UNDERSTANDING THE BENEFITS OF STEVIA REBAUDIANA BERTONI FOR DIABETES: A COMPREHENSIVE REVIEW
DOI:
https://doi.org/10.22159/ijpps.2024v16i11.52382Keywords:
Stevia rebaudiana bertoni, Stevia, Natural sweetener, Zero-calorie sweetener, Stevioside, Rebaudioside a, DiabetesAbstract
Diabetes Mellitus (DM) is a complicated metabolic condition defined by long-term elevated blood glucose levels. This chronic hyperglycemia induces metabolic dysfunctions that cause structural and functional disruptions in the vasculature, leading to macrovascular and microvascular complications. Stevia rebaudiana Bertoni, commonly known as Stevia, is a perennial shrub that contains various bioactive constituents responsible for its sweetness and several other activities. Many studies on Stevia have shown that it possesses various beneficial effects on health, including being zero-calorie, anti-obesity, anti-diabetic, anti-hypertensive, antioxidant, antimicrobial and anti-tumor. Several studies have found that neither gastric juice nor digestive enzymes decompose stevioside. The presence of bioactive phenolic and flavonoid compounds supports Stevia's medicinal properties and its potential use in both the food/nutraceutical and pharmaceutical industries. A significant antioxidant capacity of Stevia has been identified recently. It can also help limit essential nutrient supply to tumor cells. Research on Stevia's effects on the human body has largely found no negative side effects. The growing body of evidence underscores Stevia's potential role in managing various health conditions, particularly for diabetic patients, due to its minimal impact on blood sugar levels. However, to fully harness its benefits and meet the increasing global demand, further scientific research is essential to optimize its cultivation, enhance its chemical constituents and ensure its safety. Overall, Stevia stands out as a promising natural sweetener with significant health benefits for diabetic patients. In this review article, we explore different aspects of Stevia and its beneficial effects on diabetic patients.
Downloads
References
Cole JB, Florez JC. Genetics of diabetes mellitus and diabetes complications. Nat Rev Nephrol. 2020 May 12;16(7):377-90. doi: 10.1038/s41581-020-0278-5.
Cho NH, Shaw JE, Karuranga S, Huang Y, DE Rocha Fernandes JD, Ohlrogge AW. IDF diabetes atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018 Apr;138:271-81. doi: 10.1016/j.diabres.2018.02.023, PMID 29496507.
Morrish NJ, Wang SL, Stevens LK, Fuller JH, Keen H. Mortality and causes of death in the WHO multinational study of vascular disease in diabetes. Diabetologia. 2001 Sep;44 Suppl 2:S14-21. doi: 10.1007/pl00002934, PMID 11587045.
DA Rocha Fernandes J, Ogurtsova K, Linnenkamp U, Guariguata L, Seuring T, Zhang P. IDF Diabetes atlas estimates of 2014 global health expenditures on diabetes. Diabetes Res Clin Pract. 2016 Jul;117:48-54. doi: 10.1016/j.diabres.2016.04.016, PMID 27329022.
Diagnosis and classification of diabetes mellitus. Diabetes Care. 2014;37 Suppl 1:S81-90. doi: 10.2337/dc14-S081.
Introduction: standards of medical care in diabetes 2018. Diabetes Care. 2018;41 Suppl 1:S1-2. doi: 10.2337/dc18-Sint01.
Jha DK, Koneri R, Samaddar S. Antidiabetic activity of phytosaponin in STZ-induced type I diabetes in rats. Res J Pharm Technol. 2019;12(8):3919. doi: 10.5958/0974-360X.2019.00675.9.
Sarkar S, Sadhu S, Roy R, Tarafdar S, Mukherjee N, Sil M. Contemporary drifts in diabetes management. Int J App Pharm. 2023 Mar 7;15(2):1-9. doi: 10.22159/ijap.2023v15i2.46792.
Suja Pandian R, Ramalingam M. Consequences of physical activity on the markers of glycemic status among type 2 diabetic subjects. Res J Pharm Technol. 2012 Nov;5(11):1413-6.
Shinde AD, Bhise SB. Optimization of pharmacokinetics by loading bioenhancer in optimized nasal mucoadhesive microspheres of insulin. Res J Pharm Technol. 2010 Apr;3(2):613-8.
