Friday, August 30, 2013

Food for Sleep?

About two weeks ago NPR program Fresh Air, Terry Gross interviewed neuroscientist Penelope Lewis about work at the Sleep and Memory Lab at the University of Manchester in England.  You can both listen to and read the transcript here.  Naturally, my ears perked up when this part of the  conversation took place:

GROSS: Now you advise eating your last meal of the day in four to five hours before you go to bed, but then having a light snack - how long before you go to bed?
LEWIS: About an hour before you go to bed.
GROSS: And why is that helpful to have a snack?
LEWIS: Well, it could be helpful for two reasons. Firstly, we all know how hard it is to fall asleep if you're hungry, so you want to avoid that. But secondly, there are certain foods which contain proteins which actually promote sleep. And so and what they are is proteins that get broken down and processed to form neurotransmitters that promote sleep. And so if you have a snack that contains those, it can actually help you to sleep.
GROSS: And what foods have that function?
LEWIS: Well, there are lots of different foods, but things like bananas, turkey. I think tuna fish was one. There are a whole range of very common foods that contain these proteins.

And with that rather vague answer (I think I could actually hear the "Dammit Terry, I'm a neuroscientist, not a dietitian" in her voice), and my guess is that there were many people that hit the Internet to search for "these foods that contain proteins that actually promote sleep."  And these people probably also got a wealth of conflicting information about when to snack before bed, what to snack on before bed, etc.   So what exactly are "these proteins that contain sleep?"

First of all, I do have to disclose that I haven't read her book yet as I have only made it to the "put it on my wish list" stage so far.  If she does wind up saying something different in the book than what I inferred from the interview, I will definitely do a post about "SkepticRD eats crow" or something like that.  Anyway, I have a feeling that she was talking about eating foods that contains an essential amino acid (a.k.a. a protein building block that we must get from our diet) called L-tryptophan.    In short, tryptophan helps us produce a neurotransmitter called serotonin, which puts us in a better mood and helps us relax, and then the serotonin in turn helps us make melatonin, a hormone that helps us control our sleeping and waking cycles.  So, it sounds like we should eat something like tuna (which does contain tryptophan) before bed and then have plenty of blissful sleep, right? (Of course in my house, the sleep would be interrupted by the cat trying to sit on my head, but that's another story).

Unfortunately for those of you who were hoping to find a miracle, as Dr. Ben Goldacre of "Bad Science" fame is fond of saying, "I think you'll find it's a bit more complicated than that."  When we eat foods that contain tryptophan, which includes pretty much all animal protein (including dairy), nuts/seed, and legumes/soy, we wind up storing that in the body so that it can hang out waiting to be made into niacin or serotonin.  For the "serotonin boost" however, you will need the help of carbohydrate containing food to take that stored tryptophan to convert it to serotonin.

Before you eat that entire bag of tortilla chips for bed however (and you know who you are), keep in mind that you maybe only need about 15 grams of carbohydrate to put this into effect (that is maybe about 10 tortilla chips).  Naturally, you probably shouldn't have something that is empty of nutrition either, and I know I can't stop at 10 tortilla chips, so I don't even start (I just commandeer the bowl at restaurants).  A cup of berries, a small apple, a handful of sweet potato fries or chips (preferably homemade), 15 baby carrots, or even some home-popped popcorn would suffice.

Now, I can see a whole bunch of people with wide eyes thinking, "Oh, that's why I had trouble sleeping when I was doing a very low carbohydrate diet" and then another group of people furrowing their brows thinking "wait a minute, I started sleeping better when I reduced my carbohydrate intake."  In the first group, you probably had the same rough adjustment that many people have when switching from primarily glucose to ketones for fuel, so you probably sleep a little better once your body adjusted and/or you were able to increase your carb intake after the first phase.  The second group might have started eating more protein when they reduced their carbs, or if they were diabetic/pre-diabetic the lack of blood sugar swings probably contributed to better sleep.  Keep in mind too that your quality of sleep, as mentioned by Dr. Lewis in the interview, is impacted by more than just your diet.  If you have improved your diet, but you don't have a regular schedule, or your room isn't dark enough, or you're drinking too much caffeine close to bed time, or you drink too much alcohol close to bedtime, or you're taking a medication that impacts sleep, you still have some other problems to work out for you to get the rest you need.

