The therapeutic approach to obesity and type 2 diabetes mellitus (T2DM) is evolving in a similar way to how clinicians use antibiotics: targeting several pathways that often produce stronger and more durable effects than acting on a single pathway.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) laid the foundation, but the complexity of fat mass regulation quickly revealed the limits of one hormonal signal ¹.  This has led to multi-hormonal agents that act simultaneously on glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), glucagon, amylin, and/or peptide YY (PYY), better replicating the physiological and coordinated post-prandial response.

By engaging these pathways, the new therapies achieve broader and more synergistic metabolic improvements, marking a shift from single target drugs to integrated hormone-based treatment ¹.

GLP-1–Based Therapies

GLP-1 is secreted by intestinal endocrine cells after nutrient ingestion.  It enhances glucose-dependent insulin secretion, slows gastric emptying, reduces appetite, and promotes weight loss ^1–5.  Central nervous system GLP-1 signalling within the hypothalamus and brainstem is central to regulating fat mass ⁶.

Beyond glycaemia, GLP-1 exerts anti-inflammatory, endothelial, and lipid-modulating effects ¹.  Long-acting GLP-1RAs on their own such as semaglutide achieve substantial weight loss and glycaemic improvement, aided by gradual dose escalation strategies that improve tolerability ¹.

Oral semaglutide represents a significant advancement, using SNAC (sodium N-(8-[2-hydroxybenzoyl] amino) caprylate) to overcome gastrointestinal degradation and enable systemic absorption, despite low bioavailability (~1%) and strict fasting administration requirements ⁷.

Further innovations include small-molecule oral GLP-1RAs, such as orforglipron, which activate the GLP-1 receptor (GLP-1R) without peptide structures and offer simpler administration but without the same weight loss range ^1,8-9.

GIP-Related Therapies

GIP is also released by different endocrine cells in the small intestine.  It stimulates insulin secretion during normoglycemia and influences lipid storage, though its metabolic effects are highly context-dependent ¹.

Importantly, both GIP receptor (GIPR) agonism and GIPR antagonism have been shown to reduce body weight; an unexpected therapeutic paradox ¹.  Central GIPR signalling suppresses appetite in rodents, while peripheral GIP actions vary with insulin sensitivity ^1,10.  In humans, exogenous GIP shows limited appetite loss (anorectic) effects, suggesting species-specific physiological differences ¹¹.

GLP-1/GIP Dual Agonists

Dual agonism of the GLP-1R and GIPR aims to capitalise on complementary hormonal effects.  Tirzepatide is the first approved dual GLP-1/GIP agonist and achieves greater weight loss and glycaemic improvement than semaglutide alone, suggesting synergistic incretin modulation ¹².  Additional co-agonists, including SCO-094, VK2735, CT-388, and DR10627, are under development to refine receptor balance and broaden metabolic benefits ¹.

Unimolecular GLP-1RAs/GIPR Antagonists

In contrast to co-agonists, unimolecular agents combining GLP-1R activation with GIPR blockade exploit evidence that GIPR antagonism enhances weight loss by disrupting adipogenic GIP signalling and amplifying GLP-1 driven satiety pathways ¹.

Maridebart cafraglutide (formerly AMG-133) exemplifies this approach by merging GLP-1 agonism with a monoclonal GIPR-blocking antibody.  Monthly dosing produces meaningful body weight reductions (12–16%) and improves glycaemia in people with obesity and T2DM ^1,13.  Pre-clinical work with the GIPR antagonist AT-7687 shows similar synergy when paired with GLP-1RAs ¹.

Oxyntomodulin Physiology and Oxyntomodulin-Based Therapies

Oxyntomodulin (OXM) is also secreted by the endocrine cells in the intestine but does not have a dedicated receptor.  Instead OXM binds to both the glucagon and GLP-1R ¹⁴.  Glucagon as a standalone peptide is secreted by pancreatic alpha-cells.  It increases hepatic glycogenolysis and gluconeogenesis during fasting but also regulates satiety, enhances hepatic β-oxidation, reduces liver fat, and increases energy expenditure ^1,15.

OXM mimics many of these same effects when it binds the glucagon receptors ¹⁴.  These metabolic properties support OXM use within multi-agonist therapies, without the risk of pure glucagon’s inherent hyperglycaemic potential.

OXM analogues (GLP-1/Glucagon Co-agonists)

Co-activation of GLP-1R and glucagon receptors leverages the anorectic and insulinotropic actions of GLP-1 with glucagon-driven increases in energy expenditure.  Survodutide and mazdutide are leading examples.  Survodutide has demonstrated up to 13–15% weight loss, alongside significant improvement in metabolic dysfunction–associated steatohepatitis (MASH) ^1,16-17.  Mazdutide produces dose-dependent weight reduction and glycaemic improvement with good tolerability ¹⁸.

Triple GIP/GLP-1/Glucagon Co-agonists

Retatrutide is a triple agonist that simultaneously activates GLP-1Rs, GIPRs, and glucagon receptors.  This design aims to maximise appetite suppression and thermogenesis.  In phase 2 trials, retatrutide achieved approximately 17–18% weight loss in individuals with obesity without T2DM, surpassing most available pharmacotherapies ^1,19.

Amylin Physiology and Amylin-Based Therapies 

Amylin is co-secreted with insulin and slows gastric emptying, suppresses glucagon, and increases satiety through pathways distinct from other anorectic hormones ^1,20.  Long-acting analogues such as cagrilintide produce clinically significant weight loss ²¹.

Amylin/GLP-1 Dual Agents

CagriSema, a fixed combination of semaglutide and cagrilintide that integrates GLP-1–mediated appetite suppression with amylin driven satiety and gastric emptying effects.  Recent trials show approximately 23% weight loss, exceeding either monotherapy or approaching metabolic surgery efficacy ^1,21.

Peptide YY Physiology and Related Medicines

Peptide YY (PYY) is co-secreted with GLP-1 by endocrine cells in the intestine and converted to its active form PYY 3-36, which acts via Y2 receptors to inhibit neuropeptide Y (NPY) neurons and promote satiety ^1,22.   After bariatric surgery, postprandial PYY, GLP-1, and OXM rises sharply and contributes to improved adipocyte mass regulation.  Early PYY analogues show reduced food intake and modest weight loss in short-term studies ^1,22.

Table 1.  Comparison Table of Novel GLP-1–Based Medications

Conclusion

Together, these advances mark a decisive shift in obesity and T2DM therapeutics from a single pathway modulation toward integrated, multimodal hormone-based interventions.

GLP-1 remains the backbone, but layering complementary signals from GIP, glucagon, amylin, and PYY allows for unprecedented degrees of weight reduction and metabolic restoration, as summarised for comparison in Table 1.

As uni-, dual-, and triple-molecular agents continue to refine receptor balance, the field is rapidly approaching the efficacy once achievable only through metabolic surgery.

The emerging challenge is no longer whether we can produce profound metabolic benefits, but rather how to optimise durability, individualise receptor targeting, and translate these complex pharmacologic innovations into long term clinical decision making.

This therapeutic evolution represents not merely incremental drug development, but a redefinition of how we conceptualise and treat the chronic diseases of obesity and type 2 diabetes.

In recent years, pharmacological interventions have emerged as important adjuncts to traditional weight loss approaches.  These obesity medications, such as Glucagon Like Peptide-1 Receptor Agonists (GLP-1 RAs), have gained significant attention for their promising efficacy in achieving weight loss.  Currently, there are several GLP-1 RA medications delivered by injection, which are sold under various brand names, though availability and licensing vary significantly by country (Table 1).

Table 1. Examples of Global Usage of GLP-1 RAs for Weight Management

GLP-1 RAs are prescription-only pharmaceutical drugs and not dietary supplements.  They must be prescribed and monitored by a qualified healthcare professional.  Furthermore, it must be emphasised that holistic treatment strategies including lifestyle and dietary changes should be included alongside GLP-1 RAs medications.

Unsurprisingly, where data is available, GLP-1 RA usage continues to accelerate, particularly with the forthcoming release of an oral form, which will likely make medications lower cost and more widely accessible.  Additionally, usage is likely to further increase given upcoming expiring patents from 2026 onwards ^9,10, enabling the provision of more widespread, lower cost formulations.

It is estimated that in the US, over 90 million adults are eligible for GLP-1 RAs, with approximately 26 million adults eligible in the UK.  In the US, individuals with overweight or obesity using GLP-1 RAs has increased from 21,000 in 2019 to 174,000 in 2023, which is a 700% increase in usage ¹¹.  In Australia in 2023, there were approximately 2.5 million prescriptions for Semaglutide alone under the Pharmaceutical Benefits Scheme, which is nearly double the previous year’s total prescription ¹².  However, globally, real usage is likely higher given the difficulties accurately quantifying usage due to the burgeoning private market.

While North America held the largest market share for GLP-1 RA medications in 2024, with Europe following, Asia-Pacific is expected to exhibit the fastest growth market due to rising diabetes and obesity rates ¹³.  Although the Middle East and Africa market is currently smaller, it is also projected to grow significantly in the coming years ¹⁴.  GLP-1 RAs face a mix of regulatory hurdles across Latin America, shaped by fragmented healthcare systems, evolving drug policies, and rising demand.  Yet, the Latin American GLP-1 RA market is expected to grow by a third in the next five years ¹⁵.

Understanding the Biological Effects of GLP-1 RAs

GLP-1 RAs, also known as GLP1-analogs or incretin mimetics, are a class of obesity medications originally developed for the management of type 2 diabetes.  They mimic the action of endogenous GLP-1, a hormone naturally released by cells in the small intestine in response to food intake and exert effects ¹⁶ (Figure 1) in a dose-dependent manner ¹⁷.Figure 1. Physiological Effects of GLP-1 RAs.

Primarily, GLP-1 RAs help regulate blood glucose levels by stimulating insulin secretion from pancreatic beta cells, whilst decreasing the production of glucagon, a hormone that increases blood glucose.  Additionally, GLP-1 RAs modulate the hypothalamus (the region in the brain that controls appetite) to regulate hunger, slow gastric emptying, and regulate gut hormones such as leptin (a hormone that helps regulate body weight on a long-term basis).  Consequently, this prolongs the feeling of fullness (satiety), reduces appetite, and reduces overall calorie intake – subsequently leading to negative energy balance and weight loss ¹⁸.

