low blood pressure

Beware! Too much licorice tea can cause hypertension even if you have low or normal blood pressure

October 6, 2023 By Trudy Scott 38 Comments

A 45-year-old woman presented to her general practitioner with a 4-month history of hot flushes, sweating and headaches. On examination, she was found to be hypertensive, and blood tests revealed mild hypokalaemia [low potassium].

While awaiting the results of further investigation into the cause of her elevated blood pressure, the patient conducted her own research and identified liquorice tea [licorice tea] as the potential cause of her symptoms. The patient had been drinking up to six cups of liquorice tea per day as a substitute for caffeinated tea and fruit-based infusions.

The patient immediately stopped consuming the drink and within 2 weeks her symptoms, hypertension and hypokalaemia, had entirely resolved.

This case report, Hypertension induced by liquorice tea, is eye-opening because this woman had always had low blood pressure and so she ignored the small print on the box that states “not advised for people with hypertension.”

I often see this caution about avoiding licorice if you have high blood pressure (hypertension). But I have yet to see a warning on a box of tea about the fact that licorice can actually cause high blood pressure with high consumption – even when your blood pressure is low or normal. I feel the latter aspect is not as well known, which is the reason for this blog.

I’m also sharing this case report and additional information because something similar has just happened to me (more on my story below).

Here are a few more facts about this patient’s case:

She went to her doctor “with a history of hot flushes, night sweats and headaches. These symptoms had started over the preceding 4 months. The patient suspected that her symptoms were due to the onset of menopause.”
Initially her blood pressure was 162/82 and “Repeat blood pressure measurement confirmed ongoing hypertension of 150/80 mm Hg”
“Blood tests demonstrated mild hypokalaemia” (i.e. low potassium of 3.3 mmol/L).
Two weeks after she stopped drinking the licorice tea, “repeat blood pressure measurement was 128/84 mm Hg and her hypokalaemia (and other symptoms) had resolved.”

I encourage you to read the entire published case report to get an understanding of the mechanisms of licorice mediating “its effect on blood pressure via the action of glycyrrhizin on the kidney.” And the impacts on sodium, potassium, aldosterone, cortisol/cortisone and blood pressure. I will add that this is one of many such case reports in the published research.

My story with elevated blood pressure after drinking Yogi Throat Comfort tea

As I mentioned above, I’m sharing this case report because something similar has just happened to me! I had been drinking Yogi Throat Comfort tea for just over a week to soothe my throat and help after my voice loss. It contains licorice root as well as slippery elm and other herbs.

My blood pressure is typically low at 110/80 or less (sometimes as low as 102/80) and last Friday it was 130/80 which is the highest it had ever been.

I didn’t make the connection to licorice right away because I had just flown internationally from Hawaii to Australia and we were sprayed with insecticide on the plane when we landed in Australia. We all had to sit there in the toxic soup for 10 minutes. (I’ll be sharing more about all this in a future blog).

I suffered severe vertigo the next day and it was at the doctor’s office that I found out my blood pressure was 130/80. I was very surprised but he felt it could be due to the travel or vertigo or voice issues. I also know that bereavement can have major physiological impacts and increased blood pressure is one of them (I was in Hawaii for my darling mom’s memorial).

I finally made the connection when my blood pressure measured 137/84 a few days later and stopped drinking the tea immediately. Over the next few days it came down to 127/93 and then 121/90 and then 118/84. I expect it to continue to come back down to my normal low blood pressure and will update this blog when it does.

As far as symptoms, I was just not feeling myself and had a strange feeling of apprehension, spaciness and breathlessness when talking too much. These are much improved having stopped the tea. My naturopath also recommended eating a banana each day to increase my potassium levels and to have epsom salt baths to help regulate the electrolytes in my body.

I will admit there are the above confounding/contributing factors – grief, voice loss, travel, vertigo, insecticide exposure – so I can’t be sure it’s only the licorice in the tea, and I’m not willing to test it out right now.

(Update Oct 13, 2023: A week later and it’s now pretty much back to my usual low blood pressure. Over the course of this last week it measured 125/82, 118/91, 127/84, 118/85 and today it’s 112/85. I will continue to track.)

How much licorice tea is too much?

