IngredientsScientific name of source organism: Apis mellifera L. (Western honeybee), the primary species exploited commercially for hive products. This species has several subspecies or regional varieties, such as the Italian bee (Apis mellifera ligustica), European dark bee (Apis mellifera mellifera), and the Carniolan honeybee (Apis mellifera carnica).
Apitherapy, in which bee-derived products such as honey, bee pollen, propolis, bee bread (perga), royal jelly, bee venom (apitoxin), and beeswax are used to protect health and prevent or manage diseases, is within the scope of traditional and complementary medicine practices. Apiculture is the science and art of prolonging, sustaining, and retaining health by using products obtained from honeybee hives, such as honey, bee bread, bee venom, bee pollen, propolis, and royal jelly.
The six principal hive products used medicinally and as dietary supplements are:
Clinical standardization of these products is hindered by chemical variability depending on honeybee and botanical sources, but different molecules have been isolated and pharmacologically characterized.
The history of bees and their products can be traced back to approximately 13,000 BC. A certain amount of knowledge is attested by depictions of the bee and of hive beekeeping found during excavations. Rock paintings also provide some of the earliest evidence of gathering honey from wild colonies.
The health, nutritive, and medicinal values of bee products have been demonstrated by the ancient Egyptians, Greeks, and Chinese.
Honey use dates to ancient times; it was historically used as a sweetening agent and then as flavoring for medicinal preparations. Early cultures universally hailed honey for its sweetening and nutritional qualities, as well as for its topical healing properties for sores, wounds, and skin ulcers. Traditionally, honey has been used to treat burns, infected and non-healing wounds and ulcers, boils, pilonidal sinus, venous and diabetic foot ulcers.
The traditional use of propolis is known since 300 B.C. The Egyptians worshiped the bee and used propolis in the mummification process. It was also well known to the priests who, at that time, monopolized medicine and chemistry.
Egyptians used bee glue to embalm their cadavers as they well knew about its putrefactive properties. Incas employed propolis as an antipyretic agent. Greek and Roman physicians used it as a mouth disinfectant and as an antiseptic and healing product in wound treatment, prescribed for topical therapy of cutaneous and mucosal wounds.
The ancient Greeks, Romans, and Egyptians were aware of the healing properties of propolis and made extensive use of it as a medicine. In the Middle Ages, propolis was not a very popular topic and its use in mainstream medicine disappeared. However, the knowledge of medicinal properties of propolis survived in traditional folk medicine. The interest in propolis returned in Europe together with the Renaissance theory of ad fontes. Research on chemical composition of propolis started at the beginning of the twentieth century and was continued after World War II. Advances in chromatographic analytical methods enabled separation and extraction of several components from propolis.
Even if its use was already widespread since ancient times, after the First and Second World War, it has grown even more as well as the studies to identify its chemical and pharmacological features.
Royal jelly was used in traditional medicine for longevity in Europe and Asia. It has long formed part of Chinese traditional medicine (TCM) as a tonic for vitality and longevity and was incorporated into European folk remedies during the 19th and 20th centuries.
Embedded within the realm of traditional medicine and functional food for centuries, bee pollen has been ascribed with manifold therapeutic properties, including anti-inflammatory, antioxidant, antimicrobial, and immune-enhancing attributes. The use of bee pollen increased during the late 1970s following testimonials by athletes that supplementation increased stamina and improved athletic ability.
The use of bee stings for the treatment of rheumatism and baldness was discussed in the Edwin Smith Surgical Papyrus, which dates from approximately 2000 BC and is an important archive of medical practices in the ancient Nile Valley. Even Hippocrates used dried pulverized bees and bee stings in his practice of medicine. Bee venom has long been used in Europe and Asia for the treatment of arthritic conditions and, more recently, multiple sclerosis (MS).
Honey constituents with health benefits include phenolic acids, flavonoids, ascorbic acid, proteins, carotenoids, and certain enzymes, such as glucose oxidase and catalase. Major honey bioactives include phenolics, methylglyoxal, royal jelly proteins (MRJPs), and oligosaccharides.
