DISEASES OF BEEKEEPERS AND BEES
Author: Dr Miroslav Balchev
It is difficult to say whether the beekeeper is part of the apiary and the hives, or whether the hives gradually become part of the beekeeper himself.
They are like communicating vessels.
When the apiary sings and hums, intoxicated by warm weather and abundant blossom, the beekeeper's heart sings too, however burdened it may be.
When colonies weaken, queens fail, the honey flow falters, mite levels rise and hives begin to die, the person behind them suffers as well.
The beekeeper examines the bees.
He looks at the brood.
He searches for mites.
He watches the queen.
He measures the honey.
He assesses the stores.
He watches the entrance.
But far less often does he stop for a moment to examine himself.
Yet he too is part of the apiary.
Sometimes the sickest organism in the apiary is not the one inside the hive.
"AS LONG AS A PERSON IS ALIVE, HE IS ILL"
This is deliberately provocative.
Of course, it does not mean that every living person necessarily has a disease.
The meaning is different.
Most people begin to think of themselves as ill only when something hurts, when they become short of breath, when they can no longer walk, can no longer lift, see blood, or lose some function.
But the symptom is often not the beginning of the disease.
It is the moment when the disease has already become extensive enough to be felt.
Atherosclerosis begins long before the heart attack.
Osteoporosis begins long before the first fracture.
Insulin resistance begins long before diabetes produces its classic symptoms.
An intervertebral disc begins to degenerate long before the first severe episode of low-back pain.
Venous insufficiency may develop for years before large tortuous veins and oedema appear.
A polyp may exist for years before becoming colorectal cancer.
A tumour does not begin on the day a person first feels the lump.
Therefore:
"Nothing hurts" does not mean "I am healthy."
It means only:
"At this moment I am not in pain."
And this is precisely where prevention begins to make sense.
"DISEASES OF BEEKEEPERS" — A NON-EXISTENT SPECIALTY, BUT A VERY REAL PROBLEM
There is no medical specialty formally called "diseases of beekeepers".
But if we look at the occupation as a collection of exposures, we find almost an entire textbook of medicine:
orthopaedics and traumatology;
neurology;
allergology;
dermatology;
pulmonology;
cardiology and angiology;
gastroenterology and proctology;
endocrinology;
ophthalmology;
urology;
oncology;
paediatrics;
gerontology;
occupational medicine;
psychology.
The beekeeper lifts heavy loads.
He bends.
He twists.
He stands for hours.
He works in the sun.
He works in the heat.
He breathes smoke.
He is stung.
He works with propolis, wax, pollen, organic acids and other preparations.
He wears gloves for hours.
He travels and drives at night.
He works alone.
Sometimes he forgets to eat.
More often he forgets to drink water.
Sometimes he postpones even the most elementary physiological needs because "there are only two more hives to do".
And this may continue for thirty, forty or fifty years.
Risk is often:
dose × repetition × time × individual predisposition.
THE DISEASE OF THE STRONG BEEKEEPER
The young beekeeper has a particular risk factor.
He is young.
He is strong.
He can do a lot.
That is exactly why he sometimes does more than his body ought to endure.
A full honey super does not care whether the person is twenty or seventy.
Neither does a tin of honey.
But risk is not measured in kilograms alone.
The horizontal distance of the load from the body, the height from which it is lifted, trunk twisting, frequency, duration of work and quality of grip all matter. These are precisely the kinds of variables included in the Revised NIOSH Lifting Equation. [1]
Beekeeping work is often less favourable than a standard laboratory lifting situation.
The ground is uneven.
The hive body is wide.
The arms are held forward.
There is grass, mud and stones.
There is a veil.
There are gloves.
There are bees.
And there is fatigue.
In a study of professional beekeepers in New Zealand, 89% reported at least one musculoskeletal complaint during the previous year. The lower back, shoulders, neck and wrists/hands were affected most often. [2]
Therefore the first question should not be:
"How can I lift 50 kilograms correctly?"
But:
"Why should one person have to lift 50 kilograms at all?"
THE VALSALVA MANOEUVRE
During a major effort, a person instinctively takes a breath, closes the glottis and strains.
Intrathoracic and intra-abdominal pressures rise sharply.
This stabilises the trunk and enables greater force to be produced.
But venous return, cardiac output and arterial blood pressure also change for a short time.
In a predisposed person, extreme exertion may act as a trigger for a cardiovascular or other acute event.
The same increase in pressure also loads the abdominal wall, the inguinal canals, the pelvic floor and the diaphragmatic hiatus.
But we must be precise.
A heavy load does not always "create" a hernia in completely healthy tissue.
There is often an anatomical predisposition that exertion reveals or worsens.
The same principle applies to some ocular, vascular and pelvic-floor problems.
THE SPINE IS NOT A STEEL COLUMN
The intervertebral disc is a complex structure.
Its outer portion is the annulus fibrosus, while its centre contains the nucleus pulposus.
In a young disc, proteoglycans retain a substantial amount of water and allow the disc to distribute mechanical loading.
With age and degenerative processes, the quantity and structure of proteoglycans change.
The disc becomes less able to retain water.
The nucleus becomes more fibrous.
The disc loses height and elasticity.
This does not simply mean that the beekeeper "has not drunk enough water".
Adequate fluid intake is important for general hydration, but drinking extra litres cannot return a degenerated disc to its condition at the age of twenty.