Das AK, Ghosh D, Ghosh J. Assessment of patients knowledge attitude and practice regarding diabetes mellitus in a Tertiary Care Hospital in Eastern India. Asian J Pharm Clin Res. 2023 Jan 1;16(1):29-34. doi: 10.22159/ajpcr.2023.v16i1.46328.
Jaya MK, Swastini DA, Nopitasari BL, Editors. Putu rika veryanti. A case-control study on risk factors affecting peripheral neuropathic complications in elderly with type 2 diabetes mellitus. Res J Pharm Technol. 2021;14(8):4040-6.
Geetha P, Shanmugasundaram P. A prospective observational study on assessment of risk factor associated with diabetic retinopathy in patients diagnosed with type 2 diabetes mellitus in south indian population. Res J Pharm Technol. 2019;12(2):595. doi: 10.5958/0974-360X.2019.00106.9.
Hassan N, Shahwan M, Alkhoujah S, Jairoun A. Association between serum liver enzymes and metabolic syndrome among type 2 diabetes mellitus patients. Res J Pharm Technol. 2021;14(2):1050-4. doi: 10.5958/0974-360X.2021.00188.8.
Ahmad J, Khan I, Blundell R, Azzopardi J, Mahomoodally MF. Stevia rebaudiana bertoni: an updated review of its health benefits industrial applications and safety. Trends Food Sci Technol. 2020 Jun 1;100:177-89. doi: 10.1016/j.tifs.2020.04.030.
Patel S, Navale A. The natural sweetener stevia: an updated review on its phytochemistry health benefits and anti-diabetic study. Curr Diabetes Rev. 2024 Feb 1;20(2):26-36. doi: 10.2174/1573399819666230501210803.
Kamble K, Stevia KK. Stevia: alternative natural sugar for dairy industry. Just Agric. 2024 Feb;4(6):262-5.
Gupta E, Purwar S, Sundaram S, Rai GK. Nutritional and therapeutic values of Stevia rebaudiana: a review. J Med Plants Res. 2013 Nov;7(46):3343-53.
Masoumi SJ, Ranjbar S, Keshavarz V. The effectiveness of stevia in diabetes mellitus: a review. Int J Nutr Sci. 2020 Jun 1;5(2):45-9.
Goyal SK, Samsher N, Goyal RK. Stevia (Stevia rebaudiana) a bio-sweetener: a review. Int J Food Sci Nutr. 2010 Feb 1;61(1):1-10. doi: 10.3109/09637480903193049.
Ali A, Kant K, Gupta S, Kaur N, Jindal P, Naeem M. Enhancing nutritional and antidiabetic properties of Stevia rebaudiana bert. a sweet leaf plant through various scientific approaches. Antidiabetic Med Plants. 2024 Jan 1:229-53.
Tavarini S, Angelini LG. Stevia rebaudiana bertoni as a source of bioactive compounds: the effect of harvest time experimental site and crop age on steviol glycoside content and antioxidant properties. J Sci Food Agric. 2013 Jul;93(9):2121-9. doi: 10.1002/jsfa.6016, PMID 23303701.
Brahmachari G, Mandal LC, Roy R, Mondal S, Brahmachari AK. Stevioside and related compounds molecules of pharmaceutical promise: a critical overview. Arch Pharmazie. 2011 Jan;344(1):5-19. doi: 10.1002/ardp.201000181.
Talevi A. Beneficial effects of Stevia rebaudiana bertoni and steviol-related compounds on health. In: Sweeteners. 2018;263-84. doi: 10.1007/978-3-319-27027-2_24.
Momtazi Borojeni AA, Esmaeili SA, Abdollahi E, Sahebkar A. A review on the pharmacology and toxicology of steviol glycosides extracted from Stevia rebaudiana. Curr Pharm Des. 2017 Mar 1;23(11):1616-22. doi: 10.2174/1381612822666161021142835.
Joint FAO/WHO Expert Committee on Food Additives. Evaluation of certain food additives. World Health Organ Tech Rep Ser. 2006;934:1-145.