The antibacterial mechanisms of honey are multifactorial: The antibacterial action is due to its acidity, hydrogen peroxide content, osmotic effects, nutritional and antioxidant content, stimulation of immunity, and unidentified compounds. Methylglyoxal is the unique compound in the honey responsible for some of its potent antimicrobial properties. Manuka honey (Leptospermum scoparium, New Zealand) is noted for its exceptionally high methylglyoxal content: Manuka honey, derived from the Leptospermum scoparium plant, has gained prominence due to its high Unique Manuka Factor (UMF), which correlates with its antibacterial potency.
Propolis is composed mainly of resin (50%), wax (30%), essential oils (10%), pollen (5%), and other organic compounds (5%). The precise composition of propolis varies according to plant source, seasons harvesting, geography, type of bee flora, climate changes, and honeybee species at the site of collection.
Propolis contains caffeic acid phenethyl ester (CAPE) and artepillin C, specific to Brazilian propolis, with antiviral, immunomodulatory, anti-inflammatory, and anticancer effects. Propolis, consisting of plant-derived materials, wax, and bee secretions, is abundant in bioactive constituents like flavonoids, phenolic compounds. Due to its waxy nature and mechanical properties, bees use propolis in the construction and repair of their hives for sealing openings and cracks and smoothing out the internal walls and as a protective barrier against external invaders.
Chemical analyses reveal that royal jelly contains water (60β70%), protein (12β18%), carbohydrate (10β16%), lipid (3β6%), minerals, vitamins (thiamin, riboflavin, pantothenic acid, pyridoxine, niacin, folic acid, inositol, and biotin), and phenolic compounds.
In royal jelly there are antimicrobial jelleins and royalisin peptides, MRJPs, and hydroxy-decenoic acid derivatives, notably 10-hydroxy-2-decenoic acid (10-HDA), with antimicrobial, anti-inflammatory, immunomodulatory, neuromodulatory, metabolic syndrome-preventing, and anti-aging activities. Various bioactive molecules like 10-hydroxy-2-decenoic acid (10-HDA), antibacterial protein, apisin, the major royal jelly proteins, and specific peptides such as apisimin, royalisin, royalactin, apidaecin, defensin-1, and jelleins are characteristic ingredients of RJ.
The lipid content of royal jelly is an unusual component, consisting primarily of short-chain fatty acids, mostly hydroxyl and carboxylic acids, which are distinct from other organic acids found in animals and plants. The sugars glucose and fructose account for 90% of the total sugar content of royal jelly.
Bee pollen is one of the bee products most enriched in proteins, polysaccharides, polyphenols, lipids, minerals, and vitamins. In addition to being vitamin-rich, bee pollen also includes unsaturated fatty acids, sterols, and phenolic compounds that express antiatherosclerotic, antidiabetic, and anti-inflammatory properties.
Peptides found in bee venom include phospholipase A2, apamin, and melittin. Bee venom is composed of different peptides, proteins, and bioactive components, including melittin, phospholipase A2 (PLA2), and apamin. These components have various pharmaceutical properties, including anti-inflammatory, antinociceptive, antiapoptosis, antiarthritic, and anticancer effects.
Honey bee products, including propolis, royal jelly, honey, bee venom, and bee pollen, or their bioactive chemical constituents like polyphenols, demonstrate interesting therapeutic potential in the regulation of inflammatory mediator production as per the increase of TNF-Ξ±, IL-1Ξ², IL-6, IL-2, and IL-7, and the decrease of reactive oxygen species (ROS) production. Additionally, improvement in the immune response via activation of B and T lymphocyte cells, both in in vitro, in vivo, and in clinical studies was reported.
For honey specifically: Honey has also been shown to disrupt bacterial biofilms, a major factor in antibiotic resistance, enhancing its therapeutic potential in treating chronic wounds and infections, especially in patients with compromised immune systems.
