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E. Koyama, K. Kitazawa, Y. Ohori, O. Izawa, K. Kakegawa, A. Fujino and M. Ui, “In Vitro Metabolism of the Glycosidic Sweeteners, Stevia Mixture and Enzymatically Modified Stevia in Human Intestinal Microflora,” Food and Chemical Toxicology, Vol. 41, No. 3, 2003, pp. 359374. doi:10.1016/S0278-6915(02)00235-1

has been cited by the following article:

• TITLE: Edema, Enigma: 11 B-Hydroxysteroid Dehydrogenase Type 2 Inhibition by Sweetener “Stevia”

  AUTHORS: Salina Esmail, Udaya M. Kabadi

  KEYWORDS: Edema; Enigma; 11 B-Hydroxysteroid Dehydrogenase Type 2; Sweetener “Stevia”

  JOURNAL NAME: Open Journal of Endocrine and Metabolic Diseases, Vol.2 No.3, August 2, 2012

  ABSTRACT: Intrduction: Edema, Hypertension and Hypokalemia occur with inhibition of 11 B-Hydroxysteroid Dehydrogenase Type 2 (11B-HSD2) by chronic Licorice ingestion. However, a similar presentation following a chronic use of another commonly used sweetener “Stevia” is not reported. Objective: To document a first case report of a subject presenting with Edema, Prehypertension and Hypokalemia induced by 11B-HSD2 inhibition induced by chronic ingestion of sweetener stevia. Case Report: 32 year old Caucasian woman presented with generalized edema (feet, hands and face) of over 6 months. She was noted to also manifest Prehypertension (138/88 mmHg) and Hypokalemia (3.4 mM/l). Laboratory tests revealed decline in serum aldosterone and plasma renin activity, an increase in plasma cortisol/cortisone ratio. On persistent interrogation, patient admitted to daily consumption of sweetener stevia for over 9 months. All the presenting manifestations resolved with normalization of the laboratory tests on withdrawal of stevia. Conclusion: This case report indicates that chronic ingestion of sweetener stevia may induce edema, hypertension and hypokalemia via reduced conversion of cortisol into cortisone by inhibition of 11 B-Hydroxysteroid Dehydrogenase Type 2.