Licorice abuse: Time to send a warning message

Therapeutic Advances in Endocrinology and Metabolism

Volumn 3, Issue 4, 2012, Pages 125-138

  Omar, Hesham R ^a   Komarova, Irina ^a   Abdelmalak, Hany D ^a   Yerramadha, Muralidhar Reddy ^a   Ali, Yaseen ^a   Ghonemi, Mohamed ^b   Rashad, Rania ^b   Fathy, Ahmed ^c   Helal, Engy ^d   Camporesi, Enrico M ^e  

^a MERCY HOSPITAL AND MEDICAL CENTER   (United States)

^b CAIRO UNIVERSITY   (Egypt)

^c HEART INSTITUTE   (Egypt)

^d Elagouza Hospital   (Egypt)

^e UNIVERSITY OF SOUTH FLORIDA   (United States)

Author keywords

glycyrrhizin; hyperaldosteronism; hypokalemic myopathy; Licorice; pseudo hyperaldosteronism

Indexed keywords

11BETA HYDROXYSTEROID DEHYDROGENASE 2; ALDOSTERONE; DIGOXIN; GLYCYRRHETINIC ACID; GLYCYRRHIZA EXTRACT; GLYCYRRHIZIC ACID; HYDROCORTISONE; MINERALOCORTICOID; POTASSIUM; SODIUM; SWEETENING AGENT; WARFARIN;

AWARENESS; DIET SUPPLEMENTATION; EATING HABIT; ENZYME INHIBITION; FOOD AND DRUG ADMINISTRATION; FOOD INTAKE; GLYCYRRHIZA; HEALTH HAZARD; HERBAL MEDICINE; HUMAN; INGESTION; INTERNET; NONHUMAN; NUTRITIONAL VALUE; PRIORITY JOURNAL; PUBLICATION; REVIEW; TELEVISION; TRADITIONAL MEDICINE;

EID: 84864663042     PISSN: 20420188     EISSN: 20420196     Source Type: Journal    
DOI: 10.1177/2042018812454322     Document Type: Article

References (100)

