Drinking Licorice Tea Can Cause Hypertensive Emergency

Licorice root extract is not without health risks, according to a case study published this week in the Canadian Medical Association Journal.

Demonstration of the main mechanism of action of licorice through inhibition of 11-β-hydroxysteroid dehydrogenase type 2 (11-β-HSD2) in the distal tubules of the kidney. H - hydrogen ion, H2O - water, K - potassium, Na - sodium. Image credit: Falet et al, doi: 10.1503/cmaj.180550.

Demonstration of the main mechanism of action of licorice through inhibition of 11-β-hydroxysteroid dehydrogenase type 2 (11-β-HSD2) in the distal tubules of the kidney. H – hydrogen ion, H2O – water, K – potassium, Na – sodium. Image credit: Falet et al, doi: 10.1503/cmaj.180550.

“Licorice, the root of the plant Glycyrrhiza glabra, has been used for thousands of years for its therapeutic properties and as an essential ingredient to various sweets and beverages. Its use can be traced back to ancient Assyria, Egypt, China and India,” said McGill University’s Dr. Jean-Pierre Falet and colleagues.

“To this day, it remains popular in the Middle East, as well as several parts of Europe.”

According to the team, an 84-year-old man in Canada was hospitalized after drinking homemade licorice tea.

He reported a one-week history of persistently elevated measurements, taken at home, of systolic blood pressure (between 180 and 210 mm Hg), along with symptoms of headache, photophobia, chest pain and fatigue.

After admission to hospital and treatment, the patient, who had a history of high blood pressure, told physicians he had been drinking one to two glasses daily of licorice root extract called ‘erk sous’ for two weeks prior.

“Erk sous is a popular Egyptian drink, sought after for its thirst-quenching effect, especially during the month of Ramadan,” the researchers said.

“It is traditionally prepared by combining licorice root and baking soda in a cloth and adding water to it drop by drop over several hours.”

The patient was diagnosed with the licorice-induced pseudohyperaldosteronism.

“With complete abstinence from licorice extract while he was in hospital, the patient’s blood pressure gradually improved and was 140/80 mm Hg on discharge from the hospital 13 days after presentation,” the scientists said.

“He was sent home on amlodipine, metoprolol, irbesartan, hydrochlorothiazide and a taper of furosemide, along with the remainder of his usual medications.”

The patient was seen in clinic three weeks later; his blood pressure was 110/57 mm Hg and he felt well. He had not taken any licorice extract since his hospital admission.

“Excessive amounts of some herbal products can have harmful side effects,” Dr. Falet said.

“Products containing licorice root extract can raise blood pressure, cause water retention and decrease potassium levels if consumed in excess.”

“Given Canada’s multicultural population, physicians should consider screening for licorice root intake in patients with difficult-to-control hypertension.”

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Jean-Pierre Falet et al. 2019. Hypertensive emergency induced by licorice tea. CMAJ 191 (21): E581-E583; doi: 10.1503/cmaj.180550

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