginosa, Acinetobacter spp. and members
of the family Enterobacteriaceae, which have been associated with
infections of burn wounds and sites of major thermal injury and in
nosocomial infections, is much anticipated [28-30].
e honey has been used from ancient times as a method of
accelerating wound healing. It’s potential to assist with wound
healing has been demonstrated repeatedly [31,32]. Honey is gaining
acceptance as an agent for the treatment of ulcers, bed sores and other
skin infections resulting from burns and wounds [33,34]. e healing
properties of honey can be ascribed to the fact that it oers anti-
bacterial activity, maintains a moist wound environment that promotes
healing, and has a high viscosity which helps to provide a protective
barrier to prevent infection [35]. ere are many reports suggesting
that honey is very eective as a dressing of wounds, burns, skin ulcers
and inammations; the anti-bacterial properties of honey speed up the
growth of new tissue to help healing the wound [36]. e medihoney
and manuka honey have been shown to have in vivo activity and are
suitable for the treatment of ulcers, infected wounds and burns [37,38].
More specically, the honey, when applied topically, rapidly clears
wound infection to facilitate healing of deep surgical wounds with
infection [39]. e application of honey can promote the healing in
infected wounds that do not respond to the conventional therapy, (i.e.,
antibiotics and antiseptics), including wounds infected with MRSA or
multi-drug resistant Pseudomonas aeruginosa [40-43]. Moreover, it has
been used on skin gras and infected skin gra donor sites successfully
[44]. e removal of exudate in wounds dressed with honey is of help
in managing inammatory wounds.
e manuka, jelly bush and pasture honeys are capable of
stimulating the monocytes, the precursors of macrophages, to secrete
TNF-α [29,45]. Also, glycosylated proteins in honey can induce TNF-α
secretion by macrophages, and this cytokine is known to induce the
mechanisms of inammation, the formation of granulomatosus tissue
and of wound repairing [46]. us, the immune-modulatory properties
of honey, when topically applied, are relevant to wound repair.
e notion for using honey as a treatment regimen for peptic ulcers
and gastritis comes from traditional folklore as well as from reports
in modern times [11]. Honey may promote the repair of damaged
intestinal mucosa, stimulate the growth of new tissues and work as an
anti-inammatory agent [37-39]. Manuka honey has been reported to
exhibit antimicrobial activity against pathogenic bacteria Helicobacter
pylori making this honey a promising functional food for the treatment
of wounds or stomach ulcers [47].
Anti-Inammatory Eects
As mentioned above, raw honey contains substantial amounts
of compounds such as avonoids and other polyphenols which may
function as anti-oxidants [7,8].
In Malaysia, there are several types of honey, including Tualang,
Nenas, Coconut, and Gelam. Among these, Tualang and Gelam honeys
are well known in Malaysia for their potential health benets, such as
anti-oxidant and anti-inammatory activities [48,49]. Mohamed et al.
have shown that Tualang honey contains highly phenolic compounds
that possess relatively good anti-oxidant activity. In an animal model, a
topical dressing of Tualang honey showed a positive eect for treating
full-thickness burn wounds [41,50,51]. As previously reported, Gelam
honey has anti-oxidative and radical scavenging activities, which are
mainly attributed to its phenolic content.
In a recent study, it has been reported that honey reduced the
activities of cyclooxygenase-1 and cyclooxygenase-2, thus showing anti-
inammatory eects. Furthermore, ingestion of diluted natural honey
has produced reductions on concentrations of prostaglandins such as
PGE2 (prostaglandin E2), PGF2α (prostaglandin F2a) and thromboxane B2
in plasma of normal individuals [52]. Interestingly, in an inammatory
model of colitis, honey was as eective as prednisolone treatment [53].
While NSAIDS and corticosteroids may have many serious side eects,
honey has an anti-inammatory action free from major side eects.
Recently, Gelam honey has been demonstrated to decrease
inammatory mediators such as COX-2 and TNF-α via attenuating NF-
κB translocation to the nucleus and thus inhibiting the activation of the
NF-κB pathway [54]. It is widely known that the activation of NF-κB
plays a key role in the pathogenesis of inammation [55,56]. erefore,
Gelam honey has just been documented to inhibit the inammatory
process by inhibiting NF-κB pathway.
Anti-Oxidant Activity of Honey
Natural honey contains many avonoids (such as apigenin,
pinocembrin, kaempferol, quercetin, galangin, chrysin and hesperetin),
phenolic acids (such as ellagic, caeic, p-coumaric and ferulic acids),
ascorbic acid, tocopherols, catalase, superoxide dismutase, reduced
glutathione, Maillard reaction products and peptides, most of which
work together to provide a synergistic antioxidant eect [57-59].
It is noteworthy that the botanical origin of honey has the greatest
inuence on its anti-oxidant activity, while processing, handling and
storage aects its anti-oxidant capacity only to a minor degree [60-65].
e anti-oxidant activity has been shown to strongly correlate with the

Citation: Vallianou NG, Gounari P, Skourtis A, Panagos J, Kazazis C (2014) Honey and its Anti-Inammatory, Anti-Bacterial and Anti-Oxidant
Properties. General Med 2: 132. doi: 10.4172/2327-5146.1000132
Page 3 of 5
Volume 2 • Issue 1 • 1000132
General Med
ISSN: 2327-5146 GMO, an open access journal
content of total phenolics [66-70]. In addition, a strong correlation has
been found between anti-oxidant activity and the color of honey. Many
researchers have reported that dark honey has a higher total phenolic
content and consequently a higher anti-oxidant capacity [71]. Blasa et
al. have shown that the anti-oxidant activity is located in both the ether
and the water fractions, indicating that the avonoids of honey may be
available to various compartments of the human body, where they may
exert dierent physiological eects [67,72].
