Benefits of Honey in Healing Wounds

Much has been written on the benefits of honey and much has been claimed. With the marketing hype around world-famed Mānuka Honey, we may think that it is the only honey with healing properties.  There’s no doubt that Mānuka Honey is an amazing honey, but modern research and the traditonal use of honey across the cultures of the world show that honey, in general, has a range of healing properties.

Kia ora! Greetings from New Zealand, the home of some unique healing honeys. I’m Brenda Tahi of Manawa Honey NZ, and in this article I will draw on historic knowledge and scientific research from across the world to examine the astonishing properties of honey for the healing of wounds.

Here’s what we will cover in this article….

• Traditional Uses of Honey in Health and Healing
• Benefits of Honey in Healing Wounds
• Key Properties of Honey for Healing Wounds
  • Acidic Properties of Honey
  • Hygroscopic Properties of Honey
  • Hydrogen Peroxide Content of Honey
  • Consistency of Honey
  • Concentration of Sugars in Honey
  • Bee-Defensin-1 (in Some Honey)
  • Methylglyoxal (MGO) in Mānuka Honey
  • Flavonoids and Aromatic Acids in Honey
• How Does Honey Compare to Medical Treatments in Healing Wounds?
• Using Honey in Wound Healing
• Caveat on Using Honey for Wound Healing

Humans have used honey for medicinal purposes for thousands of years. There are cave paintings, ancient writings, and sacred scripts that tell of honey’s many uses in healing and in promoting good health before modern times.

The use of honey by humans can be traced back some 8000 to 10,000 years ago as honey gathering has been found depicted in Stone Age paintings in different parts of the world, notably in Spain and in Africa (1).

Honey was the most popular drug for the ancient Egyptians who flourished from 3150-1650 BC. Almost all Egyptian medicines contained honey together with wine and milk. Honey was a topical ointment, and used standard wound salve for its antibacterial properties to help heal infected wounds. Honey was also used to embalm the dead (2).

Ayurvedic knowledge originated in India more than 5,000 years ago and it considers honey to be one of nature^‘s most remarkable gifts to mankind. Traditionally, honey was used to treat conditions and ailments of many organs and parts of the body, from eye ailments and cough to wound healing and cardiac pain (2).

The ancient Egyptians, Assyrians, Chinese, Greeks and Romans all employed honey for wounds and diseases of the gut (3).

The civilisation of Ancient Mesopotamia, which thrived from 2100 BC to 700 BC, also used honey for medicinal purposes. Wounds were washed in milk or water before being dressed with honey or resin, to facilitate the healing process.

The Ancient Greeks thrived in 460BC – 375 BC, and the great Greek physician Hippocrates is considered one of the most outstanding figures in the history of medicine. Hippocrates used honey and vinegar or water and other substances to treat pain and a range of ailments, including cough, eye diseases, wound healing and scar treatment.

Traditional Chinese Medicine has used honey as a medicine for over 2000 years, for treating bacterial infections, gastrointestinal diseases,  allergic or immune disorders, and wound management. Honey was also recommended to be taken daily to maintain internal and external vitality (4).

The Islamic medical system looks to the Qur’an which is clear about the healing value of honey: “And thy Lord taught the bee to build its cells in hills, on trees and in people’s habitations… there issues from within their bodies a drink of varying colors, wherein is healing for humankind.  Verily in this is a Sign for those who give thought.”

The Muslim prophet Mohammad said: “Honey is a remedy for every illness and the Qur’an is a remedy for all illness of the mind, therefore I recommend to you both remedies, the Qur’an and honey (5)”. Avicenna, a great Iranian scientist and physician, who flourished almost 1000 years ago, recommended honey as one of best remedies for treating tuberculosis (6).

So, across cultures, across continents, and across time, honey traditionally has been used as a healing medicine. We look now to research in more recent times that confirms in so many ways what traditional healers always knew.

Just as ancient civilisations used honey, much of modern science on the healing properties of honey has focused on honey in the treatment of wounds. So over time, a body of scientific evidence has developed that clearly shows the benefits of honey in healing wounds.

