A few years ago, I wrote about honey, specifically its effect as a biological modifier and its ability to treat herpes.1,2 At that time, I was unaware the World Health Organization (WHO) mentioned honey as an option for treating colds and cough due to its demulcent effect.
Sweet Taste for Cough
Scientists noticed long ago that when liquid cough medicine was sweet, suppression tended to be better. Ronald Eccles, a United Kingdom researcher, investigated the assumed placebo effect sweeteners provided. It turns out that when a person ingests something sweet, a reflex salivation occurs, along with mucus secretion in the airway. This moistens the larynx and pharynx, leading to an antitussive (cough suppressant) effect when a dry cough is present. These airway secretions also coat the membranes, which improves ciliary function. This leads to an expectorant (loosening of mucus) effect. With looser mucus, it's easier for a productive cough to expel phlegm. Thus, sweeteners might treat both types of coughs. But it doesn't stop there. When sweet substances are ingested, the gustatory nerves are stimulated and secrete opioids. Because they are located in close proximity to opioid sensory nerves that trigger coughing, it's theorized that some of the secretions find their way to receptor sites and bind. Therefore, sweet-tasting substances also might neurologically reduce the cough response.
Dextromethorphan
One of the most common over-the-counter cough medicine ingredients is dextromethorphan (DM). Dextromethorphan is a codeine analog used to suppress cough. It also has an impressive list of side effects including ataxia, anaphylaxis, anemia (megaloblastic), cerebellar degeneration, dizziness, drowsiness, dystonia, hallucination, hypertension, increased heart rate, itching, nausea, peripheral neuropathy, rash and sweating. Exactly how DM works spurred research that shaped the 1997 American Academy of Pediatrics Physician Statement.3 The use of DM for the treatment of cough was not recommended. It has been 11 years since those recommendations were published, but DM continues to be used in many over-the-counter products.
Dextromethorphan vs. Honey
Recently, a study comparing DM to honey was performed.4 The parents of 105 children ages 2 to 18 who presented in an acute-care facility with upper-respiratory infections consented to participate in the study. The inclusion criteria limited subjects to those with a basic upper-respiratory infection presenting with a cough accompanied by one or more of the following symptoms: fever, headache, sore throat, congestion and body aches. Children with asthma, allergies or a history of airway disease were excluded from the study.
The researchers assigned the patients to one of three groups: a DM group, a honey group and a no-treatment (NT) group. The two treatment groups received a single evening dose of either DM or honey before bedtime. Buckwheat honey was selected because it's dark in color. Darker honeys have higher levels of phenolic compounds, which have antioxidant capability. Outcomes were based upon symptom survey scores filled out by the parents.
| Symptom Improvement Scores | |||
| Honey | DM | NT | |
| Cough Frequency | 1.89 | 1.35 | 0.92 |
| Cough Severity | 1.80 | 1.30 | 1.11 |
| 2nd Night Cough | 2.23 | 1.94 | 1.30 |
| Child's Sleep | 2.49 | 1.79 | 1.57 |
| Parents' Sleep | 2.31 | 1.97 | 1.51 |
| Total Score | 10.72 | 8.35 | 6.41 |
In this study, honey was superior to no treatment. The authors stated that the difference between honey and DM was not statistically significant, even though honey beat DM in every category rated. I suspect if safety and taste had been included in the study, the difference would have made the biostatisticians as happy as the parents.
References
- Andersen GD. "Honey, Part 1." Dynamic Chiropractic, Feb. 26, 2005;23(5):14. www.chiroweb.com/archives/23/05/04.html.
- Andersen GD. "Honey, Part 2." Dynamic Chiropractic, March 26, 2005;23(7):32. www.chiroweb.com/archives/23/07/01.html.
- American Academy of Pediatrics Committee on Drugs. Use of codeine-and dextromethorphan-containing cough remedies in children. Pediatrics, 1997;99(6):918-20.
- Paul IM, Beiler J, McMonagle A, et al. The effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med, 2007;161(12):1140-6.
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