Stevia: little measurable effect on blood pressure or blood sugar in trials

Across 9 randomized trials with 756 people, most at high cardiovascular risk and mostly given high doses of stevioside, steviol glycosides did not significantly lower systolic blood pressure (mean difference -2.98 mm Hg, 95% CI -6.23 to 0.27). Diastolic pressure and fasting glucose fell significantly, with large differences between trials. Rebaudioside A showed no effect on blood pressure or other cardiovascular risk factors. A network meta-analysis of 36 single-meal trials in 472 mostly healthy people found that drinks with non-caloric sweeteners, stevia among them, acted like water for blood glucose, insulin and gut hormones, at low to moderate confidence. On appetite and weight the short trials disagree. Five drops of one commercial stevia liquid match the sweetness of a teaspoon of sugar, and a packet of stevia powder weighs 1 g in the US survey database.

Every statement here is tied to a source. The badge says what kind of evidence stands behind it: A is a meta-analysis or systematic review, E is the position of an expert body without its own analysis. How we verify →

We have no USDA entry for stevia itself in this cohort. The evidence below stands on published studies rather than on a composition table, and we would rather say that than show you a number for something else.

What a real portion looks like

The 12-week trial used 5 stevia drops twice a day in drinks, with 5 drops matching the sweetness of one teaspoon of table sugar. — stevia arm of a 12-week RCT in healthy adults in Manchester (n = 28) Evidence B source
Dose 10 drops a day of a commercial stevia drops product in habitual drinks
In the US dietary survey database a packet of stevia powder weighs 1 g and a teaspoon 3 g, while a teaspoon of liquid stevia weighs 5 g. — USDA FNDDS food codes 91108000 (stevia powder) and 91108010 (stevia liquid) Evidence E source
Powder: 1 packet 1 g, 1 teaspoon 3 g; liquid: 1 teaspoon 5 g, 1 drop under 1 g

What your body absorbs

EFSA explains that steviol glycosides are not digested in the upper gut. Colon bacteria break them down to steviol, which is then absorbed. — EFSA Panel on Food Additives and Flavourings, steviol glycosides E 960a-d Evidence E source
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In a crossover study in 20 volunteers, the sweetener added to a maqui-citrus drink changed how much of its polyphenols reached the blood, with sucralose highest and stevia next. — 20 volunteers drinking a maqui-citrus beverage with sucrose, stevia or sucralose (n = 20) Evidence B source
13 phenolic metabolites in plasma peaking at 30-60 min; absorption highest with sucralose, then stevia

