DR. IZABELLA WENTZ, PHARM D

Thyroid Pharmacist

Is Stevia Good or Bad for Hashimoto’s Disease-

Is Stevia Good or Bad for Hashimoto’s Disease?

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When I began my health journey with nutrition, I was skeptical. Could giving up gluten, dairy, and sugar really make a difference? I mean really? If these foods were that problematic, I would have certainly learned about them in pharmacy school, right?

Well, much to my surprise, three days within giving up gluten, dairy, and sugar, 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??

I often speak of going gluten and dairy free—this can be incredibly helpful for Hashimoto’s as 88% and 80% of people feel significantly better, respectively. But sugar can also be a major issue!

87% of people feel better sugar free! After the initial withdrawal, most people see benefits in mood, energy, and weight!

In my past life, I would put three teaspoons of 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—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 that artificial sweeteners were toxic from papers that I read in pharmacy school. NutraSweet, Equal (aspartame), and Splenda (Sucralose) have been connected to triggering Hashimoto’s. 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.

I transitioned to honey and 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, and so I decided to give Stevia a try.

At the time when I began to use Stevia, the research I found was mostly good. However, there have been some new studies, concerns, and questions from readers that have surfaced that I’d like to address.

What My Readers Are Saying about Stevia

Over the last few years, I’ve worked with quite a few women who suffer from varying degrees of hypothyroidism. 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 bodies and, of course, we are all as unique as snowflakes! So naturally, we have a lot of questions about specific ingredients.

Lately, what has come up in many conversations with my readers and clients is Stevia. Everyone wants to know: is it good or bad for those of us with Hashimoto’s?

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 and this 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 cleaned house. She stopped baking with Stevia —and then she was able to sleep like a baby!

Let’s break down exactly what Stevia does when it enters our 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 with Hashimoto’s, so it does take some digging and connecting dots.

What, Exactly, Is Stevia Anyway?

Stevia is classified as a nonnutritive sweetener (NNS) among a group defined as low – and no – calorie sweeteners (LNCS). Unlike like other LNCS in this group such as saccharin (Sweet N Low) and aspartame (Equal), Stevia is natural and is often organic. It is derived from the plant Stevia rebaudiana Bertoni, or “honey leaf,” which contains the sweet-tasting compounds known as steviol glycosides. (1) Stevia is 200-350 times sweeter than sucrose (table sugar), but unlike sugar, Stevia contains no calories.

The History and Regulatory Status of Stevia

Stevia originated in Brazil and Paraguay and has been used by indigenous people as a food sweetener and a medicine for hundreds of years (2). Stevia was first approved for use in the United States as a dietary supplement in 1995 and was later accepted as a sweetener in 2008. Stevia 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. (5) That said, there are other potential adverse reactions one can have to a substance.

Is there Anyone Who Might Benefit from Using 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.

  • A study done in March 2015 suggests that it is “good for diabetic patients because it is calorie-free, non-toxic and cannot be oxidized.” In this study, diabetic rats were given different doses of Stevia. Those at the higher dose had lower blood glucose levels over time. Stevia increases insulin secretion without any glucose being introduced to the blood stream. This allows for the insulin to reduce high glucose levels. This will also help lower complications for people with diabetes. (Read more about Hashimoto’s, blood sugar and diabetes.) (2)
  • In another study, it was proven that Stevia also has antioxidant properties in people with diabetes because of its “free radical scavenging”, reducing the presence of potentially toxic chemicals within our bodies (5).
  • Stevia is also known to have a positive effect on hypertension, reducing blood pressure. Scientists found that giving Stevia over time will result in dilation of blood vessels, leading to a lowering of blood pressure. This effect is from long term use of Stevia and is seen after 40-60 days of use (at least in rats). (12)

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! (Here’s more information about Lyme as a trigger.) [3]

There is anecdotal evidence that Stevia has anti-cancer and anti-diarrheal qualities, but more studies need to be done on this. The number and quality of studies done are not adequate to come to a conclusion on those benefits. (12)

Can Stevia Affect Our Hormones?

There are not many studies on how Stevia effects 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. The good news is that Stevia does not seem to have any effect on thyroid hormones (at least not in rats or chickens).

