My Bees. My Bees.
– Rita Farr aka the Beekeeper
A while back I saw a hospitalized patient with cellulitis of the arm. An odd place to get a cellulitis. It looked like a typical group A Streptococcal infection. But why? One of the three questions I try and answer with every consult: What is the infection, how best to treat it and, of the most interest, why do they have it?
Why, why why? Sometimes it is Luck! Blind, stupid, simple, doo-dah, clueless luck! But I want an answer that is more satisfying than bad luck. The rule in infectious diseases is people usually get what they are exposed to. So I start asking questions and discover that the patient is a beekeeper and deliberately stings themselves on the arms and legs. Two bees (or not two bees. Is that questionable?) to each arm and leg each day.
It helps their joint and muscle pain from some undiagnosed arthritic condition. They combine the bee stings with bee milk. Just how does one milk a bee? I would be an udder failure.
Two bee-related treatments I had not heard of. I have discussed honey twice on this blog, in 2013 and 2011. But bee sting therapy? What rat holes would that take me down?
My first thought was, poor bees. The sting is the delivery vehicle for the therapeutic agent, bee venom. Stinging is fatal for bees, so that treatment causes almost 3,000 dead bees a year. My wife is a big-time gardener and in the summer I sat in the yard and watched the bees come and go while she slowly dug a hole 3 feet wide, 6 feet long and 6 feet deep. It is almost finished. I still can’t discover what she hopes to plant in there. But the bees were interesting to watch and it is sad to think of their little deaths. Mosquitoes? They deserve death. But not bees.
The trauma of a bee sting is certainly enough to result in a secondary infection. But what, if anything, is known about the microbiology of the bee stinger and venom? Bedbugs, for example, have been credited with methicillin resistant S. aureus and vancomycin-resistant Enterococcus transmission.
A distinctive microbial community of approximately nine bacterial species clusters [that] inhabits the bee gut.
As is likely for all creatures with a gut.
The stinger and venom? Sterile, or mostly so. Products in the venom have reasonably potent antimicrobial actions and:
Given the environmental conditions and the nature of the bee venom, a high microbial load might be expected. However, the microbial load was almost non-existent for most samples. This shows that bee venom produces its own antimicrobial protection system.
So I could not blame bacteria from the bee venom or stinger, just the bee trauma. So it was half the bees.
What about bee venom? Many a biologically active molecule was first discovered in nature and then refined to optimize it effects in humans, he says while sipping a combination of various processed yeast derivatives. Mmmmm. Processed yeast derivatives. I mean, if we can stave off dementia with products derived from jellyfish, and if there is any creature with a better memory than a jellyfish I can’t remember it, why not therapeutic bee venom?
Bee venom has 7,043 hits on the PubMeds dating back to 1926. Wow, that is a lot of papers on bee venom and more than I can review in this little blog entry. So let’s wander through a few.
First off, the venom volume is small. A drop of venom is mostly water and “one drop of BV consists of 88% of water and only 0.1 µg of dry venom”.
0.1 µg isn’t a lot of material although not quite homeopathy levels of nothingness. It takes one million sting deposits on a collector board to make 1 gram of dry venom.
That 0.1 µg of bee venom is:
…an extremely complex blend of peptides including melittin, adolapin, apamin, and MCD-peptide. It also contains enzymes, most importantly PLA2, and compounds of low molecular weight like bioactive amines (e.g., histamine and epinephrine) and minerals.
Still, that drop of bee venom is potent stuff, remembering back to the time I was swarmed by ground (nest in the earth, not chopped up) bees. Bee stings hurt, at least to the unexposed.
To treat patients you can either apply the poor bee directly or bee venom can be harvested. Venom can be gathered without killing bees by passing an electric current through the hive:
When the current is turned on, bees that are on the sheet automatically stick out their stingers, and the action of the muscles pushing the stinger also pumps a small amount of venom out the end of the sting.
I am going to avoid NSFW comments here. I know. Grow up, Crislip.
Uses of bee venom? Many purported. Rheumatologic diseases especially arthritis, cancer, Parkinson’s, Alzheimer’s, Amyotrophic Lateral Sclerosis and more. Much more. Dr. Novella has written about venom therapy from a neurologist’s perspective. There is apparently no disease process for which bee venom cannot help. Color me skeptical, but when an NRLM therapy purports to treat everything, it likely treats nothing.
