Licorice, today chiefly utilized as a flavoring additive in tea, tobacco and candy, is one of the oldest used herbs for medicinal purposes and consists of up to 300 active compounds.
The main active constituent of licorice is the prodrug glycyrrhizin, which is successively converted to 3β-monoglucuronyl-18β-glycyrrhetinic acid (3MGA) and 18β-glycyrrhetinic acid (GA) in the intestines.
Despite many reported health benefits, 3MGA and GA inhibit the 11-β-hydrogenase type II enzyme (11β-HSD2) oxidizing cortisol to cortisone. Through activation of mineralocorticoid receptors, high cortisol levels induce a mild form of apparent mineralocorticoid excess in the kidney and increase systemic vascular resistance.
Continuous inhibition of 11β-HSD2 related to excess licorice consumption will create a state of hypernatremia [high sodium], hypokalemia [low potassium] and increased fluid volume, which can cause serious life-threatening complications especially in patients already suffering from cardiovascular diseases.
The above is from the paper, Bioactive Candy: Effects of Licorice on the Cardiovascular System and builds on the recent licorice-hypertension blog, showing a “correlation between licorice intake, the renin-angiotensin-aldosterone-system and licorice-induced adverse effects on the cardiovascular system.”
Correlation between licorice intake, the renin-angiotensin-aldosterone-system and licorice-induced adverse effects on the cardiovascular system
From: Bioactive Candy: Effects of Licorice on the Cardiovascular System
Adverse effects on the heart
As you can see from the above image, there are many ways that licorice intake can adversely affect the heart.
Most folks are aware of the issues with licorice causing high blood pressure and some folks know it can lower potassium. However, many folks are not aware of some of these more severe cardiovascular consequences caused by high blood pressure and severely low potassium:
Hypertension is one of the major concerns for our healthcare system and was the leading contributor to premature death in 2015. It has been proven to be a major risk factor of cardiovascular diseases.
Some of the mechanisms include “increased stiffness of large arteries” and “pulmonary edema …caused by the sodium retaining effect of licorice” (this is high blood pressure in your pulmonary arteries, which carry oxygen-poor blood from your heart to your lungs. The earliest symptom is shortness of breath during your usual routine).
In addition to hypertension, the paper mentions the following:
- “Cardiac arrhythmias are the most serious side effect caused by licorice intake due to severe hypokalemia” (i.e. irregular heartbeat due to low potassium).
- “Depletion of the body’s potassium stores can cause a prolongation of the QT interval, which is closely connected with ventricular arrhythmias and tachycardia” (i.e. abnormal heartbeats and increased heart rate).
- “As a consequence, several patients experienced a cardiac arrest with a subsequent recovery.”
I encourage you to read the entire paper in order to fully understand the “correlation between licorice intake, the renin-angiotensin-aldosterone-system and licorice-induced adverse effects on the cardiovascular system.”
Who may be more susceptible to the adverse impacts of licorice intake?
There are many documented health benefits of licorice and the above paper outlines how it may even benefit the heart. However some folks are more susceptible to the adverse effects and the above paper shares who may be more adversely impacted by licorice intake:
- People aged over 40
- Patients with a history of cardiac disease (and high blood pressure). I’ll also add those with family members with heart or blood pressure issues
- Patients who are on medicines lowering potassium levels (such as thiazide or loop diuretics)
- Patients treated with antihypertensive drugs such as ACE-inhibitors and diuretics
- Patients suffering from diarrhea or alcoholism, which can worsen hypokalemia
- Patients with congestive heart failure or resistant hypertension
- Patients taking digoxin or warfarin to avoid the risk of toxicity
The authors also state that “women seem to be more susceptible to licorice intake. A possible explanation for this gender difference are many other hormonal (estrogenic and antiandrogenic) effects exhibited by licorice in addition to its activity via mineralocorticoid receptor.” And that licorice should also be avoided during pregnancy “because the conversion of cortisone into cortisol plays an important role in lung maturation.”
These other possible factors from this paper, Licorice abuse: time to send a warning message, should also be considered:
- Patients with less common causes of hypokalemia that include Cushing syndrome, Conn’s syndrome and Anorexia nervosa
- Patients with prolonged gastrointestinal transit time (The amount of glycyrrhetic acid reabsorbed depends on its transit through the small and large intestines, therefore patients with prolonged gastrointestinal transit times are more prone to toxicity after repeated intake)
And I’d add these as factors to consider too:
- Someone with known high cortisol levels
- Someone with dietary oxalate issues and/or kidney issues. Licorice tea is listed as low oxalate on the Trying Low Oxalates Facebook group but they will be updating their spreadsheet based on a paper I just shared with them – Oxalate in Foods: Extraction Conditions, Analytical Methods, Occurrence, and Health Implications “Licorice was the highest-oxalate food reported in this review with 3569.3 mg total oxalate/100 g FW (fresh weight).” (this is higher than spinach, sweet potatoes and rhubarb which are really high oxalate)
As with everything, there is no one-size fits all and we need to be diligent about what works for us and what can cause issues.