The authors of the above case report mention this about the dose of glycyrrhizin:

Experimental studies have shown that the rise in blood pressure caused by liquorice follows a linear dose–response relationship. Doses of as little as 75 mg of glycyrrhizin (equivalent to 50 g of standard liquorice confectionery) given daily for a 2-week period have been shown to cause a significant increase in systolic blood pressure (the first number).
In a survey of 33 brands of liquorice tea, the mean glycyrrhizin content was found to be 126 mg/L (range 2–450 mg/L). A cup of liquorice tea with a volume of 250 mL could therefore be expected to contain, on average, approximately 31.5 mg of glycyrrhizin.”
The European Scientific Committee on Food advises that regular glycyrrhizin doses of 100 mg/day present a risk to health, and advocate a safe average daily intake of no more than 10 mg/person/day. This is an amount equivalent to less than half a cup of liquorice tea or just 6 g of liquorice confectionery daily.

In the above published case, the patient had been “averaging around 4–6 cups per day, and had been consuming the licorice tea for about a year.” She was “unwittingly consuming daily volumes of liquorice tea containing up to 190 mg of glycyrrhizin, well in excess of the recommended limit” of 10 mg per day. It was 8 months before she started to notice the adverse effects, but I do wonder how long she had high blood pressure.

We have a home blood pressure monitor but I haven’t used it for ages and if I hadn’t gone in to the doctor for my vertigo, my elevated blood pressure may have gone unnoticed for a while too.

How much did I consume: a total of 10 Yogi Throat Comfort tea bags over the course of a week. The day before leaving I had a few cups of hot tea and was thrilled to be able to talk on my last day there. I then drank it all day on the 15+ hour flight back: I had 2 tea bags in my 2 liter / 2 quart water bottle and filled it up a few times with cold water. And I continued to do this once I was home, having it next to my bed if I woke up coughing in the night. I was probably getting 3 or 4 times more than the safe average daily intake of 10 mg/person/day.

I love licorice tea and drink it from time to time, maybe 2-4 cups a month. I’m quite surprised it affected me so quickly but have never consumed this amount and in such a concentrated time period.

Will I drink Yogi Throat Comfort tea or other herbal teas that contain licorice?

For now, I think I will – the Throat Comfort tea helped so much with my voice – but when I do I will monitor my blood pressure carefully and then make a final decision.

I also plan to dig a bit further into some of the confounding factors I mention above to see how they could possibly have made me more susceptible.

I do also have dietary oxalate issues so this could play into the effects of glycyrrhizin on the kidney. I’m finding mixed results on the oxalate content of licorice: some papers say high and some say low. But I didn’t have any of my typical oxalate reactions such as painful feet or eyes. I have, however, noticed some stiffness in my left hip the last few days so will be looking further into this aspect.

(Update Oct 13, 2023: 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)

My takeaway messages – a warning and listen to your body

There is no licorice hypertension warning on this Yogi Throat Comfort tea box (or my Tulsi Licorice tea) and I do feel there should be 2 warnings: the usual warning about licorice if you have high blood pressure AND a general warning that licorice may also affect you if you have low or normal blood pressure.

My other takeaway message is this: listen to your body and get checked out when things don’t seem as they should be.

Has something like this happened to you? How much licorice tea did you consume, which brand and over what period?

Do you typically have low blood pressure and were you also caught by surprise?

Did you know about the caution to avoid licorice if you have high blood pressure?

And what about the fact that licorice may also affect you if you have low or normal blood pressure?

Feel free to share and ask your questions below.

GABA and taurine reduce high blood pressure: the anxiety connection and what do when on blood pressure medication or if blood pressure is already low

September 1, 2023 By Trudy Scott 18 Comments

Gamma-amino butyric acid (GABA) is an amino acid that used as a supplement to help ease physical anxiety and help with insomnia, and a host of other symptoms ranging from pain to throat spasms (you can see the most recent list of symptoms here)

Research shows that GABA lowers blood pressure too. This has implications if you have high blood pressure/hypertension and are currently taking blood pressure medication or if you happen to have low blood pressure. The latter is already a precaution I review with my clients i.e. to watch the use of GABA when blood pressure is low. But we do need to add another precaution to cover folks already on blood pressure medications. Read on to learn about these precautions and what they may mean for you, and to read about the GABA (and taurine) hypertension research. And the fact that anxiety is common when you have high blood pressure and can actually be a driving factor.

