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Key Facts

  • Honey is a nutritious substance commonly used as a sweetener in beverages, breakfast cereals, and baked goods, given it provides more moisture than other sweeteners.
  • Since 2010, consumption of honey has increased, with the primary consumers of honey including older adults, households of Asian descent, and larger families.
  • The commercial honey production supply chain is composed of two steps. Initially, raw honey is produced by beekeepers and then processed and packaged by processors.
  • Bacterial growth is limited in honey due to certain chemical properties, such as low water content and high acidity (pH 3.9).
  • Honey can contain toxins such as grayanotoxins and pyrrolizidine alkaloids that are introduced by bees from other plants and animals.
  • As of June 2020, there has been only one reported foodborne outbreak in the United States that is related to a honey-containing product. Kellogg’s Honey Smacks cereal contaminated with Salmonella mbandaka caused an outbreak spanning from March 3rd to August 29th of 2018. The investigation identified 135 cases across 36 states.


Honey is a sweet, usually viscous substance that comes in a variety of forms, flavors and colors. It is produced by a specific species of domesticated bees called the Apis mellifera. Honey was first commercialized in 1959 after Apis mellifera was introduced to Belize from Mexico. Today, Apis mellifera is more commonly known as the western honeybee. Honeybees use the nectar from flowers to produce honey, in process where honeybee digestive enzymes break down and reduce the moisture content of nectar they have collected. The final product’s color and flavor depends on a variety of factors, such as what type of flower the nectar was collected from, amount of pollen, age, and storage conditions.

Honeybee-keeping dates back thousands of years to the Egyptian Old Kingdom. Hieroglyphs from 3000 BCE are the earliest depictions of beekeeping currently known. During this time, Egyptians used the honey as sweetener in their food and as medicine for cuts and burns.

Today, California and North Dakota are responsible for most of the honey production taking place in the United States. Bees need nectar year-round to survive and produce honey; North Dakota has wide landscapes with plenty of flowers and limited pesticide exposure, making it an ideal location for beekeeping. As the weather cools down in the fall, beekeepers usually bring their bees to California, where they can be rented by farmers to pollinate crops. This provides bees with nectar for survival and allows them to continue honey production year-round.

Types of Honey

  • Honey can either be unpasteurized (raw) or pasteurized. While there is no official U.S. federal definition of what constitutes raw honey, it is often associated with honey that has not been filtered or heated.
  • Different colors and flavors of honey are produced based on different flowers’ nectars.
  • The final honey product can come in variety of forms, including liquid honey, cut comb honey, naturally crystallized honey, and whipped honey.
Cut Comb Honey

Foodborne Outbreaks and Recalls

As of June 2020, there are no known U.S. or global foodborne outbreaks due to honey alone; however, there have been two U.S. outbreaks linked to products containing honey. In 2018, Kellogg’s Honey Smacks Cereal was contaminated with Salmonella mbandaka. The first cases were reported on March 3rd, 2018, and over the next six months, cases were reported in 36 states. The outbreak was announced on June 14th, 2018 and the Kellogg company recalled all packages of Honey Smacks Cereal with an expiration date within one year of this announcement. On September 26th, 2018, the investigation was completed with 75% of those who fell ill having reported eating Kellogg’s Honey Smacks Cereal.This was further confirmed as laboratory testing indicated that the DNA strain associated with the outbreak was closely related between samples from unopened Honey Smacks cereal, Honey Smacks Cereal eaten by those who had fallen ill, and bacteria isolated from patients.A total of 135 cases were confirmed using the PulseNet system:  34 people were hospitalized, and zero deaths were reported.The median age of those infected was 57, with cases ranging from less than one year of age to 95 years old.Overall, 69% of those infected were female.Symptoms began 12 to 72 hours after exposure and included diarrhea, fever, and abdominal cramps.Most people recovered without treatment four to seven days after their onset of symptoms, but children younger than five years old, adults older than 65 years old, and people with weakened immune systems were more likely to experience severe symptoms.While the Centers for Disease Control and Prevention (CDC) confirmed Kellogg’s Honey Smacks Cereal was the most likely source of the outbreak, it was not determined what ingredient in the cereal caused the outbreak.

