Health Benefits of Honey

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1
Chapter
Health Benefits of Honey
Bruna Costa Ferreirada Cruz, LudimillaRonqui,
PriscilaScharnoski, PatríciaScharnoski, MarinaPeruzzolo,
Pedroda Rosa Santos, AndréHalak, PriscilaWielewski,
Juliana MosconiMagro and Katlin Fernandade Araujo
Abstract
In addition to being used as food, honey has been used as an alternative medi-
cine for thousands of years. Honey has a great potential to be used as a medicine
because it is not suitable for micro-organisms, it is very acidic and has a very high
sugar content, which causes an osmotic effect that prevents the growth of some
micro-organisms, moreover, in some honey, hydrogen peroxide is found, which has
a strong antibacterial effect. However, properties and appearances of honey vary
greatly according to the floral source in which the bee collects the nectar, so some
honey also have a strong antioxidant and anti-inflammatory activity. Recently, there
are several studies, mainly in vitro, that prove the effectiveness of honey for various
medical purposes due to its components and its antibacterial, anti-inflammatory,
antioxidant, antiviral, antifungal, and anticancer properties.
Keywords: anti-inflammatory, antioxidant, bee, cancer, medicine
1. Introduction
Honey is a compound widely used as a medicine and food source for thousands
of years [1]. Several natural products that have been used as medicine have been
replaced by modern pharmaceuticals, but recently they have returned to the world
stage due to the growing public interest [2]. In ancient Egypt, beekeeping has been
practiced for more than 4000years, and honey has been used as a medicine in the
treatment of wounds, ulcers, burns, abscesses, gastrointestinal diseases, inflam-
mations, rigid joints, and even as a contraceptive method [1, 3]. In Asia, honey
is recognized for its medicinal value since 2000BC [1]. There are also references
to different uses of honey in the bible and in the Qur’an [1]. The ancient Greek
Hippocrates, known as the father of modern medicine, used honey to clean wounds,
gastrointestinal diseases, and ulcers [1, 3]. In Ancient Rome, honey was also pre-
scribed alone or in combinations, often used to treat throat problems, pneumonia,
and even snake bites [1].
The main components of honey are sugars, among which are predominantly
fructose and glucose [4, 5]. However, there are other compounds in smaller quanti-
ties and very variable depending on the type of each honey, from the floral source
where the bee collects the nectar, such as water and free amino acids [4, 5]. Among
them, the most found is proline [4, 6]. Some specific enzymes are also found, the
main enzymes of honey are invertase, amylase, and glucose oxidase, but other

Honey Analysis
2
enzymes such as catalase and phosphatase [6–8]. Honey is also composed of organic
acids that contribute to its characteristic flavor and are responsible for the excellent
stability of honey against micro-organisms, for example, formic, acetic, butyric,
oxalic, lactic, succinic, folic, malic, citric, and glycolic [6, 7]. Gluconic acid is
considered one of the most important organic acids in honey; it is the product of
catalytic oxidation of glucose oxidase, in this oxidation, hydrogen peroxide is also
formed, which has a strong antibacterial effect [4–7].
Honey may still have some mineral substances, such as potassium, magnesium,
sodium, calcium, phosphorus, iron, manganese, cobalt, and copper; studies show
that honey can contain several types of minerals, but potassium is the most abun-
dant in various types of honey [6, 8–10]. Carotenoids, flavones, and anthocyanins
can still be found, which contribute to the antioxidant action of honey [6]. About
80 aromatic compounds have been detected in honey, including carboxylic acids,
aldehydes, ketones, alcohols, hydrocarbons, and phenols [6]. These compounds also
contribute to the organoleptic properties of honey. The appearance of honey varies
from almost colorless to dark brown; it can be liquid, viscous, or solid. Its flavor,
aroma, and composition vary enormously, depending on the floral source in which
the honeybee collects the nectar. However, some environmental factors can strongly
influence honey composition, such as temperature and humidity [6, 7, 11].
Honey is a food that contains high energy carbohydrates, being that 95–99% of
the total solids are composed by sugars, which are easily digestible, since they are
similar to many fruits [7, 12]. Proteins and enzymes in honey often have no signifi-
cant nutritional value, as they are usually not present in sufficient amounts[7].
