Monday, December 22, 2014

Happy Holidays

Image by Viggo Johanson,Wikimedia Commons
I'm taking some much-needed time off to spend with my family during the holiday, so the blog will be taking a brief break.

I hope you have a wonderful Christmas (or whatever holiday you celebrate). Many blessings to you and yours!

Friday, December 12, 2014

Honey for Cesarean Wound Healing?

We've discussed honey for wound healing before, and specifically for cesarean wound healing.

We talked about the mechanics of how honey (medical grade honey, not supermarket honeymight help healing and what studies there were on the topic.

As one review notes:
Honey has anti-oxidant, anti-bacterial and anti-inflammatory properties. It can be used as a wound dressing to promote rapid and improved healing. These effects are due to honey's anti-bacterial action, secondary to its high acidity, osmotic effect, anti-oxidant content and hydrogen peroxide content. The use of honey leads to improved wound healing in acute cases, pain relief in burn patients and decreased inflammatory response in such patients...There is biological plausibility.
Mixed Results

While honey has "biological plausibility" as a healing agent, results from use of medical grade honey have been encouraging in some situations and discouraging in others. Results were not very good for venous ulcers, for example, but on some wounds there are better results.

A recent Cochrane review found decidedly mixed results, depending on what type of wound was being studied, and cautioned against its routine use until more data is available. So it's hard to know just how useful medical grade honey really is, and how much is just hype.

The problem is that much of the honey-based research is sponsored by the companies that make medical-grade honey, so the results are at high risk for bias.

Bottom line.....better data is needed. But given the positive results in some studies and its relatively low cost, why haven't there been more well-controlled studies done by independent groups by now?

Medical-Grade Honey for Cesarean Healing

Sadly, there's not a lot of data on using honey for cesarean wound healing. There are a couple of older studies done in third-world countries, but they had small data sets and uncontrolled conditions. As a result, using medical honey on a cesarean wound has not been been embraced in Western countries.

Now there's a new study on the use of honey for abdominal wound healing after cesarean. The data set is still very small and still from a third-world country, but at least the study design is randomized and blinded. The results from this study were encouraging.

This doesn't prove honey is a healing agent of choice for cesarean wounds, but it certainly points to the need for bigger and better studies to further examine the question. 

I would particularly like to see medical-grade honey investigated in the treatment of cesarean wound infections of "obese" women (who are substantially more at-risk for wound infection than other women).

About 15-30% of high-BMI women will experience a wound infection after a cesarean, and sometimes these infections last for months. Wound infections like this can be devastating to a new mother, can interfere with breastfeeding, and are costly to treat.

Many cesarean wound infections in obese women can likely be lowered by using more appropriate dosages of antibiotics, but medical grade honey might give another weapon in the arsenal against infections in this group of women.

Of course, the best treatment is prevention of the cesareans in the first place whenever possible, which is why the 40-80% cesarean rate in "morbidly" and "super obese" women is so completely unacceptable.

But sometimes cesareans truly are necessary. When cesareans do occur in this group of women, more tools are needed to help prevent or treat the wound infections that will result in some of them.

Medical-grade honey might be yet another tool in the toolbox for this situation. And it's past time for Western medicine to investigate this possibility more thoroughly.


Oman Med J. 2014 Jul;29(4):255-9. doi: 10.5001/omj.2014.68. The effect of honey gel on abdominal wound healing in cesarean section: a triple blind randomized clinical trial. Nikpour M1, Shirvani MA2, Azadbakht M3, Zanjani R4, Mousavi E5. PMID: 25170405
OBJECTIVE: To assess whether honey can accelerate the wound healing in women undergoing cesarean section. METHODS: This was a triple blinded randomized prospective clinical trial. Women with cesarean section were randomly designated as drug (37 cases) and placebo (38 cases) groups. The drug group received local honey gel 25% while the placebo group received similar free-honey gel on abdominal cesarean incision twice a day for 14 days. REEDA scale (Redness, Edema, Ecchymosis, Discharge and Approximation of wound edges) was used to assess wound healing. RESULTS: The mean REEDA was 2.27 ± 2.46 and 3.91 ± 2.74 (p=0.008) on the 7(th) day and 0.47 ± 0.84 and 1.59± 1.95 (p=0.002) on the 14(th) day for the drug and placebo groups, respectively. Redness, edema and hematoma in the drug group were significantly lower on the 7(th) and 14(th) days. CONCLUSION: Honey was effective in healing the cesarean section incision. Using topical honey is suggested as a natural product with rare side effects in order to reduce the complications of cesarean wounds.

