Teaser Excerpt from The Paleo Approach: The Trouble with Stevia

March 11, 2013 in Categories: , by

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The Paleo Approach by Sarah BallantyneI get often get asked why I do not endorse the consumption of stevia (see my post Is Sugar Paleo? for more information on what sugars/sweeteners I do endorse).  So, as I found myself including a section on the trouble with stevia for The Paleo Approach, I felt like this was a good topic to include as a book teaser on the blog.  I have a section of Chapter 3 that describes the role that sugars, blood sugar regulation, insulin sensitivity, fructose, sugar alcohols and nonnutritive sweeteners play in propagating inflammation in autoimmune disease.   This excerpt is included as a standalone text box following the subsection on nonnutritive sweeteners.

This excerpt is from Chapter 3 (The Diet Link to Autoimmune Disease chapter).

Stevia is often recommended as a natural sugar substitute because it comes from the leaf of a plant (Stevia rebaudiana Bertoni).  It tastes sweet on the tongue, requires very small quantities to sweeten baking, and contains no sugar.  While some experts advise caution against purified and manufactured forms of stevia, green leaf stevia is typically endorsed.  On the surface, it sounds like a perfect solution.  However, I do not recommend the consumption of stevia, even in its most natural form.  The chemicals responsible for the sweet taste of stevia are called steviol glycosides (there are at least ten different steviol glycosides present in the stevia plant).  Purified/manufactured forms of stevia often isolate one or two of these steviol glycosides whereas green leaf stevia (which is simply the dried and powdered leaves of the stevia plant) contain all ten.

Steviol glycosides are synthesized in the same pathway and end up being structurally very similar to the plant hormones gibberellin and kaurene.  This means that steviol glycosides have a hormone structure.  The majority of toxicological studies establish that stevia is safe, however there are some studies showing that it can act as a mutagen and may increase the risk of cancer (these studies are in the minority and tend to use quite high concentrations, so they are readily discarded in discussions of the overall safety of consuming stevia).  Whether or not stevia causes genetic mutations is not the only cause for concern, however (even if safety studies focus on this particular property).  For those with autoimmune disease, in which hormones have such a dramatic impact on disease development and progression, the impact of consuming stevia on hormone regulation is relevant.

There is evidence that steviol glycosides have contraceptive effects in both males and females.  In particular, one specific steviol glycoside, called stevioside, has been shown to have potent contraceptive properties in female rats, implying that stevia may have an impact on estrogen, progesterone or both.  In another study, male rats fed stevia extracts showed a decrease in fertility, reduced testosterone levels and testicular atrophy, potentially attributable binding of steviol glycosides with an androgen receptor.  Although no studies have been conducted evaluating the impact of stevia on fertility in humans, the stevia plant was traditionally used to control the fertility of women by the Guarani Indians in southern Brazil.  While small and occasional consumption of stevia likely has little to no impact on general health, it should not be consumed on a regular basis especially by those with altered hormone balance and dysfunctional immune systems.

Interested in learning even more about The Paleo Approach? This video from my YouTube Channel is just a quick tour (the book is so big that giving you a broad overview takes 13 minutes!) but you get to see just how comprehensive and detailed this book is.

Brusick DJ. A critical review of the genetic toxicity of steviol and steviol glycosides. Food Chem Toxicol. 2008 Jul;46 Suppl 7:S83-91.

Mazzei Planas G and Kuć J. Contraceptive properties of Stevia rebaudiana. Science. 1968 Nov 29;162(3857):1007.

Melis MS Effects of chronic administration of Stevia rebaudiana on fertility in rats Journal of Ethnopharmacology 1999 Nov 67(2):157–161

Melis MS. Chronic administration of aqueous extract of Stevia rebaudiana in rats: renal effects.  Journal of Ethnopharmacology 1995. July 47(3):129–134

Oliveira-Filho RM et al.  Chronic administration of aqueous extract of Stevia rebaudiana (Bert.) Bertoni in rats: Endocrine effects.  General Pharmacology: The Vascular System. 1989. 20(2):187–191


I’ve been looking on the green pasture website and they are out of oslo orange fermented cod liver oil. Would you suggest to get the unflavoured rather than the cinnamon tingle since it has stevia in it? It’s not cheap so I want to make sure I’m getting what’s best to help my autoimmune diseases and not make them worse.

