Stevia supplement extract, liquid, powder, packets, benefit, dosage, safety and side effects by Ray Sahelian, M.D., author of The Stevia Cookbook which contains sugar free recipes
January 2, 2017

Soft drinks and other sugar-sweetened beverages can seriously damage heart health. The added sugar in sodas, fruit drinks, sweet teas and energy drinks affects the body in ways that increase risk of heart attack, heart disease and stroke. But there is a sugar alternative.
Benefits of stevia supplement products: What if there were a natural sweetener that:

Was 300 times sweeter than regular sugar, with minimal aftertaste
Had no calories
Was suitable for diabetics and those with high blood pressure or other medical conditions
Appropriate for children
Did not cause cavities
Was heat stable and thus could be used for cooking and baking
Was a great alternative to synthetic sweeteners
Easily blended with other sweeteners, such as honey
And already widely and safely consumed in many countries around the world for decades?

Note: There are many companies that produce and make stevia extracts, and each company has their own methods. If you are not satisfied with a product from one company, do not give up, try another one until you find one without an aftertaste.


Brief history and review of safety
Stevia rebaudiana 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 20 years of use. Similarly, no reports of any adverse reactions have been reported in the United States. Donna (co-author of The Stevia Cookbook) and her family have been using stevia since 1990 without any health problems. I have used stevia daily in my morning tea, and to sweeten cocoa powder, since 1997 without any health problems. There are no indications at this point from any source that it has shown toxicity in humans.


Preliminary studies with stevia have shown that it contains certain chemicals that provide a sweet taste including stevioside, and rebaudioside A. Stevioside makes up about five percent of the dry weight, while rebaudioside makes up two percent. Rebaudioside A is apparently a more pleasant-tasting sweet substance. The oily part of stevia contains a number of sterols including stigmasterol, Beta-sitosterol and campesterol. The compounds within stevia are very stable and can last for decades. They are resistant to heat and time.


Role in weight gain or loss
Researchers at the Institute on Aging at the University of Florida evaluated the effect of preloads containing stevia, aspartame or sucrose on food intake, satiety and postprandial glucose and insulin levels. The study included 19 healthy lean and 12 obese individuals between the ages of 18-50 who completed three separate food test days during which they received either low-calorie pre-loads of stevia (290kcal) or asparatame (290kcal) or sucrose (493kcal) before lunch and dinner. Those consuming stevia or aspartame did not try to compensate for the lower caloric intake by eating more food. There were no differences reported in satiety and hunger levels. Participants experienced lower blood glucose and insulin levels when consuming stevia. The researchers wrote “The key finding was that participants did not compensate by eating more at either their lunch or dinner meal when they consumed lower calorie preloads containing stevia or aspartame compared to when they consumed higher calorie preloads containing sucrose.” Anton SD, Martin CK, Han H, et al. Effects of stevia, aspartame, and sucrose on food intake, satiety, and postprandial glucose and insulin levels. Appetite, 2010.


Substituting low calorie sweetener options for their regular-calorie versions results in a modest weight loss and may be a useful dietary tool to improve compliance with weight loss or weight maintenance plans. Low-calorie sweeteners and body weight and composition: a meta-analysis of randomized controlled trials and prospective cohort studies. Am J Clin Nutr 2014.


Interview for an article
I am a reporter for a health magazine: Stevia has been given the long-awaited GRAS (Generally Recognized as Safe) green light by the FDA, and recently Reb A, a zero-calorie sweetener derived from the leaf has been OK'd for more widespread use in food and drink products--but some critics don't feel that it's been tested enough to be included in the far-reaching soft drink industry. Are their safety concerns legitimate?
   Stevia has been used in Japan and other countries for several decades. It has been available in the US since the mid 1990s and there have not been any reported adverse effects with its use. Frankly, I am surprised that the FDA did not allow it to be called a sweetener until the big companies petitioned it. In fact, for many years, until 2008, the FDA continued saying that they felt it was not safe. Suddenly they changed their mind. I am not aware of any long term new stevia safety studies that were published recently that would have led the FDA to change their mind. The whole thing is suspicious and makes the FDA appear not be playing fair. When the health food industry wanted the restriction on stevia being called a sweetener lifted, the FDA was against it. But when the big companies asked, it suddenly became safe.

