Using sweeteners to reduce sugar consumption

Hedonistic receptors for sweetness play a powerful role in our selections of food and drink from shelves, shop windows and menus. We are rather poor, too, at estimating how much sugar we eat: few take in just 10% of their energy from sugars as the World Health Organization recommends[1]
. To reduce sugar calorie intake, exchanging sucrose with a high-potency sweetener (HPS) is a logical step — even more so for those with a problem with body weight or a diabetic condition.

The UK government has challenged all sectors of industry to reduce sugar across a range of products by 2020[2]
, while Americans have proposed reducing sweetness without encouraging exchanges with sweeteners[3]
. An expert workshop concluded in its report, published in April 2017, that we are likely to require all strategies to approach the ambitious population-wide goals set by the UK government[4]

Pharmacists can provide useful advice to patients and customers on this subject, particularly because the public tends to be suspicious of artificial sweeteners. But several natural sources are now available. Substances with a higher intensity of sweetness than sucrose include artificially synthesised compounds such as aspartame (E951) found in NutriSweet, acesulfame potassium (E950) found in Sunett, sucralose (E955) or Splenda, cyclamate (E952) found in some Sweet’N low, saccharin (E954) and neotame (E961), also used in Nutrasweet.

Naturally occurring compounds include steviol glycosides (E960, sold as EverSweet), as well as monk fruit glycosides (sold as Nectresse). A number of compounds are less sweet than sugar, including allulose or psicose and sugar alcohols such as xylitol, mannitol and sorbitol. These contain some calories. Sweeteners are used by food manufacturers as food additives, often in combinations to reduce any aftertastes. Their use is regulated by a number of checks, including recommended daily intakes for each[5]

When used as sugar replacement, sweeteners reduce energy intakes, particularly when used in beverages. They are associated with smaller rises in blood sugar levels after meals, maintain tooth mineralisation and reduce body weight[6]
. Natural sweeteners derived from plants often have other beneficial health effects. Glycosides derived from Stevia rebaudiana, a plant originally from Paraguay (although now mostly imported from China), have been claimed to reduce blood pressure, improve glucose tolerance and provide antioxidant effects[7]

Food companies are using Stevia in beverages and their use is likely to increase. Two common brands of soft drinks have already reduced sucrose by employing Stevia glycosides; an additive to enrich hot drinks is also available to sweeten cocoa. These glycosides may also be applied instead of sucralose to paediatric medicines, so many pharmacies will be selling Stevia products. This relative of the chrysanthemum is likely to become increasingly familiar in future.

Colin Michie

Paediatrician, London


[1] World Health Organisation WHO guideline: sugars, intake for children and adults. Geneva WHO 2015. Available at: (accessed August 2017)

[2] UK Government. Childhood obesity: a plan for action 2016. Available at: (accessed August 2017)

[3] USDA scientific report of the 2015 Dietary Guidelines Advisory Committee. Availabe at: (accessed August 2017)

[4] Gibson S, Ashwell M, Arthur J et al. What can the food and drink industry do to help achieve the 5% free sugars goal? Perspect Public Health 2017;137(4):237–247. doi: 10.1177/1757913917703419 . Epub 2017 Apr 18.

[5]  A resource of sweetners and european legislation relating to them. Available at: (accessed August 2017)

[6]  Rogers PJ, Hogenkamp PS, de Graaf C et al. Does low-energy sweetener consumption affect energy intake and body weight? A systematic review, including meta-analyses, of the evidence from human and animal studies. Int J Obes (Lond) 2016;40(3):381-394. doi: 10.1038/ijo.2015.177. Epub 2015 Sep 14.

[7] Momtazi-Borojeni AA, Esmaeili SA, Abdollahi E et al. A review on the pharmacology and toxicology of steviol glycosides extracted from Stevia rebaudiana. Curr Pharm Des 2017;23(11):1616–1622. doi: 10.2174/1381612822666161021142835

Last updated
Clinical Pharmacist, CP, September 2017, Vol 9, No 9;9(9):DOI:10.1211/PJ.2017.20203341