Science and Experience: Repairing a Fractured Medicine.

Introduction

On December 31, 2019, a new strain of the coronavirus that proved to be potentially deadly to humans was discovered in China; the strain was dubbed COVID-19 [1]. COVID-19 had immerged the province of Wuhan, China, and quickly spread to the point that it became a global epidemic. The World Health Organization (WHO) responded by declaring the situation a “public health emergency” first, then a “pandemic” [2, 3]. The first positive case was identified in Turkey on March 11, 2020; the disease then quickly spread across the country, too. As of June 23, 2021, 5,375,593 Turks had been infected with the disease, and 49,236 had died from it. As of the same date, 178,701,170 people worldwide had been diagnosed with COVID-19, while 3,877,316 people had lost their lives [4].

No permanent treatment for COVID-19 exists as of yet; vaccination and treatment studies are still on-going [5]. Therefore, it is very important that people do what they can to protect themselves from the disease. The WHO has issued a series of measures on how people can go about doing that [6]. Some of these include washing hands (or at least rubbing them with alcohol-based hand sanitizers), standing at a certain distance away from other people, wearing a face mask in public, avoiding travelling abroad unless necessary and complying with a 14-day quarantine period upon returning from abroad [7]. Strengthening the immune system is also an important means of protection against COVID-19; the weaker our immune systems are, the more susceptible we are to contracting the disease (or any other disease, for that matter) [8].

Various vitamins, minerals and antioxidant-rich foods are known to help boost our immune system and keep our body healthy [9]. One food that is particularly rich in antioxidants is honey. Honey is an antimicrobial agent that is capable of inhibiting the development of pathogenic bacteria, viruses, fungi and even parasites that cause disease in humans [10, 11, 12]. Honey stimulates the proliferation and activation of lymphocytes B and T in peripheral blood. It also is chemotactic in that it produces neutrophils that in turn kill off tumours. Hence, it strengthens the immune system. In that regard, people have been using honey to treat bacterial infections, coughs and cold since antiquity, as it is particularly effective at fighting against many infectious diseases [13]. Studies have shown that certain varieties of honey have strong antiviral effects against certain viruses [11, 14, 15]. Watanabe et al. [14] demonstrated that honey has a strong inhibitory activity against influenza. Similarly, Zeina et al. [16], Shahzad and Cohrs [15] and Al-Waili [13] have all discovered that honey can be used to treat rubella, varicella zoster and herpes simplex.

Consuming honey is very important − if we consider its many benefits. When it comes to chestnut honey in particular, in a Turkish context, no statistical data about how it is made or consumed has been published. The only data available shows us that 109,330 and 104,077 (metric) tons of it were made in 2019 and 2020 [17]. Turkey's natural environment, geographical location, suitable climatic conditions and rich vegetation are very suitable for beekeeping. In the Aegean region (i.e., Western Anatolia) − followed by the Eastern Black Sea and Mediterranean regions − most of the honey in Turkey was produced [18]. The province of Giresun is situated in Turkey's Eastern Black Sea region. While honey production in other parts of Turkey have dropped significantly due to the COVID-19 pandemic, in Giresun, it has risen from 958 tons in 2019 [19] to 1,251 tons in 2020 [20]. In other words, it is clear that the demand for honey has spiked in Giresun following the onset of the pandemic.

Honey can be used to treat COVID-19, albeit the effectiveness of any treatment largely depends on how strong the patient's immune system is. An active immune system − when defending the body against the virus in question − can cause inflammation and cytokine storm. During COVID-19, that cytokine storm is worse when compared to other diseases. The best way to remedy the cytokine storm is the use of antioxidants. Therefore, food that has immune-modulatory and anti-oxidant properties could possibly be effective at treating (or helping treat) COVID-19 [21].

There are numerous published studies that demonstrate the antiviral effects of honey on rubella [16], varicella zoster [15], influenza [14] and herpes simplex [13], but none with regard to COVID-19 (as of yet). This descriptive study, therefore, will hopefully fill that gap. It focuses on examining people's (namely Turks') chestnut honey consumption habits as a form of traditional medicine and whether or not it is effective at protecting them against COVID-19. It will go about doing this by comparing how many people among those who use chestnut honey contract COVID-19 compared to those who do not.