Take home message--eat an adequate amount of protein during the day, and having a small amount of nutrient rich carbohydrate foods might help you sleep better, but think about other parts of your lifestyle that might be interfering with sleep as well.

Thursday, August 29, 2013

Opinion: Jamie Oliver vs. George Orwell

Warning: Person reflections ahead.

One of the reasons I became a dietitian was so that I could help people sort through this mess of information about what's good and what's not so good for us to eat.  I have mentioned before that I grew up in a religious tradition (Mennonite) that actually emphaszied helping our fellow human beings, and one of the ways we were to help others was to combat hunger.  (We had Matthew 25:35 beaten into our heads.  A lot. "For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in.").  And like every good Mennonite, I owned/inherited a copy of the More with Less Cookbook which emphasized using less of the world's resources while cooking tasty healthy food for yourself and your family.

Side bar: Even though I identify as a Secular Humanist, I still try to help others and combat poor nutrition.  I still have a copy of my More with Less Cookbook because (even though my copy is from the 1970's) because it still has some tasty recipes for people on a budget (that I can modify for my own gluten-free/dairy free plan).

Of course, once I actually started working, I realized that not everyone wanted to hear my knight in shining armor, particularly since I work in a situation where I get a lot of "mandatory patients." As in the main reason they are grumpily sitting in my office is that "My doctor says I'm fat/diabetic/have high cholesterol," which is very different than "I want to eat better because I have [insert problem here.]"  And since most of my patients, both mandatory and those that are willing, are working from a fixed income, so I also have people who don't feel they can change because they don't feel they can afford what recommendations I make.  I'll admit I did spend some time pouting about people not wanting my help, but eventually I realized I had to get over myself and figure out what kind of solutions we could work out together (which is easy to say in writing, and takes a lot of listening and trial and error to do).

I was reflecting this after a friend had posted a fervent hope for Jamie Oliver to shut up with this accompanying article: Jamie Oliver Bemoans Chips, Cheese, and giant TVs of Modern day Poverty.  I blushed, because I actually remember having a lot of similar thoughts when I first started working, and was glad that I was/will never be famous enough to be that patronizing in public.  Of course, the internet has responded, with the overlying message of you don't know what real poverty is, and another extremely well read friend pointed me to this piece written in 1937 by George Orwell: The Road to Wigan Pier.    These particular passages jumped out at me:

"The basis of their diet, therefore, is white bread and margarine, corned beef, sugared tea, and potatoes--an appalling diet. Would it not be better if they spent more money on wholesome things like oranges and wholemeal bread or if they even, like the writer of the letter to the New Statesman, saved on fuel and ate their carrots raw? Yes, it would, but the point is that no ordinary human being is ever going to do such a thing. The ordinary human being would sooner starve than live on brown bread and raw carrots. And the peculiar evil is this, that the less money you have, the less inclined you feel to spend it on wholesome food."


"When you are unemployed, which is to say when you are underfed, harassed, bored, and miserable, you don't want to eat dull wholesome food. You want something a little bit 'tasty'. There is always some cheaply pleasant thing to tempt you. Let's have three pennorth of chips! Run out and buy us a twopenny ice-cream! Put the kettle on and we'll all have a nice cup of tea! That is how your mind works when you are at the P.A.C. level. White bread-and-marg and sugared tea don't nourish you to any extent, but they are nicer (at least most people think so) than brown bread-and-dripping and cold water. Unemployment is an endless misery that has got to be constantly palliated, and especially with tea, the English-man's opium. A cup of tea or even an aspirin is much better as a temporary stimulant than a crust of brown bread."

Other patients of mine have expressed similar things in that sometimes cigarettes, store bought cookies, Cheetos, etc, are all they have left.  And then there was another patient who said, and I am paraphrasing, "Life's a shit sandwich, and every day you've gotta take another bite" and that essentially you need something to either dull the taste, sweeten the taste, or help you temporarily forget that you are in fact eating a shit sandwich.

