Just How Safe is Stevia?

Dr. Christopher McGowan
February 18, 2021

Nearly everyone has heard at some point that the average American eats too many calories. What is less well understood is exactly where these calories are coming from. Sugar is often the culprit, and with many people in the United States eating as much as 22 tablespoons of extra sugar a day in their diets, excess sugar intake can be as much as 16% of our total caloric intake.

Given the towering amount of sugar we consume every day, it is no wonder food and beverage makers have been on the lookout for sugar substitutes and alternative sweeteners for decades. From early artificial sweeteners like aspartame and saccharin to recent additions of sugar alcohols like erythritol, there are plenty of choices if you are trying to drop table sugar from your diet, but still crave that sweet taste we have come to expect in a lot of our food. Recently a centuries-old sugar substitute from South America called stevia has been popping up in more and more places. Like anything new, you might wonder, “how safe is stevia?”

What is Stevia?

The sweetener you see on the shelves under the brand names Stevia, Truvia, and others is a processed extract from the leaves of the stevia rebaudiana plant. Stevia extract is a highly processed sugar substitute that has increased in popularity following approval by the Food and Drug Administration (FDA) as being generally recognized as safe. 

Stevia is native to much of the Western Hemisphere, and indigenous peoples in South America have been known to include stevia leaf in their diets for several hundred years. Though originally used in places like Brazil and Paraguay, stevia plants are cultivated around the world with much of the commercial production of stevia occurring in places like Japan and China. 

Unlike tossing basil leaves on a dish of pasta, you cannot simply chop up stevia leaf and drop it into your morning coffee to get the sweet taste you are after. Raw stevia leaf can have a bitter taste and unpleasant smell that is far from the sweet taste people are looking for. Beyond that, there are some concerns consuming raw stevia leaf may lead to some health problems.

After processing, stevia can still sometimes have a slight licorice aftertaste that makes it unsuitable for some kinds of cooking and baking. In this regard, it is similar to other artificial sweeteners like saccharine that have a flavor some people object to. Despite this, there are many products in which stevia’s unique flavor is welcome including:

  • ice cream
  • candy
  • soft drinks
  • canned fruit
  • chewing gum
  • soy sauce
  • syrups

Though it is a natural sweetener, extensive processing is necessary to get from crude stevia extract to the pure form found in stevia products. The goal of processing stevia extract is to isolate and purify glycosides that exist naturally in the plant. Of the eight glycosides in stevia, the most commonly used in sweeteners are stevioside and rebaudioside A, also known as reb A. 

After processing, stevia leaf extract is combined with other additives like dextrose and made into many different products you can find on the grocery store shelves. Beyond being used to get that alluring “zero-calorie” label on packaged foods, stevia can be bought on its own just like other sweeteners or sugar. There are many trade names for stevia extract including:

  • Enliten
  • Rebiana
  • SweetLeaf
  • Stevia
  • PureVia
  • Stevia Extract In The Raw
  • Steviacane

The Problems of Sugar

The sweetener we encounter most often as common table sugar is pure sucrose. Consuming large amounts of sucrose from the sugar beet or sugar cane plant can cause several health problems, many of which are related to weight gain. One of the most immediate effects of consuming large amounts of sugar is a spike in blood sugar levels. As your body tries to process sugar, blood glucose levels rise, resulting in a surge in insulin as your body attempts to store the energy in the glucose as fat. This spike in insulin is the first step in a process that can eventually create insulin sensitivity issues which, in the extreme, can lead to type 2 diabetes. 

Another major issue caused by sugar consumption is generalized inflammation. This has only recently come to the forefront of medical research on the effects of sugar, but more and more evidence is coming to light that links the low-grade inflammation caused by eating a diet high in sugar with a host of dangerous medical conditions.

Perhaps one of the most straightforward problems of sugar consumption is the excess body weight you gain. If your body can’t use all the energy in the sugar you consume, it is stored as fat, and over time, this fat can become a serious problem. Type 2 diabetes, heart disease, liver disease, and kidney problems are all linked to obesity. 

With all the potential problems associated with sugar, there is an obvious incentive to find artificial sweeteners and food additives that can provide the same sweet taste without the dangerous side effects and weight gain caused by sugar

Artificial Sweeteners and Sugar Substitutes

There are many different kinds of sugar substitutes, and stevia is coming late to the party in the modern American diet. For decades, other artificial and natural sweeteners have been developed to provide the sweet taste we crave without the calories we are trying to avoid.

