When it comes to finding sugar alternatives, there is a boatload to chose from. Let’s take a closer look at one of the popular choices, stevia.
We speak to our resident expert, Susan Watkins, RD, CDE, to learn more about stevia and its use for people with Type 1 or Type 2 diabetes.
What is Stevia?
Stevia is a sweetener and sugar substitute derived from the plant Stevia rebaudiana, which is native to Brazil and Paraguay.
The active compounds in stevia are steviol glycosides (mainly stevioside and rebaudioside), which have 100 to 300 times the sweetness of table sugar.
The body does not metabolize the glycosides in stevia, so it contains zero calories like some artificial sweeteners.
Recent research has found that stevia sweeteners as replacements for sugar might benefit people with diabetes, children, and those wishing to lower their intake of calories.
So far, no health concerns with stevia or its sweetening extracts have been determined.
However, the pure leaf or crude extracts are not allowed in food but can be found in dietary supplements and skin products.
Is stevia a “natural” substitute since it’s derived from a plant?
Technically, stevia can be considered natural because it is made from a plant, however, the versions sold in supermarkets vary in quality and most varieties have been processed with added ingredients.
“The form of stevia that is approved in foods is highly processed or purified,” Watkins tells dLife. “Almost all brands, such as Truvia, are processed and have other ingredients added such as sugar alcohols derived from genetically modified corn.”
Watkins says sugar alcohols can cause gut problems to those that are sensitive to it (such as gas, bloating, diarrhea).
Also, brands such as Stevia in the Raw or Purevia add dextrose, or some companies add maltodextrin, which helps the bitter, potent taste of stevia.
Is stevia a good substitute for sugar for people with diabetes?
Now that we have a little background about stevia, is it a good substitute for people with diabetes?
According to Watkins, because it does not affect blood sugar, it will not cause an increase in blood sugar levels like table sugar would.
“So this product can be used to sweeten items while keeping the carbohydrate and sugar level down and helping to achieve good blood sugar control,” Watkins explains.
She says this can help people with diabetes, as high blood glucose levels over time can cause serious complications such as heart disease, kidney damage, and eye and nerve problems.
“Because it also contains no or minimal calories, it can help keep your weight down when used in place of regular sugar,” says Watkins. “Extra body weight for those with Type 2 diabetes can increase your need for medications, insulin, and complications.”
However, Watkins points out some studies have found that by eating products like stevia that are 200-300 times sweeter than sugar, it can make you crave sugar.
“So even though you are eating fewer calories, you need to be sure you are not making up for it later,” Watkins advises.
Also, while stevia is considered safe for people with diabetes, brands that contain dextrose or maltodextrin should be used with caution.
How safe is it?
The refined extracts, such as steviol glycosides, have been approved safe to use in food products marketed in the U.S.
“It has been found to be generally recognized as safe by the FDA in moderate amounts, about 1.8 mg per day per pound of body weight,” says Watkins.
However, the whole leaf, raw, and crude extracts have not been approved safe to use in food products but can be used in supplements and skincare products.
What is the best form of stevia?
The highly purified version of stevia is the only form that is recognized as safe by the FDA.
“Whole leaf stevia and the raw version are not approved to add to food products due to lack of safety studies,” indicates Watkins, “so in food products, you will receive the purified form, therefore, it’s best to stick to one without as many added ingredients.”
The refined extract version can be found in food, as a non-nutritive sweetener.
Truvia and Purevia are purified versions of stevia with added ingredients.
Is there a brand of stevia that you recommend?
“I like to cater this recommendation to the patient,” says Watkins. “If it is someone that does not eat a lot of sugar or sweets, I try to steer them away from stevia or any sweetener altogether,” she admits.
“In these cases, we just focus on controlling the amount of natural sugar or carbohydrate totals at one meal or snack,” she says. “If it is a person that struggles with controlling their sweets, sometimes eliminating these foods altogether for at least a period of time can make a big difference in cravings and eliminate the need for sweeteners.”
Watkins says if it helps a patient to use a little sweetener, they will choose a product based on their specific needs.
For example, for her IBS patients, or those that have sensitive guts, she steers them away from brands with sugar alcohols that might cause more GI upset.
Sometimes it comes down to what brand people can tolerate the taste of.
“Then we focus on using minimal amounts of any sweetener, to get used to the natural sweetness in the foods they choose to eat.,” she says. “As you decrease cakes, cookies, pies, and candy, maybe even stop altogether for a period of time, most people will find they appreciate and enjoy the natural sweetness in foods again, such as fruit.”
In conclusion, stevia products are considered safe, even for people who are pregnant or who have diabetes. However, it’s important to keep in mind more research needs to be done to provide conclusive evidence on diabetes and weight management.
In her final thoughts, Watkins says eating balanced and healthy doesn’t have to be confusing or hard.
“Just try to eat natural, unprocessed foods as the basis of your meals with just a sprinkling of extras,” she says. “So think vegetables, lean proteins, fresh fruit, and whole grains.”
- FDA. (2018) Has stevia been approved by FDA to be used as a sweetener? Retrieved August 7, 2019, from fda.gov/aboutfda/transparency/basics/ucm194320.htm
- H.M.A.B. Cardello, M.A.P.A. Da Silva, M.H. Damasio (1999). “Measurement of the relative sweetness of stevia extract, aspartame and cyclamate/saccharin blend as compared to sucrose at different concentrations”. Plant Foods for Human Nutrition. 54 (2): 119–129. doi:10.1023/A:1008134420339.
- Goyal, S. K.; Samsher; Goyal, R. K. (February 2010). “Stevia (Stevia rebaudiana) a bio-sweetener: a review”. Int J Food Sci Nutr. 61 (1): 1–10. doi:10.3109/09637480903193049. PMID 19961353.