For someone looking to replace sugar with stevia as their main dietary sweetener, what amount is recommended for daily use? And would you recommend using it instead of sugar as much as possible? Are there any warnings/dangers to beware of when using it in this way?
   I have been using this natural sweetener daily since the mid 1990s with a few drops of stevia liquid in my tea 2 or 3 times a day without any health problems. I know many people who have been using it daily for over a decade without any health problems. I am not concerned with stevia causing any medical conditions, in fact, from all the studies that I have reviewed, it is a very safe supplement and most likely much, much safer than many artificial sweeteners. 

A natural sweetener with the following benefit:
Stevia is 300 times sweeter than regular sugar, with minimal aftertaste. Stevia extract has no calories and is suitable for diabetics and those with high blood pressure. Children can use it without health concerns and it does not cause tooth cavities. The herbal sweetener is heat stable and thus could be used for cooking and baking. Stevia extract is a great alternative to synthetic sweeteners. It can be easily blended with other sweeteners, such as honey. Stevia is already widely and safely consumed in many countries around the world for decades.

   This remarkable, no-calorie sweetener is, unfortunately, not a household name but is on its way to becoming very popular since Coke and Pepsi will be using extracts in their drinks. I believe that eventually stevia will be one of the most popular and widely used no-calorie sweeteners in the world. With the availability of stevia extract there seems to be little reason to use artificial sweeteners such as aspartame and saccharin.


Int J Food Sci Nutr. 2015. Study of Stevia rebaudiana Bertoni antioxidant activities and cellular properties. The aim of our study was to determine the antioxidant activities, cytotoxicity and proliferative properties in Stevia rebaudiana leaves and stems. Leaves extracts exhibited a higher antioxidant activity than stems extract, through oxygen radical absorbance capacity (ORAC) and cellular antioxidant activity (CAA) assays. Stevioside and rebaudioside A, the main sweetening metabolites in stevia leaves, exhibited a low ORAC value in comparison with plant extracts, while did not elicit any CAA. Stevia rebaudiana did not exhibit toxicity against HepG2 (hepatocellular carcinoma) human cells. No proliferative nor catalase modulations were observed in cells treated with such extracts. Our findings support the promising role of stevia that, apart from its sweetness, can act as a source of antioxidants, even at the intracellular level.


Chem Biodivers. 201. Cytotoxic and apoptosis-inducing activities of steviol and isosteviol derivatives against human cancer cell lines.


2008 - Stevia approved as sweetener by FDA
The Food and Drug Administration has declared the herb stevia safe for use in foods and beverages, which Coca-Cola Co., PepsiCo Inc. and other companies to market it in a variety of products. Coke introduced a reduced-calorie version of Sprite, called Sprite Green, and some Odwalla juice drinks with stevia extract. Pepsi has SoBe Lifewater, and an orange-juice drink called Trop50, containing half the calories and sugar of orange juice.
   The approval by the FDA for stevia to be used as a sweetener is puzzling since for years it had declared that stevia may not be safe. After Coke and Pepsi ask for approval, the FDA suddenly changes it's mind and now believes that it is safe to be consumed by the masses. I have seen no new research that would have led to a change of mind by the FDA. I have always ascertained that stevia was safe to use by the public and had been puzzled that the FDA had come out against it in the past.

Stevita, Simply Stevia extract 100 packets
Supplement Facts: Serving Size 1 Packet - Stevia extract 96 percent steviosides.
Suggested Use: 1 packet with tea, coffee, beverage or as desired in cooking or baking.

The Stevita Simply packets are smaller than regular packets for sugar or artificial sweeteners. You can take them along on trips or while at a restaurant to use instead in your tea or coffee.