This paper, United States Pharmacopeia (USP) Safety Review of Gamma-Aminobutyric Acid (GABA), published in 2021, reports the results of a 4-week study that investigated the tolerability of GABA supplementation in mildly hypertensive but otherwise healthy adults:

The authors first established an optimum dose in mildly hypertensive subjects (SBP/systolic blood pressure between 130 and 180 mm Hg) who were randomized to receive oral doses of GABA at 0 (placebo), 20, 40, or 80 mg/day for 4 weeks.

An intake of 80 mg/day of GABA was associated with a significant reduction of the BP in adults with mild hypertension, and no adverse effects were reported.

A subsequent study evaluated long-term effects of GABA at 80 mg daily versus placebo in mildly hypertensive subjects for 8 weeks:

At the end of the 8-week study, SBP [systolic blood pressure i.e. the top number] and DBP [diastolic blood pressure i.e. the bottom number] were on average 5% lower in all the subjects who received 80 mg/day of GABA compared to participants in the placebo group whose blood pressure levels remained above normal.

This is a substantial reduction when 80 mg of GABA a day is considered a very low dose. I typically have my anxious clients start with 125mg GABA and increase from there. They may end up using 125 mg GABA 3 or 4 times a day and sometimes 250 mg a few times a day.

I’m not suggesting using only GABA or taurine (more on this below) when blood pressure is high as there can be many variables and root causes. I would, however, like to see GABA be given more consideration, especially when anxiety is a symptom too.

The existing GABA precautions: a new one if you are taking medication for high blood pressure

If you are currently taking blood pressure medication for high blood pressure and plan to do a trial of GABA, it’s worth monitoring your blood pressure and discussing with your prescribing doctor. GABA may lower your blood pressure enough that your medication can be reduced or possibly stopped. The above paper states this:

Because some studies showed that GABA was associated with decreases in blood pressure, it is conceivable that concurrent use of GABA with anti-hypertensive medications could increase risk of hypotension [low blood pressure].

I have now added this as a new precaution – High blood pressure and on blood pressure medications: GABA, taurine. You can see it on the Amino Acid Precautions blog.

The existing GABA precautions: watch when you have low blood pressure and don’t use when pregnant or nursing

As you can read in the amino acids chapter of my book and on the above precautions blog, there is already a precaution stating to watch the use of GABA when you have low blood pressure. It’s worth being aware of but is not something I’ve actually seen to be an issue. Occasionally folks reduce their GABA dose because they feel light-headed.

This precaution is already addressed – not to use GABA when pregnant or nursing – but it’s worth repeating here as it’s a frequent question I am asked . The above paper states:

Caution is advised for pregnant and lactating women since GABA can affect neurotransmitters and the endocrine system, i.e., increases in growth hormone and prolactin levels.

Taurine: hypertension, stroke and heart disease

You’ll notice taurine grouped with GABA on the list of precautions. Based on the research, this amino acid also helps reduce blood pressure and is cardio-protective: “Advances in extensive studies on experimental models indicate that taurine is preventive against hypertension, stroke and atherosclerotic arterial diseases.”

This is one of the proposed mechanisms of taurine for lowering blood pressure : “The preventive mechanisms of taurine were ascribed to sympathetic modulation for reducing blood pressure (BP) and anti-inflammatory action.” GABA works in a similar way.

The same precautions would apply: low blood pressure and high blood pressure with blood pressure medication.

As I mentioned above, there is more to hypertension than adding only taurine or GABA. This book by Dr. Mark Houston MD, is an excellent resource – What Your Doctor May Not Tell You About(TM): Hypertension: The Revolutionary Nutrition and Lifestyle Program to Help Fight High Blood Pressure (my Amazon link).

He does mention taurine and recommends 1 to 1.5 g of taurine twice a day for high blood pressure. He does not mention GABA supplementation but does mention how vitamin B6 is important for GABA and serotonin production and improving sympathetic function.

