Stevia

What Is Stevia?

Stevia is a small South American shrub whose leaves are intensely sweet, valued as a sugar substitute that adds no calories. The Guaraní of Paraguay and Brazil call it ka’a he’ê, the “sweet herb”. They use it to sweeten yerba maté and as a medicine, including for high blood sugar and high blood pressure ^{36Reference 36Taylor · 2005The healing power of rainforest herbs: A guide to understanding and using herbal medicinals (pp}.

Stevia rebaudiana is native to southern Brazil and Paraguay, where it grows at the edges of marshes and grassland ^{39,40Reference 39North Carolina Extension Gardener Plant Stevia rebaudiana — description, native range and plant traits — species databaseView study →Reference 40FernFern, K. (n.d.). Stevia rebaudiana — range, habitat and cultivation — species database. Useful Tropical Plants. https://tropical.theferns.info/viewtropical.php?id=Stevia+rebaudianaView study →}. Europeans encountered it through the Spanish colonial administration in the sixteenth century ^{36Reference 36Taylor · 2005The healing power of rainforest herbs: A guide to understanding and using herbal medicinals (pp}. Japan was the first country outside Latin America to grow and sell it as a sugar substitute, and it is now cultivated across East Asia, the Americas and Europe ^{33Reference 33Orellana-Paucar · 2023ReviewSteviol glycosides from Stevia rebaudiana: an updated overview of their sweetening activity, pharmacological properties and safety — reviewView study →}.

Its sweetness comes from steviol glycosides, chiefly stevioside and rebaudioside A, which are about 300 and 450 times sweeter than sugar ^{33Reference 33Orellana-Paucar · 2023ReviewSteviol glycosides from Stevia rebaudiana: an updated overview of their sweetening activity, pharmacological properties and safety — reviewView study →}. Human trials have tested stevia for blood sugar, blood pressure and appetite, with small and mixed effects ^{1,3,5,6,7,8,11,12Reference 1Zare et al. · 2024Meta-analysisEffect of stevia on blood glucose and HbA1C: a meta-analysis — systematic review, meta-analysisView study →Reference 3Onakpoya et al. · 2015Meta-analysisEffect of the natural sweetener steviol glycoside on cardiovascular risk factors: a systematic review and meta-analysis of randomised controlled trialsView study →Reference 5Chan et al. · 2000RCTA double-blind placebo-controlled study of the effectiveness and tolerability of oral stevioside in human hypertension — randomised controlled trialView study →Reference 6Hsieh et al. · 2003RCTEfficacy and tolerability of oral stevioside in patients with mild essential hypertension: a two-year, randomised, placebo-controlled studyView study →Reference 7Ferri et al. · 2006RCTInvestigation of the antihypertensive effect of oral crude stevioside in patients with mild essential hypertension — randomised controlled trialView study →Reference 8Barriocanal et al. · 2008RCTApparent lack of pharmacological effect of steviol glycosides used as sweeteners in humans — randomised controlled trialView study →Reference 11Farhat et al. · 2019RCTEffects of stevia extract on postprandial glucose response, satiety and energy intake: a three-arm crossover trial — randomised controlled trialView study →Reference 12Stamataki et al. · 2020RCTStevia beverage consumption prior to lunch reduces appetite and total energy intake without affecting glycemia — randomised controlled trialView study →}.

Stevia sold as a sweetener is usually a purified extract of these glycosides rather than the whole leaf ^{33Reference 33Orellana-Paucar · 2023ReviewSteviol glycosides from Stevia rebaudiana: an updated overview of their sweetening activity, pharmacological properties and safety — reviewView study →}.

How Is Stevia Used?

• Fresh or dried leaf — dropped into yerba maté and other infusions to sweeten them, or chewed ^{36Reference 36Taylor · 2005The healing power of rainforest herbs: A guide to understanding and using herbal medicinals (pp}.
• Liquid extract — dosed to taste as a sweetener.
• Purified steviol glycosides — the commercial sweetener, approved as a food additive ^{33Reference 33Orellana-Paucar · 2023ReviewSteviol glycosides from Stevia rebaudiana: an updated overview of their sweetening activity, pharmacological properties and safety — reviewView study →}.
• Purified stevioside capsules — the preparation used in the blood-pressure trials, at 750–1,500 mg a day ^{5,6Reference 5Chan et al. · 2000RCTA double-blind placebo-controlled study of the effectiveness and tolerability of oral stevioside in human hypertension — randomised controlled trialView study →Reference 6Hsieh et al. · 2003RCTEfficacy and tolerability of oral stevioside in patients with mild essential hypertension: a two-year, randomised, placebo-controlled studyView study →}.

Traditional Uses

Guaraní Traditional Medicine

The Guaraní of the Paraguay–Brazil border country know the leaf as ka’a he’ê, the “sweet herb”, and use it both as a flavouring and as a medicine ^{36Reference 36Taylor · 2005The healing power of rainforest herbs: A guide to understanding and using herbal medicinals (pp}.

As a sweetener it goes into yerba maté (Ilex paraguariensis) and other bitter infusions, and the leaf is also chewed on its own. As a medicine it is given as a cardiotonic and for heartburn, obesity, high blood pressure and high blood sugar ^{36Reference 36Taylor · 2005The healing power of rainforest herbs: A guide to understanding and using herbal medicinals (pp}.

