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Comment by loeg | Hacker News Reader

https://parentdata.org/honey-botulism-babies/

> Infantile botulism is extremely rare. There are an estimated 100 cases per year in the U.S., among approximately 4 million children in the age range under 1. That’s a risk of 1 in 40,000. This is somewhat less likely than the chance of visiting the ER for a blanket-related injury in a given year (yes, I looked that up, and I do think it’s a good comparison).

> ... In an estimated 20% of cases — that’s about 20 cases a year — honey is one of the exposures. This doesn’t necessarily mean that the botulism actually came from honey; it’s just that because we know the spores can live in honey … it seems possible.

> At best, this suggests that by avoiding honey, you could lower the risk of infantile botulism from 1 in 40,000 to 1 in 50,000.

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I don’t think these probabilities are correct. Every parent is told not to feed their under 1 year olds honey, many times.

In an extreme example… only 20 parents fed their kids honey and 20 kids contracted botulism.

That would be a 100% risk. Obviously in real life it’s not 100% of kids, but still could be a meaningful percentage and likely higher than 1 in 50,000 for babies that eat honey.

It is correct. They are considering the most extreme case; in the most extreme case, no non-botulism-infected infants eat honey, and honey was the cause of botulism for those 20 infants.

If that is so, then completely removing honey exposure for infants would mean that 80 rather than 100 infants get botulism poisoning.

So the new probability of contracting botulism is (80 / 100) * (old probability), and (80 / 100) * (1 / 40000) = 1 / 50000.

There are no errors in the calculation, but it's wrong anyways because it calculates the answer to the wrong question. "At best" suggests this is the largest possible effect, but it is the smallest possible. To get an upper bound estimate on the usefulness of avoiding honey, you would need to know how many parents of 1-year-olds are avoiding honey.

Thanks! You said that much better than I did.

Feeding honey to newborn babies is a common practice in India. Sometimes it's their first ever food.

We waited until our kid was four, just to be safe, but it's was also honey from our own bees, so I somehow felt it less safe.

Kid went full Winnie-the-Pooh on the jar.

"OK, sister bees, now remember: this season we'll be feeding the hu-man's child, so wipe your feet before entering the hive, and if you feel the sniffles coming on, Don't Make Honey!"

It's more about the below minimum wage people harvesting, bottling for transport, transporting, then bottling for sale than the bees themselves. More intermediate steps to introduce contamination and more potentially contaminated sources all mixed together.

Yeah, and their infant mortality is on par with Sub-Saharan Africa.

"The second most common prelacteal feed is honey, a delicious natural sweetener. Numerous studies [29,30] have shown that the ingestion of honey under one year of age is linked with infant botulism, a disease that results in a blockade of voluntary motor and autonomic functions. Apart from this, other prelacteal feeds get contaminated due to unhygienic environment, especially in rural India and in urban slums, resulting in infantile diarrhea. Thus, a wide range of prelacteal feeds and the introduction of early supplements result in recurrent diarrhea with multiple illness finally ending lives because of inaccessibility and unaffordibility of treatment and delayed or inappropriate care seeking behavior."

Rohini Ghosh - Child mortality in India: a complex situation (https://doi.org/10.1007/s12519-012-0331-y)

The paper lists a bunch of other traditional practices that have deleterious effects on the infants' health, such as putting unsanitary herbal concoctions on the babies navel while it's still healing, etc.

> result in recurrent diarrhea

This mind-blowing statistic stays in my head:

"Diarrhoea is a leading killer of children, accounting for approximately 9 per cent of all deaths among children under age 5 worldwide in 2021. This translates to over 1,200 young children dying each day" - https://data.unicef.org/topic/child-health/diarrhoeal-diseas...

Almost one per minute.

> Every parent is told not to feed their under 1 year olds honey, many times.

Huh, I think this might be my first time hearing it.

I'm not sure that number is meaningful without knowing how many parents are giving their infants honey. Granted I'm in a high-income, high-education area, but at least in my bubble, "don't give babies honey" seems to be common knowledge, so it's possible there are relatively few instances and a high percentage result in complications.

Whole food crunchy Instagram grifters push that infants should eat honey

Though tbh do people really eat that much honey? I only have some in my kitchen to have with tea when I have a cold. Other then that I almost never use it.

Breakfast buns go well with honey. Often switched up with jam every few days. Also pancakes and waffles are great with honey from time to time when I'm tired of maple syrup. Jam works too.

Oh man buttered toast with honey... English muffins... But most controversially, and most deliciously, it dresses up a pizza something lovely...

For me the shift happened when I stopped thinking of it as a sweetener for liquids and started thinking about it as a condiment to deploy conservatively but frequently.

Hot honey on pizza is the BEST

The United States is the second largest honey consumer behind China according to the latest data available from the United Nations Food and Agriculture Organization (FAO) in 2019. In 2021, consumption increased 8 percent from the previous year. Between 1991 to 2021, the average rate of growth is 10.7 million pounds per year. This translates to about 1.9 pounds per capita of honey consumption in 2021 compared with 1.2 pounds per capita in the early 1990s.

Yes. I literally collect different honey (including from my own hives) and my love of it is very strong.

And no, I don’t have diabetes yet. I’m not insane about it, but I do have it frequently.

(Diabetes isn't caused by sugar intake.)

Not directly, no. But indirectly, by increasing weight gain and eventual metabolic syndrome, if eaten in excess… which was my point :)

Type 1 isn't caused by any of this stuff. Type 2 is caused by excess body fat -- consuming too many calories in total over a long period of time. It doesn't matter what the composition of those calories is. You can eat mostly sugar, at maintenance levels, and never be at risk for T2D.

No honey with greek yoghurt?

I think the rate was similar before we told parents not to give their infants honey. So we sort of have an A/B comparison.

> Some people have pointed out that botulism cases haven’t fallen over time despite parents being told not to give kids honey.

A truncated version of Bayes used here:

A=Infantile botulism

B=Kid eats honey

P(A|!B) = P(A) * (1 - P(B|A))

Not sure it is correct!

The ACX signature says:

P(A|B) = [P(A)*P(B|A)]/P(B)

P(A|!B) = [P(A)*P(!B|A)]/P(!B)

= (1/40000) * .8 / ???

??? Is very small though if people take the medical advice.

Their number assumes nobody follows the advice!

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