Friday, December 5, 2014

Widespread Misconceptions About Obesity

I recently stumbled across an article by pure coincidence. It's called "Widespread Misconceptions About Obesity."

It was written by several doctors and researchers, and it was published last month in the journal, Canadian Family Physician. You can read the full text of the article here.

In the meantime, here are some good quotes from the article (my emphasis):
  • Although obesity can be a serious health threat, we lack effective strategies to address this condition on an individual and a societal level. Myths and misconceptions about obesity are pervasive in the media, popular culture, and scientific literature
  • It is very common to hear that obese people are lazy and should get off the couch. This discriminatory bias against those with excess weight is not only widespread among the lay public but also among health professionals, even those in regular contact with patients with obesity
  • Physicians should remember that obesity is not a choice
  • Obesity management should focus on promoting healthier behaviour rather than simply reducing numbers on the scale
  • It might be time to shift the focus away from body weight to health and wellness in public health interventions
Here is their list of 7 common misconceptions about obesity:
  1. Obesity is primarily caused by a lack of physical activity or by unhealthy dietary habits
  2. Obese individuals are less active than their normal-weight counterparts
  3. Diets work in the long term
  4. Weight loss does not have significant adverse effects
  5. Exercising is better than dieting to lose weight
  6. Everyone can lose weight with enough willpower
  7. A successful obesity management program is measured by the amount of weight lost
The article is not perfect, of course, and I have some nitpicks here and there.

But I was especially pleased to hear them mention shifting the focus from numbers on a scale to health habits. We may not all be able to become a "normal" BMI, but we can all improve our health behaviors, and that will help health, regardless of where your BMI is.

This is right in line with the Health At Every Size® philosophy (even if they don't mention that concept by name), which is starting to gain more traction in mainstream research. Hopefully these authors would support eliminating obesity stigma in public health campaigns as well.

On the whole, this article is a welcome change to the dialogue about obesity. How heartening that at least some family doctors are starting to "get it."

Now if we could only get the word out to medical schools and obesity researchers, where weight stigma runs rampant and largely unchecked.

For example, did you see the recent blog post about professional obesity researchers making fun of fat people and cracking fat jokes during their conference? No less a major journal than The Lancet published a piece about it, which concluded:
In line with guidelines for publishing in obesity and journals of other disciplines that adhere to the standards of the Committee on Publication Ethics, authors should avoid bias and stereotypical language, which should apply to all dissemination activity including academic conferences. Hence, obesity researchers should adhere to these standards.
Amen to that! Hard to believe how unprofessional these researchers were. But frankly, that kind of behavior goes hand in hand with the utter contempt that so many in the obesity field have towards their study population. Kudos to authors Stuart W. Flint and Sophie Reale for having the professional courage to shine a light on this disgusting behavior.

So, on the whole, it was a week of encouragement and discouragement in some ways. It was encouraging to see the Canadian Family Physician article addressing common misconceptions about obesity, but it was frustrating to hear about professional academics resorting to fat jokes and put-downs about the very people they study and are supposed to be "helping." At least The Lancet published a letter calling them on the carpet for it, I guess.

One step forward, two steps back. Sigh.


Chaput, J. P., Ferraro, Z. M., Prud’homme, D., & Sharma, A. M. (2014). Widespread misconceptions about obesity. Canadian Family Physician, 60(11), 973-975. PMID: 25392431 Full text available here

Flint, S. W., & Reale, S. (2014). Obesity stigmatisation from obesity researchers. The Lancet, 384(9958), 1925-1926. Full text available here.