Efficacy of GLP-1 RAs in Weight Loss
GLP-1 RAs have consistently demonstrated effectiveness for weight loss in clinical trials among individuals with obesity compared with placebo treatments ^17,18.  Those using GLP-1 RAs achieve clinically meaningful weight loss of between 5 to 24% of their initial body weight, depending on dosing regime and type of drug administered. Furthermore, reductions in the incidence of cardiovascular events have also been evidenced ¹⁹.

GLP-1 RA Side Effects and Adherence
Despite the promising efficacy of GLP-1 RAs for weight loss, dropout rates in clinical trials and adherence concerns in real-world settings are notable.  Real‐world studies demonstrate high discontinuation rates of GLP‐1RAs by up to 75% within the first year of use, predominantly driven by side effects ^20-22.  Common side effects include gastrointestinal symptoms such as nausea, vomiting, diarrhoea, and constipation.  Other side effects may include headaches, dizziness, fatigue, and injection site reactions.  Rare, but potentially serious, side effects of GLP-1 RAs may include pancreatitis and gallbladder disease, as highlighted by The UK Medicines and Healthcare Products Regulatory Agency in 2024 ²³.

Whilst GLP-1 RA usage is effective at driving weight loss, the magnitude varies depending on factors such as the type of GLP-1 RA used, treatment duration, and the individual.  Weight regain following discontinuation of these medications is common (Figure 2), with up to two-thirds of weight loss being regained within the first year ²⁴.  This is likely driven by the lack of education surrounding lifestyle and behaviour change strategies adopted by GLP-1 RA users, which would encourage continued healthy lifestyle habits following medication cessation.

Figure 2. Weight Regain After GLP-1 RA Discontinuation ²⁴.  Reproduced from Wilding et al. ²⁴, © [2022], published by Wiley, under CC-BY license.

Dietary Intakes of GLP-1 RA Users – what is scientific evidence telling us?

Most of the general population fall short of achieving a healthy, balanced diet.  For example, many populations are not meeting the recommendations for fibre intake including those in Argentina, Canada, China, Lithuania, South Africa, the UK, and US.  Further, from national and international dietary survey data across the globe, sugar, saturated fat and sodium intakes remain above recommended levels.  Consequently, achieving a nutritionally adequate, balanced diet may be particularly challenging for GLP-1 RA users, who consume a reduced proportion of their usual daily intake, unless careful attention is given to food choices.

A narrative review of 10 primary studies that assessed energy intakes in GLP-1 RA users revealed that total calorie intake was reduced by 16 to 39% in a single meal ²⁵.  However, the most common measurement of food intake was a standardized test meal followed by an ad libitum lunch, dinner, or snack.  This method has inherent limitations and data should be treated with caution.  Only one study included in the review used a validated 24-h dietary recall method.  Interestingly, when data is studied in more detail, reported calorie intake remains adequate and in line with recommendations for GLP-1 RA users.  For example, reported daily energy intake of GLP1-RA users is approximately 1750 to 2180 kcal per day.  So perhaps meeting recommended nutrient intakes remains achievable.

Beyond changes in calorie intake, only eight studies, to date, have evaluated changes in macronutrient intake in GLP-1 RA users.  Unfortunately, data is inconsistent among these studies, likely due to the different methodologies used between studies, making it difficult to provide firm conclusions.  Perhaps more concerning is that 11 to 50% of total weight loss in GLP-1 RA users is attributed to loss of lean body mass, which may detrimentally include loss of skeletal muscle ²⁶, potentially negatively impacting metabolism, strength and long-term health.  Thus, protein intake, alongside physical activity, remains a priority to minimise muscle loss for GLP-1 users.

GLP-1 RA Recommendations

In studies evaluating combined GLP-1 RA with nutrition and lifestyle interventions, individuals receiving both GLP-1 RAs and structured dietary guidance achieved greater weight loss, better adherence, and were more likely to sustain weight loss after discontinuing GLP-1 RAs compared to those receiving the medication alone ²⁷.

Although limited information currently exists regarding specific dietary reference intakes for individuals using obesity medications, a recent Joint Advisory highlights specific areas of nutritional concern for GLP-1 users (Figure 3) ²⁷.  For example, protein intakes of up to 1.5 g/kg/day have been suggested for this population ²⁸.  Yet, in practice, these protein levels are likely difficult to achieve in a population of GLP-1 RA users who have 1) a higher body mass and 2) a reduced energy intake.  Future protein intake recommendations should be based on lean mass-adjusted body weight rather than total body weight, as protein requirements are largely determined by lean tissue rather than fat mass.

Figure 3. Key elements of nutritional priorities to support GLP-1 therapy users for obesity ²⁷.  Reproduced from Mozaffarian et al. ²⁷, © [2025], published by Wiley, under CC-BY license.

For Healthcare Professionals (HCPs)
Tailored approaches to GLP-1 RA treatment plans are needed to ensure sustainable weight loss strategies, improve patient adherence, and support healthier dietary intakes.  Previous research has recommended nutritional priorities to support GLP-1 RA users (Figure 3).  These recommendations can enable healthcare professionals (HCPs) to better guide GLP-1 RA users toward lasting health improvements.  For example, HCPs should discuss the importance of balanced nutritional intake with all patients prescribed GLP-1 RAs, alongside monitoring signs of malnutrition, micronutrient status, and changes in body composition.

Given the limitations in accurately quantifying body composition using more accessible body compositional measurement tools (e.g., bioelectrical impedance), physical function should also be monitored.  Further, to promote sustained weight management, GLP-1 RA users should be educated on healthy diets and physical activity recommendations, and support should be available to encourage long term behaviour change.

For Researchers
There is a clear need for future research to examine changes in dietary intake and nutrient status following use of obesity medications using robust study designs with validated, accurate methods for measuring daily habitual intakes.  Given that, to our knowledge, only two studies have estimated micronutrient intake in GLP-1 RA users ^29,30, more research is needed to both quantify changes in micronutrient intake and status in this population.

Further, whilst some anecdotal and qualitative data suggests that GLP-1 RAs effectively reduced food-related thoughts (‘food noise’) and support healthier eating behaviours, more objective data is needed.  Mechanistically, more research is needed to investigate whether GLP-1 RAs influence nutrient absorption and subsequent bioavailability, incorporating measurements of the gut microbiota diversity and composition, and nutrient biomarkers.

Such research will help develop nutritional guidance to best support GLP-1 RA users.  Information available on dietary reference intakes for individuals using obesity medications is minimal ²⁸, and currently not well-evidenced.

An Industry Perspective on Innovating for GLP-1 Users

The surge in GLP-1 RA usage for weight loss is set to increase demand for products with a wide range of attributes.  Portion size, protein and fibre content, and digestive health are the key areas for consideration.

There are a few strategic approaches that are currently gaining momentum across the food, beverage and supplement industries ³¹ (Figure 4).  One strategy is to position existing products as complementary solutions for GLP-1 RA users.  Focusing on gut health aids that might alleviate gastrointestinal side effects and nutritional supplements that help offset deficiencies linked to reduced food intake.  Another approach is to launch products that are nutrient-dense and portion-controlled for both GLP-1 RA users and individuals tapering off the medication who continue to sustain weight loss whilst preserving muscle mass.

Figure 4. GLP-1 RA Strategic Approaches for Industry ³¹.

In Summary

GLP-1 RAs represent a valuable therapeutic option to achieve weight loss and improve overall health when prescribed safely and appropriately alongside dietary and behavioural support and increased physical activity.

By balancing the potential benefits and risks of treatment using evidence-based strategies, HCPs are well placed to help optimise the use of GLP-1 RAs in the management of obesity and overweight.  This will ultimately support individuals in achieving their weight loss goals while minimising adverse effects.

Research is still required to evidence nutritional intake in GLP-1 RA users, and to subsequently inform dietary recommendations that are specific for this population.  Nutritious products must be accessible to GLP-1 users to achieve healthy eating habits that provide essential nutrients, vitamins, and minerals.

Authors’ Note: The authors recognize the fast-evolving nature of GLP-1 research and trends and will endeavour to ensure the article remains current with emerging GLP-1 RA data.

Our reliance on nature, coupled with the continued degradation of natural systems, creates risks for society and has led to an increased consumer expectation that businesses will take greater responsibility for their impact on ecosystems and the planet.

In response to these risks and consumer expectations, companies are embedding nature into their sustainability commitments and strategies.  Guided by frameworks such as the Kunming-Montreal Global Biodiversity Framework and The Taskforce on Nature-related Financial Disclosures (TNFD), companies are setting targets and taking action to achieve nature-positive* outcomes.
* Definitions of key terms are provided in Appendix 1.

What is Nature and Biodiversity?

These terms are often used interchangeably because biodiversity is an integral part of nature.  Threats to one will almost always affect the other.

Biodiversity flourishes within healthy natural ecosystems, and those ecosystems, in turn, rely on biodiversity to remain resilient and functional.

This creates a relationship which is so profound that addressing one effectively means addressing both ³.

The Climate, Nature and People Connection

Nature is a critical ally in addressing climate change and strengthening our ability to adapt to its impacts.  Climate change and nature loss are deeply intertwined challenges that can impact food security and that must be tackled together ⁴.

Figure 1. The relationship between Climate Change, Nature, and People ⁴
Source: Adapted from WWF. (2019). Climate, Nature and our 1.5°C Future. WWF International.

The three pillars of climate change, nature loss, and people are often considered in isolation.  However, adopting a holistic perspective allows for a deeper understanding of their interactions and the development of integrated solutions ⁴.  Climate change contributes to nature loss through rising temperatures and extreme weather events, which affect terrestrial and aquatic ecosystems.

Conversely, nature loss exacerbates climate change, as the conversion of natural habitats – such as grasslands, forests, and wetlands – for agriculture or urban development releases stored carbon into the atmosphere ⁵.  Human activity is central to this feedback loop, being one of the primary drivers of both climate change and nature loss ⁶.

