A few years ago I wrote about honey and its effect as a biological modifier and its ability to treat herpes ^1,2. At that time, I was unaware that the World Health Organization (WHO) mentioned honey as an option for treating colds and cough due to its demulcent effect. The WHO did not cite any references, but it did mention many anecdotes from numerous cultures supported the application.

Sweet For Cough
Scientists in the cough business 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 provide. 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 is easier for a productive cough to expel phlegm. Thus, sweeteners may support treating 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 sensitive sensory nerves that trigger coughing, it is theorized that some of the secretions find their way to receptor sites and bind. Therefore, sweet tasting substances may also reduce the cough response neurologically.

Dextrometrophan
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, dependence, dizziness, drowsiness, dystonia, hallucination, hypertension, increased heart rate, itching, nausea, peripheral neuropathy, rash and sweating. Exactly how DM works spurred research which shaped the American Academy of Pediatrics Physician Statement in 1997 ³. In that publication, the use of DM for the treatment of cough was not supported. It has been eleven years since those recommendations were published but DM continues to be used in many over-the-counter products.

Dextrometrophan vs. Honey
Recently there was a study comparing DM to honey.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 patient's to one of three groups. A DM group, a honey group and a no-treatment group. The two treatment groups received a single evening dose of either DM or honey before bedtime. The type of honey selected was buckwheat because it is dark in color and darker honeys have higher levels of phenolic compounds which in turn have antioxidant capability. Outcomes were based upon symptom survey scores filled out by the parents.

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
¹ Andersen, G.D., Honey Part 1 Dynamic Chiropractic, 2005; 23 (5): 14
² Andersen, G.D., Honey Part 2 Dynamic Chiropractic, 2005; 23 (7): 32
³ The American Academy of Pediatrics Committee on Drugs. Use of Codeine-and Dextromethorphan-Containing Cough Remedies in Children. Pediatrics 1997; 99(6): 918-920
⁴ Beiler, J., Paul, McMonagle, A., et al., The Effect of Honey, Dextromethorphan, and No Treatment On Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents. Archives of Pediatrics and Adolescent Medicine arch Pediatr Adolesc Med. 2007; 161 (12): 1140-1146

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