Honey is a natural sweetener that has been used for centuries. However, there have been rare cases of botulism associated with honey consumption. Botulism is a serious illness caused by toxins produced by the bacteria Clostridium botulinum. In infants, botulism can occur when C. botulinum spores are ingested and germinate in the immature digestive system. Adults can also develop botulism from contaminated foods, including honey. This article will examine the link between honey and infant botulism, factors that affect toxin production, and steps you can take to enjoy honey safely.
What is botulism?
Botulism is caused by potent neurotoxins produced by C. botulinum bacteria. There are three main types:
Foodborne botulism
This occurs when preformed toxins are ingested in contaminated foods. Symptoms begin 12-36 hours after ingestion.
Wound botulism
Caused by toxin production from C. botulinum introduced into a wound.
Infant botulism
Spores are ingested and germinate into bacteria that produce toxin in the gut. Affects infants under 12 months old.
Regardless of the type, botulism causes paralysis by blocking nerve function. Symptoms include double vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Botulism can be fatal in 5-10% of cases if respiratory muscles are paralyzed.
Is honey safe?
Most honey is perfectly safe. However, honey has been linked to cases of infant botulism because it may contain C. botulinum spores. Spores themselves are not dangerous, but can transform into toxin-producing bacteria in an infant’s immature digestive system.
Botulism spores in honey
C. botulinum is found in soil and dust. Spores can be picked up by bees and make their way into honey. One study found that up to 13% of honey samples can contain botulism spores. However, the number of spores is typically low. One teaspoon of honey may contain 140 spores or fewer. Adult digestive systems are usually able to inhibit spore germination.
Cases of infant botulism from honey
From 1976 to 2014, there were 169 reported cases of infant botulism in the U.S. linked to honey consumption. This amounted to about 5 cases per year. For comparison, there are about 140 cases annually of infant botulism from unknown causes. So while honey is a known risk factor, most infant botulism cases do not involve honey.
Recommendations for infants under 12 months
Health agencies, including the CDC and AAP, recommend against giving honey to infants under 12 months old due to the risk of infant botulism. Honey alternatives include corn syrup, maple syrup, and sugar.
Factors that increase botulism risk
Several factors can increase the risk of honey containing dangerous levels of botulism toxin:
Spore concentration
Higher levels of C. botulinum spores in honey increase the risk. Most honey contains only a small number of spores.
Heat and filtration
Heating honey to pasteurization temperatures (158°F/70°C) can destroy spores. Filtering can also remove spores. However, unprocessed honey still generally has low levels of spores. One study found no difference in spore levels between filtered/unfiltered or heated/unheated honey.
Type of honey
Spore levels can vary depending on floral source and geography. For example, honey from Brazil and Argentina has been found to contain more spores than honey from Canada.
Water content and pH
Higher water content and lower acidity can promote spore germination and toxin production. Most properly processed honey has a low moisture content and pH that inhibits botulism growth.
Storage temperature
Storing honey at room temperature or warmer can promote growth of any existing botulism spores. Refrigeration does not destroy spores but can prevent growth. Freezing prevents spores from growing but does not kill them.
Feeding frequency
Frequent, small doses of contaminated honey can trigger botulism more easily than a single large dose in adults. Small intestinal obstructions in infants also increase risk.
Infant gut flora
Infants have less competing “good” bacteria to inhibit growth of C. botulinum. Their guts are also more alkaline, which promotes spore germination.
Age
Almost all cases of infant botulism occur in those under 6 months old. As the digestive system matures, gut flora develop and risk decreases.
Steps for safe honey consumption
Here are some recommendations for safely enjoying honey:
Avoid giving honey to infants under 12 months
Do not add honey to foods, beverages, or pacifiers for infants. Avoid products like honey teething gels. Wait until 1 year old to introduce honey safely.
Check honey’s source and processing
When possible, choose honey from regions with lower risk like Canada. Look for honey labelled as sterilized or pasteurized to reduce any spore levels.
Store honey properly
Keep honey sealed and refrigerated after opening. Discard any honey that shows signs of fermentation, like bubbling or off smells.
Avoid risk factors
Do not feed honey frequently or in large amounts to infants or people with gastrointestinal issues. Honey should not be given through feeding tubes.
Watch for symptoms of botulism
Seek immediate medical attention if anyone who has eaten honey shows signs of botulism poisoning. Antitoxins can prevent progression if administered early.
Conclusion
Honey is a safe, healthy food for most people. However, it poses a small risk of infant botulism in those under 12 months old due to potential spore content. By avoiding honey for infants, choosing honey carefully, practicing proper storage, and watching for symptoms, you can safely incorporate honey into your diet. While infant botulism cases are rare, honey should not be fed to babies under 1 year old. If you have any concerns about your honey, throw it out – botulism is not worth the risk.