Despite the challenges, there is a clear opportunity; natural systems play a vital role in regulating the climate, sustaining food production, and supporting communities.  Investing in nature can provide co-benefits for climate mitigation, adaptation, and social wellbeing, ultimately creating a more sustainable and equitable future ⁷.

The Nature Crisis and The Food System

Nature loss poses a significant threat to business operations, particularly within the agricultural and food production sector, where there is a direct dependency on environmental factors including soil health, water security, and pollinator species.

We need ecosystems to thrive to ensure that food production can sustain the planet’s growing population.  For decades, agricultural policy has helped deliver abundant food, but often at the cost of biodiversity, fertile soil, water resources and a stable climate, prioritising high yields to meet demand over long-term sustainability ⁸.

Currently, 50% of all habitable land is used for agriculture ⁹.  To meet growing population pressures, forests are increasingly cleared for farmland, leading to habitat destruction which reduces biodiversity and raises CO_₂ emissions.  In fact, food systems account for over a third of global greenhouse gas emissions ¹⁰.

Moreover, agriculture accounts for 70% of global freshwater withdrawals and is a leading source of water pollution, which can create challenges in regions already facing water risk ¹¹.  Consequently, in just over 50 years (1970-2020), there has been a decline of approximately 73% in the average size of monitored wildlife populations ⁴.  This decline can be attributed to five major drivers of biodiversity loss ¹², which are outlined in Table 1 :

Table 1. Major drivers of biodiversity loss ¹²

Transforming food systems is not just an environmental imperative which can address the root causes of biodiversity loss – it is a strategic necessity for the global community to ensure economic prosperity, climate resilience, and long-term food security ¹⁷.

Protecting Nature and Biodiversity for Food Security

Protecting and preserving our oceans, forests, species, and soils safeguards our natural resources and can help us realise a world of sustainable nutrition.  By working in harmony with nature, the food and beverage industry has a unique opportunity to drive real environmental change across supply chains.  Some important areas of focus for our industry are soil health, avoiding further land conversion, and protecting the abundance of species that surround us and the area in which we operate.

Restoring soils
Around 95% of our food relies on healthy soil, yet one-third of the world’s soil is already degraded ¹⁸.   If conventional farming practices continue, we may be facing a future with only sixty harvests remaining ⁸.  With topsoil eroding 100 times faster than can be naturally replenished ¹⁹, immediate intervention at farm-level is essential.

Soil holds 25% of the world’s biodiversity ²⁰, providing plants and crops with the essential nutrients and moisture they need to grow and survive.  Studies have highlighted the important role regenerative agriculture can play in reviving degraded soil, promoting long-term productivity and ecosystem health.  Fertile soil can support carbon sequestration, with the top metre of soil around the world containing three times more carbon than the entire atmosphere ²¹.  This highlights the strong link between soil quality, climate stability, and nature-positive benefits.

Supporting farmer education and offering incentives for practices including cover cropping, intercropping, reduced tillage, and organic composting is a practical and effective way to enhance soil health across arable land ²².  These practices also deliver co-benefits that address climate change, water conservation, and pollution.

Conserving land
Agricultural expansion stands as the primary driver of global deforestation ²³ as forests are converted to make room for plantations cultivating high-demand crops such as palm oil, soy oil, rubber, coffee, tea, and rice.  This transformation is driven by the rising global appetite for food and consumer goods ²⁴.  Companies in the food and beverage industry have a responsibility and an opportunity to ensure their supply chains do not contribute to further deforestation.

By eliminating deforestation and land conversion, companies can ensure that the raw materials they source are not linked to environmentally destructive practices.  Implementing a clear Deforestation and Conversion Free (DCF) policy and collaborating with suppliers to enhance supply chain transparency are key to achieving this goal.

Preventing deforestation and conversion benefits both local and global communities.  Forests store carbon, enhance soil fertility, safeguard watersheds, and provide habitat for a range of species.  This, in turn, strengthens biodiversity and food security ²⁵.

Supporting species
When a species’ population declines below a certain threshold, its ability to perform natural functions can be disrupted.  This includes processes such as seed dispersal, pollination, grazing and nutrient cycling which contribute to ecosystem health and agricultural productivity.  Many pollinator species are facing the threat of extinction, an alarming trend given their role in sustaining 35% of the world’s crop production ²⁶.  Statistically, nearly 75% of crops that yield fruits and seeds consumed by humans rely on pollinators to some extent ²⁶.

A decline in crop yields also poses a serious risk to the stability of supply chains and drives up food prices globally.  A diverse range of species on farmland plays a valuable role in managing pests and parasites that threaten food-producing crops and livestock ²⁷.  These species are also key contributors to crop reproduction, enhancing both the quality and quantity of harvests.  Working with farmers to develop diversified farming systems that include hedgerows, wildflower strips, and different varieties of the same crop create habitats for pollinators and is beneficial to insects ²⁸.

In Summary

As the food and beverage industry responds to the compounding climate and nature risks, it is evident that working in harmony with nature offers a powerful means to address food insecurity through actions that protect, sustainably manage and restore ecosystems ²⁹.  Industry awareness of our reliance on nature is growing as businesses recognise their dependence on natural systems, the risks posed by nature loss, and the strategic value of integrating nature for long-term resilience and delivering against climate goals ³⁰.

By embedding nature-positive practices into food production and supply chains, businesses can harness the benefits of nature while actively contributing to its preservation.  Nature is not an unlimited resource, and our food systems are key to helping safeguard it.

In Ayurveda, Amla is known to be a potent Rasayana or rejuvenator⁶.  Various parts of the plant are used to treat a range of diseases, but the most important is the fruit, which is small, green, sour-tasting and gooseberry like (Figure 1).  It is also known as one of the oldest and best-known edible fruits in the Indian subcontinent.  It is valued both as a medicine and a tonic for restoring vitality and strength.  Additionally, Amla plays a key role in many complex Ayurvedic formulations⁷, forming an essential ingredient in polyherbal traditional remedies such as Avipattikara Churna, one of the most effective Ayurvedic formulations to manage indigestion and heartburn; or Thriphala Lepam a polyherbal used for millennia to treat inflammation and improve health^7,8.  In TCM, Amla has many functions including clearing heat, cooling blood, digesting food and relieving cough⁹.

Figure 1: Small gooseberry like fruits of Amla (Phyllanthus emblica Linn)

Chemical Components

Amla has been shown to be a font of nutrients and small bioactive chemicals that provide a wide array of health benefits.  It is a rich source of vitamin C which can occur in up to 33%¹, and as reported by Rani (2017) there are high levels of vitamins A (2%), B1 (3%) and B2 (3%), B3(2%), B5 (6%) and B6 (6%), as well as essential minerals such as Magnesium (3%), Manganese (7%), Potassium (4%). Phosphorous (4%), and Zinc (1%)^1,5.  The berry contains a number of phenolic antioxidant compounds including rutin, quercetin, myricetin, ellagic acid, gallic acid, and chlorogenic acid, curcuminoids and complex tannins such as emblicanin, punigluconin, pedunculagin, in addition to the alkaloids Phyllantine, Phyllembein, Phyllantidine².  Many of these metabolites are known to contribute to healing.

Figure 2: Main classes of chemical components in Amla (Phyllanthus emblica Linn).

Pharmacological activities

Pharmacological studies into the bioactivity of Amla fruit and plant extracts support its traditional use in the treatment of inflammation, as an immune enhancer, for antiaging and health promoting effects.  Its seeds have shown promise in treating asthma and bronchitis, while its juice is used for eye care.  Traditional healers have used Amla extracts for wound healing and treating snakebites and scorpion stings^1-5,7.  Some key activities are discussed below.

Amla and Inflammation

Inflammation is the body’s natural response to fight infections like bacteria and viruses, repair tissues, and start the healing process.  However, too much inflammation can cause tissue damage, pain, and reduced function.  Amla fruit extracts have anti-inflammatory compounds, and extracts have shown strong anti-inflammatory effects by blocking two key inflammation-related substances: Nitric Oxide (NO) and COX-2.  NO is an important molecule for immune signalling, but too much of it can cause inflammation, cardiovascular problems, and oxidative stress.  Amla’s anti-inflammatory power comes from its ability to inhibit several inflammation-triggering enzymes, including COX-1, COX-2, and 5-LOX.  By reducing these enzymes, it lowers the production of molecules that cause swelling and pain, making it a promising natural remedy for inflammatory conditions¹⁰.  In a separate study by Li et al (2020), Amla fruit extract has been shown to reduce the production of key the inflammatory substances NO, Tumour Necrosis Factor-alpha (TNF-α), Interleukin-1 beta (IL-1β), and Interleukin-6 (IL-6).  The compounds gallic acid and fisetin have been shown to be responsible for this activity.  Gallic acid is particularly notable, as its presence (over 1.2%) is used as a quality standard for Amla (P. emblica) in traditional Chinese medicine¹¹.

Amla and Cardiovascular Health

Recent scientific literature reveals compelling evidence for amla’s potential to improve cardiovascular health.  Studies have shown that amla can help lower cholesterol (LDL, or “bad” cholesterol), reduce blood pressure due to its high potassium content, and improve blood flow¹².   It also exhibits antioxidant and anti-inflammatory properties that may protect against heart disease¹³.  Some studies suggest that amla may be as effective as certain medications in lowering cholesterol and blood sugar, but without the side effects¹⁴.  While more research is needed to fully understand the mechanisms of action and optimal dosage, the existing findings strongly support amla’s role in promoting cardiovascular health.

Amla and the Immune System

Researchers are increasingly interested in plant-based bioactive compounds that can support immune health.  Amla is such a natural immunomodulator.  In vivo studies have established that at a dose of 250 mg/kg, Amla fruit extracts significantly increase important immune markers such as CD4, CD8, IgM, and IgG in the blood; Amla fruit extract at doses of 100 and 200 mg/kg administered for 19 days showed strong immune responses, including increased antibody levels, white blood cell counts, and better defence against allergens.  These findings support the potential of Amla as an effective natural immunomodulator¹⁵.

