What are natural sweeteners ?

What are Natural Sweeteners ?

First of all, we need to define what sweeteners are. Sweeteners are substances used to improve the palatability and shelf life of food products. Sweetness also balances bitterness, sourness, and saltiness. A preference for sweet taste is innate and sweeteners can increase the pleasure of eating.

Sweeteners can generally be divided into three types of sweeteners depending how there are made:

1. Natural Sweeteners come from plant origin e.g. sugar (sucrose), honey, molasses, maple syrup, coconut palm sugar, stevia, agave, brown sugar, fruit concentrates, Luo Han Guo (monk fruit) fruit extracts.
2. Artificial (synthetic) Sweeteners are man made high-intensity sweeteners e.g. Aspartame (NutraSweet® and Equal®); Acesulfame-K (Sweet One®); Neotame; Saccharin (Sweet’N Low®); Sucralose (Splenda®) and Advantame. Artificial sweeteners also known as sugar substitutes are called ‘high-intensity’ sweeteners, because small amounts pack a large punch when it comes to sweetness. Artificial sweeteners are regulated by the U.S. Food and Drug Administration (FDA) ¹. And because high-intensity sweeteners are many times sweeter than table sugar (sucrose), smaller amounts of high-intensity sweeteners are needed to achieve the same level of sweetness as sugar in food. People may choose to use high-intensity sweeteners in place of sugar for a number of reasons, including that they do not contribute calories or only contribute a few calories to the diet. High-intensity sweeteners also generally will not raise blood sugar levels ².
3. Sugar Alcohols (Polyols). Despite their name, sugar alcohols aren’t sugar, and they aren’t alcohol. They are carbohydrates that occur naturally in certain fruits and can also be manufactured. They get their name because they have a chemical structure similar to sugar and to alcohol. Examples of sugar alcohols, isomalt, maltitol, lactitol, trehalose, mannitol, erythritol, xylitol and D-tagatose.

To make it even more complicated, sweeteners can be further divided into two categories based on their calorie content:

• Nutritive sweeteners – those that contain more than 2 percent of the calories in an equivalent amount of sugar, therefore nutritive sweeteners add caloric value to the foods that contain them ³. For example, sugar (sucrose), honey, molasses, maple syrup, coconut palm sugar, agave, brown sugar, fruit concentrates, Xylitol, Sorbitol, isomalt, maltitol, lactitol, trehalose, mannitol, erythritol and D-tagatose.
• Non-nutritive sweeteners – since they offer no nutritional benefits such as vitamins and minerals and they are low or have no calories. Non-nutritive sweeteners are those that contain less than 2 percent of the calories in an equivalent amount of sugar or have no calories at all. Also known as artificial sweeteners, sugar substitutes, low-calorie sweeteners, noncaloric sweeteners, or high-intensity sweeteners ³. For example, Stevia, Luo Han Guo fruit extracts (Siraitia grosvenorii Swingle fruit extract), Aspartame (NutraSweet® and Equal®); Acesulfame-K (Sweet One®); Neotame; Saccharin (Sweet’N Low®); Sucralose (Splenda®) and Advantame. Food products are considered “no-calorie” if they have 5 calories or less per serving. Notice that even though the nutrition labels on sweetener packets claim to have zero calories and carbohydrate, there are a small amount calories and carbs from those added ingredients ³.

Table 1. Natural Sweetening Agents

[Source: ⁴]

Replacing sugary foods and drinks with sugar-free options containing non-nutritive sweeteners is one way to limit calories and achieve or maintain a healthy weight ⁵. Also, when used to replace food and drinks with added sugars, it can help people with diabetes manage blood glucose levels. For example, swapping a full-calorie soda with diet soda is one way of not increasing blood glucose levels while satisfying a sweet tooth.

We don’t know for sure if using non-nutritive sweeteners in food and drinks makes people actually eat or drink fewer calories every day. But reducing the amount of added sugar in your diet ? That we know for sure is a good thing.

