Case 17-1991 | NEJM

Babies Can't Eat Honey Because It Can Cause 'infant Botulism' - Here's What That Means

Babies less than one-year-old can get seriously sick from eating honey.

Honey contains C. Botulinum bacteria, which can produce a toxin in a baby's large intestine, leading to a rare but serious illness known as "infant botulism."

Fortunately, infant botulism is not very common, and infant botulism due to honey is even rarer. But the FDA recommends waiting until your baby is one year old to feed them the sweet treat.

While most adults can eat honey without problems, it's a different story for babies less than one-year-old. Honey contains C. Botulinum bacteria, which can produce a toxin in a baby's large intestine, leading to a rare but serious illness known as "infant botulism."

Following is a transcript of the video.

This is C. Botulinum. It's a bacterium that can produce one of the world's most lethal substances. It lives in lots of places including the soil, pollen, dust, and also right here: in honey.

So why haven't you died from eating this sweet treat? Well, because you're not a baby. As C. Botulinum grows, it produces a toxin called botulinum. It's the same stuff used in Botox. But Botox has an extremely low dose compared to infected food. In large amounts, the toxin would attack your nervous system causing the illness known as botulism.

Which can lead to paralysis and even death. And since C. Botulinum is so common in our environment, researchers believe that bees pick it up on their way to the hive, where they produce honey.

One study found C. Botulinum bacteria in about 8% of their honey samples. But before you purge your pantry, consider this: Normally when we encounter C. Botulinum, like in honey, it's dormant. And in this sleepy state, it can't produce the toxin. Even if you eat it. That is, unless you're less than 1 year old.

When C. Botulinum enters a baby's large intestine, it comes alive. Because, unlike children and adults, babies less than one year old haven't been eating real, solid foods.

Instead, they drink milk. But when babies are around 4 to 6 months old, they stop drinking human milk and they start eating other foods they've never had before. As a result, their gut microbes change very abruptly. And it's during this transition period in the baby's gut, that the lethal C. Botulinum bacteria are free to grow and produce the toxin.

As the toxin enters the baby's bloodstream, it blocks the ability of motor nerves to release acetylcholine, a chemical messenger that sends nerve signals to muscles. As a result, the baby starts to lose control of muscles and appears tired and floppy. As more toxin enters the bloodstream, the muscles that control swallowing and breathing stop working.

Fortunately, infant botulism is not very common, and infant botulism due to honey is even rarer. Fewer than 100 cases occur in the US each year, and while it's difficult to pinpoint the source of the bacterium in many cases, experts think honey accounts for 15% of cases.

So it's important that if your infant shows signs of weakness,you take them to be evaluated by medical professionals immediately, in some cases, doctors can administer an effective antitoxin. But it can take babies weeks to a month to recover. The FDA recommends waiting until your baby's first birthday to feed them honey or any products that are filled or dipped in honey.

Opinion: The Insulin Crisis Is Far From Over. Public Pharma Could Be The Solution.

You can hardly turn on the TV these days without hearing about how politicians have won the war against "Big Pharma" and made insulin affordable. Both sides of the aisle are rushing to claim credit for the $35 copay cap on insulin, which covers seniors on Medicare. But as lawmakers celebrate their victory, patients of all ages continue to suffer.

As the leader of Connecticut's #insulin4all chapter, I've met countless patients who have struggled to afford their insulin. Whenever I speak with a chapter member who's rationing—taking less than their recommended dose—I'm transported back to my 15-year-old self, skipping lunch every day to conserve each precious drop of insulin while my family was uninsured. I'll never forget the feeling of leaving the pharmacy empty-handed, unable to pay for the medication I needed to survive.

US drug price measure to cut costs by $7.5 billion in 2026

In January of this year, I once again walked away from the pharmacy without my insulin. This time, it wasn't because I couldn't afford the copay—it was because there was no insulin in stock. Weeks turned into months, and I still couldn't fill my prescription. In March, down to only a few vials of Novolog, I could see no end in sight to the shortage that had now spread across the country. So I took a dangerous gamble: I loaded my pump with insulin from an expired vial.

Two days later, I awoke in the middle of the night in excruciating pain. I was nauseous, dehydrated, and confused. I knew instantly that I was in Diabetic Ketoacidosis (DKA), a life-threatening condition that occurs when the body goes too long without insulin. I had no choice but to go to the hospital, where doctors rushed to stabilize my condition.

