Who Should Not Eat Licorice Candy?

Licorice root contains glycyrrhizin, a compound that can cause serious adverse effects, including irregular heartbeats and cardiac arrest, when consumed in large amounts or over a long period. While a small, occasional indulgence may be harmless for many, certain individuals must avoid licorice candy and related products entirely due to significant health risks.

Quick Summary

Individuals with heart disease, hypertension, or low potassium, as well as pregnant women, should not eat licorice candy because of the active compound, glycyrrhizin.

Key Points

• Avoid with Heart Conditions: Licorice can worsen congestive heart failure and cause irregular heartbeats due to lower potassium levels.

• Danger for Pregnant Women: High consumption of licorice extract is linked to increased risks of early delivery and potential cognitive developmental issues.

• High Blood Pressure Risk: The glycyrrhizin in licorice can raise blood pressure, interfering with medication and potentially causing dangerous spikes.

• Serious Drug Interactions: Licorice can interact negatively with several medications, including diuretics, blood thinners like warfarin, and heart rhythm drugs.

• Impact on Kidney Health: Individuals with kidney disease should avoid licorice, as its fluid and electrolyte effects can worsen their condition.

• Beware of Glycyrrhizin: The active compound responsible for adverse effects is often present in black licorice, herbal teas, and certain supplements, not just candy.

• Age Considerations: The FDA recommends that individuals over 40 limit black licorice intake, as they may be more susceptible to its side effects.

Understanding the Risk: What Is Glycyrrhizin?

The risks associated with licorice candy, particularly black licorice, are not from the sugar or coloring but from a naturally occurring compound called glycyrrhizin, or glycyrrhizic acid. This substance is derived from the licorice root (Glycyrrhiza glabra) and is what gives licorice its characteristic sweet taste. When consumed in high amounts, glycyrrhizin can significantly impact the body's electrolyte balance. It inhibits an enzyme, 11-beta-hydroxysteroid dehydrogenase type 2 (11β-HSD2), which leads to an increase in the stress hormone cortisol. This, in turn, can cause the body to retain sodium and water while excreting potassium, leading to several health complications. It is important to note that many licorice-flavored candies, especially red licorice sold in the U.S., do not contain real licorice root but instead use anise oil for flavoring, which does not carry these risks.

Medical Conditions Requiring Caution or Avoidance

Several health conditions are exacerbated by the effects of glycyrrhizin, making licorice candy a dangerous treat for these individuals. The mineralocorticoid-like effects can have serious consequences, even in small amounts for those with heightened sensitivity.

Heart Disease and Congestive Heart Failure

For those with existing heart conditions, consuming licorice is particularly hazardous. The potassium-depleting effect of glycyrrhizin is a major concern. Low potassium levels (hypokalemia) can lead to abnormal heart rhythms (arrhythmias) and, in severe cases, cardiac arrest. Licorice's ability to cause the body to retain water can also worsen congestive heart failure. In 2019, a tragic case was reported in the New England Journal of Medicine where a man died from cardiac arrest linked to low potassium levels after eating an excessive amount of black licorice.

High Blood Pressure (Hypertension)

Since glycyrrhizin causes the body to retain sodium and water, it can significantly raise blood pressure. For individuals already managing hypertension, this can be extremely dangerous and counteract the effects of blood pressure medications. Even relatively low doses over a period of weeks have been shown to elevate blood pressure in sensitive individuals.

Kidney Disease

Because licorice causes fluid and electrolyte imbalances, it places extra stress on the kidneys. For those with chronic kidney disease, the kidneys' ability to properly filter and balance these levels is already compromised, and licorice consumption could worsen their condition. The potassium-depleting and sodium-retaining effects make it a high-risk substance for this population.

Low Potassium (Hypokalemia)

As previously mentioned, glycyrrhizin can cause potassium levels to drop. If you already have low potassium, consuming licorice can make the levels plummet to dangerously low levels, leading to muscle weakness, fatigue, lethargy, and heart problems. This is especially concerning for individuals on diuretic medications that also deplete potassium.

Hormone-Sensitive Conditions

Licorice may have estrogen-like effects on the body, which could be problematic for people with certain hormone-sensitive conditions. These include:

• Breast cancer
• Uterine cancer
• Ovarian cancer
• Endometriosis
• Uterine fibroids

Diabetes

While licorice root is not typically high in sugar, some health experts advise caution for those with diabetes, particularly because some studies indicate that glycyrrhizin can interfere with insulin signaling. The risk primarily stems from potential interactions with medications and the metabolic changes it can induce.

Medications and Drug Interactions

Licorice is not just a candy; it is a powerful substance that interacts with numerous prescription drugs. The following are some of the medication categories with which licorice interacts:

• Diuretics (Water Pills): Licorice and diuretics both lower potassium levels, and taking them together could cause dangerously low potassium (hypokalemia).
• Blood Pressure Medications: By raising blood pressure, licorice can negate the effects of antihypertensive drugs.
• Blood Thinners (e.g., Warfarin): Licorice may decrease the effectiveness of warfarin, increasing the risk of blood clotting.
• Heart Rhythm Medications (e.g., Digoxin): Low potassium caused by licorice can increase the risk of serious side effects from digoxin.
• Corticosteroids: Licorice can increase the effects and side effects of corticosteroids by slowing their breakdown in the body.
• Estrogen: Licorice may decrease the effects of estrogen-based medications, including birth control pills and hormone replacement therapy.