According to the American Academy of Nutrition and Dietetics, consumers can safely enjoy a range of nutritive sweeteners and non-nutritive sweeteners when consumed within an eating plan that is guided by current federal nutrition recommendations, such as the Dietary Guidelines for Americans and the Dietary Reference Intakes, as well as individual health goals and personal preference ⁶. The Dietary Guidelines for Americans, recommends sugars are to be consumed in moderation, with calories from sugar making up no more than 10 percent of their total calorie intake. For example, 10 percent of 1800 calories per day is 180 calories from added sugars ⁷. The American Heart Association recommends that most women eat no more than 6 teaspoons or 100 calories a day of added sugar and men no more than 9 teaspoons or 150 calories a day of added sugar. Added sugars include any sugars or caloric sweeteners that are added to foods or beverages during processing or preparation (such as putting sugar in your coffee or adding sugar to your cereal). Added sugars (or added sweeteners) can include natural sugars such as white sugar, brown sugar and honey as well as other caloric sweeteners that are chemically manufactured (such as high fructose corn syrup). This recommendation is based on research that showed diets high in added sugars increase risk factors, such as obesity and triglycerides, for coronary heart disease. Additionally, foods and beverages high in added sugars tend to displace nutritious foods and are generally high in calories and low in nutritional value. Limiting intake of added sugars can help reduce calorie intake and can help people achieve or maintain a healthy body weight ⁸.

Nutritive sweeteners contain carbohydrate and provide energy. They occur naturally in foods or may be added in food processing or by consumers before consumption. Higher intake of added sugars is associated with higher energy intake and lower diet quality, which can increase the risk for obesity, pre-diabetes, type 2 diabetes and cardiovascular disease. On average, adults in the United States consume 14.6% of energy from added sugars. Polyols (also referred to as sugar alcohols) add sweetness with less energy and may reduce risk for dental caries. Foods containing polyols and/or no added sugars can, within food labeling guidelines, be labeled as sugar-free ⁶.

Non-nutritive sweeteners are those that sweeten with minimal or no carbohydrate or energy. They are regulated by the Food and Drug Administration as food additives or generally recognized as safe. The Food and Drug Administration approval process includes determination of probable intake, cumulative effect from all uses, and toxicology studies in animals. Seven non-nutritive sweeteners are approved for use in the United States: acesulfame K, aspartame, luo han guo fruit extract, neotame, saccharin, stevia, and sucralose. They have different functional properties that may affect perceived taste or use in different food applications. All non-nutritive sweeteners approved for use in the United States are determined to be safe ⁶.

Keep in mind that just because a product is “sugar free,” it doesn’t always mean that it’s healthy. Foods and beverages that contain non-nutritive sweeteners can be included in a healthy diet, as long as the calories they save you are not added back by adding more foods as a reward later in the day, adding back calories that take you over your daily limit. The current meta-analysis ⁹ provides a rigorous evaluation of the scientific evidence on low-calorie sweeteners and body weight and composition. Findings from observational studies showed no association between low-calorie sweeteners intake and body weight or fat mass and a small positive association with body mass index (BMI); however, data from randomised clinical trials, which provide the highest quality of evidence for examining the potentially causal effects of low-calorie sweeteners intake, indicate that substituting low-calorie sweeteners options for their regular-calorie versions results in a modest weight loss and may be a useful dietary tool to improve compliance with weight loss or weight maintenance plans ⁹.

However, in a recent (published 17 July 2017) systematic review and meta-analysis of randomized controlled trials and prospective cohort studies on the effects of non-nutritive sweeteners (artificial sweeteners) and cardio-metabolic health being conducted by Dr. Azad et al. ¹⁰ found that non-nutritive sweeteners (artificial sweeteners) had no significant effect on BMI (body mass index) on participants, in fact in the included cohort studies, consumption of non-nutritive sweeteners was associated with a modest increase in BMI. In the cohort studies, consumption of non-nutritive sweeteners was associated with increases in weight and waist circumference, and higher incidence of obesity, hypertension, metabolic syndrome, type 2 diabetes and cardiovascular events ¹⁰. Theories about why artificial sweeteners might not help weight loss tend to revolve around two schools of thought, Dr. Azad said. One school holds that the sweeteners might influence dieters’ behavior in unhealthy ways. For example, a person drinking a no-calorie soda might feel free to eat calorie-laden foods, Azad noted. Artificial sweeteners also might sharpen the person’s sweet tooth, making them more likely to indulge in sugary foods. The other school holds that artificial sweeteners might influence the body itself in some as-yet-unknown way, Azad said. The artificial sweeteners could alter the way that gut microbes function in the digestion of food, or possibly change the body’s metabolism over time by sending repeated false signals that something sweet has been ingested ¹¹. Another plausible explanation for why the study subjects gained weight and have higher incidence of obesity, hypertension, metabolic syndrome, type 2 diabetes and cardiovascular events, is that the study population involved people who are already overweight, obese, have metabolic syndrome, hypertension or suffer from type 2 diabetes ¹¹.