The week after my DKA episode, Eli Lilly, one of the "big three" global insulin manufacturers (along with Sanofi and Novo Nordisk), officially announced a shortage on its Humalog and Lispro insulins. The realities of the shortage were undeniable. Some patients drove hours to find pharmacies that had their insulin in stock; others turned to rationing and, like myself, faced dire consequences. Here in Connecticut, I was unable to get a single vial of Novolog until July.

Last year, Eli Lilly received a tidal wave of positive press when it committed to lowering the list prices on its insulin products—which, incidentally, enabled it to save millions of dollars under a new Medicaid rule. But what is the point of $35 insulin if patients can't actually get their hands on it? The time has come for a meaningful, sustainable alternative. Public pharma—placing the manufacturing, distribution, and pricing of prescription drugs like insulin into public, rather than corporate, hands—offers a solution to this growing crisis.

High price of popular diabetes drugs deprives low-income people of effective treatment

States that invest in public manufacturing of insulin and other medicines are investing in the future of their citizens. The demand for insulin, which is as essential as water to a person with Type 1 Diabetes, will only increase in the coming years, with rates of diabetes in young US populations predicted to rise dramatically. In 2021, an estimated 1.3 million Americans rationed their insulin; this number, too, will continue to rise unless urgent action is taken.

Public production of insulin won't just save lives: it will also save money for Connecticut. More accessible insulin means fewer patients going into DKA, which costs an average of $30,000 per ER visit.  It also means a reduction of long-term complications, such as amputations, kidney failure, and vision damage. In 2019, taxpayer-funded programs like Medicare and Medicaid spent over $25 billion on insulin. If patients were able to buy their medicine at a price close to the manufacturing cost, a mere $6-$10 per vial, it would improve not only their lives, but the economy of our state.

Public manufacturing has already been implemented successfully by several states. Massachusetts currently develops, manufactures, and markets biologics through MassBiologics. The California Department of Public Health produces BabyBIG, a drug used to treat infant botulism. Public manufacturing initiatives targeting insulin are underway in Washington, Maine, Michigan, Illinois, and California. Across the country, patients and lawmakers alike are realizing that we don't have to accept a system that puts patients' lives at risk and costs taxpayers millions of dollars annually. And here in Connecticut, we have the opportunity to be at the forefront of the progress in our healthcare system that is so desperately overdue.

On Tuesday, September 17, Connecticut's #insulin4all chapter is holding an event on Public Pharma and how it can become a reality in our state. We're teaming up with key stakeholders to discuss the path forward, and we're inviting you to join us, in person or virtually.

Can't make it to the event? Have questions? Reach out to CTinsulin4all@t1international.Com to learn more and get involved. Join us in our fight to put people over profit.

Arden Parrish lives with Type 1 Diabetes and serves as the president of the Connecticut chapter of Insulin4All.

Baby Milk Recall Amid Botulism Fear

Baby food manufacturer SMA Nutrition is to issue a product recall for two of its powder formulas which have been linked to a recent outbreak of infant botulism, the Food Standards Agency (FSA) said today.

The recall is in relation to batches of SMA Gold and SMA White infant formula powder with expiry dates of October 28 2001 and November 28 2001, the FSA said.

The move comes after tests on food products used in the home of a family involved in an infant botulism case.

Infant botulism is a rare but serious foodborne disease. It is caused by contamination of certain foods by the botulism bacterium commonly found in soil.

The FSA said it was not possible to prove conclusively that the food formula was linked to the outbreak but said it was a wise precautionary measure.

FSA deputy chief executive Dr Jon Bell said: "SMA Nutrition is acting in a responsible way and we welcome this precautionary recall.

"It is important that no one continues to use these particular batches of SMA Gold and White. They should be thrown away or returned to the retailer.

"There is no reason to believe that this is anything but an isolated one-off incident."

Infant botulism has only been recorded six times in the UK and there have been no reported incidents since 1994, he said.

"However the FSA intends to meet and work with the baby food industry to look at any lessons that may be learnt from this case," he said.

"In particular we will want assurances that the checks that the industry has in place to ensure that the bacteria causing botulism does not get into baby products are adequate and if not that appropriate action is taken."

An FSA spokesman would not reveal where in the country the recent outbreak took place.

He said tests were taken on food used in the infant's home as well as tests on samples of the same products.

The SMA Gold product tested positive for C botulinum type B - the same strain as the infant contracted.

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