By NATALIE DIGATE MUTH, M.D., M.P.H., R.D.
Last updated September 12, 2023
As an all-natural alternative to artificial sweeteners, Stevia has been a popular way for Americans to get their calorie-free sugar fix for more than a decade. Once limited to the health-food market as an unapproved herb, this plant-derived sweetener is now widely available and rapidly replacing artificial sweeteners in consumer products. Global stevia sales are predicted to reach about $1.4 billion by 2028.
Stevia, which is 200 to 400 times sweeter than sugar with no effect on blood sugar, has a history that goes back to ancient times. Grown naturally in tropical climates, stevia is an herb in the chrysanthemum family that grows wild as a small shrub in Paraguay and Brazil, though it can easily be cultivated elsewhere. Paraguayans have used stevia as a food sweetener for centuries, while other countries, including Brazil, Korea, Japan, China and much of South America, have a shorter, though still long-standing, record of stevia use.
Stevia’s Rocky History With the FDA
Though widely available throughout the world, in 1991 stevia was banned in the U.S. due to early studies that suggested the sweetener may cause cancer. A follow-up study refuted the initial study and in 1995, the U.S. Food and Drug Administration (FDA) allowed stevia to be imported and sold as a food supplement, but not as a sweetener. Several companies argued to the FDA that stevia should be categorized similarly to its artificial-sweetener cousins as “Generally Recognized as Safe” (GRAS). Substances that are considered GRAS have been determined to be safe through expert consensus, scientific review or widespread use without negative complications. They are exempt from the rigorous approval process required for food additives. If designated as GRAS, stevia could be used as a sweetener in a wide variety of food products and beverages.
In December 2008, the FDA accepted this argument, declared stevia GRAS, and allowed its use in mainstream U.S. food production. Stevia is now present in a number of foods and beverages in the U.S., including Gatorade Fit, VitaminWater Zero, SoBe Lifewater, Coca-Cola Life and Crystal Light. Around the world, it has been used in soft drinks, chewing gums, wines, yogurts, candies and many other products. Stevia powder can also be used for cooking and baking (in markedly decreased amounts compared to table sugar due to its high sweetness potency).
In its initial form, Stevia was sold as a ground-up powder of the stevia plant leaves. Though sweet, the powder also had a bitter aftertaste (mostly attributed to a compound found in the stevia plant called stevioside), which limited its acceptability as a sugar substitute for the health-store-shopping crowd. Manufacturers have since figured out how to retain the sweet taste and all of stevia’s benefits without the aftertaste.
There are more than 200 species of stevia plant, but one stands out for its excellent properties as a sweetener—stevia rebaudiana,?which contains the compound rebaudioside A, the sweetest-flavored component of the stevia leaf. Rebaudioside A acts chemically similar to sugar in onset, intensity and duration of sweetness, and is free of aftertaste. A majority of stevia-sweetened products contain mostly extracted rebaudioside A with some proportion of stevioside, which is a white crystalline compound present in stevia.
Stevia is marketed under the trade names of Truvia (Coca-Cola and agricultural giant Cargill), PureVia (PepsiCo and Whole Earth Sweetener Company), and SweetLeaf (Wisdom Natural Brands). Despite the three different names, the sweetener is essentially the same product, each containing slightly different proportions of rebaudioside A and stevioside.
But is it Safe?
The safety of stevia is an important consideration, particularly in light of recent conditional guidelines from the World Health Organization (WHO) regarding stevia and other non-sugar sweeteners.
That statement caused a lot of conversation and confusion on social media and among the general public, as many people misunderstood the statement to mean they had to eliminate non-sugar sweeteners from their diets if they wanted to achieve good health. If you are interested in learning more about the WHO guidelines, check out Everything You Need to Know About Non-Sugar Sweeteners. The key takeaway is that keeping sugar intake within reasonable limits and avoiding too many processed foods (which is where most non-sugar sweeteners are found) should already be a goal of any healthy eating plan—and this guideline does nothing to change that.
The safety of steviol glycosides has been widely studied in humans and reported on in scientific literature. For example, one 12-week study showed that the daily consumption of stevia in real-life doses does not affect glycemia in healthy individuals with normal weight, and may aid in weight maintenance and the moderation of energy intake. In addition, a systematic review and meta-analysis showed non-significant reductions in favor of steviol glycosides for diastolic blood pressure, body mass index, total cholesterol, fasting blood glucose and high-density lipoprotein. Another literature review revealed additional benefits from stevia consumption against oxidative stress, cancer, microbial infections, obesity and dental caries.
Stevia is recognized as safe by the FDA, which has determined an acceptable daily intake (ADI) level of 27 packets per day or 4 mg/kg of body weight per day.
Stevia’s sweet taste and all-natural origins make it a popular sugar substitute and a safe non-sugar sweetener. While the FDA has set an acceptable daily intake that is viewed as safe and having no adverse health effects, it is possible that stevia in large quantities could have harmful effects. However, it seems safe to say that when consumed in reasonable amounts, stevia may be an exceptional natural plant-based sugar substitute. Check the label next time you eat a favorite low-calorie sweet. You’re likely to find stevia near the top of the ingredient list.
References
Goyal, S.K., Samsher and Goyal, R.K. (2010). Stevia (Stevia rebaudiana) a bio-sweetener: A review. International Journal of Food Sciences and Nutrition, 61, 1, 1-10.
Kobylewski, S. and Eckhert, C.D. (2008). Toxicology of rabaudioside A: A review. Retrieved July 20, 2011.
______________________________________________________________
Natalie Digate Muth, MD, MPH, RD, is an award-winning author, pediatrician and registered dietitian, and educator. She is the founder and director of the Children’s Primary Care Medical Group W.E.L.L. nutrition clinic, is a past chair of the American Academy of Pediatrics Section on Obesity and is the author of The Clinician’s Guide to Pediatric Nutrition. She is also an adjunct assistant professor at the UCLA Fielding School of Public Health and the author of The Picky Eater Project: 6 Weeks to Happier, Healthier, Family Mealtimes.