Honey in Diabetes: Safety and Recommendations
Honey should be treated as a nutritive sweetener containing calories and carbohydrates that raises blood glucose, and patients with diabetes should minimize its consumption in favor of nutrient-dense, high-fiber carbohydrate sources. 1
Primary Guideline Position
The American Diabetes Association explicitly categorizes honey alongside sugar and agave syrup as a nutritive sweetener (containing calories) that people with diabetes should minimize, as these foods displace healthier, more nutrient-dense food choices. 1 This is the clearest and most recent guideline-based recommendation available.
Key Clinical Considerations
Blood Glucose Impact
- Honey contains carbohydrates that affect blood glucose levels and should be accounted for in meal planning for patients using carbohydrate counting. 1
- Blood glucose monitoring should be increased when introducing honey to observe individual glycemic responses, as responses may vary between patients. 1
- Honey should NOT be used to treat hypoglycemia, particularly in patients using insulin or insulin secretagogues, due to unpredictable glucose responses. 1
Recommended Dietary Approach
- Patients should prioritize nutrient-dense carbohydrate sources that are high in fiber and minimally processed rather than added sugars like honey. 1
- The focus should be on an overall healthy eating pattern rather than individual foods like honey. 1
- Patients should be encouraged to replace sugar-sweetened beverages with water and minimize foods with added sugars to control glycemia. 1
Alternative Sweetener Options
For patients who desire sweetness, nonnutritive sweeteners may be a more appropriate alternative to honey, as they can potentially reduce overall calorie and carbohydrate intake when substituted for caloric sweeteners. 2
Nonnutritive Sweetener Guidelines
- Nonnutritive sweeteners do not appear to have significant effects on glycemic management but can reduce total calorie and carbohydrate intake. 2
- These should be used as a short-term replacement strategy, not a long-term solution. 1
- Patients should ultimately be encouraged to decrease both sweetened and nonnutritive-sweetened beverages, with emphasis on water intake. 2, 1
Research Context (Secondary to Guidelines)
While some older research suggests honey may have a lower glycemic index compared to pure glucose or sucrose 3, 4, and preclinical studies suggest potential antidiabetic properties 5, 6, 7, these findings do not override the clear guideline recommendations. The research is limited by small sample sizes, poor study designs, and lack of large-scale clinical trials. 5, 7
Critical Pitfalls to Avoid
- Do not recommend honey as a "healthier" sugar alternative for diabetic patients—guidelines do not support this distinction. 1
- Never use honey to treat hypoglycemia—it should not replace standard glucose sources for this purpose. 1
- Avoid the misconception that "natural" sugars are metabolically different enough to warrant special consideration in diabetes management. 1
- Do not ignore the carbohydrate content of honey when calculating total daily carbohydrate intake. 1
Practical Implementation
If a patient insists on using honey: