Table of Contents
Part I, History of Stevia and safety research

1. Donna's Story -- Dealings with the FDA
    The Envelope with the White Powder
    The No-Calorie Miracle
    FDA Ruling Sours Sweet Stevia Story
    Sweet Revenge--The Dietary Supplement Law of 1994
    Stevia Citizenship Reinstated: Will Sugar Industry Now Hobble on Cane?

2. The Super Sweetener
    Characteristics of Stevia
    God's Gift to the Guarani
    Cultivation and Growing Pains
    The Sweet Stevia Rediscovery
    Sayonara Saccharin
    Stevia Goes Global
    Sweetening the Palm?
    Pass Me That Legal White Powder
    Déjà vu in 1998—the FDA and Fahrenheit 451?

3. How Safe Are Sweeteners?
    Artificial Sweeteners
    Saccharin
    Aspartame
    Acesulfame K
    Neotame
    Stevia Safety
    Our Daily Stevia Dose
    Animal Studies
    Latest Safety Studies with stevia and stevia extract
 
4. The Many Faces of Stevia
    Fresh Stevia Leaves
    Dried Leaves
    Green Powder
    White Extract
    Stevia Liquid Concentrates

5. Staying Healthy the Stevia Way
    Stevia and Diabetes
    Stevia and Weight Loss
    Stevia and Tooth Decay
    Stevia and High Blood Pressure--stevia helps lower blood pressure
    Pregnancy
   
6. Cooking with Stevia and recipes
    Advantages
    Stevia is Not Perfect
    Practical Tips and Suggestions
    Baking with Stevia extract
    Stevia Conversion Rate
    Time to Get Started

Part II Stevia Recipes
7. Stevia Sunrise Breakfasts recipe
8. Stevia Salads and Dressings recipe
9. Satisfying Stevia Entrees and Side Dishes
10. Sauces, Frostings, and Other Toppings
11. Heavenly Cakes and Pies
12. Homestyle Cookies, Candy, and Ice Cream
13. Luscious Custards, Puddings, and Fruit Treats - sensational stevia dessert
14. Sweet Drinks Are Made of These

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Sweet Teeth with No Cavities
Even a five-year old child knows that sugar causes tooth cavities. There are certain bacteria in our mouths, particularly streptococci mutans, that ferment various sugars to produce acids. These in turn eat through the enamel of the tooth causing pockets or cavities. For a long time, scientists have searched to find alternative sweeteners that are not fermentable by bacteria and hence do not cause cavities. Artificial sweeteners have been helpful in this regard. Fortunately, studies with stevia indicate that it does not cause tooth cavities.
 

Diabetes and hypertension
The popularity of stevia continues to grow as more and more people find out about this amazing no-calorie herbal sweetener. One of the primary constituents of stevia that gives it its sweet taste is stevioside, which has been commercialized as a sweetener in Japan for more than 25 years. Lately, studies have shown that stevia, in addition to being a sweetener, has certain health benefits, too, particularly for diabetics and those with elevated blood pressure.

   Diabetes -- Stevioside reduces postprandial blood glucose levels in type 2 diabetic patients, indicating beneficial effects on the glucose metabolism. Stevia has been used for many years in the treatment of diabetes among Indians in Paraguay and Brazil. However, the mechanism for the blood glucose-lowering effect remains unknown. A study conducted at Aarhus University Hospital in Denmark found that stevioside enhances insulin secretion from mouse pancreatic islets in the presence of glucose. The researchers state, “Stevioside stimulates insulin secretion via a direct action on pancreatic beta cells. The results indicate that the compounds may have a potential role as an anti-hyperglycemic agent in the treatment of type 2 diabetes mellitus.”
   Hypertension -- In a 2-year study in Chinese patients with mild hypertension, oral stevioside significantly decreased blood pressure compared with placebo. No significant adverse effects were noted.
   A double-blind, placebo-controlled study in Taiwan studied 106 Chinese hypertensive subjects ages ranging from 28 to 75 years. Each subject was given capsules containing 250 mg stevioside or placebo three times daily and followed-up at monthly intervals for 1 year (the average person who uses stevia ingests about 100 mg a day of stevioside). After 3 months, the systolic and diastolic blood pressure of the stevioside group decreased by about 6 points, and the effect persisted during the whole year. Blood biochemistry including lipid and glucose showed no major changes. No significant adverse effects were observed.
 

