Maggots, Honey, Ketosis

Health care innovation can be one of the most exciting things in the world. There is little more thrilling and touching than seeing lives saved, or seeing disabilities reduced in a life changing way. There are so many amazing advances in health care. Technology and robotics has given people back limbs and improved surgery to an amazing degree. Pharmaceuticals continue to do previously unthinkable miracles: treating and curing previously incurable diseases.

There are other innovations in health care that are not as flashy or impressive, but are powerful forces for improving the human experience. The biggest downsides to most “flashy” improvements are financial cost and unwanted side effects. Some of the most valuable advancements in health care have been the ones that were not impressive, or new, but those which have made an effective treatment more tolerable, or reduce cost of treatment enough to make it affordable.

Some of my favorite “not-so-flashy” innovations:

  1. Sterile maggots: wound care has taken a surprising turn in recent years. Since the development of antibiotic resistant strains of bacteria, health care providers are looking for alternative ways to treat infected wounds. In this case, the “new” innovation is actually a return to ancient medicine. Maggots have been treating wounds since they evolved out of the primordial soup. Non-healing wounds are often covered in dead “necrotic” tissue which slows down healing by starving the live tissue underneath and providing a nice home for bacteria. Maggots, conveniently, eat only dead things, and can quickly eat up the necrotic tissue covering a wound bed. They also keep bacteria at bay with the fluid they secrete (surprisingly, recent studies have shown that patient adherence is not an issue with maggot therapy). For centuries, battlefield doctors have known that maggot infested wounds heal faster than non-maggot infested wounds. William Baer applied this knowledge in his medical practice after returning from World War I, and published on it. Maggots were widely used in America for the next couple decades but they fell out of use in the medical profession with the rise of antibiotics. More recently, they are coming back into favor. New dressings allow the maggots to remain contained and sterile. Image result for sterile maggots
  2. Honey dressings: Similar to maggots, dressing wounds with honey is an ancient practice, advocated in the “Edwin Smith papyrus” (2600–2200 BC), and many other ancient Egyptian, Greek, and Roman sources. Honey creates hydrogen peroxide when it comes into contact with moisture in just the right concentration to be toxic to bacteria, but harmless for tissues. Honey is also acidic, contains flavanoids, and is dehydrating due to its high sugar content. These factors all make honey an effective antimicrobial agent. There is evidence for the use of honey to improve the healing of burns. Its antibacterial properties (in burns) is well supported with evidence as well. There is not sufficient evidence, however, for the use of honey in other wound types at this time. Many have reported honey to have deodorizing, debridement, anti-inflammatory and wound pain reducing effects, but these are not sufficiently supported by evidence yet. Ideally, this side-effect free, and cost saving treatment will receive more attention in the research in the near future. Image result for honey dressings
  3. The ketogenic diet: The ketogenic diet is a way of eating that reduces carbohydrates to a very low portion of a person’s intake (20-30 grams, or about 10% of calories). Starved of sugar, the brain switches to obtaining its energy from ketone bodies (KBs) which are created from fat in the liver. The brain is more than capable of running happily on KBs, and even derives more energy from them than from glucose. Medical professionals have used the ketogenic diet to treat childhood epilepsy since the 1920s. Recent evidence also points to the use of the ketogenic diet to treat type II diabetes (which is essentially carbohydrate intolerance), lower cardiovascular risk parameters, and reduce BMI. There is emerging evidence for several other exciting uses of the ketogenic diet. Best of all, a low-carbohydrate is easier to adhere to than a low-fat diet, due its satiety effects, and less weight gain post cessation of the diet is also reported with a low-carbohydrate diet.

New or old treatments that improve on existing therapies, or reduce side effects, are an important side of health care innovation, and one that should not be neglected. Antibiotics were a marvelous development, but now that they are decreasing in effectiveness, alternative treatments are necessary. The side effects from antibiotic medication are also a heavy burden for patients to bear. There are medications to treat type II diabetes, epilepsy, improve blood lipids, blood pressure, as well as weight loss surgery, but the ketogenic diet is a healthy, safe, effective alternative to treat all of these issues.

 

Sherman, Ronald A. “Maggot Therapy Takes Us Back to the Future of Wound Care: New and Improved Maggot Therapy for the 21st Century.” Journal of Diabetes Science and Technology, vol. 3, no. 2, 2009, pp. 336–344.

Vandamme, et al. “Honey in Modern Wound Care: A Systematic Review.” Burns, vol. 39, no. 8, 2013, pp. 1514–1525.

Udwadia, Tehemton. “Ghee and Honey Dressing for Infected Wounds.” Indian Journal of Surgery, vol. 73, no. 4, 2011, pp. 278–283.

Apovian, Caroline M. “The Low-Fat, Low-Carb Debate and the Theory of Relativity.” The American Journal of Clinical Nutrition, vol. 102, no. 4, 2015, pp. 719–20.