Natural Sweeteners List

When choosing the best natural sweetener one needs to consider calories, effect on blood sugar, effect on dental hygiene, beneficial effects, taste, price and usefulness in cooking.

The common natural sweeteners are:

• White sugar
• Brown sugar
• Raw sugar
• Powdered sugar
• Agave nectar
• Barley malt
• Brown rice syrup
• Corn syrup
• Corn syrup solids
• High-fructose corn syrup
• Invert sugar
• Dextrose
• Anhydrous dextrose
• Crystal dextrose
• Dextrin
• Evaporated cane juice
• Fructose sweetener
• Liquid fructose
• Glucose
• Lactose
• Honey
• Malt syrup
• Maltose
• Maple syrup
• Molasses
• Pancake syrup
• Stevia
• Monk Fruit (Nectresse and Luo Han Guo)
• Sucrose
• Syrup
• Trehalose
• Turbinado sugar

All of these contain calories with the exception of Stevia and Lou Han Gou (Monk Fruit) extracts.

Table 2. 100% Natural O Calorie Sweetener, Monk Fruit & Stevia Blend

[Source: United States Department of Agriculture, Agriculture Research Service. USDA Food Composition Databases. ¹²]

Stevia

Stevia (Truvia, Pure Via, Sun Crystals, Rebaudioside A, Reb A, rebiana) is a non-caloric plant-based sweetener; made from the plant Stevia rebaudiana, which is grown for its sweet leaves; common names include sweetleaf, sweet leaf, sugarleaf, or simply stevia ¹³. In addition to stevioside several other sweet principles such as steviosides A and B, Steviobioside, Rebaudioside A, B, C, D, E
and Dulcoside A were isolated from Stevia rebaudiana leaf ¹⁴. FDA approved as generally recognized as safe (GRAS) as a food additive and table top sweetener only certain high purity steviol glycosides purified from the leaves of Stevia rebaudiana (Bertoni). Stevia is 150 to 200 times sweeter than sucrose (table sugar) ¹⁵.

Stevia (Stevia rebaudiana) is a bushy shrub that is native to northeast Paraguay, Brazil and Argentina ¹⁶. It is now grown in other parts of the world, including Canada and part of Asia and Europe. It is probably best known as a source of natural sweeteners.

Extracts from the stevia leaves are available as sweeteners in Japan, South Korea, Malaysia, Taiwan, Russia, Israel, Mexico, Paraguay, Uruguay, Venezuela, Colombia, Brazil, and Argentina ¹⁷.

Some people take stevia by mouth for medical purposes such as lowering blood pressure, treating diabetes, heartburn, high uric acid levels in the blood, for weight loss, to stimulate the heart rate, and for water retention.

Studies on the glycemic effect of rebaudioside A is still not clear, but it seems that consumption of rebaudioside A did not worsen glycemic control in individuals with and without diabetes ¹⁸.

So how effective is Stevia when used for medical purposes ?

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale:

• Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for STEVIA are as follows:

Insufficient evidence ¹⁹ to rate Stevia effectiveness for:

• Diabetes. Research on how stevia might affect blood sugar in people with diabetes is inconsistent. Some early research suggests that taking 1000 mg daily of stevia leaf extract containing 91% stevioside might reduce blood sugar levels after meals by 18% in people with type 2 diabetes. However, other research shows that taking 250 mg of stevioside three times daily does not decrease blood sugar levels or HbA1c (a measure over blood sugar levels over time) after three months of treatment.
• High blood pressure. How stevia might affect blood pressure is unclear. Some research suggests that taking 750-1500 mg of stevioside, a chemical compound in stevia, daily reduces systolic blood pressure (the upper number in a blood pressure reading) by 10-14 mmHg and diastolic blood pressure (the lower number) by 6-14 mmHg. However, other research suggests that taking stevioside does not reduce blood pressure.
• Heart problems.
• Heartburn.
• Weight loss.
• Water retention.
• Other conditions.