For royal jelly's cholesterol-lowering activity: MRJP1 exerts the most potent hypocholesterolaemic effects. MRJP1 interacts with bile acids and enhances the excretion of fecal bile acids. It also induces an increased tendency for fecal excretion of cholesterol. This major protein of royal jelly also enhances the hepatic cholesterol catabolism. Another hypocholesterolaemic mechanism of royal jelly consists of the increase of low-density lipoprotein receptor (LDLR) gene expression.
For bee venom: Bee venom therapy has been reported effective in anti-inflammatory, antiapoptosis, and analgesic effects.
Manuka honey has been scientifically recognised for its anti-microbial and wound healing properties and is now used clinically as a topical treatment for wound infections. Honey's application in wound care is particularly noteworthy, as honey has been shown to promote wound healing through multiple mechanisms, including inflammation reduction, tissue regeneration stimulation, and infection prevention. Clinical studies have confirmed that honey dressings can accelerate wound healing and improve outcomes in patients.
A specific comparative clinical trial illustrates the MRSA-eradication potential: A study compared Manuka honey treatment with a commercially available hydrogel dressing in 108 patients with sloughy infected venous leg ulcers. MRSA was identified in 16 of the wounds, 10 of which were treated with the honey while six were treated with the commercially available hydrogel. After four weeks of treatment, MRSA was eradicated in seven of the ten honey-treated wounds but only one of the six hydrogel-treated wounds. These studies provide evidence supporting the use of Manuka honey as an anti-bacterial wound sterilizing agent.
Regarding evidence breadth: Recent studies confirm the efficacy of honey in treating venous ulcers. In patients suffering from malignant wounds, improvement with respect to wound size and cleanliness was seen after treatment with honey-coated bandages. Similarly, honey dressing quickened rates of healing in pressure wounds.
Manuka honey, native to New Zealand, has been FDA-approved for wound treatment in the United States after studies demonstrated its ability to inhibit a variety of pathogens. However, a note of caution applies: results provide evidence of the cytotoxicity of Manuka honey at higher concentrations, and should prompt a re-assessment of the current use of Manuka honey in wound treatment. Since most clinical honey treatment involves directly applying undiluted honey to the wound, it is likely that honey's beneficial effects are at least somewhat counteracted by its cytotoxicity.
Evidence strength: Moderate to good for topical antimicrobial/wound-healing applications, supported by multiple RCTs and systematic reviews; regulatory clearance (FDA, CE marking) for medical-grade wound dressings has been obtained.
A plethora of in vitro studies have revealed that honeys from all over the world have potent antimicrobial activity against skin relevant microbes. Studies have demonstrated that Manuka honey inhibits bacterial growth and synergizes with conventional antibiotics, enhancing their effectiveness against resistant strains.
The antimicrobial advantage of Manuka honey over other varieties may be smaller than commonly assumed: Manuka consistently inhibited bacteria at a marginally lower concentration than all other honey types tested; however, the clinical and statistical significance of that observation remains in question.
For propolis: The literature makes evident that propolis possesses several biological properties, including antibacterial, antiviral, antiprotozoal, antifungal, anticancer, antioxidant, antitumour, and antimutagenic activities. Current antimicrobial applications of propolis include formulations for cold syndrome (upper respiratory tract infections, common cold, and flu-like infections), wound healing, treatment of burns, acne, herpes simplex and genitalis, and neurodermatitis.
A double-blind clinical trial specifically examined propolis for the common cold: One double-blind study looked at the effects of an oral spray containing a propolis extract in 122 healthy adults with mild common cold symptoms. The dosage of 2β4 sprays three times per day produced resolution of symptoms two days earlier in the propolis group (three days versus five days).
Evidence strength: Strong in vitro evidence; moderate clinical evidence for topical and upper respiratory applications; larger and more rigorous RCTs are still needed for most specific infection indications.
