Elaine Gardner, British Dietetic Association (BDA) Spokesperson, presents part 3 in our series of columns on sugar and sugar alternatives.

Name: Stevia1 (steviol glycosides)
What is it? A sweetener, extracted from the stevia plant. It is 250-300 times sweeter than sugar.
Found in? It can be purchased in granular, tablet and liquid form from supermarkets. Stevia is approved for use in numerous products, for example: sugar-free soft drinks, jams, flavoured milks, yoghurts, cakes, desserts, chocolates and beer. When used as a table-top sweetener, stevia can be mixed with other artificial sweeteners to improve their texture and aftertaste.
Stevia can also be found in combination with sugar to reduce the sugar (and calorie) content of products without losing sweetness. For example, Coca-Cola Life and Sprite use stevia. Tate and Lyle produce 'Sugar with Stevia', which contains approximately half the calories of pure sugar.
The stability of stevia under high temperatures means it can be useful for cooking.

Effect on general health: Stevia has no calories, no carbohydrates, a glycaemic index of 0 and does not raise blood sugar levels. It is safe to use by diabetics and is also suitable for children, pregnant women and those with allergies.
Oral health impact: Stevia is tooth friendly as it does not contain any fermentable carbohydrate.
In a study by Brambilla et al.,2 20 volunteers rinsed for one minute with sucrose or stevia extract solutions, and plaque pH was measured. After 5, 10, 15 and 30 minutes, the sucrose rinse produced a statistically significantly lower pH value compared to the stevia extracts, meaning that more acid was formed with sucrose. The authors conclude that stevia extracts can be considered non-acidogenic and therefore appropriate to support dental health.
Advice for patients: Stevia is an excellent alternative to sugar, but it's important to check ingredient labels to ensure the sweetness is from only stevia and it is not mixed with a percentage of sugar.

Find out more about the British Dietetic Association at: www.bda.uk.com.
Coming up: Dates [dried fruit]
References
Boileau A, Fry J C, Murray R . A new calorie-free sugar substitute from the leaf of the stevia plant arrives in the UK. Nutr Bull 2012; 37: 47–50.
Brambilla E, Cagetti M G, Ionescu A, Campus G, Lingström P . An in vitro and in vivo comparison of the effect of stevia rebaudiana extracts on different caries-related variables: a randomized controlled trial pilot study. Caries Res 2014; 48: 19–23.
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Alternative sugars: Stevia. Br Dent J 223, 311 (2017). https://doi.org/10.1038/sj.bdj.2017.739
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DOI: https://doi.org/10.1038/sj.bdj.2017.739