On November 16, 2018 the FDA issued an advisory warning parents and caregivers against giving young children, especially those younger than one year, honey and other items including the substance. As discussed below, children under the age of one are at risk of infant botulism and should not be fed honey before this age. The alert came after the FDA was notified of four infants hospitalized with botulism after using honey pacifiers. It was also recommended that online retailers halt the sales of such products given the grave health risks they pose.

Pathogens Associated with Honey

Clostridium botulinum (C. botulinum) – C. botulinum is most commonly known for producing a dangerous neurotoxin, resulting in botulism, a serious illness known for paralyzing muscles. This paralysis can be fatal when muscles controlling the respiratory tract become paralyzed. Honey can contain C. botulinum, but the bacteria itself is not harmful to adults unless the neurotoxin is produced. Conditions that lead to spore formation and toxin production include low or no oxygen environment, low acid, low sugar, low salt, and certain temperature and moisture ranges. If ingested by infants, it can lead to infant botulism, a disease in which the spores colonize in the infant’s intestinal tract and produce the neurotoxin.For this reason, it is important that children younger than twelve months old are not fed honey.

Paenibacillus larvae (P. larvae) – P. larvae, a rod-shaped, spore-forming bacterium is present in honeybee colonies all around the world. It causes the disease American foulbrood (AFB), which destroys honeybee colonies. It is present in more than 90% of honey samples from all over the world, excluding Germany which contains P. larvae in less than 10% of honey samples. The spores of P. larvae are very resilient and, therefore, can survive in honey for more than 40 years. The spores have no effect on humans nor do they produce symptoms, but human ingestion aids in the spread of spores. P. larvae spreads quickly and is present in so many samples of honey, it is important that beekeepers do not feed bees honey. While not harmful to humans, the negative impacts P. larvae can have on colonies, will decrease the number of bees available to pollinate and produce honey.



According to the United States Department of Agriculture (USDA), there were 2,812,000 honey producing colonies in the United States in 2019.Each colony produced 55.8 lbs of honey on average, totaling 156.9 million lbs.The value of production totaled $309,136,000.

While the U.S. produces a lot of honey, it also imports honey from other countries. In 2018, the U.S. imported approximately 442.6 million lbs. of honey and exported approximately 9.7 million lbs.The majority of imported honey in the U.S. comes from Vietnam (84.7 million lbs.), Argentina (75.9 million lbs.), India (42. 5 million lbs.), Brazil (41.8 million lbs.), Mexico (10.3 million lbs.), and Canada (9.1 million lbs.).

Production and Processing

Harvesting: Beekeepers harvest honey by collecting honeycombs, which are covered in a wax that honeybee cap the honeycomb cells with to contain the honey. Honeycomb frames are commonly installed into bee boxes as a surface for bees to build their honeycomb cells on; this removable frame makes harvesting honeycombs a quicker task for beekeepers. To safely extract the honeycomb, the beekeeper may choose to use a bee smoker as a tool to subdue the honeybees and trigger a response that causes the bees to leave the honeycomb. Once removed from the box, the beeswax covering of cells will be removed, called uncapping, to allow honey to flow out during extraction.

Honey extractor

Extraction: After harvesting the honeycomb filled with honey, honeycombs and frames are introduced into the honey extractor. This extractor removes honey by using a centrifugal force. Sometimes liquefaction is required by heating the honey, but temperatures cannot exceed 40 °C during this process, or enzymes and vitamins in the honey will be destroyed. Once extracted, honey is usually taken to a facility for processing.

Processing: Purification of honey involves two steps:  decanting and filtration. Certain plants’ nectar produce honey with a higher amount of water. A dehumidification process is then required to lower humidity values and prevent bacterial growth in the honey after it has been canned. Dehumidification is typically achieved by either raising the temperature of the honey, with a commercial dehumidifier, or a combination of both techniques.