1. Agarwal A. Gupta D. Yadav G. Goyal P. Singh P. Singh U. (2009) An evaluation of the efficacy of licorice gargle for attenuating postoperative sore throat: a prospective, randomized, single blind study. Anesth Analg 109: 77–81.
2. Armanini D. Calò L. Semplicini A. (2003) Pseudohyperaldosteronism: pathogenetic mechanisms. Crit Rev Clin Lab Sci 40: 295–335.
3. Armanini D. Castello R. Scaroni C. Bonanni G. Faccini G. Pellati D. et al. (2007) Treatment of polycystic ovary syndrome with spironolactone plus licorice. Eur J Obstet Gynecol Reprod Biol 131: 61–67.
4. Armanini D. de Palo C. Mattarello M. Spinella P. Zaccaria M. Ermolao A. et al. (2003) Effect of licorice on the reduction of body fat mass in healthy subjects. J Endocrinol Invest 26: 646–650.
5. Armanini D. Lewicka S. Pratesi C. Scali M. Zennaro M. Zovato S. et al. (1996) Further studies on the mechanism of the mineralocorticoid action of licorice in humans. J Endocrinol Invest 19: 624–629.
6. Armanini D. Mattarello M. Fiore C. Bonanni G. Scaroni C. Sartorato P. et al. (2004) Licorice reduces serum testosterone in healthy women. Steroids 69: 763–766.
7. Arola O. (2003) Black arrhythmias. Duodecim 119: 2145–2147.
8. Bannister B. Ginsburg R. Shneerson J. (1977) Cardiac arrest due to liquorice induced hypokalaemia. Br Med J 2: 738–739.
9. Baron J. (1983) Side-effects of carbonoxolone. Acta Gastroenterol Belg 46: 469–484.
10. Basso A. Dalla Paola L. Erle G. Boscaro M. Armanini D. (1994) Licorice ameliorates postural hypotension caused by diabetic autonomic neuropathy. Diabetes Care 17: 1356
11. Bernardi M. D'Intino P. Trevisani F. Cantelli-Forti G. Raggi M. Turchetto E. et al. (1994) Effects of prolonged ingestion of graded doses of liquorice by healthy volunteers. Life Sci 55: 863–872.
12. Bijlsma J. van Vloten P. van Gelderen C. Mensinga T. Mout H. Elvers L. et al. (1996) Study into the effects of different dosages of glycyrrhizin in health female volunteers; in Dutch. RIVM report no. 348801004, RIVM, Bilthoven, The Netherlands.
13. Blachley J. Knochel J. (1980) Tobacco chewer's hypokalemia: licorice revisited. N Engl J Med 302: 784–785.
14. Böcker D. Breithardt G. (1991) Induction of arrhythmia by licorice abuse. Z Kardiol 80: 389–391.
15. Bramont C. Lestradet C. Godart L. Faivre R. Narboni G. (1985) Cerebral vascular accident caused by alcohol-free licorice. Presse Med 14: 746.
16. Calò L. Zaghetto F. Pagnin E. Davis P. de Mozzi P. Sartorato P. et al. (2004) Effect of aldosterone and glycyrrhetinic acid on the protein expression of PAI-1 and p22(phox) in human mononuclear leukocytes. J Clin Endocrinol Metab 89: 1973–1976.
17. Campana A. Manzo M. Brigante M. Marrazzo N. Melchiorre G. (2003) An unusual cause of cardiac arrest. Ital Heart J Suppl 4: 510–513.
18. Caradonna P. Gentiloni N. Servidei S. Perrone G. Greco A. Russo M. (1992) Acute myopathy associated with chronic licorice ingestion: reversible loss of myoadenylate deaminase activity. Ultrastruct Pathol 16: 529–535.
19. Cartier A. Malo J. Labrecque M. (2002) Occupational asthma due to liquorice roots. Allergy 57: 863.
20. Cayley F. (1950) Potassium deficiency in p-aminosalicylic acid therapy: cardiac and paralytic effects. Lancet 1: 447–448.
21. Chamberlain J. Abolnik I. (1997) Pulmonary edema following a licorice binge. West J Med 167: 184–185.
22. Chamberlain T. (1970) Licorice poisoning, pseudoaldosteronism and heart failure. JAMA 213: 1343.
23. Chintharlapalli S. Papineni S. Jutooru I. McAlees A. Safe S. (2007) Structure-dependent activity of glycyrrhetinic acid derivatives as peroxisome proliferator-activated receptor [gamma] agonists in colon cancer cells. Mol Cancer Ther 6: 1588–1598.
24. Crampton J. (1961) Glycyrrhizinophilia as a cause of edema. Bull Mason Clin 15: 89–92.
25. Crean A. Abdel-Rahman S. Greenwood J. (2009) A sweet tooth as the root cause of cardiac arrest. Can J Cardiol 25: 357–358.
26. de Klerk G. Nieuwenhuis M. Beutler J. (1997) Hypokalaemia and hypertension associated with use of liquorice flavoured chewing gum. Br Med J 314: 731–732.
27. Dobbins K. Saul R. (2000) Transient visual loss after licorice ingestion. J Neuroopthalmol 20: 38–41.