Sugar substitutes are generally categorized as nonnutritive sweeteners because your body cannot metabolize these compounds the same way it would process sucrose. Since your body can’t process the energy found in artificial sweeteners and sugar substitutes, your blood glucose levels often stay lower than if you consumed the same product made with added sugar. The amount of calories you can get from these alternatives varies, with some sweeteners being low-calorie alternatives, while others are considered true zero-calorie sweeteners. 

Not having extra calories in your diet is a benefit if you are working toward a weight loss goal, but that does not mean that artificial sweeteners and sugar substitutes are without their drawbacks. Since your body isn’t designed to digest some of these chemicals, you can experience bloating, abdominal pain, and even diarrhea from eating too much of these food additives. 

Is Stevia Better for You Than Sugar?

One way that stevia is better for you than sugar is in regard to blood glucose levels. By not being metabolized into glucose during digestion, stevia does not contribute to sharp increases in blood sugar levels after you eat. This can be vital to people with type 2 diabetes or other insulin sensitivity issues. Stevia may also be related to lowering your chances of some cancers, and it may help manage cholesterol levels. 

Health Benefits of Stevia

The most obvious benefit zero-calorie sweeteners can offer is for weight loss. Cutting the extra calories from your diet that come from added sugar can help you start dropping pounds, but there may be more benefits to stevia than just weight loss. 

If you have been on a high-sugar diet, chances are you are disrupting your body’s natural insulin sensitivity. If you eat large amounts of sugar, your body pumps out more and more insulin to store away the extra glucose, causing your body to become less sensitive to insulin. This spiral can eventually lead to type 2 diabetes. Stevia can help in this regard as it is not metabolized by your body, and does not contribute to increases in blood glucose levels. If you are already diabetic or pre-diabetic, this can help you manage your insulin levels by preventing the spikes in blood sugar you would get from other sweeteners. 

Some research has also suggested that consuming the glycosides found in stevia may help reduce your risk of certain types of cancer. This may seem surprising for a simple sweetener, but multiple studies have shown that the glycoside stevioside helps increase the rate of cancer cell death. It also appears that stevia-based sweeteners may be toxic to leukemia, breast cancer, stomach cancer, and other malignancies.

Keeping your cholesterol levels in check is something many people in the United States struggle with as they age, especially if they are overweight. Research shows stevia could have benefits in this area, as recent studies have shown that extracts from stevia leaves may help lower levels of bad (LDL) cholesterol while raising your good (HDL) cholesterol at the same time. 

What are the Negative Effects of Stevia?

While there has been some back and forth over the years from the FDA as to whether stevia is considered safe, recommendations have never changed when it comes to stevia and pregnant women. The FDA still considers stevia and stevia-based sweeteners to be unsafe for women during pregnancy. If you are pregnant, it should be noted that there is no direct evidence that consuming stevia will harm you or your baby, but there is also no clear evidence that it won’t, which is the basis of the FDA’s recommendation to be cautious. 

Though stevia can be helpful if you are trying to lose weight, there are concerns that raw stevia may interfere with reproduction, cause kidney damage, and do harm to your cardiovascular system. Consuming raw stevia may also cause your blood pressure to drop, which can be dangerous if you are already on medication that can artificially lower your blood pressure. 

Some other concerns with stevia sweeteners are centered around the dextrose or maltodextrin that is sometimes mixed into commercial stevia products. People who are looking to cut carbs completely may not realize that these and other additives can add carbs and calories you may be trying to avoid.

There is also limited evidence that stevia consumption may be linked to negative changes in your intestinal flora. These changes in your microbiome have been linked to glucose intolerance and other health conditions such as metabolic disorders.

Successful Weight Loss and Artificial Sweeteners

Losing weight is not easy for anyone. Switching from sugar to any kind of non-nutritive sweetener may help you cut some calories and keep your blood sugar in check, but this is just a first step. Dropping weight and keeping it off demands making changes to your lifestyle that go beyond just grabbing for a sugar free soft drink. 

At True You Weight Loss, we know how hard it can be to lose weight, and how vitally important it is for you to find freedom from excess body weight. As a physician-founded practice dedicated to helping people find ways to achieve healthy, lasting weight loss, we offer a wide range of services from medical nutrition therapy to weight loss systems like the Spatz3 and even minimally invasive procedures such as endoscopic sleeve gastroplasty and bariatric revisions. If you want to know more about the services we offer and how they could help you find the results you are looking for, request a consultation with us today.

Dr. Christopher McGowan
Dr. Christopher McGowan

Dr. Christopher McGowan, MD, a leader in endobariatrics, specializes in non-surgical obesity treatments and is triple-board-certified in Internal Medicine, Gastroenterology, and Obesity Medicine. Renowned for pioneering endoscopic sleeve gastroplasty (ESG) with over 2,000 procedures, his global influence and research contributions define him as a top expert.

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