Stress, anxiety and fear affect blood pressure and GABA helps

Dr. Houston shares that “numerous studies have linked stress, anxiety, fear and other negative emotions to an elevation in blood pressure. Conversely, as stress decreases, so does blood pressure. ”

This supports my comments above about giving GABA more consideration when it comes to high blood pressure, especially when anxiety is a symptom too. Here are some cases studies:

When GABA is not available taurine is a viable option for anxiety and hypertension.

Resources if you are new to using amino acids as supplements

If you suspect low levels of any of the neurotransmitters and do not yet have my book, The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings, I highly recommend getting it and reading it before jumping in and using amino acids on your own so you are knowledgeable. And be sure to share it with the practitioner/health team you or your loved one is working with.

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control, sugar cravings, anxiety and mood issues.

The book doesn’t include product names (per the publisher’s request) so this blog, The Antianxiety Food Solution Amino Acid and Pyroluria Supplements, lists the amino acids that I use with my individual clients and those in my group programs. You can find them all in my online store.

If, after reading this blog and my book, you don’t feel comfortable figuring things out on your own (i.e. doing the symptoms questionnaire and respective amino acids trials), a good place to get help is the GABA QuickStart Program (if you have low GABA symptoms too). This is a paid online/virtual group program where you get my guidance and community support.

If you are a practitioner, join us in The Balancing Neurotransmitters: the Fundamentals program. This is also a paid online/virtual program with an opportunity to interact with me and other practitioners who are also using the amino acids.

If you have low blood pressure, has GABA (or taurine) been an issue for you?

Do you have high blood pressure and has GABA (or taurine) lowered it? If yes, how much did you use and how much did your blood pressure improve? And did you have to adjust your blood pressure medication (and which one)?

Has GABA (or taurine) helped ease your physical anxiety and other low GABA symptoms?

If you have questions and other feedback please share in the comments too.

Is DPA stimulating; can it be used with kids and someone with bipolar disorder; can it be used with a benzo/SSRI? (and other questions)

July 22, 2022 By Trudy Scott 12 Comments

DPA (d-phenylalanine) is an amino acid that destroys the enzyme that breaks down endorphins. Endorphins are feel-good chemicals that you experience with an endorphin rush when you go for a run or when someone gives you a big hug, when you show kindness to someone or someone does something nice for you. The amino acid DPA helps to raise your endorphins. With low endorphins you can feel very weepy, overly emotional, be extra sensitive to emotional pain, be sensitive to physical pain, and indulge in comfort/reward eating. Today I’m sharing some questions (and my feedback) as to whether it’s stimulating, can it be used with kids and someone with bipolar disorder, can it be used with a benzo/SSRI and more.

Misha has had success with DPA and wants to know if it is considered too stimulating. Here is her feedback and question:

I first tried DPA after reading about it on your blog and found it helpful for raising my mood. The DPA definitely helped curb my weepiness. I used Lidtke Endorphigen 1 cap/day. I have chronic Lyme which creates severe difficulty with sleep, anxiety and depression. Six months ago my neurologist took me off DPA saying it would be too stimulating to my nervous system.

I have since begun using DPA again; I really need the endorphin boost. Do you have any insights on whether DPA is considered stimulating? Whether it interferes with sleep (unfortunately my sleep is bad whether I take DPA or not)? Or suggestions for time of day to take it?

Here is my feedback for Misha: There is no evidence that DPA is too stimulating whereas DLPA (dl-phenylalanine) is known to be stimulating (it works like a combination of DPA and tyrosine).

And when I hear all this it tells me the person needs endorphin support:

“found it helpful for raising my mood”
“The DPA definitely helped curb my weepiness”
“I have since begun using DPA again; I really need the endorphin boost”

That said anything is possible which is why using the amino acids is based on the questionnaire and trials to see how a person responds. The best way to know if sleep is affected is to monitor sleep when using it and when not using it. She says her sleep is bad whether she takes DPA or not so I would recommend going back to her neurologist, sharing this information and the fact that it’s helping her so much. And look for other causes of her sleep issues.