As disc height decreases, the mechanics of the entire motion segment change.
Loading of the facet joints may increase.
There may be disc protrusion or herniation.
Osteophytes may form.
And when the disc, osteophytes and osteoarthritic changes narrow the intervertebral foramen, the nerve root may become irritated or compressed.
Then come:
pain;
burning;
tingling;
numbness;
sensory disturbances;
muscle weakness.
And the person says:
"My back suddenly went."
But often only the symptom began suddenly.
The process started much earlier.
WHY THE BEEKEEPER GETS CLOSER TO THE GROUND WITH AGE
With age, some people genuinely lose centimetres in height.
The causes include loss of intervertebral disc height, changes in posture and kyphosis, osteoporosis and vertebral compression fractures.
An osteoporotic vertebral fracture can sometimes occur with relatively little pain.
The vertebra becomes wedge-shaped.
Several such changes increase thoracic kyphosis.
Sarcopenia and weakness of the spinal extensor muscles are added to this.
Thus, over the years, some beekeepers seem to become ever closer to the bees, the grass, the flowers and the earth.
SARCOPENIA — MUSCLE AGES TOO
Sarcopenia is a progressive loss of muscle strength, muscle mass and physical function.
It does not simply mean "a smaller muscle".
The beekeeper begins to experience it in practical ways.
It becomes harder to rise from a squat.
It becomes harder to climb onto the trailer.
Grip weakens.
Fatigue comes sooner.
Balance is recovered more slowly.
The hive body that was once lifted without a thought now requires real effort.
There is a paradox.
A person may perform heavy physical work throughout life and still develop sarcopenia.
Beekeeping is physical exertion, but it is not necessarily balanced exercise.
For people over 65, recommendations include not only aerobic activity but also muscle-strengthening exercise at least two days per week and balance activity. [3]
A particularly dangerous combination is:
sarcopenia + osteoporosis.
The first increases the chance of falling.
The second increases the chance that the fall will end in a fracture.
THE KNEES, HIPS, SHOULDERS AND HANDS
The beekeeper does not work only with his back.
He squats.
He rises.
He kneels.
He carries.
He pulls.
He pushes.
He repeats the same movements thousands of times.
Knee osteoarthritis, hip osteoarthritis and osteoarthritis of the small joints are multifactorial diseases.
We cannot claim that beekeeping alone causes them.
But decades of mechanical loading are part of the real occupational exposure.
One full frame does not seem heavy.
But one hundred full frames today, another hundred tomorrow, and thousands more over the next thirty years are a different magnitude altogether.
VARICOSE VEINS — WHEN THE BEEKEEPER STANDS STILL BUT THE BLOOD HAS TO MOVE UPWARD
The beekeeper spends a great deal of time standing.
In front of one hive.
Then the second.
Then the third.
Yet blood from the lower limbs must continuously return towards the heart against gravity.
This is assisted by the venous valves and the calf muscle pump.
When the valves do not function properly, venous reflux may occur.
Venous pressure rises.
The vein dilates.
The valve leaflets move even farther apart.
A vicious circle develops.
Prolonged occupational standing is associated with a higher risk of chronic venous disease, and more recent systematic reviews also consider heavy lifting as a possible additional occupational factor. [4]
Over time, the following may appear:
heaviness;
swelling;
pain;
itching;
night cramps;
skin changes;
pigmentation;
venous ulcers;
superficial venous thrombosis.
Sometimes resting the veins does not mean remaining still.
It means taking a few steps.
Activating the muscle pump.
Moving the ankles.
Rising onto the toes.
Sometimes the beekeeper should rest by moving.
GASTROENTEROLOGY OF THE BEEKEEPER — WHEN THE BOWEL ALSO STARTS TO SLOW DOWN
This problem is rarely discussed at beekeeping meetings.
But it is real.
The beekeeper goes to a remote apiary.
There is no toilet.
The work has started.
Then there is one more hive.
And another.
The body sends a signal.
The person suppresses it:
"Later."
Next time, again.
Gradually this can become a habit.
"INTESTINAL ATONY" — WHAT DO WE ACTUALLY MEAN?
The expression "intestinal atony" is widely used, but it is not a sufficiently precise diagnosis.
People often use it to mean reduced intestinal motility and chronic constipation.
Some patients have so-called slow colonic transit.
In others, the problem lies in coordination of the pelvic floor and defecation.
In others still, the cause is medication, dehydration, diabetes, hypothyroidism, neurological disease or a mechanical obstruction.
A true severe failure of intestinal propulsion may occur in ileus or intestinal pseudo-obstruction — conditions that are quite different from ordinary functional constipation and may be serious. In pseudo-obstruction, nerve or muscle disorders slow or stop movement of intestinal contents without a mechanical blockage. [5]
Therefore, in this article, when we use the expression "intestinal atony" we mean primarily intestinal hypomotility and slow transit, not a diagnosis applied to anyone who has simply not opened their bowels for one day.
CONSTIPATION — DISTRESSING, OFTEN UNDERESTIMATED AND SOMETIMES DANGEROUS
Constipation does not simply mean "I do not go every day".
Normal bowel frequency varies between individuals.
More medically significant features are hard and dry stools, difficult or painful defecation, a feeling of incomplete evacuation and a substantial reduction in frequency.
There may be many causes.