Special Considerations for Specific Populations

Pregnant and Breastfeeding Women

It is unsafe for pregnant women to consume licorice, especially in high amounts. Studies have suggested that high licorice intake (over 250 grams per week) could increase the risk of early delivery. Glycyrrhizin can interfere with placental function and may affect the baby's developing brain. For breastfeeding women, there is insufficient reliable information on safety, so avoidance is recommended as a precaution.

Individuals Over 40

The FDA has issued guidance specifically for those over 40, noting that consuming more than 2 ounces (57 grams) of black licorice daily for two weeks or more can lead to irregular heart rhythm. Older adults are often more sensitive to the effects of licorice, particularly if they have underlying heart conditions or high blood pressure.

Comparison Table: Licorice vs. Safe Alternatives

Feature	Traditional Black Licorice (with glycyrrhizin)	Anise-Flavored Candy (common alternative)	DGL Licorice (Deglycyrrhizinated)
Active Compound	Contains glycyrrhizin, the primary active ingredient with side effects.	Flavored with anise oil, which has a similar taste but lacks glycyrrhizin.	Glycyrrhizin has been removed, eliminating the major side effects.
Effect on Blood Pressure	Can significantly increase blood pressure.	No effect on blood pressure.	No effect on blood pressure.
Effect on Potassium Levels	Can cause potassium levels to drop (hypokalemia).	No effect on potassium levels.	No effect on potassium levels.
Pregnancy Safety	Unsafe for pregnant women due to potential risks to the fetus and increased risk of early delivery.	Considered safe for most people, including pregnant women, in moderation.	Generally considered safer, but still best to consult a doctor during pregnancy.
Medication Interactions	Interacts with numerous drugs, including diuretics, blood thinners, and heart medications.	No significant drug interactions associated with anise oil.	Minimal drug interactions due to glycyrrhizin removal.

Conclusion: Prioritizing Your Health

While a small, infrequent amount of black licorice candy is unlikely to cause harm in healthy adults, the risks for certain groups are well-documented and serious. The active compound glycyrrhizin can dangerously affect blood pressure, potassium levels, and heart function. Individuals with heart disease, high blood pressure, kidney disease, low potassium levels, or hormone-sensitive conditions should strictly avoid licorice candy and any products containing licorice root extract. Furthermore, pregnant women and those on medications that interact with glycyrrhizin must also abstain. For those who enjoy the flavor, alternatives such as anise-flavored candy or deglycyrrhizinated licorice (DGL) products offer a safer way to indulge. Always consult a healthcare professional before consuming any licorice-based product if you have underlying health issues or are taking medication.

Potential Symptoms of Licorice Overconsumption

Symptoms of licorice toxicity, or pseudoaldosteronism, include:

• Headaches
• Fatigue or lethargy
• Swelling (edema), especially in legs and ankles
• Shortness of breath
• Muscle weakness
• Cardiac arrhythmia

If you or someone you know experiences these symptoms after consuming licorice, seek medical attention immediately.

Further Reading

For more detailed information on the health effects and safe consumption guidelines for licorice, the National Center for Complementary and Integrative Health (NCCIH) provides authoritative resources, including its guide on licorice root.

Sources of Glycyrrhizin

It is important to remember that glycyrrhizin is not limited to just candy. Other products can contain licorice root extract, including:

• Certain herbal teas
• Cough drops and throat lozenges
• Flavored tobacco products
• Dietary supplements containing licorice root

Always check the ingredient list for "licorice root extract" or "glycyrrhizic acid" to be certain.

When in Doubt, Consult a Professional

Navigating dietary restrictions can be complex, especially with herbal products that may be perceived as benign. Consulting a doctor or pharmacist is the safest approach to ensure that your dietary choices do not interfere with your health or medication regimen.

Frequently Asked Questions

Why is black licorice more dangerous than red licorice?

Black licorice is typically made with actual licorice root extract, which contains the active compound glycyrrhizin. Red licorice is often flavored with anise oil, which mimics the licorice flavor but does not contain glycyrrhizin, making it generally safer.

Can I eat licorice candy in moderation if I'm healthy?

For most healthy adults, small amounts of licorice candy are unlikely to cause harm. However, excessive consumption over a period of weeks can be problematic for anyone, especially those over 40.

What is deglycyrrhizinated licorice (DGL)?

DGL is a form of licorice where the glycyrrhizin compound has been removed. This process eliminates most of the adverse side effects associated with traditional licorice, making it a safer alternative for many people.

Does licorice root in herbal tea cause the same problems?

Yes, herbal teas that contain licorice root extract can also contain glycyrrhizin. The same precautions apply to licorice tea as to licorice candy, and excessive consumption can lead to negative side effects, particularly if you have a pre-existing condition.

How much licorice is considered 'excessive'?

According to the FDA, eating 2 ounces (57 grams) or more of black licorice daily for at least two weeks could be problematic for those over 40. The World Health Organization suggests a limit of up to 100 mg of glycyrrhizic acid per day for most adults.

What should I do if I think I've had too much licorice?

If you experience symptoms like muscle weakness, irregular heartbeat, or swelling after consuming licorice, you should stop eating it and contact a healthcare provider immediately. Severe cases may require hospitalization.

Can I eat licorice if I take medication?

If you are on medication, especially for blood pressure, heart rhythm, or blood thinning, you should consult your doctor before consuming any licorice. It can interfere with the effectiveness of these drugs and cause serious health issues.