Honey, especially robinia (also known as acacia honey, a honey from false acacia or black locust trees), clover, and unprocessed raw honey, may improve glycemic control and lipid levels when consumed within a healthy dietary pattern, according to a new systematic review and meta-analysis led by the University of Toronto scientists.
Ahmed et al. showed that oral honey intake reduced fasting glucose, total cholesterol, LDL-C, fasting triglycerides, and ALT and increased HDL-C, IL-6, and TNF-α. Image credit: Fancycrave1.
High intake of added or free sugars has been shown to contribute to the rise in obesity, type 2 diabetes, and cardiovascular disease.
Health and nutrition guidelines call for a reduction in consumption of added sugars, with health agencies recommending an intake of no more than 5% to 10% of total energy intake per day.
Most regulatory agencies, including the World Health Organization, the Heart and Stroke Foundation, and the US Food and Drug Administration, include honey within their definition of free or added sugars. In contrast, honey is often regarded by the public as a healthier alternative to sugar.
Honey is a complex composition of sugars (common and rare), organic acids, enzymes, proteins, amino acids, minerals, vitamins, and bioactive substances made by honeybees from the nectar of flowers.
It has shown many benefits for cardiometabolic health in animal, clinical, and in vitro trials.
Among these benefits are improvements in body weight, inflammation, lipid profile, and glycemic control.
However, the evidence for this effect in human studies has not been systematically evaluated and quantified.
Furthermore, it is unclear whether the effect of honey differs by the type of honey, such as floral source, and whether honey is raw or processed.
“Our results are surprising, because honey is about 80% sugar,” said Dr. Tauseef Khan, a researcher at the University of Toronto and St Michael’s Hospital.
“But honey is also a complex composition of common and rare sugars, proteins, organic acids and other bioactive compounds that very likely have health benefits.”
Dr. Khan and colleagues conducted a systematic review and meta-analysis of controlled trials to examine the effect of honey intake on adiposity, glycemia, lipids, blood pressure, markers of nonalcoholic fatty liver disease, and inflammatory markers and to assess the certainty of the evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach.
They included a total of 18 controlled trials with 1,105 participants in their analysis.
The median daily dose of honey in the trials was 40 grams, or about two tablespoons. The median length of trial was eight weeks.
The authors found that honey lowered fasting blood glucose, total and LDL or ‘bad’ cholesterol, triglycerides, and a marker of fatty liver disease; it also increased HDL or ‘good’ cholesterol, and some markers of inflammation.
Raw honey drove many of the beneficial effects in the studies, as did honey from monofloral sources such as robinia and clover, which is common in North America.
“While processed honey clearly loses many of its health effects after pasteurization — typically 65 degrees Celsius for at least 10 minutes — the effect of a hot drink on raw honey depends on several factors, and likely would not destroy all its beneficial properties,” Dr. Khan said.
“The word among public health and nutrition experts has long been that ‘a sugar is a sugar’,” said Dr. John Sievenpiper, also from the University of Toronto and St Michael’s Hospital.
“These results show that’s not the case, and they should give pause to the designation of honey as a free or added sugar in dietary guidelines.”
“We’re not saying you should start having honey if you currently avoid sugar,” Dr. Khan added.
“The takeaway is more about replacement — if you’re using table sugar, syrup or another sweetener, switching those sugars for honey might lower cardiometabolic risks.”
The findings were published in the journal Nutrition Reviews.
Amna Ahmed et al. Effect of honey on cardiometabolic risk factors: a systematic review and meta-analysis. Nutrition Reviews, published online November 16, 2022; doi: 10.1093/nutrit/nuac086