What it does to your health

In a 4-week double-blind RCT in 59 healthy adults, a daily stevia drink at 25% of the ADI left gut bacteria and fecal short-chain fatty acids no different from a sucrose drink. — healthy adults aged 31 ± 9, BMI 22.6, 16 oz beverage daily with stevia (25% of ADI) or 30 g sucrose for 4 weeks, then 4-week washout (n = 59) Evidence B source
No significant differences at phylum, family, genus or species level, and no difference in fecal SCFA at week 4 (shotgun sequencing)
In a 2-week RCT of 120 healthy adults given saccharin, sucralose, aspartame or stevia below the ADI, each sweetener shifted the stool and oral microbiome, but only saccharin and sucralose impaired glucose responses. — healthy adults, sachets of saccharin, sucralose, aspartame or stevia for 2 weeks vs glucose vehicle or no supplement (n = 120) Evidence B source
Distinct stool and oral microbiome and plasma metabolome changes with each sweetener; glycemic impairment with saccharin and sucralose only
In a 14-day crossover RCT in 39 healthy adults, fasting levels of the gut hormones PYY and GLP-2 rose after 220 mg/day steviol glycosides, as they did after sucrose and saccharin. — healthy normal-weight adults, beverages with sucrose 66 g/day, saccharin 220 mg/day or steviol glycosides 220 mg/day for 14 days (n = 39) Evidence B source
Fasting PYY and GLP-2 increased with all treatments (p < 0.001), no difference between sweeteners
Across 9 RCTs with 756 people, steviol glycosides did not significantly lower systolic blood pressure (-2.98 mm Hg), and rebaudioside A showed no cardiovascular effect. — 9 randomized trials, 756 participants, mostly at high cardiovascular risk (n = 756) Evidence A source
Systolic BP MD -2.98 mm Hg (95% CI -6.23 to 0.27); small falls in diastolic BP and fasting glucose with high heterogeneity
In a double-blind crossover RCT in 20 healthy adults, a stevia drink before lunch cut total energy intake to 727 calories versus 832 calories after water. — 20 healthy adults aged 27 +/- 5, 11 fl oz (330 mL) drink with 240 ppm stevia before an ad libitum lunch (n = 20) Evidence B source
Total energy 727 +/- 239 vs 832 +/- 198 calories (P = 0.013); glucose AUC 320 vs 304 after water
In a 12-week RCT in 28 healthy adults, daily stevia did not change glucose or insulin responses, and the stevia group held weight (-0.49 lb / -0.22 kg) while controls gained 2 lb (0.89 kg). — 28 healthy lean adults aged 25 +/- 5, stevia drops daily for 12 weeks versus no change (n = 28) Evidence B source
Weight change -0.49 lb (95% CI -2.1 to 1.1; metric: -0.22 kg, -0.96 to 0.51) vs +2 lb (0.35 to 3.6; metric: 0.89 kg, 0.16 to 1.63); no difference in OGTT glucose or insulin
In a crossover trial in 30 healthy men, replacing a 65 g sucrose drink with stevia saved no energy over the day because lunch intake rose to compensate. — 30 healthy men in Singapore, preload drinks with aspartame, monk fruit, stevia or 65 g sucrose (n = 30) Evidence B source
No difference in total daily energy (P = 0.831) or 3 h glucose AUC (P = 0.960)
In a crossover trial in 30 adults, a 1 g stevia preload lowered hunger ratings versus water but did not change lunch or daily energy intake. — 30 adults (20 women) aged 26, preloads of water, 60 g sugar or 1 g stevia before a pizza lunch (n = 30) Evidence B source
Lunch energy p = 0.78, day energy p = 0.33; hunger and desire to eat lower after stevia than water (p < 0.05)
In a 14-day double-blind crossover RCT in 39 healthy adults, 220 mg a day of steviol glycosides raised fasting insulin from baseline, and glucose regulation did not differ from sucrose or saccharin. — 39 healthy normal-weight adults, drinks with sucrose 66 g/d, saccharin 220 mg/d or steviol glycosides 220 mg/d for 14 days each (n = 39) Evidence B source
Fasting insulin up after stevia versus baseline (p < 0.01); no between-sweetener difference in glucose regulation
In a 4-week double-blind RCT in 59 healthy adults, a daily drink with 25% of the stevia ADI left gut microbiome and fecal short-chain fatty acids unchanged versus 30 g sucrose. — 59 healthy adults aged 31 +/- 9, 16 oz drink daily for 4 weeks then 4-week washout (n = 59) Evidence B source
No difference in microbiome or fecal SCFA; BMI +0.3 kg/m2 with sucrose versus stevia (P = 0.013)