The Stevia Cookbook information

The Stevia Cookbook by Ray Sahelian, M.D. and Donna Gates explains the history, dealings with the FDA, safety of stevia extract, use by children, diabetics, for weight loss, and includes numerous recipes. Positive reviews in a number of magazines, including Foreword, Booklist, and Library Journal. "The authors bring a wealth of credentials to this well-prepared compendium.... The Stevia Cookook offers sweet and healthy alternatives," says Foreword. "Recipes are easy to follow," adds Booklist. "The Stevia Cookbook contains all you need to know about the safety of various sweeteners and the political and economic controversy surrounding stevia. Best of all is the authors' knowledgeable writing, sweetened with hefty dose of humor," says Taste For Life.

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
    God's Gift to the Guarani
    Cultivation and Growing Pains
    The Sweet Rediscovery
    Sayonara Saccharin
    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
    Acesulfame K
    Stevia Safety
    Our Daily Stevia Dose
    Animal Studies
    Latest Safety Studies
4. The Many Faces
    Fresh Leaves
    Dried Leaves
    Green Powder
    White Extract
    Liquid Concentrates

5. Staying Healthy
    Weight Loss
    Tooth Decay
    High Blood Pressure
6. Cooking with stevia and recipes
    Stevia is Not Perfect
    Practical Tips and Suggestions
    Conversion Rate
    Time to Get Started

Part II
7. Breakfasts recipe
8. 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


Excerpt from the book The Stevia Cookbook by Ray Sahelian, M.D. and Donna Gates

CHAPTER One The Stevia Cookbook - DONNA'S STORY

Many years ago I became interested in developing and promoting a more natural lifestyle incorporating whole foods along with sensitivity to our environment. However, early on, it became clear that I was missing one of the key ingredients of this diet: a healthy sugar substitute. I was uncomfortable with many of the artificial sweeteners (aspartame, saccharin) and thus began my search for a natural alternative.

   I first heard about stevia in 1990 from a multilevel marketing firm that was promoting it as a component of a facemask. A green-colored stevia syrup (derived from stevia leaves) was packaged with a small bottle of clay. The instructions recommended that the clay be blended with the stevia syrup and applied to the face. But it was the syrup's potential as a sweetener that interested me. I tried it. It was intensely sweet with a strong licorice-like aftertaste. Later I learned that I had taken far too much, a common mistake made by first-time users. Fortunately, a much more flavorful version of stevia came my way.


The Envelope with the White Powder

I now live in Atlanta, Georgia, and work as a nutritional consultant. During the time I was living in Washington, D.C., I knew some friends who worked at the Chinese Embassy. One night I had dinner with two of them and mentioned my frustration in finding an adequate sugar substitute. Several weeks later, to my surprise, my friends presented me with an envelope containing a white powder that they had requested from a Chinese University. I was now holding a sample of stevioside crystals (one of the main sweet ingredients from the stevia plant). These crystals were extracted from Chinese-grown stevia plants using award-winning Japanese technology. In a joint venture with the Chinese, the Japanese had developed a special technology to extract stevia's super-sweet crystals from the plant, leaving behind the licorice-tasting residue and creating a concentrated powder that, by weight, is 300 times sweeter than sugar.


The No-Calorie Miracle!

I was thrilled! Here was a widely used, totally natural sweetener that had virtually no calories. I immediately began experimenting with it--baking with it, adding it to beverages and making Stevia-flavored desserts. Many clients that I counsel as a nutritionist began to use it in place of sugar. They could now enjoy a sweet taste and avoid the harmful consequences of excessive sugar intake. Soon thereafter, I arranged for delivery of a large amount of stevia, both for my personal use and to make available to clients.


FDA Ruling Sours Sweet Stevia Story

In 1991, a curious thing happened. The Food and Drug Administration (FDA) labeled stevia an "Unsafe food additive" and issued an alert blocking the importation of stevia into the United States. This seemed to be a really peculiar development. After all, not that many people knew about stevia and it was sold almost solely in health food stores. As the months rolled by, I noticed that the health food stores, knowing of the ban, continued to sell stevia quite openly. It moved quickly off the shelves as loyal customers bought the last available supplies. Then it was gone.

   During this time, I did an enormous amount of research. First, I used a Freedom of Information Act request to ensure that I had all the information on stevia then in the hands of the FDA. No indication of any ill effects in humans appeared anywhere in any of the literature, nor in other reports that I found independently. Plus, I was using it regularly, as were many people I knew. No one had noticed any adverse effects. Everyone loved it.