I prefer the unflavored to all of them, not only because I don’t think stevia is good and because I think it tastes very mild compared to the flavored ones. We got the chocolate one once and I couldn’t wait for it to be gone, it was so gross we all had to gag it down. I’ve done unflavored ever since and use the capsules for convenience while traveling and for my older kids who can swallow capsules like those so they don’t have to taste anything at all. I just take my little dose and have some water or a bite of a carrot or apple or some other thing that’s handy to get the aftertaste out of my mouth, but Ive had way worse tasting stuff than the unflavored fermented cod liver oil!

Darn! I probably use 4 dropperfulls of sweetleaf stevia in my tea. I became hooked on it when I made the poor decision to do several HCG protocols. My hormones became disregulated, especially progesterone and I started having polycystic ovaries something I never had experienced before. I will never know what caused the hormone disregulation but now I guess I can add the stevia as a possible cause along with the HCG.

Wow, Allison! Same exact thing happened to me! I did 5 rounds of HCG for weight loss a couple of years ago and have recently been diagnosed with PCOS. Stevia is the only sweetener I have used (and I use it every day to make lemonade) since then. I also have Hashimoto’s (for 20 years). Just received “The Paleo Approach” in the mail today so I’m looking forward to healing my body (hopefully) with the Paleo AIP.

Very good article. It unfortunately is very frustrating as well. I use stevia to sweeten Kefir for my family and our kefir smoothies. I also use it in a gelatin,lemon treat. Without the sweetness, most of my family would not eat these healing foods. We all have health issues that adding the hormonal issues stevia could be causing isn’t good. I use raw honey to sweeten warm/hot beverages when needed or when I am making gelatin jigglers or “gummy” treats but honey doesn’t work well for cold items. I guess I am on the hunt for a healthy sweetener again. Thanks for posting this great info.

I’m not a scientist or anything but I don’t think that using small amounts of stevia would be worse for you than any other forms sugars or processed “stuff”. Maybe just do some research to find out what is considered safe and use even less than that.

You just blew my mind, Sara. As someone trying to conceive and having issues, this is timely info for me. I am flabbergasted that I’ve never heard a thing about this before. I realize it’s not necessarily conclusive, but it’s enough for me to be concerned and skip it. Please let us know how it goes with the unflavored FCLO. I’ve been using cinnamon tingle. Thank you for sharing this info in advance of your book release. You are doing incredible work!

So, I went back to the literature. What I found was more studies showing it has an effect on male and female fertility and probably the same number of studies showing it has no effect. I guess I would say the jury is still out–but there is sufficient evidence to warrant careful thought before consuming it (and I will continue to choose not to).

True story.

My husband is diabetic and switched to stevia 2-3 years ago. He used to use other artificial sweeteners but I urged him to at least use Stevia in his coffee. He probably has 2 of those tiny little stevia spoonfuls a day.

I pretty much avoid sugar for regular consumption – I’ll have a sweetened juice every week or two. Same goes with cake and other sweets. And coffee/caffeine – I don’t touch the stuff. Today is the first time I have ever tried it along with a caffeinated tea – I made a myself iced tea with earl grey and added one of those tiny stevia spoonfuls to it.

Here’s the interesting part of the story based on what I’m reading….

Last year I found out that I’m infertile. My husband however is the complete opposite. He’s got super healthy sperm. AND, a lot of it!

I’m not saying I don’t believe what is written above. Perhaps it’s a situation of everything in moderation? Too much of anything, especially processed stuff, is bad for us. Unfortunately this article doesn’t mention the amounts that are safe or not safe.

I do have a bit of a tummy ache. I am tired though and have had a whole cup of earl grey caffeinated tea which I am totally not used to drinking.

Hi Sarah, I’m also concerned about the stevia content in the flavored Royal Ice FCLO/BO blends… is that tsp or so a day worth a fertility concern? Also, is the connection purely a fertility issue or would it possible disrupt hormones in post-menopausal women? (Asking cause my mom’s a HUGE stevia user)

Yeah, I think it’s a shame that Green Pasture’s only sweetener is stevia (I wish they had a honey option or something similar). I personally take either oslo orange or unflavored (yuck) FCLO (I don’t to the BO blends because I have an autoimmune disease). I know my hormones are still a little off so I’m really mindful about what I eat or what is in my environment that might be stopping them from normalizing. BUT, I did just buy the licorice flavored emulsified FCLO for my kids to try and it does contain stevia. I’m also conflicted between giving them a (albeit small) daily dose of stevia but then getting all those other great vitamins into them. Anyway, we’re trying it and I can already see the dark circles under my oldest’s eyes disappear, so I think great vitamins is winning out. As for post-menopausal women, the studies in male mice indicated that the effect was probably due to binding with an androgen receptor, which would mean stevia would disrupt hormones in anyone. It’s unclear how much you need to take though for that to be a problem (and there are certainly studies showing no effect on fertility just to muddy the waters a little). But, I can tell you that even if I was post-menopausal, I would not be choosing stevia (although, just as I do now, I don’t fret over having a little once in a while).

