Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
8 Feb

A Primal Primer: Stevia

After last week’s article many of you asked about a natural alternative to sugar and artificial sweeteners: stevia. It is widely used in the low carb community to satisfy sugar cravings or simply add a touch of sweetness to a hot beverage or dessert, but should it be? What is stevia? Is it safe? What is its effect on insulin, if any, and does it have a place in a Primal Blueprint eating strategy? Let’s investigate.

Stevia is an herbaceous family of plants, 240 species strong, that grows in sub-tropical and tropical America (mostly South and Central, but some North). Stevia the sweetener refers to stevia rebaudiana, the plant and its leaves, which you can grow and use as or with tea (it was traditionally paired with yerba mate in South America) or, dried and powdered, as a sugar substitute that you sprinkle on. It’s apparently quite easy to grow (according to the stevia seller who tries to get me to buy a plant or two whenever I’m at the Santa Monica farmers’ market), and the raw leaf is very sweet.

Most stevia you’ll come across isn’t in its raw, unprocessed form, but in powdered or liquid extract form. The “sweet” lies in the steviol glycosides – stevioside and rebaudioside – which are isolated in these extracts. Some products use just one, while others use both stevioside and rebaudioside. Stevioside is the most prevalent glycoside in stevia, and some say it provides the bitter aftertaste that people sometimes complain about; rebaudioside is said to be the better tasting steviol glycoside, with far less bitterness. Most of the “raw or natural” stevia products use the full range of glycosides, but the more processed brands will most likely isolate one or more of the steviol glycosides. The popular Truvia brand of stevia products uses only rebaudioside, as do both PureVia and Enliten. Different brands provide different conversion rates, but compared to sucrose, stevioside is generally about 250-300 times as sweet and rebaudioside is about 350-450 times as sweet.

Does Stevia Affect Insulin?

There is one in vitro study that showed stevioside acts directly on pancreatic beta cells to stimulate insulin secretion and another which shows similarly insulinotropic effects of rebaudioside, which may give you pause. Insulin secretion sounds like an insulin spike, no? And since we tend to be wary of unneeded insulin spikes, maybe we should avoid stevia. It’s not so simple, of course. For one, this was an in vitro study, performed in a super-controlled laboratory petri dish type setting; this was not an in vivo study of animals or people eating stevia in a natural, organic way. The results of in vitro studies are notorious for not panning out when you try to replicate them in vivo. Secondly, insulin secretion isn’t necessarily a bad thing. I mean, we need it to shuttle nutrients into cells, and we’d die without it. As I mentioned in the dairy post a few weeks back, insulin is millions upon millions of years old. It’s been preserved throughout history because it’s an essential hormone. It’s not always the bad guy, especially if you’re insulin sensitive.

In fact, the evidence is mounting that stevia actually is an insulin sensitizer that can aid in glucose tolerance and clearance after a meal. The Japanese have been using stevia for decades in the treatment of type 2 diabetics. Let’s look at a few recent studies. In fructose-fed rats, a single instance of oral stevioside increased insulin sensitivity and reduced postprandial blood glucose in a dose-dependent manner. The same study also found that diabetic rats given stevioside required less exogenous insulin for the same effect. Taken together, these results suggest that stevia may not just be a good sugar substitute for diabetics, but an effective supplement for treatment of their insulin resistance.

Another study looked at the postprandial effects of stevia, sucrose, and aspartame in human subjects. Compared to sucrose eaters, stevia eaters showed lower postprandial blood sugar levels. Compared to both sucrose and aspartame eaters, stevia eaters had far lower postprandial insulin levels. Furthermore, eating stevia did not induce increased appetite throughout the day, indicating stable blood sugar and satiety levels. Another strike in stevia’s favor.

Any Other Effects?

There are other potential benefits to using stevia unrelated to its apparent benefits on glycemic control. Here are a few studies I was able to dig up:

  • When combined with inulin, a soluble prebiotic fiber, low-dose stevia increased HDL while lowering overall lipids in male rats. Alone, low-dose stevia lowered cholesterol without the potentially beneficial effect on HDL. It’s also useful to note that high-dose stevia negatively affected some toxic parameters – so don’t eat spoonfuls of stevia (not that you would) – but long term low-dose stevia was deemed safe.
  • Lipid numbers are fun and all, but we’re really interested in avoiding atherosclerotic plaque buildup. In mice treated with stevioside, oxidized LDL was reduced, overall plaque volume was reduced, and insulin sensitivity increased. Overall, atherosclerosis was reduced in the stevioside-treated mice. I couldn’t dig up exactly how they were “treated,” however, but they were given doses of 10 mg/kg.
  • In another study, mice memory was impaired by administration of scopolamine, an anticholigernic found in the intensely hallucinogenic jimson weed (or devil’s weed) and datura. Impaired mice were given oral stevioside (250 mg/kg) and tested for memory retention. Memory deficit was largely reversed with administration of stevioside, which also reduced the brain oxidative damage caused by scopolamine. Clinically relevant? Perhaps not, but it’s interesting.
  • A two-year randomized, placebo-controlled study of Chinese patients with mild hypertension (which a rather large swath of society probably suffers from) found that oral stevioside intake significantly reduced systolic and diastolic blood pressure. Patients either took a 500 mg capsule of stevioside or a placebo three times a day for two years. The hypertension situation improved across the board and no downsides were reported or detected. Also of note is the fact that slightly more patients in the placebo group developed left ventricular hypertrophy, a pathological thickening of the heart muscle. Of course, another study using far lower doses (up to 15 mg/kg/day) found no anti-hypertensive effects, so it appears that the dose is key. Maybe somewhere in the middle works well, as one study in hypertensive dogs showed: they used 200 mg/kg to normalize blood pressure in the canine subjects.