Safety, limits and interactions

A meta-analysis of 9 randomized trials with 756 participants taking steviol glycosides listed abdominal fullness and epigastric pain among reported adverse events. — participants in randomized clinical trials of stevioside and rebaudioside A, most with high cardiovascular risk (n = 756) Evidence A source
Adverse events: abdominal fullness, epigastric pain, dizziness; frequency not given in abstract
In a double-blind crossover trial in 60 adults with overweight or obesity, gastrointestinal symptoms after 11 fl oz (330 mL) drinks with stevia blends or sucrose were mostly mild. — healthy adults with overweight or obesity, 11 fl oz (330 mL) beverage with a sweetener blend (two of them stevia-based) or 8% sucrose, then breakfast (n = 60) Evidence B source
Gastrointestinal symptoms mostly mild for all beverages
A 2024 meta-analysis of 19 studies with 203,706 participants linked low-calorie sweetener use in pregnancy with an 11% higher risk of preterm birth, while the 42% higher gestational diabetes risk was imprecise. — Women exposed to low-calorie sweeteners before conception or during pregnancy, 19 studies (n = 203,706) Evidence C source
Preterm birth RR 1.11 (95% CI 1.07 to 1.16); gestational diabetes RR 1.42 (95% CI 0.98 to 2.04); no difference in gestational weight gain
According to the WHO 2023 guideline, higher non-sugar sweetener intake in pregnancy was associated with a 25% higher risk of preterm birth in a meta-analysis of three cohort studies of 129,009 women. — 129,009 pregnant women in three prospective cohort studies (n = 129,009) Evidence E source
Preterm birth OR 1.25 (95% CI 1.07 to 1.46); low certainty; mainly late preterm
In a Danish cohort of 59,334 pregnant women, one or more artificially sweetened carbonated soft drinks a day was associated with 38% higher odds of preterm delivery. — 59,334 pregnant women in the Danish National Birth Cohort, 1996-2002 (n = 59,334) Evidence C source
Adjusted OR 1.38 (95% CI 1.15 to 1.65) for at least 1 serving/day; OR 1.78 (1.19 to 2.66) for at least 4 servings/day; no association for sugar-sweetened drinks
EFSA found steviol glycosides not genotoxic or carcinogenic and not linked to adverse effects on reproduction or the developing child, set an ADI of 4 mg per kg body weight, and warned it could be exceeded at maximum use levels. — EFSA ANS Panel safety assessment of steviol glycosides (E 960), 2010 Evidence E source
ADI 4 mg/kg bw/day (as steviol equivalents); no reproductive or developmental toxicity
In a 4-week double-blind RCT in 100 adults with normal or low-normal blood pressure, 1000 mg a day of rebaudioside A did not change blood pressure. — 100 healthy adults aged 18-73 with normal and low-normal blood pressure, 4 weeks (n = 100) Evidence B source
No significant change in seated or 24 h ambulatory blood pressure or heart rate versus placebo
The FDA cites an acceptable daily intake of 4 mg per kg body weight for steviol glycosides, expressed as steviol equivalents, set by JECFA. — US regulatory safety assessment of high-purity steviol glycosides Evidence E source
ADI 4 mg/kg bw/day as steviol equivalents; 12 mg/kg bw/day for rebaudioside A

What people believe that the data does not support

The same gastroenterology review notes that stevia is not technically counted as an artificial sweetener, so findings on sucralose, saccharin or aspartame do not automatically apply to it. — review of artificial sweeteners and the GI tract (n = 26 papers) Evidence D source
Definition: stevia outside the five FDA-approved artificial sweeteners reviewed
A 2018 consensus of 17 experts concluded that data are too limited to show low-calorie sweeteners affect gut health at doses people actually consume. — expert consensus workshop on low-calorie sweeteners (n = 17 experts) Evidence E source
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WHO advises against using non-sugar sweeteners for weight control and states the recommendation covers pregnant and lactating women, with the exception of people with diabetes. — General population including pregnant and lactating women, WHO 2023 guideline Evidence E source
Conditional recommendation, no effect size
WHO lists stevia and stevia derivatives among the non-sugar sweeteners its 2023 recommendation covers. — Scope of the WHO 2023 non-sugar sweetener guideline Evidence E source
Stevia included in scope, no effect size
Only high-purity steviol glycosides are GRAS in the US. Stevia leaf and crude stevia extracts are not, and they cannot be imported as sweeteners. — US regulatory status of stevia-derived sweeteners Evidence E source
High purity (95% minimum) steviol glycosides GRAS; whole leaf and crude extracts not GRAS
The Academy of Nutrition and Dietetics lists stevia among seven non-nutritive sweeteners approved in the US and states all of them are determined to be safe. — US dietetic professional position paper, 2012 Evidence E source
Position statement, no effect size

