How It Works
Bottom Line: Stevia is not approved by the FDA as a food additive and should be used with caution.
Stevia is a sweet herb from Paraguay that is used as a calorie-free sweetener. Although it has been used for many years in Asia and South America, the FDA has not approved it as a food additive or sweetener. Some studies have shown that stevia helps to lower blood pressure in humans. Other animal and laboratory studies suggest stevia products can suppress inflammation mediators in the body and can help to regulate blood sugar level. However, these effects have not been studied in humans.
Purported Uses
Sweetener
Stevia is 2-300 times sweeter than sugar. However, the FDA considers it unsafe
Hypertension
Stevia may lower blood pressure
Antitumor properties
Laboratory studies show that Stevia has antitumor properties but this has not been confirmed in humans
Inflammation
Laboratory studies suggest that Stevia may reduce inflammation
Diabetes
Animals studies suggest stevia products can help to regular blood sugar but human data is lacking
Weight loss
There is no data to support this use
Warnings
The FDA has not approved the usage of stevia as a sweetener or food additive. Usage in large quantities is discouraged. There have been some studies showing that steviol at high dosages may have weak mutagenic activity.
Do Not Take If
You are pregnant or nursing.
Side Effects
Nausea
Stomach Fullness
Scientific Name
Stevia rebaudiana
Common Name
Kaa he-he, sweet herb of Paraguay, caa-ehe, honey leaf
Clinical Summary
Stevia rebaudiana is an herb native to Brazil and Paraguay. The raw leaves as well as the purified extracts, such as stevioside and its aglycone steviol, have been used as sweeteners in Asian and South American countries. Stevia extract is said to be 2-300 times sweeter than table sugar (1). In Japan it has been used to sweeten beverages and seafoods. Although this product has not been approved by the FDA as food additive, the leaves have been consumed as a dietary supplement and promoted as a non-caloric sweetener for diabetics (2). Some studies have shown that stevia may lower blood pressure (3). In a placebo-controlled trial in patients with hypertension, stevioside usage was reported to improve quality of life when compared to placebo (4). Animal studies and in vitro studies suggest that stevia may have antitumor (5) and anti-inflammatory properties (6). Stevia may also have additive effects with other antihypertensive and antidiabetic medications. Gastrointestinal and neurological side effects as well as mutagenic activity have been reported (3) (4) (7).
Purported uses
Sweetener
Hypertension
Antitumor
Inflammation
Weight loss
Diabetes
Constituents
Stevioside (Steviol is an aglycone metabolite)
Rebaudioside A
Rebaudioside C
Dulcoside A
Phosphorus, iron, calcium, potassium, sodium, magnesium, zinc
Mechanism of Action
The mechanisms underlying the antihypertensive effect of stevioside are still unclear, although it is believed to act as a calcium channel antagonist, similar to the drug verapamil
(9). It may also have antitumor properties, as evidenced by its inhibition of the tumor-promoting 12-O-tetradecanoylphorbol-13-acetate (TPA) in mouse skin
(5). In vitro studies have shown that stevioside suppresses the production of inflammatory mediators
(6). Stevia products have been shown to inhibit hepatic gluconeogenesis
(10) and increase insulin sensitivity in animal studies
(11).
Pharmacokinetics
Stevioside is hydrolyzed to steviol before being absorbed in the intestines. Steviol is metabolized by the liver microsomes
(10).
Warnings
The FDA has not approved stevia as a sweetener or a food additive. Available toxicological information on stevia is inadequate to demonstrate its safety as a food additive or to affirm its status as Generally Recognized as Safe (GRAS) (8). Usage in large quantities is discouraged. There have been some studies showing that steviol at high dosages may possess weak mutagenic activity (7).
Contraindications
Pregnant women should not consume this herb.
Adverse Reactions
Case Report: Four patients in a study experienced abdominal fullness, myalgia, nausea, and asthenia, but all symptoms disappeared after following one week of treatment
(3) (4)
Herb-Drug Interactions
Verapamil: Stevia may have additive antihypertensive effects (9).
Diabetes drugs: Stevia may affect blood glucose level, so dosages may have to be adjusted (10) (11)
Lab Interactions
Might decrease blood glucose level
Might decrease blood pressure
References
1. More about stevia, a non-approved sweetener.
Harv Womens Health Watch 2005;12(10):6-7.
2. Geuns, J.M.,
Stevioside. Phytochemistry 2003;64(5): 913-21.
3. Chan, P., et al.,
A double-blind placebo-controlled study of the effectiveness and tolerability of oral stevioside in human hypertension. Br J Clin Pharmacol 2000; 50(3):215-20.
4. Hsieh, M.H., et al.,
Efficacy and tolerability of oral stevioside in patients with mild essential hypertension: a two-year, randomized, placebo-controlled study. Clin Ther 2003; 25(11): 2797-808.
5. Yasukawa, K., S. Kitanaka, and S. Seo,
Inhibitory effect of stevioside on tumor promotion by 12-O-tetradecanoylphorbol-13-acetate in two-stage carcinogenesis in mouse skin. Biol Pharm Bull 2002; 25(11):1488-90.
6. Boonkaewwan, C., C. Toskulkao, and M. Vongsakul,
Anti-Inflammatory and Immunomodulatory Activities of Stevioside and Its Metabolite Steviol on THP-1 Cells. J Agric Food Chem 2006; 54(3):785-9.
7. Terai, T. et al.,
Mutagenicity of steviol and its oxidative derivatives in Salmonella typhimurium TM677. Chem Pharm Bull (Tokyo) 2002; 50(7):1007-10.
8.
Automatic detention of stevia leaves, extract of stevia leaves, and food containing stevia. FDA Import Alert, IA#45-06, Revised 10/27/05.
9. Melis, M.S. and A.R. Sainati,
Effect of calcium and verapamil on renal function of rats during treatment with stevioside. J Ethnopharmacol 1991;33(3):257-62.
10. Ferreira, E.B., et al.,
Comparative effects of Stevia rebaudiana leaves and stevioside on glycaemia and hepatic gluconeogenesis. Planta Med 2006; 72(8):691-6.
11. Chang, J.C., et al.,
Increase of insulin sensitivity by stevioside in fructose-rich chow-fed rats. Horm Metab Res 2005; 37(10):610-6.
12. Safety Evaluation of Certain Food Additives. WHO Food Additives Series:54, International Programme on Chemical Safety, World Health Organization (Geneva) 2006.