Several of the essential vitamins are present in honey, such as vitamin K, B1, B2,
B6, and C, but generally at insignificant levels [7, 8, 13]. The mineral content of
honey is variable, usually darker honeys have significant amounts of minerals,
but honey can be considered a nutritive sweetener, mainly due to its high fructose
content [7, 13].
In addition to its food value, honey has great potential in medicine; it has been
used for thousands of years, and has now been widely studied as an alternative
medicine. Honey is not a suitable medium for bacteria, since it is very acidic and has
a very high sugar content. This causes an osmotic effect that prevents the growth
of bacteria, this effect works literally drying the bacteria [7, 13]. Another type of
antibacterial property of honey was called inhibition in 1940 by Dold [7]. And in
1963, Jonathan White proposed that this inhibitory effect described in 1940 was due
to the hydrogen peroxide produced and accumulated in the diluted honey, which we
know today, is a by-product of the formation of gluconic acid by the enzyme glucose
oxidase [5, 7, 11].
Historically, honey has been used for various medical purposes; and recent
research has confirmed the effectiveness in the treatment of several diseases due to
its components and its properties antibacterial, anti-inflammatory, antioxidants,
antiviral, and others that will be addressed in this chapter.
2. Properties of honey
2.1 Anti-inflammatory
Inflammation is nothing more than a defense response of the body to a tissue
that has suffered a certain damage, which consists of the recruitment of leucocytes
and plasma proteins of the blood [14, 15]. This damage can be caused by physi-
cal, chemical, or even microbial agents; inflammation is characterized by edema,
erythema, pain, and increased temperature [15, 16].

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It is well known that propolis, another product from honeybee colony, has
potential anti-inflammatory properties, including in vivo. But studies on the
anti-inflammatory power of honey also are promising, such as the study that
evaluated the anti-inflammatory and antioxidant effects of Tualang honey against
conventional treatment in alkaline lesions in the eyes of rabbits and the results
showed that there was no difference in the clinical inflammatory characteristics
between the group treated with honey and the group with conventional treatment,
so it is possible to infer that Tualang may be an alternative treatment [17, 18]. Other
studies have also been depending on the use of honey, such as chronic ocular surface
diseases and infectious conjunctivitis [19, 20].
Gastric ulcers are among the most common diseases affecting humans, a study
demonstrated that the use of honey in conjunction with other compounds may
promote gastroprotection. Later, a recent study investigated the effect of gastric
protection using only honey against gastric ulcers induced by ethanol in rats and
also suggested this effect as gastroprotection [21, 22]. Manuka honey significantly
decreased the ulcer, completely protected the mucus of the lesions and preserved
the gastric mucus glycoprotein, significantly increased the mucus levels of gastric
nitric oxide, reduced glutathione, glutathione peroxidase, and superoxide dis-
mutase, and also decreased lipid peroxidation of the mucus and tumor necrosis
factor-α, interleukins-1β, and concentrations of interleukins-6 [21]. Honey has
been shown to be efficient in other types of ulcers, and this Manuka honey exerted
an antiulcer effect, keeping enzymes and antioxidants, non-enzymatic and inflam-
matory cytokines reduced [21, 23].
In addition to the Manuka honey and the Tualang honey, the anti-inflammatory
effect of Malaysia’s Gelam honey was also studied, which is associated with anti-
inflammatory effects on tissues [24, 25]. Malaysia Gelam honey was tested in rats
induced by inflammation [25]. Paw edema was induced by a subplantar injection
and the rats were treated with either the anti-inflammatory drug Indomethacin or
Gelam honey. Results showed that Gelam honey can reduce dose-dependent edema
in inflamed rat paws, decrease the production of nitric oxide, prostaglandin, tumor
necrosis factor-α, and interleukin-6in plasma, and suppress expression of synthase
inducible nitric oxide, cyclooxygenase-2, tumor necrosis factor-α, and interleu-
cine-6in paw tissue [25]. The oral pre-treatment of Gelam honey at 2g/kg body
weight at two times (1 and 7days) showed a decreased production of proinflamma-
tory cytokines, which was similar to the effect of the anti-inflammatory indometha-
cin, both in plasma and in the tissue, and Gelam honey has anti-inflammatory
effects and is potentially useful for the treatment of inflammatory conditions [25].
