Medically reviewed on January 15, 2018
Scientific Name(s): Stevia rebaudiana Bertoni. Asteraceae (daisies)
Common Name(s): Stevia , rebiana , sweet leaf of Paraguay , sweetleaf , sweetherb , honey leaf , candyleaf , honey yerba , caa-he-é , ca-a-yupi , eira-caa , capim doce , Truvia , PureVia
Stevia leaf is used as a sweetening agent and contains several sweet glycosides. The glycoside rebaudioside A is used in commercially available products in the United States and has not shown any pharmacologic effects. Stevioside and stevia preparations have shown conflicting data, indicating possible effects as hypotensive and hypoglycemic agents and possible bactericidal properties.
Stevia leaf is used for sweetening foods.
Contraindications have not yet been identified.
Information regarding safety and efficacy in pregnancy and lactation is lacking.
None well documented.
No major contraindications, warnings, or adverse reactions have been documented.
Stevioside, a main glycoside of stevia, was found to be nontoxic in acute toxicity studies in a variety of laboratory animals.
Stevia is a perennial shrub indigenous to northern South America and is commercially grown in Central America, Israel, Thailand, and China. The plant can grow to 1 m in height, with leaves 2 to 3 cm in length. The leaves are used for their sweet taste. 1
Stevia was historically used to sweeten tea by the Guarani tribe of South America. For hundreds of years, native Brazilians and Paraguayans have also used the leaves of the plant as a sweetening agent. Europeans discovered stevia in the 16th century, whereas North American researchers began investigating its sweetening properties in the 20th century. Paraguayan botanist Moises Bertoni described the plant S. rebaudiana in the early 1900s. Glycosides responsible for the plant's sweetness were discovered in 1931. Stevia extracts have been used for years in a few countries, including Japan and Paraguay, as a food and medicine. In December 2008, the US Food and Drug Administration recognized one of stevia's glycosides, rebaudioside A, as generally safe for use as a general purpose sweetener, opening the door for marketing in the United States. 2
The main glycosides of stevia include stevioside and rebaudioside. Eight of stevia's glycosides were discovered and named in 1931. 3 More recently, the glycosides have been analyzed by capillary electrophoresis. Rebaudioside A and steviobioside have been isolated by high performance liquid chromatography (HPLC) methods. 4 Stevioside determination has been reported. 5 Two glucosyl transferases acting on steviol and its glycosides have been isolated. 6 Stevioside (6% to 18% in leaves) is the sweetest glycoside and was tested and found to be 300 times sweeter than saccharose in one report. 7 Steviol hydroxylation has been reported. 8 Sterols in stevia include stigmasterol, beta-sitosterol, and campesterol. 9 Isolation of the principal sugars of stevia has also been studied. 10
Stevia also contains certain vitamins (A, B, C), minerals (iron, zinc, calcium), electrolytes (sodium, potassium), proteins, and other elements. 1
Uses and Pharmacology
Stevia has been used for centuries as a natural sweetener. 1 The plant contains sweet ent-kaurene glycosides, 14 with the most intense sweetness belonging to the species S. rebaudiana . 15 Stevia has been evaluated for sweetness in animal response testing. 16 In humans, stevia as a sweetening agent works well in weight-loss programs to satisfy sugar cravings and is low in calories. Japan is the largest consumer of stevia leaves and uses the plant to sweeten foods, such as soy sauce, confections, and soft drinks, and as a replacement for aspartame and saccharin. 1 Several studies have examined the pharmacologic effects of stevia in animals and humans. These studies were conducted on different stevia glycosides and contribute to the conflicting results. In addition, some of the earlier studies did not specify the glycoside content of the stevia used. Stevioside appears to have more pharmacologic effect than the commercially available sweeteners that primarily contain rebaudioside A.Diabetes
Stevia may be helpful in treating diabetes. Steviol, isosteviol, and glucosylsteviol decreased glucose production in rat renal cortical tubules. 17 Stevioside lowered blood glucose in type 2 diabetic fatty rats when given orally. 18 , 19 However, rebaudioside A did not affect glycemic control after 8 weeks of treatment in type 2 diabetic rats. 20 Oral use of stevia extract in combination with chrysanthemum to manage hyperglycemia has been discussed. 21Clinical data