Bee products have anti-inflammatory, antimicrobial, and immunomodulatory effects, thanks to their bioactive component content, and have a positive effect on cancer, diabetes, and cardiovascular and neurological diseases caused by oxidative stress.
Bee pollen has also demonstrated anti-inflammatory signaling effects: In an in vivo study, pollen was found to have the ability to suppress various inflammatory pathways, including nuclear factor kappa-light-chain-enhancer of activated B cells (NF-ΞΊB).
For propolis oral/topical applications in inflammatory oral conditions: A study conducted on the application of a 5% aqueous propolis solution resulted in an improvement in vaginal well-being.
Propolis has broad clinical applications such as antioxidant, anti-inflammatory, antimicrobial, anticancer, analgesic, antidepressant, and anxiolytic as well as immunomodulatory effects. It is also well known from traditional uses in treating purulent disorders, improving wound healing, and alleviating many of the related discomforts.
Evidence strength: Preliminary to moderate; the majority of the mechanistic data derives from in vitro and animal studies, with growing but still limited clinical human evidence.
Bee pollen has been applied in clinical trials for allergies and prostate illnesses. Bee pollen and its extracts have been used for decades as therapeutic agents or health food supplements to alleviate chronic nonbacterial prostatitis (CNP).
Clinical evidence accumulated over the past decades supports the efficacy of pollen extract in alleviating symptoms associated with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). As early as 1993, Rugendorff et al. reported substantial improvements in both quality of life and lower urinary tract symptoms in up to 78% of patients treated with pollen extract, alongside a notably high tolerability rate of 97%.
In Europe and Japan, Cernitin (pharmaceutical brand Cernilton), a ryegrass pollen extract, has been used to treat nonbacterial prostatitis and prostatic hyperplasia for more than 40 years with an overall success rate of 70%.
In a randomized controlled phase III clinical trial: In a randomized control trial involving 139 patients affected by inflammatory CP/CPPS and treated for 12 weeks with flower pollen extract, significant improvements were reported. Separately, Cai et al. in a non-randomized clinical study reported a clinical response rate of 90%, demonstrating that pollen extract in association with vitamins significantly improved total symptoms, pain, and quality of life in patients with non-inflammatory CP/CPPS without severe side effects.
Evidence strength: Moderate for pollen extract (not whole pollen) in CP/CPPS, with positive results from multiple trials; Cernilton is included in some European Association of Urology (EAU) guidelines for CP/CPPS management. Evidence for whole bee pollen granule supplementation is weaker.
Being rich in fatty acids with hypolipidemic properties, royal jelly is used in postmenopausal population in order to restore the balance of the lipid profile. Despite royal jelly being a potent hypocholesterolaemic and hypolipidaemic agent, its active compounds that lower cholesterol levels and the mechanisms of action are still to be fully discovered.
A specific prospective clinical study reported: In a prospective follow-up study of 36 postmenopausal healthy women, royal jelly treatment (150 mg/day) for 3 months significantly decreased total cholesterol (by 3.09%) and LDL cholesterol (by 4.1%) and increased HDL cholesterol (by 7.7%).
Some human studies suggest improved total serum lipid and cholesterol levels in those with moderately elevated levels, and improved erythropoiesis and glucose tolerance in healthy subjects. Other data suggest it may improve type 2 diabetes or cardiometabolic markers, but a meta-analysis determined that supplementation does not improve glucose levels, and quality of evidence is generally low.
Evidence strength: Preliminary to mixed; small trials show lipid-lowering signals but a meta-analysis has not confirmed glucose-lowering effects; overall evidence quality is considered low, and larger rigorous RCTs are lacking.
Studies suggest that royal jelly supplementation may improve premenstrual and menopausal symptoms. One uncontrolled, open-label trial treated 55 postmenopausal women having menopausal complaints with Melbrosia, a dietary supplement that combines royal jelly with flower pollen and fermented flower pollen, for 3 months. Melbrosia significantly improved participants' scores on the problem-solving subscale of the Frankfurt Self-concept Scale, relieved depressive and menopausal symptoms, decreased total cholesterol and low-density lipoproteins, and increased high-density lipoproteins and triglycerides.
