Stevia, a sugar substitute, is generally regarded as safe by health and food safety organizations. The studies that they rely on are industry-funded, so we have to take their take on this artificial sugar with a pinch of salt.
The World Health Organization says that the main extract of Stevia, called steviol glycosides is safe in the amounts that are typically used.

Sugar Substitute

Though Stevia is 300 to 400 times sweeter than sugar, the Center of Science in the Public Interest, which is a food advocacy group, considers it safer than other substitutes and artificial sweeteners.
Many products club Stevia with other sugar alcohols like erythritol, which can cause digestive complications.

Artificial Sweetener Stevia

It can cause metabolic effects, and may not be helpful for weight loss.
Sweeteners are also associated with obesity, diabetes and heart disease, apart from affecting our gut microbes.

Long Term Usage of Nonnutritive Sweeteners

<figure><img src="https://static01.nyt.com/images/2018/05/08/well/ask-stevia/ask-stevia-articleLarge.jpg?quality=75&amp;auto=webp&amp;disable=upscale" srcset="https://static01.nyt.com/images/2018/05/08/well/ask-stevia/ask-stevia-articleLarge.jpg?quality=90&amp;auto=webp 600w, https://static01.nyt.com/images/2018/05/08/well/ask-stevia/ask-stevia-jumbo.jpg?quality=90&amp;auto=webp 1024w, https://static01.nyt.com/images/2018/05/08/well/ask-stevia/ask-stevia-superJumbo.jpg?quality=90&amp;auto=webp 2048w" width="600" height="400"><figcaption dir="auto">Credit...
iStock</figcaption></figure>By Alice CallahanQ. Are there any downsides to the sweetener stevia? Is it associated with negative effects or gastrointestinal symptoms? Does it cause sugar cravings if you’ve given up sugar?A. Major health and food safety organizations generally regard stevia, a sweetener made from a plant native to South America, as safe. But some researchers warn that we don’t have enough evidence to fully understand how products like stevia, so-called nonnutritive sweeteners that have no calories, affect the body.Ounce for ounce, stevia is <a href="https://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm397725.htm" title="" rel="noopener noreferrer" dir="ltr">200 to 400 times</a> sweeter than table sugar, so a small amount can add a lot of sweetness. Stevia is found in products like soda and iced tea, sweetener packets with names like Truvia and Pure Via, and foods marketed as low sugar, such as ice cream and yogurt.Stevia sweeteners are purified extracts of one type of constituent, called steviol glycosides, found in the leaves of the stevia plant. The <a href="http://onlinelibrary.wiley.com/doi/10.2903/j.efsa.2010.1537/full" title="" rel="noopener noreferrer" dir="ltr">European Food Safety Authority</a> and the <a href="http://apps.who.int/iris/bitstream/10665/259483/1/9789241210164-eng.pdf" title="" rel="noopener noreferrer" dir="ltr">World Health Organization</a> both say these compounds are safe in the amounts typically used. This conclusion is based on studies — mostly industry funded — in bacteria and rodents that generally show that stevia doesn’t cause damage to DNA or cancer, as well as several human studies that found no effect on blood pressure or blood glucose.AdvertisementThe Center for Science in the Public Interest, a food advocacy group that has often been critical of sugar substitutes, initially raised concerns about stevia sweeteners when they came onto the market in 2008, saying the Food and Drug Administration should have required more testing. However, the group ranked stevia as one of the safest of the sugar substitutes in a <a href="https://cspinet.org/new/201411121.html" title="" rel="noopener noreferrer" dir="ltr">2014 report</a>, in part because it has a long history of use in Japan.Stevia sweeteners are broken down by bacteria in the large intestine, but gastrointestinal symptoms like bloating and diarrhea haven’t been <a href="https://www.tandfonline.com/doi/abs/10.1080/07315724.2017.1372821?journalCode=uacn20" title="" rel="noopener noreferrer" dir="ltr">reported</a> in studies. However, some products containing stevia also include sugar alcohols like <a href="https://www.ncbi.nlm.nih.gov/pubmed/25744158" title="" rel="noopener noreferrer" dir="ltr">erythritol</a>, which can cause digestive complaints if consumed in large amounts.<UL><LI>Thanks for reading The Times.</LI></UL>Using stevia is a reasonable strategy to reduce the amount of sugar we consume, said Marina Chaparro, a registered dietitian and spokeswoman for the Academy of Nutrition and Dietetics. “It has the flavor without adding the extra sugar and affecting your blood sugar,” which is especially useful for those with diabetes, she said. She also recommends other strategies to reduce sugar intake, like adding fresh fruit to oatmeal instead of sugar and drinking flavored water instead of soda.It’s uncertain, though, whether using calorie-free sweeteners like stevia can reduce caloric intake. A recent small <a href="https://www.ncbi.nlm.nih.gov/pubmed/27956737" title="" rel="noopener noreferrer" dir="ltr">study</a> found, for example, that when participants had a drink sweetened with stevia instead of sugar in the morning, they compensated by eating more at lunch, along with bigger lunchtime spikes in blood glucose and insulin.And some researchers worry that long-term use of nonnutritive sweeteners could have unintended metabolic effects that might not be detected using standard toxicological tests or other measures. “Over all, for nonnutritive sweeteners, we lack evidence, but that’s especially true for stevia,” which has not been extensively studied, said Meghan Azad, assistant professor of pediatrics and child health at the University of Manitoba.AdvertisementDr. Azad was the lead author of a recent <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5515645/" title="" rel="noopener noreferrer" dir="ltr">review</a> of long-term use of nonnutritive sweeteners that concluded that they may not be helpful for weight loss and, in some studies, were associated with increased incidence of obesity, diabetes and heart disease. She and her co-authors, however, found no long-term studies of stevia in particular to include in that review.Additional <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4661066/" title="" rel="noopener noreferrer" dir="ltr">research</a> is questioning how these sweeteners might affect our <a href="https://well.blogs.nytimes.com/2014/09/17/artificial-sweeteners-may-disrupt-bodys-blood-sugar-controls/" title="" dir="ltr">gut microbes</a> or if the taste of sweetness without the reward of calories could alter regulation of energy intake and response to sugar consumption.These concerns are preliminary, says Dr. Azad, and we need more research. But, she said, “Just blindly assuming that these are a healthy alternative to sugar is probably not a wise move without the evidence to back it up.”Do you have a health question? <a href="https://well.blogs.nytimes.com/ask/well/questions" title="" dir="ltr">Ask Well</a>Advertisement