What are the lasting cardiovascular effects of high blood pressure caused by drinking up to 6 cups of licorice tea a day?
As I shared on the recent licorice-hypertension blog, high blood pressure is one of the many cardiovascular issues with licorice – Beware! Too much licorice tea can cause hypertension even if you have low or normal blood pressure
In that case report, Hypertension induced by liquorice tea, a 45-year-old woman with hot flushes, sweating and headaches, was found to have high blood pressure and low potassium (mild hypokalemia) when she visited her doctor.
She had been drinking up to six cups of liquorice/licorice tea per day and within 2 weeks of stopping this, all her symptoms, the hypertension and the hypokalemia entirely resolved.
This case report is eye-opening because she had always had low blood pressure. I share more about this, my concerns and a very similar incident that I experienced when drinking Throat Calm tea – on the above blog.
What I do want to add is this woman’s concern about possible longer term effects. She says this: “I don’t know if I’ve had any lasting effects on my body by drinking this tea on a daily basis for over a year.” Hopefully her medical team explained much of what I’ve shared here and she was given a thorough cardiovascular work-up.
My cautions for consuming licorice in any form
I am of the opinion that licorice should be treated like the medicinal/therapeutic herb that it is and only be used when working with a knowledgeable practitioner.
This statement in this paper, The cardiovascular complications of licorice, sums up my beliefs:
The health benefits of licorice are minor compared to the adverse outcomes of chronic use which is never justified nor recommended. The long-established belief among the community that licorice is a natural healthy substance free of side effects promotes its liberal consumption and predisposition to toxicity.
I recommend ongoing blood pressure home monitoring if you regularly consume licorice in any form. I also recommend looking at the list of factors that may make you more susceptible to the adverse effects of licorice and discussing these with your practitioner.
I’d also encourage a thorough cardiovascular work-up for anyone who has observed high blood pressure and/or low potassium after consuming licorice for any duration. My blood pressure increased from 110/80 to 137/84 in just a week and it concerned me enough that I went to the doctor to get my potassium checked (it was in range but was only tested 10 days after I quit the licorice tea). I’ll also be discussing all this with my cardiologist and I’ll update this blog when I learn more.
Learning about all this and reading all this research – together with my personal experience and feedback from my community – has been eye-opening to me and hopefully these licorice blogs will help to create more awareness.
Has intake of licorice from tea, candy, herbal products, cough medicines and even smoking cigarettes caught you by surprise?
How much licorice did you consume and over what period?
Did you know about the caution to avoid licorice if you have high blood pressure? What about if you have low blood or normal pressure?
Are you more susceptible to the adverse impacts of licorice intake? And which factors do you suspect played a part if you had issues?
Feel free to share and ask your questions below.
Licorice root seems to be ubiquitous in many combination herbal teas, tinctures and remedies. The actual amount is not always stated, as the licorice is bundled with other herbs in a “proprietary” formula. Are there any guidelines as to max safe intake per day? There’s a little bit in a lot of things, and I’d like to know more about “how much is too much”. Perhaps I should eliminate all forms of licorice to test its effects on my blood pressure. Thank you for bringing to light this important topic!!
Bobbie Jo
Agreed and this is concerning to me – in everything, no actual amounts AND not enough in the way of warnings.
I have a section: How much is too much? on the other blog https://www.everywomanover29.com/blog/beware-too-much-licorice-tea-can-cause-hypertension-even-if-you-have-low-or-normal-blood-pressure/
My advice right now is if someone is consuming any licorice in any form is ongoing blood pressure home monitoring.
And to look at factors that may make you susceptible to the adverse impacts of licorice intake. Feel free to share which ones apply to you.
I am curious to hear where you are getting your licorice from? Feel free to mention brands. And what your blood pressure is?
Trudy
Thanks for your response!
My blood pressure can run inexplicably high. I will begin monitoring it once again while being even more diligent about licorice lurking in herbal teas.
A quick glance at most “sleep,” “immune-boosting” and “relaxing” teas on my own shelves shows licorice root as one of the ingredients, including many top-rated organic brands, such as Organic India, Traditional Medicinals and Yogi teas. As noted, specific amounts are rarely listed. Before reading your most recent blog, I had heard that licorice root might be “energizing” to some people, which may correspond to the high blood pressure concerns.