However, Stevia may affect other hormones…

Varanuj Chatsudthipong & Chatchai Muanprasat note 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. In yet another study done on hamsters, Stevia toxicity existed when administered in high doses to the hamsters and their fetuses. (11)

Another study found that Stevia can shrink the seminal vesicle of male rats. As semen is partially produced by the seminal vesicles, this may play a role in fertility. (12)

If you have Hashimoto’s, you likely have some degree of adrenal dysfunction—this is a very important root cause that most people need to address. Adrenal dysfunction manifests as fatigue, weight gain, irritability, moodiness, lowered immunity, and even have trouble sleeping. Read about how your adrenals may be sabotaging your health!

The main factors that can cause/exacerbate adrenal dysfunction are stress, inflammation, lack of sleep, and blood sugar imbalances—especially hypoglycemia.

Because Stevia can lower blood sugar, this could potentially exacerbate blood sugar imbalances, and in turn, hypoglycemia.

While no Stevia studies have been done on people with hypoglycemia, low blood pressure, or Addison’s disease, anecdotally, some individuals have reported that Stevia can make their blood sugar drop more, weakening the adrenals.

Additionally, people with adrenal issues often have low blood pressure—the dilation effect of Stevia on blood vessels can potentially exacerbate this.

My Recommendations

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 things 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 can help people lose weight, improve diabetes, lower high blood sugar, lower high blood pressure, has anti-inflammatory and immune-boosting properties, and can even help people with Lyme disease! Stevia definitely seems to be a better alternative to sugar!

But if you are someone with adrenal fatigue, low cortisol, low blood sugar and low blood pressure, or you are trying to conceive, you may want to avoid Stevia, especially long-term use. 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 any sweeteners, in general, may cause insulin releases and a stress response in the body.

If you’re struggling with your adrenals and using Stevia, this may be something to consider removing. Stevia is found in many supplements and protein powders, so be sure to check labels if you want to do a real trial (note: the Rootcology AI Paleo Protein is Stevia free and hypoallergenic).

Alternative sweeteners may include honey, maple syrup, Xylitol, or trehalose. Honey and maple syrup are natural but may contribute to Candida and blood sugar issues. Trehalose is an interesting option because it can accelerate tissue repair, but like Xylitol, both can exacerbate small intestinal bacterial overgrowth, a common issue that’s present in Hashimoto’s. Additionally, please note that some researchers have found that trehalose may feed the Clostridium difficile (C. diff.) bacteria; thus if you are struggling with an overgrowth of this gut bacteria, this sugar may not be appropriate for you.

If you haven’t read Hashimoto’s Protocol yet, in it, you will find more detail on how to not only take away things that may be harming you, but it also tells you what you should add back in that will nourish you back to good health! If you’ve been reacting to Stevia, definitely take note of the Adrenal Recovery Protocol!

