Diabetes Self-Management Blog

Thanks to everyone who posted questions last week! The use of sweeteners in people both with and without diabetes is always a great topic for discussion, and I’m glad to see that folks have done their homework and are asking questions about all of the products out there. We continue with the sweetener saga. The sweetener of the week this week is stevia (or rather, rebiana, a stevia-based sweetener).

What is it? Stevia is a shrub (related to chrysanthemums) native to South America. Its leaves have been used for many years by the people of Brazil and Paraguay to sweeten a beverage called yerba mate. The substances in this herb that make it sweet are called steviol glycosides; the sweetest and best tasting of these steviol glycosides is rebaudioside A, or rebiana.

Where is it grown? Stevia is grown in South America, Central America, Israel, Thailand, and China. It’s highly popular in Japan, where it’s used (in place of aspartame and saccharin) to sweeten beverages, candy, and soy sauce.

Is it safe? Stevia has been available in the US for many years as a dietary supplement, not as an “officially approved” sweetener. In the 1990’s, the FDA (along with Canada and a European Community panel) rejected the approval of stevia as a sweetener due to concerns about its safety. For example, high doses of stevia fed to rats led to decreased sperm production. Pregnant hamsters given a form of stevia had smaller offspring. And in the laboratory, stevia was believed to damage DNA, thus possibly increasing the risk of cancer.

Why is stevia approved as a sweetener now? Recently, two companies (Cargill and Whole Earth Sweetener, a division of Merisant) developed an extract of stevia that is 97% pure rebaudioside A and roughly 200 times sweeter than sugar. They submitted research to the FDA attesting to rebiana’s safety, and in December 2008, the FDA agreed that rebiana could be put on the GRAS (Generally Recognized As Safe) list for use as a general purpose sweetener. In order to get on the GRAS list, an ingredient or chemical added to foods and beverages must be deemed by qualified scientists to be safe for consumption, as evidenced through scientific procedures or through experience based on common use in food.

You should note that only the stevia extract rebaudioside A or rebiana has been approved for GRAS status. The use of stevia, a sweetener made from a crude preparation of dried stevia leaves, has not been approved by the FDA. Rebiana is a food-grade, high-purity extract of the stevia leaf that contains at least 97% rebaudioside A.

Is rebiana safe? Like the other nonnutritive sweeteners, rebiana has been studied and found to be safe for people of all ages to consume. Safety data is based on 25 years of research on steviol glycosides. And if you’re curious, rebiana is not absorbed in the small intestine. It’s actually broken down by bacteria in the colon into steviol. Steviol is absorbed, turned into another substance in the liver and then excreted in the urine. Studies published in the May 2008 issue of the journal Food and Chemical Toxicology showed that very high doses of rebiana (the equivalent of a 150-pound person drinking 2,000 8-ounce servings of a rebiana-sweetened drink) had no ill effects on any organs in the body. Data also shows that rebiana has no effect on blood glucose or blood pressure.

However, the consumer watchdog Center for Science in the Public Interest (CSPI) point out that rebiana has only been tested in rats (FDA guidelines advise that testing be done on both rats and mice, and there could be some concern with DNA damage, based on earlier studies with stevia fed to rats). But despite urging from CSPI and several toxicologists from UCLA for the FDA to study rebiana further, rebiana was granted GRAS status in 2008.

What’s the Acceptable Daily Intake (ADI) for rebiana? The ADI for rebiana is 12 milligrams per kilogram of body weight per day for adults and children. This translates into a 150-pound adult consuming about 30 packets of a rebiana sweetener (such as Truvia) or drinking about six 12-ounce cans of a rebiana-sweetened soda every day for life.

More on stevia (rebiana) sweeteners next week!


Nonnutritive Sweeteners: Help or Hindrance? (Part 1)
Nonnutritive Sweeteners: Help or Hindrance? (Part 2)
Nonnutritive Sweeteners: Help or Hindrance? (Part 3)
Nonnutritive Sweeteners: Help or Hindrance? (Part 4)
Nonnutritive Sweeteners: Help or Hindrance? (Part 5)
Nonnutritive Sweeteners: Help or Hindrance? (Part 6)

  1. With stevia being used for many years in Brazil and Paraguay and is very popular in Japan, are their cancer rates higher than that of the US? Are their babies considered smaller than average? Is there evidence in their DNA that might suggest any type of damage? Testing on rats is one thing, but what about the people who have been using it for years?
    Seems to me that in moderation it would have little effect on our health and in some cases may be better for it as in the case of diabetics where stevia does not raise blood glucose. And, anybody who is drinking 12 cans of soda a day needs to reconsider as this can cause other health issues of its own.

    Posted by Patty |
  2. Thank you for this informative series, particularly in regard to the safety of the products. Many people choose a sugar-substitute purely on how it tastes to them. I prefer the taste of Splenda (yellow packets), but I have friends who swear pink or blue packets taste better. There’s no arguing with taste, although the debate can be enjoyable.


    Posted by Tim Wilson |
  3. thanks for the information on Stevia. it is greatly appreciated.
    since i am 72 years of age i am not worried about increased sperm production or smaller off spring!

    Posted by G. E. Riley |
  4. Stevia has been in health food stores for years as a food suppliment. And as I undertand has been submitted to the FDA for approval many many times without success. Now however, Pepsi and Coke want to use it in thier products as a sweetner and all of a sudden the FDA finds all the info and tests to approve it for uses. A little coincidential, don’t you think?

