Azucacaa, Caa-He-É, Ca-A-Jhei, Ca-A-Yupi, Capim Doce, Chanvre d'Eau, Eira-Caa, Erva Doce, Estevia, Eupatorium rebaudianum, Green Stevia, Kaa Jhee, Mustelia eupatoria, Paraguayan Stevioside, Plante Sucrée, Reb A, Rebaudioside A, Rébaudioside A, Rebiana, Stévia, Stevia eupatoria, Stevia Plant, Stevia purpurea, Stevia rebaudiana, Stevioside, Sweet Herb of Paraguay, Sweet Herb, Sweet Leaf of Paraguay, Sweetleaf, Yerba Dulce.
Stevia (Stevia rebaudiana) is a bushy shrub that is native to northeast Paraguay, Brazil and Argentina. It is now grown in other parts of the world, including Canada and part of Asia and Europe. It is probably best known as a source of natural sweeteners.
Some people take stevia by mouth for medical purposes such as lowering blood pressure, treating diabetes, heartburn, high uric acid levels in the blood, for weight loss, to stimulate the heart rate, and for water retention.
Extracts from the stevia leaves are available as sweeteners in Japan, South Korea, Malaysia, Taiwan, Russia, Israel, Mexico, Paraguay, Uruguay, Venezuela, Colombia, Brazil, and Argentina. In the US, stevia leaves and extract are not approved for use as a sweetener, but they can be used as a "dietary supplement" or in skin care products. In December 2008, the U.S. Food and Drug Administration (FDA) granted Generally Recognized as Safe (GRAS) status to rebaudioside A, one of the chemicals in stevia, to be used as a food additive sweetener.
How does it work?
Stevia is a plant that contains natural sweeteners that are used in foods. Researchers have also evaluated the effect of chemicals in stevia on blood pressure and blood sugar levels. However, research results have been mixed.
Insufficient Evidence to Rate Effectiveness for...
- Diabetes. Research on how stevia might affect blood sugar in people with diabetes is inconsistent. Some early research suggests that taking 1000 mg daily of stevia leaf extract containing 91% stevioside might reduce blood sugar levels after meals by 18% in people with type 2 diabetes. However, other research shows that taking 250 mg of stevioside three times daily does not decrease blood sugar levels or HbA1c (a measure over blood sugar levels over time) after three months of treatment.
- High blood pressure. How stevia might affect blood pressure is unclear. Some research suggests that taking 750-1500 mg of stevioside, a chemical compound in stevia, daily reduces systolic blood pressure (the upper number in a blood pressure reading) by 10-14 mmHg and diastolic blood pressure (the lower number) by 6-14 mmHg. However, other research suggests that taking stevioside does not reduce blood pressure.
- Heart problems.
- Weight loss.
- Water retention.
- Other conditions.
Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, and Insufficient Evidence to Rate (detailed description of each of the ratings).
Stevia and chemicals contained in stevia, including stevioside and rebaudioside A, are LIKELY SAFE when taken by mouth as a sweetener in foods. Rebaudioside A has generally recognized as safe (GRAS) status in the U.S. for use as a sweetener for foods. Stevioside has been safely used in research in doses of up to 1500 mg daily for 2 years.
Some people who take stevia or stevioside can experience bloating or nausea. Other people have reported feelings of dizziness, muscle pain, and numbness.
Allergy to ragweed and related plants: Stevia is in the Asteraceae/Compositae plant family. This family includes ragweed, chrysanthemums, marigolds, daisies, and many other plants. In theory, people who are sensitive to ragweed and related plants may also be sensitive to stevia.
Diabetes: Some developing research suggests that some of the chemicals contained in stevia might lower blood sugar levels and could interfere with blood sugar control. However, other research disagrees. If you have diabetes and take stevia or any of the sweeteners it contains, monitor your blood sugar closely and report your findings to your healthcare provider.
Low blood pressure: There is some evidence, though not conclusive, that some of the chemicals in stevia can lower blood pressure. There is a concern that these chemicals might cause blood pressure to drop too low in people who have low blood pressure. Get your healthcare provider's advice before taking stevia or the sweeteners it contains, if you have low blood pressure.
LithiumInteraction Rating: Moderate Be cautious with this combination.Talk with your health provider.
Stevia might have an effect like a water pill or "diuretic." Taking stevia might decrease how well the body gets rid of lithium. In theory, this could increase how much lithium is in the body and result in serious side effects. Talk with your healthcare provider before using this product if you are taking lithium. Your lithium dose might need to be changed.