Can you clarify on avoiding BO with AI? Is it because of dairy? Or is there something else I’m missing. I apologize, I tried to do a search, and couldn’t come back with much. Getting ready to order BO because of all of its benefits but I also have an AI disease (although dairy hasn’t proven to be a trigger), and don’t want to do something totally stupid. 🙂

Yes, it’s because of the dairy. If you tolerate dairy, it’s an awesome supplement, but even trace dairy proteins can be a problem for many with autoimmune disease.

Well, they fed the mice a lot more stevia than a normal person would ever ingest. That’s the point of it, that you don’t need much at all to get the desired sweetness.
One of the first users of stevia here in Norway, a man in his forties, have used it each and every day in huge amounts in everything for more than 10 years. He has 8 children… I know women who have beem using stevia for 20 years without any adverse effects what so ever.

I use stevia in my green tea and coffee. I cannot drink either without sweetening it. What would you suggest, knowing we are fitness people who maintain a lower level of bodyfat and don’t want to mess with out insulin levels too much?

I guess it depends on how sweet you like your beverages. Generally, I would suggest either an unrefined granulated sugar or honey (molasses is awesome in coffee too and has a pretty good mineral content) while also working to gradually decrease the amount you add. Also, adding a quality fat to coffee can really take away the need for sugar completely. My favourite is the Bulletproof Exec method of blending 1Tbsp grass-fed unsealed butter and 1Tbsp coconut oil per 8 oz cup of coffee (about 20 seconds in the blender). It’s delicious! Cinnamon can also trick your taste buds into thinking its sweeter than it is. There’s also always the option of finding something else to drink that you don’t feel the need to sweeten.

Will the granulated sugar mess with insulin though? I would think so. I know coffee and green tea are very healthy drinks with tons of research on them, so I don’t want to give either up, but can’t imagine ever drinking them black with nothing to sweeten the taste a bit.


I don’t like to eat salads without a little dressing, but that doesn’t mean there is no good reason to eat a salad.

Coffee and green tea have as many potential benefits as they do potential cons, and any good scientist should be quick to point out how ambiguous and contradicting most of the research you use for your articles is. Like this man, I absolutely love my morning coffee but would never drink it black. It would not be as an enjoyable, and my morning coffee is a very enjoyable part of morning routine. However, just because I can’t drink black coffee or munch on a plain piece of spinach doesn’t mean I should just stop consuming either. I don’t understand why his remark received such an extremist response. If you can’t think of a better alternative, I would think stating that you are not currently aware of something that meets his requirements may be a better or more honest answer than, well, sounding not too dissimilar from a religious extremist defending his most beloved views…

Yikes!! I put NOW FOODS Stevia in my Matcha tea every day!!!! I used stevia because it is zero-carbs and not a horrendous gassy farty laxtive (like most low carb polyols)!! I did hear about it being a natural contraceptive before! But though that cant be bad right?!! If it lowered testosterone in the male rats, what did it do to the female ones?? Is there anything sweet tasting on earth that has no carbs and wont mess up the body?!! eeek!

Erythritol has been shown to increase epithelial permeability in cell culture studies through an effect on the tight junctions… meaning it has the capacity to cause a leaky gut.

Well, it looks like a case of omit sugar entirely except naturally occurring in foods or ‘pick your poison’.

Stevia is the recommended sweetener for those with diabetes, according to Dr.R Bernstein, ‘Diabetes Solution’. You do need to check the powdered version for maltodextrin; stevia liquid contains no sugars of any kind and only minute amounts of carb. Weighing the pros and cons many result in a different conclusion depending on your age and health.

Hi there. I am wondering if you were able to read the contents of the studies you cite. I tried to find the information to look at the studies more closely and all of them were not published in entirety on the internet, but instead you needed to pay $31.50 to read each study. Did you perhaps pay for the studies to see how they were conducted? And if not, could you please direct me to where I can read more information about the studies so I can better evaluate this information? Thanks so much in advance.