This research has found that honey supports the wound healing process directly through four key effects:

• antibacterial effects that fight or prevent infection in the wound
• antioxidant effects that neutralize free radicals and promote tissue regeneration
• anti-inflammatory effects that keeps a check on the inflammatory cells brought to bear in healing process
• osmotic pressure to clear the wound and bring fluids and nutrients to support healing.

Honey also brings indirect benefits to the process of wound healing by supporting the body’s own agents for fighting infection, promoting healing, and strengthening the body’s own immune system (7).

Typical results gained by the topical use of honey in wound healing are:

• fast healing times
• reduced scarring (8)
• soothing effect in wound healing (9) and pain reduction in burns (10) and wounds (11)

These direct and indirect effects of honey in wound healing stem from a number of key characteristics of honey ranging from its chemical content to its consistency. We will address each of these key wound healing properties in turn.

The healing process is remarkable and complex. With the right healing environment, the body works in wondrous ways to heal a wound through four overlapping phases:

1. Hemostasis or Clotting Phase, which starts immediately after injury, and is all about stopping the bleeding through coagulation of the blood.
2. Inflammatory or Cleansing Phase, where the focus is on destroying bacteria and remove debris, so as to prepare the wound bed for the growth of new tissue. This phase takes about 4-6 days.
3. Proliferative or Healing Phase, where the wound bed is filled, the wound edges margins are contracted and pulled to the centre and the wound is then covered over.  This phase can take up to 24 days.
4. Maturation or Final Phase where the new tissue gains strength and flexibility, taking from 3 weeks to 2 years.

Research has found 8 properties in honey that makes it effective in supporting the wound healing process, particularly in the inflammatory and proliferative stages. We will deal with each of these properties in the sections that follow.

Honey is quite acidic mainly from gluconic acid that it contains, so that the pH of honey can range between 3.2 and 4.5. The acidic properties of honey:

• are low enough to inhibit or kill some bacteria (12)
• encourage the blood to release oxygen, which is important in healing a wound (13)
• reduce the presence of substances called proteases that can impair the wound healing process (14)
• Support the macrophages of the body’s line-up to destroy bacteria in the wound (15).

Honey is hygroscopic, which means it has low levels of available water, so that it will draw moisture out of the surrounding environment.

When used for wound healing, honey can dehydrate bacteria that cause wound infection, destroying them or inhibiting their growth (13).

Honey contains hydrogen peroxide H₂O_2, which is well-known to have anti-bacterial benefits. Critically, it has been shown that it is the hydrogen peroxide content of honey that is the main driver of its antibacterial benefits in wound healing (16).

The level of hydrogen peroxide varies in different honeys, depending on the dilution of the honey and variety of the honey. The hydrogen peroxide in honey originally comes from an enzyme glucose oxidase added by bees in the regurgitation of nectar when they are making honey in the hive. When diluted, the glucose oxidase is broken down into gluconic acid and hydrogen peroxide (17).

Hydrogen peroxide works as an antibiotic by transforming itself into a free radical that then damages the cell walls of bacteria.

In the past it was thought that the antibacterial activity of honey was weakened when used for wound healing because it becomes diluted by the fluids or pus of the wound. However it has been shown that honey maintains antibacterial activity even when this dilution takes place. But, in some cases, the peroxide activity in honey can be destroyed easily by heat or the presence of another enzyme known as catalase, which is also found in honey (18).

The thick consistency of honey is effective in forming barrier between a wound and the external environment. This barrier in turn is effective in protecting the wound against the entry of bacteria and in keeping the wound hydrated (19).

The high concentration of sugars and other solutes in honey act in a number of ways to support wound healing:

• Osmotic pressure is created, causing fluid to flow up through the wound, flushing bacteria and debris away to the top of the wound, and carrying nutrients and oxygen from the deep tissue into the wound area to support healing (20).
• Drawing moisture from bacterial cells, which inhibits their growth (13).
• Providing an additional source of glucose for the cells proliferating for the healing of a wound (19).