The leaves are dropped whole into the maté gourd or the teapot, and the amount is judged by taste ^{36Reference 36Taylor · 2005The healing power of rainforest herbs: A guide to understanding and using herbal medicinals (pp}.

Indications

• Replacing sugar in diabetes, metabolic syndrome and weight control [leaf; purified glycosides]
• High blood sugar [leaf; Guaraní use] ⚠Caution: Meta-analyses found a small fall in fasting glucose, with no effect on HbA1c or insulin ^1,2.
• High blood pressure [purified stevioside; Guaraní use] ⚠Caution: Two long trials in Chinese patients with hypertension lowered blood pressure at 750–1,500 mg of stevioside a day. Two other trials found no effect, and a meta-analysis found no significant fall in systolic pressure ^3,5,6,7,8.
• Obesity [leaf; Guaraní use] ⚠Caution: Appetite trials are mixed, and trials of non-nutritive sweeteners have not shown a benefit for body weight ^{10,11,12,13,14,15}.
• Weak heart [leaf; Guaraní use]
• Heartburn [leaf; Guaraní use]
• Early chronic kidney disease [purified stevioside]
• Tooth decay, as a sugar replacement [leaf extract; purified glycosides]

Botany

Stevia is a small, tender perennial shrub in the daisy family (Asteraceae) ^{39,40Reference 39North Carolina Extension Gardener Plant Stevia rebaudiana — description, native range and plant traits — species databaseView study →Reference 40FernFern, K. (n.d.). Stevia rebaudiana — range, habitat and cultivation — species database. Useful Tropical Plants. https://tropical.theferns.info/viewtropical.php?id=Stevia+rebaudianaView study →}. It grows 30–60 cm tall in gardens and up to about 1 m in the wild, on slender, weak, erect stems ^{39,40Reference 39North Carolina Extension Gardener Plant Stevia rebaudiana — description, native range and plant traits — species databaseView study →Reference 40FernFern, K. (n.d.). Stevia rebaudiana — range, habitat and cultivation — species database. Useful Tropical Plants. https://tropical.theferns.info/viewtropical.php?id=Stevia+rebaudianaView study →}. It has a shallow, fibrous root system and a vigorous rhizome ^{39,40Reference 39North Carolina Extension Gardener Plant Stevia rebaudiana — description, native range and plant traits — species databaseView study →Reference 40FernFern, K. (n.d.). Stevia rebaudiana — range, habitat and cultivation — species database. Useful Tropical Plants. https://tropical.theferns.info/viewtropical.php?id=Stevia+rebaudianaView study →}.

The leaves are thin and papery, oval to elliptic, with finely toothed edges ^{39Reference 39North Carolina Extension Gardener Plant Stevia rebaudiana — description, native range and plant traits — species databaseView study →}. They are up to about 2.5 cm long ^{39Reference 39North Carolina Extension Gardener Plant Stevia rebaudiana — description, native range and plant traits — species databaseView study →}. The sweet glycosides occur in the leaves ^{33Reference 33Orellana-Paucar · 2023ReviewSteviol glycosides from Stevia rebaudiana: an updated overview of their sweetening activity, pharmacological properties and safety — reviewView study →}.

The small, tubular flowers are white with light purple accents, and grow in clusters at the ends of the stems in summer ^{39Reference 39North Carolina Extension Gardener Plant Stevia rebaudiana — description, native range and plant traits — species databaseView study →}. The fruit is a dry achene holding a single seed ^{39Reference 39North Carolina Extension Gardener Plant Stevia rebaudiana — description, native range and plant traits — species databaseView study →}.

Distribution

Stevia is native to southern Brazil and Paraguay ^{39,40Reference 39North Carolina Extension Gardener Plant Stevia rebaudiana — description, native range and plant traits — species databaseView study →Reference 40FernFern, K. (n.d.). Stevia rebaudiana — range, habitat and cultivation — species database. Useful Tropical Plants. https://tropical.theferns.info/viewtropical.php?id=Stevia+rebaudianaView study →}. In the wild it grows at the edges of marshes and grassland, up to 700 m, on infertile, sandy, acid soils with a shallow water table ^{40Reference 40FernFern, K. (n.d.). Stevia rebaudiana — range, habitat and cultivation — species database. Useful Tropical Plants. https://tropical.theferns.info/viewtropical.php?id=Stevia+rebaudianaView study →}.

It is now cultivated in the tropics and subtropics from sea level to 1,500 m, and in more or less frost-free parts of the temperate zone ^{40Reference 40FernFern, K. (n.d.). Stevia rebaudiana — range, habitat and cultivation — species database. Useful Tropical Plants. https://tropical.theferns.info/viewtropical.php?id=Stevia+rebaudianaView study →}. Commercial crops are grown in Brazil, Paraguay, Uruguay, Central America, Israel, Thailand and China ^{36Reference 36Taylor · 2005The healing power of rainforest herbs: A guide to understanding and using herbal medicinals (pp}, and plantations now extend to Southeast Asia, the United States, Canada and Europe ^{33Reference 33Orellana-Paucar · 2023ReviewSteviol glycosides from Stevia rebaudiana: an updated overview of their sweetening activity, pharmacological properties and safety — reviewView study →}.