Who this works differently for

A systematic review of 79 studies found sugar alcohols (polyols), used in many sugar-free sweeteners, cause dose-dependent gas, abdominal discomfort and laxative effects in healthy people and in IBS. — healthy men and women and patients with irritable bowel syndrome in studies of polyols (n = 79 studies) Evidence C source
Dose-dependent flatulence, abdominal discomfort and laxative effects; dysmotility in IBS
In 2024 EFSA kept the acceptable daily intake for steviol glycosides at 4 mg/kg body weight per day. — EFSA Panel on Food Additives and Flavourings, steviol glycosides E 960a-d Evidence E source
ADI 4 mg/kg bw/day steviol equivalents
A 2025 meta-analysis of 17 studies found any low-calorie sweetener use in pregnancy was not associated with birth weight, pooled from four cohort studies. — Children of women who used low-calorie sweeteners before or during pregnancy or while breastfeeding, 17 studies (n = 17 studies) Evidence C source
Birth weight SMD 0.03 (95% CI -0.03 to 0.08), 4 cohorts; BMI z-score at birth to 7 years not different; overweight at 1 year OR 1.19 (0.81 to 1.58), 2 cohorts
In the Canadian CHILD cohort of 3,033 mother-infant pairs, daily artificially sweetened drinks in pregnancy were linked to about twice the odds of infant overweight at 1 year. — 3,033 mother-infant dyads, Canadian Healthy Infant Longitudinal Development Study (n = 3,033) Evidence C source
Infant BMI z score +0.20 (95% CI 0.02 to 0.38); overweight at 1 year adjusted OR 2.19 (1.23 to 3.88)
In a Chilean cohort of 1,472 pregnant women, 41% of whom ate steviol glycosides, any non-nutritive sweetener use was linked to 58% higher odds of gestational diabetes, with the signal named for sucralose. — 1,472 pregnant women in the CHiMINCs-II cohort, Santiago, Chile (n = 1,472) Evidence C source
Any NNS adjusted OR 1.58 (95% CI 1.10 to 2.26); sucralose OR 1.44 (1.06 to 1.95); steviol glycosides consumed by 41.1%, no significant association reported
In 682 US mother-infant pairs, infants' exposure to low-calorie sweeteners through breastfeeding was linked to 2.78 times the odds of vomiting, with no link to infant weight. — 682 mother-infant dyads at 3 months postpartum, Infant Feeding Practices Study II, 2005-2007 (n = 682) Evidence C source
Vomiting OR 2.78 (95% CI 1.05 to 7.34); no association with BMI-for-age or overweight
In the Danish National Birth Cohort, children of mothers who drank at least one artificially sweetened beverage a day in pregnancy had 26% higher odds of overweight at age 18. — 72,821 women with a pregnancy food frequency questionnaire and their offspring followed to 18 years, Danish National Birth Cohort (n = 72,821) Evidence C source
Overweight at 18 years adjusted OR 1.26 (95% CI 1.12 to 1.42); raised odds also at 7, 11 and 14 years
In 12 people with type 2 diabetes, adding 1 g stevioside to a meal cut the glucose response by 18% versus maize starch. — 12 type 2 diabetic patients, single test meal with 1 g stevioside or 1 g maize starch (n = 12) Evidence B source
Incremental glucose AUC -18% (P = .013); insulinogenic index about +40%
Among 601 pregnant women in Chile, 78% used stevia and it came closest to its acceptable daily intake, averaging 12% of the ADI, with no one exceeding it. — 601 pregnant women in the two main cities of Chile (n = 601) Evidence C source
Stevia used by 78.3%; mean intake 12% of ADI; no woman above ADI
In a Taiwanese cohort of 1,696 children aged 7-17, steviol glycoside intake showed a borderline link with lower hypertension risk, while aspartame and added sugar were linked to higher risk. — 1,696 children and adolescents aged 7-17 in the Taiwan Pubertal Longitudinal Study (n = 1696) Evidence C source
Steviol glycosides p for trend 0.05 (borderline inverse); aspartame OR 1.69 (95% CI 1.03-2.75)

What is still unknown

A systematic review of 26 papers on artificial sweeteners and the gut found minimal data, and no human data, on their effect on GI symptoms or stool form. — studies of artificial sweeteners and fermentation, absorption and the GI tract (n = 26 papers) Evidence D source
Evidence gap: no human data on GI symptoms or stool form; microbiome findings conflicting and mostly from animals
According to the WHO 2023 guideline, its systematic review of non-sugar sweeteners identified 50 RCTs in adults and children and no RCTs in pregnant women. — Systematic review behind the WHO non-sugar sweetener guideline, adults, children and pregnant women Evidence E source
0 RCTs in pregnant women; pregnancy evidence from 17 cohort studies (12 cohorts)
A Norwegian cohort of 60,761 pregnant women found more than one artificially sweetened drink a day linked to 11% higher odds of preterm delivery and sugar-sweetened drinks to 25% higher odds. — 60,761 pregnant women in the Norwegian Mother and Child Cohort Study (n = 60,761) Evidence C source
Artificially sweetened >1 serving/day adjusted OR 1.11 (95% CI 1.00 to 1.24); sugar-sweetened >1 serving/day adjusted OR 1.25 (1.08 to 1.45)
Lab data in female rats given rebaudioside A at the ADI from 4 weeks before mating until weaning suggest no harm to maternal heart, glucose or lipid control, while effects on offspring were not studied. — Female rats, rebaudioside A 4 mg steviol equivalents/kg bw/day in drinking water Evidence D source
No change in glucose tolerance or cardiac function; lower fasting glycemia and cholesterol; smaller cardiomyocytes
A network meta-analysis of 36 acute trials in 472 people found drinks sweetened with non-nutritive sweeteners including stevia behaved like water for blood glucose and gut hormones. — 36 acute feeding trials, 472 mostly healthy participants, sweeteners including stevia (n = 472) Evidence B source
No effect on 2 h glucose, insulin, GLP-1, GIP, PYY, ghrelin or glucagon versus water; low to moderate confidence

