When I began my health journey with nutrition, I was skeptical. Could giving up gluten, dairy, and sugar really make a difference?
If these foods were that problematic, I would have certainly learned about them in pharmacy school, right?
Well, much to my surprise, within three days of giving up these three foods, my bloating, acid reflux, and irritable bowel syndrome vanished! “This can’t be,” I remember thinking to myself.
Why did I not know about this?
If you’ve been following me for a while, you will know that I often speak of going gluten and dairy free — this can be incredibly helpful for Hashimoto’s, as my survey of people with Hashimoto’s showed 88 and 80 percent of people reported feeling significantly better, respectively. But sugar can also be a major issue!
Of the people I have surveyed, 87 percent felt better on a sugar-free diet. After the initial withdrawal, most people see benefits in mood, energy, and weight.
In my past life, I would put three teaspoons of (white, refined) sugar in my tea. My brother would look at me in disgust and say, “This stuff will make you sick, Izabella. You need to cut out the sugar.”
I knew he was right — sugar can contribute to a yeast overgrowth, lowered immunity, blood sugar issues, weight gain, diabetes, and a whole host of health problems (1-3) — but I was a sugar addict, and it was devastating to think that I would have to let go of this old friend and not have any sweetness in my life.
So I had to find a bridge to help me off the sugar.
I knew from papers that I read in pharmacy school, that artificial sweeteners were toxic. NutraSweet, Equal (aspartame), and Splenda (sucralose) have all been connected to triggering Hashimoto’s. (4) In fact, Dr. Isaac Sachmechi, a professor at Mount Sinai, reported that two of his patients saw a complete remission of Hashimoto’s after quitting artificial sweeteners. (5,6)
To wean myself off of sugar, I transitioned to using honey as my go-to sweetener. I actually carried around little jars of honey with me everywhere I went! That seemed to work well… until one of the jars ended up spilling inside of my purse!
I knew I had to find something more practical, so I decided to give stevia a try.
At the time I began to use stevia, the research I found was mostly focused on the beneficial aspects of stevia. However, there have since been some new studies, as well as concerns and questions from readers, that have surfaced, and I’d like to address them.
In this article, we’ll discuss:
- What stevia is
- The history of stevia
- The research behind stevia
- Who might benefit from using stevia
- Who should avoid stevia
What My Readers Are Saying About Stevia
Over the past few years, the question of stevia has come up in many conversations with my readers. Everyone wants to know: is it good or bad for those of us with Hashimoto’s?
I’ve worked with quite a few women who suffer from varying degrees of hypothyroidism and Hashimoto’s. What comes up time and time again is that there are widely diverse reactions to the foods we eat. Many of us with Hashimoto’s are experimenting with new recipes with unfamiliar ingredients as we try to address our many autoimmune symptoms. We are also paying greater attention to our unique bodies — so naturally, we have a lot of questions about specific ingredients.
One very concerned reader was certain that stevia was causing her insomnia and bladder irritation. She was getting up to go to the bathroom more frequently, which was really hurting the quality of her sleep. Her mother was the only person that could relate and mentioned that she should stop using stevia. Sure enough, she read all the labels on her supplements and in her pantry, and gave her kitchen a stevia-free makeover. She also stopped baking with stevia — and was able to sleep like a baby!
Let’s break down exactly what stevia does when it enters the body, and how it may help or hurt a person, depending on the current state of their health.
Very few studies have been done on its direct link to hypothyroidism, and no studies have been done relating it to Hashimoto’s, so it does take some digging and connecting the dots.
What is Stevia?
Stevia is a natural sweetener derived from the plant Stevia rebaudiana, or “honey leaf,” which contains the sweet-tasting compounds known as steviol glycosides. It is 200-350 times sweeter than sucrose (table sugar) – but unlike sugar, stevia contains no calories. (7) Therefore, it is often recommended as a healthy sugar substitute that can sweeten up foods without the negative effects of sugar.
Stevia originated in Brazil and Paraguay, and has been used by indigenous people as a food sweetener and a medicine for hundreds of years. It was first approved for use in the United States as a dietary supplement in 1995, and was later accepted as a sweetener in 2008. (8)
It was also introduced as a sweetener in the EU in 2011, as well as in Canada in 2012. The safety studies that allowed stevia to be approved as a sweetener concluded that stevia is non-toxic, non-mutagenic, and non-carcinogenic.
