Mad honey is a type of honey which has grayanotoxins, toxic substances produced by plants that are naturally occurring and are found in the nectar and pollen of some species of Rhododendron and other plants belonging to the family Ericaceae. This is a reddish, dark honey that has moderate toxic and narcotic effects. The mad honey is grown in Nepal and Turkey; it has been used since ancient times both as a medicine and recreational drug.[1]
Description
The Mad honey has a very dark shade of reddish-brown color and a rather bitter flavor. Since it has a special coloration caused by the rhododendron pollen, it is occasionally known as the rose of the forest honey. Grayanotoxins are psychoactive and toxic properties of the honey that are passed on the nectar and pollen of certain plants into the final honey product.
Mad honey potency is quite different depending on a number of factors, some of which include concentration of grayanotoxin-producing plants in the region, altitude of production, seasonality and mode of harvesting. Small-scale honey harvesting producers that harvest honey in a small region or a single hive of honeybees usually harvest higher concentrations of grayanotoxins than large-scale commercial businesses that combine honey products of different geographical locations.
Production and Geographic Distribution
Primary Production Regions
Mad honey is predominantly produced in two major regions:
Nepal: Mad honey is honey made in the Himalayan giant honey bee ( Apis laboriosa ) using rhododendron species native to high altitude growth. The cultural traditions of the indigenous Gurung people are closely related to this production.
Turkey: Mad honey is made in the Black Sea region of Turkey mostly in the Kaçkar Mountains, locally known as deli bal (mad honey). Majority of the Turkish mad honey is usually derived through the nectar of Rhododendron luteum and Rhododendron ponticum. The beekeepers here have been practicing the ancient methods of production up to generations.
Other Regions: Mad honey is also present, though in other places such as:
- Kalmia latifolia and Kalmia angustifolia – Eastern United States, Appalachian Mountains
- Rhododendron ferrugineum – Alps and Pyrenees (Europe)
- Other regions – China, Bhutan, India, Myanmar, Laos, and Vietnam
Mad Honey from Nepal
The Himalayan Giant Honey Bee (Apis laboriosa)
The honey production of mad honey in Nepal solely depends on Apis laboriosa that is the biggest honey bee species in the globe with a length of up to 3 centimeters. Firstly, this bee was considered a subspecies of Apis dorsata and then became a species in 1980 and a recognized one in 2020.[2]
These amazing insects can be found in Hindu Kush Himalayan area and they construct their tremendous nests on the vertical cliff faces of altitudes of 1, 200-4000 meters. The nests are composed of single combs which are open and may measure 1.5 meters in diameter and hold as much as 60 kilograms of honey. The hives are located in strategic locations at cliffy sides facing south east or south west facing rocky cliffs mostly with overhanging ledges to shield the elements.[3]
Apis laboriosa feeds on altitudes as high as 4,100 m. and feeds mainly on Rhododendron species and other high altitude wildflowers. The bees are extraordinarily tolerant to the grayanotoxins of rhododendron nectar, which they metabolize without any toxic effect to produce honey in large proportions of these neurotoxins.
Types of Nepalese Mad Honey
Three distinct types of honey are produced by Apis laboriosa in Nepal:
- Spring or Red Honey: Harvested in spring from higher altitudes (2,500–3,900 m), this variety contains higher concentrations of grayanotoxins and is associated with stronger psychoactive effects. It is locally known as “red honey” due to its crimson color.
- Spring Honey (Mid- and Lower Altitudes): Produced from nectar collected at mid and lower elevations during spring, containing moderate levels of grayanotoxins.
- Autumn Honey: Harvested in autumn across various locations, generally characterized by lower grayanotoxin concentrations compared to spring varieties.
Attractive intoxicating effects, and so-called medicinal qualities of the red honey are much appreciated, and large amounts of the product are exported to Japan, South Korea, and Hong Kong. Nevertheless, the strength of the honey reduces with time during storage.
The Gurung Honey Hunters
Honey hunting is an ancient trade of the Gurung people, an ethnic group with the largest population in the Gandaki Province of Nepal and is thought to have been practiced by this ethnic group for more than 2,000 years. Oral histories also show that the initial honey harvesting took place approximately 22 generations ago when a daring hunter (Gurung) collected honey in a cliff called Maha Bhir (the Honey Hill) in Lamjung district.
Harvesting Process
Honey hunting is one of the most hazardous processes of food collection in the world requiring phenomenal courage, expertise and family secrets that have been acquired over generations. This means that the harvest is delivered twice a year; in late spring (when the grayanotoxin levels are the highest) and in late autumn.
Preparation Phase:
- Hunters make home made ladders out of hand-woven bamboo fibers as rope, which is then of a specific length that fits the particular cliff.<
- Traditional materials that are accumulated by teams include bamboo baskets, long bamboo sticks known as tango, and smoking materials.
