Effect of Natural Honey on Glycemic Control and Anthropometric Measures of Patients with Type 2 Diabetes: A Randomized Controlled Crossover Trial

Comparable Benefits of Stingless Bee Honey and Caffeic Acid in Mitigating the Negative Effects of Metabolic Syndrome on the Brain

There is mounting evidence that metabolic syndrome (MetS) contributes to the development of neurodegenerative disorders such as Alzheimer’s disease. Honey, which has been used for generations, is high in antioxidants and has been demonstrated to benefit the brain and mental health by reducing oxidative stress and boosting cognitive outcomes. Honey from the stingless bees of Heterotrigona itama has been found to have higher phenolic content compared to other types of honeys. The aim of this study is to investigate the effects of stingless bee honey (SBH) supplementation and to compare it with a pure form of antioxidant, caffeic acid (CA), on MetS parameters and inflammatory markers in the brains of MetS-induced rats. A total of 32 male Wistar rats were divided equally into groups of control, high-carbohydrate high-fructose (HCHF) diet (MetS), HCHF + SBH supplemented (1 g/kg) (SBH), and HCHF + CA supplemented (10 mg/kg) (CA) groups. The total duration for SBH and CA supplementation was eight weeks. The HCHF diet was found to promote hypertension, hyperglycemia, and hypertriglyceridemia, and to increase brain TNF-α levels. Supplementation with SBH and CA significantly reversed (p < 0.05) the hyperglycemic and hypertensive effects of the HCHF diet. Although both supplemented groups showed no significant changes to serum HDL or TG, SBH significantly reduced (p < 0.05) brain TNF-α levels and increased (p < 0.05) brain BDNF levels. Immunohistochemistry investigations of neurogenesis (EdU) and apoptosis (TUNEL) on the cornu Ammonis 1 (CA1) and dentate gyrus (DG) areas of the hippocampus showed no changes with SBH and CA supplementation compared to the control. These findings suggest that SBH and CA have the potential to mitigate HCHF-induced MetS effects and possess neuroprotective abilities.

Functional Yogurt Fortified with Honey Produced by Feeding Bees Natural Plant Extracts for Controlling Human Blood Sugar Level

The human blood sugar level is important and should be controlled to avoid any damage to nerves and blood vessels which could lead to heart disease and many other problems. Several market-available treatments for diabetes could be used, such as insulin therapy, synthetic drugs, herbal drugs, and transdermal patches, to help control blood sugar. In a double-blind human study, four kinds of honey from bees fed on acacia, sea buckthorn, chlorella alga, and green walnut extracts were used in fortifying yogurt for controlling human blood sugar. The impact of a previously fortified honey was investigated on blood levels and other parameters of healthy individuals in a human study with 60 participants. The participants received 150 mL of yogurt mixed with 30 g of honey every morning for 21 days. Before and after the study period, the basic blood parameters were tested, and the participants filled out standardized self-report questionnaires. Acacia honey was the traditional honey used as a control; the special honey products were produced by the patented technology. The consumption of green walnut honey had a significant effect on the morning blood sugar level, which decreased for every participant in the group (15 people). The average blood sugar level at the beginning in the walnut group was 4.81 mmol L⁻¹, whereas the value after 21 days was 3.73 mmol L⁻¹. The total decrease level of the individuals was about 22.45% (1.08 mmol L⁻¹). Concerning the sea buckthorn and chlorella alga-based honey product groups, there was no significant change in the blood sugar level, which were recorded at 4.91 and 5.28 mmol L⁻¹ before treatment and 5.28 and 5.07 mmol L⁻¹ after, respectively. In the case of the acacia honey group, there was a slight significant decrease as well, it was 4.77 mmol L⁻¹ at the beginning and 4.27 mmol L⁻¹ at the end with a total decrease rate of 10.48%. It could thus be concluded that the active ingredients of green walnut can significantly decrease the blood sugar level in humans. This study, as a first report, is not only a new innovative process to add herbs or healthy active ingredients to honey but also shows how these beneficial ingredients aid the honey in controlling the human blood sugar level.

History, phytochemistry, experimental pharmacology and clinical uses of honey: A comprehensive review with special reference to Unani medicine

ETHNOPHARMACOLOGICAL RELEVANCE

Honey is one of the most popular functional foods, speculated to be in use since the advent of human civilization. Its health-protective activity is endorsed by many religions and traditional medicines. In Unani medicine, honey is prescribed for many health conditions as wound-healing, anti-inflammatory, anti-diabetic, etc. In the present era, honey is gaining popularity over sugar for its myriad health benefits and low glycemic index. This review attempts to provide a comprehensive account of the biological activities and potential therapeutic uses of honey, with scientific evidence.

