Are shilajit and medicinal honey recommended for medical use?

Are Shilajit and Medicinal Honey Recommended for Medical Use?

No, neither shilajit nor medicinal honey are recommended for medical use based on current clinical guidelines. For honey specifically, the International Working Group on the Diabetic Foot (IWGDF) issues a strong recommendation against its use for wound healing, and there is insufficient evidence to support its use in other medical conditions 1, 2.

Medicinal Honey: Strong Evidence Against Recommendation

Wound Healing Applications

The IWGDF 2024 guidelines explicitly state: "Do not use honey (or bee related products) for the purpose of wound healing in diabetes-related foot ulcers" (Strong recommendation; Low quality evidence). 1

• All six randomized controlled trials examining honey or bee products for diabetic foot ulcers were deemed at high risk of bias 1
• The only blinded study using royal jelly found no difference in healing over 12 weeks compared to controls 1
• No studies reported data on amputation prevention, cost-effectiveness, or quality of life outcomes 1

Oncology Applications

The Society for Integrative Oncology-ASCO 2022 guidelines found inconclusive evidence for honey in oral mucositis 1:

• Nineteen trials tested honey for oral mucositis with inconsistent results across studies 1
• The largest and most rigorous trial (NRG Oncology network) tested manuka honey in lung cancer patients receiving radiation and found neither liquid manuka honey nor manuka honey lozenges were superior to supportive care in preventing radiation esophagitis 1
• No two trials used the same honey preparation, dose, or delivery method, making meaningful comparisons impossible 1

Historical Context

Earlier IWGDF guidance from 2016 reinforced these findings 1:

• Only three small controlled studies on honey were identified, none showing convincing benefit compared to iodine-containing dressings 1
• A Cochrane review concluded that health services should avoid routine use of honey dressings until sufficient evidence of effect is available 1

Shilajit: Insufficient Clinical Evidence

Lack of Guideline Support

No major clinical guidelines address shilajit, which itself indicates insufficient evidence for medical recommendation.

Research Limitations

The available evidence for shilajit consists only of preclinical studies and lacks rigorous clinical trials 3, 4, 5:

• A 2011 systematic review concluded that shilajit "lacks scientific evaluation and systematic documentation" 4
• In vivo antioxidant studies used irrelevant doses without positive controls 4
• Immunomodulatory activity "does not stand the test of critical assessment and currently may be considered as unproven" 4
• A 2014 review noted "relatively few well-controlled human studies have been conducted" despite traditional use 5

Theoretical Mechanisms Without Clinical Validation

While animal and in vitro studies suggest potential antioxidant, anti-inflammatory, and adaptogenic properties 5, these findings have not translated to validated clinical applications 3, 4:

• Fulvic acid, the proposed active principle, shows theoretical benefits in laboratory settings but lacks clinical trial evidence 3
• The 2012 review acknowledged that "more investigations at the basic biological level as well as clinical trials are necessary" 3

Clinical Decision Algorithm

When patients inquire about these products:

1. For wound healing: Explicitly advise against honey use based on strong IWGDF recommendations 1, 2
2. For oral mucositis in cancer: Explain that evidence is inconclusive and standard supportive care is preferred 1
3. For shilajit for any indication: Inform patients that no clinical guidelines support its use and evidence is insufficient 4
4. Direct patients toward evidence-based alternatives: Use dressings selected for exudate control, comfort, and cost for wounds 1

Important Caveats

• While honey products are generally safe with minimal adverse effects 1, 2, lack of standardization raises concerns about consistency 2
• The absence of cost-effectiveness data means resource allocation cannot be justified 1, 2
• Safety data for shilajit is documented in animal studies 5, but this does not constitute a recommendation for clinical use given the absence of proven efficacy 4