Results are not uniformly positive: In contrast, a former RCT reported no effect of Melbrosia on biochemical parameters in women with severe menopausal symptoms, although it significantly improved vitality and relieved symptoms of headache, urinary incontinence, and vaginal dryness.
Evidence strength: Weak to preliminary; trials are small, often uncontrolled or confounded by multi-ingredient formulas; results are inconsistent across studies.
In animal models of aging and Alzheimer's disease (AD), royal jelly was able to enhance learning and memory retention, as well as prevent and treat cognitive deficits. In preclinical studies, in animal models and in cell lines, RJ, enzyme-treated RJ, 10-HDA, RJ peptides, and MRJPs were effective against AD pathology by interfering with protein misfolding, amyloid synthesis, and amyloid clearance. Furthermore, RJ promoted neuronal survival and functioning by targeting inflammation, oxidative stress, mitochondrial dysfunction, disturbed proteostasis, amyloid Ξ² toxicity, Ca-mediated excitotoxicity, and bioenergetic failure.
A combination supplement that contained royal jelly appeared to benefit patients with mild cognitive impairment. Royal jelly intake is efficient for the alleviation of menopause-related neurological disorders, but the mechanisms of action remain to be better described. However, the decrease of cholesterol and beta-amyloid levels, the increase of estrogen levels, and the improvement of blood-brain barrier seem to be the most mentioned mechanisms by which royal jelly exerts its neuroprotective role.
Evidence strength: Largely preclinical (animal, cell-based); limited, methodologically weak clinical evidence; insufficient human data to draw conclusions.
A double-blind placebo-controlled human trial investigated RJ's effect on hematopoietic stem cells: This randomized, double-blind, placebo-controlled study was performed on healthy subjects (n = 90) who received protease-treated royal jelly at a dose of 1,200 mg/day or placebo daily for four weeks. Participants with a low number of hematopoietic stem cells (HSCs) in peripheral blood were preferentially selected. HSC counts, endothelial progenitor cell (EPC) counts, blood cell counts in peripheral blood, cytokines in serum, and physical conditions were evaluated.
Evidence strength: A single small RCT; considered preliminary; further replication required.
Bee venom acupuncture has been commonly used for clinical disorders such as Parkinson disease, neuropathic pain, Alzheimer disease, intervertebral disc disease, spinal cord injury, musculoskeletal pain, arthritis, multiple sclerosis, and skin disease and cancer.
In terms of musculoskeletal outcomes: Two studies assessed the effects of bee venom acupuncture (BVA) on adhesive capsulitis; one was a 12-week RCT, and the other was a 1-year follow-up RCT. The SPADI score significantly improved after 12 weeks of treatment as well as at the one-year follow-up. BVA was also performed for knee osteoarthritis in one RCT, and it was confirmed that various WOMAC scores improved.
For rheumatoid arthritis and multiple sclerosis, overall clinical evidence is more guarded: The conclusion of an evaluation was that bee venom therapy (BVT) offered no significant improvement in patients with rheumatoid arthritis. Physicians should not recommend BVT to their patients suffering from arthritis or multiple sclerosis because there is no evidence from clinical studies to show benefit to balance the inconvenience of pain, swelling, and possible risk of anaphylaxis.
A meta-analysis of bee venom studies confirmed broad adverse event reporting: A meta-analysis of therapeutic studies on bee venom showed that out of 145 studies, 58 reported adverse effects. The most common side effects observed were systemic immune reactions, local reactions, allergies, and skin problems. These adverse reactions are often due to hypersensitivity, frequency, and concentration of administered bee venom.
Evidence strength: Mixed to weak for most neurological and rheumatological indications; some positive signals for musculoskeletal pain (shoulder capsulitis, knee osteoarthritis) in small RCTs; insufficient evidence for recommending BVT in RA or MS.
