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About 45 years ago research into the healing mechanisms of honey recognised that there were marked differences in the antibacterial activity of various types of  honey and in their ability to inhibit the growth of  micro-organisms.

 

 

 

 

 

The amazing thing about honey is that it produces hydrogen peroxide at
high enough levels to kill micro-organisms but not high enough to damage
our skin.

Dr. Shona Blair

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

"The therapeutic potential of uncontaminated, pure honey is grossly underutilized. It is widely available in most communities and although the mechanism of action of several of it's properties remains obscure and needs further investigation, the time has now come for conventional medicine to lift the blinds off this 'traditional remedy' and give it its due recognition."

PROFESSOR PETER MOLAN

 

 

 

 

 

 

 

 

 

 

 

 




 

 

specialising in the manufacture
of high quality honey-based products.

Honey Research


Please note:

All the following articles appearing in this section are reproduced from the web site of the Honey Research Unit at Waikato University, New Zealand with the kind permission of Professsor Peter Molan, director of research.

While Peter Molan supports the use of Active Manuka Honey in wound care, his position regarding any company, brand or honey product is totally impartial. These articles appear here for general interest only and are not intended to constitute medical advice or make medical claims.

Professsor Peter Molan has no involvement with the business activities of the  Medicinal Honey Company or its website.

This collection of published academic articles provides an informative source of literature regarding the use of Active Manuka Honey and will be of interest to the public and medical professionals alike.


History

About 45 years ago research into the healing mechanisms of honey recognised that there were marked differences in the antibacterial activity of various types of honey and in their ability to inhibit the growth of  micro-organisms.


Honey - an ancient remedy "rediscovered"

P.C. Molan  -  Manuka Honey as a Medicine
Paper presented at Global Bioactives Summit ,Hamilton NZ July 2001

For centurys honey has been used as a food and a prized as a medicine, by many cultures around the world. The usage of honey as a medicine is referred to in the most ancient written records, it being prescribed by the physicians of many ancient races of people for a wide variety of ailments (Ransome 1937).

It has continued to be used in folk medicine ever since, but in recent times there has been a renaissance of the use of honey in the medical profession: an editorial in the Journal of the Royal Society of Medicine (Zumla and Lulat 1989 ) discussing this expressed the opinion

"The therapeutic potential of uncontaminated, pure honey is grossly underutilized. It is widely available in most communities and although the mechanism of action of several of it's properties remains obscure and needs further investigation, the time has now come for conventional medicine to lift the blinds off this 'traditional remedy' and give it its due recognition."

Now it can be seen that the effectiveness of honey in many of its medical uses is probably due to its antibacterial activity. It is well established that honey inhibits a broad spectrum of bacterial species. There are many reports of bactericidal as well as bacteriostatic activity. There have also been reports of honey having antifungal activity.

Professor Peter Molan and researchers at the Honey Reseach Unit at Waikato University in New Zealand have investigated the potential and therapeutic benefits of various honeys with special attention focused on the ability of some Manuka Honeys to inhibit the growth of  a wide range of bacteria and fungi.
Research in this area has identified that some Manuka honeys have exceptionally high levels of antimicrobial activity.This is due to both hydrogen peroxide releasing enzymes and a unique  phytochemical activity which has been termed the Unique Manuka Factor.

The establishment by research that there are bioactive components in honey, and the wide dissemination of this knowledge, has led to a general acceptance that honey is a respectable therapeutic agent, and to a rapidly increasing uptake of its usage by clinicians as well as by the general public.

The finding that there are multiple bioactive components involved in the therapeutic action makes it a much more attractive option to use the natural product rather than to attempt to identify individual active components and use synthesised copies of those.

Selection of honey for use on wounds

By Peter Molan, PhD
Director of the Honey Research Unit, Department of Biological Sciences, University of Waikato, New Zealand

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 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".

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 a concentration of sugar 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.

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

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. 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.

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

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. If it is necessary to warm honey to liquefy it, it should be heated to no more than 37C. If it is considered necessary to sterilise 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.)


The way honey is used as a wound dressing
(practical information)

By Peter Molan, PhD
Director of the Honey Research Unit, Department of Biological Sciences, University of Waikato, New Zealand

Note: The information provided in this web-site does not constitute medical advice. It is important that wounds that are not healing are seen by a registered medical practitioner - failure to heal may be the result of malignancy (cancer) or defective blood circulation. Varicose leg ulcers usually require professionally applied pressure bandaging over the dressing to heal successfully.