Our Daily Stevia Dose
It has been estimated that sugar consumption in Japan is about 80 grams a day while in the US and Europe it is between 120 to 140 mg a day (Akashi). Assuming we substitute stevia for sugar, what would be our daily consumption?
For the sake of simplicity, let's say we consume about 100 grams of sugar a day. Since the sweetness of stevioside is 300 times that of sugar, the maximum daily consumption of stevia would be 100 grams divided by 300, or a third of a gram (roughly 330 mg). Actually, Chinese researchers have already estimated that the daily human consumption of stevioside would be about 2 mg per kilogram of body weight (Xili, 1992). This is a very small amount and we should keep this in mind when we evaluate the toxicity studies with Stevia done in animals. Another point to keep in mind is that most people would only partially substitute stevia for sugar and other sweeteners. Therefore, the intake of stevia on a daily basis would even be less than 330 mg.
   There have been a number of studies performed in rodents and other laboratory animals to determine whether stevia has any toxicity. In many of these studies, stevia was provided in extremely high dosages, sometimes up to 5 percent of the weight of their food. Let's compare this to humans. Assuming we eat about two kilograms of food a day, and we ingest 200 mg of Stevia, the proportion of Stevia to our daily food intake would be about 0.01 percent; a very small amount, indeed.
Let's examine a few studies done over the past two decades with stevia.
 

Animal Studies
Whenever researchers want to test the dangers of a substance they give it to laboratory animals such as mice or rats. They give progressively higher doses of the substance until a lethal dose (LD) is reached where 50 percent of the test animals die. This level is called the LD 50. Back in the 1970s, several research groups attempted to find the lethal dose of stevia. They discovered that, on average, a dose of 8,000 milligrams or more per kilogram of body weight was necessary to achieve this LD 50. In human terms, this would be equivalent to a 70 kg male ingesting more than 480,000 milligrams (or about one pound) of the extract. In most cases, a glass of water can be sweetened by less than 5 drops, an extremely minimal amount. As can be expected, no human has ever died from stevia overdose.
   In a study published in Japan in 1985, researchers determined that giving rats 550 mg/kg of body weight every day of stevia stevioside for 2 years did not cause any abnormalities. However, could the ingestion of stevia cause abnormalities in the offspring?
   In 1991, an excellent study was done by researchers at the Chulalongkorn University Primate Research Center in Bangkok, Thailand. The researchers wanted to study the consequences of daily ingestion of stevioside in hamsters and the effects on two subsequent generations. (You may recall that stevioside is the main active sweetening agent in the stevia plant.) Three groups of 20 one-month-old hamsters (10 males and 10 females) were force-fed daily with stevia stevioside, while the fourth group stayed as the controls; they did not get any stevia. The first group was given 500 mg per kilogram of body weight; the second group got a higher dose at 1,000 mg per kilogram of body weight, and the third group got the highest dose at 2,500 mg per kilogram of body weight. The experiment was started with 80 one-month-old hamsters, 40 of each sex, each weighing between 30 and 50 grams. The 2,500 mg per kg of body weight would be equivalent to a human ingesting 150,000 mg. The likely amount of stevia most humans would ingest from sweetening their drinks and certain foods is often less than 500 mg.
   In the first generation, the average growth of the hamsters receiving various doses of stevioside did not differ significantly between each group. In the second generation, no significant difference in body weight was observed among groups of males receiving various doses of stevioside until 90 days of age. Thereafter, growth of males in the group receiving stevioside at 500 mg/kg of body weight was significantly higher than in the other groups. Nevertheless, male hamsters in the second and third groups on stevia grew the same amount as did the control group.
   In the third generation of those on stevia, at 120 days of age, no significant differences in body weights were observed in all groups of male and female animals. As to the mating performance, all three generations performed the same no matter what dose of stevia they received. Their performance was equal to the controls.
   Microscopic examination of reproductive tissues from all stevia groups, both male and female, did not differ from the control group. The production of sperm was normal, even in the males who received the highest dose of stevia. In the females taking stevia, the ovaries of all the animals were perfectly normal.
   In summary, no abnormalities were found in growth and fertility in both sexes on stevia. All males mated females efficiently and successfully. Females on stevia became pregnant after mating. The duration of pregnancy, number of fetuses, as well as number of young delivered each time from females in sevia groups were not significantly different from those in the control group. The researchers say, "The results of this study are astonishing. Stevioside at a dose as high as 2,500 mg /kg of body weight did not do any harm to these animals. We conclude that stevioside at a dose as high as 2.5 grams per kilogram of body weight affects neither growth nor reproduction in hamsters. If this is true in other mammalian species including humans, stevia will be of great benefit to industry and medicine, and can be used more widely as a non-caloric sweetener in a variety of foods and drinks as already seen in Japan and Brazil."

