Stevia and Diabetes

Using sugar as a sweetener can be a dangerous choice for people with diabetes. The good news is that diabetics now have a multitude of options for sweetening their morning cup of coffee compared to years ago. In the U.S., that choice has expanded to include a component of stevia (rebaudioside A). Stevia's stevioside compounds are also approved by European food authorities, and stevia has been used as for centuries in South America. (1-2)

Safety Concerns About Artificial Sweeteners

Concerns about artificial sweeteners have fueled research into natural alternatives. Worries began with the earliest artificial sweetener - saccharin. Once upon a time, saccharin was the only sweetener available for diabetics and for those looking to cut calories (in the United States). But in 1972, saccharin was removed from the FDA's "generally recognized as safe" (GRAS) list. (3-4)

The problem was that saccharin is it's known to cause cancer in animals. The National Toxicology Program later determined (in 2000) that it's no longer a potential carcinogen in humans. However, during the almost 30 years in between other sweeteners were developed and approved. (3-4)

The Aspartame Controversy

Side effects and health conditions linked to these newer sweeteners, especially aspartame, continue to be reported. Some complaints are supported by science. For example, excessive levels in the blood of one of the byproducts of ingesting aspartame can cause brain damage. The FDA suggests that only people with certain rare genetic disorders (or the fetuses of pregnant women with these disorders) could accrue high levels of this aspartame byproduct. (3)

Food safety organizations currently dismiss concerns raised from studies on aspartame (e.g., the build-up of formaldehyde in the brain or increased cancer risks). They, and other scientists, say that aspartame is safe. The basis for their conclusion includes the following points: (3-5)

  • Saying that formaldehyde, a byproduct of aspartame, can't build up in the body because its half-life is only 1.5 minutes. Despite evidence in animal studies that shows it does accumulate in tissues, authorities argue it's inconclusive.
  • Stating that results of studies associating aspartame with cancer are inconsistent.

Other researchers and scientists do not support the conclusion that aspartame is safe. Some suggest that there's not enough clinical data to encourage using aspartame. It's even been asserted that food authority reviewers have conflicts of interest that may bias their support for aspartame (some work/worked with food manufacturers that use the sweetener). So while the EFSA and the FDA considers aspartame to be a safe sugar alternative, there's still an unsettling amount of research that suggests otherwise. It has left diabetics with the unsavory feeling that they could possibly be trading one health problem for others. (1, 6-8)

A Safer Sweetener?

On the other hand, stevia compounds have been safely used for decades as a sweetener in Asian countries and Europe. The whole herb has been used for centuries as both a sweetener and home remedy in South America. Even researchers who say there's not enough safety evidence on non-nutritive sweeteners note that there aren't negative complaints from people who use stevia products. In fact, some mention that stevia compounds may actually be beneficial for diabetics and those trying to lose weight. (5, 9-10)

Effect on Blood Sugar - Compared to Other Natural Sweeteners

Until recently, the approved natural alternatives in the U.S. were known to have an undesirable effect on blood glucose levels and as many (or more) calories than sugar: (11)

Per Teaspoon of... Calories Carbohydrates (in grams)
Sugar 16.3 4.2
Maple Sugar 10.6 2.7
Maple Syrup 17.4 4.5
Dark Corn Syrup 19.1 5.2
Light Corn Syrup 10.4 2.8
Honey 7.0 5.8
Rice Syrup 15.5 3.9

Fortunately the two primary parts of stevia that make it sweet don't raise blood glucose levels like most natural sugars do. Research suggests some stevia compounds may even stimulate insulin and help normalize blood sugar levels in diabetics. However, those using commercial products made with stevia's rebaudioside A compound for these effects should take note. A recent study showed this stevia compound shows no effect on insulin or blood sugar levels. (12-13)

Many hail stevia compounds as the best alternative to sugar for diabetics and non-diabetics alike. Certainly the potential health benefits of this simple herb bear watching. We recommend that individuals considering the use of stevia should consult their health care practitioner before doing so. Stevia is an herb, and many herbs can interact with prescribed medications. Diabetics should never stop or alter their existing treatment plan without speaking with their health care practitioner first.

