Resources for Dietitians


With so many people concerned about added sugar and calories, stevia offers the perfect solution for a wide range of consumers: adults seeking to manage weight, parents who want to give their children less sugar, people with diabetes as well as anyone who is concerned about controlling calories.

Here are some resources, particularly for dietitians, helping to explore the world of stevia.

Discover the advantages of stevia through the video, “Stevia: The Science Behind The Sweet,” featuring Dr. Keith Ayoob, a renowned expert in nutrition.

In this video, you can learn about the health benefits of stevia, a zero-calorie sweetener, with a focus on its safety, regulatory status, and its influence on essential health metrics such as blood glucose, insulin levels, blood pressure, and gut microbiota.

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Healthy Living


Dietary Guidelines for Americans

The goal of the Dietary Guidelines for Americans (DGA) is to provide nutrition guidance that can improve the health of Americans by helping people choose healthy and enjoyable foods and beverages. According to the 2020-2025 DGAs, a healthy diet emphasizes:

  • Fruits, vegetables, whole grains and low-fat dairy products
  • A variety of protein ‎foods like seafood, lean meats and nuts
  • Food that is low in saturated fat, trans fats, cholesterol, ‎sodium and added sugars
  • A diet that stays within your daily caloric needs

The 2020-2025 DGAs also include recommendations related to increased fiber intake, as well as the use of low-calorie sweeteners to manage weight in adult populations. Replacing added sugars with low- and no-calorie sweeteners may reduce calorie intake in the short-term and aid in weight management.

Americans are making efforts to manage their weight through lifestyle changes. The ‎Harris Poll conducted an online consumer survey for the Calorie Control Council of over ‎‎2,000 U.S. adults ages 18 and older to learn what changes in lifestyle people have made ‎to achieve their weight loss goals. The survey found that the top five changes made were: ‎‎57% consume more water, 55% exercise and be more active, 47% eat smaller portions, ‎‎28% use reduced-sugar or sugar free products and 27% said they would weigh themselves more often.‎ 

The American’s polled also state having a more positive attitude toward food, health, and dieting. ‎According to a 2021 International Foot Information Council (IFIC) Survey on Food and Health more people would rather count ‎calories than follow trendy diets. Similarly, while the top motivator for dieting remains ‎losing weight, fewer people are focused on this reason than prior years. The number of ‎people dieting to improve physical appearance also dropped. ‎ 

References:

Healthy Eating for a Healthy Weight | Healthy Weight, Nutrition, and Physical Activity | CDC

2021 Food & Health Survey: Pandemic Food Habits Start to (globenewswire.com)

Achieving Results…

The most important thing is to focus on the overall quality of your diet, rather than a single nutrient or food. Try to include more nutrient-dense foods, such as vegetables, fruits, legumes, and lean proteins. Limit foods that offer lots of calories but little nutritional value. The USDA, along with other respected organizations, provide consumers with tools and eating patterns that may help them to achieve the goals set forth in the DGAs.

USDA MyPlate

USDA’s MyPlate can help you identify what and how much to eat from the different food groups while staying within your recommended calorie allowance.

Mediterranean-Style Meal Planning

“Mediterranean diet” is a generic term based on the traditional eating habits in the countries bordering the Mediterranean Sea. There are at least 16 countries that border the Mediterranean, and so there is not one standard diet from this region. Eating styles from among these countries and even among regions within each country because of differences in culture, ethnic background, religion, economy, geography, and agricultural production. However, there are some common factors:

  • Olive oil as a primary fat source
  • Dairy products, eggs, fish and poultry in low to moderate amounts
  • Fish and poultry are more common than red meat in this diet
  • Centers on minimally processed, plant-based foods
  • Wine may be consumed in low to moderate amounts, usually with meals
  • Fruit is a common dessert instead of sweets

Plant -Forward Meal Planning 

Plant-based or plant-forward eating patterns focus on foods primarily from plants. This ‎includes not only fruits and vegetables, but also nuts, seeds, oils, whole grains, legumes, ‎and beans. It doesn’t mean that you are vegetarian or vegan and never eat meat or dairy. ‎Rather, you are proportionately choosing more of your foods from plant sources.‎ 

Diabetic Friendly Meal Planning ‎ 

While there is no specific “diabetes diet,” the American Diabetes Association (ADA) does provide guidelines for creating a healthy meal that can help patients with managing their diabetes. Many different eating patterns can help you manage your diabetes – from Mediterranean to low-carbohydrate, to vegetarian. Whatever you choose, be sure to include lots of non-starchy vegetables, minimize added sugar and refine grains and choose whole, minimally processed foods. Keep in mind that a diabetic meal plan can fit into many different dietary patterns. There is also no one-size-fits-all. Talk to your doctor and get a referral o a registered dietitian nutritionist (RDN) who can help you figure out what eating plan makes the most sense for you and your treatment goals. Just because you follow a diabetic meal plan does not mean you need to give up all the foods you love.