Another study demonstrated that different types of honey promoted increased
release of TNF-α, IL-1β, and IL-6 from monocytes, which are cells that assist in
healing [26].
We can also compare the anti-inflammatory activity of honey with another
herbal remedy in a study carried out in 2012 to test the activity of honey and brown
sugar, surgically treated guinea pigs that were treated with honey, brown sugar, and
a control group treated with saline solution, it is already known that sugar can help
healing [27, 28]. The honey group showed a decrease in the area of the wound and
the formation of granulation tissue before the brown sugar group and control; the
honey group was still the only one that presented no crust in any wound and pro-
moted a faster healing by stimulating the faster formation of granulation tissue and
re-epithelization [28]. In addition, honey showed a higher antibacterial effect in
relation to brown sugar and control group [28]. Another study had the same result,
honey was effective in reducing bacterial contamination and wound healing [29].
Recent studies proved the anti-inflammatory activity of honey; different types
of honey, different regions and different floral sources, were studied and both

Honey Analysis
4
showed anti-inflammatory responses [17, 21, 25, 28]. Treatment with Tualang honey
and Gelam honey showed similar responses to conventional anti-inflammatories
used for specific treatments [17, 25]. Honey still has a better anti-inflammatory
activity than brown sugar, promoting faster healing [28]. Also, honey is a relatively
cheap and easily accessible anti-inflammatory compound that needs to be further
studied and later applied in modern medicine [17, 21, 25, 28].
2.2 Antibacterial
One of the advances of modern medicine has been the development of antibiot-
ics; these antibiotics can be bactericidal, which kill the micro-organisms directly, or
bacteriostatic, which prevent the growth of micro-organisms [30]. However, micro-
organisms are increasingly developing resistance to these antibiotics, which is a
major concern. In addition to antibiotics, the prevention of bacterial diseases can be
carried out with the use of vaccines and with basic sanitary methods [30, 31].
Many different micro-organisms can cause disease and be transmitted even
by contaminated water, and among the major aquatic pathogens are Escherichia
coli and Pseudomonas aeruginosa. Some studies have already shown that honey can
combat these pathogens [14, 18, 32, 33]. A study in 2011 tested the bacterial activity
of honey, for which the Revamil® and Manuka honey were used, and it was found
that both honeys had activity against Escherichia coli, Pseudomonas aeruginosa, and
also against Bacillus subtilis [34]. Manuka honey still had a greater efficacy than
Revamil® against Staphylococcus aureus-methicillin resistant bacteria after 24-h
incubation [34]. Despite the efficiency of honey, propolis has higher antibacte-
rial activity against Staphylococcus aureus [35]. Overall, Revamil® honey clearly
had more potent bactericidal activity than Manuka after 2h of incubation, while
Manuka honey was more potent after 24h [34].
The bacteria Streptococcus pyogenes and Streptococcus pneumoniae are important
human respiratory pathogens; Streptococcus pneumoniae can cause invasive lung
infections that can develop in secondary infections and other respiratory disorders
[14]. The antibacterial activity of honey was tested using dressings soaked with
two types of honey, including Aquacel-Tualang honey and Aquacel-Manuka honey,
the conventional dressing for burn treatment, Aquacel-Ag and only the curative
Aquacel (control), against bacteria isolated from patients with burns (in vitro) [30].
Seven organisms were isolated from burns, four types of Gram-negative bacteria,
Enterobacter cloacae, Klebsiella pneumoniae, Pseudomonas spp., and Acinetobacter
spp., and three Gram-positive bacteria, Staphylococcus aureus, Coagulase-negative
Staphylococcus aureus, and Streptococcus spp. Aquacel-Ag and Aquacel-Manuka
dressings provided a better zone of inhibition for Gram-positive bacteria. However,
similar results between Aquacel-Manuka and Aquacel-Tualang were obtained
against Gram-negative bacteria [36].