Methods

Aim

This is a descriptive study. It looks at how people consume chestnut honey as a form of traditional medicine and whether or not it is effective at protecting them against COVID-19.

Settings

This research was carried out in the central district of the Province of Giresun, Turkey (one of the country's largest chestnut honey producers) between November 20 and December 25, 2020.

Participants

This study's population featured individuals living in Giresun. Its sample consisted of 177 participants (aged 18 and over) − selected using snowball sampling − who voluntarily agreed to participate in the study.

Measurements

The researchers created an online questionnaire based on the literature and used it to collect the data [10, 11, 14, 15, 17]. It contained 20 questions covering open/closed-ended questions. The first 7 questions inquire about participants' age, gender, level of education, marital status, where they live and whether they suffer from any chronic diseases. The second part contains 6 questions that ask them about whether they consume chestnut honey, how they consume it, how often they consume it, why they consume it and where they get their information about chestnut honey. The third part features 7 additional questions that ask them about whether they have been tested and diagnosed for COVID-19 − and if yes, what symptoms have they have experienced, whether they visited any form of health institution within the past year (and if yes, how many times) and whether they believe chestnut honey to be beneficial for preventing and treating COVID-19.

Data Collection

The questionnaire was sent to the participants in the form of a online survey link via either WhatsApp or e-mail. Those who successfully filled the questionnaire in were later asked to share the link with their friends, acquaintances and/or relatives, so that they could participate as well. The collection period took 35 days to complete. A total of 177 people ultimately agreed to participate in the study and to fill in a questionnaire (the latter took them an average of 5 min).

Data Analysis

The data obtained from the questionnaire were entered into IBM SPSS, version 22. Descriptive statistics (number, percentage, frequency, median), Shapiro-Wilk, and Pearson's χ2 were used to analyse the data. Shapiro-Wilk was used to find out whether the age variable showed a normal distribution. Pearson's χ2 test was used to compare the frequency of COVID-19 testing and diagnosis among the groups of independent variables. Statistical significance was set at p < 0.05.

Results

67.8% of the participants were women, 40.1% held a bachelor's degree, 66.7% were single, 78.5% lived in central Giresun, and 18.6% had suffered from at least one chronic disease (Table 1). Chronic disease sufferers by and large either had diabetes (n = 11) or hypertension (n = 5), followed by asthma (n = 4), rheumatoid arthritis (n = 3), heart failure (n = 2), allergic asthma (n = 2), coronary artery disease (n = 1), Behcet's disease (n = 1), chronic bronchitis (n = 1), cancer (n = 1), hypothyroidism (n = 1) or ankylosing spondylitis (n = 1). The participants had a median age of 37 years.

Table 1

Demographic data

Variables		n	%
Gender	Female	120	67.8
	Male	57	32.2
Education	Literate	5	2.8
	Elementary school	13	7.3
	Middle school	10	5.6
	High school	39	22.0
	Associate degree	25	14.1
	Bachelor's degree	71	40.1
	Postgraduate (Master's or higher)	14	7.9
Marital status	Single (i.e., not married)	59	33.3
	Married	118	66.7
Place of residence	Rural village	12	6.8
	Township	26	14.7
	Central Giresun (equivalent to an urban centre)	139	78.5
Presence of any chronic disease	Yes	33	18.6
	No	144	81.4

All data on chestnut honey consumption is presented in Table 2. In total, 74% (n = 131) of the participants consumed chestnut honey. Of them, 50.3% stated that they consumed chestnut honey to keep their immune systems strong, 34.5% did so to maintain good health, 14.7% did so for nutritional purposes, and 2.8% did so to treat their other illnesses. Moreover, approximately half of the participants (46.3%) noted that they consumed chestnut honey raw (i.e., without mixing it with anything else), 14.7% consumed honey with tea or milk, 11.9% with bread, and 1.1% with fresh ginger. Likewise, 37.9% of the participants stated that they consumed chestnut honey 2–3 times a week, 21.5% every day and 14.7% once a month. 43.5% of participants reported consuming up to a dessert spoon-worth of honey. Beyond that, most claimed that they got their information about honey's benefits from their family members (Table 2).