Stevia in Your Tool Box

For people who miss having sweet desserts and drinks, stevia sweeteners can provide an alternative ‎to sugar. A natural, zero-calorie sweetener, stevia can offer sweetness without the ‎excess sugar and calories. Furthermore, stevia is up to 300 times sweeter than sugar, ‎which means you only need a little to create the same level of sweetness.  ‎ 

Activity 

Last but not least – physical activity. Strive to get up and get moving! Regular activity is important for good overall health.


References 

MyPlate Plan | MyPlate

What is the Mediterranean Diet? | American Heart Association

The right plant-based diet for you – Harvard Health

Recipes & Nutrition | ADA (diabetes.org)

Exercise: 7 Benefits of Regular Physical Activity – Mayo Clinic

FAQs


Stevia is a plant of the Asteraceae (sunflower) family. The leaves have been used as a sweetener in South America for hundreds of years. Extracts from the stevia leaf have been available as food additives (sweeteners) and/or dietary supplements in many countries around the world. 

2. What makes stevia a nature-derived sweetener, and how do we define ‘natural’?

Stevia is recognized as a nature-derived sweetener because its sweetening compounds, known technically as steviol glycosides, originate from the stevia plant. While the process to obtain these glycosides can seem industrial, it’s essential to note that these compounds are naturally produced in the stevia leaf, not artificially created in a laboratory. However, it’s worth mentioning that the term ‘natural’ does not have a universally consistent definition across companies, countries, or regulatory bodies. The primary distinction here is that the sweetening compounds in stevia sweeteners are analogous to those found directly in the stevia plant.

3. What’s the difference between stevia and artificial sweeteners?

The primary distinction between stevia and artificial sweeteners is their origin. Artificial sweeteners are chemically synthesized and do not exist in nature, whereas stevia is a sweetener derived from a plant and is naturally present in stevia leaves. While the extraction process for stevia might seem intricate, its natural source sets it apart from chemically produced artificial sweeteners. Moreover, stevia extracts can be from 50 – 450 times sweeter than sugar, depending on the application and amount and/or extract used. A simple way to measure the sweetness would be a sensory comparison with the sweetness of sugar in a water solution. 

4. How are steviol glycosides extracted from the stevia leaf, specifically in the context of stevia leaf extracts?
(This does not refer to other technologies such as BC, GSG, and fermentation.)

Stevia extracts are removed from the leaves of the stevia plant by traditional extraction methods which do not alter the composition of the plant’s sweet compounds. The extraction process involves steeping the dried leaves of the stevia plant in water, filtering and separating the liquid from the leaves and stems, and further purifying the remaining plant extract with either water or food grade alcohol. Stevia extracts are exactly the same compound outside the leaf as they are found in the leaf. Please visit our How Stevia is Made section for more information on all stevia production technologies.

5. How can stevia extracts be natural if an extraction process is required?

The definition and labeling requirements for natural vary country by country. In some markets, there are very precise and qualified requirements around the term natural. Regardless of the ability to use the term “natural” for labeling or marketing purposes, research conducted by members of the International Stevia Council clearly demonstrate both a global demand for calorie-free sweetness from a plant source as well as a full understanding that an extraction process is necessary to take place in order to release the sweetness of the stevia plant.

6. How can we trust the safety of stevia?

The safety of stevia sweeteners has been extensively reviewed and scientifically proven by numerous international organizations, such as the Joint FAO/WHO Expert Committee on Food Additives (JECFA) and the European Food Safety Authority (EFSA). Studies of stevia sweeteners clearly support the safety of these ingredients.

Further, clinical studies show that stevia sweeteners meeting purity criteria established by JECFA have no effect on either blood pressure or blood glucose response, indicating that stevia sweeteners are safe for use by persons with diabetes. 