28. Dong S. Inoue A. Zhu Y. Tanji M. Kiyama R. (2007) Activation of rapid signaling pathways and the subsequent transcriptional regulation for the proliferation of breast cancer MCF-7 cells by the treatment with an extract of Glycyrrhiza glabra root. Food Chem Tox 45: 2470–2478.
29. Epstein M. Espiner E. Donald R. Hughes H. (1977) Liquorice toxicity and the renin-angiotensinaldosterone axis in man. Br Med J 1: 209–210.
30. Eriksson J. Carlberg B. Hillörn V. (1999) Life-threatening ventricular tachycardia due to liquorice-induced hypokalaemia. J Intern Med 245: 307–310.
31. Farese S. Kruse A. Pasch A. Dick B. Frey B. Uehlinger D. et al. (2009) Glycyrrhetinic acid food supplementation lowers serum potassium concentration in chronic hemodialysis patients. Kidney Int 76: 877–884.
32. Fenwick G. Lutomski J. Nieman C. (1990) Liquorice, Glycyrrhiza glabra L. – composition, uses and analysis. Food Chem 38: 119–143.
33. Francini-Pesenti F. Puato M. Piccoli A. Brocadello F. (2008) Liquorice-induced hypokalaemia and water retention in the absence of hypertension. Phyto ther Res 22: 563–565.
34. Fraunfelder F. (2004) Ocular side effects from herbal medicines and nutritional supplements. Am J Ophthalmol 138: 639–647.
35. Funder J. Pearce P. Smith R. (1988) Mineralocorticoid action: target tissue specificity is enzyme, not receptor mediated. Science 243: 583–585.
36. Gross E. Dexter J. Roth R. (1966) Hypokalemic myopathy with myoglobinuria associated with licorice ingestion. N Engl J Med 274: 602–606.
37. Hall R. Clemett R. (2004) Central retinal vein occlusion associated with liquorice ingestion. Clin Exp Ophthalmol 32: 341.
38. Harada T. Ohtaki E. Misu K. Sumiyoshi T. Hosoda S. (2002) Congestive heart failure caused by digitalis toxicity in an elderly man taking a licorice-containing Chinese herbal laxative. Cardiology 98: 218.
39. Harris J. (2000) Lethal licorice. Aust Nurs J 7: 1–3.
40. Hasegawa J. Suyama Y. Kinugawa T. Morisawa T. Kishimoto Y. (1998) Echocardiographic findings of the heart resembling dilated cardiomyopathy during hypokalemic myopathy due to licorice-induced pseudoaldosteronism. Cardiovasc Drugs Ther 12: 599–600.
41. Hattori M. Sakamoto T. Yamagishi T. Sakamoto K. Konishi K. Kobashi K. et al. (1985) Metabolism of glycyrrhizin by human intestinal flora. II. Isolation and characterization of human intestinal bacteria capable of metabolizing glycyrrhizin and related compounds. Chem Pharm Bull (Tokyo) 33: 210–217.
42. Heard K. Campbell A. Hurley J. (1950) Hypokalemia complicating sodium para-aminosalicylate therapy for pulmonary tuberculosis. Med J Australia 2: 606–612.
43. Heck A. DeWitt B. Lukes A. (2000) Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm 57: 1221–1227.
44. Hoffmann D. Hoffmann I. (1997) The changing cigarette, 1950–1995. J Toxicol Environ Health 50: 307–364.
45. Holmes A. Young J. Marrott P. Prentice E. (1970) Pseudohyperaldosteronism induced by habitual ingestion of liquorice. Postgrad Med J 46: 625–629.
46. Hughes J. Sellick S. King R. Robbé I. (2003) Re: ‘preterm birth and licorice consumption during pregnancy’. Am J Epidemiol 158: 190–191.
47. Ishiguchi T. Mikita N. Iwata T. Nakata H. Sato H. Higashimoto Y. et al. (2004) Myoclonus and metabolic alkalosis from licorice in antacid. Intern Med 43: 59–62.
48. Jenny M. Muller A. Fabre J. Mach R. (1961) [Hypokaliemie et alcalose par ingestion abusived'extrait de reglisse (Liquorice) et d'eau bicarbonatee]. Schweiz Med Wochenschr 91:869–875.
49. Kasap B. Soylu A. Cetin B. Camlar S. Türkmen M. Kavukçu S. (2010) Acute kidney injury following hypokalemic rhabdomyolysis: complication of chronic heavy cola consumption in an adolescent boy. Eur J Pediatr 169: 107–111.
50. Kent U. Aviram M. Rosenblat M. Hollenberg P. (2002) The licorice root derived isoflavan glabridin inhibits the activities of human cytochrome P450S 3A4, 2B6 and 2C9. Drug Metab Dispos 30: 709–715.
51. Kuriyama Y. Takano T. Okada F. Nukada T. (1975) Hypersensitivity to glycyrrhizin. A case report. Med J Osaka Univ 26: 75–78.
