Honey is a natural sweetener that contains a large number of simple sugars such as glucose and fructose. The nutritional value of honey is more than the carbohydrate content it also contains vitamins, minerals, enzymes, amino acids, and polyphenols including phenolic acids and flavonoids. The polyphenols in honey have been proven to have excellent antioxidant activity, besides inhibiting α-glycosidase activity (an enzyme that breakdown carbohydrates to glucose) and improving blood-lipid metabolism. However, many people with diabetes question whether consuming honey is ok for keeping their blood glucose within the healthy range (1).

    The effect of honey on blood glucose was tested in a few animal studies. One study investigated the effects of honey, metformin (a drug to lower blood glucose in diabetes), and their combination on the characteristic pathological changes and glucose metabolism in diabetic mice over five weeks. The results showed that honey and its combination with metformin could prevent hyperglycemia, stimulate insulin secretion, reduce liver fat accumulation, and attenuate liver injury and kidney damage in these diabetic mice. Treatment with honey or a combination of honey and metformin significantly enhanced glucokinase activity (p < 0.05), and meanwhile suppressed the activities of glucose-6-phosphatase, phosphoenolpyruvate carboxykinase, pyruvate carboxylase, and pyruvate dehydrogenase kinases (p < 0.05) in diabetic mice. These are all key enzymes involved in glucose metabolism (1).

    Based on these experiment results, the effects of honey on blood glucose could be summarized into three aspects by regulating the key enzymes of glucose metabolism: stimulating the activities of key enzymes for glycolysis to promote the utilization of glucose; promoting the aerobic oxidation of pyruvic acid by inhibiting the activities of key enzymes involved in pyruvate metabolism; and reducing the source of new blood glucose production by lowering the activities of key enzymes for gluconeogenesis (1).

    In this study, the authors used two types of honey, one was Buckwheat honey which was provided by bee farmers in Liaoning Province, China, and another was rape honey which was provided by bee farmers in Hubei Province, China. If you take a closer look at the study results (1), it would not be hard to notice that the extents of blood glucose lowering effects were very close between honey (1 g/kg body weight) alone treatments and metformin (200 mg/kg body weight) treatment. It means that natural honey can reach a similar effectiveness for lowering blood glucose as that metformin, the most commonly used medication for diabetes.

    Diabetic neuropathy is the most common complication affecting more than 50% of patients with longstanding diabetes. One study (2) examined the effect of honey and insulin treatment on hyperglycemia, dyslipidemia, oxidant, anti-oxidant status, and nerve conduction in experimental diabetic neuropathy rats. Diabetic neuropathy was induced in rats with high fat and high sugar diet for 8 weeks followed by streptozotocin injection.  After the development of diabetes, rats were given standard chow and allowed four more weeks to remain diabetic and to develop neuropathy. All the diabetic rats of the experimental group developed neuropathy after 4 weeks of developing diabetes. After the development of neuropathy, these 40 rats were randomly divided into diabetic neuropathy with no treatment group (n=8) and three treatment groups of either the honey group (0.5 g/kg body weight per day) or insulin group or honey+insulin group (n = 8, each) for six weeks.

    After six weeks of intervention, there was a significant decrease in blood glucose in honey (-53.2%), insulin (-69.3%), and honey+insulin (-73.3%) treated neuropathy rats, when compared with the no-treatment group. Lipid levels such as total cholesterol and triglycerides were also decreased in the treatment groups compared to that of the no-treatment group, with honey+insulin treatment having the largest and statistically significant reduction at -25.5% and -30.3%, respectively.  Malondialdehyde (an oxidative stress marker) was reduced and total anti-oxidant status improved in all three treatment groups. The sensory nerve conduction velocity improved significantly in honey+insulin-treated neuropathy rats. This study showed that a six-week honey treatment helped in reducing dyslipidemia and oxidative stress. Honey given along with insulin for six weeks improved sensory nerve conduction velocity in experimental diabetic neuropathy rats (2).

    How about honey's effects on blood glucose in people with or without diabetes? The effect of natural honey on blood glucose was tested in 97 type-2 diabetic patients (62 females and 35 males, ages 25-68 years). The study participants were randomly divided to receive either 75 g honey (group 1), 30 g honey (group 2), or 75 g glucose (group 3). Blood samples were analyzed at baseline, after 1 and 2 hours (3).

    The mean rise in blood glucose after two hours in group 1 was 85mg/dL; in group 2, 30 mg/dL; and group 3, 170 mg/dL. The difference was statistically significant (p <0.005). The glucose response was significantly lower at 2 hours in group 2 (p <0.001) compared to group 1 or group 3. There was also a significant difference between groups 1 and 3 (p <0.0001). The plasma glucose level in response to honey peaked at 1 hour and showed a rapid decline compared to that of glucose, indicating a lower glycemic response to honey. A small proportion of patients 3 (10.7%) even showed a glucose-lowering effect after a low dose of honey. The authors suggested that a low dose of honey can be a valuable sugar substitute for patients with diabetes (3).