In a beekeeper, several can easily accumulate:
insufficient fluid intake during work in the heat;
irregular meals;
a low-fibre diet during long days away from home;
suppressing the urge to defecate;
prolonged driving;
lower physical activity outside the active season;
advancing age.
Diseases may be added to these.
Diabetes can affect the neural regulation of the bowel.
Hypothyroidism may slow motility.
Neurological diseases may alter defecation.
A number of medicines may also cause or worsen constipation — for example opioids, some antidepressants, anticholinergic drugs, iron preparations and others. Repeated suppression of the urge to defecate can also contribute to constipation. [6]
This is another example of how the different "diseases of beekeepers" are connected.
Heat → dehydration → hard stools → straining → haemorrhoidal symptoms.
Diabetes → autonomic neuropathy → impaired motility → constipation.
Hypothyroidism → slower metabolism and motility → constipation.
Sarcopenia and inactivity → less movement → poorer bowel function.
The body is not a collection of independent compartments.
WHEN DOES CONSTIPATION BECOME DANGEROUS?
For most people, functional constipation is not immediately life-threatening.
But that does not mean that prolonged severe constipation is always harmless.
It may lead to faecal impaction — the accumulation of a large, hard mass of stool that cannot be evacuated normally.
In rare severe cases, prolonged retention may cause stercoral colitis.
A hard faecal mass presses against the wall of the colon.
Local blood supply is compromised.
Ischaemia may occur.
Ulceration.
Necrosis.
Perforation.
Peritonitis.
Sepsis.
A 2026 systematic review describes stercoral colitis as an under-recognised and potentially life-threatening complication of refractory constipation. [7]
This should not frighten someone with ordinary temporary constipation.
It should teach us not to accept severe chronic constipation as a normal part of ageing.
CONSTIPATION IS SOMETIMES A SYMPTOM, NOT A DIAGNOSIS
New-onset constipation in an adult should not automatically be labelled:
"Lazy bowel."
The cause may be entirely different.
Particular attention is required when constipation is accompanied by:
blood in the stool or rectal bleeding;
persistent abdominal pain;
inability to pass gas;
vomiting;
fever;
unexplained weight loss;
a significant new change in bowel habit.
These symptoms require medical assessment, not simply another laxative. [6]
The prevention and treatment of chronic constipation deserve a separate article.
For the purposes of this article, it is enough to remember:
the bowel should not be forced, year after year, to wait until the beekeeper has finished work.
HAEMORRHOIDS — NOT EVERY DROP OF BLOOD IS "JUST HAEMORRHOIDS"
Beekeeping can provide a fairly effective combination for the development or worsening of haemorrhoidal symptoms:
chronic constipation;
straining during defecation;
prolonged sitting;
age;
repeated heavy lifting.
Current guidelines from the American Society of Colon and Rectal Surgeons regard dietary and behavioural changes as first-line treatment for symptomatic haemorrhoidal disease and emphasise the importance of constipation, straining and abnormal defecation habits. [8]
Haemorrhoids may cause:
bright-red bleeding;
itching;
discomfort;
pain when an external haemorrhoid thromboses;
prolapse of internal haemorrhoids.
But there is one rule that should be remembered:
RECTAL BLEEDING DOES NOT RECEIVE THE DIAGNOSIS "HAEMORRHOIDS" OVER THE TELEPHONE
Haemorrhoids are a common cause of rectal bleeding.
But they are not the only one.
Bleeding may arise from an anal fissure, inflammatory disease, a polyp, diverticular disease or colorectal cancer.
Therefore, particularly with new bleeding, a change in bowel habit, anaemia, weight loss, or in a person of screening age, the cause should be clarified. [9]
Here too, prevention and treatment will be discussed separately.
HEAT, VEIL AND DEHYDRATION
A beekeeper may work in high temperatures, direct sunshine and under heavy physical load.
At the same time, he wears clothing, a veil and sometimes gloves or a full bee suit.
This impairs heat dissipation.
Sweating causes loss of water and electrolytes.
Thirst, weakness, headache, dizziness, reduced concentration and cramps may develop.
Severe heat illness may cause confusion, impaired coordination and loss of consciousness.
NIOSH recommends that water be readily available close to the workplace; during moderate work in heat lasting less than two hours, a practical guide is about one cup of water — approximately 240 ml — every 15–20 minutes, while many hours of heavy sweating may also require electrolyte replacement. [10]
This is not a universal prescription for every person.
But the principle is universal:
water should be part of the beekeeper's equipment.
And one more thing:
we do not restrict fluids simply to avoid needing the toilet.
We do not suppress the urge to urinate.
We do not habitually suppress the urge to defecate either.
"Hold it" should not be a production method.
A BEE STING — NEITHER A MEDAL NOR PROOF OF MANHOOD
In some beekeeping circles, the number of stings almost becomes proof of professional competence.
But being stung is not a competition.
After stinging, the honey bee often dies.
The beekeeper receives a dose of venom.
And the immune response to repeated exposure is not completely predictable.
A person may tolerate stings for a long time and later develop a systemic reaction.
A study of 553 beekeepers in north-eastern Italy found a substantial number of self-reported systemic reactions after stings and showed that a considerable proportion of those affected had not received specific allergy assessment. [11]
In anaphylaxis, adrenaline is the principal emergency treatment.
An antihistamine does not replace it.
After a previous systemic reaction, assessment by an allergist is required. Venom immunotherapy is the specific treatment proven to prevent subsequent systemic reactions in appropriately selected patients. [12]
SMOKE IS FOR THE BEES, NOT FOR THE BEEKEEPER'S LUNGS
The smoker is a useful tool.