I’ve also been taking a new product called DNA Drops, which features distilled plant essences into a lozenge. Licorice root is featured on many of these products, which range from relaxation to mood balancing to metabolic support. I intend to query the company about this ingredient.
I do try to avoid taking anything including licorice at night now. Will update with my blood pressure later tonight.
Thanks for enlightening us as always!!
Bobbie Jo
I look forward to updates on your blood pressure (now and once you stop licorice intake) and what you hear from the company producing these DNA drops.
And yep to all these tea companies – I intend to reach out to them too
So is DGL dangerous to take for some people and bad for your heart ?
Caroline
Someone asked this question on the other blog
I’ve been taught that DGL does not cause the same issues… “A processed licorice extract, deglycyrrhizinated licorice (DGL), which is used in the treatment of peptic and aphthous ulcers, is made by removing the glycyrrhizin molecule” and it “produces equally effective results compared with glycyrrhetinic acid but is free from any side effects.”
The above is from a chapter in the Textbook of Natural Medicine by Michael T. Murray, ND https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7348626/
However another recent case report documents similar problems with DGL: “The patient had been ingesting a significant quantity of deglycyrrhizinated licorice for many years to alleviate postprandial epigastric pain.” He was consuming a very high dose: “He admitted that for the past 6-8 months he was consuming up to 20 licorice root 760 mg tablets a day, well exceeding the acceptable daily allowance (2280 mg).” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8369979/ I have reached out to the authors to get more details
Based on this I recommend discussing long-term intake with the doctor and/or naturopath and monitoring blood pressure, potassium levels and symptoms. And looking at what may make you more susceptible.
Thank you for explaining, it is so helpful !
I know this may not be appropriate question at this time.
But I have to ask and hope for the best.
Finders crossed, here goes.
I am in the UK having tried various therapies to help me recover/get over Panic Attacks/Agoraphobia.
I wondering if my diet could be the cause and then could be the cure.
I have been basically house bound for over 30yrs. I have read about the virtues of GABA etc but in the UK it is banned. I don’t know why?
I have removed refined sugar, wheat, yeast and gluten but still I don’t feel any improvement.
Any suggestions please?
Regards
Douglas Rutherford
Scotland
UK.
Douglas
These changes are a great start – well done! – but keep in mind that sugar and gluten can cause nutritional deficiencies which also need to be addressed – like low zinc, low B vitamins, low serotonin, low GABA etc. And they are also likely to damage to the gut, cause inflammation, affect the adrenals etc. We also need to add nutrient dense real whole foods like quality animal protein, organic fruit/veg, healthy fats and eat for blood sugar control.
I encourage you to work through everything I discuss in my book “The Antianxiety Food Solution” https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/
And to to start with these 2 symptoms questionnaires 1) Amino Acids Mood Questionnaire https://www.everywomanover29.com/blog/amino-acids-mood-questionnaire-from-the-antianxiety-food-solution/ and 2) the Pyroluria qustionnaire https://www.everywomanover29.com/blog/pyroluria-questionnaire-from-the-antianxiety-food-solution/
GABA can be purchased via mailorder
Thanks Trudy.
This is such a minefield, as I have always thought this was psychological problem and couldn’t get my head round that was something/s that I am consuming or lack of.
My wife bought your book on Kindle.
Douglas
Glad you have my book! Diet, nutrients, gut health, toxins, infections etc when it comes to mental health is huge and awareness (and all the research) is increasing – but yes it’s challenging to get your head around this especially when many psychologists and medical professionals are still unaware.
Oh I meant to write.
Can you suggest a GABA supplier (online)that ships to the UK?
Douglas
You can purchase from iherb – use this link to save 5% https://www.iherb.com/?rcode=BAN2021
I saw this in myself. I put a teaspoon of Licorice root powder in my drinks 3 times a day( it was so yummy!) and it increased my blood pressure. As soon I stopped using it, my blood pressure when down. I’m 54 and have no history of heart or blood pressure issues but they run in my family.
Michelle
Thanks for sharing and yes it is yummy which is why it’s added to so many beverages, herbal teas, medicines, herbal tinctures etc.
May I ask what drinks you added it to and what licorice powder root product you used (it’s fine to mention the brand)
And what shift did you see in your blood pressure and over what period?
Feel free to share which factors may have made you susceptible to the adverse impacts of licorice intake. I am going to add “family heart or blood pressure issues” to the list
Isn’t this why it’s always recommended to only use Licorice 2wks on the 2wks off?