References
  1. Magnuson B, Karakostas M, Moore N, Poulos S, Renwick A. Biological fate of low-calorie sweeteners. Nutrition Reviews. 2016;74(11):670-689. doi:10.1093/nutrit/nuw032.
  2. Chen T, Chen S, Chan P, Chu Y, Yang H, Cheng J. Mechanism of the Hypoglycemic Effect of Stevioside, a Glycoside of Stevia rebaudiana. Planta Medica. 2005;71(2):108-113. doi:10.1055/s-2005-837775.
  3. Theophilus P, Victoria M, Socarras K et al. Effectiveness of Stevia rebaudiana whole leaf extract against the various morphological forms of Borrelia burgdorferi in vitro. European Journal of Microbiology and Immunology. 2015;5(4):268-280. doi:10.1556/1886.2015.00031.
  4. Boonka Wwan C, Ao M, Toskulkao C, Rao M. Specific Immunomodulatory and Secretory Activities of Stevioside and Steviol in Intestinal Cells. Journal of Agricultural and Food Chemistry. 2008;56(10):3777-3784. doi:10.1021/jf072681o.
  5. Shivanna N, Naika M, Khanum F, Kaul V. Antioxidant, anti-diabetic and renal protective properties of Stevia rebaudiana. . 2013;27(2):103-113. doi:10.1016/j.jdiacomp.2012.10.001.
  6. Shukla S, Mehta A. Comparative phytochemical analysis and in vivo immunomodulatory activity of various extracts of Stevia rebaudiana leaves in experimental animal model. Frontiers in Life Science. 2014;8(1):55-63. doi:10.1080/21553769.2014.961615.
  7. Daneshyar M, Geuns J, Willemsen H et al. Evaluation of dietary stevioside supplementation on anti-human serum albumin immunoglobulin G, Alpha-1-glycoprotein, body weight and thyroid hormones in broiler chickens. Journal of Animal Physiology and Animal Nutrition. 2011;96(4):627-633. doi:10.1111/j.1439-0396.2011.01188.x.
  8. Payne A, Chassard C, Lacroix C. Gut microbial adaptation to dietary consumption of fructose, artificial sweeteners and sugar alcohols: implications for host-microbe interactions contributing to obesity. Obesity Reviews. 2012;13(9):799-809. doi:10.1111/j.1467-789x.2012.01009.x.
  9. Pepino M, Bourne C. Non-nutritive sweeteners, energy balance, and glucose homeostasis. Current Opinion in Clinical Nutrition and Metabolic Care. 2011;14(4):391-395. doi:10.1097/mco.0b013e3283468e7e.
  10. Brown R, Rother K. Non-Nutritive Sweeteners and their Role in the Gastrointestinal Tract. The Journal of Clinical Endocrinology & Metabolism. 2012;97(8):2597-2605. doi:10.1210/jc.2012-1475.
  11. Roberts A, Munro I. Stevioside and related compounds: Therapeutic benefits beyond sweetness. Pharmacology & Therapeutics. 2009;122(3):e1-e2. doi:10.1016/j.pharmthera.2009.03.005.
  12. Oliveira-Filho R, Uehara O, Minetti C, Valle L. Chronic administration of aqueous extract of Stevia rebaudiana (Bert.) Bertoni in rats: Endocrine effects. General Pharmacology: The Vascular System. 1989;20(2):187-191. doi:10.1016/0306-3623(89)90013-x.
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  1. I was using Xylitol as a sweetner and recently found out that many of the sugar alcohol based sweeteners are derived from corn! I had a strong reaction to corn when I did an elimination diet, so I’ve cut all these sweetners out. Please help spread the word to others with corn sensitivity!

    Reply

  2. Excellent article, as always. But for this long-time Hashimoto’s patient, stevia is a bladder/urethral irritant that keeps me having to get up at night to urinate. The same thing happened to my mother and to my aunt, neither of whom have Hashimoto’s; we all started getting more continuous nights’ sleep after we stopped using stevia. The brand I was using is SweetLeaf. I am not sure if just the mere use of stevia was the problem or if it was that over time I was starting to use increasingly more of it; maybe I was using too much, or it just built up in my system. Also, I am over 60, so any little bladder irritant can easily become a big bladder irritant for me. What my functional medicine consultant told me about it when I brought it up was that it may be the processing that extracts the product from the plant that is the problem, and not necessarily the stevia plant itself.

    Reply

  4. That only seems to leave out Lo Huan or monk fruit extract. What is your opinion of that alternative sweetener? It seems like everything is a problem for someone. Trying to figure out which is a problem for one’s self is daunting. I have been using stevia and xylitol in my coffee/tea for years, thinking everything is okay, is it really? Who knows? But since these have their issues, I would sure like to know if monk fruit has any?

    Reply

    • David- Thank you so much for following this page! I’ll say the same things about Stevia that I would about most things with medicinal properties: whether it’s good or bad depends on the person. The gold standard or the most accurate test for uncovering reactive foods and individual food sensitivities is actually the Elimination Diet.

      It works better than trying a recommended dietary approach (i.e. gluten-free, Paleo, etc.) and even better than food sensitivity testing (which may be helpful in many cases but may not be affordable for many people). The elimination diet can work as a stand-alone or in symphony with food sensitivity testing. Here is an article you may find interesting! 🙂