As you can see, stevia appears to be extremely safe. Nevertheless, it was banned for import in 1991. Where the reasons justified?

Review
Hopefully, with time, stevia can be added to a variety of sodas, candies, gums, and other foods in the US, just like it currently is in Japan and other countries. And we could see stevia packets at restaurants.

SO LONG, SUGAR...
Our health would be greatly enhanced if we could only reduce the amount of sugar we consume, especially refined sugar. At four calories per gram, basically void of any nutrients, with a fantastic ability to raise blood sugar and stimulate a wicked insulin response, you're better off not even walking near the aisle where it's shelved at your local grocery store. If you already have an unopened five-pound bag at home, consider using it for something useful--say a doorstop. Sure, we're being a bit harsh on sugar. It does have some assets, other than its sweet taste, that have contributed to its overwhelming popularity with chefs and bakers. We'll discuss these assets later.
   Fortunately, with the availability of this natural sweetener, we can greatly reduce our consumption of white, refined sugar. By blending stevia with high-quality, healthier sweet products (mineral-rich natural sugars such as molasses, barley malt, fruit juices, rice syrup, and honey), we can still have delicious low- or no-sugar meals and treats. Many of the recipes in this book use stevia as the exclusive sweetening agent. We're confident you generally will find their sweetness just as appealing as traditional recipes that use sugar. In other recipes we've greatly reduced the amount of sugar that's called for and substituted stevia. For instance, the French Chocolate Ice Cream recipe originally called for one cup of sugar. We found that by adding a tiny amount of stevia we could reduce the sugar volume to one-quarter cup and still have a delicious dessert. As you read these recipes, you may want to follow them exactly, or you may wish to take off on your own path and create recipes using a combination of stevia and other sweeteners if stevia, alone, does not satisfy your sweet tooth.
  Over the past few years Donna has been experimenting with stevia to create delicious recipes. In Atlanta, where she currently lives, chefs have created a wonderful variety of beverages, smoothies, baked goods (pies, cakes, cookies), sorbets, ice creams, puddings, and even different flavors of stevia-sweetened cheesecakes. One restaurant, R. Thomas Deluxe Grill in Buckhead, makes an organic butternut squash pie with whipped cream (both with stevia) that is extremely popular with their health-conscious patrons. You can take pride in joining those who are working to offer Americans healthier, higher quality sweets--without sacrificing taste.
   When you start using stevia in your recipes, you will find that it has a number of advantages--and also some drawbacks. Let's discuss them:

Advantages
Stevia is, in many cases, a flavor enhancer. This can be experienced when you add stevia to lemon juice, clearly heightening the flavor of the lemon. It is an appropriate sweetener for many types of foods since it is stable in acid foods (like tomato, pineapple, and limes). Cooking stevia at high temperatures does not destroy its sweetening properties. The artificial sweetener aspartame is not suitable for cooking and cannot make this claim. When heated, stevia does not ferment nor discolor.

Stevia is not perfect
Foods baked with stevia do not rise as much as those baked with sugar. In certain baked recipes, the complete elimination of sugar may not be possible. In addition to contributing necessary sweetness, sugar's crystalline structure provides texture to baked goods, aids in the creaming and whipping process during mixing, creates softening or spreading action to batter, caramelizes, and enhances browning.

Sugar feeds the fermentation of yeast and retains moisture. Stevia is not suitable for these purposes. Some users of stevia are sensitive to the slight aftertaste. We've found that baking and cooking usually reduce this aftertaste. If you have been using the artificial sweeteners such as aspartame and saccharin, they also have a noticeable aftertaste. If you experiment with different stevia products, you will find that there are slight differences in their sweetness, and even in the aftertaste. Try at least two or three different products to identify one that you find most suitable for your needs. If you use the green powder, it may slightly change the color of your food. You can avoid this by using the white powdered extract.  Most of the recipes in this book use the white stevia powder or the liquid concentrate made from the white powder.

Practical Tips and Suggestions
A common mistake beginners make with stevia is using too much of it in recipes. Since stevia is up to 300 times sweeter than sugar, excessive amounts can lead to over-sweetness and an aftertaste. For instance, Dr. Sahelian's mom followed the recipe of the oatmeal cookies suggested in this book. The recipe asked for 3/4 teaspoon of stevia. She tried two batches, one with 3/4 teaspoon of stevia, a second with one teaspoon. The second batch had a mild, but noticeable, aftertaste. The first batch was delicious.

When you first start using stevia, you may not be accustomed to its taste. Mixing stevia with even a tiny amount of another sweetener like honey will change the aftertaste. It can also have a synergistic effect with other sweeteners; a little goes a long way, so use it sparingly when combining.

