Manuka Honey

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Manuka Honey

Common Names

  • Tea tree honey
  • Australian tea tree honey
  • Active Manuka honey
  • Antibacterial honey

For Patients & Caregivers

How It Works

Manuka honey may help prevent infections and promote wound healing when used externally.

Manuka honey can help fight bacterial infections and has been used in dressings to promote wound healing. Methylglyoxal, a major compound in this honey, is thought to be responsible for these effects. In vitro and animal studies also suggest anti-inflammatory and anti-ulcer properties. Small studies in humans suggest its benefits against gingivitis and inflamed nasal sinuses. However, it has not been found to be effective in reducing cancer treatment-related side effects such as inflammation or sores in the mouth or throat. Larger studies are needed.

Purported Uses
  • Wound dressings
    Small studies suggest the value of manuka honey in wound healing.
  • Antibiotics
    Topical use of manuka was shown to be effective against bacteria.
  • Diabetes
    Clinical trials are lacking. Excessive use of honey may increase in blood sugar levels.
  • Gastrointestinal tract problems
    Clinical trials have not been able to confirm if manuka can improve beneficial bacteria in the gut.
  • Infections
    Several case studies have described manuka as being effective to treat wounds that did not respond to standard treatment.
  • Cancer prevention/treatment
    Clinical trials are lacking.
  • Radiation side effects
    Clinical trials did not find any benefit with manuka for either radiation-induced oral mucositis or esophagitis, but one study found that it reduced bacterial infections.
  • Oral health
    One small study suggests using manuka may help reduce buildup of plaque and gingivitis. Large-scale studies are needed.
Patient Warnings

Although manuka honey has antibacterial effects, patients should not self-medicate with honey products. Any infection should be examined by a physician or a qualified healthcare professional for proper care.

Side Effects
  • The sugar content in honey may raise the blood glucose level of diabetics.
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For Healthcare Professionals

Clinical Summary

Manuka honey is collected from beehives around the Manuka bush (Leptospermum scoparium) that is indigenous to Australia and New Zealand. It has been used both as food and as a topical treatment for wounds, burns, and ulcers.

In vitro and animal studies show that manuka has antibacterial (1) (25) (26), anti-inflammatory (9) (27), antioxidant, and anti-ulcer (27) effects. The constituent methylglyoxal is the major bactericidal factor (21). Manuka honey was also effective against several antibiotic-resistant bacteria (28) (29) (30).

Small studies in humans suggest potential utility of manuka honey preparations for atopic dermatitis (35), gingivitis (2), oral hygiene (33), rhinosinusitis (32), corneal edema (24), and dry eye symptoms (36). However, randomized trials did not find it more effective than standard treatments for catheter-associated bacterial infections (6), nasal decolonization of meticillin-resistant S. aureus (MRSA) (37), venous leg ulcers (20), or eyelid surgical wounds (31). Although manuka honey has been used to increase beneficial bacteria levels and relieve gastrointestinal problems, it was not found to be useful in healthy subjects (7). It also did not reduce cholesterol levels in subjects with hypercholesterolemia (8).

The anticancer potential of manuka honey has not been investigated yet, although a few studies evaluated it to relieve treatment-related side effects. Manuka was not effective in alleviating radiation-induced oral mucositis (19) (22), although one study reported a reduction in bacterial infections (22). It was also not superior to best supportive care to prevent radiation esophagitis, but did appear to reduce opioid use at 4 weeks (5). Larger studies are needed to determine the therapeutic value of manuka.

Purported Uses
  • Wound healing
  • Infections
  • Diabetes
  • GI problems
  • Cancer
  • Radiation side effects
  • Oral health
Mechanism of Action

Flavonoids present in manuka demonstrated anti-inflammatory, antimicrobial, and anticancer properties (13). Methylglyoxal, a phytochemical, is the major bactericidal factor and promotes free radical generation (14) (21). Manuka honey was shown to reduce motility of Pseudomonas aeruginosa, a gram negative bacterium and opportunistic pathogen, by suppressing genes associated with its flagella, thereby reducing virulence (34). It also inhibited the formation of biofilm, a complex polysaccharide structure produced by some bacteria such as Clostridium dificile, which confers antibiotic resistance (30). Anti-ulcer effects are attributed to increased gastric mucosal levels of glutathione peroxidase and superoxide dismutase and reductions of inflammatory cytokines including tumor necrosis factor (TNF-alpha), Interleukins 1-beta and 6 (27).

