Chapter 2 Review of Related Literature

The effect of stevia as alternative candy for children. As students of the pharmacy program, the researchers are determined to go through this study in order to lessen the number of children suffering from tooth decay and toothache. The researchers would also want to test the efficacy of stevia as a natural sweetener. This study deals with the origin and Physical appearance of stevia, Properties of stevia, Health Benefits and the process of making candy. Nature of Stevia Stevia is a genus of about 240 species of herbs and shrubs in the sunflower family (Asteraceae). Its scientific name is Stevia Rebaudiana and it grows in subtropical and tropical regions. The species Stevia Rebaudiana commonly known as sweet leaf, sugar leaf or simply stevia, is widely grown for its sweet leaves. As a sweetener and sugar substitute, stevias taste has a slower onset and longer duration compared to sugar, and some of its extracts may have a bitter or licorice-like aftertaste at high concentration. Stevia Rebaudiana contains Glycosides that have sweetness of up to 300 times compared to sugar and carrying absolutely no baggage of calories. The extract of Stevia Rebaudiana has four main Glycosides namely: Steviosides, Rebaudiosides A, Rebaudiosides C and Dulcosides A. Steviosides and Rebaudiosides A are the two dominant components and ratio of these two mainly determines the quality of the taste. Stevia has attracted with the rise in demand for low-carbohydrate, low-sugar sweeteners. Because stevia has a negligible effect on blood glucose and it is attractive to people on

carbohydrate controlled diets. (GreenRev Agro Pvt Ltd, 311 Powai Plaza, Hiranandia Garden, Powai, Mumbai, MH-40076. INDIA, n.d) Physical Appearance Stevia rebaudiana is a perennial herb with claimed medicinal and culinary characteristics. It is approximately 300 times sweeter than sucrose and an annual growing to 0.5 m (1ft 8 in). The flowers are hermaphrodite (have both male and female organs) and are pollinated by insects. This specie is suitable for light (sandy) and medium (loamy) soils. Suitable pH: acid, neutral and basic (alkaline) soils. It cannot grow in the shade it prefers moist soil. The leaves contain stevioside, a substance that is 300 times sweeter than sucrose. The dried leaves can be grind and used as a sweetener or it could be soaked in water and used in making preservatives. The powdered leaves are also added to herb teas and sometimes chewed by those who wish to reduce their sugar intake. (Ken Fern/Plants for a future, 1995-2010) Stevia is a small perennial herb belongs to the Asteraceae family of the genus stevia. Its plants grow 2-4 feet in height with slender, branched stems and flourishes well all over temperate and some parts of tropical regions. It is being cultivated as commercial crop in Japan, China, Thailand, Paraguay, and Brazil. Almost all the parts of the plant taste sweet; however, the green glycosides are typically concentrated in its dark-green serrated leaves. The Guarani Indians of Paraguay have used its leaves to sweeten drinks and foods and various traditional medicines. (Umesh Rudarappa, 2009). Medicinal Properties of Stevia In spite the prominence Stevia has obtained as a calorie free sweetener and flavour enhancer, it contains a variety of constituents the steviosides and rebaudiosides. This includes the

nutrients and sterols, triterpenes, flavonoids, tannins, and an extremely rich volatile oil comprising rich proportions of aromatics, aldehyde, monoterpenes, and sesquiterpenes. These and other, as yet unidentified constituents have some impact on human physiology and may help explain some of the reported therapeutic uses of stevia. This has been used as a preparation of the actual plant (not Steviosides) that can experience benefits other than lowering calories. Scientific research has shown it to be beneficial in regulating blood sugar levels, bringing them into normal range. It is also used as a digestive aid. As a skin care product, it has been used to treat eczema, seborrhoea and dermatitis. (Retrieved from AgricultureInformation.com 2001-2013) It is a well-known fact that stevia can be used as a sweetener. In many countries of the world, sugar and several other sweetening agents had been replaced with sweetening products derived from stevia instead of sweeteners like saccharin and cyclamate. Sugar can promote high blood sugar. Cyclamate and saccharin can lead to cancer later in life. But stevia had never been found to have any of the side effects associated with these other sweetening agents. Stevia has up to 300 times capability as a sweetening agent in comparison with sucrose, which is the major content of sugar. Stevia is used as a sweetener but it had been discovered to have a numerous of health related benefits and it have a several other sweetening agents. (Anonymous, n.d). The table below shows the summary of the properties of stevia based on Leslie Taylor. STEVIA HERBAL PROPERTIES AND ACTIONS Other Actions Standard Dosage Leaves Ground leaves: 1/4 tsp = 1 tsp of sugar Infusion: 1 cup 2-3 times daily