When creating new recipes in your own kitchen, stevia's unique sweet flavor when used with neutral or mild-flavored foods is often noticeable. A little can even overpower the original flavor. Stevia's taste disappears in strong flavors and blends especially well in citrus flavors such as lemon and cranberry. Most fruits also go very well with stevia. Stevia is delicious with dairy foods (yogurt, cream, ice cream, kefir) and also with chocolate and carob. If you are one of the millions of Americans who have a love affair with chocolate, you'll be delighted to know that stevia and chocolate, and carob, are perfect partners.

When adapting a favorite recipe, you may need to slightly increase the amount of liquid (egg, water, milk) called for in your recipe. Be careful with those eggs, though. Too many eggs can "toughen" your finished product. However, eggs do help provide the "rise" or leavening to baked goods.

In creating the recipes for this book, we found our greatest challenge was creating cakes and cookies. These are made mostly with flour and a large amount of sugar. The two together provide the "rise" or fluffiness to cake. Flour, having a slightly bitter nature, is not as delicious with stevia as with other foods. Adding other flavors like grated lemon peel and nuts helps improve the flavor, but achieving the fluffiness is difficult. One alternative is to create thinner cakes that could be put together in many layers with various kinds of icings in between.

Sugar gives icings and fillings "body." To make an icing or filling using stevia, we've found that combining it with fruit spreads and nut berries provides the creaminess and spreading quality that is missing when you do away with the sugar.

Recipe books put out by the NutraSweet and Equal companies and recipes for diabetics are good sources for ideas. Substitute natural stevia for the recipes that call for artificial sweeteners.

Baking with Stevia extract
As we mentioned above, baked goods using only stevia do not brown well. Use your sense of touch and smell to decide when your muffins or cakes are done. When your kitchen fills with a wonderful smell, open your oven door and poke the muffin or cake to see if it is "springy" to the touch. If so, then they're ready to eat. Baked goods with chocolate and carob mask stevia's aftertaste and contribute a rich brown color. We do not recommend using stevia to bake yeast breads; the yeast must be activated by sugar, or the bread won't rise.

Conversion rate
Let's say you've decided to incorporate stevia in your diet. How do you determine how much to use? Unfortunately, we can't give you an exact answer for several reasons. Very sour foods like cranberries and lemons would need more sweetening than a pie baked with apples or pears since the those are naturally sweet. Then there's personal preference. Some of us don't like foods too sweet, while others have a sweet tooth. There's also a cultural difference. As a rule, Americans like their foods sweeter than those of other countries. To complicate matters even more, there are a number of different companies making stevia. The quality, flavor, and sweetness varies from product to product. Your best option is to try a few different brands and choose the one that best suits your needs. Through practical experience, we've found the following approximate equivalences It is worth mentioning again that different products on the market could provide different sweetness equivalences.

One cup sugar = about half a teaspoon of white stevia powder = about one teaspoon of stevia liquid concentrate
One tablespoon sugar = about six to nine drops of stevia liquid extract
One teaspoon of sugar = about two to three drops of stevia liquid extract

    If you are new to cooking with stevia, always start with either the exact amount of stevia the recipe calls for, or a slightly smaller amount. Then taste the batter, sauce, salad dressing or smoothie to see if it's sweet enough before adding more. If you purchase white stevia powder you may find it a little harder to work with when you only need the tiniest amount of sweetening power. Even the amount you might gather onto the point of a dinner knife might be too much in a cup of tea or coffee. We recommend turning the powder into a "working solution." Dissolve one teaspoon of white powder into three tablespoon of filtered water, pour into a dropper bottle, and then refrigerate. Or, you can just buy any of the ready-made stevia liquid concentrates from a health food store or the mail-order firms listed in the resource section of this book. Some communities may have stevia available in pharmacies, grocery stores, or retail outlets.

SWEET DRINKS ARE MADE OF THESE
The chemicals within stevia that make it taste sweet are stable in all types of liquids and do not lose their sweetness (Kinghorn, 1985). Thus, a number of drinks can be superbly sweetened with stevia. All it takes is usually two to five drops of liquid stevia per glass. Once you get into the habit of using stevia in your drinks, you'll never feel the need to buy the pink or blue packets, or even use honey. However, if you really like honey with your drinks, you can use less of it while adding a drop or two of stevia. We both are now in the habit of carrying small stevia bottles when we go out to restaurants or when we travel. This way, we can sweeten our drinks with stevia even when not at home. Please note that for blender drinks, it is best to add the stevia in the beginning of the process. Adding it later may cause a thinning of the product. The following are some examples of drinks that you can easily sweeten with stevia extract.

