Manuka Honey Component a Potential Risk Factor in Healing of Diabetic Ulcers

Methylglyoxal-a Potential Risk Factor of Manuka Honey in Healing of Diabetic Ulcers 

Evid Based Complement Alternat Med, 2011;2011:295494

Honey has been considered as a remedy in wound healing since ancient times. However, as yet, there are inadequate supportive robust randomized trials and experimental data to fully accept honey as an effective medical product in wound care. Manuka honey has been claimed to have therapeutic advantages over other honeys.

Recently, it has been documented that the pronounced antibacterial activity of manuka honey is due, at least in part, to reactive methylglyoxal (MG). The concentration of MG in manuka honeys is up to 100-fold higher than in conventional honeys. MG is a potent protein-glycating agent and an important precursor of advanced glycation end products (AGEs). MG and AGEs play a role in the pathogenesis of impaired diabetic wound healing and can modify the structure and function of target molecules.

This commentary describes the concern that MG in manuka honey may delay wound healing in diabetic patients. Further detailed research is needed to fully elucidate the participation of honey/derived MG in healing diabetic ulcers. We advocate randomized controlled trials to determine efficacy and safety of manuka honey in this population… 

Conclusion 

A number of randomized clinical trials suggest that medical grade honey promotes wound healing but most of them have not included diabetic patients with chronic leg ulcers and nearly three-quarters of clinical trials have focused on the use of honey for acute wounds, in particular burns. In general, repair of tissue damage in diabetic foot disease is accompanied with several pathophysiological mechanisms. Since manuka honey contains high levels of MG, we speculate that patients with diabetes may be at risk due to either the direct negative effect of MG on cells and components in the wound or the indirect formation of AGEs, which could impair the wound-healing process.

We believe that honey is an effective alternative dressing for treatment of many types of chronic wounds. However, MG may have a detrimental effect on diabetic ulcers. Further research is needed to fully elucidate the effect of honey-derived MG in the treatment of diabetic ulcers. In addition, honeys with varying levels of MG should be subjected to randomized comparative clinical trials in treatment of diabetic ulcers.