Black Licorice and Heart Arrhythmias: What You Need to Know

Black licorice may evoke feelings of nostalgia for some and disgust for others, but this classic candy comes with a side effect that isn’t widely known: it can have serious, even dangerous, consequences for your heart health. Beyond its polarizing taste, black licorice contains a compound that can lead to abnormal heart rhythms, elevated blood pressure, and other health complications if consumed in excess. This isn’t just folklore—it’s backed by scientific studies and real-world medical cases. Let’s dive deep into the science, risks, and safe consumption guidelines to better understand this fascinating phenomenon.

What Makes Black Licorice Different?

Black licorice is flavored with extract from the root of the licorice plant (Glycyrrhiza glabra), which has been used for centuries in traditional medicine. It contains a natural compound called glycyrrhizin, which is responsible for its unique flavor and sweetness. Glycyrrhizin is approximately 50 times sweeter than sugar, making it a popular ingredient in candies, beverages, and even herbal remedies.

However, the very compound that gives licorice its characteristic taste also contributes to its health risks. Glycyrrhizin can interfere with the body’s potassium and sodium levels, leading to a cascade of physiological effects that may affect the heart, kidneys, and overall electrolyte balance.

The Science Behind Licorice and Heart Health

Glycyrrhizin works by inhibiting the enzyme 11β-hydroxysteroid dehydrogenase type 2, which normally converts active cortisol to its inactive form, cortisone. By disrupting this process, glycyrrhizin increases cortisol levels in the body, mimicking the effects of aldosterone—a hormone that regulates sodium and potassium levels.

This hormonal imbalance causes the body to retain sodium while excreting potassium, leading to hypokalemia (low potassium levels). Potassium is essential for maintaining proper electrical activity in the heart, and a deficiency can result in irregular heartbeats (arrhythmias) and other cardiovascular issues.

Documented Cases: Black Licorice and Cardiac Events

Several case studies and reports highlight the real-world consequences of excessive black licorice consumption. For example:

• Case 1: A 54-year-old man was hospitalized with dangerously high blood pressure and hypokalemia after consuming black licorice daily for several weeks. His symptoms resolved after he stopped eating the candy and received potassium supplementation.
• Case 2: In 2020, a 54-year-old Massachusetts man died from cardiac arrest after eating one to two large bags of black licorice every day for three weeks. The high levels of glycyrrhizin in his system led to severe potassium depletion, ultimately triggering his fatal heart condition.

These cases emphasize that even moderate daily consumption of black licorice can have cumulative and harmful effects, particularly in individuals with pre-existing health conditions.

Risk Factors for Licorice-Induced Heart Issues

Not everyone who enjoys black licorice is at equal risk. Several factors can increase susceptibility to its adverse effects:

1. Age: Older adults are more vulnerable due to slower metabolism and pre-existing conditions.
2. Underlying Health Conditions: People with hypertension, heart disease, or kidney problems are at higher risk.
3. Medications: Certain drugs, such as diuretics, corticosteroids, and blood pressure medications, can exacerbate the effects of glycyrrhizin.
4. Frequency and Quantity: Regular consumption of even small amounts of black licorice can have a cumulative effect over time.

How Much Licorice Is Too Much?

According to the U.S. Food and Drug Administration (FDA), consuming as little as 2 ounces of black licorice per day for two weeks can cause significant health issues in individuals over 40. This equates to roughly one or two small servings daily. Importantly, the risks increase with higher consumption and prolonged exposure to glycyrrhizin.

The FDA advises moderation, recommending that people avoid eating large amounts of black licorice at once and take breaks between consumption periods.

Symptoms of Licorice Overconsumption

Recognizing the early signs of glycyrrhizin-induced toxicity is crucial. Symptoms may include:

• Fatigue or weakness
• Muscle cramps
• Swelling in the legs or face
• High blood pressure
• Headaches
• Abnormal heart rhythms (palpitations)
• Shortness of breath

If you experience any of these symptoms after consuming black licorice, seek medical attention immediately.

Can Sugar-Free Black Licorice or herbal Teas Be Safer?

Many assume that sugar-free black licorice or licorice-flavored products are safer alternatives. However, glycyrrhizin is the problematic compound, not sugar. Therefore, even sugar-free versions of black licorice pose similar risks. Additionally, herbal teas containing licorice root can have the same effect on cortisol and potassium levels, especially if consumed frequently.

How to Enjoy Black Licorice Safely

For fans of black licorice, the good news is that moderate consumption can still be part of a healthy diet. Here are some tips to minimize risks:

1. Limit Quantity: Stick to occasional, small portions—no more than a handful of candies at a time.
2. Check Labels: Look for products labeled “deglycyrrhizinated licorice” (DGL), which have reduced levels of glycyrrhizin.
3. Balance Electrolytes: Maintain a potassium-rich diet (e.g., bananas, spinach, and avocados) to counteract any potential potassium depletion.
4. Monitor Symptoms: Be mindful of any unusual symptoms, especially if you have pre-existing conditions.
5. Consult Your Doctor: If you love black licorice and consume it regularly, talk to your healthcare provider about its potential impact on your health.

The Broader Implications for herbal Remedies and Supplements

Licorice root isn’t just a candy flavor—it’s also a common ingredient in herbal remedies for digestive issues, sore throats, and respiratory conditions. While these remedies can be effective, they carry the same risks as candy when consumed in excess or over long periods.

Consumers should always read product labels and consult a healthcare professional before using licorice-based supplements, particularly if they are pregnant, nursing, or taking medication.

The Future of Licorice Research and Awareness

Despite its well-documented risks, black licorice remains a popular treat, and awareness of its potential dangers is still relatively low. Ongoing research aims to better understand the precise mechanisms by which glycyrrhizin affects cardiovascular health and to develop safer alternatives for licorice enthusiasts. Meanwhile, public health campaigns could play a vital role in educating consumers about safe licorice consumption.