More evidence is needed to rate the effectiveness of stevia for these uses ¹⁹.

Is Stevia safe ?

The appropriate dose of stevia depends on several factors such as the user’s age, health, and several other conditions. At this time there is not enough scientific information to determine an appropriate range of doses for stevia. Keep in mind that natural products are not always necessarily safe and dosages can be important. Be sure to follow relevant directions on product labels and consult your pharmacist or physician or other healthcare professional before using.

Stevia and chemicals contained in stevia, including stevioside and rebaudioside A, are LIKELY SAFE when taken by mouth as a sweetener in foods ¹⁹. The U.S. Food and Drug Administration (FDA) has given the generally recognized as safe (GRAS) status for Rebaudioside A in the U.S. for use as a sweetener for foods ²⁰. Stevioside has been safely used in research in doses of up to 1500 mg daily for 2 years.

In March 2010, the European Food Safety Authority (EFSA) concluded that the stevia sweeteners are not carcinogenic, genotoxic or associated with any reproductive/developmental toxicity and established an Acceptable Daily Intake (ADI) of 4 mg/kg body weight/day. Conservative estimates of steviol glycosides exposure, both in adults and in children, suggest that it is likely that the ADI would be exceeded at the maximum proposed use levels. The use of Stevia is now authorised in the European Union at appropriate levels for 31 different food categories including soft drinks, desserts, confectionary and table top sweeteners ²¹.

Some people who take stevia or stevioside can experience bloating or nausea. Other people have reported feelings of dizziness, muscle pain, and numbness.

Special precautions & warnings:

• Pregnancy and breast-feeding: There is not enough reliable information about the safety of taking stevia if you are pregnant or breast feeding. Stay on the safe side and avoid use.

• Allergy to ragweed and related plants: Stevia is in the Asteraceae/Compositae plant family. This family includes ragweed, chrysanthemums, marigolds, daisies, and many other plants. In theory, people who are sensitive to ragweed and related plants may also be sensitive to stevia.

• Diabetes: Some developing research suggests that some of the chemicals contained in stevia might lower blood sugar levels and could interfere with blood sugar control. However, other research disagrees. If you have diabetes and take stevia or any of the sweeteners it contains, monitor your blood sugar closely and report your findings to your healthcare provider.

• Low blood pressure: There is some evidence, though not conclusive, that some of the chemicals in stevia can lower blood pressure. There is a concern that these chemicals might cause blood pressure to drop too low in people who have low blood pressure. Get your healthcare provider’s advice before taking stevia or the sweeteners it contains, if you have low blood pressure.

• Lithium: Stevia might have an effect like a water pill or “diuretic.” Taking stevia might decrease how well the body gets rid of lithium. In theory, this could increase how much lithium is in the body and result in serious side effects. Talk with your healthcare provider before using this product if you are taking lithium. Your lithium dose might need to be changed ¹⁹.

• Medications for diabetes (Antidiabetes drugs): Some research shows that stevia might decrease blood sugar in people with type 2 diabetes. In theory, stevia might cause an interaction with diabetes medications resulting in blood sugar levels going too low; however, not all research has found that stevia lowers blood sugar. Therefore, it is not clear if this potential interaction is a big concern. Until more is known, monitor your blood sugar closely if you take stevia. Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others. The dose of your diabetes medication might need to be changed ¹⁹.
• Medications for high blood pressure (Antihypertensive drugs): Some research shows that stevia might decrease blood pressure. In theory, taking stevia along with medications used for lowering high blood pressure might cause your blood pressure to go too low. However, some research shows that stevia does not affect blood pressure. Therefore, it’s not known if this potential interaction is a big concern. Some medications for high blood pressure include captopril (Capoten), enalapril (Vasotec), losartan (Cozaar), valsartan (Diovan), diltiazem (Cardizem), Amlodipine (Norvasc), hydrochlorothiazide (HydroDiuril), furosemide (Lasix), and many others ¹⁹.
• Herbs and supplements that might lower blood pressure: Stevia might lower blood pressure. Using it along with other herbs and supplements that have this same effect might increase the risk of blood pressure dropping too low in some people. Some of these products include andrographis, casein peptides, cat’s claw, coenzyme Q-10, fish oil, L-arginine, lycium, stinging nettle, theanine, and others ¹⁹.