  • The following points have come from clinical experience of many people using honey as a wound dressing:
  • The amount of honey required on the wound depends on the amount of fluid exuding from the wound. The various beneficial effects of honey on wound tissues will be reduced or lost if small amounts of honey become diluted by large amounts of fluid. Likewise the frequency of dressing changes required will depend on how rapidly the honey is being diluted by fluid.
  • Daily dressing changes are usual, but up to three times daily may be needed.
  • If the dressing sticks to the wound this indicates that more frequent changes of dressing are needed.
  • Exudation of fluid should be reduced by the anti-inflammatory action of honey, so less frequent dressing changes may be needed later - a few days between changes.
  • More honey is required on deeper infections, to obtain an effective level of antibacterial activity diffusing deep into the wound tissues.
  • Typically, 20 ml of honey (25 - 30 g, 1 ounce) is used on a 10 cm X 10 cm (4 inch X 4 inch) dressing.
  • Occlusive (waterproof) or absorbent secondary dressings are needed to prevent honey oozing out from the wound dressing. (Occlusive dressings are better as they keep more of the honey in contact with the wound - absorbent dressings soak the honey away from the wound.) Adhesive tape or bandages can be used to hold the dressings in place if an adhesive occlusive dressing is not used.
  • Pressure bandaging is used over the honey dressing for varicose ulcers.
  • Dressing pads pre-impregnated with honey are the most convenient way of applying honey to surface wounds. (Dressing pads pre-impregnated with active manuka honey are available commercially).
  • If pre-impregnated dressings are not available, it is best to spread the honey on the dressing rather than on the wound.
  • Abscesses, cavities and depressions in the wound bed are filled with honey before applying the honey dressing pad, so that there is honey in contact with the wound bed. The honey dressings are cut to a size that extends beyond the edges of the wound and any surrounding inflamed area.

What's special about active manuka honey

By Peter Molan, PhD
Director of the Honey Research Unit, Department of Biological Sciences, University of Waikato, New Zealand

 

  • "Active manuka honey" is the only honey available for sale that is tested for its antibacterial activity. It contains an additional antibacterial component found only in honey produced from Leptospermum plants: what has been called the "Unique Manuka Factor"

    There is evidence that the two antibacterial components  (hydrogen peroxide and the "Unique Manuka Factor") may have a synergistic action.
  • Unique Manuka Factor" is not affected by the catalase enzyme present in body tissue and serum. This enzyme will break down, to some degree, the hydrogen peroxide which is the major antibacterial factor found in other types of honey. If a honey without Unique Manuka Factor"were used to treat an infection, the potency of the honey's antibacterial activity would most likely be reduced because of the action of catalase.
  • The enzyme that produces hydrogen peroxide in honey is destroyed when honey is exposed to heat and light. But Unique Manuka Factor" is stable, so there is no concern about manuka honey losing its activity in storage.
  • The enzyme that produces hydrogen peroxide in honey becomes active only when honey is diluted. But Unique Manuka Factor" is active in full strength honey, which will provide a more potent antibacterial action diffusing into the depth of infected tissues.
  • The enzyme that produces hydrogen peroxide in honey needs oxygen to be available for the reaction, so may not work under wound dressings or in wound cavities. Honey with Unique Manuka Factor"is active in all situations.
  • The enzyme that produces hydrogen peroxide in honey becomes active only when the acidity of honey is neutralised by body fluids, but then the honey is diluted.
  • The enzyme that produces hydrogen peroxide in honey could be destroyed by the protein-digesting enzymes that are in wound fluids.
  • The Unique Manuka Factor antibacterial activity diffuses deeper into skin tissues than does the hydrogen peroxide from other types of honey.
  • Honey with Unique Manuka Factor is more effective than that with hydrogen peroxide against some types of bacteria. For example, active manuka honey with Unique Manuka Factoris about twice as effective as other honey against Eschericihia coli and Staphylococcus aureus, the most common causes of infected wounds.

Many medical professionals are using active manuka honey and getting good results in patients with wounds that have not responded to standard treatment. For example, a successful trial of active manuka honey on unresponsive skin ulcers was recently published in the New Zealand Medical Journal. In addition, staff at a large hospital in Brisbane, Australia, recently used active manuka honey as a wound dressing on a patient for whom honey without Unique Manuka Factor had failed. In other hospitals clinicians have likewise noted improvement in healing rates when changing from other honey to a manuka honey with a good level of Unique Manuka Factor.

