How Sweet: Honey May Help Reduce Cardiometabolic Risks

A systematic review and meta-analysis of clinical trials revealed that honey helps to lower fasting blood glucose, total LDL cholesterol, triglycerides, and a marker of fatty liver disease while increasing HDL cholesterol levels and some markers of inflammation. 

“These results are surprising, because honey is about 80 percent sugar,” said Tauseef Khan, who is a senior researcher on the study and a research associate in nutritional sciences at U of T’s Temerty Faculty of Medicine. “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.”

Honey has been shown to help improve cardiometabolic health in previous research, especially in in Vitro and animal studies. This study is suggested to be the most comprehensive review to date of the available clinical trials on honey, and it also includes the most detailed information on processing as well as floral sources. 

“The word among public health and nutrition experts has long been that a sugar is a sugar,” said John Sievenpiper, who is a principal investigator and an associate professor of nutritional sciences and medicine at U of T, who is also a clinician-scientist at Unity Health Toronto. “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.”

The researchers note that the findings of the study are important to be taken in context as the clinical trials in which the participants followed healthy dietary patterns, only had added sugars accounting for 10% or less of their daily caloric intake. 

“We’re not saying you should start having honey if you currently avoid sugar,” said Khan. “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.”

18 controlled trials involving over 1,100 participants were included in this study analysis, with the quality of the trials being assessed using the GRADE system, even though there was a low certainty of evidence for most of the studies honey consistently produced either neutral or beneficial effects that were dependant on processing, flora sources and quantity. 

The median dose of honey was 40 grams (around 2 tablespoons), and the median trial length was 8 weeks. Raw honey was found to drive many of the beneficial effects as did honey from single flora sources such as Robinia (acacia honey) and False Acacia, Black Locust Trees and common clover. According to Khan, processed honey loses many of its health benefits after pasteurization but the effect of a hot drink on raw honey depends on several factors and would not be likely to destroy all of the beneficial properties. However, he did note other ways to consume unheated honey such as with yogurt, as a spread, or in a salad dressing that would retain all of the beneficial properties. 

Khan hopes to focus on unprocessed honey from a single flora source in future studies as this would create higher quality evidence and a better understanding of the compounds in honey promoting positive health benefits.  “We need a consistent product that can deliver consistent health benefits,” said Khan. “Then the market will follow.”

The research was supported by the Canadian Institutes of Health Research, the Canada Foundation for Innovation, the Ministry of Research and Innovation's Ontario Research Fund, and Diabetes Canada.

Tauseef Khan has received prior funding support from the Canadian Institutes of Health Research, the International Life Sciences Institute, and the U.S. National Honey Board. For a full list of all researchers’ past funding, see the Declaration of Interest section at the end of the journal article.