Arthritis is the most popular use of bee venom, supposedly because beekeepers do not get arthritis. Is that true? I can’t find any epidemiologic studies to confirm or deny the idea. Perhaps my Google-fu is lacking. But. There is a specific beekeeper arthropathy.
Beekeepers have joint disease apparently related to bee stings. Etiopathogenesis is unknown. Mechanical trauma, venom compounds, infection, and foreign body synovitis are factors that are thought to influence the pathogenesis of this syndrome.
Some references suggest therapeutic bee venom has been used for 5,000 years for arthritis and the treatment is mentioned in the Bible, always a good source for science-based medicine. None of the footnotes actually point to the section of the Bible where bee venom is used, and when I search the Bible for bee or sting treatment, nothing.
This drives me nuts. The medical literature has references that point to articles that do not support the text or do not even exist. You will find this frequently if you spend a lot of time going back to the original literature, as I have in infectious diseases.
So what about bee venom to treat arthritis?
That has always been one of the primary characteristics of a bee sting: the marked lack of inflammation and pain. It does make me wonder why anyone would try bee stings as a therapy for an inflammatory condition, the alleged lack of disease in beekeepers not withstanding.
This is not to say that at pharmacologic doses, milligrams or grams, of bee venom products could not have wide-ranging effects. Mice and rats have been injected with a variety of bee venom products (phospholipase A2 and melittin as examples) at high dose with a variety of effects on the physiology of those animals. I am skeptical that these models have much to do with the treatment of human disease by the laying on of bees.
Are there human studies? Actually, no. All the clinical trials I found use bee venom on acupoints or with acupuncture, so there is already a huge overlay of the NRLM. And that is true of most of the bee venom studies for other diseases; it is used as a form of acupuncture. So even where bee venom was compared to placebo, it was as part of acupuncture. Odd, really, and what conclusions can be made from a placebo controlled intervention added to bogus medical theater? Nothing.
I cannot find a clean, i.e., a non-TCPM based, randomized, placebo-controlled study of bee venom in humans for the treatment arthritis. And there are the nonspecific effects of pain and anxiety: both can lead to an increase in cortisol, and, perhaps, need to be taken into consideration in study design.
Not everyone uses bee venom as an acupuncture adjunct. Some use the bees directly, with:
…seven to 10 live bees are used to sting the aching joint and it is done at least three times a week.
I mentioned this to my wife, who did not believe me at first. Are they nuts? she asked me. I just shrugged. I could find no studies evaluating bees directly and it would be difficult to come up with a placebo bee. “Placebo bee” has no hits on Google scholar, but I do not doubt someone clever could come up with a placebo bee.
Do bee stings affect rheumatologic processes? I can’t say from the literature. But I doubt it, if no other reason than the dose of venom is too small to cause any systemic effect besides an allergic reaction.
And, no surprise, bee venom therapy has frequent side effects:
The median frequency of patients who experienced adverse events related to venom immunotherapy was 28.87% (interquartile range, 14.57-39.74) in the audit studies. Compared with normal saline injection, bee venom acupuncture showed a 261% increased relative risk for the occurrence of adverse events (relative risk, 3.61; 95% confidence interval, 2.10 to 6.20) in the randomized controlled trials
The solution? Just how does one ensure “…the practitioner’s education and qualifications regarding the use of bee venom therapy…” is appropriate? I wonder what the tuition of NRLM U is.
And bee venom should give around half the population pause:
The findings of this study showed that repeated bee venom treatment by sting or injection to adult male mice resulted in a significant decline in testosterone levels, sperm count, sperm motility, and a very significant increase in the percentage of abnormal sperm morphology; also, there were harmful testicular histological changes in the structural organization of seminiferous tubules and degenerative changes in the germinal epithelium compared to control group.
Not the best approach to male infertility. I will admit to being skeptical about this study as well, but I have asked our exterminator to give it a go for our mice infestation.
Beekeepers are the origin of other bee investigations. It was suggested in China that beekeepers were also resistant to COVID 45, perhaps because of the recurrent bee stings. Not that beekeepers work alone, outside, in protective gear. Nope. Has to be the bee stings. It wasn’t. In further studies, bee venom therapy is not protective against COVID 45.
Is being a beekeeper protective for cancer and other medical problems for which bee venom has efficacy? I can’t find it. I doubt it. Leave those bees alone. They have some serious pollinating to do.