Salmonellosis is a gastrointestinal disease caused by eating food contaminated
with Salmonella, such as eggs, chicken, meat, and raw vegetables, or by handling
animal or animal products contaminated by the bacterium [14, 37]. It is the most
common bacterial food infection in the United States. However, most Escherichia
coli strains are not pathogenic to humans, but the few pathogenic strains of
Escherichia coli are transmitted by food and produce potent enterotoxins [14]. In
the literature, there are several studies that demonstrate the efficiency of honey
against bacteria important to human health, one of them demonstrated the anti-
bacterial potential of honey against clinical isolates of Escherichia coli, Pseudomonas
aeruginosa, and Salmonella enterica Typhi by in vitro methods [38]. Honey showed
excellent antibacterial activity against all bacteria studied, which are related,
respectively, to urinary tract infection, skin lesion, and enteric fever in human

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patients; and thus, honey can be considered an alternative treatment against such
infection [38]. In addition to honey being effective against bacterial infections, it
can be used as a treatment for one of the most common bacterial contamination
symptoms, when honey is administered as oral rehydration fluid, it can decrease the
duration of bacterial diarrhea [39].
Another form of food poisoning is caused by enterotoxins produced by Gram-
positive bacteria, such as Staphylococcus aureus; these toxins cause nausea, vomiting,
diarrhea, and dehydration, and is a major public health problem [14, 40]. The
antibacterial action of Tualang, Gelam, and Durian honeys was tested against
Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecium, Enterococcus
faecalis, Escherichia coli, Salmonella enterica Typhi, and Klebsiella pneumoniae [41].
Durian honey did not produce substantial antibacterial activity, while Tualang and
Gelam honey showed a spectrum of antibacterial activity with its growth inhibi-
tory effects against all bacterial species tested, including vancomycin-resistant
Enterococci (VRE), the results still suggest the Gelam honey has the highest antibac-
terial effect among the honey samples from Malaysia tested [41].
Clostridiums are anaerobic bacteria that are capable of growing up in canned
food [14]. In addition to the antibacterial activity of honey against the bacteria
dating to the top, Manuka honey still has antibacterial effect on Clostridium dif-
ficile, which is a Gram-positive anaerobic bacillus, which was associated with
approximately 29,000 deaths in 2001in the United States [42, 43]. A recent study
has shown that Manuka honey exhibited a bactericidal action against Clostridium
difficile; this is yet another feature that makes Manuka honey highly attractive in
the treatment of bacterial infections [42]. However, Manuka honey was considered
ineffective against other bacteria Helicobacter pylori when tested in vivo, despite
having been found effective in vitro [44, 45].
Honey has an excellent antibacterial effect against different types of bacteria, as
previously mentioned; honey is very acidic and has a very high sugar content, which
does not serve as a suitable medium for bacteria [4–7]. Moreover, in some honeys,
the peroxide of hydrogen is found, which has a strong antibacterial effect [4–7].
Remavil® honeys, Manuka honey, Tualang honey, and Gelam honey were tested
with different types of bacteria and had positive results [34, 36, 41, 42]. The bacteria
tested and susceptible to some of these honeys were Escherichia coli, Pseudomonas
aeruginosa, Pseudomonas spp., Bacillus subtilis, Staphylococcus aureus, Staphylococcus
aureus-resistant methicillin, coagulase-negative Staphylococcus aureus, Staphylococcus
epidermidis, Enterobacter cloacae, Klebsiella pneumoniae, Acinetobacter spp.,
Streptococcus spp., Enterococcus faecium, Enterococcus faecalis, Salmonella enterica
serovar Typhimurium, vancomycin-resistant Enterococci, and Clostridium difficile
[34,36, 38, 41, 42].
2.3 Antivirals
Of all human infectious diseases, the most prevalent and difficult to treat are
those that are caused by viruses, because viruses usually remain infectious in dry
mucus for a long time [14]. Also, viruses need a host cells to occur its replication; so
killing the virus means killing your host cell as well. Hence, vaccination is the most
efficient way to prevent these diseases [14, 46].