Table 2

Chestnut honey consumption habits

Variables		n	%
Do participants consume chestnut honey?	I consume honey	131	74.0
	I don't consume honey	46	26.0
Why do they consume chestnut honey?	Strengthen immunity	89	50.3
	Protect health	61	34.5
	Nutritional purposes	26	14.7
	Treat illnesses	5	2.8
How do they consume chestnut honey?	I don't consume honey	46	26.0
	I consume honey raw	82	46.3
	I add honey to tea or milk	26	14.7
	I eat honey on bread	21	11.9
	I eat honey with ginger	2	1.1
How often do they consume chestnut honey?	I do not consume honey at all	46	26.0
	I eat honey every day	38	21.5
	I eat honey 2–3 times a week	67	37.9
	I eat honey once a month	26	14.7
How much chestnut honey do they consume?	I do not consume honey	46	26.0
	A teaspoon	19	10.7
	A dessert spoon	77	43.5
	A soup spoon	25	14.1
	More than a soup spoon	10	5.6
Where do they get their information about honey?	I have no information	22	12.4
	Honey producers	28	15.8
	Salespeople	7	4.0
	The Internet	13	7.3
	Locals	35	19.8
	Family members	69	39.0
	Friends	3	1.7

28.8% (n = 51) of the participants had been tested for COVID-19; of them, 4.5% (n = 8) had been diagnosed with it. When we looked at the participants' assumptions about the benefits of chestnut honey in fighting against COVID-19, we found that 41.8% (n = 74) of them ate chestnut honey to protect themselves against COVID-19, 40.7% (n = 72) believed that chestnut honey could protect them against COVID-19, and 37.3% (n = 66) believed chestnut honey could help treat COVID-19 (Table 3).

Table 3

People's views about the effects of chestnut honey on COVID-19

Variables		n	%
Have you been tested for COVID-19?	Yes	51	28.8
	No	126	71.2
Have you been diagnosed with COVID-19?	Yes	8	4.5
	No	169	95.5
Do you use chestnut honey to protect yourself against COVID-19?	Yes	74	41.8
	No	103	58.2
Do you believe chestnut honey is beneficial for protecting you against COVID-19?	Yes	72	40.7
	No	4	2.3
	No idea	101	57.1
Do you believe chestnut honey is beneficial for treating COVID-19?	Yes	66	37.3
	No	7	4.0
	No idea	104	58.8

In this study, those participants who had been diagnosed with COVID-19 were asked about their symptoms. 16.4% (n = 29) claimed that they had suffered from muscle aches, 10.7% (n = 12) stated shortness of breath, 6.8% (n = 12) stated fever, 6.2% (n = 11) stated diarrhoea, 3.4% (n = 6) reported losing their ability to taste and smell, 2.8% (n = 5) reported having bloodshot eyes, and 1.1% (n = 2) reported their skin changing colour or breaking out in rashes. In addition, two-thirds (66.5%, n = 116) of the participants stated that they visited a health institution at least once within the past year.

No significant difference was found between those who consumed chestnut honey and those who did not in terms of whether they took a COVID-19 test (p > 0.05, χ2 = 1.080) and tested positive for it (p > 0.05, χ2 = 0.793). The same also held true in terms of their honey consumption habits, how often they ate honey and how much honey they ate (p > 0.05) (Table 4).

Table 4

Comparing people's chestnut honey consumption habits versus their COVID-19 test and diagnosis rates

	Testing for COVID-19			Testing positive for COVID-19
	yes, n	no, n	test statistics		yes, n	no, n	test statistics
Do participants consume chestnut honey?	I consume chestnut honey	35	96	p = 0.299	7	124	p = 0.373
	I do not consume chestnut honey	16	30	χ2: 1.080	1	45	χ2: 0.793
Why do they consume chestnut honey?/	I do not consume chestnut honey	16	30	p = 0.609	1	45	p = 0.881
How do they consume chestnut honey?	I do not consume honey	20	62	χ2: 2.702	5	77	χ2: 1.184
	I consume honey raw	9	17		1	25
	I add honey to tea or milk	5	16		1	20
	I eat honey on bread	1	1		0	2
Chestnut honey consumption frequency	I do not consume honey at all	16	30	p = 0.466	1	45	p = 0.360
	I eat honey every day	13	25	χ2: 2.551	2	36	χ2: 3.211
	I eat honey 2–3 times a week	16	51		5	62
	I eat honey once a month	6	20		0	26
How often do they consume chestnut honey?	I do not consume honey	16	30	p = 0.419	1	45	p = 0.500
	A teaspoon	4	15	χ2: 3.904	0	19	χ2: 3.356
	A dessert spoon	19	58		5	72
	A soup spoon	10	15		2	23
	More than a soup spoon	2	8		0	10

