A reference sheet for journalists, editors and fact-checkers covering mad honey. Every figure is attributed to a named source and links to the page carrying the underlying study. Material on this page may be quoted with attribution to the Cliff Mad Honey Index.
The 60-second version
Mad honey is honey containing grayanotoxins, a class of diterpenoid polyol compounds produced by plants in the family Ericaceae, chiefly rhododendrons. Bees foraging predominantly on grayanotoxin-bearing nectar carry the compounds through to the jar. Grayanotoxins act on voltage-gated sodium channels in nerve and cardiac tissue, so the effects are cardiovascular and neurological: slowed heart rate, low blood pressure, nausea, dizziness. Concentration varies enormously between batches, which is the single most important fact for anyone writing about it.
The error that appears most often in coverage
Commonly written: that mad honey is psychedelic, hallucinogenic, or psychoactive in the recreational sense.
What the pharmacology supports: grayanotoxins bind receptor site 2 on voltage-gated sodium channels and interfere with channel inactivation. They do not act on serotonergic receptors, which is the mechanism behind classical psychedelics. The reported human experience is dominated by bradycardia, hypotension, nausea and dizziness rather than by perceptual change.
The accurate framing is that mad honey is a cardiotoxic and neurotoxic food, historically used as a folk medicine and as a weapon, not a plant psychedelic. Sources: Jansen et al. 2012; What Are Grayanotoxins; Voltage-Gated Sodium Channel Modulation by Grayanotoxin-I.
Figures that can be cited
Each figure below is reproduced from the named study or assessment. Cite the primary paper; this site is the secondary reference.
Range in grayanotoxin I concentration across 60 Nepalese mad honey samples analysed by LC-MS/MS, from 0.75 to 64.86 micrograms per gram. A claim about the strength of mad honey in general is not supportable.
Share of symptomatic presentations reporting bradycardia in the Black Sea case series literature, alongside hypotension, nausea and vomiting, and dizziness. Onset is typically 1 to 4 hours after consumption.
Share of hospitalised presentations requiring temporary cardiac pacing, those with high-grade AV block. Atropine is reported as effective in the majority of cases.
Structurally distinct grayanotoxins characterised to date. GTX I and GTX III dominate Rhododendron nectar and are the most biologically active; GTX III is the 10-O-acetyl derivative of GTX I.
Rhododendron species recognised by botanists. Grayanotoxin production is not universal across the genus, and among producing species the concentration differs.
The European Food Safety Authority found that all commercially available mad honey concentrations raise health concerns under realistic consumption scenarios, and identified children as a group of particular concern.
Two further points that change a story
Most documented poisonings are intentional, not accidental. The typical patient in the Turkish case series is a middle-aged or older adult who consumed deli bal deliberately in a traditional medicinal context. Coverage framing poisoning as accidental contamination misdescribes the literature.
Grayanotoxins are stable in stored honey. Concentration does not decrease meaningfully over normal storage. Age is not a mitigating factor, and a claim that older honey is weaker is not supported.
How concentration is reported
Laboratory results are reported in milligrams per kilogram of honey, or equivalently in micrograms per gram; the two units are numerically identical. Concentration describes the honey. Dose describes the exposure.
The only formula that matters
delivered dose (mg) = concentration (mg/kg) x serving (kg)
Honey at 20 mg/kg in a 20 g serving delivers 0.4 mg of grayanotoxin. Honey at 50 mg/kg in the same serving delivers 1.0 mg. The concentration on a certificate describes the honey; only the serving decides the exposure. Use the dose calculator.
| Band | Total GTX I + III (mg/kg) | Grayanotoxin in a 20 g serving |
|---|---|---|
| Trace | under 1 | under 0.02 mg |
| Low | 1 to 10 | 0.02 to 0.2 mg |
| Moderate | 10 to 30 | 0.2 to 0.6 mg |
| High | over 30 | over 0.6 mg |
Serving column is concentration multiplied by a 20 g serving, shown to make the difference between concentration and delivered dose concrete. Bands are documented ranges drawn from the clinical and laboratory literature. They are not safe-versus-unsafe categories, and no concentration is safe for everyone.