The glucose content in honey, along with its acidic nature, also supports macrophages, the body’s white blood cells, whose job it is to destroy bacteria in a wound (15).

Defensin-1 is a bee-derived protein that supports wound healing. Not all honeys contain bee defensin-1, and its levels can vary depending on the location of the hive that produces the honey (21).

Bee-Defensin-1 supports wound healing in two ways:

• An anti-bacterial effect through making the cell wall of bacteria permeable, and inhibiting DNA and other elements of critical protein production within the cells of bacteria (22).
• Promoting the laying down of new skin cells and the release of secretions that support the healing process (23).

Mānuka Honey stands apart in the world of honey in wound healing, because it contains an antibacterial compound called methylglyoxal (MGO). MGO comes from the conversion of dihydroxyacetone (DHA), which is found in high concentration in the nectar of the flowers of the Mānuka tree, from which bees make Mānuka Honey. The higher the concentration of MGO, the stronger the antibacterial effect, making high grade Mānuka Honey a powerful agent in healing wounds.

The flavonoids and aromatic acids in honey are also a factor in its wound-healing properties:

• Bringing antibacterial and astringent activities that help in controlling infection.
• Increasing the migration and proliferation of the connective tissue that is so critical to the wound healing process.
• Exerting an antioxidant effect of scavenging free radicals, preventing tissue damage and controlling inflammation (13).

Honey can be compared with other medical treatments for wound healing in a number of ways. Key comparisons noted in research are:

• Most antibiotics will actually slow down wound healing as although they destroy or inhibit bacteria causing infection, they can also cause cellular damage as well. In comparison, honey both kills bacteria and promotes healing.
• Honey can be used successfully as an antibiotic against bacteria that have developed resistance to other antibiotics.
• Hydrogen peroxide spray can be used as an antibiotic to promote wound healing but it can also damage tissue, whereas honey has a healing effect on both infection and healing.

From the traditional to the modern day, our review has found that there is ample evidence for honey’s effectiveness in healing wounds. This evidence then begs the question of why honey is not being used more widely in modern medicine for this purpose?

Firstly, it can be said that much of the scientific evidence for the benefits of honey in wound healing comes from the laboratory. That is, honey’s healing properties are not the subject of many robust clinical studies in large samples of humans. Without ample scientific underpinning, many doctors are reluctant to prescribe honey for wound healing.

Secondly, honey is messy to just apply from a jar to a wound, so some people are not keen to use it in this way. To address this issue, a number of companies produce wound dressings that are impregnated with honey, particularly Mānuka Honey, that are easy to store and to apply to wounds.

Additionally, some would say that the medical profession view honey as a home remedy, not to be taken seriously in medical practice. However, the weight of the growing evidence for honey’s effectiveness in wound healing is beginning to shift thinking so that honey, particularly Mānuka Honey, is now more acceptable as a ‘go-to’ treatment for wounds.

We can see that using honey will become more accepted for medical wound treatment as the body of clinical evidence grows. To this end, we urge clinical researchers to advance studies of the healing properties of honey, to give it a more compelling base of evidential support.

I am not a doctor, and I am certainly not a wound specialist. But I can see from the evidence that honey has some very special properties when it comes to healing wounds. I cannot professionally recommend that you use honey for the treatment of wounds – that decision you need to make for yourself from the evidence that you can garner from this article and other sources of information.

If you intend to use honey in the healing of a wound then please consider:

• The severity of the wound and its level of infection, that may require other medical attention
• The type of honey that you use for this purpose. For example, manuka honey is known for healing serious or infected wounds, but other honeys may be fine for less severe wounds.
• Honey can harbour microbes that can enter and infect a wound. Medical honey wound treatments are sterilised to remove this risk. If you use honey that has not been sterilised then at least be sure your honey is produced from natural clean sites, and that it has come through clean production processing.

Have you used honey in wound healing – for yourself, for your family or your pets? If you have, then please share your stories with us.