Diabetic foot ulcer is a serious complication of diabetes. It is defined as the ulcerated foot. It creates lot of uneasiness and affects quality of life to a very large extent.
Diabetic patient begins to develop painful ulcers on the foot because of which mobility becomes difficult for the person. It is almost like a dreaded disability.
Diabetic foot ulcers affect around 15% of all diabetic individuals during their life time.
Diabetic foot ulcer is characterised by:
- Neuropathy- it refers to a condition in which sensation is lost. It affects the motor, autonomic and sensory components of the nervous system. Foot muscles get damage which leads to foot deformities, skin breakdown and ulceration.
- Ischemia (inadequate blood supply to body parts) - it leads to pain, necrosis, gangrene, ulceration on foot margin.
- Infection- In diabetic foot, infection can have very serious impact; it may even lead to limb loss. Deep infections can be more disastrous to health and lifestyle. The most common microbes involved in diabetic foot ulcer infection are- gram positive bacteria (Staphylococcus aureus) and some gram negative rods.
What is Manuka honey?
Manuka honey is made from the nectar obtained from pinkish white flowers of Manuka plant. Manuka is the common name of the plant. Scientifically Manuka is known as Leptospermum scoparium.
This honey has lot of special properties which makes it most popular among the scientist and researchers. Its medicinal value is so high that it is marketed as medicinal product in Australia and New Zealand its native countries.
Manuka honey’s Manuka factor makes Manuka honey so special. Manuka factor refers to the phenolic content of the Manuka honey. Like every other honey Manuka honey has the properties like low pH, high sugar content, antibacterial property.
But in Manuka honey there is high phenolic content and methylglyoxal content which gave it the antioxidant and anti-inflammatory properties.
How does Manuka honey help in the treatment of diabetic foot ulcer?
Since diabetic foot ulcer occurs due to the inflammation and skin damage and infection due to bacteria, it is require that treatment must effectively heal ulcers by reducing inflammation, repairing skin and preventing chances of infection.
Manuka honey seems to have these properties of wound healing, anti-inflammatory, anti-microbial and anti- oxidant which can be very beneficial for treating diabetic foot ulcers. Manuka honey also has the capacity to boost the immune system so it can also prevent foot ulcers to spread further.
Manuka honey can be used both as the topical medicine to be put on the wound and can also be administered orally.
1.Manuka honey exerts anti-microbial action
Manuka honey has a profound ability to fight from microbes due to its low pH, low water content and high sugar content. It acts as a prophylactic agent that reduces the risk of infection in wounds or ulcers and prevents cross-infection.
There are several studies conducted to show the effect of Manuka honey in preventing bacterial infection.
A study conducted to compare the effect of Manuka honey vs. hydrogel in healing venous leg ulcers which goes on for 12 weeks on 108 patients.
Another study was conducted on 108 patients to determine the bacterial changes in leg ulcers after 4 weeks when patients were treated with either Manuka honey or hydrogel dressing.
It was found in the study that Staphylococcus aureus was most common bacteria in these ulcers and it shows resistant to antibiotics like methicillin. But Manuka honey was very effective against the bacteria and eradicated it from almost 70% of venous ulcers.
What does this mean?
Manuka honey has significant effect on the chronic diabetic ulcers. The microbes and bacteria involved in infecting diabetic ulcers are effectively killed and inhibited.
2.Manuka honey helps in wound healing
Wound healing is a process which requires complete healing and formation of various skin layers. All the damaged tissue is replaced along with reduction in infection inflammation.
Antioxidant property of Manuka honey is quite helpful in wound healing as it helps in removing toxic products of damaged cells due to which healthy cells proliferate.
A study conducted on 172 patients to see the effect of honey in wound dressing of diabetic foot ulcers. It was found that honey significantly reduces the ulcers and improves wound healing of even chronic diabetic foot ulcers.
Another study on 258 patients conducted to test the effect of honey dressing for ulcer treatment shows that honey dressing is superior to normal dressing for healing diabetic foot ulcers.
A study published in WMJ, 2008 established the efficacy and safety of natural honey in healing diabetic foot ulcers.
This study was conducted on 12 patients for 4 weeks and all the patients were treated with honey dressing and after just 3 weeks ulcers were healed with no scars left. And there was 75% reduction in dressing budget.
What does this mean?
Topical use of Manuka honey on ulcers can result in early and effective healing of wounds. It is also a cost effective remedy in treating wounds and diabetic ulcers.