Jamuna P. Evaluation of certain food additives. Sixty-ninth report of the Joint FAO/WHO Expert Committee on Food Additives (JECFA). World Health Organ Tech Rep S. 2009;952:208. J Food Sci Technol. 2010;47(4):465–7. doi: 10.1007/s13197-010-0079-0.
Statista. Stevia industry statistics and facts. Available from: https://www.statista.com/topics/2304/steviaindustry.
Ahmad J, Khan I, Blundell R, Azzopardi J, Mahomoodally MF. Stevia rebaudiana bertoni: an updated review of its health benefits industrial applications and safety. Trends Food Sci Technol. 2020;100:177-89. doi: 10.1016/j.tifs.2020.04.030.
Koyama E, Kitazawa K, Ohori Y, Izawa O, Kakegawa K, Fujino A. In vitro metabolism of the glycosidic sweeteners stevia mixture and enzymatically modified stevia in human intestinal microflora. Food Chem Toxicol. 2003;41(3):359-74. doi: 10.1016/s0278-6915(02)00235-1, PMID 12504168.
Hutapea AM, Toskulkao C, Buddhasukh D, Wilairat P, Glinsukon T. Digestion of stevioside a natural sweetener by various digestive enzymes. J Clin Biochem Nutr. 1997;23(3):177-86. doi: 10.3164/jcbn.23.177.
Koyama E, Sakai N, Ohori Y, Kitazawa K, Izawa O, Kakegawa K. Absorption and metabolism of glycosidic sweeteners of stevia mixture and their aglycone steviol in rats and humans. Food Chem Toxicol. 2003;41(6):875-83. doi: 10.1016/S0278-6915(03)00039-5.
Geuns JM. Stevioside. Phytochemistry. 2003 Nov 1;64(5):913-21. doi: 10.1016/S0031-9422(03)00426-6.
Gardana C, Simonetti P, Canzi E, Zanchi R, Pietta P. Metabolism of stevioside and rebaudioside a from Stevia rebaudiana extracts by human microflora. J Agric Food Chem. 2003;51(22):6618-22. doi: 10.1021/jf0303619.
Geuns JM, Augustijns P, Mols R, Buyse JG, Driessen B. Metabolism of stevioside in pigs and intestinal absorption characteristics of stevioside rebaudioside a and steviol. Food Chem Toxicol. 2003;41(11):1599-607. doi: 10.1016/S0278-6915(03)00191-1.
Lemus Mondaca R, Ah-Hen K, Vega Galvez A, Honores C, Moraga NO. Stevia rebaudiana leaves: effect of drying process temperature on bioactive components antioxidant capacity and natural sweeteners. Plant Foods Hum Nutr. 2016;71(1):49-56. doi: 10.1007/s11130-015-0524-3, PMID 26650384.
Mohan SK, Veeraraghavan VP, Balakrishna JP, Rengasamy G, Rajeshkumar S. Antidiabetic activity of methanolic extract of Artabotrys suaveolens leaves in 3T3-L1 cell line. J Pure Appl Microbiol. 2020;14(1):573-80. doi: 10.22207/JPAM.14.1.59.
Konoshima T, Takasaki M. Cancer chemopreventive effects of natural sweeteners and related compounds. Pure Appl Chem. 2002;74(7):1309-16. doi: 10.1351/pac200274071309.
Debnath M. Clonal propagation and antimicrobial activity of an endemic medicinal plant Stevia rebaudiana. J Med Plants Res. 2008;2(2):45-51.
Pizzino G, Irrera N, Cucinotta M, Pallio G, Mannino F, Arcoraci V. Oxidative stress: harms and benefits for human health. Oxid Med Cell Longev. 2017;2017(1):8416763. doi: 10.1155/2017/8416763, PMID 28819546.
Das S, Vasisht S, Das S, Shrivastava N. Correlation between total antioxidant status and lipid peroxidation in hypercholesterolemia. Curr Sci. 2000;78(4):486-7.
Scioli MG, Storti G, D Amico F, Rodriguez Guzman R, Centofanti F, Doldo E. Oxidative stress and new pathogenetic mechanisms in endothelial dysfunction: potential diagnostic biomarkers and therapeutic targets. J Clin Med. 2020;9(6):1995. doi: 10.3390/jcm9061995, PMID 32630452.