So how does one fulfill a desire to help someone improve their health without becoming a Jamie Oliver?  I don't have any easy answers, but I can share what has helped me so far, and what I have shared with the students/interns I have taken on over the years:

1) Remember that the person who found your blog, came to your "cooking on a budget class," is sitting in front of you, or came to you as a community leader/teacher, is a human being and treat them with dignity.

2) You have to accept that not everybody wants your help, particularly other adults who don't want to be in a position of being "told what to do" in the first place. 

3) Avoid phrases like "I understand," because you probably don't.  You can use phrases like "so what I hear you saying is....."

4) Recognize that your idea of what constitutes a good life (Or making that shit sandwich easier to eat) is not going to be the other person's idea of what is a good life. 

5) Don't assume that the person wants your help or help from any kind of social services.  Asking upfront about "What can I help you with today?" can give the person that opportunity to say "Yes, I need to know how I am suppossed to eat a diabetic diet I live at the Salvation Army" or even "Fuck your do gooder ass!"

6) If the person does want advice/help, find out what they are willing to do and not willing to do so that the person can take advantage of your expertise.  For example, one of my patients will not give up his cigarettes.  He's a grownup, and a smart grownup who is perfectly aware of how much money he is spending on cigarrettes and why smoking is bad for him.  He's also on disability and the cigarettes dull the taste of the shit sandwich.  He will, however, try new recipes that make the most out of his limited income, drink water and/or unsweet tea so he doesn't have to spend money on sugar substitutes, etc.  I get to congratulate him on his 25 pound weight loss (25 more to go!) and his vastly improved blood sugar/blood pressure readings.

7) There will always be people who want to take advantage of your time or resources, social services, etc.  You will get frustrated, but find a way to take out your frustration in a healthy way.  Otherwise, you will find your sense of compassion tapped out and you won't be available for those that really need  you.

8) Advocate for ways to change the world around you as far as helping people have better access to food or other resources, hopefully ones that are based on reason.  If what you are doing isn't producing good results, find another way.

Take home message--combatting hunger is complicated.  Approach it with humility.

Monday, August 26, 2013

Hangover Prevention Drink?

Most of us who see ourselves as rational/skeptical beings admit that our actions have consequences, but that doesn't mean we stop our quest to mitigate those consequences, including the ones of drinking too much.  Go to any Skeptic Convention and you will probably find plenty of individuals hanging out at the bar area, and some may find that the conversations get better as more alcohol is consumed. So I can definitely see why a skeptic might want to try something like Mercy, a drink marketed as a "hangover prevention."  Is there any evidence that it helps?

First of all, lets discuss what causes a hangover, which I think our friends at Asap Science do quite well:

As you can see from the video, the antioxidant glutathione is crucial for removing the toxic byproducts of alcohol metabolism.    So by taking a drink that contains glutathione, we should help our body get rid of acetaldehyde, right?

Well, not exactly.  First of all, raising the levels of glutathione in your liver by taking glutathione orally is not very effective, our digestive tracts just don't absorb it very well.  "Ok," you might say, "I actually read the website that you linked to and noticed that the drink doesn't actually contain glutathione, it contains L-carnitine, N-acetylcysteine, b-vitamins, and vitamin C which can help our liver make more glutathione!"  Well, good for you for actually reading the ingredients, and maybe even doing a little Googling (and using Wikipedia), but once again, there is no evidence that taking these vitamins after 4-5 drinks will actually boost the levels of glutathione in your liver. 

In other words, there was just enough science here to make it sound good, but not enough evidence for you to by this product and take it with you to your next Skeptic Convention (or wherever you like to indulge).

