“A Spoonful of Sugar Helps the Medicine Go Down”: Bitter Masking by Sucrose Among Children and Adults

Abstract

Sweeteners are often added to liquid formulations of drugs but whether they merely make them better tasting or actually reduce the perception of bitterness remains unknown. In a group of children and adults, we determined whether adding sucrose to urea, caffeine, denatonium benzoate, propylthiouracil (PROP), and quinine would reduce their bitterness using a forced-choice method of paired comparisons. To better understand individual differences, adults also rated each solution using a more complex test (general Labeled Magnitude Scale [gLMS]) and were genotyped for the sweet taste receptor gene TAS1R3 and the bitter receptor TAS2R38. Sucrose suppressed the bitterness of each agent in children and adults. In adults, sucrose was effective in reducing the bitterness ratings from moderate to weak for all compounds tested, but those with the sensitive form of the sweet receptor reported greater reduction for caffeine and quinine. For PROP, sucrose was most effective for those who were genetically the most sensitive, although this did not attain statistical significance. Not only is the paired comparison method a valid tool to study how sucrose improves the taste of pediatric medicines among children but knowledge gleaned from basic research in bitter taste and how to alleviate it remains an important public health priority.

Variation in the Ability to Taste Bitter Thiourea Compounds: Implications for Food Acceptance, Dietary Intake, and Obesity Risk in Children

“…Mennella and colleagues (95) showed in an ethnically diverse cohort that children who were homozygous for bitter-sensitive alleles preferred sweeter sucrose solutions and reported liking beverages and cereals with higher sugar content compared to children who were genetically bitter insensitive. A similar relationship between TAS2R38 genotype and sucrose preference was reported in a follow-up study (96). Given the health implications of consuming excess dietary sugars, additional studies are warranted to understand the relationships between PROP phenotype, TAS2R38 genotype, and dietary sugar consumption.…”

“…Determining the most effective methods of blocking bitter taste in children's medications to improve palatability and compliance is a public health priority. Mennella and colleagues (96) showed evidence to suggest that sucrose was the best method of blocking bitter taste in children who were the most sensitive to PROP, although the effects did not reach significance. As this research becomes more established, it is conceivable that different versions of medications might be formulated to optimize palatability in tasters and nontasters.…”

Flavor Perception and Preference Development in Human Infants

“…First, as discussed above, we do not need to encourage consumption of unhealthful foods, given that children are already predisposed to preferentially consume them. Not only are children attracted to the sweet taste of sugar in these foods, but the presence of sugar can also effectively suppress or mask the bitterness [34,35] that is inherent in some foods and beverages (e.g., caffeinated energy drinks) that children would otherwise avoid.…”

The sweetness and bitterness of childhood: Insights from basic research on taste preferences

“…That is, the level of sucrose most preferred by children, as measured in the laboratory, was significantly related to children’s preferences for sweet-tasting foods, such as cereals [42, 43], puddings [44], and beverages [43]. Because genetic variation in the TAS1R3 sweet receptor gene accounts for differences in sweet taste preference in adults but not in children [44, 45], we posit that children’s desire for sweetness may relate to some aspect of development, such as the need for nutrients during periods of maximal growth, which “trumps” the more subtle effects of genotype on sweet taste perception [44]. We emphasize here that there have been changes in our food supply, even in foods geared toward children, such that they often contain non-nutritive sweeteners (NNS) that provide sweetness with fewer calories [46].…”