Who Should Avoid Stevia or Exercise Caution?
While highly purified steviol glycoside extracts are generally considered safe by regulatory bodies like the FDA, the plant-based sweetener can have potential adverse effects for certain individuals. Understanding the specific circumstances under which one should be cautious is crucial for safe consumption.
Medical Conditions and Stevia Intake
Certain health conditions can be impacted by stevia's properties, particularly its effects on blood sugar and blood pressure. It is important to differentiate between highly purified stevia extracts and raw or whole-leaf forms, as the latter have less research and are not FDA-approved for use in foods.
Diabetes
Stevia and Diabetes Management For many with diabetes, stevia is a preferred sweetener because it does not raise blood sugar levels like table sugar. Pure stevia extract has a glycemic index of zero and does not cause a glucose spike. However, caution is advised for two main reasons:
- Medication Interaction: Stevia can lower blood sugar levels, and taking it alongside diabetes medication could cause blood sugar to drop too low (hypoglycemia). Close monitoring is essential.
- Stevia Blends: Many commercial stevia products are not pure and contain additives like dextrose or maltodextrin. These fillers can cause a blood sugar increase and should be avoided by diabetics.
Low Blood Pressure
Stevia and Blood Pressure Regulation Stevia has vasodilator properties, meaning it can cause blood vessels to widen and lower overall blood pressure. While this might benefit individuals with hypertension, it can be problematic for those who already have low blood pressure (hypotension). Symptoms could include dizziness, fatigue, or lightheadedness.
Kidney Concerns
The Debate Over Stevia and Kidneys Early concerns about raw stevia affecting the kidneys have largely been disproven or addressed by the use of highly purified extracts. Some newer animal studies, however, suggest that uncontrolled, excessive intake of stevia-based sweeteners may lead to heart and kidney damage. Conversely, other research indicates that stevia may help protect against kidney damage. Given these conflicting results, individuals with pre-existing kidney conditions, or those who consume large quantities, should consult their doctor before using stevia regularly.
Medication Interactions
Several medications can interact with stevia, potentially altering their effectiveness or causing unwanted side effects. Always discuss your stevia intake with a healthcare provider if you are on medication.
Blood Pressure Medications (Antihypertensives)
Because stevia can naturally lower blood pressure, combining it with antihypertensive drugs could cause blood pressure to drop too low. This is particularly important for those on prescribed medication to manage hypertension.
Lithium
Stevia is a diuretic, which means it promotes the excretion of water and electrolytes from the body. This diuretic effect can interfere with how the body clears lithium, potentially leading to a dangerous buildup of the drug. Individuals taking lithium should be especially cautious and speak to their doctor.
Potential Side Effects and Additives
While highly purified stevia extract is generally well-tolerated, some individuals may experience side effects, often linked to other ingredients in the product.
- Digestive Issues: Many stevia blends contain sugar alcohols like erythritol to reduce bitterness and add bulk. In some sensitive individuals, sugar alcohols can cause gastrointestinal distress, including bloating, gas, nausea, and cramping.
- Allergies: Stevia belongs to the Asteraceae family of plants, which also includes ragweed, daisies, and chrysanthemums. Though rare, individuals with allergies to these plants may experience cross-reactivity, leading to mild symptoms like itching or tingling in the mouth. This is more likely with less-purified forms of stevia.
Special Considerations for Specific Populations
Certain groups of people should be mindful of their stevia consumption.
Pregnancy and Breastfeeding
Highly purified stevia extracts are generally considered safe in moderation during pregnancy and breastfeeding, as determined by major regulatory bodies. However, the FDA does not approve raw stevia leaves or crude extracts for use as sweeteners during this period due to a lack of safety research. It is best to stick to reputable, purified products and consult a doctor.
Children
Like adults, children can safely consume stevia within the acceptable daily intake (ADI) levels. The concern lies in the potential for excessive consumption, as children have smaller body weights and could more easily exceed the ADI. Some experts also suggest that frequent use of intense sweeteners could alter a child's preference for sweet tastes. It is recommended to use stevia sparingly for children and consult a pediatrician.
Comparing Sweeteners: Stevia vs. Other Options
To better understand how stevia fits into a diet, here is a comparison with other common sweeteners.
| Feature | Highly Purified Stevia | Sugar (Sucrose) | Monk Fruit | Aspartame |
|---|---|---|---|---|
| Calories | Zero | 4 calories per gram | Zero | Zero |
| Glycemic Index | Zero | 65 (High) | Zero | Zero |
| Sourcing | Plant-based | Plant-based (beet, cane) | Plant-based | Artificial |
| Blood Sugar Impact | None | Significant increase | None | None (but research on gut and metabolic effects ongoing) |
| Side Effects | Rare (can include digestive issues if with sugar alcohols) | Cavities, weight gain, blood sugar spikes | Rare (can include digestive issues if with sugar alcohols) | Headaches, migraines, dizziness (rare) |
| Medication Interactions | Yes (BP, diabetes, lithium) | No direct interactions with these specific drugs | Yes (hypoglycemia risk for diabetics) | Possible concern with certain drugs and PKU (phenylketonuria) |
Conclusion
While highly purified stevia is a generally safe and effective sugar substitute for many, it is not without its caveats. Individuals on medications for diabetes, high blood pressure, or those taking lithium should exercise caution and consult their doctor due to potential interactions. Those with allergies to ragweed and related plants may experience cross-reactivity. The use of raw or crude stevia leaves is not recommended for anyone, including pregnant or breastfeeding women, due to limited safety research. Additionally, paying close attention to the ingredients in commercial stevia blends is essential, especially for those sensitive to sugar alcohols or avoiding added sugars like dextrose. By understanding these specific circumstances, consumers can make informed decisions about incorporating stevia into their diet.
This article is for informational purposes only and is not a substitute for professional medical advice. Always consult with a healthcare provider before making significant dietary changes, especially if you have a pre-existing medical condition or are taking medication.