Chickenpox is caused by the varicella-zoster virus and it is a very common
childhood disease that usually does not cause many problems; but when it affects
the elderly, it can be easily fatal [14, 47]. Varicella-zoster is highly contagious and is
transmitted by infectious droplets, which results in a systemic rash on the skin [14].
As honey can be conveniently applied to the skin, it is easily found and relatively
inexpensive, it can be considered an excellent remedy against Zoster rash, especially

Honey Analysis
6
in developing countries, or in countries where antiviral drugs are relatively
expensive and difficult to access. Therefore, a study determined in vitro antiviral
effect of honey against the varicella-zoster virus; two types of honey were used,
Manuka honey and clover honey, and both types showed antiviral activity against
the varicella-zoster virus, showing that honey has significant antiviral activity
against varicella-zoster [48]. A study on the relationship of honey to another virus,
analyzed in vivo, showed that the use of topical honey is safe and effective in the
treatment of recurrent herpes and genital herpes lesions [49].
Respiratory syncytial virus is the most common cause of viral respiratory infec-
tions in infants and young children, also seriously affects adults, the elderly and immu-
nocompromised, causing deaths mainly in the elderly [50, 51]. The antiviral activity of
honey was tested for its action against the respiratory syncytial virus. A variety of tests
using cell culture was developed to assess the susceptibility of respiratory syncytial
virus to honey. The results confirmed that treatment with honey promoted inhibition
of viral replication [50]. Attempts to isolate the antiviral component in honey demon-
strated that sugar was not responsible for the inhibition of respiratory syncytial virus,
but could be methylglyoxal; this component of honey may play a role in the increased
potency of Manuka honey against respiratory syncytial virus [50]. Thus, honey may
be an alternative and effective antiviral treatment for the therapy of respiratory viral
infections, such as respiratory syncytial virus; however, other measures, such as an
effective vaccine, are still necessary for the control of this disease [50, 52].
Influenza is a highly infectious respiratory disease of viral origin that causes
even more deaths than the respiratory syncytial virus at all ages, except in children
less than a year old [14, 51]. Influenza viruses are transmitted from person to person
through the air, especially from droplets expelled during coughing and sneez-
ing and are a serious threat to human health, and there is an urgent need for the
development of new drugs against these viruses. Therefore, the anti-influenza virus
activity of honey from several sources was studied [53]. The results showed that
honey, in general, and particularly Manuka honey, has potent inhibitory activity
against the influenza virus, demonstrating a potential medicinal value [53]. In addi-
tion to honey, propolis has also been studied against the influenza virus and appears
to decrease the activity of the influenza virus [54].
Honey, especially Manuka honey, has strong antiviral properties. Studies show
that honey has action against the varicella-zoster virus, the respiratory syncytial
virus, and also has anti-influenza activity [47, 50, 53]. New studies on this property
of honey are necessary, mainly with other types of honey.
2.4 Antifungal
Most people associate fungi with organic matter decomposition or superficial
fungal infections, but fungi can cause various human diseases, from mild to firmly
established systemic diseases; the most serious infections can even be fatal [14].
The incidence of Candida infections is increasing worldwide. Candida albicans is
present in the normal human microbiota; however, this fungus can cause a variety
of diseases, such as vaginal, oral, and systemic infections, especially in immuno-
suppressed patients, as carriers of the HIV virus, these infections can be further
aggravated by the increase in resistance levels of this fungus to the medicines [14,
55, 56]. Clinical isolates of Candida albicans, Candida glabrata, and Candida dubli-
niensis were tested against four different honeys. The antifungal activities of floral
honeys were significantly higher than artificial honey against Candida albicans and
Candida glabrata; but for Candida dubliniensis, only Jarrah honey was significantly
active [56]. Candida glabrata, which is innate less susceptible to many conventional
antifungals, was also the least susceptible to the honey tested [56].

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As previously stated, honey has antifungal properties and may act against
Candida [57]. A study in 2012 evaluated the clinical and mycological cure rates of
a mixture of honey and vaginal mucus compared to local antifungal agents for the
treatment of patients with vulvovaginal candidiasis during pregnancy, recurrent
asymptomatic candidiasis in early pregnancy is associated with preterm birth [57,
58]. The clinical cure rate was significantly higher in the honey and mucus group
than in the conventional antifungal group, while the mycological cure rate was
higher in the conventional antifungal group than in the mucus and honey group;
therefore, the mixture of honey and mucus can be used with a complement or an
alternative to antifungal agents, especially in patients with vulvovaginal candidiasis
during pregnancy [57].
