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Stevia(Stevia rebaudiana Bertoni)

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Also listed as: Stevia rebaudiana, Rebaudioside A, Stevioside
Related terms
Background
Evidencetable
Tradition
Dosing
Safety
Interactions
Attribution
Bibliography

Related Terms
  • Alpha-monoglucosylrebaudioside A, alpha-monoglucosylstevioside, amaha sutebia (Japanese), Asteraceae (family), azucacaa, Ca-A-E, caá-eé (Brazilian Portuguese), caáché (Spanish), candyleaf, capim doce (Portuguese), Compositae (family), dihydroisosteviol (DHISV), dihydropsuedoivalin, dihydrosteviol A, édesfu (Hungarian), ent-kaurenoic acid, epidihydropseudoivalin, erva doce (Portuguese), estevia (Spanish), estévia (Portuguese), estévia-doce (Portuguese), folhas da stévia (Portuguese), glucosilsteviol, gurmaar (Punjabi), heuningblaar (Afrikaans), hierba dulce (Spanish), honey leaf, Honigkraut (German), honingkruid (Dutch), isosteviol, jázmin pakóca (Hungarian), ka'a he'e (Guaraní), kaa he-he (Guaraní), kaa jhee (Guaraní), madhu parani (Marathi), madhu patra (Sanskrit), madhu patri (Telugu), NPI-028, octa-acetylombuoside, ombuine, ombuoside, Paraguai suhkruleht (Estonian), Paraguayan sweet herb, piccolo arbusto con foglia dolce (Italian), rebaudioside A (RA), rebaudioside F, retusine, roninowa, ronion, sacharol, satiwia (Thai), SE, seeni tulsi (Tamil), Sřd stevia (Danish), sötflockel (Swedish), Sötstevia (Swedish), Stevia connata, stevia del norte de Paraguay (Spanish), Stevia eupatoria, stevia glycosides, Stevia lita, Stevia pilosa, Stevia rebaudiana, Stevia rebaudiana Bertoni (SrB), Stevia rebaudiana standardized extracts (SSEs), Stevia salicifolia, Stevia subpubescens, Stevia tomentosa, Stevia triflora DC, Stevia viscida, steviol (SV), steviolbioside, stevioside (SVS), stevisalioside A, Stevita, stiviyyah (Hebrew), sugar leaf, Süßblatt (German), Süßkraut (German), sweet herb, sweet honey leaf, sweet leaf, sweet leaf of Paraguay, tian jü (Chinese), tian jü ye (Chinese), ya wan (Thai), yerba dulce (Spanish).
  • Note: Do not confuse Stevia rebaudiana with Stevia salicifolia, also called ronion or roninowa. Stevia salicifolia contains the bitter glycoside stevisalioside.

Background
  • Extracts of leaves from Stevia rebaudiana Bertoni have been used for many years in traditional treatment of diabetes in South America. Paraguay's rural and indigenous populations have used Stevia rebaudiana for the control of fertility.
  • Stevia rebaudiana standardized extracts are used as natural sweeteners or dietary supplements in different countries for their content of stevioside or rebaudioside A. These compounds possess up to 250 times the sweetness intensity of sucrose, and do not have any calories. Stevioside, a natural plant glycoside isolated from the plant Stevia rebaudiana, has been commercialized as a non-caloric sweetener in Japan for more than 20 years.
  • Stevia is not generally recognized as safe (GRAS) nor approved as food additives by the U.S. Food and Drug Administration (FDA). Stevia may be imported only if "explicitly labeled as a dietary supplement or for use as a dietary ingredient in a dietary supplement." Although stevia may be marketed as a dietary supplement or an ingredient of a dietary supplement under the Dietary Supplement Health and Education Act (DSHEA), products that are labeled as using stevia plant parts or extracts as flavoring agents, sweeteners, or for other food additive purposes are deemed as "unsafe." Regulatory agencies in Canada and Europe also have not approved use of stevia as a food additive. However, rebaudioside A (reb-A) is a steviol glycoside that is extracted from stevia and obtained FDA GRAS status as of December 2008.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


Stevioside is a natural plant glycoside isolated from the plant Stevia rebaudiana, which has demonstrated blood pressure lowering effects. Despite evidence of benefits in some human studies and support from laboratory and animal studies, more research is warranted to compare stevia's effectiveness with the current standard of care and make a firm recommendation. Reports of major side effects related to stevia are currently lacking in the available literature.

B


Stevia has been widely used for diabetes in South America and animal studies have had promising results. Studies report decreases in plasma glucose when stevia was taken in normal volunteers, but there is currently inconclusive evidence of effectiveness when used for diabetes. Additional study is needed in this area to confirm these findings.

C
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

  • Alcohol abuse, antibacterial, anti-inflammatory, antimicrobial, antimutagenic, antitumor, antiviral (human rotavirus activity), contraceptive (birth control), diarrhea, digestive aid, diuretic, food additive, immunomodulation, obesity.

Dosing

Adults (18 years and older)

  • For hyperglycemia (high blood sugar), 1 gram of stevioside has been taken with meals to lower blood sugar in patients with type 2 diabetes. Water extracts of 5 grams of leaves have also been used at regular six-hour intervals for three days to increase glucose tolerance.
  • For hypertension (high blood pressure), stevioside (250-500mg) capsules given three times daily decreased systolic and diastolic blood pressure after three months of therapy, and have been studied for up to two years. Despite early evidence that this may be an effective dose, a recent study did not find any benefit of crude stevosides (up to 15mg/kg taken twice daily) for two years.