Medications for diabetes (Antidiabetes drugs)Interaction Rating: Minor Be cautious with this combination.Talk with your health provider.
Some research shows that stevia might decrease blood sugar in people with type 2 diabetes. In theory, stevia might cause an interaction with diabetes medications resulting in blood sugar levels going too low; however, not all research has found that stevia lowers blood sugar. Therefore, it is not clear if this potential interaction is a big concern. Until more is known, monitor your blood sugar closely if you take stevia. The dose of your diabetes medication might need to be changed.
Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others.
Medications for high blood pressure (Antihypertensive drugs)Interaction Rating: Minor Be cautious with this combination.Talk with your health provider.
Some research shows that stevia might decrease blood pressure. In theory, taking stevia along with medications used for lowering high blood pressure might cause your blood pressure to go too low. However, some research shows that stevia does not affect blood pressure. Therefore, it's not known if this potential interaction is a big concern.
Some medications for high blood pressure include captopril (Capoten), enalapril (Vasotec), losartan (Cozaar), valsartan (Diovan), diltiazem (Cardizem), Amlodipine (Norvasc), hydrochlorothiazide (HydroDiuril), furosemide (Lasix), and many others.
The appropriate dose of stevia depends on several factors such as the user's age, health, and several other conditions. At this time there is not enough scientific information to determine an appropriate range of doses for stevia. Keep in mind that natural products are not always necessarily safe and dosages can be important. Be sure to follow relevant directions on product labels and consult your pharmacist or physician or other healthcare professional before using.
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
Abudula, R., Jeppesen, P. B., Rolfsen, S. E., Xiao, J., and Hermansen, K. Rebaudioside A potently stimulates insulin secretion from isolated mouse islets: studies on the dose-, glucose-, and calcium-dependency. Metabolism 2004;53(10):1378-1381. View abstract.
Aritajat, S., Kaweewat, K., Manosroi, J., and Manosroi, A. Dominant lethal test in rats treated with some plant extracts. Southeast Asian J Trop.Med Public Health 2000;31 Suppl 1:171-173. View abstract.
Boonkaewwan, C., Toskulkao, C., and Vongsakul, M. Anti-Inflammatory and Immunomodulatory Activities of Stevioside and Its Metabolite Steviol on THP-1 Cells. J Agric.Food Chem 2-8-2006;54(3):785-789. View abstract.
Chaturvedula, V. S. and Prakash, I. Structures of the novel diterpene glycosides from Stevia rebaudiana. Carbohydr.Res 6-1-2011;346(8):1057-1060. View abstract.
Chaturvedula, V. S., Rhea, J., Milanowski, D., Mocek, U., and Prakash, I. Two minor diterpene glycosides from the leaves of Stevia rebaudiana. Nat.Prod Commun 2011;6(2):175-178. View abstract.
Chen, T. H., Chen, S. C., Chan, P., Chu, Y. L., Yang, H. Y., and Cheng, J. T. Mechanism of the hypoglycemic effect of stevioside, a glycoside of Stevia rebaudiana. Planta Med 2005;71(2):108-113. View abstract.
D'Agostino, M., De Simone, F., Pizza, C., and Aquino, R. [Sterols in Stevia rebaudiana Bertoni]. Boll.Soc Ital Biol Sper. 12-30-1984;60(12):2237-2240. View abstract.
Gardana, C., Simonetti, P., Canzi, E., Zanchi, R., and Pietta, P. Metabolism of stevioside and rebaudioside A from Stevia rebaudiana extracts by human microflora. J.Agric.Food Chem. 10-22-2003;51(22):6618-6622. View abstract.
Geuns, J. M., Buyse, J., Vankeirsbilck, A., and Temme, E. H. Metabolism of stevioside by healthy subjects. Exp Biol Med (Maywood.) 2007;232(1):164-173. View abstract.
Jeppesen, P. B., Gregersen, S., Alstrup, K. K., and Hermansen, K. Stevioside induces antihyperglycaemic, insulinotropic and glucagonostatic effects in vivo: studies in the diabetic Goto-Kakizaki (GK) rats. Phytomedicine 2002;9(1):9-14. View abstract.
Jeppesen, P. B., Gregersen, S., Rolfsen, S. E., Jepsen, M., Colombo, M., Agger, A., Xiao, J., Kruhoffer, M., Orntoft, T., and Hermansen, K. Antihyperglycemic and blood pressure-reducing effects of stevioside in the diabetic Goto-Kakizaki rat. Metabolism 2003;52(3):372-378. View abstract.