Manuka honey enhanced effects of antioxidants in animal studies (15) and promoted wound healing by modulating cytokine production (4) and lowering pH on wound surfaces (16). Some products list antibacterial potency by using a Unique Manuka Factor (UMF) rating, which is equal to the inhibitory potential of a phenolic solution of the same strength (7). However, clinical relevance of this measurement is unclear.

Contraindications

Individuals allergic to honey should avoid this product.

Adverse Reactions

Manuka honey may increase blood glucose levels.

Herb Lab Interactions

The sugar in manuka may raise the blood glucose level in diabetics.

Dosage (OneMSK Only)
References
  1. Cooper RA, Molan PC, Harding KG. Antibacterial activity of honey against strains of Staphylococcus aureus from infected wounds. J R Soc Med. Jun 1999;92(6):283-285.
  2. English HK, Pack AR, Molan PC. The effects of manuka honey on plaque and gingivitis: a pilot study. J Int Acad Periodontol. Apr 2004;6(2):63-67.
  3. Cooper RA, Molan PC, Harding KG. The sensitivity to honey of Gram-positive cocci of clinical significance isolated from wounds. J Appl Microbiol. 2002;93(5):857-863.
  4. Tonks AJ, Cooper RA, Jones KP, Blair S, Parton J, Tonks A. Honey stimulates inflammatory cytokine production from monocytes. Cytokine. Mar 7 2003;21(5):242-247.
  5. Fogh SE, Deshmukh S, Berk LB, et al. A Randomized Phase 2 Trial of Prophylactic Manuka Honey for the Reduction of Chemoradiation Therapy-Induced Esophagitis During the Treatment of Lung Cancer: Results of NRG Oncology RTOG 1012. Int J Radiat Oncol Biol Phys. Mar 15 2017;97(4):786-796.
  6. Johnson DW, van Eps C, Mudge DW, et al. Randomized, controlled trial of topical exit-site application of honey (Medihoney) versus mupirocin for the prevention of catheter-associated infections in hemodialysis patients. J Am Soc Nephrol. May 2005;16(5):1456-1462.
  7. Wallace A, Eady S, Miles M, et al. Demonstrating the safety of manuka honey UMF 20+in a human clinical trial with healthy individuals. Br J Nutr. Apr 2010;103(7):1023-1028.
  8. Munstedt K, Hoffmann S, Hauenschild A, Bulte M, von Georgi R, Hackethal A. Effect of honey on serum cholesterol and lipid values. J Med Food. Jun 2009;12(3):624-628.
  9. Prakash A, Medhi B, Avti PK, Saikia UN, Pandhi P, Khanduja KL. Effect of different doses of Manuka honey in experimentally induced inflammatory bowel disease in rats. Phytother Res. Nov 2008;22(11):1511-1519.
  10. Adams CJ, Manley-Harris M, Molan PC. The origin of methylglyoxal in New Zealand manuka (Leptospermum scoparium) honey. Carbohydr Res. May 26 2009;344(8):1050-1053.
  11. Weston RJ, Mitchell KR, Allen KL. Antibacterial phenolic components of New Zealand manuka honey. Food Chemistry. 1999;64(3):295-301.
  12. Yao L, Datta N, Tomás-Barberán FA, Ferreres F, Martos I, Singanusong R. Flavonoids, phenolic acids and abscisic acid in Australian and New Zealand Leptospermum honeys. Food Chemistry. 2003;81(2):159-168.
  13. Lopez-Lazaro M. Flavonoids as anticancer agents: structure-activity relationship study. Curr Med Chem Anticancer Agents. Nov 2002;2(6):691-714.
  14. Kalapos MP. The tandem of free radicals and methylglyoxal. Chem Biol Interact. Feb 15 2008;171(3):251-271.
  15. Medhi B, Prakash A, Avti PK, Saikia UN, Pandhi P, Khanduja KL. Effect of Manuka honey and sulfasalazine in combination to promote antioxidant defense system in experimentally induced ulcerative colitis model in rats. Indian J Exp Biol. Aug 2008;46(8):583-590.
  16. Gethin G, Cowman S. Bacteriological changes in sloughy venous leg ulcers treated with manuka honey or hydrogel: an RCT. J Wound Care. Jun 2008;17(6):241-244, 246-247.
  17. Timm M, Bartelt S, Hansen EW. Immunomodulatory effects of honey cannot be distinguished from endotoxin. Cytokine. Apr 2008;42(1):113-120.