Lemonade and lemon juice. Not only does this herbal extract provide sweetness, it actually slightly enhances the flavor of the lemon. You can now serve lemonade to your kids on a hot summer afternoon without loading them up with high doses of harmful sugar.

Iced Tea. Forget sugar or artificial sweeteners. Stevia's the one to use.

            Sodas. A number of types of sodas in Japan have been sweetened using stevia since the mid-1970s. We hope that over the next few years, the FDA will allow stevia to be added to soft drinks. Thus, the consumption of saccharin and aspartame will decrease.

Herbal teas--We have tried stevia in quite a variety of herbal teas and it works well in all cases. The liquid extracts are perfect for teas. Have you considered having a variety of different herbal teas on your kitchen counter? Each morning you could try a different one. Some examples that we have tried include ginger, licorice, Earl gray, elderberry, dandelion, St. John's wort, kava, ginkgo, green, black, cinnamon, ginseng, echinacea, peppermint, goldenseal, fenugreek, and others. You could add the stevia drops after you brew the tea bag, or better yet, add the drops in the glass before you pour the hot water. As a rule, two to five drops of the liquid extract will provide enough sweetness to satisfy most people.

Coffee. Stevia is a perfect substitute for the artificial sweeteners. The amount of stevia used in coffee will be similar to the herbal teas. If you drink a few cups of coffee a day, and let's say you use two teaspoons of sugar per cup, just imagine how many calories a day you will not consume if you switch to stevia!

Hot cocoa with milk and stevia on a cold winter night in a Swiss chalet. How delicious!

Shakes and Smoothies--There are enough carbohydrate calories from fructose in these drinks. Why add additional sugar calories when you can use stevia. Actually, most shakes and smoothies are sweet enough on their own and, unless you really have a sweet tooth, there's no need to have additional sweeteners.

Research studies
Antihyperglycemic effects of stevioside in type 2 diabetic subjects.
Metabolism. 2004 Jan;53(1):73-6.
Stevioside is present in the plant Stevia rebaudiana Bertoni. Extracts of stevia have been used for the treatment of diabetes in, for example, Brazil, although a positive effect on glucose metabolism has not been unequivocally demonstrated. We studied the acute effects of stevioside in type 2 diabetic patients. We hypothesize that supplementation with stevia stevioside to a test meal causes a reduction in postprandial blood glucose. Twelve type 2 diabetic patients were included in an acute, paired cross-over study. A standard test meal was supplemented with either 1 g of stevioside or 1 g of maize starch (control). Blood samples were drawn at 30 minutes before and for 240 minutes after ingestion of the test meal. Compared to control, stevioside reduced the incremental area under the glucose response curve by 18%. The insulinogenic index (AUC(i,insulin)/AUC(i,glucose)) was increased by approximately 40% by stevioside compared to control. Stevioside tended to decrease glucagon levels, while it did not significantly alter the area under the insulin, glucagon-like peptide 1, and glucose-dependent insulinotropic polypeptide curves. In conclusion, stevioside reduces postprandial blood glucose levels in type 2 diabetic patients, indicating beneficial effects on the glucose metabolism. Stevia Stevioside may be advantageous in the treatment of type 2 diabetes. 
 

Efficacy and tolerability of oral stevioside in patients with mild essential hypertension: a two-year, randomized, placebo-controlled study.
Hsieh MH. Taipei Medical University--Wan Fang Hospital, Taipei City, Taiwan.
Clin Ther. 2003 Nov;25(11):2797-808.
Stevioside, a natural glycoside isolated from the plant Stevia rebaudiana Bertoni, has been used as a commercial sweetening agent in Japan and Brazil for >20 years. Previous animal and human studies have indicated that stevioside (stevia) has an antihypertensive effect. This study was undertaken to investigate the long-term (2-year) efficacy and tolerability of stevia in patients with mild essential hypertension. Secondary objectives were to determine the effects of stevia on left ventricular mass index (LVMI) and quality of life (QOL). This was a multicenter, randomized, double-blind, placebo-controlled trial in Chinese men and women aged between 20 and 75 years with mild essential hypertension (systolic blood pressure [SBP] 140-159 mm Hg and diastolic blood pressure [DBP] 90-99 mm Hg). Patients took capsules containing 500 mg stevioside powder or placebo 3 times daily for 2 years. After 2 years, the stevia group had significant decreases in mean (SD) SBP and DBP compared with baselineand compared with placebo). There were no significant changes in body mass index or blood biochemistry, and the results of laboratory tests were similar in the 2 groups throughout the study. No significant difference in the incidence of adverse effects was noted between groups, and QOL scores were significantly improved overall with stevia compared with placebo. Neither group had a significant change in mean LVMI. However, after 2 years, 6 of 52 patients (11.5%) in the stevia group had left ventricular hypertrophy (LVH), compared with 17 of 50 patients (34.0%) in the placebo group. Of those who did not have LVH at baseline, 3 of 46 patients (6.5%) in the stevia group had developed LVH after 2 years, compared with 9 of 37 patients (24.3%) in the placebo group. In this 2-year study in Chinese patients with mild hypertension, oral stevia significantly decreased SBP and DBP compared with placebo. QOL was improved, and no significant adverse effects were noted.
 