The bottom line

In 20 healthy adults, a stevia drink before lunch brought total energy for drink plus meal to 727 calories against 832 calories after water, in a single double-blind test. In 30 healthy men in Singapore, swapping a drink with 65 g of sucrose for stevia saved nothing over the day, because the energy was made up at later meals (P = 0.831). A 1 g stevia preload in 30 adults lowered hunger ratings compared with water, while lunch and daily intake did not change. Over 12 weeks, 28 lean adults who added 10 drops a day held their weight (-0.49 lb (95% CI -2.1 to 1.1; metric: -0.22 kg, -0.96 to 0.51)) while controls gained 2 lb (0.89 kg), in an open trial without a placebo. Their glucose and insulin responses did not differ. In 39 healthy adults, 220 mg a day of steviol glycosides for 14 days raised fasting insulin compared with their own baseline (p < 0.01), with no difference from sucrose or saccharin in glucose regulation. A daily drink with 25% of the stevia acceptable daily intake for 4 weeks left the gut microbiome and fecal short-chain fatty acids unchanged in 59 healthy adults, compared with 30 g of sucrose. In 12 people with type 2 diabetes, 1 g of pure stevioside added to one meal cut the glucose rise by 18% compared with maize starch, a dose far above what a tabletop serving delivers. The FDA cites an acceptable daily intake of 4 mg per kg of body weight for steviol glycosides, counted as steviol equivalents and set by the joint FAO/WHO expert committee. It is a safety threshold and says nothing about effects. In 100 adults with normal or low-normal blood pressure, 1000 mg a day of rebaudioside A for 4 weeks did not change blood pressure or heart rate. In a survey of 601 pregnant women in Chile, 78% used stevia and their average intake reached 12% of the acceptable daily intake, with nobody above it. In 1,696 Taiwanese children aged 7 to 17, steviol glycoside intake had a borderline link with lower hypertension risk (p for trend 0.05), in observational data. We found no study of stevia alongside medicines or on stevia allergy. Stevia leaf is a different product from the purified sweetener. The FDA does not consider stevia leaf or crude stevia extracts generally recognized as safe, and their import for use as sweeteners is not permitted. The Academy of Nutrition and Dietetics, in a 2012 position paper, lists stevia among seven sweeteners approved in the US and calls all of them safe. We have no composition table for stevia and no study of how it holds up in baking.