    The blood glucose and plasma insulin responses to some simple carbohydrates (glucose, fructose, lactose) and some complex ones (apples, potatoes, bread, rice, carrots, and honey) were studied in 32 type-2 diabetic patients. Blood glucose and plasma insulin were measured at baseline and then at 15, 30, 60, 90, and 120 minutes after ingestion of 25 g glucose, fructose or lactose, or 30 g honey, 50 g white bread, 125 g white rice or potatoes, 150 g apples or 260 g carrots. Maximum blood glucose and plasma insulin responses were recorded 60 minutes after ingestion of each test meal. At this time the increases in blood glucose and plasma insulin were significantly higher after the more refined carbohydrates (glucose, fructose, and lactose) than after the more complex ones (apples, potatoes, rice, carrots, and honey, p< 0.01). Counting the blood glucose increase after glucose as 100%, the corresponding increases in blood glucose for other carbohydrates were: fructose, 81.3%; lactose, 68.6%; apples, 46.9%; potatoes, 41.4%; bread, 36.3%; rice, 33.8%; honey, 32.4% and carrots, 16.1% (4).

    The relative glycemic tolerance of natural honey compared with simulated honey and glucose using oral glucose tolerance testing up to 180 minutes was conducted in 26 healthy human subjects with a mean age of 28.6 ± 9.3 years. The study participants were randomly divided into 3 groups, that is, natural honey consumers (n= 13), simulated honey consumers (n= 6), and glucose consumers (n= 7). After recording fasting blood glucose, the participants consumed either natural honey or simulated honey or glucose (1g/kg body weight). Subsequently, additional plasma glucose levels were recorded at 60, 120, and 180 minutes. At 60 minutes, glucose and simulated honey group members exhibited similar plasma glucose level elevation (that is, 52% and 47%, respectively) compared to the natural honey group with only a 20% increment. On the other hand, after 180 minutes, a 20% decrease in plasma glucose level was observed in the glucose group compared to a 9.75% reduction in the natural honey group. Results showed that glucose response was significantly lower in the natural honey group at all time points (p < 0.005) compared to the simulated honey and glucose groups. The study suggested that natural honey could stabilize physiological glycemic response with rebound recovery of plasma glucose level (5).

    Diabetic neuropathy, a common complication of type 2 diabetes, can occur despite adequate treatment. A study assessed the effects of three months of honey supplementation on insulin resistance, lipid profiles, oxidant status, nerve conduction, and QOL in 48 patients (mean age of 58.9 ± 7.9 years) with diabetic neuropathy. The study participants took honey for three months at a dose of 0.5 gm/Kg of body weight per day. They completed the Neuropathy Total Symptom Score-6 (NTSS-6) questionnaire and the Norfolk QOL Diabetic Neuropathy (Norfolk QOL-DN) questionnaire at baseline and post-intervention. The glucose levels, lipid profiles, and biochemical markers were analyzed before and after the treatment (6).

    A significant reduction occurred in the NTSS-6 score (p < .0001) and the Norfolk QOL-DN total score (p < .0001) from baseline to post-intervention. The fasting blood glucose, triglycerides, and total cholesterol decreased significantly (p<0.05). The malondialdehyde (MDA), and inflammatory markers interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) also decreased significantly, and MDA showed a significant correlation with neuron-specific enolase. These authors concluded that three months of honey supplementation reduced participants' subjective pain scores and symptoms from diabetic neuropathy and improved their QOL (6).

Honey is a natural substance with various medicinal properties, which include antibacterial, antihypertensive, hepatoprotective, hypoglycemic, and antioxidant effects. Diabetic patients tend to crave sweet-tasting foods so it is usually advised to reduce or omit sugar from their diet.
    
    Honey has an anti-hyperglycemic and anti-inflammatory effect and it is a potent antioxidant. Honey being a sweet-tasting substance, can be a good supplement to give satisfaction and at the same time help to reduce the complications of diabetes.
 

References:

1. Yue Ding, Mingjuan Xu, Qun Lu, Ping Wei, Jun Tan, Rui Liu. Combination of honey with metformin enhances glucose metabolism and ameliorates hepatic and nephritic dysfunction in STZ-induced diabetic mice. Food Funct. 2019;10(11):7576-7587. doi: 10.1039/c9fo01575b.

2.  Allampalli Sirisha, Girwar Singh Gaur, Pravati Pal, Zachariah Bobby, Bharathi Balakumar, Gopal Krushna Pal. Effect of honey and insulin treatment on oxidative stress and nerve conduction in an experimental model of diabetic neuropathy Wistar rats. PLoS One. 2021;16(1):e0245395. doi: 10.1371/journal.pone.0245395. eCollection 2021.

3. Lubna Nazir, Faiza Samad, Wahid Haroon, Saera Sohail Kidwai, Shaista Siddiqi, Mahrukh Zehravi. Comparison of glycaemic response to honey and glucose in type 2 diabetes. J Pak Med Assoc. 2014; 64(1):69-71.

4. C Ionescu-Tîrgovişte, E Popa, E Sîntu, N Mihalache, D Cheţa, I Mincu. Blood glucose and plasma insulin responses to various carbohydrates in type 2 (non-insulin-dependent) diabetes. Diabetologia. 1983; 24(2):80-4. doi: 10.1007/BF00297385.

5. A Ahmad, M K Azim, M A Mesaik, R A Khan. Natural honey modulates physiological glycemic response compared to simulated honey and D-glucose Comparative Study. J Food Sci. 2008; 73(7):H165-7. doi: 10.1111/j.1750-3841.2008.00887.x.

6. Allampalli Sirisha, Girwar Singh Gaur, Pravati Pal, Bettadpura Shamanna Suryanarayana, Zachariah Bobby, Gopal Krushna Pal. Effects of Three Months of Honey Supplementation on Quality of Life and Neuropathy in Type 2 Diabetic Patients. Altern Ther Health Med. 2021; 27(S1):54-60.
   
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