Some researchers warn that we don’t have enough evidence to fully understand how sweeteners that have no calories affect the body.

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By Alice Callahan Q. Are there any downsides to the sweetener stevia? Is it associated with negative effects or gastrointestinal symptoms? Does it cause sugar cravings if you’ve given up sugar? A. Major health and food safety organizations generally regard stevia, a sweetener made from a plant native to South America, as safe. But some researchers warn that we don’t have enough evidence to fully understand how products like stevia, so-called nonnutritive sweeteners that have no calories, affect the body.

Ounce for ounce, stevia is <a dir="ltr" href="https://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm397725.htm" rel="noopener noreferrer" title="">200 to 400 times </a>sweeter than table sugar, so a small amount can add a lot of sweetness. Stevia is found in products like soda and iced tea, sweetener packets with names like Truvia and Pure Via, and foods marketed as low sugar, such as ice cream and yogurt.

Stevia sweeteners are purified extracts of one type of constituent, called steviol glycosides, found in the leaves of the stevia plant. The <a dir="ltr" href="http://onlinelibrary.wiley.com/doi/10.2903/j.efsa.2010.1537/full" rel="noopener noreferrer" title="">European Food Safety Authority </a>and the <a dir="ltr" href="http://apps.who.int/iris/bitstream/10665/259483/1/9789241210164-eng.pdf" rel="noopener noreferrer" title="">World Health Organization </a>both say these compounds are safe in the amounts typically used. This conclusion is based on studies — mostly industry funded — in bacteria and rodents that generally show that stevia doesn’t cause damage to DNA or cancer, as well as several human studies that found no effect on blood pressure or blood glucose.

