Stevia

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Stevia

Common Names

  • Kaa he-he
  • Sweet herb of Paraguay
  • Caa-ehe
  • Honey leaf

For Patients & Caregivers

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
  • Nausea
  • Stomach fullness
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 sugest 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

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). Other studies indicate 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).

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

Four patients in a study experienced abdominal fullness, myalgia, nausea, and asthenia following consumption of 500 mg stevioside powder. Symptoms resolved after 1 week of treatment (4).

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. Has Stevia been approved by FDA to be used as a sweetener? Statement issued December 19, 2017. Accessed June 30, 2020.
  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 Apr 8;S0002-9378(20)30385-9. Online before print.
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