   It was at about this time that I moved to Atlanta and decided to take a stand. The FDA had, by then, succeeded in stonewalling the marketing of stevia by refusing to consider petitions that sought to have it officially placed on the "generally recognized as safe," or "GRAS" list. I found this peculiar since animal studies had indicated saccharin to be cancer causing, yet it was being widely sold. In fact, the SWEET-N-LOW package clearly mentions this concern. Why was saccharin available, yet Stevia, a natural sweetener used for centuries in South America, wasn't?

   The ban on stevia put supporters in a classic "Catch-22" position. In order to prove that stevia was safe for human consumption, millions of dollars (and years of effort) would be required to move this herb through the FDA approval process as an accepted food additive. However, whoever invested all this money would not be able to recoup the full benefits since they could not patent this product. A number of manufacturers could start importing it and marketing it. That's because, unlike aspartame, stevia is an herb and not a synthetic creation by a pharmaceutical company. Economists call this a "free rider." One person or company pays the costs of obtaining the approval and then everyone else rides along for free.


Sweet Revenge--The Dietary Supplement Law of 1994

During 1993, the FDA miscalculated. It attempted to take control of dietary supplements and herbal products and limit their availability to the public. To everyone's surprise, a massive grassroots movement started objecting to this intrusion into each person's right to self-medicate with dietary supplements. Various natural food industry groups organized to respond to this threat. A few senators and members of Congress rallied behind them. Orrin Hatch, the Senator from Utah, was instrumental in solidifying the movement's opposition. Ads were taken on television. I remember seeing a television ad of Mel Gibson in his kitchen opening a vitamin C bottle and about to pop one in his mouth when FDA agents burst into his house and handcuffed him, dragging him out of his house for prosecution. Of course, this was quite an exaggeration, but it made the point. The public rallied, afraid to have their multivitamin bottle snatched away from them.

   Based on the continued pressure from the public, the natural foods industry, and from the American Herbal Products Association, Congress passed the Dietary Supplement Health and Education Act in fall of 1994. This law eased restrictions on a number of dietary supplements for sale to the public. The FDA could no longer classify supplements as food additives, hence they did not be subjected to intensive safety testing before their introduction to the American consumer. You may recall that the hormones melatonin and DHEA became available to the public as a consequence of this law. And, as a result of a vitamin company notifying the FDA of its intention to market stevia, The FDA lifted its ban on stevia in 1995.


Stevia Citizenship Reinstated: Will Sugar Industry Now Hobble on Cane? Written in 1998

So stevia began to flow back into the United States. Not, mind you, as a sweetener, but only when labeled as dietary supplement. Its natural sweetening qualities, the FDA warned, would still be considered a "technical effect," and thus should not be mentioned. While the natural foods industry was encouraged by the lifting of the import ban, few had wanted to attract the attention of the FDA by including stevia in their products and advertising it for what it is--a sweetener. Because stevia remains in legal limbo, food manufacturers are nervous to use it in products.

   I've always wondered whether the FDA was pressured from any giant sugar or artificial industry to ban the import of stevia. After all, if stevia can be imported and sold by anyone, it could be a major economic threat to various companies.

   As this book goes to press, a natural, practically no-calorie, safe-for-diabetics, non-pharmaceutical sweetener already widely used in other countries, including Japan (whose Ministry of Health is notoriously more strict than the FDA), cannot be openly sold as a sweetener in this country.


What is Stevia?

Known by the official taxonomy name of Stevia rebaudiana, it 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.

   At least 150 species are believed to exist in North and South America. In a study done in 1982, more than 110 species were tested for their sweetness. Stevia rebaudiana was found to be the sweetest, although 18 other species were found to also exhibit a sweet taste.The researchers in the above study mention an interesting observation. They found fragments of a 62 year-old leaf that exhibited potent sweetness. This indicates that the chemicals within this herb are very stable and have the ability to withstand time and drying.