METHODOLOGY

In this paper, we have provided a comprehensive overview of historical uses, types, physical characteristics, bioactive constituents and pharmacological activities of honey. The information was gathered from Classical Unani textbooks and leading scientific databases. There is a plethora of information regarding various therapeutic activities of honey, and it is daunting to draw practical conclusions. Hence, in this paper, we have tried to summarize those aspects which are most relevant to clinical application.

OBSERVATIONS AND CONCLUSIONS

Many important bioactive constituents are identified in different honey types, e.g. phenolics, proteins, vitamins, carbohydrates, organic acids, etc., which exert important biological activities like anti-microbial, wound healing, immunomodulatory, anti-toxin, antioxidant, and many others. Honey has the potential to alleviate many lifestyle disorders, mitigate the adverse effects of drugs and toxins, and also provide healthy nutrition. Although conclusive clinical evidence is not available, yet honey may potentially be a safer alternative to sucrose for diabetic patients.

The Effect of Honey on Lipid Profiles: A Systematic Review and Meta-analysis of Controlled Clinical Trials

Honey is known not only as a natural food but also as complementary medicine. According to the controversial evidence about the effects of honey on blood lipids, this meta-analysis was performed to investigate the potential effects of honey on lipid profiles. Relevant studies were identified by searching PubMed, Web of Science (WOS), Scopus, EMBASE, and Cochrane databases. All human controlled clinical trials (either with a parallel or a crossover design) published in English that reported changes in serum lipid markers (Total Cholesterol (TC), Triglyceride (TG), Low Density Lipoprotein Cholesterol (LDL-C), High Density Lipoprotein Cholesterol (HDL-C), and LDL-C/HDL-C ratio) following honey consumption were considered. Standardized Mean Differences (SMDs) and their respective 95% Confidence Intervals (CIs) were calculated to assess the changes in lipid profiles following honey consumption by random effects model. Statistical heterogeneity, sensitivity analysis, publication bias, and quality of the included studies were assessed, as well. The meta-analysis of 23 trials showed that honey had no significant effects on TC, TG, LDL-C, HDL-C, and LDL-C/HDL-C ratio. Significant heterogeneity was seen among the studies for all the studied factors (I2 index > 50%). Subgroup analysis based on the lipid profile status, types of honey, and intervention duration revealed no significant effect on TC, TG, LDL-C, and HDL-C. Quality of the evidences varied form very low to moderate according to various parameters. In conclusion, honey consumption did not affect serum lipid profiles (TC, TG, LDL-C, HDL-C, and LDL-C/HDL-C ratio).

A systematic review of interventions to mitigate radiotherapy-induced oral mucositis in head and neck cancer patients

BACKGROUND

Oral mucositis is a debilitating consequence of radiotherapy in patients with head and neck cancers. Radiation-induced oral mucositis (RIOM) can cause pain and weight loss, reduce quality of life and affect treatment outcomes.

METHODS

A systematic review was undertaken to identify and examine the efficacy of low-cost interventions to mitigate RIOM and to develop clinical guidelines based on the evidence.

RESULTS

The author identified three interventions: benzydamine hydrochloride mouth rinse (BHM), honey and oral glutamine (OG). The search identified twenty-four studies in total. Four studies examined BHM; all findings were favourable, although only one had moderate methodological quality, and the rest were low. The product was poorly tolerated by some participants in one study. Twelve studies examined honey. Eleven of these had favourable results; two studies had moderate methodological quality, and the rest were low. Eight studies examined OG. Six of these had favourable results; two studies had moderate methodological quality, and the rest were low.

CONCLUSION

The author cannot recommend BHM to mitigate RIOM due to the overall low quality of the studies and poor tolerance to the product. The author cannot recommend honey to mitigate RIOM due to weak evidence supporting the intervention. The author can recommend OG to mitigate RIOM. There is a need for high-quality studies with a consensus of the methodology to reduce heterogeneity and examination of the cost-effectiveness of the interventions.