But "natural" smoke does not mean harmless smoke.
Combustion produces particles and gaseous products of incomplete burning.
In the Italian beekeeper study, almost all participants used a smoker, 39.1% reported frequent inhalation of the smoke, and practically none used respiratory protection. Measurements found high concentrations of ultrafine particles and various volatile organic compounds, including periods of elevated formaldehyde. [11]
This demonstrates an occupational respiratory exposure.
But we must remain scientifically precise:
it has not been demonstrated that the use of a beekeeping smoker itself causes a defined excess incidence of lung cancer among beekeepers.
We should therefore not write what has not been proven.
But neither should we wait for a future cancer study before reducing unnecessary inhalation.
Smoke is for the bees, not for the beekeeper's lungs.
TABAKISM
I deliberately use the word tabakism.
It is not an official diagnostic entity.
In medicine we speak of nicotine dependence and of diseases caused or promoted by tobacco use.
But the word "smoking" can sometimes sound too innocent for a dependence that affects almost the entire body.
Sometimes an older beekeeper even boasts that he does not use a smoker.
He blows cigarette smoke directly at the bees.
This is not beekeeping mastery. It is dependence turned into technology.
Even more dangerous is the transmission of the ritual:
work → success → break → cigarette.
Tobacco increases the risk of cardiovascular, pulmonary, oncological and metabolic disease. WHO recommends combining behavioural support with evidence-based pharmacological treatments when treating tobacco dependence. [13]
"ONE DRINK AFTER WORK"
Alcohol can also become part of the occupational ritual.
But:
heat + dehydration + fatigue + alcohol + driving
is a particularly unfavourable combination.
Alcohol is not a means of hydration.
It should not be the obligatory reward at the end of the working day.
DERMATOLOGY OF THE BEEKEEPER
The skin encounters:
sun;
sweat;
heat;
propolis;
wax;
honey;
pollen;
plant material;
smoke;
gloves;
organic acids;
disinfectants.
Propolis is a valuable bee product, but it can also be a contact allergen.
In a study of 340 beekeepers, dermatitis was found in 17.1%, most often as hand eczema, and propolis proved to be an important sensitiser. [14]
Gloves protect.
But inside them they can create a warm, damp and occlusive environment.
The skin becomes macerated.
Barrier function is impaired.
Prolonged use of wet or contaminated gloves can facilitate dermatitis and infection.
Not every nail change is fungal disease.
Not every eczema is propolis allergy.
Diagnosis should come before treatment.
THE SUN — THE INVISIBLE LENGTH OF SERVICE WRITTEN ON THE SKIN
The beekeeper is an outdoor worker.
Year after year, UV exposure accumulates on:
the face;
the ears;
the neck;
the nape;
the forearms;
the hands.
Solar ultraviolet radiation is carcinogenic to humans, and occupational outdoor exposure is associated with an increased risk of non-melanoma skin cancer. [15]
Precisely because this exposure is cumulative, the young beekeeper should think about his skin not when he turns seventy, but when he is twenty-five.
SKIN CANCER
Attention should be paid to:
a new pigmented lesion;
a change in an existing mole;
asymmetry;
irregular borders;
uneven colour;
growth;
bleeding;
a crust or sore that does not heal.
The exposed parts of the body deserve particular attention in a beekeeper with many years of outdoor work.
Preventive assessment should be risk-based, and a suspicious lesion should not wait for the next routine examination.
THE SKIN OF THE NECK — AGE AND SUNLIGHT LEAVE THEIR SIGNATURE
Sagging skin of the neck is not a disease in the strict sense.
But it is a very visible result of biological ageing.
Contributing factors include:
loss and structural alteration of collagen;
changes in the elastic fibre system;
changes in subcutaneous fat;
muscular and fascial changes;
gravity;
hormonal changes;
chronic UV exposure.
The skin of the neck is relatively thin and highly mobile, and its elasticity decreases with age. UV exposure increases the degradation and fragmentation of dermal collagen. [16]
No cream can turn the biology of the skin back by twenty years.
But it is sensible not to add decades of unnecessary photoageing to unavoidable intrinsic ageing.
ENDOCRINOLOGY OF THE BEEKEEPER
The beekeeper lives with a metabolic paradox.
On the one hand, physical work may improve insulin sensitivity.
On the other:
age advances;
body weight may increase;
visceral obesity may develop;
the work is seasonal;
sleep is often irregular;
there may be tabakism and alcohol use;
and the person is constantly surrounded by honey, sugar and syrups.
THE BEEKEEPER LIVES SURROUNDED BY SUGAR
Honey is not simply white sugar in a jar.
Its composition is different.
Different types of honey have different glucose-to-fructose ratios and may produce different metabolic responses.
But this does not mean that honey is metabolically "free".
There is an enormous difference between:
honey replacing some refined sugar
and
the usual quantity of food and sweets plus large amounts of honey.
A meta-analysis of controlled studies found some favourable changes in glycaemic and lipid parameters with honey intake, but the certainty of evidence for a number of outcomes was low and does not justify the conclusion that honey prevents diabetes. [17]
Still less can we claim that diabetes has been shown to be less common among beekeepers.
That is an interesting hypothesis that deserves to be studied.