Classified as a nonnutritive sweetener (NNS), stevia is among a group defined as low- and no-calorie sweeteners (LNCS). However, unlike synthetic LNCS options in this group, such as saccharin (Sweet’N Low) and aspartame (Equal), stevia is plant-based and the plant is often organically grown. (Several stevia products currently on the market are USDA-certified organic.)
Steviol glycosides, which are refined extracts of stevia, are recognized as safe by the Food and Drug Administration (FDA). Whole-leaf varieties and raw stevia extracts are currently not approved by the FDA for industrial food production, due to a lack of research. (9,10)
Regulatory agencies like the FDA, the Scientific Committee on Food (SCF), and the European Food Safety Authority (EFSA), have defined the acceptable daily intake of steviol glycosides as up to 1.8 mg per pound of body weight (4 mg per kg). (11)
Today, stevia is often used in teas and coffee. It can also be found in other products, such as supplements, protein powders, and snacks.
Note that some stevia products that you’ll find on the shelf aren’t pure stevia, and could contain other sweeteners like erythritol. I encourage you to read the labels and look for 100% pure, USDA-approved stevia products where possible.
What Are the Benefits of Stevia?
The majority of the studies to date have come to the conclusion that those with diabetes, high blood pressure, and obesity can benefit from using stevia.
Research confirms that stevia can be beneficial for people with diabetes, as it does not appear to increase glucose or insulin levels, and may even help to prevent diabetes by increasing insulin sensitivity. In addition, it is calorie-free and non-toxic. In one study, diabetic rats were given different doses of stevia, and those given the higher dose had lower blood glucose levels over time. (12,13)
Stevia increases insulin secretion without any glucose being introduced to the bloodstream. This allows for the insulin to reduce high glucose levels. This will also help lower complications for people with diabetes. This can be good news for some of us with high blood sugar issues and diabetes, which are common in those with Hashimoto’s. However, if you already have issues with hypoglycemia, as do many of us with Hashimoto’s, stevia could exacerbate the hypoglycemia. (12-14)
In another study, it was proven that stevia also has antioxidant properties in people with diabetes because of its “free radical scavenging properties,” reducing oxidative stress and the risk of liver and kidney damage. (15)
Stevia may be beneficial for those with hypertension, as it may lower blood pressure. Scientists found that feeding stevia to rats over time will result in the dilation of blood vessels, leading to a lowering of blood pressure. (16) This effect results from long-term use of stevia and can be seen after 40-60 days of use. Again, this could be a positive if you have high blood pressure, but a negative if your blood pressure is already low, which is the case for many with hypothyroidism and adrenal issues. (17)
Additionally, stevia may help with suppressing Borrelia burgdorferi, the bacteria that causes Lyme disease — a potential Hashimoto’s trigger — at least in a petri dish! In one study, researchers evaluated the antimicrobial potential of whole leaf stevia extracts against B. burgdorferi, by comparing the antimicrobial effect of stevia with three commonly used antibiotics (doxycycline, cefoperazone, and daptomycin). The results revealed that stevia was capable of eliminating the bacteria as effectively as the reported three-antibiotic combination treatment. (18)
There is some evidence that stevia has anti-cancer, immunomodulatory, and anti-diarrheal qualities, but more research is needed for these claims to be conclusive. (19,20)
How Could Stevia Affect Thyroid Health?