Over the last 13 years, the U.S. Food and Drug Administration (FDA) stated it has no questions regarding the conclusion of expert panels that stevia sweeteners is Generally Recognized As Safe (GRAS) for use as a general-purpose sweetener. To date, the FDA has stated that it has no questions in response to a number of separate stevia sweeteners GRAS notifications. 

There are no known side effects or allergies from the use of stevia extracts in foods and beverages.

7. Is stevia safe for pregnant women and children to consume? What guidelines or recommendations exist regarding the consumption of stevia by these particular demographic groups?

Stevia, as a natural and non-nutritive sweetener, has been extensively evaluated for its safety. Regulatory bodies worldwide, including the U.S. Food and Drug Administration (FDA), the European Food Safety Authority (EFSA), and the Joint FAO/WHO Expert Committee on Food Additives (JECFA), have concluded that high purity stevia leaf extracts are safe for consumption by the general population, which includes pregnant women and children above 3 years old. It’s important to note that like all foods and beverages, stevia should be used as part of a balanced and varied diet.

8. Is stevia safe for consumption by people with diabetes? Does it affect blood sugar levels? What is its glycemic index? 

Research has shown that stevia sweeteners do not affect blood glucose levels or interfere with insulin. With effectively zero calories, stevia sweeteners offer people with diabetes greater variety and flexibility in budgeting total calorie intake and assisting with weight management. Stevia extracts do not have an effect on glycemic response, at the levels of use. 

 

9. The recent World Health Organization (WHO) guidelines on low or zero-calorie sweeteners have sparked some discussion. Could you help us understand how we should interpret these guidelines, particularly in relation to stevia’s role as a non-nutritive sweetener?

The WHO recently (2023) recommended that all low and zero-calorie sweeteners including stevia should not be used as a tool for weight management. The WHO did not comment on the safety of low or zero-calorie sweeteners. The WHO separated studies on low and zero calorie sweeteners into randomized control studies (RCTs, Gold standard) and observational studies (OS, which do not establish cause and effect) to make their suggestion. The WHO acknowledged that RCTs show benefits in the short term (1-3 months) in weight management however that OS (which can go on for years) do not. Thus, the WHO does not recommend low or zero sweeteners for weight management. This recommendation was met with criticism as it ignores gold standard studies which show that low and zero calorie sweetener can aide in weight management via sugar reduction while relying solely on OS. The recommendation also is at odds with recommendations from the 2015-2020 USDA Dietary Guidelines which suggest benefits from low and zero-calorie sweeteners. The WHO is not a regulatory agency, and the recommendation will likely have little effect on stevia as is has attained global regulatory approval. Recent studies show that stevia indeed has benefits on weight management including appetite, short term food intake, and small weight loss when compared to sugar.

10. How sustainable is the production of stevia? Are there any environmental impacts associated with the cultivation, processing, or distribution of stevia? How does stevia production compare to other sweeteners in terms of environmental footprint?

Stevia cultivation and production is considered to be environmentally friendly and sustainable. Stevia is a perennial plant, meaning it can be harvested multiple times before replanting, which can help conserve soil and resources. In comparison to other sweeteners, stevia has a smaller environmental footprint. It requires less land and water to produce the same amount of sweetness as sugar. The extraction and purification process of stevia also strives to minimize environmental impact, using water and food-grade alcohol, both of which are recovered and reused. As more sustainable production technologies are leveraged, such as enzymatic conversion and fermentation, the environmental footprint of stevia production continues to decrease.  Stevia production is globally recognized for its environmentally friendly and sustainable characteristics. It’s a perennial plant, allowing for multiple harvests before the need for replanting, thus optimizing the conservation of soil and resources. When compared to traditional sugars, stevia requires substantially less land and water to produce the same level of sweetness, highlighting its significantly smaller environmental footprint. Recent advancements in production technologies have introduced methods like enzymatic conversion and fermentation to stevia production, further reducing its environmental impact and improving its sustainability metrics in comparison to other sweetening alternatives.

 

11. How have consumer preferences influenced the sustainability initiatives of food and beverage companies in relation to stevia?

Consumers around the world are increasingly placing sustainability at the forefront of their purchasing decisions, actively seeking products and brands that reflect their values and concerns regarding environmental conservation. A significant number of consumers are modifying their diets and lifestyles to be more sustainable and are looking for products that are not just flavorful but are also environmentally conscious. Stevia, with its intense natural sweetness and lower environmental impact, serves as an optimal solution for companies to align with these evolving consumer preferences and values.