White stevia extract

This is the form most commonly used in Japan, and generally contains 85 to 95 percent of the sweet glycosides. In this form, it is close to 300 times sweeter than sugar. A teaspoon of this extract has sweetening power equivalent to 2 to 4 cups of sugar. The sugar-type stevia packets found in many Japanese restaurants are bulked up with another substance (such as maltodextrin) since a much smaller amount of the extract itself is needed. One company in the US has also started marketing stevia in small packets, similarly adding maltodextrin. Could stevia ever become so popular in the US that practically every restaurant in the country would offer packets of this sweetener alongside the pink packets of Sweet' N Low and blue packets of Equal?

   There are hundreds of patents for stevia extraction processes existing around the world. Japan, itself, has over 150. Canadian researchers are hard at work to make a pure extraction process that they hope may completely eliminate the aftertaste. The type of extraction would influence the concentration of the various sweet glycosides, such as stevioside and rebaudioside, and could therefore influence its aftertaste. Thus, not all stevia powders are the same.

   Since extracted white stevia powder is so intensely sweet, we recommend that it be mixed with water and the solution used by the drop. You can dissolve 1 teaspoon of the powder with 3 tablespoons of filtered or sterile water. Once mixed, this solution should be stored in the refrigerator. You can then use it whenever you need a splash of sweetening when cooking. Generally one teaspoonful of this liquid solution, also called a 'working solution,' is roughly equivalent to one cup of sugar.


Stevia Liquid concentrates
These come in two distinctly different forms. One is a black, syrupy concentrate and the other is clear. The black, syrup-like concentrate is made by boiling the dried leaves in water. The clear type of liquid concentrate is made by mixing a large amount of the white powder in distilled water or grain alcohol. All types of liquid extract concentrates are available in health food stores or some retail outlets. They come in various sizes ranging from a third of an ounce to four ounce bottles. Generally a few drops of this concentrate is enough to sweeten a glass of tea, coffee or your favorite drink.

Safety, toxicity tests

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 30 years of use. Similarly, no reports of any adverse reactions have been reported in the United States. There are no indications at this point from any source that stevia has shown toxicity in humans.

A critical review of the genetic toxicity of steviol and steviol glycosides.
Food Chem Toxicol. 2008
The components responsible for the sweet properties of the plant are glycosides of steviol, primary stevioside, which is 250-300 times sweeter than sucrose and rebaudiosides A and C. Stevioside and steviol have been subjected to extensive genetic testing. The majority of the findings show no evidence of genotoxic activity.


Testimonial received by email
Q. I had ocular migraines when I was pregnant 31 years ago and have not had them since until recently. As soon as I started using stevia on my morning oatmeal, I would get ocular migraines almost every day that I used it (around 15 times). As soon as I stopped the stevia, I have had no ocular migraines since. I am doing weight watchers and pretty much eating the same things daily except for the artificial sweetener I use in the morning.
   A. We have not heard of this side effect reported before. Perhaps you can try another brand, there may be ingredients within the stevia product, other than the sweetener, that may cause it.


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 g 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.


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 (Kinghorn, 1985). 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 two pounds) 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 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 (Yodyingyuad, 1991). 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 stevioside, while the fourth group stayed as the controls; they did not get any stevioside. 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 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 grew the same amount as did the control group.
   In the third generation, 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 stevioside they received. Their performance was equal to the controls.
   Microscopic examination of reproductive tissues from all experimental 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 stevioside. In the females, the ovaries of all the animals were perfectly normal.
   In summary, no abnormalities were found in growth and fertility in both sexes. All males mated females efficiently and successfully. Females became pregnant after mating. The duration of pregnancy, number of fetuses, as well as number of young delivered each time from females in the experimental groups were not significantly different from those in the control group."


Summary of the Safety Issue

One can study the influence of a particular chemical in an isolated Petri dish, or a test tube, or on rodents, ad infinitum but not know what this chemical will do in the human body when ingested in the small amounts normally consumed. In our opinion, having reviewed all the safety studies published thus far, and considering the safe, centuries-old consumption in south America, and the two decades-plus use of stevia by Japanese consumers, we conclude that stevia is safe for human consumption, particularly in the dosages normally consumed as a partial alternative to sugar, other natural sweeteners, and artificial sweeteners.