I do (my husband is a university professor and can usually access articles for me) and I have read both studies showing effects and the studies showing no effects. It is not a good idea to dismiss a study simply because it is performed at high doses (although you might want to dismiss studies that give stevia by injection compared to orally). This is typical in scientific research, in part because rodents are usually more resilient than humans, and in part because this is how you see clearly measurable effects. For human consumption, this means that consuming stevia is unlikely to make you sterile the way it does in high doses in rodents, but it does give a strong indication that there could be an effect on your gonadotrophins. Maybe in humans it is a 5% or or even 1% difference at the amounts that most people who consume stevia frequently would get. For plenty of people, this might not be noticeable, but for those with autoimmune disease, who already tend to have issues with hormone regulation, I think anything with this type of an potential effect should be avoided. That being said, there is certainly no consensus in the scientific literature as to the effects of stevia on reproductive hormones.

Hi again, Sarah. I did some more poking around and this post seems to show that there are major problems with the fertility studies in rats. The scientist who published the study even admits that there were problems. This part of the post is quite interesting from a study in 1999 on primates:
“n 1999, the primate research center of Chulalonhkorn University in Bangkok, Thailand gave high doses of Stevia to both male and female hamsters to see if their fertility would be affected. Even though 2,500 mg a day was administered ( a human dose is about 2 mg), there was no evidence of decreased fertility.”
Here is a link to the post. http://natural-fertility-info.com/does-stevia-cause-infertility.html

Stevia can also cause Polyhydramnios in pregnancy (too much amniotic fluid)… I got it – it could have been just coincidence, but I was consuming stevia in a protein powder I was taking.

Just some thoughts… I love your site and thank you for all of your research and great explanations!! Can’t wait for the book. But I can’t help but question whether your case should be so against using stevia. It could possibly be worse to encourage people with autoimmune disorders to use “natural sugars” instead of a pure form of stevia without fillers. I am new to researching autoimmune disease, so I honestly don’t know what is healthiest and I don’t know that anyone really knows yet. I read a couple of books lately that suggested stable blood sugar regulation is critical in treating autoimmune and hormone disorders. The suggestion is that low and/or high blood sugar is stressful to the body and can disrupt cortisol and other adrenal hormones, which ultimately impacts endocrine hormones and even brain function. I recently found out I have reactive hypoglycemia and autoimmune disease so I’m not sure it is a good idea for me to throw out stevia and replace it with blood-sugar-raising sweeteners like honey and maple syrup. I’ve made (and love the taste of) foods made with natural cane sugar, coconut sugar, raw honey, maple syrup, etc. But they me make me hungrier, sometimes tired, and then I crave more carbs. Even too much fruit can make me notice differences in my energy/mood. I don’t use scary sweeteners like aspartame, so stevia is the only thing I’ve found so far that does not make me feel that way. Although the other sugars are natural, very tasty, and conducive to baking, it does not mean that natural sugars are not disrupting insulin/leptin/glucose functioning and causing problems. It might be better for me to not eat anything sweet at all, but that kind of diet does not seem sustainable forever. I would like to include a little bit of sweet in my life so that I don’t feel deprived, yet still reach a more optimal health status.

What about Lo Han (monk fruit)? I have 100% pure powder (no fillers). The herb has been used extensively in Chinese Medicine. Also, what are your thoughts on the following other sweeteners – Palm Sugar, Yacon Syrup, Lucuma powder, Chicory syrup?

For autoimmune disease specifically? or generally? Actually, I think my opinion is the same either way!

Chicory and yacon are very high fructose and fructooligosaccharides, which can cause a variety of issues and I don’t recommend. Reports contradict each other on the saccharide content of palm/coconut sugar… if it really is high inulin, that’s a fructooligosaccharide that can potentially contribute to overgrowths so I don’t like the concentrated form of it, but if it’s similar to cane sugar as some report, then I think it’s fine. Lucuma powder seems to be about twice as much glucose as fructose, but does have some sugar alcohols, should be fine except for people with sever polyol sensitivity.

Thanks! I read that Yacon was very low fructose. There is so much conflicting info out there. What about the Lo Han? I have been using it quite a bit.

You know, when stevia became all the rage, I had read an article stating exactly what you have stated about its traditional use for controlling fertility. Then for years I could not find that anymore anywhere, as if the information disappeared and of course stevia has become super popular. It actually makes my mouth numb, so I stay away. Thank you for posting this.

