A natural sweetener called stevia has proven to be a popular alternative to sucralose and other sweeteners, but it may come with its own potential issues. A new study from the Ben-Gurion University of the Negev found that stevia may cause gut health problems by upsetting the balance of beneficial bacteria. The scientists are encouraging more research into the potential consequences of stevia use.

Stevia is a sweetener processed from leaves; it is a low-calorie alternative to sugar and, due to its ‘natural’ designation, many view it as a safer and healthier option compared to artificial sweeteners. The FDA only considers high-quality steviol glycosides — sweet compounds in the plant — as ‘generally recognized as safe’ (GRAS).

Crude stevia extracts and stevia leaves do not have a GRAS designation and the FDA hasn’t approved them for use in food products. Consumers can purchase a variety of processed stevia products, including ones formulated to resemble ordinary sugar, for use in everything from beverages to baked goods.

Though many people report consuming stevia without any obvious health changes, a percentage of people have reported experiencing unwanted side effects from the sweetener, including heart palpitations and digestion troubles. The new study focuses on the second matter, noting that stevia triggers changes in bacteria that may cause various gut health problems.

Though stevia wasn’t found to kill the gut bacteria, the study did note that this sweetener may interfere with the communication between different bacteria in one’s gut microbiome. This disruption may explain anecdotal reports from some consumers who report having experience stomach pain, gas, constipation, and more while using stevia, though more research is needed.

Dr. Karina Golberg, the study’s lead author, explained, “This is an initial study that indicates that more research is warranted before the food industry replaces sugar and artificial sweeteners with stevia and its extracts.”