Main Actions blood sugar

Health Benefits The great interest in stevia as a non-caloric, natural sweetener has fuelled many studies on it - including toxicological ones. The main sweet chemical, stevioside, has been found to be nontoxic in acute toxicity studies with rats, rabbits, guinea pigs, and birds. It also has been shown not to cause cellular changes (mutagenic) or to have any effect on fertility. The natural stevia leaf also has been found to be nontoxic and has no mutagenic activity. Studies conflict as to the effect of stevia leaf on fertility. The majority of clinical studies show stevia leaf to have no effect on fertility in both males and females. In one study, however, a water extract of the leaf was shown to reduce testosterone levels and sperm count in male rats. Brazilian scientists recorded stevioside's ability to lower systemic blood pressure in rats in 1991. Then in 2000, a doubleblind, placebo-controlled study was undertaken with 106 Chinese hypertensive men and women. Sixty subjects were given capsules containing stevioside (250 mg) or placebo thrice daily and followed up at monthly intervals for one year. After three months, the systolic and diastolic blood pressure of the stevioside group decreased significantly and the effect persisted over the whole year. The researchers concluded, "This study shows that oral stevioside is a well-tolerated and effective modality that may be considered as an alternative or supplementary therapy for patients with hypertension." Another team of scientists tested the hypoglycemic effects of the individual glycoside chemicals in stevia and attributed the effect on glucose production to the glycosides steviol, isosteviol, and glucosilsteviol. The main sweetening glycoside, stevioside, did not produce this effect. Researchers in Denmark published a study (in 2000) which demonstrated

that the in vitro hypoglycemic actions of stevioside and steviol are a result of their ability to stimulate insulin secretion via a direct action on beta cells. They concluded, "Results indicate that the compounds may have a potential role as anti hyperglycemic agents in the treatment of type 2 diabetes mellitus." Stevia's effects and uses as a heart tonic to normalize blood pressure levels, to regulate heartbeat, and for other cardiopulmonary indications first were reported in rat studies (in 1978). Following these studies, a crude extract of stevia demonstrated hypotensive activity in a 1996 clinical study with rats, showing that at dosages higher than used for sweetening purposes, [stevia extract] is a vasodilator agent in normo- and hypertensive animals." In humans, a hot water extract of the leaf has been shown to lower both systolic and diastolic blood pressure. Several earlier studies on both stevia extracts, as well as its isolated glycosides, demonstrated this hypotensive action (as well as a diuretic action). In hypertensive rats the leaf extract increased renal plasma flow, urinary flow, and sodium excretion and filtration rate. In addition to its studied hypotensive effects, a Brazilian research group demonstrated that water extracts of stevia leaves had a hypoglycemic effect and increased glucose tolerance in humans, reporting that it "significantly decreased plasma glucose levels during the test and after overnight fasting in all volunteers." In another human study, blood sugar was reduced by 35% 6-8 hours after oral ingestion of a hot water extract of the leaf. In other research, stevia has demonstrated antimicrobial, antibacterial, antiviral, and anti-yeast activity. A water extract was shown to help prevent dental cavities by inhibiting the bacteria Streptococcus mutans that stimulates plaque formation. Additionally, a U.S. patent was filed in 1993 on a extract of stevia that claimed it to have vasodilator activity and deemed it effective for various skin diseases (acne, heat rash, pruritis) and diseases caused by blood circulation insufficiency. (Leslie Taylor, 1996)

Stevia herb parts are very low in calories. Its dry are roughly 40 times sweeter than sugar. The sweetness of sugar in stevia is due to several glycosides compounds including stevioside, steviolbioside, rebaudiosides A-E, and dulcoside. Stevioside is non-carbohydrate glycoside compound. Hence, it lack of properties that sucrose and other carbohydrates have. Stevia extracts like rebaudiosides-A, are found to be 300 times sweeter than sugar. However, stevia extracts have several unique properties such as long shelf life, high temperature tolerance, nonfermentative; but contain non-zero calorie. In addition, stevia plants have many sterols and antioxidant compounds like triterpenes, flavonoids and tannins. Some of flavonoid polyphenolic anti-oxidant phyto-chemicals present in stevia is kaempferol,quercetin, chlorogenic acid, caffeic acid, isoquercetin, and isosetiviol. Studies found that kaemferol can reduce risk of pancreatic cancer by 23% (American journal of epidemiology). Chlorgenic acid reduces enzymatic conversion of glycogen to glucose in addition to decreasing absorption of glucose in the gut. Thus, it helps reduce blood sugar levels. Glycosides in stevia extract have been found to dilate blood vessels, increase sodium excretion, and urine output. In effect, stevia, at slightly higher doses than sweetener, can help lower blood pressure. Being a non-carbohydrate sweetener, stevia would not favour the growth of Streptococcus mutans bacteria in the mouth which is attributed to be a causative agent for dental caries and tooth cavities. On the other hand, certain compounds in stevia are rather to inhibit caries causing bacteria in the mouth. In addition, being a herb, stevia contain many vitals minerals, vitamins that are selectively absent in the artificial sweeteners. (Umesh Rudrappa, 2009) Toothache Toothache (also termed dental pain, odontalgia, dentalgia, odontodynia, or odontogenic pain). Is a pain in the teeth or their supporting structures, caused by dental disease or pain