p, significance; χ2, Pearson's chi-squared test.

In the study, it was also determined that there was no difference between the groups in terms of taking a COVID-19 test and being tested positive for it, based on the status of using chestnut honey for COVID-19 protection, believing that it is useful in COVID-19 protection, and believing that it is useful in COVID-19 treatment (Table 5).

Table 5

Comparison of opinions about chestnut honey and testing for COVID-19

		Testing for COVID-19			Testing positive for COVID-19
		yes n	no, n	test statistics	no, n	yes n	test statistics
Do you use chestnut honey to protect yourself against COVID-19?	Yes	21	53	p=0.914	6	68	p=0.0.051
	No	30	73	χ2: 0.012	2	101	χ2: 3.794
Do you believe chestnut honey will protect you against COVID-19?	Yes	25	47	p = 0.191	4	68	p = 0.802
	No	0	4	χ2: 3.309	0	4	χ2: 0.442
	No idea	26	75		4	97
Do you believe chestnut honey can treat COVID-19?	Yes	22	44	p = 0.459	4	62	p = 0.669
	No	1	6	χ2: 1.559	0	7	χ2: 0.804
	No idea	28	76		4	100

p, significance; χ2, Pearson's chi-squared test.

Discussion

People have used honey for millennia, both for its antibacterial and antifungal properties and to protect themselves against various diseases and, thus, improve their overall health [22, 23]. Chestnut honey is widely used in Giresun, Turkey, to treat illness. This study found that, although Giresunites popularly used chestnut honey to ward off or treat COVID-19, it unfortunately proved ineffective at protecting them from contracting it.

A total of 74% of the participants were found to eat chestnut honey. The Agricultural Economics and Policy Development Institute (a subsidiary of the Turkish Ministry of Agriculture and Forestry) reported that Turkey is the world's second largest honey producer as of 2020. However, only 5.9% of Turkey's honey gets exported abroad; the remainder stays within the country for local consumption [24]. In parallel with the Ministry of Agriculture and Forestry's data, honey is widely consumed in the province where this study was conducted (Giresun).

Only 14.7% of the participants in this study consumed chestnut honey for nutritional purposes; the rest consumed it to maintain their health and treat diseases. Soylu and Silici [25] reported that 54% of their study's participants consumed honey because it is nutritious and 19% of them eat it to protect their health. Kaya et al. [26] found that chestnut honey was widely used (29.9%) in Turkey to treat children diagnosed with asthma. Özkars and Kırık [27] also discovered similar findings with regard to honey consumption in asthmatic children in Turkey.

Kobya Bulut and Bektaş [28] reported that 32.8% of Turkish children who received chemotherapy consumed chestnut honey as a complementary treatment. Tuncel et al. [29] reported that honey (37%) was extensively consumed among children who suffered from asthma and allergic rhinitis. Çiçek et al. [30] reported that chestnut honey is frequently used in Turkey to treat diabetes (21%). Melikoğlu et al. [31] reported that Turks traditionally use chestnut honey to treat asthma. In parallel with the literature, those who participated in our study also used chestnut honey to improve their health, boost their immune system and treat diseases.

The use of complementary and alternative medicine is steadily on the rise in Turkey. Moreover, such medicinal products are generally associated with local origin [27, 32]. The widespread use of chestnut honey among Giresunites, in particular, largely has to do with the fact that it is a locally made product. Karayağız Muslu and Öztürk [33] discovered that certain individuals looked to complementary medicine either because they were unable to access standard treatment or because they feared the side effects of the drugs (under the assumption that alternative medicine was harmless).