INSULIN RESISTANCE, PREDIABETES AND DIABETES
In insulin resistance, tissues respond less effectively to insulin.
At first, the pancreas compensates by increasing insulin secretion.
A person may therefore maintain relatively normal glucose levels for a long time.
Eventually compensation begins to fail.
The glucose response after meals may become abnormal first.
Prediabetes may follow.
And in some people, type 2 diabetes.
According to the Standards of Care in Diabetes—2026, prediabetes includes HbA1c 5.7–6.4%, fasting plasma glucose 5.6–6.9 mmol/L, or a two-hour glucose value after a 75-g OGTT of 7.8–11.0 mmol/L. Screening in people without other indications should begin no later than age 35, and earlier in people with overweight/obesity and additional risk factors. [18]
Once again:
a normal fasting glucose level does not necessarily prove normal glucose tolerance.
METABOLIC SYNDROME
The beekeeper may be strong.
He may carry hive bodies.
He may have powerful forearms.
And at the same time he may have substantial visceral obesity.
Physical strength does not guarantee metabolic health.
The combination of abdominal obesity, hypertension, dyslipidaemia and impaired glucose metabolism represents significant cardiometabolic risk.
Metabolic dysfunction-associated steatotic liver disease often joins this picture.
THE BEEKEEPER WITH DIABETES — WHEN THE DANGER IS LOW BLOOD GLUCOSE
In someone already treated for diabetes, heavy physical work can create the opposite danger — hypoglycaemia.
The beekeeper has eaten little.
He works for several hours.
It is hot.
The muscles are using glucose.
With certain medicines or insulin, blood glucose may fall.
The following may appear:
trembling;
sweating;
hunger;
palpitations;
weakness;
impaired concentration;
confusion.
And the beekeeper may decide:
"It is just the heat."
If he is alone at a remote apiary, on a trailer or behind the wheel, this becomes an occupational safety problem.
THE THYROID GLAND — NOT EVERYTHING IS "JUST AGE"
Hypothyroidism may cause:
fatigue;
weight gain;
cold intolerance;
dry skin;
muscle weakness;
constipation.
Hyperthyroidism may cause:
palpitations;
tremor;
sweating;
heat intolerance;
weight loss;
muscle weakness;
arrhythmias.
Therefore an unexplained change in weight, pulse, work capacity or bowel function should not automatically receive the diagnosis:
"Old age."
CANCER — THE DISEASE THAT OFTEN DOES NOT HURT FOR A LONG TIME
Oncology is perhaps the clearest demonstration of why prevention must come before symptoms.
Of particular importance are:
breast cancer;
colorectal cancer;
cervical cancer;
prostate cancer;
bladder cancer;
lung cancer;
skin cancer.
There is no proven mass-screening programme for all of them.
And that matters.
Early diagnosis does not mean indiscriminate testing.
The European Code Against Cancer, 5th Edition, recommends organised programmes for colorectal cancer, breast cancer, cervical cancer and, in appropriately selected high-risk individuals, lung cancer. [19]
For colorectal cancer, the recommendation is quantitative FIT every two years from ages 50 to 74.
For breast cancer, digital mammography every two years, primarily between ages 50 and 69, with the possibility of extending the age range depending on the programme.
For cervical cancer, HPV-based screening at intervals no shorter than five years, approximately between ages 30 and 65.
For lung cancer, low-dose CT is intended for people at sufficiently high risk, not for every beekeeper who uses a smoker. [19]
For prostate cancer, European urological guidance recommends informed, risk-adapted PSA testing, generally from around age 50, and earlier in certain high-risk groups. [20]
For bladder cancer, there is no proven general population screening programme for asymptomatic adults. But visible haematuria is already a symptom, not a screening situation, and requires assessment. [21]
THE BEEKEEPER OFTEN WORKS ALONE
The beekeeper works alone during the day.
Sometimes at night as well.
In a field.
In a forest.
In the mountains.
At a remote apiary.
If he falls, suffers a heart attack, stroke, anaphylaxis, hypoglycaemia or heat stroke, he may be unable to call for help.
Working alone is therefore a risk factor in itself.
A close relative or trusted person should know approximately where the beekeeper is and when he is expected to return or make contact.
Modern technology also allows periodic safety check-ins at an interval chosen by the individual, so that failure to respond can trigger an alert to a trusted contact.
This does not prevent the incident.
But it may shorten the time between the incident and help.
PAEDIATRICS OF BEEKEEPING
In family apiaries, children often begin taking part at an early age.
This can be wonderful education.
But a child is not a small adult.
The growing skeleton, coordination and ability to assess risk are different.
A particularly dangerous principle is:
"If I can lift it, it must be safe."
No.
Muscular ability is not a certificate of safety for the joints, spine, tendons, abdominal wall and growing bones.
A child should learn early:
strength is an ability; safety is knowledge.
GERONTOLOGY OF BEEKEEPING
The beekeeper grows older.
The hive does not.
At seventy, a full honey super weighs exactly what it weighed when the beekeeper was thirty.
But the beekeeper may now have:
osteoarthritis;
disc degeneration;
sarcopenia;
osteoporosis;
varicose disease;
constipation;
reduced vision;
slower reactions;
impaired balance;
diabetes;
cardiovascular disease;
several medicines taken at the same time.
Experience makes him wiser.
But physiological reserve is smaller.
Mechanisation, a trolley, a ramp, a helper and a smaller hive body are therefore not surrender to age.