Anna asks if DPA and other amino acids are safe for kids and how high doses? This is her question:

My 10 yr old has been diagnosed with social anxiety and she ticks off most of the boxes for low endorphins, low GABA, low serotonin. She’s very sensitive and very very emotional. We tried, but can’t seem to find a naturopath that can help her much. I feel after a while they all reach a dead end. I have been following you for a year and recently got your book. It looks relatively easy to follow, however I’m a bit reluctant, as she’s a kid.

My feedback: I work with women and once they have figured out the amino acids and neurotransmitter imbalances themselves they find it much easier to help their children who often have similar issues. When that is not the case working with a practitioner is ideal. That being said many moms become informed and educated enough to trial the amino acids on their own (like this mom who had her daughter use GABA with much success).

Anna says her daughter is very sensitive and very very emotional so I’d consider using 125 mg DPA to start (500 mg is an adult starting dose).With kids we also always start with dietary changes as laid out in my book. A good place to start is with a gluten-free and sugar-free diet and DPA (and the other amino acids) can help curb the cravings and feelings of deprivation.

Anon has bipolar disorder and likes comfort foods. This is her question:

I have bipolar disorder and wonder if the DPA will send me into a manic state. It’s one of the reasons I can’t take anti-depressants or stimulants otherwise I go manic. But I can eat for comfort so I only have food in the house I’m going to eat according to meal schedules. So I want to try the DPA.

Here is my feedback: I have not seen DPA to be an issue with bipolar disorder and it’s fabulous when you are a comfort-eater. If you have bipolar disorder and are on medications, it’s always advised to discuss new supplements with your prescribing doctor. You can share that DPA is not on the list of amino acids that have precautions with bipolar disorder.

I would not recommend the use of DLPA (dl-phenylalanine) with bipolar disorder because some of this increases dopamine (which can trigger a manic state).

Kristie is doing a benzodiazepine taper and would like to use DPA:

I am currently going through a benzo taper & there are numerous wonderful products that I am unable to mix with benzos. Would this be safe for me?

This is my feedback: I have not had issues with DPA with clients who are doing a benzo taper and there are no documented contraindications. DPA can help with some of the emotional blunting caused by benzos and the emotional fragility we often see during a benzo taper. I know some of the great benzo support groups say not to use GABA but I find it very helpful when tapering too.

The medication question is a common one. Someone else described her depression as weepy and is using the SSRI. There are also no documented contraindications when using DPA with a SSRI. But again, best to discuss with the prescribing doctor.

Arleen has a question about blood pressure and the DPA product I recommend (Lidtke Endorphigen):

1) Is this product gluten free and 2) What effect if any would it have on blood pressure (mine is naturally low)

Here is my feedback: Lidtke Endorphigen is gluten-free and I have not seen it or other DPA products to be an issue with low blood pressure.

Jan wants to use GABA and DPA. She asks:

Can I use Gaba 125mg and also take DPA? Would either offset the other?

If someone has low GABA symptoms and GABA helps with the physcal anxiety and they also have low endorphin symptoms and DPA helps then they are absolutely fine to use together and even at the same time. However, I have clients trial one at a time in order to find the ideal dose and so you know how each one is working.

Resources if you are new to using the amino acids as supplements

If you are new to using any of the amino acids as supplements, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see all the symptoms of neurotransmitter imbalances, including low endorphins).

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control, sugar cravings, self-medicating with alcohol and more.

The book doesn’t include product names (per the publisher’s request) so as mentioned above, this blog, The Antianxiety Food Solution Amino Acid and Pyroluria Supplements, lists the amino acids that I use with my individual clients and those in my group programs.

As mentioned above, Lidtke Endorphigen is the DPA product I’ve had the most success with (and it can be found in my online store). Doctor’s Best D-phenylalanine is also a good product.

If, after reading this blog and my book, you don’t feel comfortable figuring things out on your own (i.e. doing the symptoms questionnaire and respective amino acids trials), a good place to get help is the GABA Quickstart Program (if you have low GABA symptoms). This is a paid online/virtual group program where you get my guidance and community support. There are many moms in the program who are having much success with their kids.

You can then use this knowledge to then trial DPA and other amino acids or move on to the Amazing Aminos for Anxiety Program and get help there.

Have you used DPA with success and if yes how has it helped?

If you’re a practitioner, do you use DPA with your clients/patients?

If you have questions please share them here too.