      https://thyroidpharmacist.com/articles/elimination-diet-for-hashimotos/

      Reply

      • Hi Izabella,
        I have been a long time Stevia user without any sleep problems.
        Before bed each night, I do though use a magnesium cream that has natural melatonin in it and place a dab of Lavender Essential Oil on the sole of each foot. Without fail – even on a night of full moon – I sleep easy & deep and awake refreshed.
        I am interested to know your thoughts on two products that both David and Ryan have made enquires about.
        I have done a little research, though it is inconclusive and so am disappointed you have not responded.
        Luo han guo (Monk Fruit) contains 25-38% carbohydrates in the form of both fructose & glucose. Due to it’s low G.I. & it’s compounds, it is claimed to stimulate insulin secretion and so assist combat diabetes. Apparently only the sweet component called mogrosides are extracted from the green melon fruit – leaving behind the fructose.
        I have read it is 200 times sweeter than sugar though with 96% less calories however because of this sweetness, is blended with Erythritol so that it can be used as a spoon for spoon sugar substitute.
        Erythritol is said to be a naturally occurring nectar found in fruit like melons and grapes, though it has such a scientific name it leaves me suspicious that it may be an alcohol like substance with similar concerns for the gut, like Xylitol.
        David Gillespie in his book ‘Sweet Poison’ refers to Glucose (also known as Dextrose) as our bodies primary source of energy and that all carbs, including fructose are converted into glucose by our body. He advocates a sugar free lifestyle – in particular avoiding fructose – and suggests using pure glucose/dextrose as the safest form of sweetener.
        Ryan’s product combining dextrose and stevia would then I assume, be a good alternative.
        I am aware that Gillespie has written from a weight loss perspective with good health resultant of that.
        Izabella, can you please comment on Monk Fruit, Erythritol & Glucose/Dextrose as being acceptable sweeteners for those of us with Hashimotos.
        With Gratitude.

        Reply

        • Pamela – thank you for your interest. I wouldn’t want to venture an opinion on any subject that I hadn’t researched thoroughly. Thanks for highlighting your interest in these foods and I will certainly add them to the long list of subjects to write future articles on.

          Reply

  5. I was using Stevia until I read the label and found that there is other sweeteners in it as fillers.

    From one of the types I was buying…

    Front of the package: “100% natural zero calorie sweetener”
    Back of the package: dextrose, stevia leaf extract.

    Dextrose is another name for glucose, which is a kind of sugar. How is it possible for sugar to be in a zero-calorie product? There is an asterisk on the nutrition facts with this fine print: “Each packet contains less than 4 calories per serving which the FDA considers dietetically zero.” Stevia in the Raw — blazing new trails in math and grammar.

    And another brand I bought was similar with some other type of sugar added..

    How is this possible and if I do go back to stevia I will have to pay particular attention to the adders.

    Reply

      • I have hypothyroidism (not Hashimoto’s), and I started using liquid stevia extract in carbonated water, drinking stevia soft drinks from time to time, and also using it in my tea, I was using quite a bit on a daily basis. After eliminating certain foods from my diet, including sugar and all substitutes, I of course felt better and lost some stubborn weight. I have since been able to add back in a little honey and extra dark chocolate, and still feel good, and decreased inflammation. I think the stevia extract was having a negative effect on my insulin response and causing bloating and weight gain! The extract also only contains a small portion of the stevia plant, which itself, has none of the health benefits of the whole leaf, that were used in the studies you reference above. If you use it, it should be the whole leaf, otherwise, I think it tricks your body into an insulin response. Thanks for all you do!

        Reply

        • Lauren, thank you so much for your kind comments and insights from your personal experience. Everyone is different and people have different levels of sensitivity. I’m glad to hear you are making improvements.

          Reply

  6. I have celiac and hashimoto’s And use stevia in my morning hot tea!!! I never dreamed that it could possible have an effect on me!!! I usually have 4 packets per day ( two per cup), more when it’s cold ,,, Use sugar or Splenda when baking!, Interesting info!!!

    Reply

  7. Interesting article on Stevia… I, too, am extremely sensitive to Stevia. Even in very small quantities, I have determined that it causes me to become incontinent. Not fun! This is the first time I have seen this correlation noted. Facinating! I wonder if this is why so many women are having incontinence issues — having not heard of the possible connection. Fortunately by completely avoiding Stevia, my bladder feels 15 years younger. I would like to learn more about this side effect should you come across additional information/data concerning it.

    Many thanks for your valuable work and this well researched article!

    Reply

    • Jan – thank you so much for your kind words! I’m so glad you were able to work out this connection and makes changes for your health. I will certainly look out for more research on this issue.