3.Manuka honey has anti-inflammatory and antioxidant action
High amount of superoxide and free radicles are found at the place of wound site which damages the newly formed tissue at the wound site.
Manuka honey contains various antioxidant components like phenolic, flavonoids, ascorbic acids and enzymes in it which degrade these superoxide radicals and prevent them to form.
Antioxidants help in more effective wound healing on topical application of Manuka honey.
The high rate of inflammation due to microbes and toxic components is seen in wounded area as these components stimulate various pro-inflammatory cytokines like interleukins, tumour necrosis factor. These cytokines prevent healing of ulcers.
Manuka honey contains anti-inflammatory factors which help in reducing the level of these pro-inflammatory cytokines and hence improve the healing effect on diabetic foot ulcers.
What does this mean?
Anti-inflammatory and antioxidant properties of Manuka honey are quite beneficial in treating diabetic foot ulcer. Manuka honey stimulates immune system in a way to accelerate wound healing but prevents excessive inflammation.
However some scientists feel that manuka honey does not help in diabetic foot ulcer
Along with various positive effects of Manuka honey in treating diabetic foot ulcers few studies conducted have shown no such results. Even few other studies conducted have shown side effects on some patients.
In a study conducted on 63 patients with diabetes, to test the effect of Manuka honey impregnated dressing compare to that of conventional dressing there was no significant difference found in percentage of ulcer healed. But time of healing seemed to decrease significantly.
In another study conducted on 30 patients to compare the effect of honey and iodine solution as dressing for diabetic foot ulcers no significant difference was found in ulcer healing in both the studies.
In another study conducted to test the effect of methylglyoxal in treating diabetic ulcers. It was found that methylglyoxal is a potential risk in treatment.
In an animal study it was found that methylglyoxal induces diabetes and perturbs healing of wounds.
Methylglyoxal help in the process of glycation by acting as precursor to glycation products. Glycation is a process in which glucose or sugar molecules in blood bound to any lipid or protein compound. This could be very harmful condition for diabetic patient as it further increases blood sugar level.
Methylglyoxal can also modify the structure of target molecules which helps in wound healing and lead to loss in their function. This results in delayed wound healing. This is most commonly seen in patients suffering from diabetes and hence healing of diabetic ulcer is delayed.
It has been found that the methylglyoxal content of Manuka honey is 100 times higher than other honey . It quantitative analysis of Manuka honey shows that it has around 38-761mg/kg methylglyoxal content .
This can be seen for the above mentioned studies that due to its high methylglyoxal content, Manuka honey can have negative effects on diabetic patients. Instead of healing the ulcers fast it can delay their healing process. So it is advisable to diabetic patients to not to consume Manuka honey on very high doses.
Dosage of Manuka Honey In Diabetic Foot Ulcers
There is no such specific dosage restriction on the use of Maunka honey if it is used at low concentrations. At market level to maintain the safety of Manuka honey, its quality is tested on the basis of its Unique Manuka Factor (UMF).
UMF is a registered trademark for Manuka honey marketing and is used most commonly in New Zealand and Australia.
The UMF value of Manuka honey ranges from 5 to 40 above that concentration Manuka honey has negative effect on health. The UMF value is the measure of concentration of phenol with same antibacterial activity as Manuka honey.
The UMF value of 18 is considered best for wound care and antibacterial action of Manuka honey. 1-2 teaspoons a day of manuka honey is safe.
For topical application ensure that manuka honey is sterilized and has high UMF rating.
Since Manuka honey seems to have few detrimental effects on the health of people and many people are allergic to certain bee products present in honey. So it is advisable to people to use Manuka honey carefully and keep the few precautions in mind which are as follows:
For first time users it is recommended to perform a sensitivity assay. Just consume a very little amount of honey once in a while and wait for at least 48 hours to see its effect on your body. If no adverse effect seen than it is safe to use.
For diabetic patients Manuka honey should be used more carefully either in very dilute amount or not at all. It is better to take prescription from doctor.
Manuka honey for children below 12 months is very injurious to health and can cause disease like botulism (condition of swelling and breathing resistance).
For storing Manuka honey glass and plastic bottles are best. It should be kept at normal room temperature and away from sunlight.
Manuka honey seems to have many benefits in treating ulcers but there have been studies which do not show much greater effect compared conventional treatment, some even cause side effects in diabetic ulcer treatment.
So care must be taken before using the Manuka honey in case of diabetic patients. Since sugar content of honey is very high, so before consuming Maunka honey diabetic patients must consult health practitioners. But for topical treatment of ulcer honey seems quite safe and effective in most cases.