Effects of High-Fiber Biscuits on Lipid and Anthropometric Profile of Patients with Type 2 Diabetes

This study aimed to evaluate the efficacy of two types of high-fiber biscuits on the lipid and anthropometric profile of patients with type 2 diabetes mellitus (DM). This study involved a pre- and posttest randomized controlled trial design conducted on 33 subjects of the first first group given caromma biscuit (made from modified cassava flour mixed with koro sword flour and date jam) and 31 subjects of the second first group given temma biscuit (made from a mixture of tempeh flour with date jam). Each group consumed 100 g of biscuit each day for 4 wk. The anthropometric data collected included body mass index (BMI), waist-hip circumference ratio (WHCR), body fat percentage (BFP), blood pressure, and fasting blood glucose (FBG). The lipid profile included total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride collected before and after the study. The two types of biscuits had similar nutritional contents in terms of energy, carbohydrate, and fat contents, and their glycemic indices were low. However, the fiber content of caromma was higher than that of temma. After 4 wk, the anthropometric profiles, such as BMI (24.47+5.62 to 24.56+5.55; p=0.008), BFP (32.18+6.83 to 32.68+7.22; p=0.4), and WHCR (0.85+0.67 to 0.86+0.65; p=0.015), were unchanged in the caromma and temma groups (BMI 26.68+3.82 to 26.75+3.92; p=0.072; BFP 35.96+5.34 to 35.90+5.15; p=0.907; WHCR 0.86+0.66 to 0.88+0.4; p=0.006), except reducing FBG (167.06+82.8 to 154.85+95.0; p=0.150 in the caromma group and 173.19+92.72 to 150.06+73.64; p=0.095 in the temma group). A significant improvement was observed in the lipid profile of the caromma group (cholesterol, 239.73+35.3 to 195.70+34.13, p=0.000; LDL, 145.18+29.89 to 122.24+29.00, p=0.000; HDL, 61.00+17.76 to 51.12+15.40, p=0.000; triglyceride 175.09+112.64 to 123.67+73.89, p=0.000) and temma group (cholesterol, 264.42+75.10 to 204.68+37.11, p=0.000; LDL, 154.97+53.59 to 125.45+30.56, p=0.001; HDL, 59.68+1,328 to 49.48+11.52, p=0.000; triglyceride, 226.00+172.56 to 152.48+99.88, p=0.007). Lipid and animal protein intake should be limited among patients with type 2 DM. A high lipid profile, which is dangerous for patients with type 2 DM, can be prevented. Originality: Caromma and temma biscuits can be consumed by patients with diabetes. Although these biscuits cannot improve the anthropometric profiles of the subjects, their consumption has positive effects on the blood lipid profile.

The Effects of Oral Consumption of Honey on Key Metabolic Profiles in Adult Patients with Type 2 Diabetes Mellitus and Nondiabetic Individuals: A Systematic Review of Clinical Trials

Objectives

Although several clinical trials have revealed the beneficial effects of honey on metabolic profiles, the results are conflicting. The aim of this study was to systematically summarize the effects of oral consumption of honey on key metabolic profiles in adult patients with type 2 diabetes mellitus (T2DM) and nondiabetic individuals.

Methods

In total, four electronic databases, including PubMed/Medline, Web of Science, Scopus, and Cochrane library, were searched from 2000 to 31 July 2019 to identify all English language studies that would meet the eligibility criteria. Clinical trials which have examined the effects of oral consumption of any types of honey on anthropometric indices, glycemic status, lipid profiles, and blood pressure in both diabetic and nondiabetic adult subjects were included in the study.

Results

Of the 7769 possible relevant studies (including 3547 duplicates) identified in the initial search, finally, 13 clinical trials were included in the systematic review. All studies except three had a parallel design. Of 13 studies, 8 trials did not have placebo/control groups. The included studies examined the impact of oral consumption of honey on glycemic status (n = 12), anthropometric indices (n = 6), lipid profiles (n = 10), and blood pressure (n = 3). Based on the Jadad scale, 5 studies had acceptable methodological quality, and the remaining (n = 8) had low methodological quality.

Conclusion

The current systematic review showed that oral consumption of honey might have no significant effects on the modulation of metabolic profiles in nondiabetic subjects. In addition, a high intake of honey might increase glucose levels and worsen other metabolic parameters in patients with T2DM. Due to substantial heterogeneity in study design and limited clinical trials, results, however, should be interpreted with great caution.