So what can you do to prevent a hangover?  Well, you might have already clicked through to the follow up video from Asap Science, but just in case you didn't:
My additional tips:
1) Know your limit and avoid drinking to the point of a hangover.  No seriously, think about what other medical conditions you have and/or what medications you take that might make this whole situation worse.
2) Ok, so you've decided you are probably going to indulge anyway, it is your body. If you normally follow a carbohydrate controlled diet, and you know you are going to be drinking too much, now is NOT the time to stick with your diet plan, particularly if you have diabetes.  First of all, you don't want a blood glucose drop making you feel miserable, second of all, alcohol inhibits the formation of glucose from your liver stores, putting you more at risk for a blood glucose drop (which could be dangerous if you take insulin to control your diabetes). 
3) For the suggestion to load up on fats, have some cheese with your adult beverages, or if you don't tolerate dairy (like me) load up on nuts or guacamole.
4) Bring bottles of water with you to the party, or order a large glass/bottle of water with your first drink.  I like to bring flavored sparkling water with me to parties because it's tasty and I am more likely to be able to drink more. 
5) Make sure you have already have eggs in your fridge for the morning after as it will be hard to stagger to the store. 
6) I prefer broth for electrolytes (homemade if you have it in your freezer) or keep organic boullion cubes around, rather than loading up on more sugary beverages like fruit juice (although a little fruit will be fine).

Take home message--know your limit, bring your own water, and skip the Mercy.

Friday, August 23, 2013

Talkin' bout My Evolution

Wednesday night I got to fill in as the Atheist Dietitian on Dogma Debate.  You can listen to show #82 on iTunes or follow the links from the website.  Most of me talking is at the beginning, although later I make a comment about "Intelligent Falling." (Because gravity is just a theory, right?).

I have already received my first e-mail indicating that I hate the paleo diet, love vegans, and wish I could still be a vegan but I can't.  Of course, I didn't say any of that, nor (in the short space of time) did I get to expound on one topic like I am used to doing on a blog, as I haven't been on a podcast before.  I think the author was mostly angry that I didn't immediately burn all vegans at the stake (steak? har-har).

First of all,  I have no problem with people consuming protein from humanely raised animals, incorporating plenty of healthy fats, avoiding added sugars, avoiding nutritionally devoid grains, and filling in the gaps with more vegetables.  Why would I, when the evidence points to this being a healthy plan, particularly for all those diabetics I work with?   Let me say it again, I have no problem with people eating a whole foods diet free of added sugars with adequate protein and fat.

Now for the "issues," which have already been summarized here over at Nothing in Biology Makes Sense: The Beef I Have with the Paleo Diet.  Sarah Hird and Noah Reid also have a great title.  Let me hit the highlights:
1.  Evolution optimizes your ability to pass on offspring, it does not act to optimize health.
2.  Evolution has adapted us to our diet, in other words to help us eat whatever is readily available, not adapted us to a specific diet.
3.  Evidence points to omnivory being healthy, but the restriction on eating foods based on when they were introduced into the human diet is problematic.
4. Anything you buy in a store today is not the same, no matter how careful you were to keep that animal raised in a natural environment.  If you make that pudding with coconut milk and organic cocoa and honey (and call it coconut milk pudding) I will be the first in line to gobble that up.  Call it paleo pudding and you wonder every one in the skeptic community is laughing at you, because it implies that the cavemen sat around eating this.

So yes, I personally have a semantics problem with calling it a paleo diet.  But then the Omnivorous Unprocessed Foods diet probably isn't so snappy.  Told you marketing was not my strong point.

I will also be the first to jump in and state that there are many people that are eating too much bread, pasta, rice, corn, etc and not getting enough protein, fat, and vegetables.  Should you avoid all gluten containing grains if you have celiac, gluten intolerance, or inflammatory bowel disease/irritable bowel syndrome.  Yes.  Should you restrict carbs if you have diabetes type 2, or prediabetes, or even a strong family history of insulin resistance?  Yes.   Does everybody else have to avoid eating grains?  Not necessarily, but if one bite of pasta leads to too much, you might need to avoid them.  Should you gorge on grains?  No.