There are not many studies on how stevia affects thyroid hormones, and I’ve never seen any issues with it clinically. I’ve only found two studies that evaluated the effect of stevia on thyroid hormones, and the good news is that stevia does not seem to pose any adverse effects (at least, not in rats or chickens). (21,22)
However, stevia may affect other hormones…
Varanuj Chatsudthipong and Chatchai Muanprasat have noted multiple studies that analyze stevia’s effect on fertility. In one study, they cite that rats who were fed high doses of stevia over two months did, in fact, show a decrease in fertility. (20,23) In another study done on hamsters, stevia toxicity existed when administered in high doses to the hamsters and their fetuses. This was observed as a significant decrease in maternal body weight gain during the experimental period (days 6-14), a high percentage of maternal mortality, a decrease in the number of live fetuses per litter, and a decrease in fetal weight. (25)
The first study mentioned also found that stevia can shrink the seminal vesicle of male rats. (23) As semen is partially produced by the seminal vesicles, this may play a role in fertility. Beyond potentially affecting hormones related to fertility, stevia may also affect the adrenals. (25)
If you have Hashimoto’s, you likely have some degree of adrenal dysfunction — in my experience, this is a very important root cause that most people find beneficial to address. Adrenal dysfunction manifests as fatigue, weight gain, irritability, moodiness, lowered immunity, and sleep issues. (26,27)
The main factors that can cause or exacerbate adrenal dysfunction are stress, inflammation, lack of sleep, and blood sugar imbalances — especially hypoglycemia (low blood sugar). (27) Because stevia can lower blood sugar, this could potentially exacerbate blood sugar imbalances, and in turn, lead to hypoglycemia. (14)
Additionally, studies suggest that stevia may not be beneficial for gut health, which is always a factor with Hashimoto’s. Several studies suggest that low-calorie sweeteners including stevia could inhibit beneficial gut bacteria, which play an important role in disease prevention, digestion, and immunity. (28-30)
Some research has even concluded that stevia and other calorie-free sweeteners could lead a person to consume more calories throughout the day. For example, one study of 30 men determined that drinking a stevia-sweetened beverage caused participants to consume more calories later in the day than they did when they drank a sugar-sweetened beverage. (31) While overeating isn’t a symptom of Hashimoto’s, I’ve found that many people with hypothyroid conditions may have issues with weight gain, so this is important to keep in mind.
Those with low pressure may also want to be cautious with stevia, as studies have shown that it may reduce blood pressure. (20) Many people with adrenal issues, as well as thiamine deficiency (which are both common in Hashimoto’s), often have low blood pressure — the dilation effect of stevia on blood vessels can potentially exacerbate this. (26,32,33)
Should You Use Stevia?
As a pharmacist, I’ve spent a lot of time figuring out appropriate medication use. My training is in evaluating the pharmacology of a particular substance and learning about how it could affect the human body. I’ll say the same thing about stevia that I would about most things with medicinal properties: whether it’s good or bad depends on the person.
On one hand, stevia could help certain people lose weight, improve diabetes, lower high blood sugar levels, lower high blood pressure, and even potentially help people with Lyme disease. (13,16,18) Given this, stevia definitely seems to be a better alternative to sugar!
But if you are someone with adrenal fatigue, low cortisol, low blood sugar, and/or low blood pressure, or if you are trying to conceive, you may want to avoid stevia — and especially using it long-term. Though I have no evidence that occasional or short-term use would pose a problem at the moment, there is a school of thought that sweeteners, in general, may cause insulin releases and a stress response in the body.
If you’re struggling with your adrenals and are currently using stevia, I recommend that you consider removing it from your diet. Stevia is found in many supplements and protein powders, including Rootcology Organic Pea Protein (the stevia in Rootcology products is pure).
If you want to do a real trial of how you feel without stevia, check the labels of your protein powders (note: the Rootcology AI Paleo Protein is stevia-free and hypoallergenic).
What About Other Sweeteners?
There are many other alternative sweeteners on the market: some that have always been around, as well as new options that are being promoted every year. They all have their advantages and disadvantages, and as with stevia, each individual will have a different level of tolerance. As with most substances, the dose is key!
- Honey, molasses, coconut sugar, and maple syrup are natural sweeteners. However, they will raise blood sugar levels just like regular refined cane sugar. They may also contribute to Candida overgrowth and blood sugar imbalances.