    Posted by Gail |
  5. I have had diabetes for over 28 years and have tried several different types of sweetener. I tried Stevia but the health food store only carried the product in bulk. I found it very hard to determine how much to use to sweeten a gallon of tea because there was no equivalency chart on the container. I also felt that it left an after taste that I didn’t particularly like. I have not tried cooking or baking with it however. It may be great for that. Thank you for your ongoing article concerning this relatively new sweetener to the American market.

    Posted by Betsy Hardin |
  6. Stevia has been used for hundreds, if not thousands of years by indigenous cultures in South America and Asia, not only as a sweetener, but also as a health care product. Its properties have long been associated with healing formulas by the shamans and medicine men in these cultures.
    At the time that stevia was first imported into the US, food manufacturers in this country who produced and marketed artificial sweeteners here lobbied the federal government against allowing stevia to be offered to the public as a sweetener. Their interest was not benevolent but purely a strong desire to block the competition that stevia would likely provide. This is nothing new in considering the power of lobbies in Washington, DC.
    Fortunately, small importers were allowed to sell the stevia as long as they didn’t market it as an artificial sweetener but as a different food supplement that just happened to sweeten whatever foods or drinks you added it too.

    Posted by Eugene Gaudreau |
  7. Has anyone ever heard of XYLO SWEEY supposed to be all natural XYLITOL sweetener. Someone gave it to me and I don’t think it is available in Quebec as this was bought in Ontario. I have not used it because I have never heard it mention in any of my diabetic news letters.
    Thank You, Regards

    Posted by Lorraine |
  8. Sorry that should be xylo sweet.

    Posted by Lorraine |
  9. I am not sure if I am alone but I would much rather eat something from a plant then a chemical company. I find stevia to have its “moments” when I would rather skip due to flavor but overall it is easier for me to wrap my head around a natual product.

    Posted by Jodi |
  10. To: Betsy Hardin
    Stevia is available at most supermarkets and health food stores in packets from a few different companies. While more costly than bulk, the convenience might be worth it for you. You should be able to get equivalency #’s either from the store or online for bulk. Most packets are equal to 2 tsps sugar in sweetness. You may not agree, but it’s a starting point.

    Posted by sunburst1969 |
  11. I use stevioside (contentrated) all the time and I love it. I make lo carb muffins (flour is made from protein powder, ground flax seed and ground pecans)and I only use 1 3/4 teaspoons for 2 dozen muffins. I also make unsweetened-dark chocolate covered nuts made with the stevioside. I had to make my own foods because even though a package says “sugar free” (like Russell Stover sugar free candy) It still raises my blood sugar too high. Make your own - it’s easy. Just melt the entire package unsweetended dark chocolate with 1/4 stick of butter and add in enough stevioside to sweeten to your taste and pour it into a big bowl of slightly chopped almonds, pecans, and walnuts, mix up, and put into a freezer bag and spoon out just enough to satisfy your craving. Fantastic.
    Always use less stevia and then you can add more if you need it. Using too much will make it bitter.

    Posted by Marge Niren |
  12. 30 packets of stevia? NO ONE would use that amount…It is time the FDA approves stevia. I believe TRUVIA (a stevia sweetner) has been added to some frozen dessert products…simply put stevia is a whole lot safer than Splenda and Nutrasweet.

    Posted by rick |
  13. Could you please comment on the safety of the brand, SweetLeaf sweetener All Natural Stevia Plus?
    Ingredients on back of package are: inulin soluble fiber, stevia leaf extract.

    No where on the packaging does it state: Rebiana

    I get them by the box in individual packets in health food stores.


    Posted by Stephanie Lehrer |
  14. I have been buying Truvia for about six months now, but I have not noticed it being used in any other products. I used Splenda and after a short time it gave me headaches and a very lethargic feeling. The blues and pinks I’ll leave for the added ingredients in various diet products. Here is my dilemna, I have an Ileostomy which I have no colon and only small intestines. It is reported in the article that stevia is abrorbed in the colon and broken down by bacteria. So where does the stevia do and go in my case? My sugars are ok, yes I said just ok. The standards are too tight for most people I talk to, to achieve a normal blood glucose. Having said that and haveing no colon, my PCP simply states that I absorb differently, which means we all have a uniquely different metabolism. Thanks for the article.

    Posted by John |
  15. Hi all, I am a user of Sweetleaf stevia as Stephanie is. The health food stores where I live stock it in forms other than packets. There are stevia drops in small bottles which may be added to tea or coffee. For baking and cooking there is Sweatleaf stevia in small plastic containers. One tablespoon of product is equal to a half cup of table sugar.
    I especially dislike the artificial sweetners from the chemical companies because they are, well, chemicals. Powerful lobbiests, though.
    My research has drawn the same conclusions as Eugene. Money talks and the chemical companies have more than us natural foods devotees.
    My concern is with the processing of the readily commercial stevia products. Now that the huge corporations are offering products in our grocery stores, I want to know what kind of chemicals are used in the refining process. I feel much safer purchasing things from health food stores.



    Posted by Rocky |
  16. Hi John,

    Stevia is broken down and absorbed in the small intestines, not the large intestine. The resulting substance, called steviol, is then metabolized by the liver. So, stevia isn’t processed any differently for you.

    Posted by acampbell |

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