52. Latif S. Conca T. Morris D. (1990) The effects of the licorice derivative, glycyrrhetinic acid, on hepatic 3 alpha- and 3 beta-hydroxysteroid dehydrogenases and 5 alpha- and 5 beta-reductase pathways of metabolism of aldosterone in male rats. Steroids 55: 52–58.
53. Lee C. Park K. Lim S. Park J. Chung W. (2007) Effects of the licorice extract against tumor growth and cisplatin-induced toxicity in a mouse xenograft model of colon cancer. Bio Pharm Bull 30: 2191–2195.
54. Lin S. Davids M. Halperin M. (2003 a) Hypokalaemia and paralysis. QJM 96: 161–169.
55. Lin S. Yang S. Chau T. Halperin M. (2003 b) An unusual cause of hypokalemic paralysis: chronic licorice ingestion. Am J Med Sci 325: 153–156.
56. Lozano P. Flores D. Martínez S. Artigues I. Rimbau E. Gómez F. (2000) Upper limb ischemia induced by chronic licorice ingestion. J Cardiovasc Surg (Torino) 41: 631–632.
57. Maas P. (2000) Zoethout in levensmiddelen: onderzoek naar het glycyrrhizine gehalte van thee, kruidenmengsels, dranken en drop [Liquorice root in food stuffs: survey of the glycyrrhizin content of tea, herbal mixtures, alcoholic drinks and liquorice] (in Dutch). de Ware(n) Chemicus 30: 65–74.
58. Maresca M. Calconi G. Amici G. Teodori T. Da Porto A. (1988) Hypopotassemia and rhabdomyolysis. Description of 3 cases of different etiologies. Minerva Med 79: 55–60.
59. Mattarello M. Benedini S. Fiore C. Camozzi V. Sartorato P. Luisetto G. et al. (2006) Effect of licorice on PTH levels in healthy women. Steroids 71: 403–408.
60. Miyamoto K. Kawai H. Aoyama R. Watanabe H. Suzuki K. Suga N. et al. (2009) Torsades de Pointes induced by a combination of garenoxacin and disopyramide and other cytochrome P450, family 3, subfamily A polypeptide-4-influencing drugs during hypokalemia due to licorice. Clin Exp Nephrol 14: 164–167.
61. Mollaret P. Goulon M. Tournilhac M. (1960) [Quadriplegie avec hypokaliemie et alcalose metabolique secondaire a l'ingestion massive et prolongee d'extrait de reglissie chez unpsychopathe ethylique et potomane]. Bull Mem Soc Med Hop Paris 1: 491–512.
62. Montoliu J. (1977) Liquorice-induced cardiac arrest. Br Med J 2: 1352–1353.
63. Mumoli N. Cei M. (2008) Licorice-induced hypokalemia. Int J Cardiol 124: 42–44.
64. Murphy S. Agger S. Rainey P. (2009) Too much of a good thing: a woman with hypertension and hypokalemia. Clin Chem 55: 2093–2096.
65. Nightingale S. Smith P. Turnbull D. (1981) Anorexia nervosa, liquorice and hypokalaemic myopathy. Postgrad Med J 57: 577–579.
66. Nugmanova M. Kalitina N. (1979) Case of contact dermatitis caused by licorice. Vestn Dermatol Venerol (11): 62–64.
67. Obolentseva G. Litvinenko V. Ammosov A. Popova T. Sampiev A. (1999) Pharmacological and therapeutic properties of licorice preparations (a review). Pharm Chem J 33: 24–31.
68. O'Connell R. White I. White J. McFadden J. (2008) Liquorice extract in a cosmetic product causing contact allergy. Contact Dermatitis 59: 52.
69. Oerter Klein K. Janfaza M. Wong J. Chang R. (2003) Estrogen bioactivity in fo-ti and other herbs used for their estrogen-like effects as determined by a recombinant cell bioassay. J Clin Endocrinol Metab 88: 4077–4079.
70. Palermo M. Armanini D. Delitala G. (2003) Grapefruit juice inhibits 11beta-hydroxysteroid dehydrogenase in vivo, in man. Clin Endocrinol (Oxf) 59: 143–144.
71. Ploeger B. Mensinga T. Sips A. Seinen W. Meulenbelt J. DeJongh J. (2001) The pharmacokinetics of glycyrrhizic acid evaluated by physiologically based pharmacokinetic modeling. Drug Metab Rev 33: 125–147.
72. Ploeger B. Meulenbelt J. DeJongh J. (2000) Physiologically based pharmacokinetic modeling of glycyrrhizic acid, a compound subject to presystemic metabolism and enterohepatic cycling. Toxicol Appl Pharmacol 162: 177–188.
73. Potton F. Janin J. Cruaud J. (1970) 2 cases of arterial hypertension due to glycyrrhizin poisoning. Analysis of the syndrome by voluntary poisoning. Lyon Med 223: 721–726.
74. Revers F. (1948) Behandeling van ulcus ventriculi en ulcus, duodeni mer succus liquiritiae. Nederel Tijdschr v Geneesk 92: 2968–2972.
75. Russo S. Mastropasqua M. Mosetti M. Persegani C. Paggi A. (2000) Low doses of liquorice can induce hypertension encephalopathy. Am J Nephrol 20: 145–148.