They are adaptation to it.
THE SUPER-BEEKEEPER
To a young person, the old master often appears invincible.
He recognises the hive by its sound.
He finds the queen in seconds.
He knows when it is going to rain.
But together with knowledge, he may also pass on bad habits:
"I don't wear gloves."
"I don't need water."
"One sting is nothing."
"I carry this by myself."
"My back has hurt for twenty years."
"I'll go to the toilet later."
"One cigarette after work."
The young beekeeper should not inherit everything.
The experience of the old beekeeper should be inherited. His injuries should not.
DISEASES OF THE BEEKEEPER'S MIND
Hive mania
Five hives.
Then ten.
Then fifty.
Then one hundred.
And the person says to himself:
"If I can manage fifty, I can manage one hundred."
But one hundred hives are not simply twice fifty.
When swarming, nectar dearth, varroa treatment, honey extraction and feeding arrive, they all demand work at the same time.
The number of hives is not always a measure of wealth.
Sometimes it is a measure of disorder.
The disease called "one more treatment"
The colony is weak.
Something must be poured in.
Then something else.
But the cause may be an old queen, varroa, a virus, hunger or too much empty hive volume.
Treatment without diagnosis turns the hive into a chemical laboratory.
Diagnosis by preference
The easiest cause is the one for which we are not responsible.
The weather.
The farmer.
The breed.
The neighbour.
"Some virus."
But sometimes the truth is:
we were late;
we did not measure;
we did not feed;
we did not replace the queen.
Self-blame does not help.
Honest analysis does.
Secrecy mania
Disease does not recognise fences.
Bees drift.
They rob.
They exchange mites.
Hiding a dangerous infection is not the protection of a trade secret.
The disease of cheap honey
A low price leads to more hives, more labour, less time, no helper and delayed mechanisation.
Sometimes the price of cheap honey is paid by the beekeeper's spine.
AND WHAT DO THE BEES SUFFER FROM?
The bee colony functions as a superorganism.
The individual bee has its own organism, but the life of the colony depends on the interaction of:
the queen;
the workers;
the brood;
the stores;
the combs;
temperature regulation;
immune defence;
behaviour.
Therefore it is not enough to ask:
"What did this bee die from?"
The more important question is:
"Can the colony preserve its population, organisation and functions?"
VARROA DESTRUCTOR
Varroa destructor is an external parasite of adult bees and brood and plays an important role as a vector of viruses, including deformed wing virus. [22]
By the time we see crawling bees with deformed wings, the problem is not beginning.
It is already advanced.
The most dangerous sentence is:
"I don't see many mites."
The beekeeper should measure, not guess.
It is not enough to know how many mites fell after treatment.
What matters is how many remained.
AMERICAN FOULBROOD
Paenibacillus larvae forms extremely resistant spores that can survive for long periods in combs, honey and equipment. WOAH also emphasises the possibility of subclinical infection, which requires laboratory detection. [23]
This makes American foulbrood more than a disease of the brood.
It is a test of beekeeping discipline.
Hiding the infection does not save the apiary.
It merely expands the problem.
EUROPEAN FOULBROOD
Melissococcus plutonius primarily affects larvae.
But here the interaction between the pathogen and the general condition of the colony is particularly clear.
Stress, nutrition, weather and colony strength can all influence the clinical picture.
NOSEMOSIS
Nosemosis may occur without dramatic signs.
The colony simply fails to thrive.
It weakens.
It does not exploit the nectar flow well.
Faecal spotting may be suggestive, but its absence does not exclude Nosema.
Reliable diagnosis includes laboratory methods. [24]
VIRUSES
Viruses may be present in a bee colony without necessarily producing a dramatic clinical picture.
When varroa and other stressors disturb the balance, viral load may become much more important.
That is why the question:
"What can I pour in for the virus?"
is often the wrong question.
FUNGI, STARVATION AND POISONING
Chalkbrood and other fungal diseases remind us how important moisture and the overall condition of the colony are.
Starvation does not necessarily mean an empty hive.
There may be food that the winter cluster cannot reach.
There may be carbohydrate stores but insufficient high-quality protein resources.
Poisoning does not always leave a carpet of dead bees either.
There may be disorientation, failure to return to the hive and gradual weakening.
PARASITES AND INVADERS
WOAH lists among the important diseases and infestations of honey bees American and European foulbrood, Aethina tumida, Tropilaelaps and Varroa. [25]
With a new pest, the first case is especially important.
If it is concealed, the next case may already be tens of kilometres away.
THE BEEKEEPER IS PART OF BIOSECURITY
The hive tool can carry infection.
A comb can.
Food can.
A hive can.
A trailer can.
The beekeeper himself can.
A weak colony should not automatically be united with a strong one before we know why the weak colony is weak.
Sometimes the most dangerous tool is not the dirty hive tool.
It is the van that can move a disease one hundred kilometres in a single hour.
PREVENTION — THE CHEAPEST TREATMENT
There are three levels.
Primary prevention — the disease is not yet present and we try to prevent it from appearing.
Secondary prevention — the process may already have begun, but we look for it before severe symptoms appear.
Tertiary prevention — the disease already exists, but we limit progression, complications and disability.
Occupational medicine also uses a hierarchy of controls:
first eliminate the hazard;
then substitute it;
then use engineering controls;
organise the work;
and only at the end rely on personal protective equipment. [26]
Therefore:
not "put on a lifting belt and lift 50 kg";
but "organise the work so that you do not have to lift 50 kg".