In addition to the antifungal activity of honey against Candida albicans, the
antifungal activity against Rhodotorula sp. was studied; this fungus can also affect
humans, cases of meningitis caused by Rhodotorula species in immunosuppressed
people have been reported [59, 60]. Four honeys from Algeria from different botan-
ical origins were analyzed to test the antifungal effect against Candida albicans and
Rhodotorula sp., different concentrations of honey were studied in vitro for antifun-
gal activity, and the study demonstrated that, in vitro, these natural products clearly
show antifungal activity against Rhodotorula sp. and Candida albicans [60].
Aspergillus spp. is a saprophyte commonly found in nature as a mold of leaves,
produces potent allergens, and often causes asthma and other hypersensitivity
reactions [14]. The antifungal activities of some samples of honey obtained from
different geographic locations in Nigeria were tested against some fungal isolates
[61]. Honey samples were examined for antifungal activity against Aspergillus niger,
Aspergillus flavus, Penicillium chrysogenum, Microsporum gypseum, Candida albicans,
and Saccharomyces sp., and results show that honey samples had different levels of
inhibitory activity at various concentrations against the fungi tested, with zones of
inhibition increasing with increasing honey concentration; Microsporum gypseum,
which can infect immunosuppressed patients, was the most sensitive of all fungal
isolates studied, while Candida albicans was the least sensitive, other studies have
shown efficient inhibitory activity of honey against the growth of Candida albicans
[61–64]. Honey samples used in the study showed spectrum and promising antifun-
gal activity, the honey from Nigeria may serve as a source of antifungal for possible
development of antifungal drugs for the treatment of fungal infections [61].
Besides the antibacterial and antiviral properties, some honeys also have anti-
fungal properties [56, 57, 59, 61]. Recent studies showed some honey have properties
against Candida albicans, Candida glabrata, Candida dubliniensis, Rhodotorula sp.,
Aspergillus niger, Aspergillus flavus, Penicillium chrysogenum, Microsporum gypseum, and
Saccharomyces sp., which make these honey as possible alternative medicines, espe-
cially against candidiasis, a disease that is growing worldwide [24, 56, 59, 61].
2.5 Anticancer
In 2016, the cancer mortality rate has dropped 23% since 1991 [65]. Despite this
progress, mortality rates are increasing for liver, pancreatic, and uterine cancers;
and cancer is now the leading cause of death in 21 states from United States, lung
cancer is still the most lethal, followed by breast cancer [65, 66]. The advance for
cancer treatment needs more clinical and basic research [65].
Many scientists have focused on the antioxidant property of honey. Studies indi-
cate that ingestion of honeybee products, such as honey, can prevent cancer [67, 68].
Through the use of human renal cancer cells, the antiproliferative activities, apopto-
sis, and the antitumor activity of honey were investigated [67]. Honey decreased cell
viability in malignant cells regardless of concentration and time [67]. Honey induced

Honey Analysis
8
apoptosis of human renal cancer cells according to honey concentration, and apop-
tosis plays an important role, most of the drugs used in the treatment of cancer are
apoptotic inducers, so the apoptotic nature of honey is considered vital [67].
The anticancer activity of honey samples was extracted from three different
Egyptian floral sources and was tested against colon, breast, and liver tumor lineage
[69]. Cassia honey showed moderate cytotoxic activity against colon cancer and
breast cancer, with the weakest cytotoxic activity against liver cancer; Citrus honey
exhibited the highest cytotoxic activity against breast cancer; and Ziziphus honey
showed potent efficiency against colon, liver, and breast cancer [69]. Breast cancer,
which is the type of cancer that most affects and kills women, was also tested for
another type of honey, the Manuka honey, and the results showed that it is cyto-
toxic to MCF-7 breast cancer cells in vitro and the effects are mainly correlated with
the total content of phenols and their antioxidant power [65, 70].