Approximately half of the participants (46%) in this study consumed as much as a dessert spoon-worth of raw chestnut honey − that is, without mixing it with any other product food. More than one-third of them consumed it 2–3 times per week. Soylu and Silici [25] found that 47.9% of (university) students consumed honey infrequently, while only 14.7% ate it once a week. Again, in this study, most of the participants had learned about the benefits of chestnut honey from family members. In contrast, Saner et al. [34] found that people mostly learned about honey from TV (28%) and from others in their immediate circle (20%). Overall, the latter source of information seems to have the most influence on people when it comes to getting them to consume honey, and one could consider it as a form of traditional knowledge − or folk medicine [35]. Folk medicine is the result of centuries' worth of accumulated folk knowledge and experience about health and disease that has been passed down by word of mouth from generation to generation [36]. Moreover, cultures that directly interact with nature tend to have a more refined sense of folk medicine [37]; honey is an excellent example of this. People around the world have been using honey for over 3,000 years to maintain their health and protect themselves against illness [38].

In this study, many of the participants reported using chestnut honey in order to maintain their health and less so for its nutritional value. To sum up, 41.8% of the participants used chestnut honey to protect themselves against COVID-19, 40.7% of them thought that chestnut honey was effective at protecting them against it, and 37.3% of them believed chestnut honey might be useful for treating it outright. However, there did not appear to be any significant relationship between their views about the (possible) effects of chestnut honey on COVID-19 and their testing positive for COVID-19 (p > 0.05). Those participants who reported having suffered from COVID-19 had mostly complained of muscle pain (16.4%) and shortness of breath (10.7%). There was no significant difference between those who ate honey but still tested positive for COVID-19 and those who did not. Similarly, there also was no relationship between how often those who consumed honey actually consumed honey, how much honey they consumed, and whether they (still) tested positive for COVID-19 (p > 0.5).

Limitations

Only 4.5% of the participants in this study had actually tested positive for COVID-19. The low number is one limitation of our research. Another limitation of the study is that the data on the participants' chestnut honey consumption habits before and following the pandemic were not collected and, therefore, could not be compared to one another. Nevertheless, the literature is filled with published studies that boast about chestnut honey's antibacterial, antifungal and antiviral properties; however, none − as of yet − looked at whether it could be effective against COVID-19 [22, 23].

Conclusion

This study demonstrated that the majority of the participants consumed chestnut honey to protect their health and boost their immunity and that most feel that it could prevent them from contracting COVID-19 as well as that it could treat it. However, their use of chestnut honey seemed to bear no impact on them (still) testing positive for COVID-19, presenting COVID-19 symptoms or visiting a health institution for other health issues. We believe that the cause behind these findings might be the low number of individuals who actually tested positive for COVID-19.

We suggest that scientists conduct further research into the matter and if they come to a positive conclusion, pass their findings about chestnut honey's (potential) benefits to the public through various forms of media.

Statement of Ethics

The researchers obtained written permission from both the Ethics Committee at Ankara Yıldırım Beyazıt University (No. 2020-342) and the Turkish Ministry of Health Scientific Research Platform (form name: ERDAL CEYLAN-2020-11-02T00_15_45, date: November 3, 2020) to perform the study as it met ethical standards. A blurb was included on the first page of the questionnaire for the participants, informing them about the study and asking for their consent. The principles of the Declaration of Helsinki were rigorously met at all phases of the study. Written informed consent was obtained from participants prior to the study.

Conflict of Interest Statement

The authors have no conflicts of interest to declare.

Funding Sources

No funding support was used in the research.

Author Contributions

Conceptualization: K.Y., G.D. Data curating: K.Y., E.C., G.D. Formal analysis: E.C. Methodology: K.Y., E.C., G.D. Project coordination: K.Y. Visualisation: K.Y., E.C., G.D. Manuscript draft: K.Y., E.C., G.D. Writing/review and editing: K.Y., E.C., G.D. This article has not been published elsewhere. All authors have approved the manuscript and agree with submission.

Data Availability Statement

All data generated or analysed during this study are included in this article. Further enquiries can be directed to the corresponding author.