Honey then undergoes pasteurization, a heating process that helps particles such as pollen grains aggregate around air bubbles. Unlike dairy products, pasteurization of honey is not performed for safety reasons. Instead, it is used commercially to slow down the natural process of granulation and encourage the honey to stay in liquid form for longer.

Honey filtration

Finally, the process of filtration occurs, in which honey is filtered to remove all pollen grains, air bubbles, and fine particles that may be suspended in it. The main reason for this process is to create a clear liquid that is more appealing to consumers. The final product is often canned in a glass or plastic bottle. 

Preservation: Honey changes physically and chemically over time; it darkens, loses aroma, loses flavor, and begins to crystallize. The rate of these processes depends on the storage temperature, but the usual shelf life of honey is estimated to be two years. However, sealed containers of honey can remain stable for decades, depending on whether the honey was properly processed, packaged, and stored by producers. The National Board of Honey suggests that if you are ever in doubt about the safety of your honey, you should throw it out.

Food Safety

Contamination risk

Honey has a very low water content and high acidity, which usually inhibits the growth of bacteria. The main step beekeepers can take to reduce contamination of honey is sanitizing hive equipment after each extraction to limit contamination by outside sources such as other animals.

Pesticide Exposure and Affects

Pesticides pose several threats to honeybees and humans. From 1950 to 2010, the number of U.S. honeybee colonies declined by 45%. This decline is partially due to pesticide use on crops, which accounted for most colonies lost between 1966 and 1979. Pesticides have also been used within hives to combat honey bee mites. Honeybees are more vulnerable to the effects of pesticides because their genome lacks coding for several detoxification enzymes that other insects have. Insecticides such as neonicotinoid and phenylpyrazole are spread systemically throughout the plant, exposing bees to a substantial amount over long periods of time. These insecticides lead to hyperexcitation and death. Another insecticide, tau-fluvalinate, affects the reproductive health of the colony. Queen bees exposed to tau-fluvalinate are statistically smaller than queens that have not been exposed. As expected, a decrease in the total number of honeybee colonies correlates to a decrease in honey production.

Furthermore, bees that have been exposed to pesticides can contaminate honey. The concentration of pesticides in honey depends on the bees’ exposure to pesticides in local crops. Pesticide effects on human health depend on the toxicity of the pesticide as well as the magnitude of exposure. These chemicals can also bioaccumulate in the body over time. For this reason, children are most susceptible to harmful effects from pesticide exposure. The effects of pesticide exposure can include skin rashes, birth defects, tumors, genetic changes, endocrine disruption, and death.


Honey is sometimes contaminated with toxins from pollinated flowers. Large producers of honey pool together multiple sources so that any toxins present are diluted to levels that are harmless. Honey is also made locally by smaller beekeepers and sold at local farmers’ markets. While this honey is not pooled into a larger source, local farmers are usually more aware of the plant sources used by their bee colonies for honey production. Consumers can ask their local beekeepers about the following toxins as well as the flower species used by their colonies.

Pyrrolizidine Alkaloids – This is a large class of naturally-occurring alkaloids that contain pyrrolizidine rings. Pyrrolizidine alkaloids have been identified in over 6000 species of plants. These toxins are present in the nectar of plants and contaminate honey supplies when a bee pollinates a plant containing pyrrolizidine alkaloids. The toxins, while rare in the U.S., can be in imported honey supplies. Low-level exposure to pyrrolizidine alkaloids over a long period of time can cause liver damage and eventually death. This effect is another important reason for infants to avoid honey consumption.

Grayanotoxins – These toxins are found exclusively in the Ericaceae, RhododendronPieris, Agarista, and Kalmia families of plants. Honey may be contaminated with these toxins when it is produced using the nectar of plants containing the toxin. Contamination of honey occurs most commonly in Turkey, as bees there produce honey using nectar from predominately, Rhododendron plants. Turkish beekeepers are also often producing honey on a smaller scale, allowing for a high concentration of grayanotoxins. These toxins are rarely lethal but can affect the nervous system, causing symptoms such as dizziness, hypotension, nausea/vomiting, blurred vision and atrial-ventricular block which subsides after 24–48 hours, termed mad honey disease.


