Honey: small, uncertain metabolic differences

Overview

Ahmed A et al.. Nutr Rev 2023 · PMID 36379223 · DOI 10.1093/nutrit/nuac086

Trials suggest honey may slightly lower blood sugar and blood fats compared with usual diet, but the certainty is low and few trials compared honey directly with sugar.

Does the study support the specific claim? Partly · Methodological quality: moderate

Original publication

Plain-language summary

Scientific in-depth review

1. Full reference

Authors

Ahmed A et al.

Journal

Nutr Rev

Year

2023

Identifier

PMID 36379223 DOI 10.1093/nutrit/nuac086

Verification

verified – PubMed efetch 2026-10-26 + Crossref 2026-10-26

Retracted

no

Corrections

none

Extent checked

abstract only

Conflicts of interest and funding

Funded by CIHR; one author (T.A.K.) reported research support from the National Honey Board and ILSI; other authors reported various food-industry links (full-text declaration).

2. Research question

What is the effect of oral honey intake on cardiometabolic risk factors?

3. Study design and population

Study design

Meta-analysis – Systematic review and meta-analysis of controlled trials >=1 week (MEDLINE, Embase, Cochrane to January 2021), GRADE; PROSPERO CRD42015023580

Population

Trial participants (healthy and with metabolic conditions)

Country

International

Period

to 4 January 2021

Sample size

18 controlled trials, 33 comparisons, 1105 participants

Inclusion and exclusion criteria

Controlled trials >=1 week of oral honey

4. Methods and endpoints

Exposure / intervention

Honey (median dose 40 g/day)

Comparator

Mostly usual diet (23 of 33 comparisons); sucrose in 5, HFCS in 2, mixed in 3 (full-text table)

Endpoints

Adiposity, glycaemia, lipids, blood pressure, uric acid, inflammation, NAFLD markers

Statistical methods

Inverse-variance pooling; mean differences; GRADE

5. Actual results

Results

Honey reduced fasting glucose (MD -0.20 mmol/L, -0.37 to -0.04; low certainty), total cholesterol (-0.18 mmol/L), LDL-C (-0.16 mmol/L), fasting triglycerides (-0.13 mmol/L), ALT (-9.75 U/L) (all low certainty) and increased HDL-C (+0.07 mmol/L; high certainty). Benefits were seen mainly for robinia, clover and raw honey.

Absolute risks

not applicable

Authors' conclusion

Honey, especially robinia, clover and raw honey, may improve glycaemic control and lipids when consumed within a healthy dietary pattern.

6. Strengths

• GRADE assessment
• Pre-registered
• Subgroups by floral source and processing

7. Weaknesses

• Most comparisons against usual diet, not against equal amounts of sugar
• Small trials, low certainty
• Author links to honey industry funding

8. Risk of bias

Orienting tool

AMSTAR 2

Type of assessment

simplified assessment (abstract only)

Full formal assessment

no

Overall risk of bias

some concerns

Rationale

Indirect comparator; possible conflicts of interest.

9. Assessment of the statistical interpretation

Small mean differences of low certainty; because only 5 of 33 comparisons used sucrose as comparator, the data say little about honey versus sugar directly.

10. Relevance to the specific claim

Adds nuance to C-SUG-02: honey is mainly sugar, but trials suggest small, low-certainty differences from usual diet in some cardiometabolic markers. It does not show that honey can be eaten freely.

11. Independent contrary findings

Norouzzadeh 2025 overview (not added) reported possible adverse effects of honey on some markers; WHO counts honey sugars as free sugars.

12. Transferability to Germany and Europe

International; applicable.

13. Overall methodological judgement

Honey is chemically mostly sugar; possible small differences in metabolic markers are uncertain and do not change the advice to limit free sugars.

14. Open questions

Head-to-head honey versus sucrose trials at equal sugar doses.

15. Linked fact checks

• Honey is chemically essentially sugar ('sugar knotted by the bee'); white sugar and honey are nutritionally similar. – Studies with mixed or unclear results