Adverse effects of honey on low-density lipoprotein cholesterol and adiponectin concentrations in patients with type 2 diabetes: a randomized controlled cross-over trial

Background: Due to antioxidant and fructose content, honey may be a suitable sweetener for patients with type 2 diabetes. The aim was to investigate the long-term effect of natural honey on oxidative and inflammatory status of patients with type 2 diabetes.  Methods: In a randomized controlled cross-over trial, 43 patients with type 2 diabetes were allocated to either natural honey (50 g/day) plus dietary recommendations or only dietary recommendations for 8 weeks with one month washout period in between. Dietary recommendations included weight maintenance diets for participants on honey treatment and a deficit of -150 kcal for those on control. Serum lipids, malondialdehyde, total antioxidant capacity, high-sensitivity C-reactive protein (hs-CRP), and adiponectin levels were measured at baseline and the end of each sequence.  Results: Malondialdehyde (10.9%, p=0.01), hs-CRP (10.6%, p=0.003), and adiponectin (7.1%, p<0.001) concentrations significantly decreased in honey condition. Also, low-density lipoprotein (LDL) cholesterol (16.8%, p<0.001) significantly decreased in control and high-density lipoprotein (HDL) cholesterol significantly increased in both conditions. Between-group differences were only statistically significant for adiponectin (p=0.005) and LDL cholesterol (p=0.005). Energy intake increased during honey condition (9.4%, p=0.045) but the difference was not statistically significant between the two conditions (p=0.1).  Conclusion: The results suggest that consumption of 50 g/day honey has adverse effects on LDL cholesterol and adiponectin levels in patients with type 2 diabetes. These adverse effects may occur because of high fructose content of honey.  Trial registration: Iranian Registry of Clinical Trials, IRCT2015062122364N2. Registered on 4 August 2015 - Retrospectively registered, available at: https://en.irct.ir/trial/19299. Keywords : Honey, type 2 diabetes, LDL cholesterol, adiponectin, cross-over, trial, malondialdehyde, hs-CRP.