Questions about stevia, answered from the trials

Sources

stv1-daily-r1-05 · randomized controlled trial
The participants in the stevia group were given a commercially available stevia drops product (SweetLeaf Stevia Sweet Drops Clear, SweetLeaf®, Wisdom Natural Brands, Arizona, USA) and were instructed to consume 5 drops twice daily with their habitual drinks (5 drops of stevia corresponds to the sweetness of one teaspoon of table sugar).
Nutrients, 2020 · checked 2026-09-29
stv1-daily-r1-18 · reference dataset
FNDDS 2710264 Sugar substitute, stevia, powder: 1 individual packet 1 g · 1 teaspoon 3 g; FNDDS 2710265 Sugar substitute, stevia, liquid: 1 teaspoon 5 g · 1 drop 0 g
USDA FNDDS 2021-2023, fdc_id 2710264 and 2710265 · checked 2026-09-29
ev-stgut-10 · agency opinion
After entering the colon, steviol glycosides are subject to degradation by the gut microbiota, resulting in the release of the aglycone steviol which is then absorbed.
EFSA FAF Panel, Scientific opinion on steviol glycosides (E 960a-d) and the ADI for steviol, EFSA Journal 2024;22(11):e9045 · checked 2026-10-07
stv1-daily-r1-12 · randomized crossover trial
In general, sucralose provided the greatest absorption value for most of these metabolites, followed by stevia.
Nutr Metab Cardiovasc Dis, 2021 · checked 2026-09-29
ev-stgut-02 · RCT
At week 4 (after intervention), there were no significant differences in the HGM at the phylum, family, genus, or species level between the stevia and sucrose groups and no significant differences in fecal SCFA.
J Nutr, 2024 · checked 2026-10-07
ev-stgut-03 · RCT
As groups, each administered NNS distinctly altered stool and oral microbiome and plasma metabolome, whereas saccharin and sucralose significantly impaired glycemic responses.
Cell, 2022 · checked 2026-10-07
ev-stgut-05 · RCT, crossover
Fasting PYY and GLP-2 increased following all treatments (p < 0.001), without differences between sweeteners.
Nutrients, 2026 · checked 2026-10-07
stv1-daily-r1-02 · meta-analysis of RCTs
Meta-analysis revealed a non-significant difference in systolic blood pressure between steviol glycoside and placebo, mean difference (MD): -2.98 mm Hg (-6.23 to 0.27). Significant reductions in diastolic blood pressure and fasting blood glucose were observed. ... Rebaudioside A does not appear to have any significant effects on blood pressure or cardiovascular risk factors.
Eur J Prev Cardiol, 2015 · checked 2026-09-29
stv1-daily-r1-03 · randomized crossover trial
Total energy intake (beverage and meal) was significantly lower after the stevia beverage (727 ± 239 kcal) compared with water (832 ± 198 kcal, P = 0.013), with no significant difference between the water and caloric beverages (P = 1.00 for water vs. maltodextrin, glucose, and sucrose).
J Nutr, 2020 · checked 2026-09-29
stv1-daily-r1-04 · randomized controlled trial
There was no significant difference in the glucose or insulin responses. There was a significant main effect of group on BW change (F(1,26) = 5.56, p = 0.026), as the stevia group maintained their weight as opposed to the control group (mean weight change at week 12: -0.22 kg, 95%CI [-0.96, 0.51] stevia group, +0.89 kg, 95%CI [0.16, 1.63] control group).
Nutrients, 2020 · checked 2026-09-29
stv1-daily-r1-06 · randomized crossover trial
The energy 'saved' from replacing sucrose with NNS was fully compensated for at subsequent meals; hence, no difference in total daily energy intake was found between the treatments (P=0.831).
Int J Obes (Lond), 2017 · checked 2026-09-29
stv1-daily-r1-07 · randomized crossover trial
Energy intake did not significantly differ between preloads for ad libitum meals (p = 0.78) and overall day (p = 0.33). VAS scores for hunger and desire to eat (DTE) were lower following stevia preload compared to water (p < 0.05).
Nutrients, 2019 · checked 2026-09-29
stv1-daily-r1-08 · randomized crossover trial
Compared with baseline, fasting glucose increased after sucrose and saccharin, and fasting insulin increased after stevia (p < 0.01). ... Short-term intake of sucrose and non-caloric sweeteners resulted in broadly similar metabolic responses, with no significant differences in glucose regulation.
Nutrients, 2026 · checked 2026-09-29
stv1-daily-r1-09 · randomized controlled trial
Daily consumption of a beverage sweetened with 25% of the ADI of stevia for 4 weeks had no significant effects on the HGM, fecal SCFA, or fasting cardiometabolic measures, compared with daily consumption of a beverage sweetened with 30 g of sucrose.
J Nutr, 2024 · checked 2026-09-29
ev-stgut-01 · meta-analysis of RCTs
Adverse events included abdominal fullness, epigastric pain, and dizziness.