Amla as an Antioxidant: Benefits in Diabetes

Current diabetes treatments include insulin and oral medications like sulfonylureas, biguanides, and glinides.  However, these can have side effects, prompting the search for safer alternatives.  Amla has high concentrations of the essential minerals’ chromium, zinc, and copper.  Research studies have shown that chromium, in particular, has shown strong antidiabetic effects, and has been found to improve fat metabolism in diabetic rats, suggesting potential benefits for managing diabetes^3,16.  The antioxidative effects of Amla, and its ability to reduce reactive oxygen species (ROS), can also confer additional health benefits in diseases like diabetes.  Research shows that the ethanolic extract of Amla may help lower blood sugar.  In vivo experiments have shown that administration of extracts of Amla led to a reduction of blood glucose from 380 mg/dL to 166 mg/dL after treatment with 80 mg/kg of the extract.  This study suggests that Amla metabolites, such as tannins, act by blocking digestive enzymes that break down sugars, boosting the storage of glucose, enhancing insulin sensitivity, and preventing harmful sugar-related compounds from forming¹⁷.

Amla and Healthy Ageing

A ground-breaking study by Wu et al. (2022) using the nematode model of Caenorhabditis elegans revealed that polyphenols in Amla fruit have anti-aging effects¹⁸.  These effects were demonstrated by an increase in thermal resistance and a significant reduction in cholinesterase enzymic activity.  The study also found that antioxidant enzyme activity rose significantly. Simultaneously levels of malondialdehyde (MDA), a marker of oxidative stress, dropped by 36.25%.  The fruit’s rich content of antioxidant polyphenols may contribute to these effects.

Beyond healthcare, Amla’s fruit and extracts are widely used in various industries.  They are found in food products, cosmetics, dyes, leather tanning, and it is even used as firewood.  Additionally, its oil has long been valued as a hair tonic, promoting hair growth, and preventing premature greying^7,19.

Conclusion

Amla has well established use as a traditional medicine and food.  It has shown a remarkable array of benefits, from immune system enhancement to its potential as an antidiabetic and health promoting agent.  Extensive research into this powerful plant has unveiled its wide-ranging therapeutic possibilities, sparking interest for future studies and practical applications in medicine and healthcare.  However, most studies have been carried out in laboratory settings or using animal models, which means clinical trials are needed to confirm the efficacy and safety of amla-based treatments for humans.  Another challenge lies in the plant’s diverse chemical composition, which varies depending on geographical and environmental factors. This variation complicates efforts to standardise its use in therapies.  Due to variation in chemical composition, it is best to source quality, standardised extracts and raw material from established producers using validated supply chains.

Cognitive health refers to the state of an individual’s cognitive abilities, including memory, attention, reasoning, language, and problem-solving skills. Maintaining cognitive health is essential for overall well-being and quality of life, as cognitive decline can affect daily functioning and lead to conditions such as dementia and Alzheimer’s disease ¹.

Stress

The impact of stress on cognitive function, memory, and the role of stress hormones in modulating cognitive health plays a significant role in current society. The concept of stress, however, was first defined by the “father of stress”, Hans Selye, a Hungarian – Canadian endocrinologist back in 1956. Selye defined stress as the non-specific response of the body to any demand placed upon it, which he termed a “stressor.” He proposed that stressors could be both external (e.g., physical threats) and internal (e.g., psychological pressures). The response of the body to these stressors is called the “stress response,” which includes physiological and behavioral changes aimed at adapting to the stressor ².

Physiology of stress

The physiology of stress is a well-characterized and extensively studied phenomenon in the field of biology and neuroscience. When the body encounters a perceived threat or challenge, it initiates a complex cascade of physiological responses to cope with the stressor. The central player in this response is the hypothalamic-pituitary-adrenal (HPA) axis, a critical neuroendocrine system that coordinates the stress response ¹⁹.

Upon encountering a stressor, the hypothalamus, a small region located in the brain, is activated and releases corticotropin-releasing hormone (CRH) into the bloodstream. CRH, in turn, stimulates the anterior pituitary gland, a pea-sized structure located just below the hypothalamus, to release adrenocorticotropic hormone (ACTH)²⁰.
ACTH travels through the bloodstream and reaches the adrenal glands, which are located on top of the kidneys. The adrenal cortex, the outer layer of the adrenal glands, responds to ACTH by releasing glucocorticoid hormones, with cortisol being the primary glucocorticoid in humans²⁰.

Cortisol, a potent stress hormone, plays a pivotal role in orchestrating the body’s response to stress. It mobilizes energy reserves by increasing glucose availability, enhances cardiovascular function to support physical readiness, and temporarily suppresses non-essential bodily functions like digestion and immune response. These actions prepare the body for a fight-or-flight response, enabling it to confront or flee from the stressor²¹. In parallel with the HPA axis, the sympathetic nervous system (SNS) is also activated during stress. SNS activation leads to the release of adrenaline and noradrenaline, which prepare the body for immediate physical response to the stressor (fight-or-flight response)²².

Once the stressor is resolved, a negative feedback loop operates to restore the body to its baseline state. High cortisol levels signal the hypothalamus and pituitary gland to decrease CRH and ACTH release, respectively, leading to a decline in cortisol production²³ (overviewed in Figure 1).

Figure 1: Physiology of stress: a perceived threat impacts the HPA axis to evoke a physiological stress response. This signaling cascade results in the secretion of cortisol, often referred to as the stress hormone, as well as epinephrine and norepinephrine, also commonly known as adrenaline and noradrenaline, from the adrenal glands, which impact various physiologic processes.

However, chronic stress or ongoing exposure to stressors can disrupt the balance of the HPA axis, resulting in prolonged elevation of cortisol levels. This dysregulation may lead to adverse health effects, including anxiety, depression, metabolic disorders, immune dysfunction, and cardiovascular problems^24,25,26.

Adapting to Stress

In 2022, the WHO released a scientific brief that stated the COVID-19 pandemic triggered a 25% increase in the prevalence of anxiety and depression worldwide¹⁷. Therefor adapting to stressors has become common practice in modern life. Consumers are now employing various to manage stress-related conditions and promote overall well-being such as using wearable technology with stress management tools³, practicing mindfulness and mediation ⁴, breathing practices⁵, physical exercise⁶, social support and avoiding isolation⁷, sleep management¹⁸ and consuming the correct nutrition⁸.

Nutrition and Cognitive health

Epidemiological studies, such as the Mediterranean Diet, have shown numerous beneficial outcomes including reduced cardiovascular (CV) risk and prevention of non-communicable diseases (NCDs), which include cognitive decline and dementia. Adherence to the Mediterranean diet and cognitive decline and other dietary interventions are excellently reviewed in⁸. The Mediterranean diet, which emphasizes whole grains, fruits, vegetables, fish, and olive oil. Therefor elucidation of key components of these epidemiological studies supporting cognitive health are now underway and several have been studied and show to have benefits (see Table 1):

Table 1: Overview of nutrients and their role in cognitive health

Ayurveda is an ancient traditional system of medicine that originated in India more than 5,000 years ago. It is considered one of the oldest holistic healing systems in the world and focuses on balancing the mind, body, and spirit to promote health and prevent disease. Ayurveda extensively uses herbal remedies derived from plants, minerals, and other natural substances. These herbs or botanicas are believed to have specific properties that can balance the doshas and promote healing²⁷.

Both the modern medical literature and traditional Ayurveda writings report many potential health benefits of the Ashwagandha herb (Withania somnifera, also known as Indian Ginseng or Winter Cherry under the rubrics of anti-stress, neuroprotective effects, immunomodulatory effects and rejuvenating effects, via the herd’s interplay with the nervous system, the endocrine system, the cardiopulmonary system, the energy production system and the immune system including analgesic, antimicrobial, anti-inflammatory, anti-tumor, anti-stress, anti-diabetic, neuroprotective, immune-protective and cardio-protective effects.^27-32. This literature has only a small set of published papers, which is surprising because traditional Ayurveda explicitly advocates the use of Ashwagandha toward “Bala”, which means “strength” in the Sanskrit language^28,29.

Ashwagandha (Withania somnifera) is a member of the family of herbs referred to as “adaptogens”. The term adaptogen was introduced into scientific literature by Russian toxicologist Nikolay Lazarev in 1957 to refer to substances that increase the “state of non-specific resistance” in stress. The term “adaptogen” is applied to an herb with phytonutrients that regulate metabolism when a body is perturbed by physical or mental stress and help the body adaptation³⁰. The adaptogen family of herbs has many members, noteworthy among them being Ashwagandha, rhodiola, ginseng, schisandra and maca. Adaptogens are used commonly for stress relief, brain health and for ameliorating HPA-axis dysfunction. More recently, adaptogens have started to be used in sports supplements that aim to enhance physical fitness^31,32.

Ashwagandha is classified as a “rasayana” (rejuvenator and have been used toward promoting health and longevity, slowing the aging process, revitalizing the body and generally creating a sense of well-being³³. It also stimulates respiratory function, causing smooth muscle relaxation and stimulates thyroid activity³⁴. Studies in humans show that Ashwagandha is well tolerated and is associated with decreases in cortisol³⁵ and increases in testosterone³⁶.

There are a number of biochemical parameters that are indicators of activation of the stress response, such as salivary alpha-amylase, an important enzyme in the oral cavity that has been proposed as a potential marker of sympathetic activation and rises in response to prolonged stress. Exposure to stress activates the autonomic nervous system and increases sympathoadrenomedullary drive, which causes a widespread reaction that can stresses in the face of challenges. Numerous additional systems, such as the pro-inflammatory cytokines interleukin-1β, interleukin-6, and tumour necrosis factor-α, also have temporal connections to stressful events³⁴.

Sleep disorders and stress are related. The central nervous system and metabolism are both impacted by the bidirectional link between stresses and sleep disorders. High levels of stress hormones are connected to shorter sleep duration, while obesity and metabolic syndrome are both associated to stress and sleep-related issues. Common sleep disorders include insomnia (difficulty falling and/or staying asleep), hypersomnia (excessive daytime sleepiness), and sleep apnea (airflow is limited while sleeping, causing low oxygen saturation and disrupted sleep). Stress can cause insomnia and be the result of it, thereby explaining the positive association between stress and insomnia that is often observed. In general, stress alone had a stronger association with mental health problems than sleep disorders alone, and the combination of stress and sleep disorders had the strongest association.

