Wound care is problematic for people with diabetes. A mere nick from an ill-fitting shoe or hangnail haphazardly cut can fester for months and develop into a gaping ulcer teeming with bacteria. Foot ulcers, in fact, are the most common reason people with diabetes are hospitalized, and studies show that an alarming 1 out of 5 people with an infected ulcer ends up undergoing amputation. Recently, however, researchers have started to find that an ancient and affordable remedy—a dab of a certain type of honey with potent antimicrobial properties—is a worthy weapon against an ulcer that refuses to heal.
People like Rita Arsenault, a retired bank administrator from Methuen, Mass., can vouch for what honey can do. Arsenault, who has diabetes and developed a gaping sore near her toe after a nighttime spider bite, says she could nearly see her tendon when the silver-dollar-size wound had reached its peak. (Diabetes typically worsens ulcers by making it more difficult for the body to replace infected tissue with healthy skin.) Some doctors Arsenault consulted recommended a skin graft, but there's a good chance that wouldn't have worked, she says, in which case she most likely would have lost her foot. Instead, she went with a doctor who was willing to try treating her with honey-infused bandages. After a little more than a month, her foot ulcer was gone. "I hardly even have a scar," she says.
Using honey to treat wounds is hardly a new idea. Anthropologists have found evidence showing ancient Egyptians used the approach as far back as 5,000 years ago. Aristotle wrote of using the sweet stuff as a salve for wounds around 350 B.C. The practice has persisted to the present day in certain tribal areas in Africa. Yet the bulk of the 2 million Americans with chronic foot ulcers probably aren't aware of honey's curative power, says Peter Molan, a researcher at the University of Waikato in New Zealand who has been studying honey's properties for decades.
Research suggests that honey's microbe-killing ability stems from its tendency to dehydrate bacteria and its high acidity. Yet the antimicrobial potency of different strains of honey varies as much as 100-fold, and scientists are still working to pinpoint specific substances that make some types so much more potent than others. The most potent, for example, is a strain called Manuka honey, which is produced mainly in New Zealand.
As many bacteria become increasingly resistant to conventional antibiotics, more doctors have been willing to give honey a try. "[It] can seem bizarre or like an alternative treatment, but when you investigate the evidence, you find that there's plenty of good research to support using honey," says Paul Liguori, Arsenault's doctor and a physician at Whittier Rehabilitation Hospital in Haverhill, Mass. Indeed, a study published in August in the Journal of Clinical Nursing found that treating venous ulcers with honey dressings for 12 weeks decreased their size 34 percent. By contrast, dressings kept moist by hydrogel, a transparent gel that's commonly used on wounds, cut the size by only 13 percent during the study. A month earlier, Molan published a paper in Advances in Skin & Wound Care, arguing that honey is particularly useful for diabetic foot ulcers. He cites several clinical trials and hundreds of case reports in which honey appeared to be more effective than conventional treatments.
For difficult-to-treat diabetic wounds, which are often infiltrated by staph bacteria or other pathogens, doctors may use silver-containing bandages, although they can be pricey relative to other treatments. A 2007 analysis in the Cochrane Review, however, found little rigorous evidence to support their use. "Billions of dollars have been put into promoting silver dressings, but the clinical evidence supporting their use is almost nonexistent," says Molan. Other review studies, which considered the evidence for various types of modern antimicrobial wound dressings—such as iodine—have also been underwhelming.
In addition to its antimicrobial qualities, honey offers other pluses for patients. Research suggests that honey dressing may be less painful to use and cause less scarring. Certain potent types even seem to be effective against MRSA, a particularly irksome type of staph infection that's resistant to antibiotics. Plus, honey bandages are cheaper than many of the other options and easy for patients to apply, says Steven Kavros, a podiatrist and wound specialist at the Mayo Clinic.
Still, promising as Manuka honey may be, some caution is in order. Despite the recent resurgence of interest, some experts warn that much of the research supporting honey is still anecdotal; some of the studies that suggested it's effective were so small that they aren't statistically reliable. A Cochrane Review article published this week concludes that more rigorous research is needed to determine whether honey offers any benefit. One recent study found that Manuka honey dressings healed leg ulcers no more quickly than conventional dressings. Certain people find honey stings when it's applied, and there's a small risk that honey-infused bandages can spark an allergic reaction.