  18. Cooper RA, Jenkins L, Henriques AF, Duggan RS, Burton NF. Absence of bacterial resistance to medical-grade manuka honey. Eur J Clin Microbiol Infect Dis. Jun 13 2010.
  19. Hawley P, Hovan A, McGahan CE, Saunders D. A randomized placebo-controlled trial of manuka honey for radiation-induced oral mucositis. Support Care Cancer. 2014 Mar;22(3):751-61.
  20. Jull A, Walker N, Parag V, et al. Randomized clinical trial of honey-impregnated dressings for venous leg ulcers. Br J Surg. 2008 Feb;95(2):175-82.
  21. Kwakman PH, Te Velde AA, de Boer L, Vandenbroucke-Grauls CM, Zaat SA. Two major medicinal honeys have different mechanisms of bactericidal activity. PLoS One. 2011 Mar 4;6(3):e17709.
  22. Bardy J, Molassiotis A, Ryder WD, et al. A double-blind, placebo-controlled, randomised trial of active manuka honey and standard oral care for radiation-induced oral mucositis. Br J Oral Maxillofac Surg. 2012 Apr;50(3):221-6.
  23. Aron M, Victoria Akinpelu O, Dorion D, Daniel S. Otologic safety of manuka honey. J Otolaryngol Head Neck Surg. 2012 Apr;41 Suppl 1:S21-30.
  24. Albietz JM, Lenton LM. Standardised antibacterial Manuka honey in the management of persistent post-operative corneal oedema: a case series.Clin Exp Optom. 2015 Sep;98(5):464-72.
  25. Kumar ND, Kalluru RS, Ahmed S, et al. Comparison of the Antibacterial Efficacy of Manuka Honey Against E.faecalis and E.coli - An In vitro Study. J Clin Diagn Res. 2014 Aug;8(8):ZC29-31.
  26. Schmidlin PR, English H, Duncan W, Belibasakis GN, Thurnheer T. Antibacterial potential of Manuka honey against three oral bacteria in vitro. Swiss Dent J. 2014;124(9):922-4.
  27. Almasaudi SB, El-Shitany NA, Abbas AT, et al. Antioxidant, Anti-inflammatory, and Antiulcer Potential of Manuka Honey against Gastric Ulcer in Rats. Oxid Med Cell Longev. 2016;2016:3643824.
  28. Hillitt KL, Jenkins RE, B Spiller O, Beeton ML. Antimicrobial activity of Manuka honey against antibiotic resistant strains of the cell wall free bacteria Ureaplasma parvum and Ureaplasma urealyticum. Lett Appl Microbiol. 2017 Mar;64(3):198-202.
  29. Jenkins R, Wootton M, Howe R, Cooper R. A demonstration of the susceptibility of clinical isolates obtained from cystic fibrosis patients to manuka honey. Arch Microbiol. 2015 May;197(4):597-601.
  30. Hammond EN, Donkor ES, Brown CA. Biofilm formation of Clostridium difficile and susceptibility to Manuka honey. BMC Complement Altern Med. 2014 Sep 3;14:329.
  31. Malhotra R, Ziahosseini K, Poitelea C, Litwin A, Sagili S. Effect of Manuka Honey on Eyelid Wound Healing: A Randomized Controlled Trial. Ophthal Plast Reconstr Surg. Jul/Aug 2017;33(4):268-272.
  32. Lee VS, Humphreys IM, Purcell PL, Davis GE. Manuka honey sinus irrigation for the treatment of chronic rhinosinusitis: a randomized controlled trial. Int Forum Allergy Rhinol. 2017 Apr;7(4):365-372.
  33. Rupesh S, Winnier JJ, Nayak UA, Rao AP, Reddy NV, Peter J. Evaluation of the effects of manuka honey on salivary levels of mutans streptococci in children: a pilot study. J Indian Soc Pedod Prev Dent. 2014 Jul-Sep;32(3):212-9.
  34. Roberts AE, Maddocks SE, Cooper RA. Manuka honey reduces the motility of Pseudomonas aeruginosa by suppression of flagella-associated genes. J Antimicrob Chemother. 2015 Mar;70(3):716-25.
  35. Alangari AA, Morris K, Lwaleed BA, et al. Honey is potentially effective in the treatment of atopic dermatitis: Clinical and mechanistic studies. Immun Inflamm Dis. Jun 2017;5(2):190-199.
  36. Albietz JM, Schmid KL. Randomised controlled trial of topical antibacterial Manuka (Leptospermum species) honey for evaporative dry eye due to meibomian gland dysfunction. Clin Exp Optom. Nov 2017;100(6):603-615.
  37. Poovelikunnel TT, Gethin G, Solanki D, et al. Randomized controlled trial of honey versus mupirocin to decolonize patients with nasal colonization of meticillin-resistant Staphylococcus aureus. J Hosp Infect. Feb 2018;98(2):141-148.
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