Growing Conditions

Cultivation snapshot for Stevia

Lifetender perennialZoneUSDA 9–11

• Wants full sun to light shade and warm, consistently moist but well-drained soil — it resents both drought and waterlogging.
• Tender and frost-intolerant: hardy only in roughly zones 9–11, so in colder climates it is grown as an annual, containerized, or overwintered under cover.
• Best started from cuttings or plugs rather than seed, since wild seed germinates poorly and unevenly.
• Pinch stems to keep the plant bushy, and harvest the leaves as flowering begins.

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Harvesting, Collection & Preparation

Only the leaves are harvested. They are best picked just as the plant begins to flower, then dried ^{39Reference 39North Carolina Extension Gardener Plant Stevia rebaudiana — description, native range and plant traits — species databaseView study →}.

Stevia is hard to propagate. Its seed has poor viability and a very low germination rate, and cuttings need specific conditions to take root ^{34Reference 34Singh et al. · 2014Two-stage culture procedure using thidiazuron for efficient micropropagation of Stevia rebaudiana, an anti-diabetic medicinal herb}. Tissue culture solves both problems. In one micropropagation study, plants raised this way held more stevioside than field-grown plants ^{34Reference 34Singh et al. · 2014Two-stage culture procedure using thidiazuron for efficient micropropagation of Stevia rebaudiana, an anti-diabetic medicinal herb}.

Pharmacology & Research

Stevia has a sizeable human literature. Randomised trials and meta-analyses have tested it for blood glucose, blood pressure, appetite and body weight ^{1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16Reference 1Zare et al. · 2024Meta-analysisEffect of stevia on blood glucose and HbA1C: a meta-analysis — systematic review, meta-analysisView study →Reference 2Bai et al. · 2024Meta-analysisEffect of steviol glycosides as natural sweeteners on glucose metabolism in adult participants — meta-analysisView study →Reference 3Onakpoya et al. · 2015Meta-analysisEffect of the natural sweetener steviol glycoside on cardiovascular risk factors: a systematic review and meta-analysis of randomised controlled trialsView study →Reference 4Bundgaard Anker et al. · 2019Meta-analysisEffect of steviol glycosides on human health with emphasis on type 2 diabetic biomarkers: a systematic review and meta-analysisView study →Reference 5Chan et al. · 2000RCTA double-blind placebo-controlled study of the effectiveness and tolerability of oral stevioside in human hypertension — randomised controlled trialView study →Reference 6Hsieh et al. · 2003RCTEfficacy and tolerability of oral stevioside in patients with mild essential hypertension: a two-year, randomised, placebo-controlled studyView study →Reference 7Ferri et al. · 2006RCTInvestigation of the antihypertensive effect of oral crude stevioside in patients with mild essential hypertension — randomised controlled trialView study →Reference 8Barriocanal et al. · 2008RCTApparent lack of pharmacological effect of steviol glycosides used as sweeteners in humans — randomised controlled trialView study →Reference 9Anton et al. · 2010RCTEffects of stevia, aspartame, and sucrose on food intake, satiety, and postprandial glucose and insulin levels — randomised controlled trialView study →Reference 10Tey et al. · 2017RCTEffects of aspartame-, monk fruit-, stevia- and sucrose-sweetened beverages on postprandial glucose, insulin and energy intake — randomised controlled trialView study →Reference 11Farhat et al. · 2019RCTEffects of stevia extract on postprandial glucose response, satiety and energy intake: a three-arm crossover trial — randomised controlled trialView study →Reference 12Stamataki et al. · 2020RCTStevia beverage consumption prior to lunch reduces appetite and total energy intake without affecting glycemia — randomised controlled trialView study →Reference 13Stamataki et al. · 2020RCTEffects of the daily consumption of stevia on glucose homeostasis, body weight, and energy intake: a randomised open-label 12-week trial — randomised controlled trialView study →Reference 14Higgins et al. · 2019RCTA randomised controlled trial contrasting the effects of 4 low-calorie sweeteners and sucrose on body weight in adults with overweight or obesityView study →Reference 15Azad et al. · 2017Meta-analysisNonnutritive sweeteners and cardiometabolic health: a systematic review and meta-analysis of randomised controlled trials and prospective cohort studiesView study →Reference 16Almiron-Roig et al. · 2023RCTImpact of acute consumption of beverages containing plant-based or alternative sweetener blends on postprandial appetite, food intake and metabolism — randomised controlled trialView study →}. The antioxidant, anti-inflammatory, anticancer and antimicrobial findings come from cell and animal studies ^{17,18,19,20,21,22,23,24,25,26Reference 17Papaefthimiou et al. · 2023Meta-analysisAntioxidant activity of leaf extracts from Stevia rebaudiana Bertoni: a systematic review and meta-analysis (animal models)View study →Reference 18Alavala et al. · 2019In vitroStevioside, a diterpenoid glycoside, shows anti-inflammatory property against DSS-induced ulcerative colitis — in vitro and in vivo mouse studyView study →Reference 19Boonkaewwan et al. · 2006In vitroAnti-inflammatory and immunomodulatory activities of stevioside and its metabolite steviol on THP-1 cells — in vitroView study →Reference 20Wang et al. · 2014AnimalStevioside plays an anti-inflammatory role by regulating the NF-κB and MAPK pathways in S. aureus-infected mouse mammary glands — animal modelView study →Reference 21Rizzo et al. · 2013In vitroSteviol glycosides modulate glucose transport in different cell types — in vitroView study →Reference 22Kang et al. · 2025ReviewEffects and mechanisms of steviol glycosides on glucose metabolism: evidence from preclinical studies — reviewView study →Reference 23Chowdhury et al. · 2022Meta-analysisEffect of stevia leaves on diabetes: a systematic review and meta-analysis of preclinical studies — animalView study →Reference 24Iatridis et al. · 2022In vitroAnti-cancer properties of Stevia rebaudiana; more than a sweetener — review (in vitro and in vivo)View study →Reference 25Ferrazzano et al. · 2015ReviewIs Stevia rebaudiana Bertoni a non-cariogenic sweetener? A reviewView study →Reference 26Gamboa et al. · 2012In vitroAntimicrobial potential of extracts from Stevia rebaudiana leaves against bacteria of importance in dental caries — in vitroView study →}.