We can think about stevia as a Primal sugar alternative with some potentially therapeutic effects. Kind of like cinnamon or turmeric, we don’t consume it for the calories or as literal fuel for our bodies, but for flavor, variety, and, possibly, the health benefits. It may induce insulin secretion, but it increases insulin sensitivity, reduces blood glucose (i.e., the insulin is doing its job), and does not increase appetite. It’s been used by humans for hundreds of years and by diabetic patients in Asia for decades. The goofy health food store dude who claims aspartame was created by Donald Rumsfeld to give us cancer may be a vociferous supporter of it, but don’t hold that against stevia. I’m a fan of the stuff and recommend it as a Primal way to satisfy a sweet tooth.

What do you guys think of stevia? Love it? Hate it? Have you ever used its potential therapeutic effects? Let me know in the comment section!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Great post and comments!
    Stevia is really easy to grow and I use it in lots of things for sweetness. I can also dry the leaves and grind them or make a syrup out of the leaves. The plants come back year after year. i’d much rather eat my stevia this way then have it ultra processed, which is not exactly part of a healthy diet.

    The Savvy Sister wrote on April 21st, 2013
  2. In defense of stevia, the latest study:

    Mark wrote on May 31st, 2013
  3. I injested twice stevia contained products. First time it was rice crispy added steviai nstead of regular sugar. I had horible reaction to it. I had my heart beating so hard that almost fainted. Since I do not have any allergy to any food, i did not made conncetion right away. second time I drank Tropo-50 (It is tropicana orange juice that has stevia instead of sugar). I had horrible reaction. My heart start beating out of control, my tongue got numb. my whole body was shaky and i am happy i survived. After this I am checking every product for little hint of stevia and became very scared to injest it in any form. I do not have any other known allergy or reaction to anything and I am very healthy individual in general. I will appreciate comments.

    Kathy wrote on July 10th, 2013
  4. Stevia, or possibly the solvents used to extract it, cause combinations of mental fog, lethargy and dizziness in some users. The plain leaf is likely safer but not to everyone’s taste. I stick to small amounts of raw, tropical forest honey.

    Trevor wrote on July 24th, 2013
  5. I use stevia all the time. In primal recipes I replace honey, maple syrup, and agave with it as much as possible (I often use some honey but replace most of it with stevia). I make lemonade and limeade with it, and it goes in my coffee. I don’t know if I’m just used to it, but unless I accidentally add too much, I don’t get a bitter or unpleasant aftertaste. I use KAL’s pure stevia extract in powdered form. And at over 2,300 servings per container, I think it’s actually a pretty damn cost-effective sweetener. I have had the same container for probably a year and a half or more, and there’s still plenty to go, I’m sure it will last me another year or two easily.

    Samuel wrote on July 24th, 2013
  6. i have been using stevia for decades. i grow the plant and make my own sweetener and i purchase the pure stevia as well in a crystalline state. i read the book “sugar blues” back in the mid-70’s when it came out and was convinced sugar was “the enemy” among other things. if one has a sweet tooth-stevia especially in it’s real full-nutrition state is the way to go. i even eat it straight off the plant-the new growth is so tasty!

    dana pallessen wrote on July 25th, 2013

    KEN MELTON wrote on July 28th, 2013
  8. If you’re having stomach cramps and diarrhea after ingesting stevia it’s likely because it contains erythritol as an extender. I too am radically intolerant of erythritol and spent a summer with worsening lower GI symptoms which finally necessitated a total GI work up. While I was waiting for the results I thought hard about what I might be doing differently in my diet that’s been paleo for 30 plus years and suddenly thought, “Zevia” soda! Looked at the label and there was erythritol. I react this way to other sugar alcohols but since the sodas are promo’d as stevia sweetened I never thought to read the label. I know better. The GI tests came up negative. Two days after stopping drinking Zevia my gut settled down and quickly normalized. I have the same reaction to using stevia powder extended with erythritol. Though the FDA deems erythritol as the sugar alcohol that doesn’t cause GI disturbance, for plenty of people it certainly does. Google it to see.
    I use Wholesome brand organic stevia which is extended with inulin.