FOUR GROUPS FOR PREVENTIVE EXAMINATIONS AND TESTS
The following division is practical, not a biological boundary between "young" and "old".
For the purposes of this article, younger means approximately ages 18–49, and older means 50+.
From age 65 onwards, specific gerontological risks become increasingly important.
These are general guides for people without symptoms. Symptoms may always require earlier investigation.
1. YOUNGER MEN — AGES 18–49
It is sensible to monitor blood pressure, body weight and waist circumference periodically, as well as lipid profile according to overall cardiovascular risk and glucose metabolism.
From age 35, the ADA recommends screening for prediabetes/diabetes even in people without other risk factors; if results are normal, a minimum interval of around three years is reasonable, while people with prediabetes should be tested annually. [18]
Dental health, eyesight, vaccination status, skin in people with substantial UV exposure, and allergy assessment after a systemic sting reaction should not be overlooked.
Persistent new constipation, rectal bleeding or a significant change in bowel habits should not wait until the person reaches "screening age".
2. MEN AGED 50 AND OVER
All the preceding checks remain relevant, but the importance of assessing cardiovascular risk, diabetes, kidney function when indicated, eyesight, hearing, skin, muscle strength and balance increases.
From age 50, organised colorectal screening becomes relevant — in the European framework, FIT every two years between ages 50 and 74. [19]
At around age 50, an informed, risk-adapted discussion about PSA testing may begin; earlier in selected high-risk men. [20]
In people with substantial tobacco exposure, suitability for an organised low-dose CT lung cancer screening programme should be assessed.
With constipation, the medicines that may be contributing to it should also be reviewed.
Loss of height, new kyphosis, a fracture after minimal trauma or other risk factors should prompt assessment of bone health. Evidence remains insufficient to recommend universal DXA screening for all men. [27]
3. YOUNGER WOMEN — AGES 18–49
In addition to blood pressure, weight, waist circumference, lipids and glucose metabolism, gynaecological prevention and HPV prevention are important.
In the European framework, HPV-based cervical cancer screening covers approximately ages 30–65, at intervals no shorter than five years and according to the national programme. [19]
A breast lump, nipple discharge, skin change or another suspicious finding should not wait until screening age.
After a systemic reaction to a sting, allergy assessment is necessary.
Chronic eczema of the hands should raise the possibility of occupational contact dermatitis.
Pregnancy, childbirth and pelvic-floor disorders may add separate risks for constipation, haemorrhoidal disease and prolapse.
4. WOMEN AGED 50 AND OVER
Alongside general cardiometabolic monitoring, cancer screening and bone health become particularly important.
In the European framework, mammography is recommended every two years, primarily between ages 50 and 69, with possible extension to ages 70–74. [19]
Colorectal screening with FIT is performed every two years between ages 50 and 74.
HPV screening continues approximately to age 65 depending on previous results and the national programme.
Women aged 65 and over are a group in whom screening for osteoporosis with DXA has proven benefit; in younger postmenopausal women it is performed according to fracture risk. [27]
From age 65, falls, balance, strength, eyesight, hearing and medicines become particularly important.
TESTING IS NOT AN END IN ITSELF
Prevention is not a package of twenty laboratory parameters.
Nor is it an annual collection of:
tumour markers;
scans;
ultrasound examinations;
hormones;
"full blood tests".
The correct preventive question is:
"What is this particular person's risk?"
Age.
Sex.
Family history.
Tobacco.
Alcohol.
Weight.
Blood pressure.
Work.
Sun exposure.
Medicines.
Previous diseases.
Bowel habits.
Only then comes the appropriate test.
Sometimes prevention is a laboratory test.
Sometimes FIT.
Sometimes mammography.
Sometimes a vaccine.
Sometimes a dermatologist.
Sometimes a trolley.
Sometimes a bottle of water.
Sometimes a toilet.
Sometimes simply:
"This is too heavy. I am going to call another person to help."
THE HEALTHY BEEKEEPER
A healthy beekeeper is not someone who never becomes ill.
He is not the one who tolerates the greatest number of stings.
He is not the one who carries the heaviest hive body.
He is not the one who works twelve hours without water, food or a toilet.
He is not the one who continues despite pain.
The healthy beekeeper is the person who understands risk early enough.
He does not wait for:
pain to become disability;
varicose veins to become an ulcer;
constipation to become faecal impaction;
haemorrhoids to bleed for years without a diagnosis;
osteoporosis to become a fracture;
prediabetes to become diabetes;
diabetes to become neuropathy;
a polyp to become cancer;
sun damage to become carcinoma;
high blood pressure to become a stroke.
And he does not wait for the bee colony to die before discovering that it had varroa.
ONE COMMON DIAGNOSIS
Beekeeping is a system.
It includes:
the bee;
the colony;
the beekeeper;
the plants;
the sun;
the climate;
agriculture;
chemistry;
technology;
the market;
age;
character.
The sick beekeeper misses problems in the colony.
The exhausted beekeeper is late.
The overworked beekeeper makes mistakes.
The poor beekeeper postpones mechanisation and medical examinations.
And the sick apiary gives everything back to the person as anxiety, loss and sleepless nights.
That is why the most important inspection of the apiary does not end when the last hive is closed.
At that moment, the beekeeper should look at himself as well.
Do I have the strength to continue like this?