Meta-analyses find a small fall in fasting blood glucose, with HbA1c and insulin largely unchanged and the certainty of evidence rated low ^{1,2Reference 1Zare et al. · 2024Meta-analysisEffect of stevia on blood glucose and HbA1C: a meta-analysis — systematic review, meta-analysisView study →Reference 2Bai et al. · 2024Meta-analysisEffect of steviol glycosides as natural sweeteners on glucose metabolism in adult participants — meta-analysisView study →}. Blood-pressure results are mixed: two long trials of purified stevioside in patients with hypertension were positive, and two other trials found no effect ^{5,6,7,8Reference 5Chan et al. · 2000RCTA double-blind placebo-controlled study of the effectiveness and tolerability of oral stevioside in human hypertension — randomised controlled trialView study →Reference 6Hsieh et al. · 2003RCTEfficacy and tolerability of oral stevioside in patients with mild essential hypertension: a two-year, randomised, placebo-controlled studyView study →Reference 7Ferri et al. · 2006RCTInvestigation of the antihypertensive effect of oral crude stevioside in patients with mild essential hypertension — randomised controlled trialView study →Reference 8Barriocanal et al. · 2008RCTApparent lack of pharmacological effect of steviol glycosides used as sweeteners in humans — randomised controlled trialView study →}.

1. Glycemic Control

A 2024 systematic review and meta-analysis (26 studies, n=1439) found stevia significantly reduced blood glucose (WMD −3.84 mg/dL), most in people with higher BMI, diabetes or hypertension, but with no significant effect on insulin or HbA1c and low-to-very-low certainty of evidence ^{1Reference 1Zare et al. · 2024Meta-analysisEffect of stevia on blood glucose and HbA1C: a meta-analysis — systematic review, meta-analysisView study →}.

A second 2024 meta-analysis of 12 RCTs (n=871) found a significant fasting-glucose reduction (−4.10 mg/dL) and no change in HbA1c ^{2Reference 2Bai et al. · 2024Meta-analysisEffect of steviol glycosides as natural sweeteners on glucose metabolism in adult participants — meta-analysisView study →}. An earlier meta-analysis of steviol glycoside trials also found a fall in fasting glucose ^{3Reference 3Onakpoya et al. · 2015Meta-analysisEffect of the natural sweetener steviol glycoside on cardiovascular risk factors: a systematic review and meta-analysis of randomised controlled trialsView study →}, while a 2019 review of type 2 diabetes biomarkers found no significant effect on fasting glucose or HbA1c ^{4Reference 4Bundgaard Anker et al. · 2019Meta-analysisEffect of steviol glycosides on human health with emphasis on type 2 diabetic biomarkers: a systematic review and meta-analysisView study →}.

Much of the acute effect is sugar substitution. In a crossover trial in 31 lean and obese adults, a stevia-sweetened preload before meals produced lower post-meal glucose than sucrose and lower insulin than sucrose or aspartame, and participants did not make up the missing calories later in the day ^{9Reference 9Anton et al. · 2010RCTEffects of stevia, aspartame, and sucrose on food intake, satiety, and postprandial glucose and insulin levels — randomised controlled trialView study →}. In a crossover trial in 30 men, the calories saved were fully made up at the next meal, and total glucose and insulin over three hours did not differ from a sucrose drink ^{10Reference 10Tey et al. · 2017RCTEffects of aspartame-, monk fruit-, stevia- and sucrose-sweetened beverages on postprandial glucose, insulin and energy intake — randomised controlled trialView study →}.

Cell and rodent studies show glucose-dependent insulinotropic action, better insulin sensitivity, and glucose uptake through the PI3K/Akt pathway ^{21,22,23Reference 21Rizzo et al. · 2013In vitroSteviol glycosides modulate glucose transport in different cell types — in vitroView study →Reference 22Kang et al. · 2025ReviewEffects and mechanisms of steviol glycosides on glucose metabolism: evidence from preclinical studies — reviewView study →Reference 23Chowdhury et al. · 2022Meta-analysisEffect of stevia leaves on diabetes: a systematic review and meta-analysis of preclinical studies — animalView study →}.

