✓ No active regulatory warningsFDA MedWatch, EMA EudraVigilance, WHO VigiBase, WADA Prohibited List · 2026-05-29
📰Read the full Stevia (Steviol glycosides) evidence review on GMJ News →Complete clinical article, references and updates on news.gmj.ge. This page is the structured safety summary.⚠ Patient assuming crude stevia leaf = approved stevia extract — FDA only approves ≥95% pure glycosides [1]
⚠ Hypertensive patient on antihypertensives taking high-dose stevioside supplement — additive BP lowering [2]
⚠ Patient with stevia 'allergy' — possible cross-reactivity with ragweed/Asteraceae family [1]
⚠ Parent concerned about stevia in children's supplements — safe within ADI on body-weight basis [1]
ℹ️ Not obtained from food. Not applicable — this is a sweetener/additive, not a nutrient you build up from a daily diet.
🔬 Lab interpreter
ℹ️ No validated blood test. There is no established laboratory test to assess status or guide dosing for this ingredient. Clinical response and symptoms are the practical guide.
⚕ For professionals — confirm ranges against your local laboratory.
Clinical verdict
Stevia is one of the most thoroughly safety-evaluated food additives globally (FDA GRAS, EFSA E960, JECFA ADI). In supplement contexts, it appears as an excipient in chewable/gummy formulations. The dual personality: at sweetener doses, it's a simple sugar substitute; at pharmacological doses (750–1,500 mg/day), it has genuine antihypertensive meta-analytic evidence. Reb A/M preferred over stevioside for taste [1] [2].
1 How much do I need?
👤 Adults: Specific dosage data under clinical review
👴 Elderly: Specific dosage data under clinical review
🤰 Pregnancy: See guidance
Safe within ADI (4 mg/kg/day). EFSA and FDA consider purified steviol glycosides safe in pregnancy. Avoid crude leaf extracts [1].
👦 Pediatric: See guidance
Safe for children at sweetener doses within ADI. The ADI applies to all age groups on a body-weight basis. American Academy of Pediatrics has not issued specific guidance on non-nutritive sweeteners i
🏃 Athletes: Standard dose
⚖️ Obesity: Standard dose
Fat-soluble compounds may require dose adjustment in obesity.
🩺 Renal: Consult specialist
Dose adjustment may be needed in renal impairment.
🌱 Vegan: Standard dose
How to take
🍽 Timing: As sweetener: with food/beverages. As supplement for BP: divided doses with meals [1].
💊 With food: No specific requirements [1].
2 Which form?
| Form | Bioavailability | Vegan | Cost |
|---|---|---|---|
| ['High-purity Reb A extract (≥95%)', 'preferred', 'Least bitter, best taste profile. The form approved by FDA and EFSA. Used in commercial beverages and supplements [1].'] | Standard | Check label | |
| ['Stevioside extract', 'common', 'More bitter/licorice aftertaste than Reb A. Still effective as sweetener [1].'] | Standard | Check label | |
| ['Reb M / Reb D (fermentation-derived)', 'premium', 'Closest to sugar taste with minimal bitterness. Produced by fermentation. More expensive [1].'] | Standard | Check label | |
| ['Stevia leaf (crude/whole)', 'traditional', 'Green stevia leaf powder. Not approved as food additive by FDA (only high-purity extracts are GRAS). Used in traditional herbal preparations [1].', 'orange'] | Standard | Check label | |
| ['Stevia-monk fruit blends', 'popular', 'Combines stevia with monk fruit (luo han guo) to improve taste and reduce aftertaste [1].'] | Standard | Check label |
3 Common questions
Is stevia safe? I've heard conflicting things. ▼
High-purity steviol glycoside extracts (≥95% purity, like Reb A) are among the most thoroughly evaluated food additives globally. FDA, EFSA, JECFA, and WHO have all concluded they are safe at the ADI. Older concerns were based on crude stevia leaf extracts and low-quality studies; these do not apply to purified extracts [1].
Does stevia affect blood sugar? ▼
At sweetener doses (a few mg per serving): no significant effect on blood glucose. At pharmacological doses (1,000+ mg/day stevioside): modest blood glucose reduction reported in diabetic patients. For most consumers using stevia as a sugar substitute, the main benefit is simply avoiding sugar calories [1] [2].
Why does stevia sometimes taste bitter? ▼
Stevioside has a pronounced bitter/licorice aftertaste due to activation of bitter taste receptors. Rebaudioside A (Reb A) is less bitter. Newer glycosides (Reb M, Reb D) have the cleanest taste, closest to sugar. Many products blend stevia with erythritol or monk fruit to mask bitterness [1].
Is stevia 'natural'? ▼
Stevia rebaudiana is a plant, and steviol glycosides are naturally occurring compounds. However, commercial extracts undergo significant purification (water extraction, chromatography, crystallization). Some Reb M/D is produced by fermentation (bioconversion), not directly from leaves. Whether this counts as 'natural' depends on definition [1].