One of the questions David asked me was "Why do you think so many of the atheists we encounter are vegetarian/vegan?"  I replied that I thought that they thought it was the most ethical way to live, and the author of my first response piece appeared to think that I thought that eating vegan was the only ethical way to live.    Never mind that I mentioned that evidence indicates that the most environmentally sound way of eating actually includes dairy and meat, as per this study done by Cornell University.  I was merely replying to David's question and then we moved on.  I did quit being a vegan for health reasons, but I also stopped because the more reading I did, the more I was able to assimilate the evidence and say "Hey, this isn't the way to live my life anymore."

As a health care professional, however, if a patient/client of mine said "Would it hurt me to become a vegan tomorrow?" I would not answer them until I got a detailed health history from them, and also asked some personal questions about why they wanted to do this.  For example, if that person had diabetes I would probably discourage them based on the difficulty of controlling your carbohydrate intake.  If they person said "I think it would be better for the environment" I would discuss the evidence to the contrary.  If they don't want to eat animals and hate the modern meat industry, I would again discuss how their vegan diet might not help.  And if they still wanted to eat vegan because the idea of eating animals makes them physically ill, or they are bound and determined to do this, then I help them do the best they can with what they have and avoid any nutritional deficiencies.

Some day I hope to be as eloquent as Aron Ra when it comes to answering questions, and maybe I will get more practice.  In the mean time, people can comment here!

Wednesday, August 14, 2013

Should I eat yogurt?

A friend of mine was kind enough to lend me some DVDs of a BBC series called The Truth About Food.  So far I have been able to watch about two episodes and am enjoying the questions that they are raising about how certain foods might actually help improve disgestive function, sexual function, etc.  One of the questions that was raised was whether or not yogurt (or yoghurt, depending on which side of the Atlantic you are spelling it in), which contains pro-biotics or "good" bacteria, can actually help increase the "good" bacteria in your digestive system.

Sidebar: While I am finding this show interesting, and somewhat entertaining, so far, I have one major quibble about this show.  All of the little "experiments" that they are doing are not necessarily double blind, and they are usually so small as to not be able to extract that information to the general public.  I think they are missing out on a huge opportunity to explain how the scientific method works, how to look at news reports critically, etc.  Curmudgeon duties over.

First of all, let me point you back to this article, which I have quoted before, for a little primer on probiotics from Probiotics.  Read it?  Good.  What I would like you to remember for this situation is that the body sees the bacteria in the yogurt as a foreign object, and since the digestive system works as a "first defense" in your immune system, then your body is going to try to push the foreign objects out.  So it was no surprise to me that on the TV show the small group of people that ate yogurt for a week (and pooped into a bucket so the sample could be collected) did not increase the favorable bacteria in the gut.  The group that ate a lot of leafy greens (that happend to be high in pre-biotic fiber), actually did have an increase in "good" bacteria.  And though this was a small study, there has been more research that indicates that eating a variety of plants seems to be more beneficial for feeding the favorable gut.  So it looks like eating yogurt won't help increase the general favorable bacteria in your gut.

But my doctor told me to eat yogurt when I was put on antibiotics for an infection!
Right, and Dr. Crislip mentioned this in the above listed blog post.  He reminds us that antibiotics can "kill off" the good bacteria as well as the bad, leaving room for the "even worse" bacteria, like C. difficile, from moving in.  Think of the probiotics in the yogurt or capsule as a placeholder, albeit a temporary one, that keeps the bad guys out until you can replenish your good guys.

What about those advertisements that tell you to eat yogurt to keep things "regular?"
I'm sure you are thinking of Activia, and the reason that I don't usually watch TV is so that I don't have to hear more than I wanted to know about celebrity digestive systems.  Remember what I said about your body trying to push the "foreign objects" out?  When you eat the yogurt, you will likely experience an increase in your bowel movements because your body is trying to push the foreign object out.  So, if you eat the Activia light, you just ate 70 calories and 11 grams of carbohydrate that you may or may not have needed to have, when you could have just taken a laxative or a probiotic capsule. If you have trouble with constipation, defined as less than three bowel movements per week, you might need to increase your vegetable intake, exercise more, and/or cut out your refined flours.  (In my patients, we also have to consider what medications they are taking that might be causing a problem, and if they have a longstanding history of diabetes, we have to consider more serious conditions like gastroparesis).