Gap: human effects are modest and confined mainly to fasting glucose; HbA1c and insulin are largely unchanged, and no trial shows stevia treating (rather than helping manage) diabetes.

2. Antihypertensive

Two multicentre placebo-controlled RCTs in Chinese patients with hypertension, using purified stevioside, were positive. In 106 patients taking 750 mg a day, systolic and diastolic pressure fell within three months and stayed lower for the year ^{5Reference 5Chan et al. · 2000RCTA double-blind placebo-controlled study of the effectiveness and tolerability of oral stevioside in human hypertension — randomised controlled trialView study →}. In 174 patients with mild hypertension taking 1,500 mg a day for two years, blood pressure also fell ^{6Reference 6Hsieh et al. · 2003RCTEfficacy and tolerability of oral stevioside in patients with mild essential hypertension: a two-year, randomised, placebo-controlled studyView study →}. Mean left-ventricular mass index did not change, but fewer patients on stevioside had left ventricular hypertrophy at two years (11.5% against 34%) ^{6Reference 6Hsieh et al. · 2003RCTEfficacy and tolerability of oral stevioside in patients with mild essential hypertension: a two-year, randomised, placebo-controlled studyView study →}.

Two other trials found no effect. Crude stevioside up to 15 mg/kg/day did not beat placebo in mild hypertension ^{7Reference 7Ferri et al. · 2006RCTInvestigation of the antihypertensive effect of oral crude stevioside in patients with mild essential hypertension — randomised controlled trialView study →}, and stevioside at 750 mg a day for three months did not change blood pressure in people with type 1 or type 2 diabetes or with normal to low blood pressure ^{8Reference 8Barriocanal et al. · 2008RCTApparent lack of pharmacological effect of steviol glycosides used as sweeteners in humans — randomised controlled trialView study →}.

A 2015 meta-analysis of nine trials found the pooled systolic effect non-significant (−2.98 mmHg), while diastolic pressure fell, with high heterogeneity ^{3Reference 3Onakpoya et al. · 2015Meta-analysisEffect of the natural sweetener steviol glycoside on cardiovascular risk factors: a systematic review and meta-analysis of randomised controlled trialsView study →}. A 2019 meta-analysis reported a significant systolic fall of 6.32 mmHg ^{4Reference 4Bundgaard Anker et al. · 2019Meta-analysisEffect of steviol glycosides on human health with emphasis on type 2 diabetic biomarkers: a systematic review and meta-analysisView study →}.

Calcium-channel antagonism in vascular smooth muscle has been proposed as the mechanism ^{5Reference 5Chan et al. · 2000RCTA double-blind placebo-controlled study of the effectiveness and tolerability of oral stevioside in human hypertension — randomised controlled trialView study →}.

Gap: both positive trials were in hypertensive patients at doses well above sweetener use ^{33Reference 33Orellana-Paucar · 2023ReviewSteviol glycosides from Stevia rebaudiana: an updated overview of their sweetening activity, pharmacological properties and safety — reviewView study →}, and the pooled estimates disagree on systolic pressure ^{3,4Reference 3Onakpoya et al. · 2015Meta-analysisEffect of the natural sweetener steviol glycoside on cardiovascular risk factors: a systematic review and meta-analysis of randomised controlled trialsView study →Reference 4Bundgaard Anker et al. · 2019Meta-analysisEffect of steviol glycosides on human health with emphasis on type 2 diabetic biomarkers: a systematic review and meta-analysisView study →}.

3. Antioxidant

A 2023 systematic review and meta-analysis of animal models (24 articles, 104 individual studies) found stevia restored oxidative-stress markers (SOD, CAT, GSH, MDA) by roughly 65–85% across tissues, with the largest response in diabetic rats ^{17Reference 17Papaefthimiou et al. · 2023Meta-analysisAntioxidant activity of leaf extracts from Stevia rebaudiana Bertoni: a systematic review and meta-analysis (animal models)View study →}.

Whole-leaf extracts restored the markers more than purified glycosides, and organic-solvent extracts more than aqueous or hydroalcoholic ones ^{17Reference 17Papaefthimiou et al. · 2023Meta-analysisAntioxidant activity of leaf extracts from Stevia rebaudiana Bertoni: a systematic review and meta-analysis (animal models)View study →}. Which leaf compounds carry the effect has not been established ^{17Reference 17Papaefthimiou et al. · 2023Meta-analysisAntioxidant activity of leaf extracts from Stevia rebaudiana Bertoni: a systematic review and meta-analysis (animal models)View study →}.

Gap: no human study measures an antioxidant clinical endpoint, and the active preparation (whole-leaf/organic extract) is not the purified-glycoside sweetener most people consume.

4. Anti-Inflammatory

Stevioside suppresses the NF-κB and MAPK inflammatory pathways. In THP-1 monocytes, stevioside inhibited LPS-induced TNF-α and IL-1β release and blocked IKKβ/NF-κB activation, while its metabolite steviol did not ^{19Reference 19Boonkaewwan et al. · 2006In vitroAnti-inflammatory and immunomodulatory activities of stevioside and its metabolite steviol on THP-1 cells — in vitroView study →}.