4 Clinical evidence
Strong
Safety as sweetener: JECFA, EFSA, FDA, and multiple national regulatory bodies have concluded that high-purity steviol glycosides (≥95%) are safe for human consumption at the established ADI. No genotoxicity, carcinogenicity, or reproductive toxicity in extensive regulatory review [1]. HIGH
Moderate
Blood pressure: a meta-analysis of 7 RCTs found stevioside (750–1,500 mg/day for 1–2 years) significantly reduced systolic and diastolic blood pressure in hypertensive patients. Effect sizes were modest (SBP −6.7 mmHg, DBP −3.4 mmHg). These doses are far above sweetener use [2]. Blood glucose: stevioside (1,000 mg/day) reduced postprandial glucose in 2 small RCTs of T2DM patients, with proposed mechanisms including GLP-1 potentiation and TRPM5 channel activation [2]. MODERATE
Insufficient
Anti-cancer effects: preclinical data on steviol derivatives; no human studies [1]. Gut microbiome: steviol glycosides are metabolized by gut bacteria (to steviol); impact on microbiome composition is unstudied [1]. Weight management: while replacing sugar with stevia reduces caloric intake, no RCTs demonstrate weight loss from stevia specifically [1]. Kidney function: preclinical nephroprotective data; no human evidence [1]. LOW
5 Safety, toxicity & adverse events
Absolute contraindications
✕ Ragweed/Asteraceae allergy (plant-source reactions)
Relative
⚠ Antihypertensives/antidiabetics — mild additive lowering reported
⚠ Whole-leaf/crude stevia is not approved as a sweetener in some regions (only purified glycosides) — use purified forms
🚩 Red flags
● Patient with ragweed/Asteraceae allergy reporting reactions to stevia — cross-reactivity possible [1]
● Patient using crude stevia leaf extract assuming it's the same as purified product [1]
● Hypertensive patient on multiple BP meds adding high-dose stevioside — monitor [2]
6 Interactions
Drug interactions
Antihypertensives (at pharmacological stevia doses) Moderate
Mechanism: Stevioside has vasodilatory and mild diuretic effects [2].
Effect: Additive BP reduction (−6.7/−3.4 mmHg in meta-analysis) [2].
Action: Monitor BP if using >750 mg/day stevioside alongside antihypertensives [2].
Supplement synergies
Erythritol · Standard blend ratios in commercial products
Common stevia-erythritol blends improve taste and provide bulk. Erythritol is non-cariogenic and well-tolerated [1].
Common stevia-erythritol blends improve taste and provide bulk. Erythritol is non-cariogenic and well-tolerated [1].
7 Regulatory
United States (FDA): High-purity steviol glycosides (≥95%) are GRAS. Whole stevia leaf and crude extracts are NOT approved as food additives. Multiple GRAS notifications accepted since 2008 [1].
European Union (EFSA): Steviol glycosides approved as food additive E960. ADI: 4 mg/kg/day steviol equivalents. Specifications require ≥95% total steviol glycosides [1].
Codex Alimentarius (WHO/FAO): JECFA established the ADI of 0–4 mg/kg/day (steviol equivalents) in 2008. Codex maximum use levels set for multiple food categories [1].
Japan: Pioneer market — stevia has been used as food sweetener in Japan since the 1970s, providing decades of post-market safety data [1].
8 Cite this page
Vancouver: Pkhakadze G. Stevia (Steviol glycosides) — safety profile [Internet]. Tbilisi: PHIG; 2026 [cited 2026 Jul 17]. Available from: https://supplement.ge/ingredients/stevia-steviol-glycosides/
APA 7th: Pkhakadze, G. (2026). Stevia (Steviol glycosides) — Safety profile. Public Health Institute of Georgia. https://supplement.ge/ingredients/stevia-steviol-glycosides/
📋 Editorial information
Author: Prof. G. Pkhakadze, MD, MPH, PhD
Institution: Public Health Institute of Georgia (PHIG)
Affiliation: David Tvildiani Medical University (DTMU)
First published: January 2026
Last reviewed: 2026-05-29
Next review: January 2027
References: 4 cited sources
COI: SupplementIndex receives no funding from supplement manufacturers. All content independently authored by PHIG.
Process: Systematic literature review
📄 License & reuse
Published under Creative Commons Attribution 4.0 International (CC BY 4.0). You may share and adapt for any purpose with attribution.
Pkhakadze G. "Stevia (Steviol glycosides) — Safety Profile." SupplementIndex, PHIG, 2026. https://supplement.ge/ingredients/stevia-steviol-glycosides/ CC BY 4.0.
GP
Prof. G. Pkhakadze, MD, MPH, PhD
Professor of Public Health · Head of Department, DTMU
Editor-in-Chief, Georgian Medical Journal (ISSN 3088-4322)
Chair, Public Health Institute of Georgia · UEMS Public Health Section
Educational and public health purposes. CC BY 4.0. Consult your healthcare provider before starting any supplement. Corrections: info@accreditation.ge. Publisher: PHIG