Ali A, Shahu R, Balyan P, Kumari S, Ghodmare R, Jobby R. Antioxidation and antiglycation properties of a natural sweetener: Stevia rebaudiana. Sugar Tech. 2022;24(2):563-75. doi: 10.1007/s12355-021-01023-0.
Cho BO, Ryu HW, SO Y, Cho JK, Woo HS, Jin CH. Anti-inflammatory effect of austroinulin and 6-O-acetyl austroinulin from Stevia rebaudiana in lipopoly saccharide stimulated RAW264.7 macrophages. Food Chem Toxicol. 2013;62:638-44. doi: 10.1016/j.fct.2013.09.011.
Kim SY, JO MJ, Hwangbo M, Back YD, Jeong TY, Cho IJ. Anti-inflammatory effect of Stevia rebaudiana as a results of NF-κB and MAPK inhibition. The Journal of Korean Oriental Medical Ophthalmology and Otolaryngology and Dermatology. 2013;26(3):54-64. doi: 10.6114/jkood.2013.26.3.054.
CS, Rajeshkumar S, Lakshmi T, Roy A. Antidiabetic activity of Piper longum and Stevia herbal formulation. J Complement Med Res. 2022;13(2):29. doi: 10.5455/jcmr.2022.13.03.06.
Gregersen S, Jeppesen PB, Holst JJ, Hermansen K. Antihyperglycemic effects of stevioside in type 2 diabetic subjects. Metabolism. 2004;53(1):73-6. doi: 10.1016/j.metabol.2003.07.013.
Klein S, Gastaldelli A, Yki-Jarvinen H, Scherer PE. Why does obesity cause diabetes? Cell Metab. 2022;34(1):11-20. doi: 10.1016/j.cmet.2021.12.012, PMID 34986330.
Philippaert K, Pironet A, Mesuere M, Sones W, Vermeiren L, Kerselaers S. Steviol glycosides enhance pancreatic beta-cell function and taste sensation by potentiation of TRPM5 channel activity. Nat Commun. 2017;8(1):1-16. doi: 10.1038/ncomms14733.
Philippaert K, Pironet A, Mesuere M, Sones W, Vermeiren L, Kerselaers S. Steviol glycosides enhance pancreatic beta-cell function and taste sensation by potentiation of TRPM5 channel activity. Nat Commun. 2017;8(1):1-16. doi: 10.1038/ncomms14733.
Wang Z, Xue L, Guo C, Han B, Pan C, Zhao S. Stevioside ameliorates high fat diet induced insulin resistance and adipose tissue inflammation by downregulating the NF-κB pathway. Biochem Biophys Res Commun. 2012;417(4):1280-5. doi: 10.1016/j.bbrc.2011.12.130.
Anton SD, Martin CK, Han H, Coulon S, Cefalu WT, Geiselman P. Effects of stevia aspartame and sucrose on food intake satiety and postprandial glucose and insulin levels. Appetite. 2010;55(1):37-43. doi: 10.1016/j.appet.2010.03.009.
Sarowar H, Badrul AM, Muhammad A, Islam M, Monirul R. Antihyperglycemic and anti-hyperlipidemic effects of different fractions of Stevia rebaudiana leaves in alloxan induced diabetic rats. Int J Pharm Sci Res. 2011;2(7):1722-9.
Brijesh K, Kamath M. Experimental evaluation of anti-hyperglycemic and hypolipidemic effects of stevia rebaudiana Anacardium occidentale on wistar rats. Int J Basic Clin Pharmacol. 2016;5(6):2463-7.
Uswa A, Shabir AR, Sajid AM, Zarina M, Makhdoom S. Antihyperlipidemic efficacy of aqueous extract of Stevia rebaudiana Bertoni in albino rats. Lipids Health Dis. 2018 Jul 27;17(1):175. doi: 10.1186/s12944-018-0810-9.
Assaei R, Mokarram P, Dastghaib S, Darbandi S, Darbandi M, Zal F. Hypoglycemic effect of aquatic extract of stevia in pancreas of diabetic rats: PPAR gamma dependent regulation or antioxidant potential. Avicenna J Med Biotechnol. 2016;8(2):65-74. PMID 27141265.