In RAW264.7 macrophages and a mouse colitis model it lowered TNF-α, IL-6 and reactive oxygen species ^{18Reference 18Alavala et al. · 2019In vitroStevioside, a diterpenoid glycoside, shows anti-inflammatory property against DSS-induced ulcerative colitis — in vitro and in vivo mouse studyView study →}.

Given by injection, it dampened NF-κB/MAPK signalling in a mouse mastitis model ^{20Reference 20Wang et al. · 2014AnimalStevioside plays an anti-inflammatory role by regulating the NF-κB and MAPK pathways in S. aureus-infected mouse mammary glands — animal modelView study →}.

In people, the only signal is a secondary marker in one small chronic-kidney-disease trial, where stevioside reduced high-sensitivity C-reactive protein and ESR ^{27Reference 27Rizwan et al. · 2025RCTEffects of stevia on inflammatory markers, renal and hematological parameters in patients with stage I-III chronic kidney disease — randomised controlled trialView study →}. No trial has been run with inflammation as its primary endpoint.

5. Weight & Appetite

Replacing sugar with stevia lowers the energy content of a food or drink, and trials disagree on whether people then eat less overall.

A stevia preload lowered hunger compared with water, without changing later food intake ^{11Reference 11Farhat et al. · 2019RCTEffects of stevia extract on postprandial glucose response, satiety and energy intake: a three-arm crossover trial — randomised controlled trialView study →}. A pre-lunch stevia drink cut total energy intake compared with water, without affecting blood glucose ^{12Reference 12Stamataki et al. · 2020RCTStevia beverage consumption prior to lunch reduces appetite and total energy intake without affecting glycemia — randomised controlled trialView study →}.

In a trial of three sweetener blends in 60 adults with overweight, blends containing stevia lowered the post-meal insulin rise compared with sucrose, with no difference in energy intake over the next 24 hours ^{16Reference 16Almiron-Roig et al. · 2023RCTImpact of acute consumption of beverages containing plant-based or alternative sweetener blends on postprandial appetite, food intake and metabolism — randomised controlled trialView study →}.

In another crossover trial, participants ate more at the next meal after a stevia drink, making up the calories saved ^{10Reference 10Tey et al. · 2017RCTEffects of aspartame-, monk fruit-, stevia- and sucrose-sweetened beverages on postprandial glucose, insulin and energy intake — randomised controlled trialView study →}.

In a 12-week open-label trial in 28 healthy adults, daily stevia did not change glucose or insulin responses; the stevia group held its weight while controls gained a little ^{13Reference 13Stamataki et al. · 2020RCTEffects of the daily consumption of stevia on glucose homeostasis, body weight, and energy intake: a randomised open-label 12-week trial — randomised controlled trialView study →}. In a 12-week trial comparing sweeteners, rebaudioside A did not raise body weight, unlike sucrose and saccharin ^{14Reference 14Higgins et al. · 2019RCTA randomised controlled trial contrasting the effects of 4 low-calorie sweeteners and sucrose on body weight in adults with overweight or obesityView study →}.

A broader meta-analysis of non-nutritive sweeteners found no significant BMI benefit in RCTs ^{15Reference 15Azad et al. · 2017Meta-analysisNonnutritive sweeteners and cardiometabolic health: a systematic review and meta-analysis of randomised controlled trials and prospective cohort studiesView study →}.

Gap: results are inconsistent — appetite effects appear acutely but energy compensation and null longer-term weight outcomes are common.

6. Anticariogenic

Steviol glycosides are not fermented by oral bacteria, so they do not feed the acid production that drives tooth decay. A review of the evidence concluded that stevioside extracts are not cariogenic ^{25,33Reference 25Ferrazzano et al. · 2015ReviewIs Stevia rebaudiana Bertoni a non-cariogenic sweetener? A reviewView study →Reference 33Orellana-Paucar · 2023ReviewSteviol glycosides from Stevia rebaudiana: an updated overview of their sweetening activity, pharmacological properties and safety — reviewView study →}.

In vitro, Stevia rebaudiana leaf extracts inhibited 16 strains of cariogenic Streptococcus and Lactobacillus in diffusion assays ^{26Reference 26Gamboa et al. · 2012In vitroAntimicrobial potential of extracts from Stevia rebaudiana leaves against bacteria of importance in dental caries — in vitroView study →}.

No clinical trial has measured caries in people using stevia.

7. Nephroprotective

A single small clinical trial provides the only human data. In a prospective single-blind placebo-controlled study of 83 patients with stage I–III chronic kidney disease, with 10 healthy controls, stevioside (250 mg twice daily) reduced microalbuminuria, systolic and diastolic blood pressure, post-meal blood sugar, ESR and high-sensitivity CRP over nine months ^{27Reference 27Rizwan et al. · 2025RCTEffects of stevia on inflammatory markers, renal and hematological parameters in patients with stage I-III chronic kidney disease — randomised controlled trialView study →}. Most of these gains faded during a washout period without stevia ^{27Reference 27Rizwan et al. · 2025RCTEffects of stevia on inflammatory markers, renal and hematological parameters in patients with stage I-III chronic kidney disease — randomised controlled trialView study →}.