B
May I ask where you’ve seen this warning/caution? It’s new to me.
Unfortunately you can have problems after 2 weeks too – Daily Liquorice Consumption for Two Weeks Increases Augmentation Index and Central Systolic and Diastolic Blood Pressure https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4143270/
As you can see in this post, “Beware! Too much licorice tea can cause hypertension even if you have low or normal blood pressure” https://www.everywomanover29.com/blog/beware-too-much-licorice-tea-can-cause-hypertension-even-if-you-have-low-or-normal-blood-pressure/ I had issues after just one week.
In the winter, I have been drinking powdered carob, cacao and licorice as a hot tea.
Is this a problem?
Thanks,
Cathe’
Gold Country WAPF Chapter Leader
Cathe’
My advice right now is if someone is consuming any licorice in any form is to do ongoing blood pressure home monitoring.
And to look at factors that may make you susceptible to the adverse impacts of licorice intake. Feel free to share which ones may apply to you.
May I ask what licorice powder root product you use (it’s fine to mention the brand) and how much you drink in a day? Have you seen any increase in blood pressure?
One other thing to keep in mind is that carob, cacao and licorice are all very high oxalate.
Good point of those three being high im oxalates.
I would drink about 24 Oz a day of hot water with cinnamon and 1/2 tsp of each the three with raw milk or cream.
The licorice is in bulk from Mountain Rose Herbals.
Cathe’
Thanks for the additional info.
I see this on the Mountain Rose Herbals site “Precautions: Not for use in pregnancy except under the supervision of a qualified healthcare practitioner. Not for use in persons with hypertension, liver disorders, edema, severe kidney insufficiency, low blood potassium, or heart disease. We recommend that you consult with a qualified healthcare practitioner before using herbal products, particularly if you are pregnant, nursing, or on any medications.” https://mountainroseherbs.com/licorice-root-powder
I’d like to see these precautions include more and recommend ongoing blood pressure monitoring.
I’m curious to hear about your blood pressure and if you have factors that may make you susceptible to the adverse impacts of licorice intake?
She was drinking 6 cups a day – that seems like a lot. What about de-glycerrizzed products for gut hess as lung?
*gut healing
Karla
Yes it was a lot and she drank this much for a year
But as you can see in this post, “Beware! Too much licorice tea can cause hypertension even if you have low or normal blood pressure” I had issues after just one week. https://www.everywomanover29.com/blog/beware-too-much-licorice-tea-can-cause-hypertension-even-if-you-have-low-or-normal-blood-pressure/
I address the DGL question for Caroline
Trudy, you are on point with your concerns and lack of warning labels. I actually received this email/blog when I was sitting in the ER with my father for hypertension in the systolic 230s. He was taking licorice for shingles recovery.
I had this on hand to take for detox and premenopause issues and I am now making connections with my own recent hypertensive episodes.
Thank you for your diligent research and sharing this on your blog!! I also appreciate your book, very well done.
Sonya
Gosh I’m sorry to hear about your father but glad he’s in the ER being taken care of. Be sure to read the actual published case I shared in the other blog (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480140/) so you can ask relevant questions.
This DGL case is helpful too https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8369979/ The good news is that “the licorice-induced mineralocorticoid excess is reversible; however, the associated suppressed enzyme processes have different rates of recovery. Since licorice was withdrawn, 11-hydroxysteroid dehydrogenase activity was inhibited for two weeks. The renin-aldosterone system’s basal production, on the other hand, remained poor for several months after licorice withdrawal. It can be treated with the cessation of licorice consumption and potassium replacement. Potassium-sparing diuretic, spironolactone, and dexamethasone should be consumed.”
I’m glad you made the connections for yourself too.
When you get a chance please share more details about you and your father if you’re comfortable doing so – what products, how much, for how long, before and after BP and which factors you feel may make you more susceptible. I plan to do more blog posts and having specifics will be helpful for me and those in my community.
Thanks for your kind words 🙂
What about people who have low cortisol production — could licorice be a healthier supporter of the adrenals than taking corticosteroids?
Lily
I am aware of licorice being used for this purpose and for very low blood pressure – “Licorice has also been used in the treatment of the chronic fatigue syndrome and of Addison’s disease, especially before the discovery of fludrocortisone: these effects are due to the reduced inactivation of cortisol in cortisone through the block of 11HSD2, even when cortisol production is reduced, and to the binding to the MR.” https://www.frontiersin.org/articles/10.3389/fendo.2019.00484/full
It would need to be used under medical supervision with very careful monitoring of cortisol, blood pressure, potassium, aldosterone etc.