      Reply

  8. I have been taking Stevia for many years.The brand I use also contains inulin.I’m not sure what inulin does,or if it does any harm.however since you mentioned that stevia might be good for people with high blood pressure and high blood sugar,I will continue using stevia,since I have both.I’m 92 years old,and still going strong,mostly without sugar, Thank you,I enjoyed reading your article on Stevia.

    Bill Fagenson

    Reply

    • Bill – Inulin is a component of coconut and can cause stomach upset. If you feel like your brand is affecting your stomach you may like to try other brands. However it sounds like you are doing something right!

      Reply

  9. Hi, thanks so much for this information.

    Wondering if the same goes for green stevia? I know it’s more unprocessed but wondering if it could still cause me issues. I have at least 1 tsp everyday in my morning smoothie as I have to be low sugar. Curious for your response

    Reply

  10. Stevia comes in different forms:
    – The white stuff as pictured at the top of this article
    – The liquid form
    – The natural dried leaves (most difficult to find).
    I avoid the white stuff as it just seems too processed – and as another commenter said, there can be additives in it (or things done during processing that you wouldn’t want). I’ve been using the liquid stuff, because it’s convenient to add a few drops. But this reminds me that the simple dried leaves is likely the best option – and even so, not to overdo them. One thing I’ve learned from illness is to eat a variety of foods – to optimize nutrition – and not to overdo any single food.

    Reply

    • Catherine – Everyone is different and may affected differently by the varieties on offer. The only way to be sure how much it is affecting you is to cut it out for a short period and see if you feel better and see if you feel worse when you add it back to your diet. Going though an elimination diet will help you figure out your own individual food triggers and your specific response to each trigger food. Here is an article I hope you find interesting! 🙂

      ELIMINATION DIET FOR HASHIMOTO’S
      https://thyroidpharmacist.com/articles/elimination-diet-for-hashimotos

      Reply

  11. This is interesting……I shall try cutting out stevia to see if it has any affect on my chronic abdominal bloating, and other health problems, (I have previously tried going gluten/dairy free with no change in symptoms)…..I have been using a good quality liquid stevia for years (Stevita brand, has no additives, just pure organic stevia) thinking it was doing me no harm, but now it’s possible it may be.
    Thank you for the info, and all the comments from everyone.

    Reply

  12. I was diagnosed with hypothyroidism 5.5 years back and have been taking levothyroxine since. I have heard people say that if you have taken meds longer than 4-5 years, there are no chances of it healing. I am eager to know if this is true? Do you have any success stories where people have healed themselves after many years of medicating. I am 32 years old and a vegetarian.

    Reply

  13. I would also like to know if there is a doctor around Seattle area who is open to work with natural approach. Please suggest.

    Reply

  14. I was surprised to read that Stevia may be have anti-diarrheal qualities because whenever I eat too much of it I get stomach bloating and diarrhea. Does this mean I have an allergy to it?

    Reply

  15. TRUVIA BRAND MAY CAUSE A GUT & SKIN REACTION
    After using 2-4 packets of Truvia daily for a few weeks, I developed itchy raised bumps in my inner elbow and in one of my inner thighs as well as abdominal pain each time I used it. It took me a few weeks of eliminating things before I figured out it was the Truvia. About two weeks after elimination, the itchy bumps were gone. It has Erythritol which could have been causing the pain.

    Reply

  16. Oh wow, I thought it was just me, but I also noticed that if I drink any soft drinks sweetened with Stevia – up all night peeing!! lol. As if I didn’t already get up once or twice in the night, but this increased it to about 6 times – big bags under my eyes!!

    Reply

  17. All artificial or substitute sweeteners give me brain fog and make it hard for me to think. Honey and maple syrup don’t do this. But I don’t use it because sugar makes it very hard for me to lose weight. I recently started (two days) to try 100 % pure monk fruit that is organic as well and has nothing else. VERY, VERY, VERY, VERY, SWEET. A tiny sprinkle in tea or coffee is enough. 1/16 of teaspoon or less is sufficient, So far no brain fog. But sometimes it takes about a week to show itself. Hope this is helpful.

    Reply

  18. Thank you for your thought-provoking post. What is your opinion on palm jaggery as an alternative sweetener? Also, would it have a place in an anti-inflammatory diet?

    Reply

    • Sudha – thank you for reaching out. In general palm jaggery should be fine if used in moderation. However, if you are following the AIP diet added sugars are are not recommended.

      Reply

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