Animal studies also report a kidney-protective effect ^{27Reference 27Rizwan et al. · 2025RCTEffects of stevia on inflammatory markers, renal and hematological parameters in patients with stage I-III chronic kidney disease — randomised controlled trialView study →}.

Gap: the sole human trial is small and single-blind (not double-blind), and the finding needs replication in a larger blinded trial.

8. Anticancer

Antitumor activity is entirely preclinical. Reviews collate cell-line evidence that stevia derivatives inhibit proliferation and induce apoptosis across several tumor types, with some supporting rodent data ^{24Reference 24Iatridis et al. · 2022In vitroAnti-cancer properties of Stevia rebaudiana; more than a sweetener — review (in vitro and in vivo)View study →}. Steviol and isosteviol are the constituents most often implicated.

Gap: there are no human studies.

Mechanisms

Stevia’s main effect in people comes from replacing sugar, which removes the glucose and insulin load of a sugary food or drink ^{9Reference 9Anton et al. · 2010RCTEffects of stevia, aspartame, and sucrose on food intake, satiety, and postprandial glucose and insulin levels — randomised controlled trialView study →}. Steviol glycosides are not absorbed intact: gut bacteria break them down to steviol, which is absorbed and excreted in urine as steviol glucuronide ^{28,30Reference 28Renwick et al. · 2008ReviewMicrobial hydrolysis of steviol glycosides — reviewView study →Reference 30Purkayastha et al. · 2020ReviewMetabolic fate in adult and pediatric population of steviol glycosides produced from stevia leaf extract by different production technologies — reviewView study →}.

In cells and animals, stevioside has been studied for suppressing inflammatory signalling, for effects on insulin release and glucose uptake, and for relaxing blood vessels ^{5,18,19,20,21,22Reference 5Chan et al. · 2000RCTA double-blind placebo-controlled study of the effectiveness and tolerability of oral stevioside in human hypertension — randomised controlled trialView study →Reference 18Alavala et al. · 2019In vitroStevioside, a diterpenoid glycoside, shows anti-inflammatory property against DSS-induced ulcerative colitis — in vitro and in vivo mouse studyView study →Reference 19Boonkaewwan et al. · 2006In vitroAnti-inflammatory and immunomodulatory activities of stevioside and its metabolite steviol on THP-1 cells — in vitroView study →Reference 20Wang et al. · 2014AnimalStevioside plays an anti-inflammatory role by regulating the NF-κB and MAPK pathways in S. aureus-infected mouse mammary glands — animal modelView study →Reference 21Rizzo et al. · 2013In vitroSteviol glycosides modulate glucose transport in different cell types — in vitroView study →Reference 22Kang et al. · 2025ReviewEffects and mechanisms of steviol glycosides on glucose metabolism: evidence from preclinical studies — reviewView study →}. The antioxidant activity of leaf extracts is stronger than that of the purified glycosides ^{17Reference 17Papaefthimiou et al. · 2023Meta-analysisAntioxidant activity of leaf extracts from Stevia rebaudiana Bertoni: a systematic review and meta-analysis (animal models)View study →}.

Clinical Trials

Stevia has an active human trial record for a sweetener, covering blood sugar, appetite, gut microbiota and dental outcomes. Many registry entries use stevia as a comparator or vehicle rather than as the treatment being tested.

Last checked: July 2026.

Phytochemistry

The leaf’s sweetness comes from steviol glycosides, a family of ent-kaurene diterpene glycosides built on the aglycone steviol. Eight occur naturally in the leaf: stevioside, rebaudiosides A–E, dulcoside A and steviolbioside ^{33Reference 33Orellana-Paucar · 2023ReviewSteviol glycosides from Stevia rebaudiana: an updated overview of their sweetening activity, pharmacological properties and safety — reviewView study →}. Together they make up 4–20% of the leaf, depending on genotype and growing conditions ^{33Reference 33Orellana-Paucar · 2023ReviewSteviol glycosides from Stevia rebaudiana: an updated overview of their sweetening activity, pharmacological properties and safety — reviewView study →}.

Stevioside is the most abundant, at about 9% of the leaf, followed by rebaudioside A at about 4% ^{33Reference 33Orellana-Paucar · 2023ReviewSteviol glycosides from Stevia rebaudiana: an updated overview of their sweetening activity, pharmacological properties and safety — reviewView study →}. In one analysis, plants raised by tissue culture held 9.2% stevioside against 7.0% in field-grown plants ^{34Reference 34Singh et al. · 2014Two-stage culture procedure using thidiazuron for efficient micropropagation of Stevia rebaudiana, an anti-diabetic medicinal herb}. Stevioside is about 300 times sweeter than sucrose and rebaudioside A about 450 times ^{33Reference 33Orellana-Paucar · 2023ReviewSteviol glycosides from Stevia rebaudiana: an updated overview of their sweetening activity, pharmacological properties and safety — reviewView study →}.