Honey barbecue sauce

Over the last decade, honey consumption has increased in the U.S. In 2010, the average per capita honey consumption was approximately 1.20 lbs. In 2017, the per capita consumption was approximately 1.51 lbs., totaling 555.1 million lbs. consumed that year. Consumption of honey in the U.S., especially organic honey, is predicted to continue growing as honey becomes a more widely used sweetener.

Honey is increasingly being used and consumed in alcoholic beverages such as mead (fermented honey with water), cereals, and baked goods, which together account for nearly half of the new product launches containing honey. Sauces and spreads containing honey account for another quarter of new honey product launches. Many of these sauces and dressings, such as honey barbecue, honey mustard, and honey glazes, are increasingly used in restaurants on appetizers and entrees.

Demographically, older adults, larger families, and people in urban areas are more likely to purchase honey. In 2016, the greatest increase in consumption was among lower income families and people under the age of 40. People of Asian descent reportedly consumed the most honey, with people of African American descent or Hispanic descent consuming slightly less. Caucasians consumed the least amount of honey compared to other racial and ethnic groups in the U.S. Currently, there are no observed differences in honey consumption between genders.


Honey contains 65 calories per tablespoon, 17 grams of carbohydrates and no significant amounts of fat or protein. Honey is made up of primarily the simple sugars, fructose and glucose, and has low levels of water, disaccharides (maltose and sucrose), other carbohydrates, and various minerals, vitamins and enzymes.

Honey also contains a wide variety of vitamins, minerals, amino acids and antioxidants. Common antioxidants in honey include flavonoids and phenolic acids, but the amount and type of these compounds depends on factors such as botanical source. Some of the micronutrients found in one tablespoon of honey includes low quantities of potassium, sodium, phosphorous, calcium, and vitamin C. Additionally, Honey contains trace amounts of riboflavin, niacin, vitamin B6, iron, and zinc.

A common health-related misconception about honey is that pasteurization removes the nutrients received from enzymes and vitamins when the pollen is filtered out. This as the nutrient content and antioxidant levels remained unchanged after pasteurization. Furthermore, a 2012 study by the National Honey Board confirmed that the nutrient profile of honey is not associated with the amount of pollen present and, therefore, it is not affected by processing.

Medicinal Uses

Honey has many additional health benefits and can be used medicinally in throat lozenges or as an alternative to over-the-counter cough syrup to help soothe sore throats and suppress coughs. Research has shown that honey reduces mucus secretions, has antioxidant properties, and can increase the release of anti-inflammatory cytokines which act in the immune responses to infection.

Historically, honey has been used in the process of healing wounds since the times of ancient Egypt. Honey has antimicrobial properties, such as hydrogen peroxide generation and reducing biofilm production, that help limit bacterial growth. It also inhibits mechanisms that are not fully understood, such as its ability to limit infection in the presence of catalase and stop bacterial cell cycle progression. Honey has also been shown to have anti-microbial activity against the microorganisms E. coli, P. aeruginosa, S. aureus, Acinetobacter, and Stenotrophomonas. Additionally, honey’s anti-inflammatory properties along with its ability to create a moist wound-healing environment help promote wound and burn healing. Its hygroscopic properties also promote drainage and limit wound edema. Further research is needed to fully understand how honey affects microorganisms and the mechanisms of action.


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Rachel Massey

Rachel Massey

BA Public Health, BA Political Science; University of Washington

Emmanuel Rodriguez

Emmanuel Rodriguez

MPH Epidemiology Student; University of Washington

Maayan Simckes

Maayan Simckes

PhD Epidemiology; University of Washington

Haylea Hannah

Haylea Hannah

MSPH in Epidemiology, PhD Student in Epidemiology

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