- Ritual ceremonies are also conducted in the honor of Rangkemi, the sacred bee spirit; where there is a sacrifice of chickens and sheep, flowers, fruits and rice offering.
- Before the expedition, some prayers and dances of the ritual are performed.
Harvesting Technique:
- Hunters also use only handmade hemp ropes and bamboo ladders in order to descend cliff faces that may be more than 300 meters high.
- The aggressive giant bees are soothed down with smoke but hunters get many stings when doing so.
- Hunters go to the work of cutting honeycombs out of tangos suspended hundreds of feet above the ground.
- The honey that is collected is filtered through bamboo filters (chhora) and placed in bamboo containers to eliminate remnants of wax.
The whole process is a model of teamwork and the contribution of each member is significant. The assigned climber is exposed to direct contact with bee stings, the probability of falls, and severe mountain conditions. Irrespective of these threats, honey hunting is an important cultural activity, which represents courage, survival, and solidarity.
Cultural and Spiritual Significance
To the Gurung people honey hunting is not an economic practice but a religious ceremony of their bond with nature and inheritance. It is viewed as a ritual of initiation to young men and shows their bravery and power. The old generations in the community impart wisdom and learning to the young ones in order to maintain the cultures.
The traditional beliefs are of the benefit that mad honey is medicinal and helps cure hypertension, diabetes, arthritis, digestive disorders, sexual dysfunction and many other diseases. Historical evidence of the Gurung people using mad honey as a form of pain relief and stress management as well as general health maintenance is evident.
Conservation Crisis
The Apis laboriosa species in Nepal is experiencing a debilitating degradation with the population per annum being estimated as around 70 percent. There are several causes of this crisis:
Habitat Loss:
- The development of hydroelectric dams, especially mega-projects that are required by power deals in Nepal destroys the habitat of the bees.
- The construction of roads along mountainous areas destroys nesting areas.
- Deforestation and landslides kill important sources of water and flowering plants.
- >Apis laboriosa nests especially around water bodies and as such, water diversion is especially devastating.
Unsustainable Harvesting:
- Mad honey is in high demand all over the world, which has also resulted in overharvesting.
- The alterations to the ownership of the cliffs by the government have brought in honey hunters who are not traditionally trained and experienced.
- The interests of commercial activities are more focused on short term gains rather than long term sustainability.
- The timing and procedure of harvesting usually interferes with reproduction cycles of colonies.
Climate Change:
- Flowering patterns are affected leading to change in the availability of nectar.
- Temperature and precipitation alterations affect the survival of bees.
- The changes in vegetation zones minimize the habitat.
Socioeconomic Factors:
- The young Gurung find themselves migrating to cities or finding jobs in foreign countries.
- There is a decline in the traditional knowledge passed between the old generation and young people.
- The hunting activities also disrupt the bee habitats by the tourist activities taking place when the hunting period is not the usual season.
Conservation Efforts: The traditional Gurung honey hunters and conservation groups have promoted sustainable methods of harvesting honey such as not touching half of newly built combs but only harvesting part of old combs. Other organizations are involved directly with the communities that engage in honey hunting to ensure their education, sustainable development, and equitable economic gains. When managed in a proper way, honey hunting tourism can serve as a source of economic incentive to conserve the ecosystem, and also create awareness about the ecological relevance of Apis laboriosa.
Chemical Composition
Grayanotoxins
Grayanotoxins are polyhydroxylated cyclic diterpenes which have a 5/7/6/5 ring structure. It has been found that Rhododendron species are the source of over 25 isoforms of grayanotoxins: grayanotoxin I (synonym andromedotoxin) and grayanotoxin III are discussed as the major toxic toxins. The Rhododendron species have different proportions of the isoforms of grayanotoxin, which lead to the variation in the toxicity of honey.
The production of these low molecular weight hydrophobic compounds is also found in plants belonging to the Ericaceae family including Rhododendron, Kalmia, Leucothoe, Pieris and Andromeda. These molecules are present in almost all sections of the grayanotoxin-producing plants such as the stems, leaves, flowers, pollen, and nectar.
Mechanism of Action
Grayanotoxins are reversible sodium channel agonists (Nav1.x), which disrupts sodium channels on cell membranes of neurones and cardiac muscle cells, which are voltage-gated. Under normal conditions, the voltage-gated sodium channels open to allow influx of sodium ions and depolarization of cells needed to produce action potentials. Such channels subsequently fast-inactivate and depolarize only after the cell repolarizes to rest.
The binding of grayanotoxin to sodium channels does cause a conformational alteration that inhibits the inactivation of the channel causing extended depolarization. This mechanism results in:
- Unremitting sodium entry into cells.