12. How crucial is a Life Cycle Assessment (LCA) in discerning the sustainability of stevia and how does it facilitate comparisons with other sweeteners in terms of environmental impacts?

A Life Cycle Assessment (LCA) is pivotal as it offers a thorough and quantified analysis of the environmental impacts of a product from its raw materials to its consumption. This assessment is vital in fostering informed decision-making for manufacturers, focusing on sustainability and product innovation.

For stevia, a robust, peer-reviewed, and internationally compliant LCA has been undertaken, highlighting its environmental implications relative to other sweeteners, including cane sugar, beet sugar, and high-fructose corn syrup, considering factors such as climate change, land use, water scarcity, and cumulative energy demand.

The results elucidate that stevia, when evaluated on a sweetness equivalence to one kilogram of white sugar, significantly excels in minimizing environmental impacts, reinforcing its substantial potential to contribute to sustainability in the food and beverage industry. The LCA underscores stevia’s outstanding environmental performance across diverse metrics and substantiates its role in reducing environmental impacts in food and beverage formulations.

13. How can I find stevia sweetened products?

Many companies and food manufacturers today incorporate next-generation stevia ingredients into their products. These foods and beverages are sold across the globe. Stevia-based sweeteners can be found in reduced and zero sugar beverages like teas, juice drinks, flavored waters, sodas, coffees, etc., and in foods from sweet condiments to bars, cereals, candies and desserts. When looking for products that contain stevia ingredients, consumers can look for the following names on the ingredient list: stevia leaf extract, stevia sweetener, stevia-based sweetener, stevia extract, steviol glycosides, Reb A, and Reb M. Consumers can enjoy sweet-tasting food and beverages guilt free, because stevia-based sweeteners contribute zero calories and deliver an enjoyable sweet taste.

14. Can stevia be used in any kind of food and beverage? Are there any restrictions in usage? How does it interact with other sweeteners?

Stevia extracts are incredibly versatile and can be incorporated into a vast array of food and beverage applications. From baked goods like cookies and cakes to salad dressings, sauces, and beverages, stevia can seamlessly replace sugar to offer a reduced-calorie, naturally-derived sweetness. However, it’s essential to keep in mind that stevia is much sweeter than sugar, so you only need a little. The versatility of stevia is such that, in essence, anywhere you would use sugar, you can utilize stevia as an alternative. Individual usages and use levels may vary depending on the country’s specific regulations. Additionally, when stevia is used in tandem with other sweeteners, they often act synergistically, enhancing the sweetness profile of the final product without introducing additional calories.

15. Are stevia extracts soluble? 

Stevia extracts have excellent solubility in a wide range of applications. 

16. Are stevia extracts heat stable, photo stable and stable under all pH conditions? 

Stevia extracts are extremely heat, photo and pH stable under a wide range of processing conditions and have exhibited excellent shelf stability. 

17. How many calories do stevia extracts contribute? 

Stevia extracts contribute effectively zero calories. 

18. Are stevia plants genetically modified? 

Stevia plants are not genetically modified. Development of new plant varieties takes place by selective breeding and not genetic modification. 

19. What is the Acceptable Daily Intake (ADI) of stevia, and how is it determined?

In the U.S., stevia has been recognized as GRAS (Generally Recognized As Safe), which means there isn’t a specified ADI. However, for those seeking a broader perspective, the World Health Organization has established an ADI for steviol equivalents (which are components of stevia) at 4 milligrams per kilogram of body weight. While this translates to a much higher consumption limit than the average person would typically consume, it’s useful to note that these measures are set conservatively to ensure safety.

For practical applications, especially for dietitians guiding their clients or patients, it’s essential to understand that while stevia can be consumed safely in reasonable amounts, it’s always advisable to moderate the consumption of any sweetener. Specific consumption recommendations can be tailored based on individual dietary needs and overall health objectives. Like with all dietary choices, moderation and a balanced approach are key.

20. With emerging new production technologies, how will this impact the naturalness and safety of stevia?

As the world of production technology evolves, the extraction and purification process of stevia greatly benefits from these advancements. Innovation and technology not only help in preserving the naturalness of stevia but also enhance its quality and safety. Through advanced methodologies, we can extract stevia more efficiently while ensuring its inherent properties remain intact. Additionally, the progressive nature of these technologies aligns with sustainable practices, ensuring that stevia remains an eco-friendly choice. This not only ensures consumers receive a high-quality product but also emphasizes our commitment to making stevia accessible to everyone in an environmentally responsible manner.