The phytochemical content and antioxidant activity of melon honey and
Manuka honey and their cytotoxic properties were tested against human and
metastatic colon adenocarcinoma. The ability to induce apoptosis in colon cancer
cells depends on the concentration of honey and type of cell line, in addition to hav-
ing a great relation with the phenolic content and residues of tryptophan. Honey
was analyzed for phenolic, flavonoid, amino acid, and protein contents, as well as
their free radical scavenging activities [71, 72]. Melon honey presented the highest
amount of phenolics, flavonoids, amino acids, and proteins, as well as antioxidant
capacity in relation to Manuka honey [71]. Both melon honey and Manuka honey
induced cytotoxicity and cell death independently of dose and time in human
and metastatic colon adenocarcinoma cells [71]. Melon honey showed to be more
efficient in concentrations [71]. The results indicate that melon honey and Manuka
honey can induce inhibition of cell growth and the generation of reactive oxygen
species in colon adenocarcinoma and metastatic cells, which may be due to the pres-
ence of phytochemicals with antioxidant properties. These results suggest a poten-
tial chemo-preventive agent against colon cancer; in addition, honey can improve
the functioning of other substances already used in cancer treatment [71, 73].
Research on cancer control has shown the importance of adjuvant therapies
[74]. Aloe vera may reduce tumor mass and rates of metastasis, and its association
with conventional therapy can produce benefits for the treatment, while honey
may inhibit tumor growth [74, 75]. The influence of Aloe vera and honey on tumor
growth and the apoptosis process was evaluated by evaluating tumor size, the rate
of cell proliferation for Walker 256 carcinoma [74]. Tumor-bearing mice received
a daily dose of Aloe vera and honey, and the control group received only sodium
chloride solution [74]. The effect of Aloe vera and honey against tumor growth was
observed through a decrease in relative weight (%) [74]. The results suggested that
Aloe vera and honey can modulate tumor growth, reduce cell proliferation, and
increase susceptibility to apoptosis. Studies have shown that honey has antiprolif-
erative activity because of its ability to induce apoptosis, so this combination is a
possible adjuvant therapy [74, 76, 77].
Several types of honey have been studied because of their anticancer properties
[65, 67, 69–71, 74]. Currently, cancer is one of the world’s leading diseases, requir-
ing further studies [65]. Some honey have already been tested against colon, breast,
and liver tumor, as well as human kidney cancer and Ehrlich ascites carcinoma cell
lines, where most have weak to strong cytotoxic activity depending on the type of
honey tested and depending on the dose of honey [67, 69–71]. The effect of Aloe vera
on honey has also been studied, and the whole has the capacity to modulate tumor
growth, reducing cell proliferation, and also increasing susceptibility to apoptosis
[74]. The antitumor effects of honey were highly correlated with their ability to
induce apoptosis of cells and with their antioxidant power [65, 67, 69–71, 74]. The

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effect of Aloe vera along with honey has also been studied, and the set has the capac-
ity to modulate tumor growth, reducing cell proliferation, and also increasing suscep-
tibility to apoptosis [74]. The antitumor effects of honey were highly correlated with
its ability to induce cell apoptosis and with its antioxidant activity [65, 67, 69–71, 74].
2.6 Antioxidants
Antioxidants, which are present in large amounts of honey, making it a food
with great antioxidative potential, are free radical scavengers that reduce the forma-
tion or neutralize free radicals [11, 78]. A comparative analysis of total phenolic
content and antioxidant potential of commercially available common honey was
performed along with Malaysia’s Tualang honey. Biochemical analyzes revealed a
significantly high phenolic content in Tualang honey [78]. In addition, the anti-
oxidant capacity of Tualang honey was higher than that of common honey; these
data suggested that the high activity of elimination of free radicals and antioxidant
activity observed in Tualang honey were due to the increase in the level of phenolic
compounds, it was also observed that the antioxidant activity of honey depends
on its botanical origin [78, 79]. Therefore, the favorable antioxidant properties of
Tualang honey can be important for nutrition and human health [78].