Kinghorn, A. D., Soejarto, D. D., Nanayakkara, N. P., Compadre, C. M., Makapugay, H. C., Hovanec-Brown, J. M., Medon, P. J., and Kamath, S. K. A phytochemical screening procedure for sweet ent-kaurene glycosides in the genus Stevia. J Nat Prod. 1984;47(3):439-444. View abstract.
Klongpanichpak, S., Temcharoen, P., Toskulkao, C., Apibal, S., and Glinsukon, T. Lack of mutagenicity of stevioside and steviol in Salmonella typhimurium TA 98 and TA 100. J Med Assoc Thai. 1997;80 Suppl 1:S121-S128. View abstract.
Koyama, E., Kitazawa, K., Ohori, Y., Izawa, O., Kakegawa, K., Fujino, A., and Ui, M. In vitro metabolism of the glycosidic sweeteners, stevia mixture and enzymatically modified stevia in human intestinal microflora. Food Chem.Toxicol. 2003;41(3):359-374. View abstract.
Lee, C. N., Wong, K. L., Liu, J. C., Chen, Y. J., Cheng, J. T., and Chan, P. Inhibitory effect of stevioside on calcium influx to produce antihypertension. Planta Med 2001;67(9):796-799. View abstract.
Li, J., Jiang, H., and Shi, R. A new acylated quercetin glycoside from the leaves of Stevia rebaudiana Bertoni. Nat.Prod Res 2009;23(15):1378-1383. View abstract.
Takasaki, M., Konoshima, T., Kozuka, M., Tokuda, H., Takayasu, J., Nishino, H., Miyakoshi, M., Mizutani, K., and Lee, K. H. Cancer preventive agents. Part 8: Chemopreventive effects of stevioside and related compounds. Bioorg.Med.Chem. 1-15-2009;17(2):600-605. View abstract.
Taware, A. S., Mukadam, D. S., and Chavan, A. M. Antimicrobial Activity of Different Extracts of Callus and Tissue Cultured Plantlets of Stevia Rebaudiana (Bertoni). Journal of Applied Science Research 2010;6(7):883-887.
Yadav, A. A review on the improvement of stevia [Stevia rebaudiana (Bertoni). Canadian Journal of Plant Science 2011;91(1):1-27.
Yang, P. S., Lee, J. J., Tsao, C. W., Wu, H. T., and Cheng, J. T. Stimulatory effect of stevioside on peripheral mu opioid receptors in animals. Neurosci.Lett 4-17-2009;454(1):72-75. View abstract.
Yasukawa, K., Kitanaka, S., and Seo, S. 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):1488-1490. View abstract.
Yodyingyuad, V. and Bunyawong, S. Effect of stevioside on growth and reproduction. Hum.Reprod. 1991;6(1):158-165. View abstract.
Barriocanal LA, Palacios M, Benitez G, et al. Apparent lack of pharmacological effect of steviol glycosides used as sweeteners in humans. A pilot study of repeated exposures in some normotensive and hypotensive individuals and in Type 1 and Type 2 diabetics. Regul Toxicol Pharmacol 2008;51:37-41. View abstract.
Boonkaewwan C, Ao M, Toskulkao C, Rao MC. Specific immunomodulatory and secretory activities of stevioside and steviol in intestinal cells. J Agric Food Chem 2008;56:3777-84. View abstract.
Brusick DJ. A critical review of the genetic toxicity of steviol and steviol glycosides. Food Chem Toxicol 2008;46 Suppl 7:S83-91. View abstract.
CFSAN/Office of Food Additive Safety. Agency Response Letter: GRAS Notice No. 000252. U.S. Food and Drug Administration, December 17, 2008. Available at: http://www.cfsan.fda.gov/~rdb/opa-g252.html.
CFSAN/Office of Food Additive Safety. GRAS Notices Received in 2008. GRN No. 252. U.S. Food and Drug Administration, December 2008. Available at: http://www.cfsan.fda.gov/~rdb/opa-gn08.html.
Chan P, Tomlinson B, Chen YJ, et al. A double-blind placebo-controlled study of the effectiveness and tolerability of oral stevioside in human hypertension. Br J Clin Pharmacol 2000;50:215-20. View abstract.
Chan P, Xu DY, Liu JC, et al. The effect of stevioside on blood pressure and plasma catecholamines in spontaneously hypertensive rats. Life Sci 1998;63:1679-84. View abstract.
Curi R, Alvarez M, Bazotte RB, et al. Effect of Stevia rebaudiana on glucose tolerance in normal adult humans. Braz J Med Biol Res 1986;19:771-4. View abstract.