Studies with rebaudioside A indicate no effect on blood glucose. A 16-week study in patients (n = 122) with type 2 diabetes did not find any statistically significant changes from baseline versus placebo in hemoglobin A 1c (HbA 1c ), fasting glucose, insulin, or C-peptide when patients were administered rebaudioside A 500 mg twice a day with meals for 16 weeks. 22 Another study supports this lack of pharmacological effect of steviol glycosides. This study included 72 patients divided into 3 groups consisting of patients with type 1 diabetes, with type 2 diabetes, or without diabetes. After 3 months of the patients receiving steviol glycosides 250 mg 3 times a day, no change in HbA 1c was observed. 23 Commercially available rebaudioside A has not been shown to affect blood glucose; however, earlier studies, some conducted with the stevioside glycoside, indicate a potential effect on blood glucose. Aqueous extracts of the plant increased glucose tolerance in 16 healthy volunteers, as well as markedly decreasing plasma glucose levels. 24 When given 1 g capsules (consisting of 91% stevioside) orally along with a meal, postprandial blood glucose was decreased in a crossover study of 12 patients with type 2 diabetes. 25Hypertension
Stevia's effects on blood pressure have been reported. The plant may have cardiotonic actions, which normalize blood pressure and regulate heartbeat. 1 The plant displayed vasodilatory actions in both normotensive and hypertensive animals. 26 Stevia has also produced decreases in blood pressure and has increased diuretic and natriuretic effects in rats. 27 , 28 A study of stevioside in dogs indicated hypotensive effects. 29 However, a study with rebaudioside A indicated no effect on blood pressure in rats. 20Clinical data
Several studies with rebaudioside A in normotensive and hypotensive patients indicated the agent had no effect on blood pressure. 22 , 23 , 30 Conflicting data exist concerning the effect of stevioside as an antihypertensive agent. A decrease in systolic and diastolic blood pressure has been observed in patients with hypertension when given stevioside 250 mg 3 times daily for 1 year. 31 In another study, stevioside administered at a dosage of up to 15 mg/kg/day for 6 weeks did not decrease blood pressure compared with placebo. 32Other uses
Stevia extract has exhibited strong bactericidal activity against a wide range of pathogenic bacteria, including certain Escherichia coli strains. 33 Steviol was observed to be mutagenic toward Salmonella and other bacterial strains under various conditions and toward certain cell lines. 34 , 35 , 36 , 37 Stevia may also be effective against Candida albicans and has shown some antirotavirus activity. 1 , 38 Stevioside has shown promising immunomodulating effects in rats and cell lines. 39 , 40 , 41 In addition, stevia may have antiproliferative/antimutagenic/antioxidant properties. 42 , 43 , 44 One report addresses stevia's role in reducing dental plaque. 45
Stevia leaf is used for sweetening foods.
Information regarding safety and efficacy in pregnancy and lactation is lacking. Rebaudioside A has been studied in rats for 2 generations, with no effects on gestation lengths or growth. 50
None well documented.
No major contraindications, warnings, or adverse reactions have been documented.
Stevia is not mutagenic or genotoxic. 1 One report found that constituents of stevioside and steviol were not mutagenic in vitro. 51 Stevioside was found to be nontoxic in acute toxicity studies in a variety of laboratory animals. 1 Chronic administration of stevia to male rats had no effect in fertility versus controls. 52 Another report concluded that stevioside in high doses did not affect growth or reproduction in hamsters of both sexes. 53 Rebaudioside A showed no toxic effects when given to rats at dosages of up to 2,000 mg/kg/day for 90 days. 54
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26. 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(5):669-675.
27. Melis MS, Sainati AR. Effect of calcium and verapamil on renal function of rats during treatment with stevioside. J Ethnopharmacol . 1991;33(3):257-262.
28. Melis MS. Chronic administration of aqueous extract of Stevia rebaudiana in rats: renal effects. J Ethnopharmacol . 1995;47(3):129-134.
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