More than 60 steviol glycosides have been found in the plant. Some, such as rebaudiosides D and M, make up less than 0.1% of the leaf ^{30Reference 30Purkayastha et al. · 2020ReviewMetabolic fate in adult and pediatric population of steviol glycosides produced from stevia leaf extract by different production technologies — reviewView study →}.

The leaf also contains flavonoids (apigenin, quercetin, kaempferol, luteolin, isoquercitrin and others), phytosterols (β-sitosterol, stigmasterol, campesterol), labdane-related diterpenes (sterebins, kaurene), phenolic acids (chlorogenic acid and its isomer cryptochlorogenic acid), coumarins (scopoletin, umbelliferone) and pigments ^{36Reference 36Taylor · 2005The healing power of rainforest herbs: A guide to understanding and using herbal medicinals (pp}.

Constituent Summary

Glycoside amounts are a share of the dried leaf; the other constituents are reported without amounts ^{33,36Reference 33Orellana-Paucar · 2023ReviewSteviol glycosides from Stevia rebaudiana: an updated overview of their sweetening activity, pharmacological properties and safety — reviewView study →Reference 36Taylor · 2005The healing power of rainforest herbs: A guide to understanding and using herbal medicinals (pp}.

Dosage

In research, stevia is given either as a purified steviol glycoside (stevioside or rebaudioside A) at a fixed milligram dose, or as a stevia-sweetened drink at sweetener-level intake. These doses do not map onto whole-leaf or tincture use.

The estimated dried-herb equivalent is a rough back-conversion, assuming stevioside is about 9% of the dried leaf ^{33Reference 33Orellana-Paucar · 2023ReviewSteviol glycosides from Stevia rebaudiana: an updated overview of their sweetening activity, pharmacological properties and safety — reviewView study →}. It is not a recommended dose.

Traditional Dosage

Safety & Pregnancy

Purified steviol glycosides are approved food additives, with an acceptable daily intake of 4 mg/kg of body weight a day ^{33Reference 33Orellana-Paucar · 2023ReviewSteviol glycosides from Stevia rebaudiana: an updated overview of their sweetening activity, pharmacological properties and safety — reviewView study →}. The main caution is an added lowering of blood pressure and blood sugar at high doses of purified stevioside.

Full Safety & Interactions Detail

Regulatory status. JECFA evaluated stevia in 2007, the European Union approved steviol glycosides as a food additive in 2011, and the US FDA granted GRAS status to stevia leaf extract in 2018 ^{33Reference 33Orellana-Paucar · 2023ReviewSteviol glycosides from Stevia rebaudiana: an updated overview of their sweetening activity, pharmacological properties and safety — reviewView study →}. EFSA set an acceptable daily intake of 4 mg/kg of body weight a day ^{33Reference 33Orellana-Paucar · 2023ReviewSteviol glycosides from Stevia rebaudiana: an updated overview of their sweetening activity, pharmacological properties and safety — reviewView study →}.

How it is absorbed. Steviol glycosides are not absorbed intact. Gut bacteria break them down to steviol, which is absorbed and excreted ^{28,29,30Reference 28Renwick et al. · 2008ReviewMicrobial hydrolysis of steviol glycosides — reviewView study →Reference 29Mahalak et al. · 2020In vitroImpact of steviol glycosides and erythritol on the human and Cebus apella gut microbiome — in vitroView study →Reference 30Purkayastha et al. · 2020ReviewMetabolic fate in adult and pediatric population of steviol glycosides produced from stevia leaf extract by different production technologies — reviewView study →}. This happens in the same way in children’s and adults’ gut bacteria ^{30Reference 30Purkayastha et al. · 2020ReviewMetabolic fate in adult and pediatric population of steviol glycosides produced from stevia leaf extract by different production technologies — reviewView study →}.

Tolerability. In trials at both sweetener-level and higher doses, side effects were minor and infrequent, such as abdominal fullness, stomach pain and dizziness ^{3Reference 3Onakpoya et al. · 2015Meta-analysisEffect of the natural sweetener steviol glycoside on cardiovascular risk factors: a systematic review and meta-analysis of randomised controlled trialsView study →}. The one- and two-year blood-pressure trials reported good tolerability ^{5,6Reference 5Chan et al. · 2000RCTA double-blind placebo-controlled study of the effectiveness and tolerability of oral stevioside in human hypertension — randomised controlled trialView study →Reference 6Hsieh et al. · 2003RCTEfficacy and tolerability of oral stevioside in patients with mild essential hypertension: a two-year, randomised, placebo-controlled studyView study →}.

Blood pressure and blood sugar. At high doses, stevioside may add to antihypertensive or antidiabetic medicines. People prone to low blood pressure or low blood sugar should take high doses with care ^{5,6Reference 5Chan et al. · 2000RCTA double-blind placebo-controlled study of the effectiveness and tolerability of oral stevioside in human hypertension — randomised controlled trialView study →Reference 6Hsieh et al. · 2003RCTEfficacy and tolerability of oral stevioside in patients with mild essential hypertension: a two-year, randomised, placebo-controlled studyView study →}.

Whole leaf. Whole-leaf stevia and crude extracts have not been through the same regulatory safety evaluation as purified glycosides.

Interactions. No study has tested stevia against drug-metabolising enzymes such as CYP450.

References

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