None of the results being obtained clinically should be considered evidence that active manuka honey is more effective than other honey - a comparative clinical trial will be needed to establish that. Nevertheless, there are good theoretical reasons for choosing to use active manuka honey with a good level of Unique Manuka Factor for management of wound infections.

To rate the potency of antibacterial activity of honey, Proff. P.C. Molan devised the testing method and the Unique Manuka Factor number. The Unique Manuka Factor numbers come from a standard laboratory test of antibacterial activity, with honey being compared with a standard antiseptic (phenol, also known as carbolic) for potency. For example, a honey with a Unique Manuka Factor rating of 4 would be equivalent to the antiseptic potency of 4% solution of phenol, as used as carbolic disinfectant; a honey with a rating of 10 would have a potency equivalent to a 10% solution of phenol.

Medical professionals in New Zealand use active manuka honey with a rating of Unique Manuka Factor10 or higher. Although good results may be obtained with lower levels of activity, there is a chance that the lower activity will not be enough to fully clear an infection. In addition, honey with a lower level of activity will not allow as much of the antibacterial elements to diffuse into infected tissue, which could mean that effective control of infection may not be achieved in deeper tissue.

To alleviate any concern over the possible risk of introducing infection by the use of an unprocessed natural product on wounds, honey can be sterilised by gamma irradiation without loss of any of its antibacterial activity. Active manuka honey and the Australian Leptospermum honey are commercially available sterilised in this way.

 

The Unique Properties of Manuka Honey

By Peter Molan, PhD
Associate Professor of Biochemistry and Director of the Honey Research Unit University of Waikato, Hamilton, New Zealand

For over 10 years, I have scientifically investigated what many local New Zealanders have accepted as common wisdom: our local manuka honey is a superior treatment for wounds and infections. Manuka honey is gathered in New Zealand from the manuka bush, Leptospermum scoparium, which grows uncultivated throughout the country. (More recently, as a result of systematic screening of Australian honeys, a honey with the same properties has been found to be produced from Leptospermum polygalifolium, which grows uncultivated in a few parts of Australlia.)

After the results of my work became known through scientific journals, many people contacted me to find out what is so special about active manuka honey. A thorough and scientific response is available in articles listed on my Web site,

www.honey.bio.waikato.ac.nz.

However, I have compiled the pertinent facts here:

  • Approximately 50 reports in medical journals detail the effectiveness of honey as a wound dressing and as therapy for eye infections and diarrhea 1, 3.
  • Honey has an antibacterial activity, due primarily to hydrogen peroxide formed in a "slow-release" manner by the enzyme glucose oxidase present in honey, which can vary widely in potency. Some honeys are no more antibacterial than sugar, while others can be diluted more than 100-fold and still halt the growth of bacteria. The difference in potency of antibacterial activity found among the different honeys is more than 100-fold.
  • "Active manuka honey" (and its Australian equivalent) is the only honey available for sale that is tested for its antibacterial activity. It contains an additional antibacterial component found only in honey produced from Leptospermum plants: "unique manuka factor" (UMF). There is evidence that the 2 antibacterial components may have a synergistic action.
  • Unique manuka factor is not affected by the catalase enzyme present in body tissue and serum. This enzyme will break down, to some degree, the hydrogen peroxide which is the major antibacterial factor found in other types of honey. If a honey without UMF were used to treat an infection, the potency of the honey's antibacterial activity would most likely be reduced because of the action of catalase.
  • The enzyme that produces hydrogen peroxide in honey is destroyed when honey is exposed to heat and light. However, UMF is stable, so there is no concern about manuka honey losing its activity in storage.
  • Honey with UMF is more effective than that with hydrogen peroxide against some types of bacteria. For example, active mauka honey with UMF is about twice as effective as other honey against Eschericihia coli and Staphylococcus aureus4, 5, the most common causes of infected wounds.


Many medical professionals are using active mauka honey-and getting good results-in patients with wounds that have not responded to standard treatment. For example, a successful trial of active manuka honey on unresponsive skin ulcers was recently published in the New Zealand Medical Journal 6. In addition, staff at a large hospital in Brisbane, Australia, recently used active mauka honey as a wound dressing on a patient for whom honey without UMF had failed.