But I like yogurt!
That's ok, foods that are fermented are often more easily digested by those of us that have Irritable Bowel Syndrome or other digestive conditions; therefore, people who are lactose intolerant can usually tolerate yogurt because the good bacteria breaks down the lactose.  Yogurt is also a good source of protein and calcium, and the creamier yogurts are quite satiating/satisfying.  Just avoid the yogurts that have sugar added; your best bet is to get plain Greek yogurt and sweeten it yourself so you don't wind up with a bunch of extra calories or carbodrates,

Take home message--No sugar added yogurt can be a good snack, but maybe not for the reasons you think.

Monday, August 12, 2013

Should I eat breakfast?

If you were born in the United States in the late 1960s  or after, and watched Saturday morning cartoons, chances are you saw a public service announcement like this one:
If you didn't watch TV but attended public school, you probably still had "nutrition units" that reminded you that breakfast was the most important meal of the day.  All well and good, as there is research to indicate that children in school do perform better when they eat something for breakfast (Link).  Children are also obviously at a stage where good nutrition is crucial to growth and future health, and it makes sense that to get everything that they need that they are probably better off spreading their intake throughout the day.  But what about adults, especially those who are, um, trying to shed some of their growth, so to speak?  That question might be on your mind if you have seen some of the reports that come out in the news lately, some of them conflicting.

The first news report to catch my attention came out a few weeks ago: Skipping Breakfast Might Do a Dieter Good, Scientists say.  The statement from that article that jumped out at me the most was this one:
"It’s common belief that people who skip breakfast overeat later in the day. But that’s “based on a myth, not on hard data,” Levitsky said by phone. It’s hard to measure what people eat because memories are faulty and people don’t do a great job at estimating amounts."
I too was guilty of believing that myth, and admit that I "preached" it to many of my patients for longer than I care to admit.  But fortunately I had enough people who were willing to admit that they sometimes did better with skipping breakfast that I decided it was time to look at the data (I know I need to have my assumptions challenged on a regular basis, I am probably not alone either).  Some people really do wind up consuming less (and isn't that the goal?) if they cut out that meal, and some people find themselves less hungry during the day if that first meal is skipped.

Of course, along comes another study like this one, as reported on the Wall Street Journal: Bigger Meals Earlier Can Help Weight Loss.  This small, short term study indicated that people who ate a higher calorie breakfast lost more weight.  So what do we do with this?

First of all recognize that the second study was too short to determine long term benefits, and what really makes a "good" eating plan is one that we can sustain, so we can't really recomend a change of practice until we have more studies and more information.  Second, remember that in the first study people ate what they wanted during the day (although what they ate was measured), and in the second study the meals were planned out for them, and comparing eating "ad lib" to a series of planned meals isn't exactly a fair comparison either (although at least both studies contained measurements!).  Third, there are plenty of obese people with type 2 diabetes and pre-diabetes out there, and having that amount of carbohydrate to start out your day isn't going to be so good for your blood glucose control the rest of the day either.

So, it looks like skipping breakfast might be a viable option for some, but not so good for others.   Based on what we do know, here are some things for you to take into account when considering your breakfast habits.

1) What happens to me when I skip breakfast?  Do I have any hard data to support my overeating?  If not, keep a food diary for a week or longer.  Keep track of how hungry you are when you do eat.  If you are miserable by the time lunch comes around, this might not be for you.

2) If you are "starving" when you wake up, think about what how what you are eating and drinking the day before affects you.  If your carbohydrate intake is excessive, you might be elevating your levels of circulating insulin in your body, triggering hunger that day and the next day.  You might have to have an eating overhall before you think about skipping a meal.

3) Some medications need to be taken with food or you might have nausea/vomiting/diarrhea, which is not the most pleasant way to lose weight.  Sometimes you might be able to switch the timing of your medicine to later in the day, but you will need to ask your physician first.

