Sugar as an active ingredient in pharmaceutical applications

As the world’s favourite sweetener, sugar has been bringing taste, bulk, colour and texture to medicines and pharmaceutical products for centuries. Research shows that the role of sugar can be more than an excipient and bulking agent: it has the potential to perform as an active ingredient too. 

We all know the familiar refrain from the original movie Mary Poppins, a spoonful of sugar helps the medicine go down, and this has a basis in truth. Apart from masking the taste of bitter or unpalatable substances, it’s long been used as an excipient in tablets, capsules and liquids to improve appearances and ease transport and storage. It also extends the shelf life of everything from vitamins to lozenges. 

Pharma grade sucrose or invert sugar syrups are top choices for medicine or supplement manufacturers. Powdered sugar protects a tablet from air and moisture and makes a bitter pill easier to swallow, while invert syrups, liquid sugar and glucose syrup add viscosity to liquid medicines, and act as a diluent (adding bulk).  

Traditional medicine systems over the world, like Ayurveda and traditional Chinese medicine have used formulations prepared with a saccharide sweetener for thousands of years. Sugar, honey or jaggery are all common. ‘Unani’ is a traditional medicine system with roots in Hippocratic teachings and is also recognised by the World Health Organization. It uses formulations called ‘electuaries’: herbal extracts cooked in one or more sweeteners.  

A recent research paper supports what Unani practitioners have known for centuries: apart from their own therapeutic effects, saccharides also form deep ‘eutectic’ solvents which enhance the bioactivity of other ingredients present in drugs. On top of that, sugar provides energy for the fermentation (biotransformation of compounds) in many traditional remedies.¹ 

Sugars have also been used as wound dressings for at least 4,000 years in many parts of the world. The first recorded examples are from Ancient Egypt and Mesopotamia, and involve the application of honey mixed with grease, like lard or resin. The Graeco-Roman physician Galen reported on the medical implications of sugar on wounds in about 170 AD, and the first scientific study of sugar as an anti-infective agent was carried out in 1750 by the British physician and polymath, Sir John Pringle. He showed that ‘solutions of sugar are proportionately antiseptic’ and could prevent ‘the putrefaction of flesh’.² 

In the western world, the modern pharmaceutical industry has long made use of sugar as a functional, but inactive ingredient of medicines. But new research has found that sugar has been playing a quiet role in the background of many popular pharmaceutical products as a medicine in itself. 

While evidence surfaced that sugar could help minor ailments like the hiccups or a cough in 1971,³ for some reason, nobody took notice of it. In the years since, the proof has been slowly mounting that sugar does more for our coughs and colds than provide a comforting sugar hit in the form of a lozenge. 

One group of researchers found that rather than being a ‘nominally inactive ingredient’, sugar has a real physiological effect in modulating cough sensitivity: it raises the threshold of mechanical and chemical stimuli going on in your body before you have to cough.⁴ 

What many experts have considered to be a simple placebo effect – the soothing, familiar sweet taste of a cough syrup tricking us into feeling better – has been found to be ‘real.’ While more research is needed to make a firm conclusion, it appears that sugar may modulate coughing at the level of a part of your brain called the ‘nucleus tractus solitarius’, by influencing the production of endogenous opioids (the painkillers your body naturally produces).⁵ 

Perhaps sugar’s most promising use for humankind could lie in its potential to fight the ever-growing problem of antibiotic resistance. Interestingly, white crystalline sugars have been found to be slightly more effective than demerara sugar in fighting MRSA and Staphylococcus infected wounds, with one study revealing that all wounds treated with the sugars were clean in a mean of 11.13 days, with reduced pain too. Patient and staff surveys showed ‘overwhelming support for the sugar therapy,’ said the researchers.⁶ 

Sugar has a long history of innovative applications. From ancient Egyptian wound dressings to 21^st century tool in the fight against superbugs, to modern leather tanning agents, biodegradable plastics and biofuels, sugar keeps surprising us. 

References

[1] Fazil M, Nikhat S. Why the “sugars” in traditional Unani formulations are a pivotal component: A viewpoint perspective. J Integr Med [Internet]. 2022;20(2):91–5. Available from: https://www.sciencedirect.com/science/article/pii/S2095496422000024 

[2] Selwyn S, Durodie J. The antimicrobial activity of sugar against pathogens of wounds and other infections of man. In: Properties of Water in Foods. Dordrecht: Springer Netherlands; 1985. p. 293–308. 

[3] Engleman EG, Lankton J, Lankton B. Granulated sugar as treatment for hiccups in conscious patients. N Engl J Med [Internet]. 1971 [cited 2023 Jan 30];285(26):1489. Available from: https://pubmed.ncbi.nlm.nih.gov/5122907/ 

[4] Wise PM, Breslin PAS, Dalton P. Sweet taste and menthol increase cough reflex thresholds. Pulm Pharmacol Ther [Internet]. 2012 [cited 2023 Jan 30];25(3):236–41. Available from: https://pubmed.ncbi.nlm.nih.gov/22465565/ 

[5] Eccles R. Mechanisms of the placebo effect of sweet cough syrups. Respir Physiol Neurobiol [Internet]. 2006 [cited 2023 Jan 30];152(3):340–8. Available from: https://pubmed.ncbi.nlm.nih.gov/16326149/ 

[6] Murandu M, Webber MA, Simms MH, Dealey C. Use of granulated sugar therapy in the management of sloughy or necrotic wounds: a pilot study. J Wound Care [Internet]. 2011 [cited 2023 Jan 30];20(5):206, 208, 210 passim. Available from: https://pubmed.ncbi.nlm.nih.gov/21647066/ 

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