Antihyperglycemic effects of stevioside in type 2 diabetic subjects.
Gregersen S,. Aarhus University Hospital, Denmark.
Metabolism. 2004 Jan;53(1):73-6.
Stevioside is present in the plant Stevia rebaudiana Bertoni (stevia). Extracts of stevia have been used for the treatment of diabetes in, for example, Brazil, although a positive effect on glucose metabolism has not been unequivocally demonstrated. We studied the acute effects of stevioside (stevia) in type 2 diabetic patients. We hypothesize that supplementation with stevia to a test meal causes a reduction in postprandial blood glucose. Twelve type 2 diabetic patients were included in an acute, paired cross-over study. A standard test meal was supplemented with either 1 g of stevioside or 1 g of maize starch (control). Blood samples were drawn at 30 minutes before and for 240 minutes after ingestion of the test meal. Compared to control, stevia reduced the incremental area under the glucose response curve by 18%. The insulinogenic index was increased by approximately 40% by stevia compared to control. Stevia tended to decrease glucagon levels. In conclusion, stevia reduces postprandial blood glucose levels in type 2 diabetic patients, indicating beneficial effects on the glucose metabolism. Stevia may be advantageous in the treatment of type 2 diabetes.

Stevia lowers blood pressure
Chan P, et al. A double-blind placebo-controlled study of the effectiveness and tolerability of oral stevioside in human hypertension. Taipei Wan Fang Hospital, Taiwan.: Br J Clin Pharmacol 2000 50(3):215-20
A multicentre, randomized, double-blind, placebo-controlled study was undertaken. This study group consisted of 106 Chinese hypertensive subjects with diastolic blood pressure between 95 and 110 mmHg and ages ranging from 28 to 75 years with 60 subjects (men 34, women 26) allocated to active treatment and 46 (men 19, women 27) to placebo treatment. Each subject was given capsules containing stevioside stevia (250 mg) or placebo thrice daily and followed-up at monthly intervals for 1 year. After 3 months, the systolic and diastolic blood pressure of the stevia group decreased significantly and the effect persisted during the whole year. Blood biochemistry parameters including lipid and glucose showed no significant changes. No significant adverse effect was observed and quality of life assessment showed no deterioration. This study shows that oral stevia is a well tolerated and effective modality that may be considered as an alternative or supplementary therapy for patients with hypertension.

Stevia helpful for diabetes and hypertension
Jeppesen PB, et al. Stevioside acts directly on pancreatic beta cells to secrete insulin. Metabolism 2000 Feb;49(2):208-14.
The popularity of stevia continues to grow as more and more people find out about this amazing no-calorie herbal sweetener. One of the primary constituents of stevia that gives it its sweet taste is stevioside, which has been commercialized as a sweetener in Japan for more than 25 years. Lately, studies have shown that stevia, in addition to being a sweetener, has certain health benefits, too, particularly for diabetics and those with elevated blood pressure.
    Stevia has been used for many years in the treatment of diabetes among Indians in Paraguay and Brazil. However, the mechanism for the blood glucose-lowering effect remains unknown. A study conducted at Aarhus University Hospital in Denmark found that stevioside enhances insulin secretion from mouse pancreatic islets in the presence of glucose. The researchers state, "Stevioside stimulates insulin secretion via a direct action on pancreatic beta cells. The results indicate that the compounds may have a potential role as an anti-hyperglycemic agent in the treatment of type 2 diabetes mellitus."
    A double-blind, placebo-controlled study in Taiwan studied 106 Chinese hypertensive subjects ages ranging from 28 to 75 years. Each subject was given capsules containing 250 mg stevioside or placebo three times daily and followed-up at monthly intervals for 1 year (the average person who uses stevia ingests about 100 mg a day of stevioside). After 3 months, the systolic and diastolic blood pressure of the stevioside group decreased by about 6 points, and the effect persisted during the whole year. Blood biochemistry including lipid and glucose showed no major changes. No significant adverse effects were observed.
    Dr. Sahelian comments: Stevia is a wonderful alternative to sugar and artificial sweeteners for those who have diabetes. The first study mentioned above gives us one more reason to recommend diabetics take advantage of this safe, no-calorie herbal sweetener. The second study indicates that not only stevia is safe for those with hypertension, but can actually reduce blood pressure.

