Stevia Side Effects and Best Alternatives

Learn about beneficial and potentially dangerous stevia side effects and alternatives to stevia you can use to sweeten your foods without raising your blood sugar.

Close-up of a Stevia flower.
Kelsey Kunik, RDN
— Signos
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Updated by

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Science-based and reviewed

May 20, 2024
April 22, 2024
— Updated:
April 22, 2024

Table of Contents

Stevia is a natural, non-nutritive sweetener that adds plenty of sweetness without all the calories or sugar, making it a common addition to many low-carb and low-calorie foods. It can be found on the ingredient list for everything from tea to cookies, protein bars, sodas, and countless other foods. 

While stevia-sweetened foods won’t raise your blood sugar like table sugar and many other sweeteners, potential side effects may not be so sweet. In this article, you’ll learn what stevia is, and what the research says about its benefits and downfalls. Plus, you’ll learn about some common alternative sweeteners you may see or want to try!


What Is Stevia Leaf Extract?

Stevia leaf extract comes from the leaves of the stevia rebaudiana plant, a small, leafy herb native to South America. Stevia has been used to sweeten foods and drinks for centuries in other parts of the world but was first introduced in commercially produced foods in the United States in the 1980s. The sweetness comes from steviol glycosides, which are up to 300 times sweeter than regular sugar, so you only need a small amount to make food taste sweet.1

In the United States, only high-purity steviol glycosides, including stevioside, rebaudioside A, rebaudioside D, rebaudioside M, and enzyme-modified steviol glycosides, which are extracted from the stevia plant, are approved by the U.S. Food and Drug Administration (FDA). This form of stevia has been thoroughly researched and found to be safe for consumption. On the flip side, crude stevia extracts and raw or whole stevia leaves are not approved by the FDA for use in food because we don’t have enough information on their safety.1

What Are the Potential Side Effects of Stevia?

Man looking down while resting on a table.

The amount of stevia you get from eating foods or beverages sweetened with it is unlikely to cause any adverse health reactions. The Joint FAO/WHO Expert Committee on Food Additives states that the acceptable daily intake (ADI) of stevia sweeteners is 4 milligrams per kilogram of body weight per day or 12 milligrams of high-purity stevia extracts per kilogram of body weight for 16 weeks, is considered safe based on a number of studies. Keep in mind that this amount is much lower (sometimes 100 times lower) than the amounts used in many studies, where no adverse effects were found.

Swapping sugar for stevia products can help you eat fewer added sugars and carbohydrates overall, aiding in weight loss and improved metabolic health. As a consequence, it could potentially benefit health conditions like non-alcoholic fatty liver disease, diabetes, and heart disease. Still, there have been some concerns over the years about stevia's potential effects on various organ systems and overall health. Here’s what the research tells us about potential stevia side effects. 

1. Low Blood Pressure

Stevia’s blood pressure-lowering effects are helpful to some but could potentially be dangerous to others. If you struggle with low blood pressure or take blood-pressure-lowering medication, you want to be aware of these effects, but you don’t necessarily need to stay away from stevia in your food. A 2015 review, including 756 participants, found that the average systolic blood pressure-lowering effect of stevia vs placebo was only -2.98 mm Hg.

The amount of stevia used in these studies ranged from 200 milligrams to 1,000 milligrams per day, which is more than you’d likely get from naturally eating stevia in food throughout the day. 

2. Kidney Damage

Few animal studies have found stevia to induce kidney damage because of a build-up of stevia compounds in the kidneys as they wait to be excreted in urine.

However, these results are not consistent, especially in human trials. One recent human trial found that 1,000 milligrams of stevia extract daily resulted in a significant improvement in kidney markers like uric acid, serum creatine, and microalbumin in people with chronic kidney disease compared to the group who received a placebo.5

3. Gut Health

While stevia is generally well tolerated by the digestive system, unlike some non-nutritive sweeteners like sugar alcohols, there are mixed results on its effect on the gut microbiome

In animal and human studies, some found an increase in beneficial bacterial strains and a decrease in harmful strains while several other studies found that stevia supplementation had the opposite effect.6 Currently, it’s unclear exactly what effect stevia has on the gut microbiome. 