• Herbs and supplements that might lower blood sugar: Stevia might lower blood sugar. Using it along with other herbs and supplements that have the same effect might cause blood sugar to drop too low in some people. Some of these products include alpha-lipoic acid, bitter melon, chromium, devil’s claw, fenugreek, garlic, guar gum, horse chestnut seed, Panax ginseng, psyllium, Siberian ginseng, and others ¹⁹.

Monk Fruit or Lou Han Guo Extracts

Monk Fruit (Nectresse and Luo Han Guo) also known as Siraitia grosvenori Swingle, has been used in China for centuries as a natural sweetening agent and has been reported to be beneficial for diabetic population ²², ²³. However, limited research has been conducted to elucidate the relationship between the sweetening action and biological parameters that may be related to potential health benefits of Luo Han Kuo fruit. The present study ²² examined the effect of LHK fruit and its chemical components on insulin secretion using an in vitro cell model system. Mogroside V is the most abundant and the sweetest chemical component among the mogrosides in Luo Han Kuo fruit. The experimental data demonstrated that the crude Luo Han Kuo fruit extract stimulated the secretion of insulin in pancreatic beta cells; furthermore, pure mogroside V isolated from Luo Han Kuo fruit also exhibited a significant activity in stimulating insulin secretion by the beta cells, which could partially be responsible for the insulin secretion activity of Luo Han Kuo fruit and fruit extract. The current study supports that Luo Han Kuo fruit/extract has the potential to be natural sweetener with a low glycemic index and that mogroside V, possible other related mogrosides, can provide a positive health impact on stimulating insulin secretion ²².

Luohanguo is collected as a round green fruit that turns brown upon drying. The sweet taste of the fruit comes mainly from mogrosides, a group of triterpene glycosides that make up about 1% of the flesh of the fresh fruit ²⁴. The mogrosides have been numbered 1-5 ²⁵ and the main component is called mogroside-5, previously known as esgoside. Other, similar compounds from luohanguo have been labeled siamenoside and neomogroside ²⁴. The mixed mogrosides are estimated to be about 300 times as sweet as sugar by weight, so that the 80% extracts are nearly 250 times sweeter than sugar; pure mogrosides 4 and 5 may be 400 times as sweet as sugar by weight ²⁴. Through solvent extraction, a powder containing 80% mogrosides can be obtained, the main one being mogroside-5 (esgoside). Other similar agents in the fruit are siamenoside and neomogroside ²⁴. The powdered extract of monk (Luo Han Kuo fruit) fruit, a round green melon that grows in central Asia; 150 to 200 times sweeter than sucrose (table sugar); heat stable and can be used in baking and cooking and is more concentrated than sugar (¼ teaspoon or 0.5 grams equals the sweetness of 1 teaspoon or 2.5 grams sugar). FDA approved as generally recognized as safe (GRAS) as a food additive and table top sweetener.

Natural Sweeteners for Diabetics

Non-nutritive or artificial sweeteners are not actually needed to help manage diabetes. People with diabetes can still use regular sugar to sweeten foods and beverages, as long as it is used in small amounts and generally eaten as part of a healthy meal. An example of this might be one teaspoon of sugar sprinkled over a hot bowl of plain rolled oats or a thin spread of regular jam on some grainy toast. This is the same advice that would be given to someone who does not have diabetes, as large amounts of added sugar is not good for anyone, regardless of whether or not they have diabetes.