Stevia Emails
Q. I suffer from fructose intolerant. I am wondering if stevia is safe for those of us who suffer from this disease. Also I am needing the Chemical breakdown of this sugar in the body. I am not able to digest fructose, sucrose, honey, molassas, splenda, or just about any regular sugar. I am also not a fan of the diet industry puting aspartime in foods, it taste nasty and is not good for you. If you could please look into this for me I will tell everyone on the fructose intolerant forum about this sugar and hopefully we can live a better life.
     A. Stevia contains stevioside, a compound that has a unique structure far different than fructose or any sugar. We don't see any relationship, even remotely, between the stevia chemical structure and sugars.

I have been using stevia since 1988. I'm a 55 year old female. There are no ill effects from this product. I use stevia in yerba mate tea daily. I drink at least 12 cups, every day for all these years. I was recently in a very bad accident and had my back fractured in four places. I'm up, going and getting back my physical strength. I truly believe the tea and stevia are responsible for my well being.

Q. I purchased some stevia from a local health food store. I have tried using stevia to sweeten desserts but we find it to be very bitter. Are different stevia brands different?
   A. Yes, there are differences between brands. I prefer the stevia clear liquid. Most people make the mistake of using too much stevia thus tasting the bitterness. Try smaller amounts and a different brand.

Q. Is this herb safe to use for persons with hypoglycemia?
   A. Most of the time stevia is used in such small quantities that it should not influence blood sugar to any significant extent.

Q. I have kidney failure - will be on dialysis soon. Is there anything known about using stevia with this condition?
   A. Stevia should be safe to use in kidney failure.

Q. You had an artcle in the February 2000 "Better Nutrition" magazine entitled "Suddenly Stevia". In the article you said that the Japanese have used stevia to sweeten a number of products, including chewing gum. But you go on and say that these such foods are prohibited in the United States. I know that I have purchased teas with stevia at local health food stores. The chewing gum is what I was really interested in and I was wondering if I could order it from Japan or would that be prohibited too?
   A. Stevia can be added to certain teas and other products, but the label cannot claim that stevia is being used as a sweetener. I don't know the legality of ordering stevia enriched foods from Japan.
 

References
Alvarez M, Bazzote RB, Godoy GL, et al. Effect of aqueous extract of Stevia rebaudiana Bertone on biochemical parameters of normal adult persons. Arq Biol Tech 24:178, 1981. A daily dose of 250 mg of stevioside from stevia four times a day on the glucose tolerance test showed a marked hypoglycemic effect.
Akashi J, Yokohama S. Safety of extract of dried Stevia leaves--results of toxicity tests. Shokuhin Kogya 10B, 34-43, 1975.
Aquino RP, Behar I, Biondi A, De Simone F, Scalesse G. Isolation of the principal sugars of Stevia rebaudiana. Boll Soc Ital Biol Sper, 61(9):1247-52, 1985.
Bridel M, Lavielle R. Le principe a saveur sucree du Kaa'-he'-e (Stevia rebaudiana Bertoni). J Pharm Clin 14:99-154, 1931.
Crammer B, Ikan R. Progress in the chemistry and properties of setvia ebaudioside; in Greenby TH (ed): Developments in Sweeteners. London, Elsevier, vol 3:45-64, 1987.
Curi R, Alvarez M, Bazotte RB, Botion LM, Godoy JL, Bracht A. Effect of Stevia rebaudiana on glucose tolerance in normal adult humans. Braz J Med Biol Res 19(6):771-4, 1986. "It is generally accepted that the inhibition of gluconeogenesis is able to lead to hypoglycemia. Thus, some substances which inhibit gluconeogenesis are therapeutic to diabetes. It is possible that the stevia extract, by increasing the mitochondrial respiration rate and inhibiting the gluconeogenetic pathway, can indeed lead to hypoglycemia. Nevertheless, a possible effect of this plant on insulin secretion or peripheral action should be considered."
Das S, Das AK, Murphy RA, Punwani IC, Nasution MP, Kinghorn AD. Evaluation of the cariogenic potential of the intense natural sweeteners stevia stevioside and rebaudioside A. Caries Res 26(5):363-6, 1992.
Kinghorn AD, Soejarto DD, Nanzakkara NP, Compadre CM, Makapugay HC, Hovanec-Brown JM, Medon PJ, Kamath SK. A phytochemical screening procedure for sweet ent-kaurene glycosides in the genus Stevia. J Nat Prod 47(3):439-44, 1984.
Mauri P, Catalano G, Gardana C, Peitta P. Analysis of stevia glycosides by capillary electrophoresis. Electrophoresis 17:367-371, 1996.
Melis MS. Chronic administration of aqueous extract of Stevia rebaudiana in rats: renal effects. J Ethnopharmacol 47(3):129-34, 1995.
Melis MS. A crude extract of Stevia rebaudiana increases the renal plasma flow of normal and hypertensive rats. Braz J Med Biol Res 29(5):660-75, 1996. Stevia extract, at doses higher than used for sweetening purposes, dilates blood vessels in animals who have either normal or high blood pressure.
Planas Mazzei G, Kuc J. Contraceptive properties of Stevia rebaudiana. Science 162 (857):1007, Nov 29,1968. This study found a reduction in fertility in female rats given stevia decoction. According to the article, Paraguayan Matto Grosso Indian tribes have been known to drink stevia tea as a form of contraceptive. Later inquiries made in several locations in northeastern Paraguay did not confirm the use of stevia for contraceptive purposes (Soejarto, 1983).
Soejarto DD. Potential sweetening agents of plant origin, field search for sweet-tasting Stevia spieces: Economic Botany 77, 1983.
Soejarto D, Kinghorn AD, Farnsworth NR. Potential sweetening agents of plant origin. III. Organoleptic evaluation of Stevia leaf herbarium samples for sweetness. J Natural Products 45:590-99, 1982.
 