Decades later, this observation was noticed again, where vaccinated children in high-mortality areas of West Africa had a significantly lower mortality rate ¹.  In 2012, the mystery behind these observations was finally solved and a new type of immune protection was identified, which is now called trained immunity ².

The understanding of immune memory has been centred around the idea of targeted disease-specific approaches.  The aim of a vaccine is to induce a disease specific memory in your adaptive immune system (memory T and B cells), which then can spring into action if an individual is exposed to that disease.

However, trained immunity research has been ground-breaking within the field of immunology due to its differences in immune memory.  It revealed that cells of the innate immune system also have a kind of memory, although this memory works in a very different way and results in defence against a broad range of threats.

With the discovery of trained immunity, we now know that it is possible to also increase protection against multiple, unrelated diseases.  This important discovery has therefore presented new opportunities to bolster immune defences against a myriad of threats in a non-targeted manner; a new method to protect ourselves from future disease.  Moreover, research has recently shown that it is possible to induce trained immunity through food ³.

How Does Innate Training Occur?

A growing body of research over the past decade has helped identify key mechanisms which explain how innate training occurs. Innate training agents, such as the BCG vaccine ^2,4, and the adenoviral ChAdOx1 nCoV-19 vaccine ⁵ are able to induce trained immunity via metabolic reprogramming and epigenetic modifications ⁶.

Epigenetic Changes – Placing a Bookmark

DNA contains instructions for making proteins, including proteins crucial for launching immune responses.  However, DNA is a very tightly coiled structure where gaining access to the instructions required can take precious time.

Training stimuli, such as the BCG vaccine, in essence creates bookmarks in this instruction manual to be placed on crucial pages for launching immune responses.  This act of “placing the bookmark” is done via epigenetic changes; reversible chemical modifications to the DNA structure that loosen the DNA at certain sites, making the genes/instructions at those sites more easily accessible.

These epigenetic changes are made possible due to altered metabolism within the cell, which provides the materials for these chemical modifications to occur.  Consequently, when a subsequent danger is detected in future, the relevant pages/genes are more easily read, allowing an immune response that is more rapid and potent, compared with non-trained immune cells.  This more potent response is also possible due to metabolic reprogramming.

Placing the bookmark: Innate trainers place bookmarks in the DNA instruction manual; metabolic reprogramming provides the building blocks for chemical modifications (bookmarks) to occur on the DNA – epigenetic changes – resulting in loosened DNA, ready to be read when a new potential danger occurs. Adapted from “Mihai Netea and Niels Riksen at ImmunoMetNet’s Seminar – The double-edged sword of trained immunity” – https://www.youtube.com/watch?v=5AWnp5cEw_4

Metabolic Reprogramming – Meeting Energy Requirements

When an immune cell is activated as part of launching an immune response, processes engage which require a lot of energy and the production of numerous compounds, such as immune messenger signals.  These energy and production demands are met by metabolic machinery.

Innate training stimuli initiate metabolic reprogramming, which not only provides the necessary building blocks for epigenetic changes to occur to the DNA (“placing the bookmark”), but also increases the metabolic machinery available to the cell, to meet future energy and production requirements.  This could be seen as the trained cell building up its energy infrastructure to be better prepared for future challenges.  When a subsequent danger is detected, the innate immune cells can immediately spring into action, as this enhanced metabolic machinery is ready to meet the required energy and production needs, facilitating a rapid and robust immune response ⁷.

Is Trained Immunity Long Lasting?

A hallmark of the adaptive immune response is the induction of long-lived memory cells, which mobilise should a “memorised” danger appear again.  This is the type of memory targeted with a vaccine, to induce long-lived protection.  Trained immunity has also been shown to last for several months, despite innate immune cells not living for very long.

Innate immune cells are replaced regularly, both by cell division and by influx of new cells, coming from hematopoietic stem cells in bone marrow.  These stem cells divide and mature into different types of immune cells, replenishing the body’s immune cells as needed.

The explanation of innate training above has focused on individual innate immune cells coming across training stimuli and thus having a more efficient responses against subsequent dangers.  This type of trained immunity is known as peripheral trained immunity, and is thought to be maintained, at least to a degree, by cell division – where epigenetic modifications (bookmarks) can be passed on to daughter cells ⁸.  Although this is believed to contribute to the longevity of trained immunity, the core component is due to training of hematopoietic stem cells in the bone marrow, as identified by epigenetic changes therein.  This is known as central trained immunity ⁹.

How this training occurs is not fully understood, although certain immune messenger signals have been identified to contribute to this phenomenon.  It has also been postulated that stem cells may be able to detect danger signals, in a similar manner as innate immune cells, possibly leading to similar metabolic and epigenetic outcomes.

Because stem cells divide and become lots of different immune cells, their training can result in altered amounts of certain immune cells, as well as affect their responses.  For instance, central trained immunity induced by BCG vaccination, has been shown to result in a higher number of innate immune cells that are more effective at fighting off infections up to five months post vaccination, due to altered gene expression ¹⁰.

Although studies have shown that innate training can be long lasting, there is an important aspect of this phenomenon that needs to be highlighted: it is reversible.  Epigenetic changes, placing bookmarks at relevant pages, are a core component of trained immunity, which are caused by chemical modification to the DNA.  However, these modifications can be reversed, and the bookmarks consequently removed ^11,12.  This is a highly dynamic feedback system, where the innate immune response is adapting to new information all the time.

Can you Train your Immune Response?

There are numerous substances and challenges that have been shown to cause trained immunity, such as the earlier mentioned BCG and adenovirus COVID-19 vaccines, and more are being discovered all the time.  However, most identified innate trainers need to be either administered by medical staff or occur as the result of an infection/being sick, neither of which is ideal for day-to-day protection.  To both induce and maintain trained immunity, the most desirable approach is something an individual can eat or drink.

Fortunately, research suggests that certain functional/bioactive ingredients found in everyday food, beverages, and dietary supplements may be able to induce and maintain this process of trained immunity.  For instance,  food-safe whole beta glucan particles (WGPs) not only induce trained immunity in isolated innate immune cells (peripheral trained immunity) but also resulted in central trained immunity when ingested by mice ³.  This discovery has opened new dietary possibilities to bolster defences against immune challenges.

In Summary

There is growing enthusiasm in understanding the influence of diet and supplementation on the immune system.  These approaches include the use of probiotics to support balanced gut flora and the inclusion of essential nutrients, such as vitamin C, to maintain regular immune function.  What is exciting about the discovery of trained immunity, and the possibility to induce it through diet, is that it enables next level immune protection.  As discussed herein, it is a recently discovered, natural enhancement of the innate immune defence, enabling the immune system to be at the ready for future challenges.

“Nutrition plays a role in women’s health, both in managing different life stages and in promoting long-term health, but with so many options available it can be overwhelming,” says Dr. Karin Dorrepaal, Independent Non-Executive Director at Kerry.

“At Kerry, we have a dedicated team of scientists and experts in women’s health, so we’ve called on them to bust some myths, navigate the science on what actually works, and tell us how nutrition can support health and quality of life throughout a woman’s life.”

Women’s unique nutritional needs 

“When you consider the various stages of a woman’s life, adolescence, reproductive age, pregnancy, lactation, peri-menopause, menopause and post-menopause, it’s not surprising that each of these stages requires distinct nutrition to support overall wellbeing.  For example, adolescent females have an increased requirement for calcium to build life-long bone density. A deficiency in calcium at this life stage can result in increased risk of osteoporosis post-menopause, when the protective effects of estrogen decline,” said Dr. Lisa Ryan, Head of Department of Sport, Exercise and Nutrition at Atlantic Technological University in Ireland, and Scientific Advisory Council member of Kerry’s Health & Nutrition Institute (KHNI).  

By understanding the specific nutritional requirements of each life stage, women can make informed choices about their own health. This article focuses on fertility, pregnancy and breastfeeding, and menopause, and looks at how nutrition affects these life stages.  

Nutrition and fertility 

One in six women experience infertility. Hormonal imbalances can disrupt a woman’s delicate reproductive process, leading to irregular cycles, failure to ovulate (anovulation), difficulty conceiving, or infertility. 

There are some unknown causes of infertility, but one in three cases of female infertility is caused by polycystic ovary syndrome (PCOS) – the most common hormonal disbalance affecting women.

What is PCOS? 

Polycystic ovary syndrome (PCOS) is a common condition that affects how a woman’s ovaries work. Polycystic ovaries are bigger than healthy ovaries and have twice the number of follicles than healthy ovaries do. In PCOS ovulation doesn’t take place each month causing women to stop having periods or have irregular periods and can also cause fertility issues.  It’s a complex, chronic condition associated with a range of endocrine and metabolic symptoms. It can have a profound impact on a woman’s health, fertility, self-esteem, and body image, leading to emotional distress. PCOS is not just a fertility issue but one affecting a woman’s overall health, including her mental wellbeing. PCOS is leading cause of female infertility (PCOS is responsible of 25-40% of cases).

“The exact cause of PCOS is unknown. It’s thought to be linked to abnormal hormone levels in the body, including high levels of insulin. It is also related to a deficiency in inositol (a sugar made in the body and found in foods) and specifically a systemic deficiency in the D-chiro-inositol and ovarian deficiency in Myo-inositol. Women with PCOS need to ensure an adequate intake of inositol through their diet or consider taking a supplement,” said Dr. Monica Maria Olivares, RD&A Director for Women’s and Infant Health at Kerry. 

Monica added: “The benefits of inositol in PCOS are very well known there are more than 300 scientific publications about this topic, more than 50 clinical trials, and 20 metanalysis demonstrating the benefits of inositol on fertility, skin, cardiovascular disease, hyperandrogenism and hyperinsulinemia.”

Nutrition in Pregnancy and Breastfeeding 

“The first 1,000 days of a child’s life – beginning with conception through the first two years of childhood – critically impact development and health throughout life.  Therefore, it is essential that women have the nutrition, care, and the support they need for the healthiest possible future for themselves and for their children,” said Dr. Izaskun Monsalve, Marketing Manager for Women’s Health at Kerry. 