• Stevia: This leafy herb also known as honey leaf has been used for centuries by native South Americans. The extract from stevia is approximately 100 to 300 times sweeter than white sugar. It can be used in cooking, baking and as a sugar substitute in most beverages. Stevia has been shown to have a positive effect on blood sugar levels by increasing insulin production, and decreasing insulin resistance.

Natural Sweeteners for Coffee

Choose any form of natural sweetener that you like or that suits your coffee or meal the best. Just use them in small amounts to reduce the impact on your blood glucose levels and weight. Apart from sugar, honey, coconut sugar, yacon syrup, maple syrup and blackstrap molasses, that contain calories, you may want to consider the low to zero calorie natural sweeteners:

• Erythritol: Erythritol is a naturally occurring sugar alcohol found in fruit and fermented foods. Erythritol has 0.2 calories per gram (0.8 calories per teaspoon) and 60% to 80% as sweet as sugar. Erythritol does not result in as much of a rise in blood sugar after meals or cause tooth decay. Unlike other sugar alcohols, it does not cause stomach upset. This sugar alcohol is a sweetener available in a powdered form. It is formed from the breaking down, fermenting, and filtering of sugar cane or corn starch. It has a cool taste that works well in coffee and tea.

• Xylitol: Xylitol has 2.4 calories per gram and the same sweetness as sugar Sugar alcohols like Xylitol (when consumed in large amounts) can cause abdominal pain, gas/bloating and diarrhea as common side effects. Other gastric symptoms may also occur in some people, especially in children.

Natural Sweeteners for Tea

Again choose any form of natural sweetener that you like or that suits your coffee or meal the best. Just use them in small amounts to reduce the impact on your blood glucose levels and weight. Apart from sugar, honey, coconut sugar, yacon syrup, maple syrup and blackstrap molasses, that contain calories, you may want to consider the low to zero calorie natural sweeteners:

• Erythritol: Erythritol is a naturally occurring sugar alcohol found in fruit and fermented foods. Erythritol has 0.2 calories per gram (0.8 calories per teaspoon) and 60% to 80% as sweet as sugar. Erythritol does not result in as much of a rise in blood sugar after meals or cause tooth decay. Unlike other sugar alcohols, it does not cause stomach upset. This sugar alcohol is a sweetener available in a powdered form. It is formed from the breaking down, fermenting, and filtering of sugar cane or corn starch. It has a cool taste that works well in coffee and tea.