21. What is the relationship between stevia, stevia extracts, steviol glycosides and Rebaudioside A? 

The term stevia can refer to a preparation (powder or liquid) of dried stevia leaves or the stevia plants themselves. Stevia extracts refer to selected molecules used as stevia sweeteners and flavor modifiers extracted from the stevia plant.

Steviol glycosides are the molecules found within the stevia plant. Rebaudioside A (as well as other Rebaudioside ingredients such as Reb D and Reb M) are examples of specific steviol glycosides found naturally within the stevia plant.

22. What is the difference between steviol glycosides and steviol equivalents? Is there a way to convert steviol glycosides into steviol equivalents? 

Steviol glycosides are the sweet compounds of the leaves of the stevia plant. Each one is made up of a backbone unit of steviol, with differing numbers/configurations of sugar units attached, specific to that steviol glycoside. In order to address the overall safety of steviol glycosides, many regulatory agencies have created maximum use limits, expressed in steviol equivalents. These limits are then adjusted upward, using a specific steviol equivalent factor, to reflect the molecular weight of the steviol glycoside molecule(s) present (see the table below). 

This table compares the sweetness obtained from 4mg of steviol equivalents/kg body weight to the sweetness obtained from sugar. 

The conversion is based on this formula: 

SG((Conv1 × %SG1) + (Conv2 × %SG2) + …. + (Conv × %SGn)) = x mg steviol equivalents 

SG: the amount of Stevia leaf extract in the product, Conv: the relevant conversion factor for each steviol glycoside and %SG : the percentage content of the relevant steviol glycoside in a particular stevia leaf extract.  

Steviol Glycoside  Molecular Weight   Conversion factor 
Steviol  318.45  1.00 
Stevioside  804.38  0.40 
Rebaudioside A  966.43  0.33 
Rebaudioside B  804.38  0.40 
Rebaudioside C  950.44  0.34 
Rebaudioside D  1128.48  0.29 
Rebaudioside E  967  0.33 
Rebaudioside F  936.42  0.34 
Rebaudioside M 1291.3 .25
Dulcoside A  788.38  0.40 
Rubusoside  642.33  0.50 
Steviolbioside  642.33  0.50 

In the EU(1) and other geographies, the factors to convert steviol glycosides to steviol equivalents are given in the specific regulations and are rounded. They are not the exact factors as would be derived from fully accurate molecular weights. The regulation factors should be used for all calculations. 

Calculation Based on the EU Regulation: 

As an example of how the factors work, in the case of pure, dry rebaudioside A, 80 mg/l steviol equivalents means (80 * 3.03) = 242.4 mg/l reb A. The legal limit on reb A in EU beverages (in the absence of any other steviol glycoside) is thus 242 mg/l. 

(1) EU regulation 231/2012, laying down specifications for food additives listed in Annexes II and III to Regulation (EC) No 1333/2008, OJ 22/3/2012 L83:1-217 

23. Can any extract solvent be used to obtain stevia extracts? 

In order for stevia extracts to be used in food, stevia extracts must strictly adhere to established specifications of identification and purity established by national and global food safety authorities. These specifications clearly indicate which food grade alcohols have been included in safety evaluations and are accepted for use in the extraction of steviol glycosides. 

Furthermore, the CODEX General Standard for Food Additives requires that the established specification of identification and purity should be followed, and that all food additives comply with good manufacturing practices (GMPs). Members of the  

International Stevia Council fully support and comply with these laws and standards. 

24. Does the International Stevia Council have guidelines for extraction? 

The members of the International Stevia Council are committed to the highest standards for the international stevia industry. All members of the International Stevia Council, as a condition of membership in the organization, have committed to producing stevia extracts which meet the specifications established by the Joint FAO/WHO Expert Committee on Food Additives (JECFA) which provide for the use of water and alcohol extraction in the production of steviol glycosides. The International Stevia Council has also established a leading-edge Proficiency Testing Program for steviol glycosides which helps stevia producers and the food industry continually improve methods of analysis for stevia extracts. This program provides food and beverage manufacturers an important tool in their due diligence efforts in ensuring that they are procuring stevia extracts that meet the legal requirements for use in food.