From the Guidelines
Licorice root can be dangerous when consumed in large amounts or for extended periods due to its active compound glycyrrhizin, and I recommend limiting licorice root consumption to no more than 100 mg of glycyrrhizin daily and avoiding regular use beyond 4-6 weeks. The primary danger is pseudoaldosteronism, which can cause serious health issues including high blood pressure, low potassium levels, fluid retention, heart rhythm abnormalities, and muscle weakness 1. People with heart disease, kidney disease, liver disease, high blood pressure, or those taking medications like diuretics, digoxin, or corticosteroids should avoid licorice entirely, as it may exacerbate their condition 2. Pregnant women should also avoid licorice as it may increase the risk of preterm labor and developmental issues in children.
Key Considerations
- Patients with cirrhosis and patients on immune drugs are advised to avoid licorice juice due to its mineralocorticoid and drug-drug interaction activities 1
- Deglycyrrhizinated licorice (DGL) supplements, which have the glycyrrhizin removed, are generally safer alternatives if you want licorice's digestive benefits without these risks
- If you experience symptoms like headaches, fatigue, fluid retention, or muscle weakness while consuming licorice, stop use immediately and consult a healthcare provider
Special Precautions
- Licorice root may interact with certain medications, such as cyclosporine A, methotrexate, and cilostazol, and concurrent use is not recommended 1
- Patients with a history of hypertension, hypokalemia, or edema should be cautious when consuming licorice root, as it may worsen their condition 1
From the Research
Dangers of Licorice Root
- The consumption of licorice root can lead to several health issues, including apparent mineralocorticoid excess syndrome, which is characterized by hypertension, fluid retention, and hypokalemia with metabolic alkalosis and increased kaliuresis 3.
- Glycyrrhizin, a main constituent of licorice, can bind to mineralocorticoid receptors and induce apparent mineralocorticoid excess syndrome through dose-dependent inhibition of 11β-hydroxysteroid dehydrogenase type 2 in renal tissue 3, 4.
- Chronic use of licorice can lead to hypokalemia and hypertension, and some people are more sensitive to licorice exposure 4.
- Licorice consumption has been associated with an increase in diastolic blood pressure and hypernatremia, which can be problematic for hypertensive patients 5.
- Hypokalemia, a potential side effect of licorice consumption, can lead to life-threatening cardiac conduction disturbances and neuromuscular dysfunction if left untreated 6.
- The diagnosis of glycyrrhizin-induced apparent mineralocorticoid excess syndrome is based on the history, clinical examination, and biochemical analysis, and management is primarily based on symptomatic care and stopping licorice consumption 3.
Potential Interactions and Precautions
- Licorice consumption should be avoided by hypertensive patients due to the potential increase in blood pressure 5.
- Patients with chronic kidney disease should be cautious when consuming licorice, as it can exacerbate hypertension and potassium imbalance 7.
- The use of licorice in combination with other medications, such as diuretics, can increase the risk of hypokalemia and other electrolyte disorders 6.