What is not established
Reporters are frequently offered claims in this category. None is currently supported by evidence that would meet a clinical standard.
Medicinal benefit in humans
Grayanotoxins have a documented mechanism, and mad honey has a long ethnographic record of traditional use. Neither establishes clinical benefit. The therapeutic-potential literature is preclinical and exploratory, and there are no controlled human trials showing benefit at a defined dose with an acceptable safety margin. See the review.
A safe serving size
Because concentration varies by batch to the degree documented above, a serving described in spoons carries no fixed grayanotoxin content.
Aphrodisiac effect
Frequently claimed in marketing and in coverage. Not established in the literature.
A reliable sensory test
There is no colour, taste or texture cue that indicates concentration. Only laboratory analysis of the specific batch does.
Consistency within a producer or region
A tested batch says nothing about the next batch from the same source.
Questions worth asking about any specific claim
- Which batch does this laboratory result refer to, and is the batch identifier on both the certificate and the jar?
- Which grayanotoxin isoforms were measured, and was a total reported?
- Which analytical method was used, and what were its limits of detection and quantification?
- Is a health claim supported by a mechanism, by traditional use, or by a controlled trial in humans? Only the third supports the claim.
- Is a quoted toxicity figure an animal LD50? If so, which isoform, which species, which route of administration, and has the extrapolation caveat been stated?
Terminology and geography
Deli bal
The Turkish name, associated principally with the Black Sea provinces of Rize and Trabzon, the source of most published clinical case series.
Himalayan mad honey
Produced in Nepal, and the subject of most published quantitative concentration work, including the 60-sample LC-MS/MS study above.
GTX honey
An informal trade and laboratory shorthand for the same material. It carries no separate technical meaning and is not a grade.
Full definitions for every term used here are in the grayanotoxin glossary.
Primary sources referenced on this page
| Authors | Title | Publication | DOI |
|---|---|---|---|
| Ahn S-Y, Oh S, Woo S, Kim C-H, Kim J-H | Detection and Simultaneous Quantification of Three Grayanotoxins in Mad Honey by LC-MS/MS | Toxins 2022;14(1):64 | 10.3390/toxins14010064 |
| Jansen SA, Kleerekooper I, Hofman ZLM, Kappen IFPM, Stary-Weinzinger A, van der Heyden MAG | Grayanotoxin Poisoning: ‘Mad Honey Disease’ and Beyond | Cardiovascular Toxicology 2012;12(3):208,215 | 10.1007/s12012-012-9162-2 |
| Ullah S, Khan SU, Saleh TA, Fahad S | Mad honey: uses, intoxicating/poisoning effects, diagnosis, and treatment | RSC Advances 2018;8:18635 to 18646 | 10.1039/c8ra01924j |
| Aryal M | Grayanotoxins in Mad Honey: Mechanisms of Toxicity, Clinical Management, and Therapeutic Implications | Journal of Applied Toxicology 2025;0:1 to 17 | 10.1002/jat.4855 |
| Yavuz Y, et al. | Grayanotoxin levels in blood, urine and honey and their association with clinical status in patients with mad honey intoxication | Toxicology Letters 2018 | n/a |
| Biberoglu S, et al. | Mad honey poisoning | PMC3658790, 2013 | n/a |
| European Food Safety Authority | Risk assessment of grayanotoxins in food | 2023 | n/a |
The full annotated set, including the studies not cited directly above, is in the research references index.
Using this material
Figures and definitions on this page may be quoted with attribution to the Cliff Mad Honey Index, with a link to the page carrying the underlying source. Where a figure originates in a peer-reviewed paper, cite the paper as the primary source; this site is the secondary reference.
The Cliff Mad Honey Index is an independent, non-commercial reference on mad honey and grayanotoxin. It does not sell mad honey, certify products, or designate any concentration as safe.
Scope note. This page is a reference for reporting. It is not medical advice and not a dosing guide. Anyone who suspects mad honey poisoning should seek emergency medical care.
