Delibal (Eng. Mad Honey) is a natural type of honey produced by honeybees processing the nectar collected from certain plants belonging to the Ericaceae and Sapindaceae families, particularly the species Rhododendron ponticum (purple-flowered rhododendron) and Rhododendron luteum (yellow-flowered rhododendron). The presence of neurotoxic compounds called grayanotoxins in the nectar of these plants imparts the toxic properties of mad honey.

 

^{Visual of the Purple-Flowered Rhododendron Plant (AA)}

Botanical Source and Distribution

The primary sources of mad honey are Rhododendron species, which belong to the heath family (Ericaceae). These species grow in moist, acidic, and organically rich soils. Their leaves are arranged spirally, and their flowers are either campanulate or zygomorphic in structure. In Türkiye, R. ponticum and R. luteum, which grow naturally in the Black Sea Region, are the two main species with toxic potential used in mad honey production. Locally, these plants are referred to as “purple poison” and “yellow poison,” respectively. These species exhibit a wide ecological range, spreading from coastal areas to high-altitude mountainous regions.

Chemical Composition and Toxicity

The primary compounds responsible for the toxic effects of mad honey are grayanotoxins. Grayanotoxins are nitrogen-free, polyhydroxylated cyclic diterpenes with lipophilic properties. The three most common types are grayanotoxin I (GT-I), II (GT-II), and III (GT-III), with GT-I being particularly noted for its cardiotoxic effects. These toxins bind to voltage-gated sodium channels in cell membranes, causing the channels to remain persistently open. This leads to continuous depolarization and dysfunction in excitable cells, such as nerve and muscle cells.

Historical Background

The earliest known written record of mad honey dates back to 401 BCE in Xenophon’s Anabasis. While passing through the region of Pontus, Xenophon reported that his soldiers experienced altered states of consciousness and temporary paralysis-like symptoms after consuming a local type of honey. In 67 BCE, Roman General Pompey’s soldiers were similarly poisoned by honey deliberately placed by enemies in the region and were subsequently attacked. These events indicate that mad honey has been known since antiquity and has occasionally been used as a form of biological weapon.

Geographical Distribution and Production

In addition to Türkiye’s Eastern Black Sea Region, mad honey is also produced in Nepal, Japan, Brazil, certain parts of North America, and limited areas of Europe. In Türkiye, production typically occurs in valley-surrounded regions, as local bee species such as the Caucasian honeybee have restricted flight ranges and are dependent on specific plant flora. This makes it easier to identify the plant sources of the honey. In this context, there is a close relationship between beekeeping and geography in the Black Sea Region.

 

^{Visual of Mad Honey Production (AA)}

Physical Characteristics

Mad honey is typically dark brown in color and crystallizes slowly. When heated, its toxic effect may diminish. Therefore, poisonings are generally associated with the consumption of fresh honey. Among local populations, mad honey is also referred to as “bitter honey” or “stunning honey” due to its bitter taste and the burning sensation it causes in the throat.

Uses and Traditional Practices

In certain regions, mad honey is used in traditional medicine for purposes such as controlling hypertension, treating gastrointestinal disorders, addressing sexual dysfunction, and occasionally managing diabetes. It is also believed to have immune-boosting and aphrodisiac effects in local folklore. However, scientific studies are insufficient to support these claims, and controlled consumption is recommended due to its toxic effects.

Symptoms of Poisoning and Clinical Findings

The most common symptoms observed in mad honey poisoning cases include:

• Dizziness, lightheadedness, fatigue
• Nausea, vomiting, cramp-like abdominal pain
• Excessive sweating, increased salivation
• Blurred vision, temporary blindness, double vision
• Bradycardia (slow heart rate), hypotension (low blood pressure)
• Altered consciousness, syncope, confusion
• In rare cases: atrial fibrillation, complete atrioventricular block, asystole, transient ischemic attack, and hepatotoxicity

Symptoms typically begin 1 to 3 hours after honey consumption and usually resolve spontaneously within 24 hours. The clinical picture varies depending on the amount of honey consumed and individual sensitivity.

Diagnosis and Differential Diagnosis

Diagnosis is generally based on patient history and clinical symptoms. The presence of grayanotoxins in biological fluids can be identified using liquid chromatography–mass spectrometry (LC-MS/MS). Additionally, microscopic detection of Rhododendron pollen in the honey sample can support the diagnosis.

Treatment and Clinical Monitoring

Most cases of mad honey poisoning improve with symptomatic treatment. Key interventions include:

• Medication (administered by medical professionals)
• Electrocardiographic monitoring
• In severe cases, temporary pacemaker application may be necessary, though it is rare
• Observation periods range from 6 to 24 hours, depending on the case. Mild poisonings may be treated on an outpatient basis.

Public Health Considerations

Although mad honey is traditionally used in alternative medicine, its unregulated consumption can lead to serious health problems. In this context, it is important to inform the public—especially in production regions—about its toxic effects and the recognition of possible symptoms. In recent years, the vast majority of reported mad honey poisoning cases have originated from Türkiye.

Mad honey, while a natural bee product, can cause serious toxic effects due to its grayanotoxin content. Historically documented and geographically limited in production, this type of honey remains a focal point for scientific research in both traditional medicine and toxicology. Preventive health services, public education, and clinical diagnostic approaches necessitate a comprehensive strategy regarding its use.

 

Warning: The content presented in this entry is intended solely for general encyclopedic information purposes. The information provided herein must not be used for diagnosis, treatment, or medical guidance. For any health-related decisions, it is essential to consult a physician or qualified healthcare professional. Neither the author of this entry nor KÜRE Encyclopedia assumes any responsibility for outcomes resulting from the use of this information for diagnostic or therapeutic purposes.