Type 2 diabetes consists of progressive hyperglycemia, insulin resistance, and
β-pancreatic cell failure, which may result from glucose toxicity, inflammatory
cytokines, and oxidative stress, and is responsible for 90–95% of all cases of diabe-
tes [80, 81]. A study investigated the effect of pre-treatment with Gelam honey, and
the individual flavonoid components chrysin, luteolin, and quercetin on the pro-
duction of reactive oxygen species, cell viability, lipid peroxidation, and insulin in
hamster pancreatic cells, cultured under normal conditions and hyperglycemic, the
pre-treatment of cells with Gelam honey extract or flavonoid components showed
a significant decrease in the production of reactive oxygen species, glucose-induced
lipid peroxidation, and a significant increase in insulin content and viability of
cultured cells under hyperglycemic conditions. The results indicated the in vitro
antioxidant property of Gelam honey and flavonoids on hamster β cells, creating a
protective effect against hyperglycemia [80]. Another study demonstrated the effect
of honey on diabetics, the study with rats concluded that the pancreatic tissues of
rats with diabetes were exposed to great oxidative stress and that supplementation
with other honey, Tualang honey, had protective effects in the pancreas [80, 82].
Honey contains antioxidants, such as phenolic compounds that prevent cellular
oxidative damage that leads to aging, disease such as cancer, metabolic distur-
bances, cardiovascular dysfunction and even death [83, 84]. The antioxidant effect
of honey in young and middle-aged rats was compared, the rats were fed with pure
water (control), those supplemented with 2.5 and 5.0g/kg of Gelam honey for
30days. Results showed that Gelam honey supplementation reduced DNA damage,
plasma malondialdehyde level, and glutathione peroxidase. Liver activity super-
oxide dismutase also decreased in young rats supplemented with 5g/kg of Gelam
honey [84]. Gelam honey reduces the oxidative damage of young and middle-aged
rats by modulating the activities of the antioxidant enzymes that were more promi-
nent in higher concentration compared to the lower concentration [84]. Another
study indicates that honey has these antioxidant and free radical sequestering
properties, mainly due to its phenolic compounds [85].
Honey has antioxidant properties that can be further explored and studied,
because antioxidants reduce free radicals and oxidative stress, which can help to
promote and maintain health [80, 82, 84]. Besides the previously described, the
antioxidant effect of honey can be an important property to help in the anticancer
effect [67, 71].

Honey Analysis
10
Author details
Bruna Costa Ferreirada Cruz1, LudimillaRonqui2*, PriscilaScharnoski3,
PatríciaScharnoski3, MarinaPeruzzolo4, Pedroda Rosa Santos5, AndréHalak6,
PriscilaWielewski5, Juliana MosconiMagro7 and Katlin Fernandade Araujo8
1 Londrina State University—UEL, Londrina, Brazil
2 Interdisciplinary Department of Technology and Sciences of the Federal
University of Rondonia—UNIR, Ariquemes, Brazil
3 Medical clinic, Porto Velho, Brazil
4 University of Sao Paulo—USP, Ribeirao Preto, Brazil
5 Maringa State University—UEM, Maringá, Brazil
6 Cooperativa Agrícola e Apícola das Beiras—COOPBEI, Mangualde, Portugal
7 State College Professor Francisco Villanueva, Maringá, Brazil
8 Cesufoz/Fafig, Foz do Iguaçu, Brazil
*Address all correspondence to: ludimillar@yahoo.com.br
3. Conclusions
Several studies have proven the effectiveness of honey as an alternative medi-
cine; some have even shown that honey is as good a medicine as conventional
medicine. Use of different types of honeys showed anti-inflammatory effect very
similar to the conventional drug and that can be used as an alternative medicine in
the treatment of diseases or inflammations. Honey can also be used as an antimicro-
bial agent anti-inflammatory, antibacterial, antivirals, antifungal, anticancer, and
antioxidants. However, there is still a need to increase research on honey, especially
in its potential as a medicine and also a dissemination of this knowledge to the
population and the medical community, so an increase in the use of this powerful
compound will be possible.
Conflict of interest
The authors declare that there is no conflict of interest.
© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms
of the Creative Commons Attribution License (http://creativecommons.org/licenses/
by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.

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