Should Honey and Peanuts Be Part of Your Diet?

by Alan Greene, MD, FAAP

Honey in the Diet

The honey issue is fascinating. The safety concern about honey arose because honey often contains spores that, under the right circumstances, can cause a rare deadly disease discovered in 1976, called infant botulism. Infant botulism is spread by these spores, not by preformed botulism toxin.

Botulism spores are found throughout nature, in soil, in dust, and on the unwashed surfaces of fruits and vegetables. The spores are present in about 10 percent of the samples of honey tested. These spores are tough to kill. They are quite heat-resistant; some can survive boiling for several hours. Honey is naturally resistant to many bacteria.

Sometimes, honey is pasteurized -- usually it is not. Pasteurizing does not reliably destroy botulism spores. Some honey is filtered; some is not. Filtering does not reliably remove botulism spores. There are advantages and disadvantages to pasteurizing and filtering. I don't feel strongly either way, but this is one food I prefer unpasteurized. No honey, though, is best for infants.

The CDC recommends that children younger than 1 year of age should not be given honey unless the product has been certified free of spores. Babies' intestines are an ideal environment for the spores. When babies swallow them, the spores can turn into growing, multiplying bacteria that pump out a poison called botulinus toxin. This toxin is absorbed through their immature intestines, and causes infant botulism. Some cases of infant botulism are mild; some are fatal.

The peak age that babies are susceptible is when they are 2 to 4 months old. They may be at risk from about 1 week until 9 to 11 months. This is the reason babies under one year old should not be fed honey. Because the spores are so heat-resistant, there is a theoretical risk for babies eating even processed foods containing honey. Commercial canning, however, usually destroys the spores.

Normally, swallowing spores is not a problem for healthy adults or older children. The spores usually remain spores. The bacteria do not grow well in mature intestines teeming with beneficial bacteria. Pregnant women, other adults, and older children are routinely exposed to spores without being affected. The safety of honey as a food for healthy adults and older children is unquestioned.

Adults can get botulism, though, from other sources. The preformed toxin can be found in improperly canned or processed foods. The botulinus toxin is among the most lethal of all naturally occurring substances. A trace amount can be deadly.

Thankfully, toxin production can be prevented with proper refrigerating, freezing, drying, or adding the correct amounts of salt, sugar, or sodium nitrate. The toxin can be destroyed by heat (20 minutes at 176 degrees or 10 minutes at 196 degrees). It can even be harnessed (BoTox is in vogue to reduce wrinkles).

Eating Peanuts During Pregnancy

Eating peanuts while pregnant is another issue. In general, the results are mixed about how mom's pregnancy diet affects allergies in the baby. When it comes to peanuts, however, the results are consistent. The chance that a baby will develop peanut allergies goes up with the amount of peanuts that a pregnant mother eats. It makes sense to me for mothers to avoid them if their child is likely to be prone to allergies (in a family with allergies, eczema or asthma).

Some have also raised concerns about aflatoxin, produced by a fungus that grows on some peanuts. The government has set "allowable" levels of aflatoxin for peanuts and peanut products. There are not enough data to make a general public health recommendation that pregnant women avoid all peanuts for this reason. Nor are there enough data to recommend peanuts for pregnant women without caution.

Dr. Alan GreeneDr. Alan Greene, author of Raising Baby Green and Feeding Baby Greene, is the founder of Dr.Greene.com and the WhiteOut Movement. He is a frequent guest on such shows as Good Morning America, The Today Show, and the Dr. Oz Show. He is on the Board of Directors of Healthy Child Healthy World and The Lunchbox Project. Dr. Greene is a practicing pediatrician at Stanford University's Packard Children's Hospital. Copyright © Greene Ink, Inc., all rights reserved. Permission to republish granted to Pregnancy.org. Reviewed by Alan Greene M.D., FAAP September 12, 2009.