Eur J Prev Cardiol, 2015 · checked 2026-10-07
ev-stgut-04 · RCT, crossover
Gastro-intestinal symptoms for all beverages were mostly mild.
Appetite, 2023 · checked 2026-10-07
ev-stpg-01 · meta-analysis
LCS consumption during pregnancy was associated with 11% increased risk of preterm birth (RR = 1.11, 95% CI: 1.07-1.16, I2 = 0.01%) and 42% increased risk of gestational diabetes (RR = 1.42, 95% CI: 0.98-2.04, I2 = 67.60%) compared with no consumption, however, the effect size for gestational diabetes was not precise as the 95% CI indicated that the effect estimate could range from 2% lower risk to 204% (or 2.04 times) higher risk.
Clinical Nutrition ESPEN, 2024 · checked 2026-10-07
ev-stpg-04 · agency guideline
Higher intakes of NSS were associated with a 25% increase in risk of preterm birth, as assessed by meta-analyses of three prospective cohort studies (odds ratio [OR] 1.25; 95% CI: 1.07 to 1.46; 129 009 pregnant women).
WHO, 2023, Use of non-sugar sweeteners: WHO guideline · checked 2026-10-07
ev-stpg-07 · prospective cohort
In comparison with women with no intake of artificially sweetened carbonated soft drinks, the adjusted odds ratio for women who consumed ge 1 serving of artificially sweetened carbonated soft drinks/d was 1.38 (95% CI: 1.15, 1.65).
Am J Clin Nutr, 2010 · checked 2026-10-07
ev-stpg-11 · agency news
Toxicological testing showed that the substances are not genotoxic, nor carcinogenic, or linked to any adverse effects on the reproductive human system or for the developing child. ... The Panel points out, however, that this ADI could be exceeded by both adults and children if these sweeteners are used at the maximum levels proposed by the applicants.
EFSA, 2010, news: EFSA evaluates the safety of steviol glycosides · checked 2026-10-07
stv1-daily-r1-10 · randomized controlled trial
These results indicate that consumption of as much as 1000mg/day of rebaudioside A produced no clinically important changes in blood pressure in healthy adults with normal and low-normal blood pressure.
Food Chem Toxicol, 2008 · checked 2026-09-29
stv1-daily-r1-13 · agency guidance
Rebaudioside A, a type of steviol glycoside, is 12 mg/kg bw/d. This is based on the ADI for steviol glycosides: 4 mg/kg bw/d, expressed as steviol equivalents, set by the Joint FAO/WHO Expert Committee on Food Additives, on which the FDA participates.
U.S. Food and Drug Administration, Aspartame and Other Sweeteners in Food · checked 2026-09-29
ev-stgut-07 · systematic review
Other non-nutritive sweeteners, such as stevia, exist but these are not technically considered to fall under the term “artificial sweeteners.”
Journal of Neurogastroenterology and Motility, 2016, 22(2):168-180 · checked 2026-10-07
ev-stgut-09 · consensus statement
Regarding effects on the human gut microbiota, data are limited and do not provide adequate evidence that LCS affect gut health at doses relevant to human use.
Nutr Res Rev, 2020 · checked 2026-10-07
ev-stpg-05 · agency guideline
With the exception of individuals with diabetes (as noted below), this recommendation is relevant for everyone: children and adults of any age, including pregnant and lactating women.
WHO, 2023, Use of non-sugar sweeteners: WHO guideline · checked 2026-10-07
ev-stpg-06 · agency news release
Common NSS include acesulfame K, aspartame, advantame, cyclamates, neotame, saccharin, sucralose, stevia and stevia derivatives.
WHO, 2023, news: WHO advises not to use non-sugar sweeteners for weight control in newly released guideline · checked 2026-10-07
stv1-daily-r1-14 · agency guidance
The use of stevia leaf and crude stevia extracts is not considered GRAS, and their import into the U.S. is not permitted for use as sweeteners.
U.S. Food and Drug Administration, Aspartame and Other Sweeteners in Food · checked 2026-09-29
stv1-daily-r1-17 · position statement
Seven NNS are approved for use in the United States: acesulfame K, aspartame, luo han guo fruit extract, neotame, saccharin, stevia, and sucralose. ... All NNS approved for use in the United States are determined to be safe.
J Acad Nutr Diet, 2012 · checked 2026-09-29
ev-stgut-08 · systematic review
Polyols can induce dose-dependent symptoms of flatulence, abdominal discomfort, and laxative effects when consumed by both healthy volunteers and patients with IBS.
Adv Nutr, 2017 · checked 2026-10-07
ev-stgut-11 · agency opinion
The Panel concluded that there is insufficient justification to increase the current ADI for steviol glycosides (E960a–d) of 4 mg/kg bw per day (expressed as steviol equivalents).
EFSA FAF Panel, Scientific opinion on steviol glycosides (E 960a-d) and the ADI for steviol, EFSA Journal 2024;22(11):e9045 · checked 2026-10-07