- Higher automatism of cardiac tissue.
- Increased vagal tone on the heart rhythm.
- Alterations in the central nervous system.
- Long-term depolarization of excitable tissues.
Muscarinic action of grayanotoxins has been reported with atropine being able to reverse respiratory depression and bradycardia caused by the poison and indicating a cholinergic component to the toxicity.
Effects and Toxicity
Clinical Presentation
Mad honey varies in effects, but with regard to the amount of grayanotoxin ingested and concentration in the toxicin, the effects of mad honey range between a mild and intoxication and serious and potentially fatal. Symptoms normally come out between a span of 30 minutes to 3 hours following intake.
Cardiovascular Effects:
- Low blood pressure (hypotension) – occurs in almost all cases.
- Bradycardia (low heart rate) – found in the majority of patients.
- This is accompanied by different arrhythmias such as sinus bradycardia, complete atrioventricular block, atrial fibrillation.
- Asystole or myocardial infarction is rarely observed.
Gastrointestinal Symptoms:
- Nausea and vomiting (extremely frequent)
- Diarrhea
- Abdominal pain
- Excessive salivation
Neurological Effects:
- Dizziness and vertigo.
- Blindness or blurred vision or diplopia (two images).
- Headache.
- Affected mental status or impaired consciousness (in about 67% of cases).
- Sweatiness and excessive perspiration.
- General weakness and incapability to stand.
- Paresthesia or numbness of the extremities.
- In extreme situations: convulsions, delirium, hallucinations, unconsciousness.
Psychoactive Effects (with moderate doses):
- Light euphoria and well being.
- Tingling sensations.
- Lightheadedness.
- Mood upliftment and relaxation.
- Increased sense of perception.
Dosage and Tolerance
The effects of mad honey include the feeling of intoxication based on the consumption of 1-5 tablespoons of mad honey. Nevertheless, the individual reactions are quite different depending on such aspects as the body weight, sensitivity, and the previous exposure, and the concentration of the exact grayanotoxins in the honey itself. With repeated use, the user can develop tolerance of the sodium channels desensitization, which results in less symptomatic characteristics than first time users.
Prognosis and Recovery
Although the signs can be quite alarming, the prognosis of mad honey poisoning is in most cases very good. The symptoms do not last long (under 24 hours) because of a high metabolic rate and excretion of grayanotoxins. With proper supportive care, most of the patients recuperate fully in 24-48 hours. In contemporary medicine there are no reports of deaths of mad honey poisoning in developed nations, where medical care is accessible, but historical accounts dating to the 1800s show there were deaths where medical care was not available.
Exception A case series, Lanping County, China, 8 out of 31 patients died as a result of taking honey contaminated with toxins of Tripterygium hypoglaucum; this is a different profile of toxic compounds.
Historical Accounts
Ancient Greek and Roman Records
The history of mad honey dates back more than 2000 years with some of the earliest references being found in ancient Greek and Roman texts.
Xenophon’s Account (401 BCE): Greek military commander and historian Xenophon was one of the earliest to describe mad honey poisoning, and he wrote about it in his account of the expedition of the Ten Thousand, Anabasis. With victorious military missions against the Persians, Greek warriors who had sailed around Trabzon (modern day Turkey) towards the black sea found large numbers of beehives and ate massive amounts of honey. According to Xenophon, soldiers who ate little were ruthlessly drunk and those who had eaten a lot of food were mad or almost dead. The affected men were vomiting, diarrhea, lost sense, and unable to stand, lying on the ground, like there were a defeat. Surprisingly, no soldiers were killed, and all of them recovered on the next day and the army proceeded with their expedition.
Military Weapon (65 BCE): In the Third Mithridatic War, the King Mithridates VI of Pontus (the so-called Poison King) used mad honey as a biological weapon against Roman troops led by General Pompey. The Pontic army in their retreat was tactical enough to place honeypots on the path of the Romans. Roman soldiers who were unaware of it ate the honey and got paralyzed. Persian forces that were allied with them then brought them back and killed more than 1,000 Roman soldiers who could not protect themselves while showing minimal losses themselves. This is one of the earliest reported cases of biological warfare.
Classical Authorities:
- Aristotle commented on honey in Trapezus (Trabzon) being sedative, and stated that it would cure epilepsy.
- Pliny the Elder called mad honey meli mænomenon and was one of the earliest ever to identify a relationship between toxicity and certain species of plants such as oleander, azalea and Rhododendron.
- A doctor named Pedanius Dioscorides, a Greek doctor noted that the power of the honey changed with season.
- The Roman and Greek leaders thought mad honey would cure insanity and other disorders.