    Annie wrote on August 8th, 2013
  9. Couldn’t drink my tea without it; now to find out it actually has beneficial effects is a happy surprise….

    zebonaut wrote on August 19th, 2013
  10. I’ve been having a hard time attempting ketosis for years. I have been on Paleo for a few months now and switched to Stevia. Finally- amazing ketosis with great weight loss results, and – interestingly enough- I am finally sweating and can SMELL the ketosis. I have also found that having a non Paleo dinner with my family once a week doesn’t affect my ketosis so long as I continue a strenuous exercise schedule and use stevia. I wish I had known this years ago.

    Chandra Marski wrote on September 1st, 2013
  11. Yep, I have been using stevia for years, in many forms. The plants ARE easy to grow in hot, direct sun and then can be dried, and easily ground in the blender to make powder. This form would obviously be the “best” in that that it is the least processed. However, I do use the liquid form and white powder, all depending on what I am using it in. I’d highly recommend using it to some degree or another to decrease use of other “sugars” or sweeteners :)

    sally anne wrote on September 2nd, 2013
  12. I have used stevia exclusively to sweeten my drinks for around 10 years now, and I love it! But I only like one brand – NuStevia by a company called NuNaturals. It is marketed by Vitamin World, and it’s the best because it has no aftertaste. They use maltodextrin to keep it free-flowing (I guess) and natural flavors to get rid of the bitterness. It works very well for any and all uses.


    Joy wrote on September 9th, 2013
  13. I bought a Stevia plant a couple months ago and it’s growing well. I put either fresh leaves, or leaves I’ve picked and let dry, (actually-I use the stems too-I tasted them and they are sweet) into a tea ball and steep with tea. Not as sweet as a packet of stevia, but I know I’m not getting additives this way. I also mince and toss small amounts into spaghetti sauce or soups. I’m still experimenting. Not sure if the plant will be deciduous, but if it starts dying, I’ll dry what’s left. The dried leaves seem to keep their sweetness.

    Ellen wrote on October 1st, 2013
  14. This is a fantastic post! I literally learned everything I wanted to know about Stevia from this article alone. Your research is impeccable – and your writing is fairly easy to follow. I know I sound like a bot, but I really want to thank you for this fantastic information. It’s SO RARE to find a health site that isn’t shilling products or spouting off generic information that anybody could learn just by visiting Wikipedia. You present it in a fair and balanced way. MUAH!

    Alexa Big Banger wrote on October 29th, 2013
  15. I use only Sweetleaf, no additives. And like some others, I only use it on Greek yogurt, which I make. Other than that one application, I don’t use it for anything else because of the aftertaste. That is the only sweet thing in my diet. I’ve never cared for sweets to start with so not eating sweet food is easy for me.

    tuba wrote on February 5th, 2014
  16. Thanks for the awesome info. In this journey for complete health my wife struggles a bit with unsweetened beverages. I’m completely sufficient with water but she needs “taste”. I told her to use Stevia as a sweetener and realized I didn’t know much about it.

    Robert Wilder wrote on February 20th, 2014
  17. I have had issues feeling dizzy when drinking products with stevia in it. I am wondering if raw stevia would have the same effect or if it may be the processed stevia that my body cannot handle. I do have issues with a low blood pressure and reactive hypoglycemia. Maybe the stevia aggravates these 2 issues. Any thoughts?

    Dar wrote on March 2nd, 2014
  18. I use KAL brand powder from the healthfood store. I love Trader Joe’s in general but their store brand is not sweet enough for me (different glycoside content?). I use it for blender drinks–usually an AM routine for me–but pretty much that’s it. No need for me to be eating baked goods anyhow!

    Corey B. (Long Beach, CA) wrote on March 11th, 2014
  19. We’ve stopped recommending Stevia at our clinic. Numerous people were reporting moderate to severe diarrhea after consuming Stevia and therefore we have come to the conclusion it is unfit for consumption. Good old PURE CANE sugar or coconut sugar is still the most natural way to enjoy something sweet without adverse affects on the body. Agave is a sweetener we are now testing and seems to not cause diarrhea in people the Stevia did.

    Steve wrote on March 13th, 2014
    • Ditch the agave! It’s mostly fructose, and a processed nightmare. I really liked coconut sugar, but recent information I’ve read is that it is also high in fructose-Not as high as the agave though.
      I have fructose malabsorption, so I really pay attention to that kind of information.
      My concern is that stevia will turn out to be just as bad for us as the aspartame and Splenda have been revealed to be.
      I am old enough to remember the roll out and fanfare with the above mentioned sweeteners – I feel so gullible! Not inclined to be fooled a third time…

      RenegadeRN wrote on April 7th, 2014

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