I am not a stevia user, I was just curious about what you had to say about it. Thank you for that very intelligently written excerpt. I very much appreciate the knowledge you are sharing.

This is a great article. Since I have started using Stevia regularly the time between my periods has become shorter (18-21 days). And Stevia was the only thing I added to my supplement regimen in the last few months. So, I’m off Stevia as of right now and will post again in couple of months to let you know if there will be any difference.

Do you have any thought specifically on xylitol? Is has been proven to have specific benefits for oral health, and acts as a pre-biotic.

Hi Sarah,
I just started the AIP diet a few days ago and I was wondering if I can have vitamin b 12 lozenge that is made with stevia? I used to take it everyday before I started to help me manage my stress and keep me relaxed. I would like to take it if it wouldn’t affect my diet. Please let me know if it’s okay if it’s such a tiny amount. Thanks!!!!

Hi Sarah,
I just started the AIP diet a few days ago and I was wondering if I can have vitamin b 12 lozenge that is made with stevia? I used to take it everyday before I started to help me manage my stress and keep me relaxed. I would like to take it if it wouldn’t affect my diet. Please let me know if it’s okay if it’s such a tiny amount. Thanks!!!!

Thank you so much for the article, Sarah. I just bought a small bottle of stevia and was thinking that I could finally add some sweetness to my life. But now, I know that it disregulate hormones (and I do have hormonal imbalance), I’m also having adrenal issues, because of that my blood sugar is often high. I’ll to need to replace it with another sweetener. Could you please recommend a good low GI sweetener? Thanks a million.

Hi, I’ve been using and recommended stevia for a while … and while I don’t personally have auto-immune issues, the hormone thing is concerning.
Do you happen to know what type of stevia is used in the studies? Meaning whole leaf vs. extract.
I still plan to minimize, but am curious about that.


I’d like you to answer these 20 or so people that responded to your article (or write up). STEVIA IS TRULY A MIRACLE SWEETENER AND NUTRITIONAL SUPPLEMENT. As you know they use it in the orient for a long time to treat Diabetes. It is a sweetener that sweetens and does the opposite of what sugar does (any form even natural). But I’m open minded to learn new things about Stevia that I’m not aware of. Please enlighten me, if you will.

“While small and occasional consumption of stevia likely has little to no impact on general health,”

What constitutes “small and occasional consumption of stevia” and for whom and when does it constitute it?

“[Stevia] should not be consumed on a regular basis”

What constitutes “a regular basis”?


I have been a stevia user (only Sweet Leaf brand liquid mostly) for many years because it was suggested by my naturopath because I had high hemoglobin A1C levels and have been diagnosed with prediabetes. After reading your article, the responses, and a few other articles on the topic, I decided to stop using stevia for a few months and use honey in moderation instead to see what happens. I have also been on a fairly strict autoimmune paleo protocol for about three months. I just got my HA1c level checked and it was 5.9 — after keeping it around 5.4-5.6 for a few years, and then I see articles like this one about honey being great, except when it comes to HA1C levels. I know the answer is probably don’t use any sweeteners at all, but just was curious for those of us who truly relish our tea with some sweetener in it and stevia seems to have mixed responses depending on research and perspective.


I just found your website and have been devouring all the great information! Are you familiar with a sweetener called Just Like Sugar? It is recommended by Dr. Russell Blaylock. The ingredients are chicory root dietary fiber, calcium vitamin c, natural flavors from the peel of the orange. It has 0 calories and 0 carbs and is non-gmo and gluten free. Tastes pretty good, too. So I imagine there is a downside somewhere. LOL. It is a bit pricey.

I am in awe of your restraint. With all of the work you put into this, people still enjoy trying to discredit your opinion by dragging up unrelated research, irrelevant points, and their own anecdotal evidence.

It’s easy enough for me to say to critics that how we have been eating is why we are struggling today. So make changes and stop complaining that you can’t have it all.

But I am not Paleomom ;).

If you have an allergic reaction to ragweed you might have a reaction to stevia. It snuck up on me after using it for a few months. I would have asthma like symptoms, wheezing, coughing and having trouble breathing. I thought it was my coffee causing the problem but then I found out that the stevia plant is in the ragweed family which I have an allergy to. Just a thought some here might want a heads up.

The article says that stevia could have an impact on estrogen. What kind of impact on estrogen would it have? Would it reduce estrogen or would it raise estrogen? Stevia is a plant so would it be a phytoestrogen as well hormonal? Thanks

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