Medieval and Early Modern Period
Russian Conflicts: According to reports in 946 CE, allied with Queen Olga of Kiev shipped several tons of fermented honey to Russian enemies which led to the slaughter of around 5,000 drunk Russians. A comparable circumstance happened in 1489 during which Tatars drank mead prepared using mad honey that was left in a camp and as a result, 10,000 Tatars were slaughtered by Russians.
European Trade: In the 18th century, about 25 tons of mad honey was being exported out of the black sea region to Europe each year. It was used in France as miel fou (crazy honey) to be added to beer and other drinks to increase the intensity of its effect. It was reported by American botanist Benjamin Smith Barton that Pennsylvania beekeepers would grope mad honey drunk, and sell mixtures of honey-liquor in New Jersey as an elixir known as metheglin (mead).
Scientific Discovery
The chemical characterization of the active toxin was first done in 1891, when German scientist P.C. Plugge isolated the chemical compound andromedotoxin (also known as grayanotoxin I) of Trabzon honey. The first scientific description of grayanotoxin I was given by Otto Tunmann in 1912 who extracted the toxin using tannin and glucose produced by Ericaceae.
Medical Management
Diagnosis
Mad honey poisoning is mainly diagnosed by the presentation along with the history of honey ingestion. Grayanotoxin can be detected by specific laboratory tests, which are not very common in the majority of clinical facilities. The liquid chromatography-tandem mass spectrometry (LC-MS/MS) has the capability to determine the amount of grayanotoxin I and III in blood, urine, and honey but such tests are usually done on a research basis and not on an acute clinical basis.
Treatment Protocol
Mad honey intoxication is generally supportive in nature and the majority of patients respond to the standard intervention:
Initial Management:
- Continuous hemodynamic cardiac monitoring.
- Stabilization and assessment of the vital signs.
- Judgment of awareness and neurological condition.
Pharmacological Treatment:
- Normal saline intravenous fluid resuscitation of hypotension.
- Atropine sulfate (0.5-2mg IV) of symptomatic bradycardia and heart blocks.
- Vasopressors (epinephrine or dopamine infusion) of severe hypotension, which does not respond to fluids and atropine.
- Nausea and vomiting control antiemetics.
Advanced Interventions:
- Complete atrioventricular block or asystole (infrequently necessary) Temporary transvenous pacemaker.
- Activated charcoal can be regarded in case of its presentation during 1-2 hours after ingestion.
Observation Period: Majority of patients need to be monitored (6-24 hours) to facilitate stabilization. Quickly stabilized patients can be released on observation in the emergency department, and a serious patient needs to be hospitalized to be properly observed. It takes patients around 24 hours to resume normal vital levels as a result of the treatment.
Prevention
There is need to do public health education on the danger of taking mad honey in large amounts that have no regulation. To avoid accidental poisoning, it is possible to label and recommend the dosage of commercially sold mad honey products. Education should be ensured to healthcare providers in areas where mad honey is taken to ensure that they understand this condition and act immediately to cure the patients.
Cultural Significance
Traditional Medicine Applications
Mad honey has traditionally been used in centuries in many cultures of traditional medicine:
In Nepal and Himalayan regions:
- Hypertension and cardiovascular disease treatment.
- Management of diabetes.
- Alleviation of arthritis and joint pain.
- Digestive disorder cures such as gastritis and peptic ulcers.
- Improvement of sexual activity and libido.
- Enhancement of immune system.
- Relief of pain and alleviation of stress.
In Turkey and the Black Sea region:
- Sore throat and respiratory infection Treatment.
- Indigestion and abdominal pain Management.
- In milk Traditional tonic.
- Improvement of physical condition.
Recreational Use
Otherwise, outside medical usage, mad honey has been used recreationally as a psychoactive, with mild euphoric and relaxation effects as well as sensory distortion. The tradition is performed in both traditional settings and among contemporary consumers who want to have alternative psychoactive substances. South Korea, in 2005, prohibited mad honey because of the recreational abuse and poisoning cases.
Economic Importance
Mad honey is a major economic asset in the production community, especially the Gurung of Nepal. The premium price of red honey, which is 5 times the Hunter honey price, is an important source of income to remote mountain communities. Nevertheless, the same economic incentive is also a part of the unsustainable harvesting and conservation problems.
The increased popularity of mad honey all over the world has brought about export business to other foreign markets especially in the east Asian region where the honey is considered to have certain medicinal values and peculiar qualities. The traditional honey-hunting communities have opportunities and threats in this commercialization.
Contemporary Challenges
The current honey-hunting has been facing many challenges that are posing threats to its survival as a cultural activity:
- Traditional knowledge being lost as the young generation seeks the benefits of urban life.
- Tension between conventional sustainability mechanisms and business forces.
- Regulatory changes to the customary access rights by government.
- Tourism has effects on the time of harvest and population of bees.
- Striking the right balance between cultural preservation and conservation requirements.