Vitamin and mineral needs can vary greatly between pre-pregnancy, pregnancy, and lactation. A carefully chosen diet can meet recommendations for most nutrients, but the diets of pregnant and lactating women often fall short of many essential nutrients.  For example, many pregnant women under-consume: 

• • • folic acid (to help protect against neural tube defects);  
    • choline (for fetal brain and nervous system development);  
    • iron (for increased maternal and fetal blood volume); and  
    • calcium (for bone growth and reduced risk of maternal hypertension). 
    • Omega-3 (for fetal brain and eye maturation) 

During lactation, the mother is able to provide all of a child’s nutrient needs via breastfeeding. For optimal health of the infant, the World Health Organization (WHO) recommends exclusive breastfeeding for the first six months. For the mother, this means that the required intake of many nutrients becomes even greater than during pregnancy – after all, the baby is still totally dependent on the mother for nutrition, but it is now bigger than it has ever been. As a result, it is essential for the mother to eat a balanced diet during this time to ensure both she and her baby are healthy. For some nutrients, the mother’s body will ensure the breast milk contains enough for the baby even at the risk of depleting her own body’s reserves. These are mostly nutrients that are absolutely essential for proper growth and development of the baby, such as protein, calcium, and zinc. Inadequate intake by the mother could lead to higher risk of iron deficiency, anemia, or loss of bone mineral density. 

Some mothers don’t get the support they need to sustain breastfeeding. Mastitis is the leading medical cause of women ceasing breastfeeding with ~15% of women experiencing mastitis during breastfeeding. The main symptom is pain.

“Many women are told that pain is normal during breastfeeding. It’s not true,” according to Izaskun. “Pain is not normal in breastfeeding.  Pain is often caused by mastitis, it is a problem, and in most cases it can be easily managed by treating the cause of the mastitis with a natural probiotic.” 

She continued: “We were the pioneers in investigating probiotics in human breast milk and after extensive research our R&D team isolated the first strain from women’s breast milk and it has been shown to be effective in reducing mastitis and significantly reducing the pain symptoms of mastitis in three clinical trials, involving more than 1,000 women.”

What is mastitis? 

Mastitis is an inflammation of breast tissue and is associated with an imbalance of the microbiota of the mammary gland. The main symptom is pain, and the pain, heat and swelling can be very intense.  Other symptoms include inflammation and obstruction of mammary ducts, and it can be associated with systemic symptoms like fever and tiredness.  Mastitis a very common problem during breastfeeding, affecting around 15% of women.  

Nutrition in Menopause 

Peri-menopause, pre-menopause, menopause, post-menopause. The menopause isn’t a single event in a woman’s life, but something women experience over the course of a couple of decades.  It’s a transformative phase, marking the end of a woman’s reproductive years. This natural transition brings about a myriad of changes, both physical and emotional.  

1 billion women worldwide will be experiencing menopause in 2025. 80% of them will have menopausal symptoms, symptoms that can severely impact their quality of life.   

“I really believe that helping women achieve real understanding of how their hormonal health impacts their overall health can increase positive sentiment and have a hugely positive impact on women’s lives,” said Izaskun.  

What is the menopause? 

Menopause is the consequence of the reduction in the ovarian function as it’s a gradual decrease in the level of estrogens in a woman’s system. Estrogens regulate the growth development and physiology of the human reproductive system, but also are involved in neuroendocrine, skeletal, adipogenesis and cardiovascular system. The low level of estrogen during menopause reduces the activation of estrogen receptors and causes the symptoms associated with menopause.   

There are more than 30 different symptoms associated with the menopause.  Common symptoms include: 

• • • • hot flushes 
      • night sweats 
      • difficulty sleeping 
      • fatigue 
      • lack of energy 
      • low mood or anxiety 
      • problems with memory or concentration 
      • vaginal dryness and pain, itching or discomfort 
      • reduced sex drive (libido) 
      • discomfort during sex 
      • irregular periods 
      • headaches 
      • heart palpitations  
      • recurring UTIs 
      • loss of muscle 
      • weight gain, and 
      • joint aches and pains.

Women choose to manage their symptoms and look ahead to healthy ageing in many different ways – pharmaceutical treatments, herbal remedies, life-style changes and increasingly nutritional changes, like adding more phytoestrogens to their diet. 

Monica said: “Phytoestrogens are plant-based compounds that mimic the effects of estrogen in the body. They occur in different botanicals, for example in red clover, soybeans and hops, and have been shown in clinical studies to reduce the frequency and intensity of menopause symptoms without serious side effects, which is very important. In fact, there are more than 1,500 scientific publications, 300 clinical trials, and 30 metanalysis demonstrating how phytoestrogens can help to address symptoms in menopause.” 

Lisa added: “There are also specific nutritional considerations for post-menopausal women. For instance, many experience changes in taste perception and suffer from severe dry mouth. Their food preferences may shift, and they may require different supplements or novel botanicals to support these changes. This presents opportunities for food and nutrition innovation specifically tailored to women’s health.” 

Conclusion 

There is a growing recognition of the unique health needs of women and a shift toward prioritising women’s wellbeing. “This increased awareness and advocacy have created a demand for more comprehensive research and solutions. With women’s health spanning from adolescence to old age, innovative technologies, treatments and products are being developed to address various aspects of women’s health,” said Karin. 

That said, every woman is different, and their needs are distinct and unique throughout various stages of life. Nutrition therefore needs to be personalised. Izaskun illustrates the point: “If we take menopause for an example, we’re talking about 30 different symptoms that affect women in greater or lesser extent. So, for each woman it’s a different experience. Women need specific solutions for the symptoms they are experiencing.” 

New technology is making personalisation easier.  By tracking what happening in their bodies, women can better understand the symptoms they are experiencing, allowing them to make decisions about taking a specific diet or ingredient to meet their individual needs.  

“There is wealth of information available about how women can use nutrition to manage their physical and emotional wellbeing throughout their lives. What’s important is to seek out science-based information and products that have been tried and tested in clinical studies,” concluded Lisa.     

 For more scienced-based information about the nutritional needs of women subscribe to KHNI.

• • Sodium’s role in health
  • Tax and legislation initiatives on sodium reduction being enacted globally, and their impact
  • Voluntary initiatives from food industry and impact on sodium intake
  • What to expect in the future

Effects of Excess Sodium Intake on Health

Cardiovascular diseases (CVD) account for most non-communicable deaths (NCDs) globally¹, which equates to 17.9 million people annually ².   Of these deaths, an estimated 1.89 million each year is associated with excessive intake of sodium in Europe ³, which is a major driver of high blood pressure in many countries ⁴, which is the leading risk factor for CVD ^5,6.

Salt is the main source of sodium in foods⁷, therefore reducing salt intake can naturally translate into a lower sodium intake, which is beneficial for health ^4,8, and is associated with reduced cardiovascular events ¹.  However, sodium isn’t all bad!  The human body requires a small amount of sodium for critical body function such as muscle contraction and relaxation, conduction of nerve impulses, and regulation of body fluids ⁷.  Unfortunately, our intake far exceeds the amount required by the human body and, hence, has a negative impact on health ³.

The global average dietary sodium intake in adults is 4,310mg per day (10.78g salt per day) which is more than double the recommendation advised by World Health Organisation (WHO) (2000mg sodium/day = 5g salt per day) ^9,10.  In general, daily sodium intake targets range between 2,000mg and 2,400mg per day (5 – 6g) across the globe ^9,11-13.  Alarmingly, reports from international organisations reveal that the Middle East has extremely high rates of salt consumption, with an average per capita consumption of more than 12g per day ¹⁴.

According to the UK National Diet & Nutrition Survey (NDNS), the main contributors of dietary salt are bread, cheese, and processed meat products ¹⁵.  This is similar for Europe, with a large proportion of salt intake coming from foods that don’t necessarily taste salty such as potato products and tinned produce ¹⁶.  On the other hand, sources of dietary sodium have been shown to differ between high-income countries (HICs) and low- and middle-income countries (LMICs) ¹⁷.  For instance, in Southeast Asia, manufactured and processed foods provide 80% of the dietary salt intake in HICs, whereas most of the consumed salt in LMICs is added during food preparation and cooking and/or discretionary table salt^17,18.  It is important to bear in mind that, in general, consumption of processed foods is still relatively low in South Asian countries.  A study conducted in South India identified key food sources of sodium were pulses (29.7%), rice-based dishes (27%), and vegetables (16.7%) ¹⁹.

What Actions are Being Taken to Lower Sodium Intakes?

Implementing highly cost-effective sodium reduction initiatives could potentially save an estimated seven million lives globally by 2030, according to the WHO ²⁰.  Many countries have implemented salt reduction targets for commonly consumed foods as part of a strategy to reduce salt intakes.  In 2013, the WHO Member States adopted a voluntary global target of 30% reduction in mean population salt intake by 2025 ²¹.  In 2023, the WHO published a global report on sodium intake reduction that details countries which have adopted and implemented sodium reduction policies ⁶.

Although there has been an increase in the number of salt reduction initiatives around the world since 2014 ²², efforts must be urgently accelerated and replicated in other countries, with more rigorous monitoring and evaluation of strategies needed to achieve salt reduction targets.

Table 1. National sodium/salt reduction initiatives by WHO region ²²

South-East Asia:  To align with the WHO global sodium reduction target, in 2013, the WHO South-East Asia countries set an intermediate regional target of 10% reduction in mean salt intake over the next 5 years ¹⁰.

Europe & UK:  Many countries in Europe either have mandatory and/or voluntary salt reduction initiatives such as maximum permitted salt levels in foods and reformulation programs.  Policies include strategies such as taxes on high-salt food (Hungary), mandatory high-salt content labels (Finland), and targets for reformulation and close monitoring of the food supply (UK) ²³.

Eastern Mediterranean:  The Eastern Mediterranean Region, which includes 22 countries and a population of approximately 580 million people, is a region that has a high burden of CVD ^17,24.  National sodium/salt reduction strategies have been identified in Bahrain, Egypt, Iran, Jordan, Saudi Arabia, Kuwait, Lebanon, Morocco, Oman, Palestine, Qatar, Tunisia, and the UAE ¹⁷.  The least common initiative was taxation on foods and beverages, whereas the most common strategy was reformulation (100%), followed by consumer education (77%), initiatives in specific settings (54%), and front of pack labelling (46%).  However, only 27% of Eastern Mediterranean countries monitored activities, and impact evaluations are lacking ²⁴.