4. Endocrine Disruptions

There's some debate around stevia's effect on hormones. Certain studies suggest that steviol glycosides could interfere with hormones controlled by the endocrine system.7 In one study, stevia supplementation led to an increase in cortisol levels, which is a hormone related to stress and inflammation.

However, other studies have found beneficial effects of stevia on hormones, like improving fasting blood sugar levels and luteinizing hormone in animal studies, which could have a beneficial effect on male fertility.9

5. Liver Disruptions

For the most part, experts agree that stevia protects the liver and may even support healing from acute and chronic liver failure.10

Still, some studies suggest there may be a downside to stevia and liver health, as the same animal study that found stevia to cause kidney damage also found elevated liver enzymes, supporting the theory that it could, in some ways, be detrimental to the liver.4

<p class="pro-tip"><strong>Also Read: </strong><a href="hot-flashes-and-blood-sugar">Can Blood Sugar Impact Hot Flashes?</a>.</p>

Can You Use Stevia During Pregnancy?

Pregnant woman seated.

The FDA claims stevia extract is safe to consume during pregnancy and breastfeeding.11 However, be wary of stevia supplements. Supplements are not regulated by the FDA and could potentially use crude stevia or whole leaf stevia, which has not been studied thoroughly enough to determine its safety for pregnant women. 

7 Alternatives to Stevia

Whether you don’t enjoy the taste of stevia (some people think it has a slightly bitter aftertaste) or want to avoid its potential health effects, there are plenty of alternatives to stevia. From artificial sweeteners to other natural low or no calories sugar alternatives, here are 6 popular sugar substitutes that won’t raise your blood sugar: 

  • Aspartame: This artificial sweetener, along with sucralose, is one of the most popular artificial sweeteners. It tastes a lot like sugar but has zero calories. It’s often found in diet sodas and low-calorie desserts and can be an option for people looking to reduce their sugar intake. Common brand names include Equal or Nutrasweet. People with phenylketonuria (PKU), a rare genetic condition, need to avoid aspartame and any foods that contain it. 
  • Acesulfame-K: An artificial sugar sold under the brand names Sunett and Sweet One. It holds its flavor at high heat, making it a good option for sugar-free baking. This zero-calorie sweetener can be found in foods like frozen desserts, chewing gum, drinks, and more. 
  • Saccharin: This artificial sweetener was banned in the 1980s as it was thought to cause cancer, but has since been removed from that list after more research was done.12 It has a slightly bitter aftertaste and isn’t often used in food products, as it’s been swapped with better-tasting artificial sweeteners. 
  • Sucralose: Aka Splenda, sucralose is a sweetener commonly added to low-carb or low-calorie foods and used at home to sweeten drinks or for baking. While it is a no-calorie sweetener, several studies have found that it may actually increase blood glucose and insulin levels through various processes in the body.13
  • Monk Fruit: A natural sweetener that’s 100 to 200 times sweeter than sugar and doesn’t have the same blood glucose-raising effect. 
  • Allulose: This natural sugar is found in foods like molasses and raisins and has just 90 percent of the calories that table sugar does. So, while it’s not calorie-free, it won’t raise your blood sugar in the same way, and it has even been found to have blood glucose-lowering effects.14
  • Erythritol: Sugar alcohols are natural sweeteners that add a sweet flavor with no calories since they can’t be digested. Because of this, they can have side effects like gas, bloating, and diarrhea in people who are sensitive to them. 

 Is Stevia Good for You?

Stevia extracts used in food and drinks and sold as sweeteners are considered safe for use, even by people who are pregnant, breastfeeding, and who have type 1 or type 2 diabetes. Even at high doses, many studies report no adverse effects of stevia. 

Because stevia is so sweet, you can use much less to sweeten your food than if you were using table sugar. Eating foods and drinking beverages that contain stevia or sweetening your own foods and drinks with it can help you enjoy a sweet taste without raising your blood sugar or eating excess calories. 

Before using supplements that contain stevia or swapping all of your sweeteners for it, be sure to consult with your doctor to ensure there are no concerns or potential interactions with your medical history or medications. 

Learn More About How to Improve Blood Sugar Health With Signos’ Expert Advice

Eating the right foods is a major part of managing your health, diabetes, and weight. Incorporating no or low-calorie sweeteners, like stevia, into your diet could be a part of your plan. Signos can help you find what food choices work best for your body to improve your health and meet your goals. Find out if Signos is a good fit for you by taking our free, quick quiz!