Effect on blood pressure
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.


When normal human volunteers between the ages of 20 to 40 years were given a tea prepared with stevia leaves, a lowering of blood pressure occurred. Certainly more human studies are needed before we can come to any conclusions regarding the full effect of normal daily ingestion of stevioside on blood pressure.


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.


Diabetes patients

The availability of artificial sweeteners has been of enormous benefit to those with diabetes. However, there's always been a concern that over consumption of these synthetic sweeteners may cause some unknown harm to the body. Could stevia substitution be a good alternative for those with diabetes? We believe so. Stevia leaves have been used as herbal teas by diabetic patients in Asian countries. No side effects have been observed in these patients after many years of continued consumption (Suttajit, 1993). Furthermore, studies have shown that stevia extract can actually improve blood sugar levels (Alvarez, 1981, Curi, 1986).
   In 1986, Brazilian researchers from the Universities of Maringa and Sao Paolo evaluated the role of stevia in blood sugar (Curi, 1986). Sixteen healthy volunteers were given extracts of 5 grams of stevia leaves every six hours for three days. The extracts from the leaves were prepared by immersing them in boiling water for 20 minutes. A glucose tolerance test (GTT) was performed before and after the administration of the extract and the results were compared to another group who did not receive the stevia extracts. During a GTT, patients are given a glass of water with glucose and their blood sugar levels are evaluated over the next few hours. Those who have a predisposition to diabetes will have a marked rise in blood sugar levels.
   The volunteers on stevia were found to have significantly lower blood sugar levels after ingestion of stevia. This is a positive indication that stevia can potentially be beneficial to diabetics who substitute stevia in order to decrease their sugar consumption. Even if stevia by itself is not able to lower blood sugar levels, just the fact that a diabetic would consume less sugar is of significant importance in maintaining better blood sugar control.
   If you have diabetes, chances are you consume a large amount of artificial sweeteners and you may be concerned about switching to stevia since long-term human studies have not been done with this herb. You may also be accustomed in your use of these artificial sweeteners and would not be willing to completely stop them. One option is to gradually use less of them while substituting stevia. For instance, you can initially use stevia in some of your drinks, like coffee or tea. After a few weeks, if your comfort level with stevia increases, you can gradually use more of the herbal extract. Over the next few weeks and months you can either switch completely to stevia, or you can continue using it in combination with artificial sweeteners. With time more research will become available on the safety of stevia and artificial sweeteners. Based on the results of these studies, you can determine which ones to continue using in a larger amount. It's also quite possible that artificial sweeteners may be safe in low amounts, but problems could arise when they are used in excessive quantities. By partially or mostly substituting stevia, you can reduce any potential risk. Stevia is a good supplement for those with diabetes.


I am type 2 Diabetic patient since last 4 years. Is it true that Stevia Extracts can activate Beta Cells in pancreas. Can you give me some info & its medical use for diabetes.
   The amount used daily is so small that it probably does not have a major influence on blood sugar control except that it can substitute partially for sugar.


Sweet Teeth with No 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. Scientists have searched to find alternative sweeteners that are not fermentable by bacteria and hence do not cause cavities. Does ingesting stevia lead to tooth cavities? A study done on rats has not shown this to be case. Stevioside and rebaudioside A, the two primary sweet constituents of the stevia plant, were tested in a group of sixty rat pups (Das, 1992) in the following way:


Group 1 was fed sucrose (table sugar), at 30 percent of their diet

Group 2 was given 0.5 percent of their diet in stevioside

Group 3 got 0.5 percent of their diet in rebaudioside A

Group 4 ingested no sugars.


   After 5 weeks there were no differences in food and water intake and weight gain between the four groups. However, the first group had significantly more cavities than the rest of the groups. Groups 2, 3, and 4 were equivalent. 
   The researchers state, "It was concluded that neither stevioside nor rebaudioside A is cariogenic [cavity causing] under the conditions of this study." It appears that the chemicals within the stevia plant that impart its sweetness are not fermentable, and thus do not cause tooth cavities.