Works Cited

  1. Kobylewski, Sarah and Eckhert, Curtis D. Toxicology of Rebaudioside A: A Review. Center for Science in the Public Interest. [Online] University of California: Department of Molecular Toxicology and School of Public Health, August 14, 2008. [Cited: April 1, 2014.]
  2. Saulo, Aurora A. Food Safety and Technology: Sugars and Sweeteners in Foods. University of of Hawai'i at Mänoa. Honolulu: College of Tropical Agriculture and Human Resources, 2005. pp. 1-7, Cooperative Extension Service. FST-16.
  3. Henkel, John. Sugar Substitutes: Americans Opt for Sweetness and Lite. FDA Consumer. U. S. Food and Drug Administration, November-December 1999, Vol. 33, 6. (ISBN: 1-4223-2690-X; revised December, 2004).
  4. U.S. Food and Drug Administration. Artificial Sweeteners: No Calories ... Sweet! FDA Consumer. July-August 2006, Vol. 40, 4.
  5. Aspartame, low-calorie sweeteners and disease: Regulatory safety and epidemiological issues. Marinovich, Marina, et al., et al. [ed.] A. Wallace Hayes. Andover: Elsevier Ltd., October 2013, Food and Chemical Toxicology, Vol. 60, pp. 109-115. DOI: 10.1016/j.fct.2013.07.040. ISSN: 0278-6915.
  6. Non-nutritive sweeteners: Review and update. Shankhar, Padmini, Ahuja, Suman and Sriram, Krishnan. [ed.] Michael M. Meguid. 11-12, Syracuse: Elsevier Inc., November-December 2013, Nutrition, Vol. 29, pp. 1293-1299. ISSN: 0899-9007.
  7. A review of the genotoxic and carcinogenic effects of aspartame: does it safe or not? Yılmaz, Serkan and Uçar, Aslı. [ed.] D.W. Barnes, O.-W. Merten and S. Shirahata. Lawrenceville; Evry; Fukuoka: Springer Netherlands, February 2014, Cytotechnology. DOI: 10.1007/s10616-013-9681-0. eISSN: 1573-0778.
  8. Millstone, Erik. EFSA on Aspartame January 2013: a lost, but not the last, opportunity. SPRU - Science and Technology Policy Research Monograph. Brighton, UK: University of Sussex, February 22, 2013. pp. 1-67.
  9. Effects of stevia, aspartame, and sucrose on food intake, satiety, and postprandial glucose and insulin levels. Anton, Stephen D., et al., et al. [ed.] Peter Atkins, et al., et al. 1, Durham: Elsevier Ltd., August 2010, Appetite, Vol. 55, pp. 37-43. ISSN: 0195-6663.
  10. Stevioside acts directly on pancreatic β cells to secrete insulin: Actions independent of cyclic adenosine monophosphate and adenosine triphosphate--sensitivie K+-channel activity. Jeppesen, P.B., et al., et al. [ed.] Christos S. Mantzoros. 2, Boston: Elsevier Inc., February 2000, Metabolism, Vol. 49, pp. 208-214. DOI: 10.1016/S0026-0495(00)91325-8. ISSN: 0026-0495.
  11. USDA Database for Standard Reference. NutriBase 7 Clinical Edition. s.l.: CyperSoft, 2007.
  12. Memorial Sloan-Kettering Cancer Center. Stevia. About Herbs. [Online] September 29, 2012. [Cited: April 4, 2014.]
  13. Glycemic and Blood Pressure Responses to Acute Doses of Rebaudioside A, a Steviol Glycoside, in Subjects with Normal Glucose Tolerance or Type 2 Diabetes Mellitus. Maki, Kevin C., et al., et al. [ed.] Gerald Weissmann. Meeting Abstract Supplement, New York: Federation of American Societies for Experimental Biology , April 2009, The FASEB Journal, Vol. 23, p. 351.6. ISSN: 0892-6638.
The chemical found in Equal.®
Such as phenylketonuria. (3)
Including animal research, case reports, and epidemiological studies in humans. (3-5)
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