Children (younger than 18 years):

  • There is no proven safe or effective dose for stevia, and use in children is not recommended.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • Avoid in individuals with a known allergy or hypersensitivity to stevia or the daisy family (Asteraceae/Compositae). Other members of the daisy family include ragweed, chrysanthemums, marigolds, and many other herbs.

Side Effects and Warnings

  • Stevioside may lower blood glucose levels. Caution is advised in patients with diabetes or hypoglycemia (low blood sugar), and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare provider, and medication adjustments may be necessary.
  • Myalgia (muscle pain), muscle weakness, dizziness, asthenia (loss of strength), nausea, and abdominal fullness have been reported after taking stevioside. These effects resolved after the first week of treatment. Stevia may also lower systolic and diastolic blood pressure in patients with high blood pressure. Use cautiously in patients with hypotension (low blood pressure) or taking hypotensive drugs since various human and animal studies have shown that stevioside may significantly decrease systolic and diastolic blood pressure.
  • Higher doses of stevia may affect renal activity and perfusion, sodium excretion, and urinary flow. Avoid using stevia therapeutically in patients with impaired kidney function or other kidney diseases until human safety data is available.

Pregnancy and Breastfeeding

  • Stevia is not recommended in pregnant or breastfeeding women due to a lack of available scientific evidence.

Interactions

Interactions with Drugs

  • Stevia may lower blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia (low blood sugar), and in those taking drugs that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare provider, and medication adjustments may be necessary.
  • Based on clinical observations in humans, stevioside may decrease systolic and diastolic blood pressure. Caution is advised in patients taking blood pressure lowering medications.
  • Although not well researched, stevia may also interact with monoketocholate (a substance that may affect glucose and lipid levels), diuretics (medications that increase urine flow), ant-inflammatories, anti-cancer agents, or hypocalcemic agents. Caution is advised.
  • Steviol is a vasodilator (medication that causes the blood vessels to dilate or expand). Caution is advised when taking stevia with other vasodilators. Consult with a qualified healthcare professional, including a pharmacist, before combining therapies.
  • Verapamil is a calcium antagonist and may exhibit additive effects with stevioside. In an animal study, verapamil tended to increase the renal (kidney) and systemic effects of stevioside. Caution is advised.
  • Stevia has been used as a method of birth control in some countries. However, its use as a method of birth control is unclear and caution is advised.

Interactions with Herbs and Dietary Supplements

  • Although not well researched, stevia may also interact with monoketocholate, diuretics (herbs and supplements that increase urine flow), inflammatories, anti-cancer agents, or hypocalcemic agents. Caution is advised.
  • Stevia may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
  • Stevioside may decrease systolic and diastolic blood pressure. Caution is advised in patients taking blood pressure lowering herbs and supplements.
  • Steviol is a vasodilator. Caution is advised when taking stevia with other herbs and supplements that are vasodilators. Consult with a qualified healthcare professional, including a pharmacist, before combining therapies.
  • Stevia has been used as a method of birth control in some countries. However, its use as a method of birth control is unclear and caution is advised.

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. 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(1):37-41.
  2. Boonkaewwan C, Toskulkao C, 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.
  3. Carakostas MC, Curry LL, Boileau AC, et al. Overview: the history, technical function and safety of rebaudioside A, a naturally occurring steviol glycoside, for use in food and beverages. Food Chem Toxicol 2008;46 Suppl 7:S1-S10.
  4. 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(3):215-220.
  5. Chatsudthipong V, Muanprasat C. Stevioside and related compounds: therapeutic benefits beyond sweetness. Pharmacol Ther 2009;121(1):41-54.
  6. Chen TH, Chen SC, Chan P, et al. Mechanism of the hypoglycemic effect of stevioside, a glycoside of Stevia rebaudiana. Planta Med 2005;71(2):108-113.
  7. 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 Sep;20(9):732-6.
  8. Gregersen S, Jeppesen PB, Holst JJ, et al. Antihyperglycemic effects of stevioside in type 2 diabetic subjects. Metabolism 2004;53(1):73-76.
  9. 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(11):2797-2808.
  10. Koyama E, Kitazawa K, Ohori Y, et al. 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.
  11. 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-S46.
  12. Mizushina Y, Akihisa T, Ukiya M, et al. Structural analysis of isosteviol and related compounds as DNA polymerase and DNA topoisomerase inhibitors. Life Sci 9-9-2005;77(17):2127-2140.
  13. Raskovic A, Jakovljevic V, Mikov M, et al. Joint effect of commercial preparations of Stevia rebaudiana Bertoni and sodium monoketocholate on glycemia in mice. Eur J Drug Metab Pharmacokinet. 2004;29(2):83-86.
  14. Wong KL, Chan P, Yang HY, et al. Isosteviol acts on potassium channels to relax isolated aortic strips of Wistar rat. Life Sci 3-26-2004;74(19):2379-2387.
  15. Wong KL, Yang HY, Chan P, et al. Isosteviol as a potassium channel opener to lower intracellular calcium concentrations in cultured aortic smooth muscle cells. Planta Med 2004;70(2):108-112.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.

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