Taxes and Legislation

Taxing high salt products – Case Study in Europe

In 2011, Hungary implemented a tax called Public Health Product Tax (PHPT) on packaged foods that contain high levels of salt such as salty snacks and condiments.  The aim of introducing taxes is to reduce the consumption of food products that are not beneficial to public health ²⁵.  However, it is not easy to prove causality between the implementation of a nutrient tax and a reduction in consumption of that specific nutrient.

For Hungary, an evaluation was conducted after the introduction of the PHPT to monitor its impact on the population.  Unfortunately, the consumption of taxed products by the adult population did not decrease, thus the salt tax had a minimal impact on Hungarian consumers behaviours ²⁶.

Establishing mandatory upper limits on salt content of foods

Americas

On December 6, 2023, the Ministry of Health of Colombia issued Resolution 2056 which amended their “sodium rule”.  This amendment allows US exporters to use self-declarations to certify compliance with Colombia’s maximum sodium levels in processed products, which will help facilitate the trade of processed products to Colombia ²⁷.

Europe & UK

European countries, including Belgium, Bulgaria, France, Greece, Netherlands, and Portugal, have implemented mandatory maximum salt targets on products with a generally high salt content.  The main products of focus are those that significantly contribute to dietary sodium intakes.  The United Kingdom is often viewed by other countries as a good example for addressing an issue in public health ²⁸.  It implemented a successful voluntary salt reduction initiative, and now the government legislated to restrict the promotion, location and advertising of products deemed high in fat, sugar, and/or salt (HFSS) ²⁹.

Warning labels on high salt foods

Across the globe, many countries use front of pack nutrition labels or warning labels that highlight the content of energy and usually these four nutrients – fat, saturated fat, sugar, and salt in foods and beverages.  It is widely accepted that one of the most effective ways to reduce sodium intake at a population level is through lowering the sodium content of foods that are consumed frequently.  Engaging industry on a voluntary basis to reformulate products high in salt is a key strategy to achieve success ²³.  Many countries have established voluntary industry-led initiatives with category-specific salt targets for a wide range of food products.

Europe & UK

The EU is planning to propose a unified front-of-pack labelling scheme for all member states in 2025.  European food industry and retailers show Reference Intakes (RI) on the front of product packaging, where the content of the above mentioned are displayed along with the daily RI for energy and for the four nutrients per portion ³⁰.  In addition, the energy value is also expressed per 100g/100ml.    In recent years many countries have adopted similar front-of-pack labels displaying information on sodium (or salt).  For instance, in mainland Europe, several countries have implemented the Nutri-Score labelling scheme which grades the nutritional value of foods from A to E ³⁰.  From January 2026, companies using the Nutri-Score logo must adopt the latest, and more restrictive, Nutri-Score algorithms for food and beverages ³¹.

In Finland, numerous activities have been undertaken to reduce salt, in particular voluntary initiatives, and compulsory front-of-pack warning labels.  Warning labels are required if a specific product contains sugar or salt above a defined threshold.  For example, foods that are high in salt are required to carry a “high salt content” warning ³².  Interestingly, since their introduction, the average sodium content in food products in Finland has decreased by 20-25% ³².

Americas and Canada

Many countries in Latin America such as Chile, Mexico, Peru, Uruguay, and soon Brazil, have adopted front-of-pack black warning labels that indicate if a product is high in calories, fat, sugar, and salt ^30,33 (Figure 1).

In October 2021, the US Food and Drug Administration published new voluntary sodium reduction goals for the food and beverage industry ³⁴.  Due to pressures to reduce sodium intake, the targets are only for 2.5 years compared with those issued previously.  The strategy supports sodium reduction already achieved by industry, provides targets for defining and measuring progress, and provides companies with the flexibility and time to meet these targets.

In Canada, as of January 2026, a front-of-package nutrition symbol is mandatory for pre-packaged foods that meet or exceed set levels for saturated fat, sugars or sodium.

South-East Asia

In most South Asian countries, salt reduction initiatives are still in the planning phase and are yet to be fully implemented, with outcomes not evaluated or reported ¹⁰.  Scaling up community-wide salt reduction strategies in this region is imperative for reducing salt intakes.

From a public health perspective, voluntary industry initiatives can be more effective, as they may be more achievable than government measures which can be hampered by pressure from interest groups, political gridlock, and bureaucratic inertia.  They may also achieve public health objectives quicker, more efficiently and less intrusively than governmental regulation.

An Industry Perspective

There are many positives with engaging in nutritional improvement of products, such as public health responsibility, creating positive publicity for the brand, goodwill among stakeholders and preventing binding government regulation and fiscal measures.  Product reformulation has large potential effects on the quality of the diet and has the potential to improve population health ¹⁶.

One primary hurdle is that reformulation can alter the sensory attributes of food products and influence consumer liking.  However, there is evidence that consumers do not detect gradual decreases in the salt content of foods when slowly reduced over time ³⁵.

Examples of successful industry-government partnerships for salt reduction

Community-based salt reduction programs have been conducted in many parts of the world, resulting in reduced salt intake, increased awareness and lowering of BP ¹⁰.  Of all the WHO 194 Member States, 79% (154) have committed a policy towards sodium reduction and these commitments are usually included in national nutrition plans (n = 82), non-communicable disease plans (n = 94) or health sector plans (n = 40) ⁶.  In 2023, the WHO published their global report on sodium intake reduction providing detailed examples of sodium intake reduction initiatives across their Member States ⁶.

Western Pacific

A community-based Eat Less Salt intervention in Vietnam decreased community salt intake from 21.5 to 20.4 g per day together with reduction in both systolic and diastolic blood pressure between baseline and follow-up of 1-year intervention ¹⁰.  A similar project in Australia demonstrated a mean salt intake reduction from 8.8 to 8 g per day over a 3-year period.  A study in Japan found significant reduction in community salt intake, and a corresponding reduction in BP ¹⁰.

Europe & UK

Similarly, a research study conducted in Portugal reported a significant reduction in community salt intake, and a corresponding reduction in BP ¹⁰.  Many EU governments in countries including Austria, Belgium, Czech Republic, France, Greece, Italy, Netherlands, and Spain have proposed a collaborative approach with industries on setting voluntary salt targets.  In Ireland, a salt reduction program was run over ten years from 2003 to 2013 which led to a reduction in daily adult salt intake by 1.1g³⁶.  In 2021, the Irish Government published their ambitious ‘Reformulation Roadmap’ with 2025 targets for reducing calories (20%), saturated fat (10%), salt (10%) and sugar (20%) in products that contribute to the most intake of these nutrients ³⁷.

Recently, the UK released the fifth sets of voluntary salt reduction targets.  The UK’s gradual salt reduction program has been successful in reducing population-level salt intake: it achieved an overall reduced salt intake of 1 g per day in the adult population, reducing adult average sodium intake from 3,752 mg per day (9.38 g per day) in 2000 to 3,352 (8.38 g per day) in 2018 ³⁸.  This is a great step forward for public health despite the intake still being considerably higher than the UK recommended intake of 2,400g per day.

Conclusion

Many countries have taken and will continue to take actions to reduce population sodium intake.  High sodium intake is associated with not only increased BP but also risk of CVD.  Global sodium consumption is too high, so reducing intake will significantly improve public health.  For this reason, the sodium levels in products will continue to be scrutinised and the pressure on industry to reformulate products will continually increase.

The role of salt is essential in the preservation, flavour, and structure of food products; therefore, it is essential that governments and food industry collaborate to educate consumers, invest in new technologies and develop innovative reformulation methods and practices.

This article was originally published on 13 October 2021. It is being currently updated January 2026.

Sugar, in the form of the carbohydrate glucose, is the primary energy of life.  It is the main source for the human body, as all carbohydrates are broken down into sugars by our body to perform.  For instance, the human brain needs around 50 grams of sugar per day to function.  This is one of the reasons humans evolved to find the taste of sugar favourable.  This was especially important during human evolution when sources of sugar were not as easily accessible as they are now.  However, there is a difference between naturally occurring / free sugars and added sugars. How do consumers tell the difference? 

The WHO definition of term free sugars refers to ‘monosaccharides (such as glucose, fructose) and disaccharides (such as sucrose or table sugar) added to foods and drinks by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates’.  By this definition, for example, fruit juice would contain free sugars but might not be considered an ‘added sugar’ unless it was added to another food or beverage for the purpose of sweetening.  The EFSA and FDA go into further detail about definitions of what is and isn’t an added sugar.  Added sugars are considered empty calories (i.e. supplying energy but little else nutritionally) and therefore have been the focus of increasing attention in dietary guidelines in recent years. 

As per European Regulation (EU) No 1169/2011 on the provision of food information to consumers “sugars” are defined as “all monosaccharides and disaccharides present in food, but excludes polyols”.  To date, there is no similar clear-cut definition of the term ‘added sugars’ in the same piece of Regulation.

However, Regulation (EC) No 1924/2006 on nutrition and health claims made on foods does reference a “No Added Sugar” claim as “where the product does not contain any added mono- or disaccharides or any other food used for its sweetening properties.” Within the food industry, this then prompts discussion on how to define “any other food used for its sweetening properties”.  

In the United States, the FDA definition of added sugars includes sugars that are either added during the processing of foods, or are packaged as such, and include sugars (free, mono- and disaccharides), sugars from syrups and honey, and sugars from concentrated fruit or vegetable juices that are in excess of what would be expected from the same volume of 100 percent fruit or vegetable juice of the same type.  The definition excludes fruit or vegetable juice concentrated from 100 percent fruit juice that is sold to consumers (e.g. frozen 100 percent fruit juice concentrate) as well as some sugars found in fruit and vegetable juices, jellies, jams, preserves, and fruit spreads. 

It is the consumption of increased added sugars that is blamed for various health conditions such as increase of a person’s risk for heart disease, type two diabetes, and obesity.  Additionally, there is a strong link between sugar intake and dental caries, or more commonly known as tooth decay or cavities.   It has been estimated that, globally in 2010, US$ 298 billion was spent on direct costs associated with dental caries (WHO). 