4) If  you have Type 2 diabetes and take certain medications or certain kinds of insulin, you might need to eat three times per day to avoid low blood glucose.  Now, keep in mind, if you are having to eat constantly just to avoid low blood glucose, you likely need less medication or insulin, so get in touch with your physician ASAP to help adjust it.   If you have Type 1 diabetes, or have Type 2 that requires insulin, you can also ask for a more flexible insulin regimen that can be tailored to your eating schedule or ask about insulin pump therapy.

5) Are you already having trouble meeting your protein needs, etc, with just two meals?  Then you might need to spread your food intake over three meals.

6) Do you have any health conditions that effect your digestive system (IBS, etc)?  If so, your body might absorb nutrients better if you spread your intake out over three meals.

Take home message--skipping breakfast is still not recommended for children and teenagers, but it might be an option for overweight adults.

Friday, August 2, 2013

Is Stevia Safer?

Overconsumption of sugar is a problem, I think we have consensus on that.  But let's face it, sweet things taste good.  Even Boyfriend of SkepticRD, who will normally turn up his nose at anything sweet (which is not a bad quality when you have Type 1 diabetes), wants to have a little sweetener in his coffee in the morning.    There are plenty of sugar substitutes out there, but sometimes, even those of us that like to believe we are critical thinkers, have a not so rational reaction to the thought of using something "artificial."  If we don't want those extra calories and carbohydrate, however, we might start turning toward some other sweeteners that occur in nature, but is that a good idea?

Dr. Harriet Hall, over at Science-Based Medicine, has already covered this topic in her usual thorough way.  I will highlight this paragraph:

"Stevia comes from a plant, and the GuaranĂ­ Indians of South America have been using it to sweeten their yerba mate for centuries. The “natural fallacy” and the “ancient wisdom fallacy” sway many consumers, but for those of us who are critical thinkers, who want to avoid logical fallacies and look at the scientific evidence, what does science tell us? Is stevia preferable to aspartame? We really don’t know. Concerns have been raised about possible adverse effects such as cancer and birth defects. Stevia is banned in most European countries and in Singapore and Hong Kong because their regulatory agencies felt that there was insufficient toxicological evidence to demonstrate its safety. The US banned its import in 1991 as a food additive, but the 1994 Diet Supplement Health and Education Act (DSHEA) legalized its sale as a dietary supplement. Most of the safety concerns have been dismissed, but so have the concerns about aspartame. Arguably, the concerns about stevia are more valid than those about aspartame, because there is less evidence refuting them.
The plant extract is refined using ethanol, methanol, crystallization and separation technologies to separate the various glycoside molecules. The Coca-Cola Company sells it as Truvia. Pepsi sells it as PureVia. It is a product of major corporations and is prepared in a laboratory using “toxic” chemicals like methanol. For some reason that doesn’t bother those who are promoting stevia as a natural product."

So is it safer for those of us who are quite lazy like me and just want to throw something in the morning coffee and not have to count the carbs?  Maybe.   But I think I will have to repeat my favorite adage from Paracleus, "The dose makes the poison."  Water, oxygen, vitamin C, vitamin A, protein, table sugar, and so on can all be toxic when consumed excess.  Let's take vitamin C as my prime example.  You make a point of eating vitamin C rich fruit and vegetables daily you should be fine.  You take that vitamin, extract if from the fruit and vegetables that it's found in, put it in the form of a capsule or maybe a drink, market it as a cure for the common cold, and suddenly certain people are taking huge doses of it.  Suddenly those people are also having nausea and diarrhea.  Was it because the vitamin C itself was bad for you?  No, it was because you had too much of it in an easily accessible form.

So given what we do know about stevia (and other artificial sweeteners, and table sugar, etc) what might we do?  SkepticRDs suggestion is that you use the minimum of whatever it is necessary to meet your personal health goals (which includes a certain calorie intake and/or carbohydrate intake for those of us with diabetes and pre-diabetes) and enhance the quality of life of you and those around you.  Apparently for some people that even means growing and making their own stevia extract.  It uses vodka......hmmmm......there are reasons to not be lazy.....