ev-stpg-02 · meta-analysis
Any LCS consumption during pregnancy compared with no consumption was not associated with birth weight [SMD (95% CI) = 0.03 (-0.03, 0.08)] (four cohort studies).
Maternal & Child Nutrition, 2025 · checked 2026-10-07
ev-stpg-09 · prospective cohort
Compared with no consumption, daily consumption of artificially sweetened beverages was associated with a 0.20-unit increase in infant BMI z score (adjusted 95% CI, 0.02-0.38) and a 2-fold higher risk of infant overweight at 1 year of age (adjusted odds ratio, 2.19; 95% CI, 1.23-3.88).
JAMA Pediatr, 2016 · checked 2026-10-07
ev-stpg-10 · cohort
The adjusted model showed a significant association between the consumption of any NNS and sucralose and the risk of GDM (OR for any NNS = 1.58; 95% CI: 1.10-2.26; P = 0.014; OR sucralose = 1.44; 95% CI 1.06-1.95; P = 0.020).
Nutrition, 2024 · checked 2026-10-07
ev-stpg-13 · cross-sectional study
While no significant associations were observed between infants' LCS exposure and BMI-for-age or risk of overweight, infants' LCS exposure was associated with a 2.78-fold increased risk of vomiting (95% confidence interval 1.05-7.34).
Nutrients, 2021 · checked 2026-10-07
ev-stpg-14 · prospective cohort
We found increased odds of overweight in 7-, 11-, 14- and 18-year-old offspring whose mothers reported drinking ≥ 1 artificially sweetened beverage daily during pregnancy compared with no consumption (18 years: adjusted OR 1·26 (95 % CI 1·12, 1·42)).
Br J Nutr, 2025 · checked 2026-10-07
stv1-daily-r1-11 · randomized crossover trial
Compared to control, stevioside reduced the incremental area under the glucose response curve by 18% (P =.013).
Metabolism, 2004 · checked 2026-09-29
stv1-daily-r1-15 · cross-sectional study
The most consumed sweetener was sucralose (95.6%), followed by acesulfame k (80.6%), stevia (78.3%), aspartame (75.1%), saccharin (14.8%), and cyclamate (10%). ... However, except stevia, which reached 12%, average values were under 5% of the acceptable daily intake. No pregnant woman in the sample exceeded the acceptable daily intake
Nutr Hosp, 2019 · checked 2026-09-29
stv1-daily-r1-16 · prospective cohort
Aspartame and added sugars were dose-dependently associated with increased pediatric hypertension risk (aspartame: OR = 1.69, 95%CI:1.03-2.75; p = 0.04; added sugar: OR = 2.63, 95%CI:1.50-4.60; p < 0.001), while steviol glycosides showed borderline protective effects (p for trend = 0.05).
Clin Nutr, 2025 · checked 2026-09-29
ev-stgut-06 · systematic review
There is minimal data (and no human data) on the effect of AS on GI symptoms, stool form, GI histology, and alterations in the anatomy of the GI tract.
Journal of Neurogastroenterology and Motility, 2016, 22(2):168-180 · checked 2026-10-07
ev-stpg-03 · agency guideline
No RCTs in pregnant women were identified.
WHO, 2023, Use of non-sugar sweeteners: WHO guideline · checked 2026-10-07
ev-stpg-08 · prospective cohort
A high intake of AS beverages was associated with preterm delivery; the adjusted OR for those drinking >1 serving/d was 1.11 (95% CI: 1.00, 1.24). Drinking >1 serving of SS beverages per day was also associated with an increased risk of preterm delivery (adjusted OR: 1.25; 95% CI: 1.08, 1.45).
Am J Clin Nutr, 2012 · checked 2026-10-07
ev-stpg-12 · animal study
Female rats were exposed to RebA (4 mg steviol equivalents/kg body weight/day) in the drinking water from 4 weeks before mating until weaning. ... This work suggests that this RebA dose is safe for female consumption during the reproductive stage, from a cardiometabolic perspective. However, studies on the effects of RebA exposure on the offspring are mandatory.
Biology (Basel), 2024 · checked 2026-10-07
stv1-daily-r1-01 · network meta-analysis
Thirty-six trials involving 472 predominantly healthy participants were included. ... In uncoupling interventions, NNS beverages (single or blends) had no effect on postprandial glucose, insulin, GLP-1, GIP, PYY, ghrelin, and glucagon responses similar to water controls (generally, low to moderate confidence), whereas SSBs sweetened with caloric sugars (glucose and sucrose) increased postprandial glucose, insulin, GLP-1, and GIP responses with no differences in postprandial ghrelin and glucagon responses (generally, low to moderate confidence).
Nutrients, 2023 · checked 2026-09-29

Review. Reviewed on 2026-09-29 for evidence level, dose and population context, and claims a reader could misread. Bioma Learn has no human medical reviewer at this time, and we say so rather than invent one. Methodology. This is information, not medical advice.