None of the results being obtained clinically should be considered evidence that active manuka honey is more effective than other honey-a comparative clinical trial will be needed to establish that. Nevertheless, when asked, I recommend active mauka honey with a good level of antibacterial activity for management of infections.

Medical professionals in New Zealand use active mauka honey with a rating of 10 UMF or higher. Although good results may be obtained with lower levels of activity, there is a chance that the lower activity will not be enough to fully clear an infection. In addition, honey with a lower level of activity will not allow as much of the antibacterial elements to diffuse into infected tissue, which could mean that effective control of infection may not be achieved in deeper tissue.

To rate the potency of antibacterial activity of honey, I devised the testing method and the UMF number. The UMF numbers come from a standard laboratory test of antibacterial activity, with honey being compared with a standard antiseptic (phenol) for potency. For example, a honey with a UMF rating of 4 would be equivalent to the antiseptic potency of 4% solution of phenol, a carbolic disinfectant; a honey with a rating of 10 would have a potency equivalent to a 10% solution of phenol. To alleviate any concern over the possible risk of introducing infection by the use of an unprocessed natural product on wounds, honey can be sterilised by gamma irradiation without loss of any of its antibacterial activity.

For information on the use of honey in managing wounds, burns, skin ulcers and necrotising fasciitis, read the article: "The role of honey in the management of wounds".



References

1. Molan PC. A brief review of honey as a clinical dressing. Primary Intention 1998; 6(4): 148-58.
2. Molan PC. The role of honey in the management of wounds. J Wound Care 1999; 8(8): 423-6.
3. Molan PC. Why honey is effective as a medicine. 1. Its use in modern medicine. Bee World 1999; 80(2): 80-92.
4. Willix DJ, Molan PC, Harfoot CJ. A comparison of the sensitivity of wound-infecting species of bacteria to the antibacterial activity of manuka honey and other honey. J Appl Bacteriol 1992; 73: 388-94.
5. Cooper RA, Molan PC, Harding KG. Antibacterial activity of honey against strains of Staphylococcus aureus from infected wounds. J R Soc Med 1999; 92: 283-5.
6. Wood B, Rademaker M, Molan PC. Manuka honey, a low cost leg ulcer dressing. N Z Med J 1997; 110: 107.
7. Molan PC, Allen KL. The effect of gamma-irradiation on the antibacterial activity of honey. J Pharm Pharmacol 1996; 48: 1206-9.



 

Establishing Honey as a Recognised Medicine

By Peter Molan, PhD
Director of the Honey Research Unit, Department of Biological Sciences, University of Waikato, New Zealand

Honey is becoming accepted as a reputable and effective therapeutic agent by practitioners of conventional medicine, and by the general public. This has been a consequence of there being an increasing awareness of the good clinical results that are obtained, and of there being rational explanations for its therapeutic actions. Further establishing this recognition of honey as a medicine involves a combination of literature research and laboratory research to obtain evidence and explanations of the therapeutic effectiveness of honey, and educating medical practitioners and the general public about the results of this research. Increasingly the medical profession is requiring evidence-based decisions on therapeutic options.

There are many reports in the medical literature of honey being very effective as a dressing for wounds, burns and skin ulcers: inflammation, swelling and pain are quickly reduced, malodour is reduced, shedding of dead tissue is induced so surgical removal is unnecessary, healing occurs rapidly with minimal scarring and with no need for skin grafting, and infection is rapidly cleared. A moist environment is created which promotes the growth of new skin tissue. Although a moist environment also favours the growth of infecting bacteria, the antimicrobial properties of honey prevent infection. But unlike other antiseptics, honey is not harmful to tissues, and actually speeds up the growth of new tissue to heal the wound.

Most practitioners have not been aware that there is a marked variation in the potency of the antimicrobial activity of honey, due mainly to differences in the amount of hydrogen peroxide generated, but sometimes to additional antimicrobial components from specific plant sources. Honey from manuka (Leptospermum scoparium) has an exceptionally high level of plant-derived antibacterial activity. The most common wound-infecting species of bacteria, Staphylococcus aureus, has been found to be particularly sensitive to this. All of the common wound-infecting species of bacteria have been tested and found to be sensitive to both types of antibacterial activity in honey. Clearing bacterial infection from a wound is essential to allow the healing process to occur.