<p class="pro-tip"><strong>Learn More: </strong><a href="meal-sequencing">The Relationship Between Food Order and Blood Sugar: A Closer Look</a>.</p>

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Topics discussed in this article:


  1. U.S. Food and Drug Administration. (n.d.). Import Alert 119. 
  2. Ashwell M. (2015). Stevia, Nature's Zero-Calorie Sustainable Sweetener: A New Player in the Fight Against Obesity. Nutrition today, 50(3), 129–134.  
  3. Onakpoya, I. J., & Heneghan, C. J. (2015). Effect of the natural sweetener, steviol glycoside, on cardiovascular risk factors: a systematic review and meta-analysis of randomised clinical trials. European journal of preventive cardiology, 22(12), 1575–1587. 
  4. Farid, A., Hesham, M., El-Dewak, M., & Amin, A. (2020). The hidden hazardous effects of stevia and sucralose consumption in male and female albino mice in comparison to sucrose. Saudi pharmaceutical journal : SPJ : the official publication of the Saudi Pharmaceutical Society, 28(10), 1290–1300. 
  5. Rizwan, F., Rashid, H. U., Yesmine, S., Monjur, F., & Chatterjee, T. K. (2018). Preliminary analysis of the effect of Stevia (Stevia rebaudiana) in patients with chronic kidney disease (stage I to stage III). Contemporary clinical trials communications, 12, 17–25.
  6. Kasti, A. N., Nikolaki, M. D., Synodinou, K. D., Katsas, K. N., Petsis, K., Lambrinou, S., Pyrousis, I. A., & Triantafyllou, K. (2022). The Effects of Stevia Consumption on Gut Bacteria: Friend or Foe?. Microorganisms, 10(4), 744. 
  7. Shannon, M., Rehfeld, A., Frizzell, C., Livingstone, C., McGonagle, C., Skakkebaek, N. E., Wielogórska, E., & Connolly, L. (2016). In vitro bioassay investigations of the endocrine disrupting potential of steviol glycosides and their metabolite steviol, components of the natural sweetener Stevia. Molecular and cellular endocrinology, 427, 65–72. 
  8. Al-Dujaili, E. A., Twaij, H., Bataineh, Y. A., Arshad, U., & Amjid, F. (2017). Effect of Stevia Consumption on Blood Pressure, Stress Hormone Levels and Anthropometrical Parameters in Healthy Persons. American Journal of Pharmacology and Toxicology, 12(1), 7-17.
  9. Cao, L. (2019). The protective effect of Stevia rebaudiana Bertoni on serum hormone levels, key steroidogenesis enzymes, and testicular damage in testes of diabetic rats. Acta Histochemica. 
  10. Ramos-Tovar, E., Hernández-Aquino, E., Casas-Grajales, S., Buendia-Montaño, L. D., Galindo-Gómez, S., Camacho, J., Tsutsumi, V., & Muriel, P. (2018). Stevia Prevents Acute and Chronic Liver Injury Induced by Carbon Tetrachloride by Blocking Oxidative Stress through Nrf2 Upregulation. Oxidative medicine and cellular longevity, 2018, 3823426.
  11. American Pregnancy Association. (2015). Artificial Sweeteners and Pregnancy. 
  12. National Cancer Institute. (2023). Artificial Sweeteners and cancer.
  13. Schiffman, S. S., & Rother, K. I. (2013). Sucralose, a synthetic organochlorine sweetener: overview of biological issues. Journal of toxicology and environmental health. Part B, Critical reviews, 16(7), 399–451. 
  14. Xia, Y., Cheng, Q., Mu, W., Hu, X., Sun, Z., Qiu, Y., Liu, X., & Wang, Z. (2021). Research Advances of d-allulose: An Overview of Physiological Functions, Enzymatic Biotransformation Technologies, and Production Processes. Foods (Basel, Switzerland), 10(9), 2186.

About the author

Kelsey Kunik is a registered dietitian, health and wellness writer, and nutrition consultant

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Please note: The Signos team is committed to sharing insightful and actionable health articles that are backed by scientific research, supported by expert reviews, and vetted by experienced health editors. The Signos blog is not intended to diagnose, treat, cure or prevent any disease. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider. Read more about our editorial process and content philosophy here.

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