Amy Campbell is a registered dietitian and Certified Diabetes Educator who has been working in the field of diabetes for many years. She is the author of several books about diabetes, including 16 Myths of a Diabetic Diet and Staying Healthy with Diabetes: Nutrition and Meal Planning. In addition, Amy is a lecturer and frequent contributor to several diabetes-related websites.

Welcome to the world of sweeteners!

If you thought managing your diabetes was confusing enough, you now (perhaps) need to contend with the many different kinds of sweeteners out there, ranging from nutritive sweeteners (including sugar, honey, agave, and coconut sugar) to non-nutritive sweeteners (aspartame, sucralose, saccharin, and stevia) to those that lie somewhere in between, also known as sugar alcohols (sorbitol, mannitol, erythritol). Phew! There’s a lot to know and keep up with, that’s for sure.

I’m not going to write about the pros and cons of these sweeteners—that’s a topic for another day. What I would like to address, though, is the somewhat murky difference between stevia and the fairly new stevia-based sweeteners that have been appearing on the market over the last few years. Are they the same? Is one better to use than the other?

The case for stevia

Stevia is touted as a “natural” sweetener, which, in many people’s minds, automatically means it’s good or at least better for you than those chemical-laden sweeteners like aspartame. But, show of hands here: how many of you really know what stevia is?

Stevia comes from a shrub that’s native to South America and Southeast Asia. The folks of Paraguay have long used stevia for culinary and medicinal purposes. People in Japan are big fans of stevia as well. The sweetness in stevia comes from substances called steviosides and rebaudiosides. In the 1990s, the FDA banned the use of stevia as a food ingredient, as studies showed high doses of this herb caused reduced sperm production in rats and fewer and smaller offspring in hamsters. In the lab, stevia can be converted into a mutagenic compound that could potentially lead to cancer. These issues have consumer watchdog groups like Center for Science in the Public Interest (CSPI) a little wary about jumping on the stevia bandwagon with abandon.

So, because of these findings, stevia can’t be legally sold as a sweetener or food ingredient. It can, however, be sold as a dietary supplement, because they are regulated differently. You can also legally purchase stevia plants; many people use the leaves to sweeten their foods and beverages.

The case for Truvia, PureVia, and other stevia-based sweeteners

Although the FDA continues to ban the sale of stevia as a sweetener, in 2008, it did listen to a few companies, including Cargill and Pepsi, and agreed to consider extracts of stevia to be GRAS, or Generally Recognized as Safe. If a food ingredient has GRAS status, it’s not considered to be a food additive and it can be used without FDA approval.

GRAS status is not the same as FDA approval, by the way.

As a result of this GRAS status, Cargill and Coca Cola introduced Truvia, Pepsi and Whole Earth Sweetener Company introduced PureVia, and Wisdom Natural Brands introduced SweetLeaf. These are sweeteners that contain an extract of the stevia leaf called rebaudioside A, or rebiana. Despite consumers casually mentioning that they use “stevia” in, say, their coffee or tea, it’s not the same as using the stevia leaf.

Here’s what you’ll find in these new sweeteners:

- Stevia leaf extract (rebaudioside A)
- Erythritol (a sugar alcohol that provides bulk)

- Stevia leaf extract
- Dextrose (a type of sugar and used as a bulking agent)
- Cellulose powder (added to help the product flow and to give texture)

- Stevia leaf extract
- Inulin (a type of fiber and a prebiotic)

Some people, including some healthcare professionals, object to how these newer stevia-based sweeteners market themselves as seemingly “all natural” and basically the same thing as whole-leaf stevia. The fact is that these new sweeteners are not the same as using a stevia leaf to sweeten your tea or coffee. They contain an extract of stevia and yes, they do contain other ingredients like erythritol, dextrose, or inulin. So, no, they are not the same as pure stevia. But is this a bad thing?

A few people dislike the fact that erythritol is used in Truvia, for example. Erythritol is a sugar alcohol that, if consumed in excess, can lead to bloating, cramping, and diarrhea. But the amount in Truvia may not be enough to trigger these symptoms. (Of course, it depends on how much Truvia you use!) And erythritol seems to cause fewer symptoms than other types of sugar alcohols, such as sorbitol. Other people object to erythritol because they claim that it’s made from genetically modified corn. However, Cargill, on its Truvia website, claims that the erythritol used in this sweetener is not from GMO corn, nor are any of Truvia’s ingredients.

What about the dextrose in PureVia? Dextrose is a sugar naturally found in many foods, including fruits, honey, and grains. While it’s a sugar and therefore contains carbohydrates, the amount of carbs in one serving of PureVia is less than one gram. You’d have to add many packets of PureVia to your food or drinks to have it impact your blood sugar.

The Center for Science in the Public Interest continues to be a little bit leery of these stevia-based sweeteners, claiming that it’s too soon to tell if they really are safe to use. They recommend that they be tested further. They do acknowledge that using small amounts should be fine.

Bottom line

The decision to use any type of sweetener (nutritive or non-nutritive) is up to you. There are pros and cons to using any of these sweeteners. You need to decide what’s most important to you. But, as far as the stevia-based sweeteners go, there’s no evidence that suggests that they’re harmful, and given that they are very sweet, you’re probably unlikely to overdo their use.

To learn more about sweeteners:
Two Sides to the Artificial Sweetener Story
Battle of the Sweeteners: Agave vs. Honey
Why We Fear Artificial Sweeteners