A 54 year-old man died recently from eating too much licorice. Hard to believe right? It is true. This was reported in The New England Journal of Medicine and on the news. The man was a construction worker from Massachusetts. He lost consciousness inside a fast-food restaurant and was taken to a hospital, where he died the next day.

Doctors wrote that he had “a poor diet, consisting primarily of several packages of candy daily.” Three weeks before his death he switched from eating fruit-flavored soft candy to licorice candy, which contained glycyrrhizic acid. Eating more than 57 gram (2 ounces) of black licorice for at least 2 weeks could lead to potentially serious health problems, such as an increase in blood pressure and an irregular heart rhythm (arrhythmia).

The adverse effects are due to glycyrrhizin, a compound found in licorice root that is between 30 and 50 times sweeter than sugar and can alter your body’s level of potassium and sodium, which help regulates body fluid.

Too much glycyrrhizin can lead to problems, such as high blood pressure, fluid retention, muscle weakness and heart rhythm abnormalities (arrhythmia).

Licorice is a very well known herb in traditional Chinese medicine. In China, it is called “gancao” (meaning “sweet grass”) and has been recorded in the Shennong’s Classic of Matreia Medica around 2100 BC. In this book, licorice was supposed to have life-enhancing properties. During the following thousands of years licorice has been present in most of Chinese traditional prescriptions. It was believed to have the functions of nourishing qi, alleviating pain, tonifying spleen and stomach, eliminating phlegm, and relieving coughing. Licorice extract has always been recognized as a sweetener and thirst quencher. Its nutritive value is overrated by many who consume significant amounts and are prone to complications.

No matter how old you are, you should avoid eating large amounts of black licorice over a short space of time.

If you have been eating a lot of black licorice and have heart palpitations, muscle weakness or other health-related problems, stop eating it immediately and seek medical advice.

Black licorice can interact with some medications, herbs and dietary supplements. Get the advice from a GP or pharmacist if you have questions about possible interactions with a medication or supplement you’re taking.

Glycyrrhizic acid, or glycyrrhizin, a sweetening compound derived from licorice root, can cause a drop in potassium levels in the body, which in turn may cause high blood pressure, swelling, abnormal heart rhythms and even heart failure, according to the FDA.

“While black licorice is safe in small quantities, it can be dangerous when consumed in large amounts or even in more moderate amounts on a regular basis,” Dr. Jacqueline Boykin Henson told CNN. She cared for the subject of the study as an internal medicine resident physician at Massachusetts General Hospital, and is now a gastroenterology fellow at Duke University.

The patient was not suffering from underlying conditions that would have had an impact on what happened to him, Dr. Boykin Henson noted. The negative effects of eating too much licorice are reversible, and disappear when consumption is interrupted. A return to normal potassium levels may take one to two weeks, and some of the hormonal imbalances and effects on blood pressure can take months to normalize, Dr. Boykin Henson explained.

The FDA cautions that even 2 ounces per day, over a two-week period, could cause irregular heart rhythm and may require hospitalization.

Licorice daily (for two weeks or more), you can run into health problems. the amount of glycyrrhizin you would be consuming, can cause potassium levels to drop, leading to abnormal heart rhythms, high blood pressure, swelling, lethargy, and over time to congestive heart failure. If you stop eating licorice, potassium levels go back to normal with no apparent aftereffects on health. In 2011 the FDA issued a pre-Halloween warning about the potential  dangers of eating too much licorice and noted that several medical journals had linked black licorice to health problems in people over 40, some of whom already had a history of heart disease or high blood pressure. (red licorice usually contains no licorice, but you should always check labels).

ANISE OIL

NOTE, however, that while licorice is sometimes used as a flavoring in food, including candy, the FDA notes that most “licorice” or “licorice flavor” products available in the U.S. do not contain any licorice at all. Instead, manufacturers use anise oil, which has a very similar smell and taste. Anise does not contain glycyrrhizin.

NOTE: a dietary supplement called DGL (deglycyrrhizinated licorice), which is licorice with the glycyrrhizin removed, for digestive problems including chronic indigestion, heartburn, stomach ulcers and canker sores. It is available as chewable tablets, wafers, capsules, tea and powder. DGL has no side effects and does not interact adversely with prescribed medications you may be taking. You can take DGL as long as necessary. 

Dr. Andrew Weil, recommends whole licorice extract for menstrual and menopausal disorders and inflammatory disorders, as well as herpes, eczema and psoriasis. Whole licorice is available as roots, extracts and topical preparations, but these products should be used prudently. Overdoses of glycyrrhizin can also trigger sodium and water retention and increase blood pressure. Avoid whole licorice or licorice root if you have high blood pressure, kidney or liver disease, diabetes or heart disease, if you are using diuretics, and during pregnancy. In addition be aware that whole licorice taken orally may increase the effects of certain drugs including corticosteroids, digitalis preparations (used to treat congestive heart failure and heart rhythm problems), and estrogens/progesterone; it can also decrease the effect of some blood pressure medications. Do not take licorice root for longer than six weeks. No such interactions occur with DGL.

Licorice overconsumption should be suspected in people presenting with otherwise unexplained hypokalaemia and muscle weakness. The cortisol:cortisone ratio in the peripheral venous plasma is raised and there is a reduction in plasma renin and aldosterone levels.

Sensitivity to glycyrrhizin is increased by prolonged gastrointestinal transit time, hypertension, and older age, and is more common in females.

Interactions with medications are possible with licorice and fludrocortisone due to mineralcorticoid effects, and with licorice and medicines that deplete potassium levels such as diuretics. Patients taking these medications should avoid regular consumption of licorice. Consult with your pharmacy and your primary care providers.