Reference
Münstedt K, Voss B, Kullmer U, Schneider U, Hübner J. Bee pollen and honey for the alleviation of hot flushes and other menopausal symptoms in breast cancer patients. Mol Clin Oncol. 2015;3(4):869-874.
Design
A prospective, randomized, crossover trial in breast cancer patients receiving antihormonal treatment
Participants
A total of 46 patients were recruited for the study but only 31 completed both phases, the majority dropping out during the pollen phase because they found the taste of the pollen mixture unpleasant. Mean age of participants was 60.8 years.
All participants had completed surgery for breast cancer and had been on antihormonal therapy for at least 3 months before the study. Exclusion criteria included distant metastases, pregnancy, allergy to bee pollen and/or honey, concomitant disease, psychiatric disease, use of other treatments for menopause symptoms, or an inability to read German.
Study Medication and Dosage
Patients received 1 tablespoon a day of either a mixture of pollen and honey (pollen group) or pure honey (honey group) for 2 weeks. After a washout period participants received the alternate treatment for an additional 2 weeks.
Outcome Measures
Menopausal complaints were assessed using the Schneider and Heinemann Menopause Rating Scale (MRS). Blood samples were collected at each stage of the study and tested for triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and estradiol.
Key Findings
All participants reported significant improvements during the study: 68.3% of patients receiving honey and 70.9% of patients receiving pollen. The differences between groups were not significant; both honey and pollen relieved menopausal symptoms caused by adjuvant treatment of breast cancer. These improvements were noted 3-4 days after initiation of treatment regardless of whether patients received tamoxifen or an aromatase inhibitor, or were in the honey or the pollen groups. Patients receiving pollen and taking tamoxifen showed a trend toward higher rates of improvement (86.7 vs 58.8%), but this difference was not significant. No differences in serum cholesterol, triglycerides, or estradiol were seen. Patients taking aromatase inhibitors experienced significantly more improvement of symptoms compared to patients treated with tamoxifen. There was also a trend toward an increase in estradiol levels by honey in patients receiving aromatase inhibitors.
Practice Implications
Suggesting to patients with menopausal symptoms secondary to adjuvant treatment of breast cancer that they try taking a tablespoon of honey once a day for a week or so as a clinical experiment sounds almost too simple, but it is certainly worth a try.
Finding ways to relieve menopausal symptoms is clinically important as many breast cancer patients will discontinue treatment rather than experience the discomfort of hot flashes. The Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial reported discontinuation rates of 14.3% for tamoxifen and 11.1% for anastrozole.1 Providing relief may increase compliance with these currently accepted therapies.
In the past we have advocated for a range of alternative supplements to relieve menopausal symptoms, including vitamin E, soy, black cohosh, flax, and red clover. Questions have remained about the safety of those that employ phytoestrogens and whether they may stimulate breast cancer growth. Chi et al’s 2013 meta-analysis of soy and breast cancer suggests that at least in the case of soy, the phytoestrogens are protective.2
Several papers have reported that pollen extracts were useful in treating hot flashes, but this may be the first to suggest that even plain honey was useful. In this case honey was used as a placebo against which to compare the active pollen and honey mixture.3,4
While some placebo effect was possible, the researchers suggest that the improvements seen greatly exceeded the 25% response rate that would have been predicted from placebo effect.5
Tualang honey, a rare form of wild honey produced by Asian honeybees from jungle floral nectars, may have an estrogenic effect.6 The “common” honey used in this menopausal study, and the kind we eat, is produced by European honeybees (Apis mellifera). Tualang honey is produced by Apis dorsata bees that nest in Tualang trees. This Tualang honey has in fact been suggested as a means to prevent osteoporosis.7 So although for unknown reasons the Tualang honey may somehow stimulate estrogen production, at this point there is no reason to think that common table honey does the same. It is unfortunate that Tualang honey is not yet readily available to our patients. Tualang honey has been reported to augment the effect of tamoxifen against breast cancer cells8 and so might be helpful if consumed.
Note that there was a trend toward increased estrogen levels in the honey group, but this association did not reach significance. If this association proves true, it will no doubt trigger debate as to whether breast cancer patients should consume or abstain from honey.
While a rationale for a mechanism of action remains to be found for honey’s reported benefit, there is little reason to justify not attempting to employ it clinically. In this report honey worked better in women taking aromatase inhibitors, and it took only 3-4 days of regular honey use until improvement was felt. The downsides of honey supplementation are negligible, so there is no reason to not try this in practice.