76. Sailler L. Juchet H. Ollier S. Nicodème R. Arlet P. (1993) Generalized edema caused by licorice: a new syndrome. Apropos of 3 cases. Rev Med Interne 14: 984.
77. Santaella R. Fraunfelder F. (2007) Ocular adverse effects associated with systemic medications: recognition and management. Drugs 67: 75–93.
78. Sato H. Goto W. Yamamura J. Kurokawa M. Kageyama S. Takahara T. et al. (1996) Therapeutic basis of glycyrrhizin on chronic hepatitis B. Antiviral Res 30: 171–177.
79. Scali M. Pratesi C. Zennaro M. Zampollo V. Armanini D. (1990) Pseudohyperaldosteronism from liquorice-containing laxatives. J Endocrinol Invest 13: 847–848.
80. Scheinman S. Guay-Woodford L. Thakker R. Warnock D. (1999) Genetic disorders of renal electrolyte transport. N Engl J Med 340: 1177–1187.
81. Scientific Committee on Food (2003) Opinion of the Scientific Committee on Food on Glycyrrhizinic Acid and its Ammonium Salt. Brussels: European Commission Heath and Consumer Protection Directorate General.
82. Sigurjonsdottir H. Manhem K. Axelson M. Wallerstedt S. (2003) Subjects with essential hypertension are more sensitive to the inhibition of 11 beta-HSD by liquorice. J Hum Hypertens 17: 125–131.
83. Singer G. Brenner B. (2005) Fluid and electrolyte disturbances. In: Ed. Kasper D. Fauci A. Longo D. Braunwald B. Hauser S. Jameson J. (eds), Harrison's Principles of Internal Medicine, 16th ed. New York: McGraw-Hill.
84. Stewart P. Wallace A. Valentino R. Burt D. Shackleton C. Edwards C. (1987) Mineralocorticoid activity of liquorice: 11-beta hydroxysteroid dehydrogenase deficiency comes of age. Lancet 2: 821–824.
85. Støving R. Lingqvist L. Bonde R. Andries A. Hansen M. Andersen M. et al. (2011) Is glycyrrhizin sensitivity increased in anorexia nervosa and should licorice be avoided? Case report and review of the literature. Nutrition 27: 855–858.
86. Strandberg T. Järvenpää A. Vanhanen H. McKeigue P. (2001) Birth outcome in relation to licorice consumption during pregnancy. Am J Epidemiol 153: 1085–1088.
87. Sugimoto K. Shionoiri H. Inoue K. Kaneko Y. (1984) A case report of hypokalemic myopathy due to ingestion of large dose of ‘jintan’ (in Japanese). Nippon Naika Gakkai Zasshi 73: 66–70.
88. Tacconi P. Paribello A. Cannas A. Marrosu M. (2009) Carpal tunnel syndrome triggered by excessive licorice consumption. J Peripher Nerv Syst 14: 64–65.
89. Takahara T. Watanabe A. Shiraki K. (1994) Effects of glycyrrhizin on hepatitis B surface antigen: a biochemical and morphological study. J Hepatol 21: 601–609.
90. Tamir S. Eizenberg M. Somjen D. Izrael S. Vaya J. (2001) Estrogenlike activity of glabrene and other constituents isolated from licorice root. J Steroid Biochem Mol Biol 78: 291–298.
91. Tancevski I. Eller P. Spiegel M. Kirchmair R. Patsch J. (2008) Images in cardiovascular medicine. Malicious licorice. Circulation 117: 299.
92. Thomas Q. Frank R. Sidney S. Thomas F. (2001) Lüscher. Aldosterone receptor antagonism normalizes vascular function in liquorice-induced hypertension. Hypertension 37: 801–805.
93. Tsukamoto S. Aburatani M. Yoshida T. Yamashita Y. El-Beih A. Ohta T. (2005) CYP3A4 inhibitors isolated from licorice. Biol Pharm Bull 28: 2000–2002.
94. van der Zwan A. (1993) Hypertension encephalopathy after liquorice ingestion. Clin Neurol Neurosurg 95: 35–37.
95. Vaya J. Belinky P. Aviram M. (1997) Antioxidant constituents from licorice roots: isolation, structure elucidation and antioxidative capacity toward LDL oxidation. Free Radic Biol Med 23: 302–313.
96. Walker B. Edwards C. (1994) Licorice-induced hypertension and syndromes of apparent mineralocorticoid excess. Endocrinol Metab Clin North Am 23: 359–377.
97. Wang Z. Nixon D. (2001) Licorice and cancer. Nutr Cancer 39: 1–11.
98. Whorwood C. Sheppard M. Stewart P. (1993) Licorice inhibits 11 betahydroxysteroid dehydrogenase messenger ribonucleic acid levels and potentiates glucocorticoid hormone action. Endocrinology 132: 2287–2292.
99. World Health Organization (2005) Evaluation of certain food additives. World Health Organ Tech Rep Ser 928: 1–156.
100. Yaguchi M. Yaguchi H. Sakano M. (2008) A case of hypokalemic myopathy mimicking hemiparesis. Brain Nerve 60: 191–194.