Identification of anti-inflammatory vesicle-like nanoparticles in honey

Honey has been used as a nutrient, an ointment, and a medicine worldwide for many centuries. Modern research has demonstrated that honey has many medicinal properties, reflected in its anti-microbial, anti-oxidant, and anti-inflammatory bioactivities. Honey is composed of sugars, water and a myriad of minor components, including minerals, vitamins, proteins and polyphenols. Here, we report a new bioactive component‒vesicle-like nanoparticles‒in honey (H-VLNs). These H-VLNs are membrane-bound nano-scale particles that contain lipids, proteins and small-sized RNAs. The presence of plant-originated plasma transmembrane proteins and plasma membrane-associated proteins suggests the potential vesicle-like nature of these particles. H-VLNs impede the formation and activation of the nucleotide-binding domain and leucine-rich repeat related (NLR) family, pyrin domain containing 3 (NLRP3) inflammasome, which is a crucial inflammatory signalling platform in the innate immune system. Intraperitoneal administration of H-VLNs in mice alleviates inflammation and liver damage in the experimentally induced acute liver injury. miR-4057 in H-VLNs was identified in inhibiting NLRP3 inflammasome activation. Together, our studies have identified anti-inflammatory VLNs as a new bioactive agent in honey.

Modern Methods for Assessing the Quality of Bee Honey and Botanical Origin Identification

This paper is a summary of the latest literature on methods for assessing quality of natural bee honey. The publication briefly characterizes methods recommended by the International Honey Commission, published in 2009, as well as newer methods published in the last 10 years. Modern methods of assessing honey quality focus mainly on analyzing markers of individual varieties and classifying them into varieties, using, among others, near infrared spectroscopy techniques (NIR), potentiometric tongue, electronic nose, nuclear magnetic resonance (NMR), zymography, polymerase chain reaction (PCR), DNA metabarcoding, and chemometric techniques including partial least squares (PLS), principal component analysis (PCA) and artificial neural networks (ANN). At the same time, effective techniques for analyzing adulteration, sugar, and water content, hydroxymethylfurfural (HMF), polyphenol content, and diastase activity are being sought. Modern techniques enable the results of honey quality testing to be obtained in a shorter time, using the principles of green chemistry, allowing, at the same time, for high precision and accuracy of determinations. These methods are constantly modified, so that the honey that is on sale is a product of high quality. Prospects for devising methods of honey quality assessment include the development of a fast and accurate alternative to the melissopalynological method as well as quick tests to detect adulteration.

Adverse effects of honey on low-density lipoprotein cholesterol and adiponectin concentrations in patients with type 2 diabetes: a randomized controlled cross-over trial

Background

Due to phenolic and fructose content, honey may be a suitable sweetener for patients with type 2 diabetes. However, its effect on oxidative and inflammatory status of diabetes patients is not clear. We aimed to investigate the effect of natural honey on some of oxidative, inflammatory, and anti-inflammatory markers of patients with type 2 diabetes.

Methods

In a randomized controlled cross-over trial, 43 patients with type 2 diabetes were allocated to isocaloric conditions with either dietary recommendations (control) or natural honey (50 g/day) plus dietary recommendations (honey) for 8 weeks with one month washout period in between. Serum lipids, malondialdehyde (MDA), total antioxidant capacity (TAC), high-sensitivity C-reactive protein (hs-CRP), and adiponectin levels were measured at baseline and the end of each sequence.

Results

Malondialdehyde (10.9%, P = 0.01), hs-C reactive protein (10.6%, P = 0.003), and adiponectin (7.1%, P < 0.001) concentrations significantly decreased in honey condition. Low-density lipoprotein cholesterol (LDL-C) (16.8%, P < 0.001) significantly decreased in control and high-density lipoprotein cholesterol (HDL-C) significantly increased in both conditions. Between-group differences were only statistically significant for adiponectin (P = 0.005) and LDL-C (P = 0.005).

Conclusions

Consumption of 50 g/day honey had adverse effects on LDL-C and adiponectin levels in patients with type 2 diabetes. Honey may need to be consumed with caution in type 2 diabetes patients.

Non-nutritive sweeteners for diabetes mellitus

BACKGROUND

Products sweetened with non-nutritive sweeteners (NNS) are widely available. Many people with type 1 or type 2 diabetes use NNS as a replacement for nutritive sweeteners to control their carbohydrate and energy intake. Health outcomes associated with NNS use in diabetes are unknown.

OBJECTIVES

To assess the effects of non-nutritive sweeteners in people with diabetes mellitus.