Chan P, Tomlinson B, Chen YJ, Liu JC, Hsieh MH, Cheng JT. A double blind placebo controlled study of the effectiveness and tolerability of oral stevioside in human hypertension. Br J Clin Pharmacol. 2000;50(3):215-20. doi: 10.1046/j.1365-2125.2000.00260.x, PMID 10971305.
Barriocanal LA, Palacios M, Benitez G, Benitez S, Jimenez JT, Jimenez N. Apparent lack of pharmacological effect of steviol glycosides used as sweeteners in humans a pilot study of repeated exposures in some normotensive and hypotensive individuals and in type 1 and type 2 diabetics. Regul Toxicol Pharmacol. 2008;51(1):37-41. doi: 10.1016/j.yrtph.2008.02.006, PMID 18397817.
Prabavathy JV, Sangeetha R. An association between work stress and serum cortisol with the development of type 2 diabetes mellitus among industrial workers. Res J Pharm Technol. 2020;13(1):27-32. doi: 10.5958/0974-360X.2020.00005.0.
Prabavathy JV, Sangeetha R. Stress induced type 2 diabetes mellitus among industrial workers a review. Res J Pharm Technol. 2019;12(1):396-402. doi: 10.5958/0974-360X.2019.00072.6.
Iatridis N, Kougioumtzi A, Vlataki K, Papadaki S, Magklara A. Anti-cancer properties of stevia rebaudiana; more than a sweetener. Molecules. 2022;27(4):1362. doi: 10.3390/molecules27041362.
Kurek JM, Krejpcio Z. The functional and health promoting properties of Stevia rebaudiana bertoni and its glycosides with special focus on the antidiabetic potential a review. J Funct Foods. 2019;61:103465. doi: 10.1016/j.jff.2019.103465.
Singh SD, Rao GP. Stevia: the herbal sugar of 21st century. Sugar Tech. 2005;7(1):17-24. doi: 10.1007/BF02942413.
Mathur S, Bulchandan N, Parihar S, Shekhawat GS. Critical review on steviol glycosides: pharmacological toxicological and therapeutic aspects of high potency zero caloric sweetener. Int J Pharmacol. 2017;13(7):916-28. doi: 10.3923/ijp.2017.916.928.
Lohner S, Toews I, Meerpohl JJ. Health outcomes of non nutritive sweeteners: analysis of the research landscape. Nutr J. 2017;16(1):55. doi: 10.1186/s12937-017-0278-x.
Kujur RS, Singh V, Ram M, Yadava HN, Singh KK, Kumari S. Antidiabetic activity and phytochemical screening of crude extract of Stevia rebaudiana in alloxan induced diabetic rats. Pharmacognosy Res. 2010;2(4):258-63. doi: 10.4103/0974-8490.69128, PMID 21808578.
Nikiforov AI, Rihner MO, Eapen AK, Thomas JA. Metabolism and toxicity studies supporting the safety of rebaudioside D. Int J Toxicol. 2013;32(4):261-73. doi: 10.1177/1091581813492828, PMID 23766392.
Ucar A, Yılmaz S, Yılmaz S, Kılıc MS. A research on the genotoxicity of stevia in human lymphocytes. Drug Chem Toxicol. 2018;41(2):221-4. doi: 10.1080/01480545.2017.1349135, PMID 28738695.
Yodyingyuad V, Bunyawong S. Effect of stevioside on growth and reproduction. Hum Reprod. 1991;6(1):158-65. doi: 10.1093/oxfordjournals.humrep.a137251, PMID 1874950.
Usami M, Sakemi K, Kawashima K, Tsuda M, Ohno Y. Teratogenicity study of stevioside in rats. Eisei Shikenjo Hokoku. 1995;(113):31-5. PMID 8717225.
Carakostas MC, Curry LL, Boileau AC, Brusick DJ. Overview: the history technical function and safety of rebaudioside a naturally occurring steviol glycoside for use in food and beverages. Food Chem Toxicol. 2008;46(7):S1-S10. doi: 10.1016/j.fct.2008.05.003.
Published
How to Cite
Issue
Section
Copyright (c) 2024 B. DHARANI, SUBA A, STEPHY SEBASTIAN
This work is licensed under a Creative Commons Attribution 4.0 International License.
