What are the adverse effects of Stevia (Stevia rebaudiana)?

From the Guidelines

Stevia is generally considered safe for most people, but it can cause mild side effects in some individuals, including nausea, bloating, and digestive discomfort, as reported in a study published in Pediatrics in 2019 1. The potential side effects of stevia are varied and can include:

• Allergic reactions, particularly in individuals with allergies to plants in the Asteraceae family (like ragweed, chrysanthemums, marigolds, and daisies)
• A slight drop in blood pressure or interaction with medications that control blood sugar or blood pressure
• Worsening of low blood sugar symptoms in individuals with hypoglycemia
• Headaches, dizziness, or a metallic aftertaste
• Inflammation of the kidneys or effects on fertility in rare cases It is essential to note that the long-term safety of stevia and other nonnutritive sweeteners has not been systematically reviewed, and their effects on cardiometabolic health are still being studied, as discussed in a comprehensive review published in Circulation in 2016 1. Therefore, it is recommended to consume stevia in moderation and be aware of potential side effects, especially in individuals with pre-existing health conditions or those taking medications, and to consult with a healthcare provider if persistent side effects occur. Some key points to consider when consuming stevia include:
• Estimating total content of nonnutritive sweeteners in manufactured products can be challenging, as they are not required to specify the content of nonnutritive sweeteners in a product
• The consumption of nonnutritive sweeteners, including stevia, has increased, and their long-term safety and potential benefits have not been fully established
• Nonnutritive sweeteners may not be entirely benign, with potential impacts on cognitive processes, oral-gastrointestinal taste receptors, and glucose-insulin and energy homeostasis, as well as the gut microbiome.

From the Research

Side Effects of Stevia

• The studies available do not provide a comprehensive list of side effects of stevia consumption, but they do mention some potential effects on the body.
• Stevia has been found to have antibacterial, anti-inflammatory, hypotensive, antiseptic, diuretic, anti-fertility, and cardiotonic properties 2.
• It has also been documented to have good effects on treating skin diseases such as dermatitis, acne, and eczema 2.
• Stevia consumption has been found to have a potential benefit on the microbiome's alpha diversity, but alterations in the colonic microenvironment may depend on the amount and frequency of stevia intake, as well as on the simultaneous consumption of other dietary components 3.
• The anti-inflammatory properties of stevioside were confirmed in vitro and in vivo, but the effects of stevia consumption on the host's gut microbiota are not fully understood and may depend on various factors 3.
• Low-dose stevia consumption has been found to perturb gut microbiota and the mesolimbic dopamine reward system in laboratory animals, but its impact on glucose metabolism and weight gain was found to be minimal 4.

Potential Interactions and Effects

• Stevia consumption may interact with other dietary components and affect the gut microbiota, leading to changes in the colonic microenvironment 3.
• The addition of prebiotics to stevia consumption may reduce fat mass, food intake, and gut permeability, but may also interfere with the benefits of the prebiotic in some cases 4.
• The effects of stevia consumption on gut microbial taxa should be further examined in populations exhibiting dysbiosis, such as obesity 4.