SEARCH METHODS

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Ovid, Scopus, the WHO ICTRP, and ClinicalTrials.gov. The date of the last search of all databases (except for Scopus) was May 2019. We last searched Scopus in January 2019. We did not apply any language restrictions.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) with a duration of four weeks or more comparing any type of NNS with usual diet, no intervention, placebo, water, a different NNS, or a nutritive sweetener in individuals with type 1 or type 2 diabetes. Trials with concomitant behaviour-changing interventions, such as diet, exercise, or both, were eligible for inclusion, given that the concomitant interventions were the same in the intervention and comparator groups.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened abstracts, full texts, and records retrieved from trials registries, assessed the certainty of the evidence, and extracted data. We used a random-effects model to perform meta-analysis, and calculated effect estimates as risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, using 95% confidence intervals (CIs). We assessed risk of bias using the Cochrane 'Risk of bias' tool and the certainty of evidence using the GRADE approach.

MAIN RESULTS

We included nine RCTs that randomised a total of 979 people with type 1 or type 2 diabetes. The intervention duration ranged from 4 to 10 months. We judged none of these trials as at low risk of bias for all 'Risk of bias' domains; most of the included trials did not report the method of randomisation. Three trials compared the effects of a dietary supplement containing NNS with sugar: glycosylated haemoglobin A1c (HbA1c) was 0.4% higher in the NNS group (95% CI -0.5 to 1.2; P = 0.44; 3 trials; 72 participants; very low-certainty evidence). The MD in weight change was -0.1 kg (95% CI -2.7 to 2.6; P = 0.96; 3 trials; 72 participants; very low-certainty evidence). None of the trials with sugar as comparator reported on adverse events. Five trials compared NNS with placebo. The MD for HbA1c was 0%, 95% CI -0.1 to 0.1; P = 0.99; 4 trials; 360 participants; very low-certainty evidence. The 95% prediction interval ranged between -0.3% and 0.3%. The comparison of NNS versus placebo showed a MD in body weight of -0.2 kg, 95% CI -1 to 0.6; P = 0.64; 2 trials; 184 participants; very low-certainty evidence. Three trials reported the numbers of participants experiencing at least one non-serious adverse event: 36/113 participants (31.9%) in the NNS group versus 42/118 participants (35.6%) in the placebo group (RR 0.78, 95% CI 0.39 to 1.56; P = 0.48; 3 trials; 231 participants; very low-certainty evidence). One trial compared NNS with a nutritive low-calorie sweetener (tagatose). HbA1c was 0.3% higher in the NNS group (95% CI 0.1 to 0.4; P = 0.01; 1 trial; 354 participants; very low-certainty evidence). This trial did not report body weight data and adverse events. The included trials did not report data on health-related quality of life, diabetes complications, all-cause mortality, or socioeconomic effects.

AUTHORS' CONCLUSIONS

There is inconclusive evidence of very low certainty regarding the effects of NNS consumption compared with either sugar, placebo, or nutritive low-calorie sweetener consumption on clinically relevant benefit or harm for HbA1c, body weight, and adverse events in people with type 1 or type 2 diabetes. Data on health-related quality of life, diabetes complications, all-cause mortality, and socioeconomic effects are lacking.

Honey consumption is inversely associated with prediabetes among Chinese adults: results from the Tianjin Chronic Low-Grade Systemic Inflammation and Health (TCLSIH) Cohort Study

Evidence has suggested that honey intake has a beneficial impact on glycaemic control in patients with type 2 diabetes. Whether these findings apply to adults with prediabetes is yet unclear. The aim of the present study was to examine whether honey intake is associated with a lower prevalence of prediabetes. A cross-sectional study was performed in 18 281 participants (mean age 39·6 (sd 11·1) years; men, 51·5 %). Dietary intake was assessed through a validated 100-item FFQ. Prediabetes was defined according to the American Diabetes Association criteria: impaired fasting glucose, impaired glucose tolerance or raised glycosylated Hb. Multivariable logistic regression models were used to estimate the association between honey consumption and prediabetes. As compared with those who almost never consumed honey, the multivariable OR of prediabetes were 0·94 (95 % CI 0·86, 1·02) for ≤3 times/week, 0·77 (95 % CI 0·63, 0·94) for 4-6 times/week and 0·85 (95 % CI 0·73, 0·99) for ≥1 time/d (Pfor trend < 0·01). These associations did not differ substantially in sensitivity analysis. Higher honey consumption was associated with a decreased prevalence of prediabetes. More large prospective cohort studies are needed to investigate this association.