1. U.S. Food and Drug Administration. Additional Information about High-Intensity Sweeteners Permitted for use in Food in the United States. https://www.fda.gov/food/ingredientspackaginglabeling/foodadditivesingredients/ucm397725.htm[↩]
2. U.S. Food and Drug Administration. High-Intensity Sweeteners. https://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm397716.htm[↩]
3. American Diabetes Association. 5 Must-Know Facts About Sweeteners. http://www.diabetesforecast.org/2016/jan-feb/5-must-know-facts-about-sweeteners.html[↩][↩][↩]
4. ResearchGate. Natural sweeteners: A complete review. https://www.researchgate.net/publication/265163543_Natural_sweeteners_A_complete_review[↩]
5. American Heart Association. Non-Nutritive Sweeteners (Artificial Sweeteners). http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Non-Nutritive-Sweeteners-Artificial-Sweeteners_UCM_305880_Article.jsp[↩]
6. Fitch C, Keim KS; Academy of Nutrition and Dietetics.J Acad Nutr Diet. 2012 May;112(5):739-58. doi: 10.1016/j.jand.2012.03.009. Epub 2012 Apr 25. Position of the Academy of Nutrition and Dietetics: use of nutritive and nonnutritive sweeteners. https://www.ncbi.nlm.nih.gov/pubmed/22709780/[↩][↩][↩]
7. 2015–2020 Dietary Guidelines for Americans. https://health.gov/dietaryguidelines[↩]
8. American Heart Association. Added Sugars Add to Your Risk of Dying from Heart Disease. http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/Added-Sugars-Add-to-Your-Risk-of-Dying-from-Heart-Disease_UCM_460319_Article.jsp[↩]
9. Miller PE, Perez V. Low-calorie sweeteners and body weight and composition: a meta-analysis of randomized controlled trials and prospective cohort studies. The American Journal of Clinical Nutrition. 2014;100(3):765-777. doi:10.3945/ajcn.113.082826. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4135487/[↩][↩]
10. Azad MB, Abou-Setta AM, Chauhan BF, et al. Nonnutritive sweeteners and cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials and prospective cohort studies. CMAJ : Canadian Medical Association Journal. 2017;189(28):E929-E939. doi:10.1503/cmaj.161390. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5515645/[↩][↩]
11. U.S. National Library of Medicine. Medline Plus. Could Artificial Sweeteners Raise Your Odds for Obesity ?. https://medlineplus.gov/news/fullstory_167249.html[↩][↩]
12. United States Department of Agriculture, Agriculture Research Service. USDA Food Composition Databases. https://ndb.nal.usda.gov/ndb/[↩]
13. Lemus-Mondaca R, Vega-Galvez A, Zura-Bravo L, Ah-Hen K. Stevia rebaudiana Bertoni, source of a high-potency natural sweetener: A comprehensive review on the biochemical, nutritional and functional aspects. Food Chem. 2012;132:1121-1132. [↩]
14. Jaroslav Pol, Batbora Hohnova, Tuulia Hyptylainen, Characterisation of Stevis rebaudiana by comphrehensive two-dimensional liquid chromatography time-of–flight mass spectroscopy, Journal of chromatography, 1150, 2007, 85-92.[↩]
15. Yadav, A. A review on the improvement of stevia [Stevia rebaudiana (Bertoni). Canadian Journal of Plant Science 2011;91:1-27.[↩]
16. Chaturvedula, V. S. and Prakash, I. Structures of the novel diterpene glycosides from Stevia rebaudiana. Carbohydr.Res 6-1-2011;346:1057-1060. https://www.ncbi.nlm.nih.gov/pubmed/21489412?dopt=Abstract[↩]
17. Li, J., Jiang, H., and Shi, R. A new acylated quercetin glycoside from the leaves of Stevia rebaudiana Bertoni. Nat.Prod Res 2009;23:1378-1383. https://www.ncbi.nlm.nih.gov/pubmed/19809909?dopt=Abstract[↩]
18. Shin DH, Lee JH, Kang MS, et al. Glycemic Effects of Rebaudioside A and Erythritol in People with Glucose Intolerance. Diabetes & Metabolism Journal. 2016;40(4):283-289. doi:10.4093/dmj.2016.40.4.283. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4995183/[↩]
19. U.S. National Library of Medicine. Medline Plus. Stevia. https://medlineplus.gov/druginfo/natural/682.html[↩][↩][↩][↩][↩][↩][↩][↩]
20. U.S. Food and Drug Administration. Has Stevia been approved by FDA to be used as a sweetener ? https://www.fda.gov/aboutfda/transparency/basics/ucm194320.htm[↩]
21. European Union. Questions and Answers on Food Additives. http://europa.eu/rapid/press-release_MEMO-11-783_en.htm[↩]
22. Zhou Y, Zheng Y, Ebersole J, Huang CF. Yao Xue Xue Bao. 2009 Nov;44(11):1252-7. Insulin secretion stimulating effects of mogroside V and fruit extract of luo han kuo (Siraitia grosvenori Swingle) fruit extract. https://www.ncbi.nlm.nih.gov/pubmed/21351724[↩][↩][↩]
23. Suzuki YA, Tomoda M, Murata Y, Inui H, Sugiura M, Nakano Y. Br J Nutr. 2007 Apr;97(4):770-5. Antidiabetic effect of long-term supplementation with Siraitia grosvenori on the spontaneously diabetic Goto-Kakizaki rat. https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/antidiabetic-effect-of-longterm-supplementation-with-siraitia-grosvenori-on-the-spontaneously-diabetic-gotokakizaki-rat/FC59DC2955AA96A75154985DAE6809E6[↩]
24. Institute for Traditional Medicine. LUO HAN GUO. http://www.itmonline.org/arts/luohanguo.htm[↩][↩][↩][↩]
25. Chaturvedula VSP, Prakash I. Kaempferol glycosides from Siraitia grosvenorii. J. Chem. Pharm. Resi. 2011;3:799–804.[↩]