e presence of free radicals and reactive oxygen species (ROS)
is of the outmost importance in the process of cellular dysfunction,
pathogenesis of metabolic and cardiovascular diseases as well as aging.
e consumption of foods and substances rich in anti-oxidants may
protect against these pathological changes and consequently prevent
the pathogenesis of chronic inammatory disorders. Researches have
reported that honey contains several important substances and these
include mainly anti-oxidants [73,74]. e qualitative and quantitative
composition of honey (including the anti-oxidants constituent and
the other phytochemical substances) is a reection of the oral source
as well as the variety of the particular honey [75]. In their analysis
of the phytochemical composition of mono-oral Cuban honeys,
Alvarez-Suarez et al. [71] have concluded that Cuban honeys contain
important phenolic, avonoid and carotenoid concentrations with high
substantial anti-oxidant capacity [72,76]. Researchers in California
have also advocated the consumption of the anti-oxidants from foods
such as honey highly-rich.
A report in which two buckwheat honey treatments were
administered to 37 healthy human adults at the rate of 1.5 g/kg body
weight, with corn syrup as control, has demonstrated increased (p <
0.05) plasma total-phenolic content and plasma anti-oxidant. is study
has supported the notion that phenolic anti-oxidants from processed
honey are bioavailable and that they increase the anti-oxidant activity
of plasma. erefore, they advocated for the substitution of honey in
some foods as traditional sweetener for enhanced anti-oxidant defense
system in healthy human adults [77].
It has been shown that honey intake ameliorates risk factors
of metabolic and cardiovascular diseases in patients and healthy
individuals at risk. Unlike rened sugars, diabetic patients can
safely and harmlessly eat this natural and sweetest sugar (fructose)-
containing product, natural honey. Recently, researchers have fed male
and female rats with honey or sugar (golden syrup) supplemented
diet for 12 weeks from 7 days of age to compare their metabolic
response, and see if honey is protective against metabolic syndrome.
In male rats, golden syrup has signicantly increased (p<0.05) blood
levels of metabolic substrates (glucose and triglycerides); and caused
enhanced (p<0.001) visceral adiposity, hypercholesterolemia, hyper-
insulinemia, hepatomegaly and fatty liver. ese cardiovascular
diseases and metabolic diseases’ risk factors were not observed
in the honey fed rats in this trial. ey concluded that honey is
cardio-protective, and its consumption may ameliorate risk factors
of metabolic and cardiovascular diseases in patients and healthy
individuals at risk. Unlike rened sugars, diabetic patients can
safely and harmlessly eat this natural and sweetest sugar (fructose)-
containing product, natural honey. ese results conrmed the
conclusion drawn from earlier study that substituting honey for
rened carbohydrates was benecial [78]. Earlier researches from
other laboratories and clinical trials further armed the metabolic
and cardiovascular health signicance of eating honey by recording
some health proles. ese were reduction in the plasma levels of risk
factors which include total cholesterol, LDL-cholesterol, triglycerides,
glucose in normal and diabetic patients, C-reactive protein, while the
health indices elevated in the blood were HDL cholesterol [79-81].
Besides that, other researchers recorded higher plasma anti-oxidants
levels in rats nurtured with natural honey relative to fructose-fed rats,
and consequently low susceptibility of these subjects to cardiovascular
diseases. Another study has demonstrated that the combination of
glibenclamide or metformin with honey improves glycemic control,
and provides additional metabolic benets, not achieved with either
glibenclamide or metformin alone in streptozocin-induced diabetic
rats.
Conclusion
Honey mainly consists of sugars and water, but also contains
several vitamins, especially B complex and vitamin C, together with a
lot of minerals. Honey has been used for its healing, nutritional and
therapeutic properties since ancient times. It possesses anti-bacterial,
anti-inammatory and anti-oxidant properties that may be benecial
for combating multi-drug resistant bacteria as well as for preventing
chronic inammatory processes, such as atherosclerosis and diabetes
mellitus (Figure 1).
Teaching Points
Honey has antibacterial properties.Honey has wound healing
activity.Honey possesses anti-oxidant and anti-inammatory
capacities, which may be useful in chronic inammation process such
as atherosclerosis and diabetes mellitus.
Conicts of Interest
ere are no conicts of interest regarding this manuscript. Also,
there was no funding. Ethical approval was not required.
Honey
Low pH
High
Osmolarity
H
2
0
2
Producon
An-inflammatory
and An-0xidant
Acvies
Wound Healing
Acvity
An-bacterial
Acvity
Phenolic acids
Flavonoids
Reduced
Prostaglandins
Producon
Figure 1: The anti-bacterial, anti-inammatory, anti-oxidant and wound healing
properties of Honey.

Citation: Vallianou NG, Gounari P, Skourtis A, Panagos J, Kazazis C (2014) Honey and its Anti-Inammatory, Anti-Bacterial and Anti-Oxidant
Properties. General Med 2: 132. doi: 10.4172/2327-5146.1000132
Page 4 of 5
Volume 2 • Issue 1 • 1000132
General Med
ISSN: 2327-5146 GMO, an open access journal
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Citation: Vallianou NG, Gounari P, Skourtis A, Panagos J, Kazazis C (2014) Honey and its Anti-Inammatory, Anti-Bacterial and Anti-Oxidant
Properties. General Med 2: 132. doi: 10.4172/2327-5146.1000132
Page 5 of 5
Volume 2 • Issue 1 • 1000132
General Med
ISSN: 2327-5146 GMO, an open access journal
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Citation: Vallianou NG, Gounari P, Skourtis A, Panagos J, Kazazis C (2014)
Honey and its Anti-Inammatory, Anti-Bacterial and Anti-Oxidant Properties.
General Med 2: 132. doi: 10.4172/2327-5146.1000132