Nature’s No-Calorie Sweetener 
Stevia is a plant of the daisy family that grows naturally in South America. The plant, at its full maturity, reaches a height of close to three feet. The green leaves of this plant contain large amounts (up to 5 percent of dry weight) of stevioside, a sweetener estimated to be 300 times as sweet as table sugar. 

 Is Stevia Safe?

Stevia has been used as a sweetening ingredient in foods and drinks by South American natives for many centuries, and there is no report of any plant toxicity to the consumers. Stevia has been added to a number of food products in Japan since the mid 1970s. No indications of any significant side effects have yet been reported after more than two decades of use. Similarly, no reports of any adverse reactions to stevia have been reported in the United States.
 

Sugar substitute

Those who are novices at using stevia often make the mistake of using too much thinking they should use it as much as sugar. Stevia is 300 times sweeter than sugar, excessive amounts can lead to over-sweetness and an aftertaste. Generally, one teaspoon of stevia would be equivalent to one cup of sugar, while a quarter teaspoon would be equivalent to one tablespoon of sugar. Stevia is available in concentrated liquid form, and often two to four drops of the liquid extract added to tea or coffee is sufficient to sweeten the drink. Hopefully, with time, stevia can be added to a variety of sodas, candies, gums, and other foods in the US, just like it currently is in Japan and other countries. And we could see stevia packets at restaurants right along with the pink and blue artificial sweeteners.

For additional references, see The Stevia Cookbook.
Ray Sahelian, M.D. says, " I have used stevia daily for more than 10 years with absolutely no adverse effects. I spent long hours at the UCLA medical library while writing my book The Stevia Cookbook. I evaluated in detail all the published studies on stevia over the past few decades, and based on a thorough evaluation, I am confident to say that stevia, in my opinion, is safe and quite likely significantly safer than some of the artificial sweeteners currently on the market. Stevia has been given in massive doses to three generations of rodents with no harmful effects noted. Stevia has been used in Japan for more than 3 decades with no adverse reactions reported. It's too bad that more Americans have not heard of this amazing and safe sweetener. Those with diabetes can take stevia as a substitute for artificial sweeteners and sugar."

Q. Just wanted to let you know that I "met" you not too long ago by accident while attending the "University of Google" (you are familiar, right?) and I was so excited and impressed with all I read on your site, esp your story. You made me smile and you made me learn. Imagine my surprise today when I found that you know Donna Gates. I have been using her Body Ecology diet with much success for my autistic son for a few months. When your newsletter spoke of the Stevia Cookbook, I was suspect that you were a copycat of Donna Gates. and then, wow, it turns out you co-authored the book! So sorry for thinking evil of you for one split sec! We are trying to recover our 11 yo son from autism, and so, are very appreciative of all we can learn toward this goal. Thanks again for all you are doing to help so many,

Stevia Extract is available in 80% and 90% steviosides