Will I still be able to do what I am doing today in twenty years?
Am I accepting pain as a normal part of the occupation?
Am I suppressing every day the signals my own body is sending me?
Am I turning an old harmful habit into a lesson for the young?
Am I waiting for the symptom instead of looking for the disease before it announces itself?
The bees cannot choose another doctor.
The beekeeper can.
And sometimes the best treatment for the bee colony begins with prevention in the person standing behind the hive.
The beekeeper grows older. The hive does not.
That is why we must protect them both.
SOURCES AND PRIMARY REFERENCES
[1] NIOSH. Applications Manual for the Revised NIOSH Lifting Equation. DHHS (NIOSH) Publication No. 94-110, revised 2021. DOI: 10.26616/NIOSHPUB94110revised092021.
[2] Pierce J, Lamm F, Zeng IS, et al. Do Beekeepers Have a Sweet Life? Work-Related Musculoskeletal Disorders and Their Impact Among Apiarists in New Zealand. J Agromedicine. 2026;31(2):242–253. DOI: 10.1080/1059924X.2025.2591056.
[3] Centers for Disease Control and Prevention. Older Adult Activity: An Overview. Updated 2025.
[4] Hirsch T, Wahl U, Rabe E. Venous disorders as an occupational disease – a systematic review on epidemiology, pathophysiology, and modification strategies. Vasa. 2024;53(3):172–184. DOI: 10.1024/0301-1526/a001116.
[5] National Institute of Diabetes and Digestive and Kidney Diseases. Intestinal Pseudo-obstruction.
[6] National Institute of Diabetes and Digestive and Kidney Diseases. Constipation – Symptoms and Causes.
[7] Stirrat T, Bejugam D, Kim S, et al. Stercoral colitis from constipation to complication: A systematic review. Am J Med Sci. 2026;371(3):267–273. DOI: 10.1016/j.amjms.2025.12.003.
[8] Hawkins AT, Davis BR, Bhama AR, et al. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. Dis Colon Rectum. 2024;67(5):614–623. DOI: 10.1097/DCR.0000000000003276.
[9] National Institute of Diabetes and Digestive and Kidney Diseases. Hemorrhoids – Symptoms, Causes and Diagnosis.
[10] NIOSH. Workplace Recommendations: Heat Stress. Updated July 2026.
[11] Mauro M, Tassinari A, Cavallo Ronchi F, Rizzo M, Larese Filon F. Between stings and smoke: prevalence of allergic disorders and exposure to combustion smokes in Northeast Italy's beekeepers. Occup Environ Med. 2026;83(2):85–90. DOI: 10.1136/oemed-2025-110392.
[12] Sturm GJ, Varga EM, Roberts G, et al. EAACI guidelines on allergen immunotherapy: Hymenoptera venom allergy. Allergy. 2018;73(4):744–764. DOI: 10.1111/all.13262.
[13] World Health Organization. WHO clinical treatment guideline for tobacco cessation in adults. Geneva: WHO; 2024. ISBN 978-92-4-009643-1.
[14] Qayoom M, Hassan I, Jeelani S. Prevalence, pattern, contact sensitisers and impact on quality-of-life of occupational dermatitis among beekeepers in North India. Contact Dermatitis. 2025;92(3):217–223. DOI: 10.1111/cod.14724.
[15] World Health Organization / International Labour Organization. The effect of occupational exposure to solar ultraviolet radiation on malignant skin melanoma and non-melanoma skin cancer: a systematic review and meta-analysis. WHO; 2022. ISBN 978-92-4-004083-0.
[16] Liu H, Dong J, Du R, Gao Y, Zhao P. Collagen study advances for photoaging skin. Photodermatol Photoimmunol Photomed. 2024;40(1):e12931. DOI: 10.1111/phpp.12931. Roberts WE. Neck Aging and Rejuvenation: A Balanced Approach to Assessment and Treatment. Dermatological Reviews. 2024;5(3):e238. DOI: 10.1002/der2.238.
[17] Ahmed A, Tul-Noor Z, Lee D, et al. Effect of honey on cardiometabolic risk factors: a systematic review and meta-analysis. Nutr Rev. 2023;81(7):758–774. DOI: 10.1093/nutrit/nuac086.
[18] American Diabetes Association. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1). DOI: 10.2337/dc26-s002.
[19] International Agency for Research on Cancer. European Code Against Cancer, 5th Edition – Organized Cancer Screening Programmes. IARC/WHO, 2025–2026.
[20] European Association of Urology. EAU Guidelines on Prostate Cancer – Diagnostic Evaluation. Current edition.
[21] U.S. Preventive Services Task Force. Bladder Cancer in Adults: Screening. Current surveillance reviewed through 2024.
[22] World Organisation for Animal Health. Terrestrial Animal Health Code, Chapter 9.6 – Infestation of honey bees with Varroa spp. (Varroosis).
[23] World Organisation for Animal Health. Infection of honey bees with Paenibacillus larvae (American foulbrood). Terrestrial Code and Manual.
[24] World Organisation for Animal Health. Terrestrial Manual – Nosemosis of honey bees.
[25] World Organisation for Animal Health. Terrestrial Animal Health Code, Section 9 – Apinae.
[26] NIOSH. Hierarchy of Controls.
[27] U.S. Preventive Services Task Force. Osteoporosis to Prevent Fractures: Screening. JAMA / USPSTF, 2025.
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