When a Sweet Treat Turns Deadly: Man's Heart Stops After Overindulging in Licorice

The Deadly Sweet Tooth: How Too Much Licorice Claimed a Man’s Life

Licorice candy might seem harmless—a nostalgic treat reminiscent of childhood. However, for a 54-year-old man from Boston, an excessive consumption of licorice-flavored candy proved fatal, highlighting the dangerous consequences of glycyrrhizin, a compound found in real licorice. This case serves as a stark reminder of how seemingly innocent dietary habits can result in catastrophic health outcomes.

The Patient and Initial Symptoms

The patient, a healthy-looking 54-year-old man, was dining at a restaurant when the unthinkable happened. Without warning, he gasped, began shaking uncontrollably, and collapsed. Witnesses described the event as sudden and terrifying.

Emergency responders arrived promptly, performing CPR to restore his heartbeat. Initial assessments revealed that the lower chambers of his heart, the ventricles, were not pumping blood effectively, a condition known as ventricular fibrillation. Despite their efforts, the man remained in critical condition, fluctuating between consciousness and unconsciousness on his way to the hospital.

What Happened Next: A Heart in Crisis

Upon arrival at the hospital, doctors confirmed that the patient had suffered cardiac arrest. This condition, where the heart stops beating abruptly, demands immediate intervention. The treatment team stabilized his vitals using intravenous (IV) fluids and medications to regulate his heart rhythm and relieve pain. A mechanical pump was employed to assist the heart, while an endotracheal tube was placed to aid his breathing.

Despite aggressive interventions, lab results revealed a critical clue: the patient’s potassium levels were dangerously low. Potassium, an essential mineral, plays a pivotal role in maintaining heart muscle function. Intravenous potassium was administered in an attempt to correct the imbalance, but his condition rapidly deteriorated, progressing to multiorgan failure. Tragically, the man passed away 32 hours after being admitted.

The Shocking Diagnosis: Licorice Candy Poisoning

The cause of this man's fatal condition was not a heart defect or a previously undiagnosed disease. It was licorice candy. According to the family, the man had developed a habit of eating one to two large bags of licorice-flavored candy daily. Three weeks prior to his collapse, he had switched from fruit-flavored to licorice-flavored candy.

Licorice contains glycyrrhizin, a naturally occurring compound that interferes with the enzyme 11β-hydroxysteroid dehydrogenase type 2. This disruption causes the kidneys to retain excess water and sodium while depleting potassium. Inadequate potassium levels lead to electrical instability in the heart, culminating in arrhythmias or, as in this case, cardiac arrest.

How Glycyrrhizin Affects the Heart

The cascade of effects from glycyrrhizin is particularly concerning in older adults. Here’s how it works:

1. Potassium Loss: Glycyrrhizin prompts the kidneys to expel potassium, impairing the heart’s electrical conduction system.
2. Fluid Retention: Excess sodium retention leads to high blood pressure, putting additional strain on the heart.
3. Electrolyte Imbalance: The imbalance of potassium and sodium creates an environment ripe for arrhythmias and other cardiovascular complications.

FDA Warning on Licorice Consumption

The U.S. Food and Drug Administration (FDA) has issued clear warnings about the dangers of consuming black licorice in excess. Specifically:

• Adults over 40 should avoid eating more than 2 ounces (56 grams) of black licorice per day for two weeks or longer.
• Excessive licorice consumption can lead to hospitalization due to irregular heart rhythms, high blood pressure, or even cardiac arrest.

The FDA also cautions that licorice can interact with certain medications, exacerbating its effects. For individuals taking diuretics, corticosteroids, or medications for high blood pressure, the risks are amplified.

Lessons for Medical Professionals and Patients

This tragic case underscores the importance of considering dietary habits when diagnosing unexplained medical conditions. For healthcare providers:

• Electrolyte Monitoring: Always check potassium levels in patients presenting with arrhythmias or cardiac arrest.
• Dietary History: Ask patients about their consumption of licorice or licorice-flavored products.
• Patient Education: Inform patients about the risks associated with excessive consumption of licorice, particularly those with existing heart or kidney conditions.

For patients, moderation is key. Licorice may be a nostalgic treat, but its overconsumption poses real risks.

Final Thoughts

The death of this Boston man serves as a sobering reminder that even everyday foods can have lethal consequences when consumed in excess. Licorice candy, often considered a harmless indulgence, became the catalyst for a series of events that led to his untimely death. As healthcare providers, understanding the physiological effects of glycyrrhizin is critical to preventing similar tragedies in the future.