Molecules. 2015. Is Stevia rebaudiana Bertoni a Non Cariogenic Sweetener? A Review. Several studies have suggested that in addition to their sweetness, steviosides and their related compounds, including rebaudioside A and isosteviol, may offer additional therapeutic benefits. These benefits include anti-hyperglycaemic, anti-hypertensive, anti-inflammatory, anti-tumor, anti-diarrheal, diuretic, and immunomodulatory actions. Additionally, critical analysis of the literature supports the anti-bacterial role of steviosides on oral bacteria flora. The aim of this review is to show the emerging results regarding the anti-cariogenic properties of S. rebaudiana Bertoni. Data shown in the present paper provide evidence that stevioside extracts from S. rebaudiana are not cariogenic (cavity causing).


Use in Children

Candies, sodas, ice cream, pies, cakes... it's disturbing how many sweet products are ingested by children on a daily basis. All that sugar can lead to tooth cavities and obesity. Partially substituting with stevia can help children satisfy their sweet tooth while decreasing the risks from excessive sugar intake. If you're a parent, you can take advantage of the many recipes provided in The Stevia Cookbook to provide your children with tasty sweets that will satisfy their sweet teeth but not cause damage to the teeth. Obesity in children is a growing problem in this country and any method we have of helping children reduce their caloric intake will be greatly beneficial. There is also a concern with children consuming excessive amounts of artificial sweeteners. The potential, long-term health consequences of saccharin and aspartame ingestion are currently not fully known, but they do need to be kept in mind. Eliminating all artificial sweeteners will be a frustrating enterprise since they are extremely prevalent. However, by partially substituting stevia in homemade desserts, you can significantly reduce your children's exposure to these artificial chemicals.

Use in Pregnancy or Breast Feeding
Since human studies providing stevia during pregnancy have not been done, it is not known whether its use during this period is safe. It’s very likely that small amounts would not cause any problems.


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.

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.

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 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 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. 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. Stevia's taste disappears in strong flavors and blends especially well in citrus flavors such as lemon and cranberry. 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. 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
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
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.

The chemicals within stevia that make it taste sweet are stable in all types of liquids and do not lose their sweetness. Thus, a number of drinks can be superbly sweetened with it. All it takes is usually two to five drops of liquid stevia per glass. Once you get into the habit of using it 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 even when not at home. 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!

Research studies
Antihyperglycemic effects of stevioside in type 2 diabetic subjects.
Metabolism. 2004.
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.

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
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
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.

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


Please stop promoting and using Stevia. Double blind studies have now shown that stevia is a direct cause of Multiple Sclerosis, and the FDA issued a warning against its use.
   A. I have seen no such evidence as of August 2014. I have seen no studies that it is a cause of multiple sclerosis. Perhaps the source of your information was misdirected.

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. Excessive amounts can lead to over-sweetness and an aftertaste. Generally, one teaspoon 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.


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."


Q. Just wanted to let you know that I "met" you not too long ago by accident while attending the "University of Google"? and I was so excited and impressed with all I read on your site. 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.

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I use stevia liquid every day in my morning tea and have been doing so for the past 2 decades without any health problems.
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Supplement Facts
Serving Size: 5 drops (0.208 ml) per 8 oz of liquid or to taste
Servings Per Bottle: 576
  Amount Per Capsule %Daily Value*
Calories 0  
Total Fat 0 g 0%
Saturated Fat 0 g 0%
Trans Fat 0 g  
Cholesterol 0 mg 0%
Sodium 0 mg 0%
Total Carbohydrates 0 g 0%
Dietary Fiber 0 g 0%
Sugars 0 g 0%
Protein 0 g 0%
*Percent Daily Values are based on a 2,000 calorie diet.

Stevia extract pure liquid
Dietary Supplement

Stevia extract contains a minimum steviosides, the active ingredient of Stevia while retaining the other beneficial components. Because of this, you can be assured that you are indeed buying a true stevia extract and that it will be consistent in quality. This is a highly concentrated extract and should not be confused with less potent tinctures or extracts.

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