referred to the teeth by non-dental diseases. Common causes of includes pulpitis (inflammation of the pulp, usually response to dental caries, dental trauma or other factors), dentin hypersensitivity (short, sharp pain usually associated with exposed root surfaces), apical periodontitis (inflammation of the periodontal ligament and alveolar bone, dental abscesses (localized collection of pus), alveolar osteitis (dry socket, a possible complication of tooth extraction where is the loss of the blood clot and exposure of bone), acute necrotizing ulcerative gingivitis (a gum infection, also called trench mouth), and others. Toothache is the most common type of orofacial pain, and when severe it is considered a dental emergency since there may be a significant impact on sleep, eating and daily activities. It is one most common reason for emergency dental appointments. Since the cause of toothache is varied, the treatment is dependent upon the exact cause. The relief of toothache is considered one of the main responsibilities of dentists. (Segen, 2002)

In the Philippines, toothache is a common ailment among schoolchildren, and is the primary cause of absenteeism from school (DOH, 2008). Indeed, dental and oral diseases create a silent epidemic, placing a heavy burden on Filipino school children.

Tooth decay Tooth decay is the process that results in a cavity (dental caries). It occurs when bacteria in your mouth make acids that eat away at a tooth. If not treated, tooth decay can cause pain, infection, and tooth loss. The combination of bacteria and food causes tooth decay. A clear sticky substance called plaque that contains bacteria is always forming on your teeth and gums. As the bacteria feed on the sugars in the food you eat, they make acids. The acids attack the teeth for 20

minutes or more after eating. Over a period of time, these acids destroy tooth enamel, resulting in tooth decay. (WebMD, 2005) According to the Department of Health, tooth decay and gum diseases do not directly cause disability or death. However, these conditions can weaken bodily defenses and serve as portals of entry to other more serious and potentially dangerous systemic diseases and infections. Serious conditions include arthritis, heart disease, endocarditis, gastro-intestinal diseases, and ocular-skin-renal diseases. Process of Making Candy 1. Start a pot of water boiling on the stove 2. Twit a piece of cotton string around the middle of the stick 3. Wet the string with a little water and roll it in the sugar. 4. Lay the stick over the top of the glass jar so that the string hangs down inside the jar, but dont touch the bottom of jar. 5. When the water has started boiling, remove it from the heat and let the water settle. 6. Stir in the sugar one half cup at a time. 7. If you want to add flavouring or colour, stir it in now. 8. Pour the sugary syrup solution into the glass until it is about 1 inch. 9. Place the pencil over the jar and allow the string to dangle into the solution. 10. Place the glass somewhere where it can sit for a while (but do not refrigerate). 11. Leave the string in the solution until the crystals are big enough or they have completely stopped. 12. Remove the string from the glass and let it dry. (Travis Derouin, et. al., n.d)

Synthesis According to one study done on laboratory rats, stevia does not lead to tooth cavities. In this study, stevioside and rebaudioside A -- the two primary sweet constituents of the stevia plant -were tested on a group of sixty rat pups (Das, 1992). The rats were divided into four groups. Group 1 was fed 30 percent of its diet in sucrose (table sugar). Group 2 was given 0.5 percent of its diet in stevioside. Group 3 received 0.5 percent of its diet in rebaudioside A. Group 4, the control group, was given no sugar or sweetener of any kind. There was no difference in the food or water intake among the groups. After five weeks, the rats were evaluated. There was a significant difference in the condition of their teeth. The sugar-fed rats in Group 1 had significantly more cavities than the rats in the other groups. The rats in Groups 2, 3, and 4 had about the same number of cavities. It appears that the chemicals within the stevia plant that impart its sweetness are not fermentable, and thus does not cause tooth cavities. According to another researcher named Leslie Taylor, the dried leaf of Stevia was described as having sweet properties as early as 1899. It contains Steviasoid, a natural sweetener, which is 300 times as sweet as sugar, yet is not absorbed by the body and contains practically no calories. These properties make it useful in weight loss programs. Despite Stevia's sweetness, it does not produce tooth cavities. This may be due to its high fluoride or other high mineral content. Conclusion Toothache and tooth decay is a common problem with children. Aside from physical deformity, these two oral diseases may also cause disturbance of speech significant enough to

affect work performance, nutrition, social interactions, income, and self-esteem. Poor oral health poses negative effects on school performance and ruin success in later life. Hence, there is a great need of a solution to this occurring problem. With this, the researchers will push through with their study. Stevia as an alternative sugar in making candies will be the focus of the research study. The researchers will make use of the no-calorie and no-carb properties of Stevia. They will also make use of stevia as a natural sweetener. The researchers will test the efficacy of stevia to the teeth of children.