Recent tests carried out in collaboration with the Central Public Health Laboratory in London, UK, on many strains of multi-antibiotic-resistant bacteria such as MRSA strains MRSA, VRE and Acinetobacter baumarii have shown that these bacteria have no resistance to honey. (These "superbugs" are a serious clinical problem as infections with them often cannot be treated at all with antibiotics.) All of the testing of sensitivity of wound-infecting species of bacteria that we have carried out has been done with honeys selected to have mid-range levels of antibacterial activity. These have been found to have ten to fifty times more activity than is needed to completely suppress the growth of the bacteria tested. Although this may suggest that therefore other less potent honeys would be suitable for use on wounds, it should be taken into account that honey gets diluted by serum exuding from wounds, and that the depth of penetration of an effective level of antibacterial activity depends on the strength of the activity on the surface.

The hydrogen peroxide generated in honey is responsible for some of the other therapeutic effects seen in wound treatment as well as for the antibacterial activity. It stimulates the growth of the cells responsible for replacing damaged tissue. Additionally it has an insulin-like effect on cells which would be expected to be beneficial to the healing process as application of insulin to wounds aids healing. It also stimulates the development of new blood vessels, a key first step in tissue regeneration. It serves as a messenger between the different types of cells involved in the immune response of the body to infection. It also activates protein-digesting enzymes in tissues which are involved in the healing process. Although hydrogen peroxide is generally an inflammatory substance, the enzymic generation in honey gives only low levels. Also, antioxidants in honey prevent the formation of free radicals which are responsible for this inflammatory effect. The antioxidants in honey are also the likely explanation of the anti-inflammatory action of honey.

The acidity of honey and its content of sugars and other nutrients are also important for the promotion of the healing process. Acidification of a wound prevents ammonia from bacterial metabolism being harmful to the body tissues. It also increases the release of oxygen from haemoglobin in the blood, oxygenation of the tissues being essential for growth of new tissue. Another important factor for growth of new tissue is a supply of nutrients, usually limited because of damage to the underlying circulation resulting from injury or infection. Honey will supply the cells with a wide range of vitamins, amino acids and minerals. It will also supply white blood cells with the glucose necessary for their "respiratory burst" to destroy bacteria. Further, it will supply nutrients to the cells by drawing serum out through the tissue by osmosis induced by the high sugar content of honey. This is what creates the moist environment for healing, preventing the deformity that would result if the re-growth were forced down by a dry scab forming on the surface. It also serves to create a film of liquid between the tissues and the dressing, which allows the dressing to be lifted off painlessly and without tearing off the recently re-grown cells.

Another benefit is that it serves to reduce swelling in the surrounding inflamed tissue, and thus reduces a major cause of pain. The sugar content of honey also eliminates the unpleasant odour associated with major burns and skin ulcers, as the infecting bacteria use the sugar from the honey in preference to amino acids from the serum and dead cells, from which amines and sulphur compounds are produced.

Other traditional therapeutic uses of honey, for peptic ulcers, diarrhoea, eye infections, and throat infections, have also been researched to find evidence for their effectiveness. Clinical trials have been reported in which honey was found to be effective in the treatment of peptic ulcers and diarrhoea, and a clinical reports of the use of honey for the treatment of eye infections indicate that the treatment is effective. Laboratory research has been carried out that demonstrates that the bacteria that cause these infections are sensitive to the antibacterial action of honey.

In addition, laboratory research has been carried out to establish if there is a rational basis for trialing honey treatment of fungal infections of the skin, for protection of dental health, and treatment of mastitis in dairy cows and goats. In all of these it has been found that the microorganisms involved are sufficiently sensitive to the antimicrobial action of honey for a good therapeutic effect to be expected.

Clinical trials are currently being undertaken to measure the effectiveness of honey as a treatment for persistently non-healing wounds, for eczema, and for mastitis in dairy cattle.



All Articles in this section are reproduced with kind permission of  Professsor  Peter Molan, director of  the research at the Honey Research Unit, Waikato University, New Zealand.



Disclaimer 

Note that we (Medicinal Honey Company Pty. Ltd.) or the manufacturers of any of our products accept no liability for any injury, loss, discomfort, etc., arising from the use of any product supplied. You are strongly advised to seek the advice of your medical practitioner before using any of our products if you are presently taking any medication or if you are in any doubt concerning their use for your condition.  

Medicinal Honey Company Pty. Ltd. presents these research articles on the application of active for general interest only and these articles are not intended to constitute medical advice or to make medical claims. We should say here, of course, that you should consult your doctor or health practitioner before using Medigold  Australian Tea Tree honey for any medicial condition.

 


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