It’s no surprise the focus from the authorities around sugar reduction.  Reducing sugar consumption is a global focus as a health imperative, the World Health Organization recommends reducing free sugar intake for both children and adults to under 10 percent of total daily calories, equivalent to around 50 grams of free/added sugar maximum for the average person per day.  It is undeniable that overconsumption of sugars – added sugars – has been recognized as a worldwide problem by top public health agencies and consumers’ interest regarding reducing sugar consumption over time is maintained high.  

Environmental Impact of Sugar Production 

Sugar is a major industry with significant effects on the global environment resulting from growing, harvesting, refining, and distribution.  On average, sugarcane accounts for nearly 80% of global sugar production, with some 110 countries currently producing sugar from either cane or beets. For the period October/ September 2019, the top 10 producing countries (India, Brazil, Thailand, China, the US, Mexico, Russia, Pakistan, France, and Australia) accounted for nearly 70% of global output, with more than 170 million tonnes consumed annually (International Sugar Organisation).  The production of sugar is a highly water intensive operation, especially from sugar cane which has deep roots. 

According to a recent sugar life cycle analysis and report conducted by Kerry, manufacturing 1kg of cane sugar uses 1,110 litres of water and leads to 0.42kg of CO₂ emissions.  For the case of beet sugar, it would require 640 liters of water and emit 0.85kg of CO₂ emissions (LCA). 

The increase in global demand for sugar is resulting in high water consumption, air and water pollution, soil degradation, and change in natural habitat.  It is estimated that 10% of soil is lost during harvest of beet sugar and 3-5% of soil in sugar cane harvest.  This has resulted in the clearing of natural habitats such as rain forests, coastal wetlands, and savannah (WWF Action for Sustainable Sugar). 

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Global Sugar Reduction Initiatives   

Following the 2015 publication of the World Health Organization’s “Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020” (GAP), 20 governmental bodies introduced taxation intended to reduce obesity and rising levels of diabetes, most often by targeting sugar sweetened beverages (SSBs) as they have been determined to be a major source of added/ free sugars.  By mid-2018, 39 countries, states and cities had introduced nutritional taxation with more working toward voluntary sugar reduction approaches to encourage optimised nutrition. 

Today, that number continues to grow, with more than 50 countries or jurisdictions having implemented taxes on sugary drinks as a way to discourage consumption.  Among the latest places to turn to taxation as a means of encouraging healthy habits and fighting obesity-related illness are Spain and Poland, which introduced new sugar taxes in January of 2021. 

In the same time, there are front-of-pack labelling initiatives that are implemented across the countries on a global level.  Those initiatives seem to attract even more consumer’s attention.  They are easier to be interpreted by the consumer and have alerted manufacturers since they have an impact on the marketing of a products as they may restrict the advertisement of unhealthy foods.  

• Although sugar taxes have been a developed world reality, some of the earliest and most enthusiastic adopters are emerging markets.  According to the PLoSONE journal article “Regulatory initiatives to reduce sugar-sweetened beverages (SSBs) in Latin America”, 14 Latin American countries have adopted public and private SSB initiatives since 2006.  These include Mexico, which has one of the highest rates of diabetes globally, and Chile which coupled its tax with warning labels on foods high in sugar, fat or sodium. 
• Hungary was another early adopter, with the introduction of its broad “health tax” in 2011 which took aim at a range of products including those containing high fat and sodium. Today, around a dozen European countries have some form of sugar or health tax, including the UK, Ireland, France and Portugal. 
• Canada introduced a front-of-pack nutrition symbol in 2023 that is required on foods high in sugar, sodium and/or saturated fat.  The United States does not currently have a national strategy for SSB taxation, although city authorities such as those in Berkeley, California, and Boulder, Colorado, have introduced local measures. 
• Among nations in the Middle East and Africa, sugar taxes are in play in countries including Saudi Arabia, the United Arab Emirates, Oman, Morocco, Nigeria and South Africa.  In Asia Pacific, several long-standing sugar taxes are in effect and more recent legislation has been applied in Thailand, Philippines and Malaysia. 

The structure of the taxes often follows a similar pattern, usually with a tiered system that awards a higher tax for products with higher sugars.  In most cases the tax is passed on to the final consumer, though some manufacturers have managed to mask price increases through the introduction of smaller pack sizes.
  

In addition to applying pressure to cost-conscious consumers, sugar taxes incentivise manufacturers to rethink recipes and create nutritionally optimised food and beverages.  For example, ahead of the introduction of the UK Soft Drink Industry Level (SDIL) sugar tax in April of 2018, manufacturers began reformulating products, shrinking the number of high- and mid-sugar soft drinks in their portfolio and increasing their low- and zero-sugar offerings. 

A study in BMC Medicine found that six of the top ten brands affected by the SDIL reformulated more than half of the products in their portfolios between 2015 and end of 2018.  As these products hit the market, the total volume sales of high- and mid-sugar soft drinks was cut in half, while volume sales of low- and zero-sugar drinks rose by 40%.  A separate report on the SDIL found that around its implementation, sugar content in soft drinks was reduced by an average of 44%. 

A similar pattern can be seen across Latin America, where 15% of the carbonated soft drinks launched in 2023 had a reduced/low/no or free sugar claim, reflecting the current focus of both the industry and the consumer.  In Brazil, the food and beverage industry agreed to voluntarily reduce sugar in over 1,100 products by 2022.  Some participating manufacturers have also made voluntary commitments to the reduction of sodium, suggesting that overall  nutrition optimisation is an increasingly popular goal.  New labelling requirements, including in Mexico and Brazil, are also pressuring brands to create lower sugar products. 

Even in markets and categories without formal legislation, there is still considerable pressure on manufacturers.  In the United States, The National Salt and Sugar Reduction Initiative (NSSRI) is in the process of setting voluntary sugar reduction targets after having gotten widespread commercial support for its salt reduction infrastructure.

In the UK, some SSBs that fall outside of the SDIL purview, including unsweetened juices and sweetened milk-based beverages, have seen sugar reductions of around 10% following requests from Public Health England.  In Germany, voluntary targets have been set and, although no official taxes have been introduced, a small consumer survey suggests such efforts would have popular approval. 

As low sugar, no added sugar, reduced and free sugar claims become more prominent in new product launches, reformulation efforts are improving and consumer perceptions about reduced sugar beverages—which have historically faced taste and texture challenges—are changing.  

Consumers Attitudes Toward Different Sweeteners

Striking the balance between taste and nutrition is now more crucial than ever before.  People are not demanding but expecting food and drink that provide them with accessible and nutritional solutions that also cater to their taste buds.   

The need for sugar reduction is undeniable – 79% of global consumers believe that reduced sugar food and drinks are healthier than full sugar versions. Consumer’s sweetness expectations are no longer nebulous.  They are voicing their sugar reduction desires and laying down rules.  The degree of ‘desired’ sugar reduction is complex.  

What sweetener? In what product? Natural or artificial? And how much?  

The type of sweetener used in food and drink is important to 77% of consumers globally.  There’s lots of variables in the reduced sugar conversation, and consumers’ preferences vary considerably depending on the food or drink in question.  The figure below shows consumer familiarity when it comes to different types of sweeteners:

This understanding is important to consider when we look at which sweeteners consumers would prefer.  In the table below, honey was the most preferred sweetener among all consumers, followed by sucrose.  Neotame, advantame were the least preferred (do not prefer).

Preference for Sweeteners (% – Global; Base = Total Respondents)

Although taste remains a primary driver of sugar consumption, consumers increasingly acknowledge and turn to reduced sugar products as healthier alternatives.  

81% of global consumers indicate diabetes and weight gain as significant drawbacks of sugar consumption, which are major deterrents.  Hence, the need for sugar reduction is undeniable, with 79% of global consumers believe that reduced sugar food and drinks are healthier than full sugar versions. (© Kerry Proprietary Consumer Research | Sensibly Sweet 2023 | n=12.784) 

In a World That Loves Sugar’s Familiar Qualities…Where to Start for Successful Reduction? 

The responsibility and cost of helping consumers reduce their sugar intake is being pushed onto the food and beverage industry.  Why so many sugar-reduced products fail?  Though consumers cite taste as the biggest driver of their intention to repurchase, what are the other key factors that may stop great-tasting products from getting off the shelf. 

Every product category has different challenges when reformulating or developing from a low/no sugar added base.  From Beverages to dairy, from bakery to sauces the approach is different.  Reducing sugar or developing from a low/no sugar base in beverages needs to address simultaneously various challenges; low overall sweetness, high sourness, appearance of bitterness and off-notes while product mouthfeel is low.  

Considering the bakery product category the challenges are different to beverages; sweetness and mouthfeel are low, however now parameters as texture, shelf life, colour and crumb porosity are also impacted. 

There is not one solution fits all.  T he approach is usually a combination of various ingredients that work in synergy to address the various challenges.  From the selection of the desired sweetening system, to texturants and preservation systems the choices are dependent to your formulation and target consumer.  However, as taste is the primary driver when it comes to consumer’s purchase behaviour, flavours have a significant role to play in the formulation of reduced and low/no sugar containing products.  Flavours with modifying properties, mouthfeel, and masking are used to optimise the sweetness profile of the product, deliver clean sweet taste and offer full-bodied mouthfeel with no off notes while optimising the flavour profile when sugar is being reduced/ low or not present in the product formulation.  They work in synergy with the rest of the ingredients present in food and beverages enabling great clean taste without off notes that consumers will crave for.  

The sugar market has been greatly challenged the last years, with global deficit in the 2021/22 season replaced by a global surplus in 2022/23 season.  This crop uncertainty has a high impact on the whole supply chain of sugar.  Sugar is universally used across food and beverages industry.  Hence there is a major need for cost stabilisation and potentially savings in the various product offerings to address consumer need for affordable nutrition in the current volatile environment.  

Conclusion 

Although there has been significant progress in sugar reduction and sweetness optimisation technology, there is still some way to go.  The sugar consumption is increasing in the years.  Diabetes, obesity and teeth decay are still high in the health agenda’s agendas globally.  Therefore, there is still much to play for as manufacturers stride to offer great tasting products that meet lower sugar targets and do not impact taste, texture and shelf life.