Stevia

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Stevia

Common Names

  • Sweet herb of Paraguay
  • Candy leaf
  • Honey leaf
  • Sugar leaf

For Patients & Caregivers

Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.


How It Works

Stevia is used as a substitute for sugar.

Stevia is an herb that is used as a sweetener. The FDA allows only a purified ingredient from stevia as a food additive. Animal and laboratory studies suggest stevia products can suppress inflammation in the body or help regulate blood sugar, but studies of benefits in humans are unclear.

Purported Uses
  • Sweetener
    Stevia can be used as a low-calorie sweetener.
  • Hypertension
    Studies on whether stevia may lower blood pressure are mixed.
  • Diabetes
    Animals studies suggest stevia products can help to regular blood sugar, but human data are lacking.
  • Weight loss
    There are no data to support this use.
Do Not Take If
  • You are pregnant or nursing.
Side Effects

Case Reports

  • Nausea, stomach fullness: In 4 patients during a study following intake of 500 mg stevioside powder. Symptoms resolved after 1 week of treatment.
  • Restless leg syndrome: In a 54-year-old man with complex medical conditions. A medication review did not yield potential causes. Symptoms seemed related to use of a stevia product, and stopped when the product was discontinued.
Special Point

Because non-nutritive sweeteners including stevia are becoming more prevalent in beverages, foods, supplements, and medications, individuals may not be aware of their actual consumption of such ingredients.

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For Healthcare Professionals

Scientific Name
Stevia rebaudiana
Clinical Summary

Stevia rebaudiana is an herb native to Brazil and Paraguay. Its raw leaves as well as purified extracts such as stevioside and steviol have been used as sweeteners and promoted as sugar substitutes for diabetics (2). Stevia extract is many times sweeter than table sugar (1), but only purified steviol glycosides have the Generally Recognized as Safe (GRAS) status by the FDA for use in food (8).

In vitro and animal studies suggest that stevia has anti-inflammatory (5) (6), hepatoprotective and renoprotective effects (11). In humans, small studies suggest stevia may reduce hypertension and hyperglycemia (3) (4) (13), but a meta-analysis of steviol glycosides on type 2 diabetes biomarkers did not find significant benefit (14). In an RCT comparing low-calorie sweeteners, ingestion of rebaudioside did not appear to affect body weight (15). Additional studies are needed to clarify any benefits.

Purported Uses
  • Sweetener
  • Hypertension
  • Weight loss
  • Diabetes
Mechanism of Action

Mechanisms of purported antihypertensive effects with stevioside are unclear, although it may act as a calcium channel antagonist, similar to the drug verapamil (9). Other studies suggest steviosides are metabolized in the gut where bacteria provide an aglycone metabolite that then enters the blood circulation (16).

In vitro studies suggest stevioside suppresses production of inflammatory mediators (6). In mouse skin, it inhibited tumor-promoting 12-O-tetradecanoylphorbol-13-acetate (5). In other animal studies, stevia products inhibited hepatic gluconeogenesis (10) and increased insulin sensitivity (11).

Potential effects of stevia on the dopaminergic system and iron metabolism, primary pathways implicated in restless leg syndrome, need further evaluation as there is a case report of a patient with complex comorbidities but no other potential causes for RLS except newly initiated stevia intake (17).

Warnings

Laboratory studies indicate weak mutagenic activity with large doses (7).

Contraindications

Pregnant women should not consume this herb, as there is a lack of knowledge on how non-nutritive sweeteners including stevia may affect offspring (16).

Adverse Reactions

Case Reports

Abdominal fullness, myalgia, nausea, and asthenia: In 4 patients during a study following consumption of 500 mg stevioside powder. Symptoms resolved after 1 week of treatment (4).

Moderate restless leg syndrome: In a 54-year-old man with complex comorbidities who reported limb restlessness that interfered with sleep. Medication review did not yield potential causes. Symptom onset corresponded to recent stevia use and subsided with product discontinuation. A brief reintroduction of stevia after a few months caused a recurrence which again subsided after product discontinuation (17).

Herb-Drug Interactions
  • Verapamil: Animal studies suggest stevia may have additive antihypertensive effects (9). Clinical relevance has yet to be determined.
  • Antidiabetics: Animal studies suggest stevia may affect blood glucose levels (10). Clinical relevance has yet to be determined.
Dosage (OneMSK Only)
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. U.S. Food and Drug Administration. How Sweet It Is: All About Sugar Substitutes Accessed January 4, 2022.
  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. Shivanna N1, Naika M, Khanum F, Kaul VK. Antioxidant, anti-diabetic and renal protective properties of Stevia rebaudiana. J Diabetes Complications. 2013 Mar-Apr;27(2):103-13.
  12. 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.
  13. Safety Evaluation of Certain Food Additives. WHO Food Additives Series:54, International Programme on Chemical Safety, World Health Organization (Geneva) 2006.
  14. Bundgaard Anker CC, Rafiq S, Jeppesen PB. Effect of Steviol Glycosides on Human Health with Emphasis on Type 2 Diabetic Biomarkers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. Aug 21 2019;11(9).
  15. Higgins KA, Mattes RD. A randomized controlled trial contrasting the effects of 4 low-calorie sweeteners and sucrose on body weight in adults with overweight or obesity. Am J Clin Nutr. May 1 2019;109(5):1288-1301.
  16. Palatnik A, Moosreiner A, Olivier-Van Stichelen S. Consumption of non-nutritive sweeteners during pregnancy. Am J Obstet Gynecol. 2020 Aug;223(2):211-218.
  17. Goswami U, Pusalavidyasagar S. Restless legs syndrome associated with use of stevia nonnutritive sweetener. J Clin Sleep Med. Oct 15 2020;16(10):1819-1821.
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