Advertisement The Center for Science in the Public Interest, a food advocacy group that has often been critical of sugar substitutes, initially raised concerns about stevia sweeteners when they came onto the market in 2008, saying the Food and Drug Administration should have required more testing. However, the group ranked stevia as one of the safest of the sugar substitutes in a <a dir="ltr" href="https://cspinet.org/new/201411121.html" rel="noopener noreferrer" title="">2014 report </a>, in part because it has a long history of use in Japan.

Stevia sweeteners are broken down by bacteria in the large intestine, but gastrointestinal symptoms like bloating and diarrhea haven’t been <a dir="ltr" href="https://www.tandfonline.com/doi/abs/10.1080/07315724.2017.1372821?journalCode=uacn20" rel="noopener noreferrer" title="">reported </a>in studies. However, some products containing stevia also include sugar alcohols like <a dir="ltr" href="https://www.ncbi.nlm.nih.gov/pubmed/25744158" rel="noopener noreferrer" title="">erythritol </a>, which can cause digestive complaints if consumed in large amounts.

<ul><li>Thanks for reading The Times. </li> </ul>Using stevia is a reasonable strategy to reduce the amount of sugar we consume, said Marina Chaparro, a registered dietitian and spokeswoman for the Academy of Nutrition and Dietetics. “It has the flavor without adding the extra sugar and affecting your blood sugar,” which is especially useful for those with diabetes, she said. She also recommends other strategies to reduce sugar intake, like adding fresh fruit to oatmeal instead of sugar and drinking flavored water instead of soda.

It’s uncertain, though, whether using calorie-free sweeteners like stevia can reduce caloric intake. A recent small <a dir="ltr" href="https://www.ncbi.nlm.nih.gov/pubmed/27956737" rel="noopener noreferrer" title="">study </a>found, for example, that when participants had a drink sweetened with stevia instead of sugar in the morning, they compensated by eating more at lunch, along with bigger lunchtime spikes in blood glucose and insulin.

And some researchers worry that long-term use of nonnutritive sweeteners could have unintended metabolic effects that might not be detected using standard toxicological tests or other measures. “Over all, for nonnutritive sweeteners, we lack evidence, but that’s especially true for stevia,” which has not been extensively studied, said Meghan Azad, assistant professor of pediatrics and child health at the University of Manitoba.

Advertisement Dr. Azad was the lead author of a recent <a dir="ltr" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5515645/" rel="noopener noreferrer" title="">review </a>of long-term use of nonnutritive sweeteners that concluded that they may not be helpful for weight loss and, in some studies, were associated with increased incidence of obesity, diabetes and heart disease. She and her co-authors, however, found no long-term studies of stevia in particular to include in that review.

Additional <a dir="ltr" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4661066/" rel="noopener noreferrer" title="">research </a>is questioning how these sweeteners might affect our <a dir="ltr" href="https://well.blogs.nytimes.com/2014/09/17/artificial-sweeteners-may-disrupt-bodys-blood-sugar-controls/" title="">gut microbes </a>or if the taste of sweetness without the reward of calories could alter regulation of energy intake and response to sugar consumption. These concerns are preliminary, says Dr. Azad, and we need more research. But, she said, “Just blindly assuming that these are a healthy alternative to sugar is probably not a wise move without the evidence to back it up.” Do you have a health question? <a dir="ltr" href="https://well.blogs.nytimes.com/ask/well/questions" title="">Ask Well </a>

Are There Downsides to the Sweetener Stevia?

Sugar Substitute

Artificial Sweetener Stevia

Long Term Usage of Nonnutritive Sweeteners

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