Stevia comes in several forms, but the Food and Drug Administration has not approved it for use as a sweetener in the United States.
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Folks with a sweet tooth face a common dilemma. They want to eat more healthfully without giving up the taste of sugary desserts and drinks.
That means making sense of sugar alternatives. Artificial sweeteners like Splenda, Sweet'N Low and NutraSweet are pretty familiar, but what about the sweet substances found in health food stores, such as xylitol, stevia or agave nectar? Are they really better for you?
Sugar alternatives are popular among dieters, but they are also important for people with diabetes who must monitor foods' impact on their blood sugar levels.
When ingested, sugar and other carbohydrates cause blood sugar levels to rise. This means there's more glucose - a type of sugar that fuels the body's cells - in the bloodstream. The glucose triggers the release of insulin, a hormone that enables cells to take in glucose.
Problems occur when the body doesn't process glucose properly. Diabetics are plagued by high blood sugar levels caused by insufficient insulin or insulin resistance - a state in which the body produces enough insulin, but the cells don't respond well to it.
The opposite problem - low blood sugar, or hypoglycemia - is caused when your body doesn't have enough glucose or when your pancreas produces too much insulin. Depending on the severity of hypoglycemia, symptoms can include heart palpitations, dizziness, mood swings, headaches, depression and extreme fatigue.
Stevia, agave nectar - also called agave syrup - and xylitol can address some of these problems, but none of them is a perfect substitute. Here's a closer look at the three.
The naturally sweet leaves of Stevia rebaudiana, a plant cultivated in South America and Asia, have been used for centuries as a sweetener in various countries. But not so in the United States, where the Food and Drug Administration calls it a dietary supplement. "I don't know a lot of people that use it," says Jen Reardon, a registered dietitian with the Cornell Cooperative Extension of Genesee County in Batavia. "The Equals and the Splendas have really got a grip on the market. But as far as I know, stevia is safe."
Trish Kazacos, a corporate nutritionist at Wegmans Food Markets, warns that users should still be aware that stevia is not approved by the FDA as a sweetener, so it has not been tested as thoroughly as other sugar substitutes.
Stevia comes in the form of white powder, yellowish liquid, whole leaf or ground-up leaves. In its pure form, it contains no calories and no carbohydrates, and it won't raise blood sugar levels. Just check the packaging to make sure your stevia isn't mixed with other sugars.
Stevia, which is up to 300 times sweeter than sugar, works best in drinks and desserts such as puddings and pie fillings, says Ania Catalano, author of Baking With Agave Nectar: 80 Recipes Using Nature's Ultimate Sweetener (Celestial Arts, $15.95). It won't lend cookies, muffins or cakes the proper texture.
This nectar, a thin, honeylike substance harvested from agave plants, is noted for its low glycemic index - an indication that it may affect blood sugar levels less than sugar.
The glycemic index ranks carbohydrates by their effect on blood glucose levels. Foods with a higher glycemic index raise blood sugar more quickly than foods with a lower glycemic index.
Diabetes educators also don't advise eating too much agave syrup for two reasons. First, it contains 60 calories per tablespoon. And just because a substance has a low glycemic index doesn't mean that it automatically keeps blood sugar levels low. Blood sugar levels are affected by the amount of the substance eaten, its combination with other foods and the individual person's metabolism.
"You see within your own body how you respond," says Susan Hopper, a registered nurse and certified diabetes educator with Saint Agnes Medical Center in Fresno, Calif. She advises using the glycemic index as a guide.
This white powder looks very similar to sugar, but it's actually a sugar alcohol made from plants such as corn.
Humans can't process xylitol completely, which makes it low in calories and less of a problem for blood sugar levels. But there's a price to pay. Eating xylitol or other sugar alcohols can result in cramps and diarrhea and other digestive problems.
"They could be OK substitutes, but a lot of times when you take a lot of sugar alcohols, they won't settle people's stomachs very well," says Lisa Winghart, a registered dietitian in Webster who owns Winghart Nutrition and Fitness. "It's not a complete yes or no. Definitely use in moderation."
"The reason we have side effects is because we don't absorb all of it," says Michelle Carrick, a registered dietitian at Saint Agnes Medical Center. She follows the American Diabetes Association's advice for calculating carbohydrates of foods with sugar alcohols: Subtract half of the sugar alcohol grams from the grams of total carbohydrates.
Xylitol works well in liquids such as tea but not everything else. One brand, XyloSweet, lists xylitol's limitations on the package: "XyloSweet will not cause breads and pastries to rise and is not a good choice for hard candies since it will not crystallize with heating. Xylitol is not recommended for sweetening juices and instant beverages that require large amounts of sweetener."
No matter what sugar substitute you use, it's important not to use too much of it.
"When you're looking to substitute sugar, it doesn't mean an opening to overindulge," says Kazacos. "Artificial sweeteners cut calories down, but you still want to keep your portion sizes in check."
Includes reporting by staff writer Justina Wang and The Fresno Bee.