Honey has been tested against cough and upper respiratory symptoms in children, and historically, honey has been used in various medicinal applications, ranging from wound dressings to treatments for respiratory ailments. Multiple small RCTs in pediatric populations have reported honey to be superior to placebo and comparable to some over-the-counter preparations for nocturnal cough reduction; however, these trials have significant methodological limitations and require cautious interpretation.
Evidence strength: Weak to moderate for symptomatic relief of upper respiratory tract cough; small pediatric trials; not sufficient for formal therapeutic claims in most regulatory frameworks.
The following dosages are drawn directly from the cited clinical literature and do not represent recommendations:
Clinical standardization of these products is hindered by chemical variability depending on honeybee and botanical sources. No universally agreed pharmacopoeial dosing standards currently exist for most bee products used as dietary supplements, and dosages vary widely across commercial preparations and research protocols.
Honeybee products (HBPs), including honey, bee pollen, bee bread, royal jelly, propolis, beeswax, and bee brood, are increasingly used in food, nutraceutical, and cosmetic contexts. Because of their natural origin, HBPs can provoke allergic reactions ranging from localised dermatitis to life-threatening, systemic anaphylaxis.
The incidence of asthma and anaphylaxis, in some instances upon the consumption of royal jelly, bee venom, and bee pollen, somewhat hinders their use for some individuals despite their medicinal and health benefits.
The food supplement bee pollen has been recommended to treat "everything from infectious to allergic diseases," but it has been found to cause anaphylactic reactions. Bee pollen is a complex heterogeneous mixture of pollens from different plant species, and its aetiological role in some allergic clinical manifestations following the ingestion of bee pollen and other bee products has been demonstrated.
Bee pollen, honey, royal jelly, or propolis should not be used in patients with an allergic predisposition, in particular those with pollen allergy, because it is well-known that atopic and asthmatic individuals may be at an increased risk.
Contact dermatitis from propolis is a well-known complication of bee-keeping and can occur with topical and oral administration of propolis. Allergic reactions including angioedema and anaphylaxis from commercial sources of propolis have been reported. The allergic reactions are likely due to plant flavonoid aglycones.
Propolis is also a potent sensitizer and should not be used in patients with an allergic predisposition, in particular an allergy to pollen. A pharmacovigilance study found: Sixteen reports concerned allergic reactions (with dermatological or respiratory symptoms), while two concerned the digestive tract. Some of the reactions were serious: six patients were admitted to hospital or visited an emergency department and in two of these a life-threatening event was reported.
In most clinical trials, adverse event rates have not been mentioned, but propolis is reported to be well tolerated. Propolis, like bee pollen, is highly variable with chemical compositions that differ markedly by genus of bees and geographic location (based upon local plant species). Propolis may contain contaminants, insect parts, and allergens from the environment.
Liver injury attributable to bee products has not been reported. In clinical trials of beeswax and propolis as therapy of diabetes, obesity, and cancer, side effects were rarely mentioned and ALT elevations and hepatotoxicity were not reported. Despite their availability and widespread use as alternative therapies, there have been no published reports of liver injury attributed to bee products. Likelihood score: E (unlikely cause of clinically apparent liver injury).
Bee venom can cause a range of adverse effects, most of which are unpredictable. A meta-analysis of therapeutic studies on bee venom showed that out of 145 studies, 58 reported adverse effects. The most common side effects observed were systemic immune reactions, local reactions, allergies, and skin problems. Bee venom therapy (BVT) is contraindicated in pregnancy.
The benefits of using honeybee products are well-documented, and their effects on the human organism stem from their complex composition. However, this complexity can also be the reason for adverse reactions, with allergies being the most common and dangerous.
According to a prospective, cross-sectional survey (N=250) analyzing use of 31 complementary and alternative medicine remedies for dental or mouth issues, propolis was recommended by 33% of German dentists and maxillofacial surgeons.
Health conditions that Bee products may help support.
Body systems that Bee products may help support.
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