FDA. Office of Regulatory Affairs. Automatic detention of stevia leaves, extract of stevia leaves, and food containing stevia. http://www.fda.gov/ora/fiars/ora_import_ia4506.html (Accessed 21 April 2004).
Ferri LA, Alves-Do-Prado W, Yamada SS, et al. Investigation of the antihypertensive effect of oral crude stevioside in patients with mild essential hypertension. Phytother Res 2006;20:732-6. View abstract.
Geuns JM. Stevioside. Phytochemistry 2003;64:913-21. View abstract.
Gregersen S, Jeppesen PB, Holst JJ, Hermansen K. Antihyperglycemic effects of stevioside in type 2 diabetic subjects. Metabolism 2004;53:73-6. View abstract.
Hsieh MH, Chan P, Sue YM, et al. Efficacy and tolerability of oral stevioside in patients with mild essential hypertension: a two-year, randomized, placebo-controlled study. Clin Ther 2003;25:2797-808. View abstract.
Hubler MO, Bracht A, Kelmer-Bracht AM. Influence of stevioside on hepatic glycogen levels in fasted rats. Res Commun Chem Pathol Pharmacol 1994;84:111-8. View abstract.
Jeppesen PB, Gregersen S, Poulsen CR, Hermansen K. Stevioside acts directly on pancreatic beta cells to secrete insulin: actions independent of cyclic adenosine monophosphate and adenosine triphosphate-sensitive K+-channel activity. Metabolism 2000;49:208-14. View abstract.
Lailerd N, Saengsirisuwan V, Sloniger JA, et al. Effects of stevioside on glucose transport activity in insulin-sensitive and insulin-resistant rat skeletal muscle. Metabolism 2004;53:101-7. View abstract.
Lemus-Mondaca R, Vega-Galvez A, Zura-Bravo L, Ah-Hen K. Stevia rebaudiana Bertoni, source of a high-potency natural sweetener: A comprehensive review on the biochemical, nutritional and functional aspects. Food Chem. 2012;132(3):1121-1132.
Maki KC, Curry LL, Carakostas MC, et al. The hemodynamic effects of rebaudioside A in healthy adults with normal and low-normal blood pressure. Food Chem Toxicol 2008;46 Suppl 7:S40-6. View abstract.
Matsui M, Matsui K, Kawasaki Y, et al. Evaluation of the genotoxicity of stevioside and steviol using six in vitro and one in vivo mutagenicity assays. Mutagenesis 1996;11:573-9. View abstract.
Melis MS, Sainati AR. Effect of calcium and verapamil on renal function of rats during treatment with stevioside. J Ethnopharmacol 1991;33:257-622. View abstract.
Melis MS. Effects of chronic administration of Stevia rebaudiana on fertility in rats. J Ethnopharmacol 1999;67:157-61. View abstract.
Melis MS. A crude extract of Stevia rebaudiana increases the renal plasma flow of normal and hypertensive rats. Braz J Med Biol Res 1996;29:669-75. View abstract.
Melis MS. Chronic administration of aqueous extract of Stevia rebaudiana in rats: renal effects. J Ethnopharmacol 1995;47:129-34. View abstract.
Morimoto T, Kotegawa T, Tsutsumi K, et al. Effect of St. John's wort on the pharmacokinetics of theophylline in healthy volunteers. J Clin Pharmacol 2004;44:95-101. View abstract.
Pezzuto JM, Compadre CM, Swanson SM, et al. Metabolically activated steviol, the aglycone of stevioside, is mutagenic. Proc Natl Acad Sci USA 1985;82:2478-82. View abstract.
Prakash I, Dubois GE, Clos JF, et al. Development of rebiana, a natural, non-caloric sweetener. Food Chem Toxicol 2008;46 Suppl 7:S75-82. View abstract.
Tomita T, Sato N, Arai T, et al. Bactericidal activity of a fermented hot-water extract from Stevia rebaudiana Bertoni towards enterohemorrhagic Escherichia coli O157:H7 and other food-borne pathogenic bacteria. Microbiol Immunol 1997;41:1005-9. View abstract.
Toskulkao C, Sutheerawatananon M, Wanichanon C, et al. Effects of stevioside and steviol on intestinal glucose absorption in hamsters. J Nutr Sci Vitaminol (Tokyo) 1995;41:105-13. View abstract.
Wasuntarawat C, Temcharoen P, Toskulkao C, et al. Developmental toxicity of steviol, a metabolite of stevioside, in the hamster. Drug Chem Toxicol 1998;21:207-22. View abstract.