- Agave is often touted as a healthy, low glycemic sweetener. This is because it’s made of mostly fructose which, unlike glucose, does not raise blood sugar and insulin levels in the short term. However, the liver is the only organ in the body that can metabolize fructose. Excess fructose can overload the liver, where it’s turned into fat. Long term, this can actually increase your risk for metabolic issues like type 2 diabetes, heart disease, and insulin resistance. (34-37)
- Trehalose (a sugar derived from insect cocoons) is an interesting option because it can accelerate tissue repair. (38) However, it is also possible that trehalose exacerbates small intestinal bacterial overgrowth (SIBO), a common issue in Hashimoto’s. There is some conflicting research around whether or not it contributes to the growth of Clostridium difficile (C. diff.) bacteria. Some researchers have found that trehalose may feed the bacteria, while another study found that it could prevent the growth of C. difficile. (39-41) Thus, if you are struggling with an overgrowth of this gut bacteria, this is something to keep in mind.
- Xylitol is a sugar alcohol derived from corncobs and birch, that contains 40 percent fewer calories than table sugar. It has a very low glycemic index and won’t spike blood sugar levels. While it has some positive side effects, such as reducing harmful bacteria in the mouth and increasing collagen production, xylitol may also contribute to gut bacteria overgrowth and should be avoided by those with SIBO or an intolerance to FODMAPs. (42,43)
- Erythritol is a sugar alcohol, created when a certain type of yeast ferments glucose from corn or wheat starch. However, it contains even fewer calories. Erythritol does not raise blood sugar, insulin, cholesterol, or triglyceride levels, and is very well tolerated by most people. Unfortunately, in my experience, it did flare up a loved one’s ulcerative colitis, so be mindful of this if you are currently having digestive issues. (44)
- Monk fruit extract is 150-250 times sweeter than table sugar, has zero calories and carbohydrates, and does not raise blood glucose levels. (45) It is considered safe for those with diabetes and has been found to have anti-inflammatory properties. (46) However, research is still new at looking at this sweetener, and as mentioned above, many non-nutritive (low-calorie) sweeteners can impact gut bacteria and the lining of the intestines, so you may want to use it with caution.
- Myo-inositol is a form of inositol, a type of natural sugar alcohol that’s present in mammalian cells. It is found in many plants and in the tissues of animals. Foods with the highest concentration of myo-inositol are fruits, beans, corn, and nuts. Due to its key role in TSH signaling, myo-inositol supplementation has been shown to reduce TSH levels, reduce thyroid antibodies, and even achieve remission in people with Hashimoto’s. (47) It can also be effective for reducing PCOS, blood sugar balance, anxiety, depression, and other mood disorders. (48-50) Rootcology Myo-inositol Powder is about half as sweet as table sugar and can be used to replace other sweeteners in tea or coffee.
Unrefined cane sugars, which include sucanat, panela, rapadura, and muscovado, are sometimes used as healthier alternatives to refined sugar. However, while they do contain higher levels of nutrients such as calcium, potassium, magnesium, vitamin A, and B vitamins, the sucrose levels are so high that they will still have a significant impact on blood sugar levels. (51)
Instead, I encourage you to start weaning your taste buds away from sweets where possible. Most people do find that, once they start reducing the level of sugar or sweetened foods and beverages that they consume on a daily basis, their cravings for those sweetened flavors fade and they no longer miss the sweetness.
Getting blood sugar imbalances under control and reducing sugar intake are key parts of reducing symptoms of Hashimoto’s, and finding an alternative to refined sugar can make that process easier for many people.
However, there are pros and cons to all of the sugar alternatives on the market, including stevia.
If you have high blood pressure, diabetes, high blood sugar levels, or even Lyme disease, stevia may be a great option for you. However, other people with health concerns like low blood pressure or adrenal dysfunction may want to avoid this sweetener.
If you haven’t read my book Hashimoto’s Protocol yet, you may wish to pick up a copy! In it, you will find more on how to take away foods that may be harming you, as well as what you should add back in, to nourish yourself back to good health! (If you’ve been reacting to stevia, definitely take note of the Adrenal Recovery Protocol, as adrenal issues may be at the root of your reaction!)
As always, I wish you well on your journey to better health!
P.S. For continued updates and interaction, please become a part of our Facebook community and sign up for my newsletter to have helpful information delivered right to your email inbox. You’ll also receive occasional updates about new research, resources, giveaways, and more!
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Note: Originally published in April 2017, this article has been revised and updated for accuracy and thoroughness.