When it comes to black licorice, opinions tend to be polarized — you either savor its unique flavor or you simply can’t stand it. For those who cherish this distinctive treat, the alarming reports of individuals facing severe health issues, or even death, from excessive consumption can be quite unsettling. Is it true that this spicy and often contentious candy can have fatal effects when consumed in large quantities?

This article aims to explore the potential dangers associated with high doses of black licorice, while also providing insight into the recommended serving sizes, essential safety tips, and delicious alternatives that can satisfy your sweet tooth without the risks.

Is Black Licorice Dangerous?

While deaths attributed to excessive black licorice consumption are rare, there have been recorded instances that raise concerns. Numerous case studies indicate that frequent intake of black licorice can result in a condition known as pseudohyperaldosteronism, which, if left untreated, can prove fatal. The latest recorded case — documented on September 23, 2020 — involved a 54-year-old man who collapsed suddenly while dining at a fast-food establishment.

Emergency medical responders arrived promptly and diagnosed the man with ventricular fibrillation, a severe irregular heartbeat that poses significant health risks. Despite being rushed to the hospital, he succumbed after 32 hours due to severe electrolyte imbalances and multiorgan failure. The attending physician concluded that his death was a consequence of pseudohyperaldosteronism, a condition where the body exhibits symptoms akin to heightened aldosterone levels, leading to high blood pressure. This indicates that his excessive black licorice intake likely triggered the ventricular fibrillation.

Pseudohyperaldosteronism manifests through elevated blood pressure, diminished potassium levels, disruptions in the body's acid-base balance, and reduced levels of renin, an enzyme crucial for blood pressure regulation. A conversation with the man’s family revealed that he had switched from fruit-flavored candies to black licorice just three weeks prior and was consuming 1–2 large packages daily. In a related case from 2008, a 55-year-old woman visited a clinic exhibiting low potassium levels and high blood pressure. She did not respond to medications designed to lower blood pressure. She disclosed that she had been consuming 1–2 packages of black licorice each day for four years after quitting smoking.

Following a thorough medical evaluation, she was diagnosed with pseudohyperaldosteronism due to excessive black licorice intake. She was advised to cut licorice from her diet and adopt a potassium-rich diet, along with potassium supplements to address her low levels. After adhering to the prescribed regimen, several months later, her blood pressure stabilized, and all her lab results, including potassium levels, returned to normal. These cases underscore the link between excessive daily consumption of black licorice and the potentially lethal condition known as pseudohyperaldosteronism.

How Do the Compounds in Black Licorice Influence Your Body?

Black licorice, known for its distinctive flavor, contains a key compound called glycyrrhizic acid. This particular acid is responsible for the delightful sweetness found in licorice candies.

Interestingly, glycyrrhizic acid is reported to be approximately 50 times sweeter than common table sugar, or sucrose. The body metabolizes glycyrrhizic acid into another compound known as glycyrrhetinic acid, which medical professionals generally agree is safe when consumed in moderate amounts.

However, excessive intake of glycyrrhetinic acid and its by-products can hinder an enzyme that plays a crucial role in converting active cortisol into its inactive form, cortisone. This disruption results in an increased level of cortisol binding to its receptors, which can trigger a condition known as pseudohyperaldosteronism.

In many instances, discontinuing the consumption of licorice can lead to a resolution of pseudohyperaldosteronism within a few weeks or months. It is important to note that, in some cases, persistent high blood pressure may arise due to other underlying factors.

In summary, while licorice contains glycyrrhizic acid that converts to glycyrrhetinic acid, excessive quantities may inhibit a vital enzyme, potentially resulting in pseudohyperaldosteronism—a serious health condition that could be life-threatening if left unchecked.

Recommended Maximum Dose

Licorice root (Mulethi) has been a cornerstone of traditional medicine for centuries, utilized to alleviate ailments such as coughs, asthma, stomach discomfort, insomnia, and infections. This herb is rich in an array of beneficial plant compounds that exhibit anti-inflammatory, antioxidant, and antimicrobial properties, making it a valuable addition to various health regimens. However, despite its extensive and seemingly safe usage history, health organizations emphasize caution regarding excessive consumption of licorice. This is primarily due to its potential effects on increasing blood pressure and causing electrolyte imbalances.

The World Health Organization (WHO) recommends a daily intake of glycyrrhizic acid not exceeding 100 mg for most adults, which is roughly equivalent to about 60–70 grams (2–2.5 ounces) of licorice. Nonetheless, determining a safe amount for black licorice candy is challenging, as the glycyrrhizic acid concentration can vary significantly—by up to 30 times—between different products. The Food and Drug Administration (FDA) cautions that individuals aged 40 and above should limit their consumption to 57 grams (approximately 2 ounces) per day for a minimum of two weeks, as doing otherwise may lead to irregular heart rhythms that could necessitate hospitalization.

It is important to note that many herbal teas and dietary supplements may contain licorice root extract, which contributes to the overall intake of glycyrrhizic acid. Additionally, it's essential to clarify that red licorice, despite its name, does not include licorice root extract and therefore does not provide glycyrrhizin. Consumers should be vigilant, as products containing licorice must clearly indicate this on their labels, with licorice extract or glycyrrhizic acid listed among the ingredients. In summary, adhering to the WHO's guideline of a daily glycyrrhizic acid intake of up to 100 mg, or around 60–70 grams (2–2.5 ounces) of licorice, is advisable for most adults.

What Precautions Should You Take?

Individuals with heart or kidney issues must exercise heightened caution regarding their intake of black licorice. It is vital to monitor both the amount you consume and how often you indulge in this treat, as excessive consumption can lead to complications. Licorice possesses a notably long half-life, which means it remains in your system for an extended period before being eliminated. This characteristic can lead to the accumulation of glycyrrhetinic acid, especially if licorice is consumed regularly.

The ongoing buildup of this compound can raise the risk of developing pseudohyperaldosteronism, a condition that can pose serious health threats. For those already grappling with heart or kidney ailments, the consequences of pseudohyperaldosteronism can be particularly severe. Therefore, if you have any preexisting heart or kidney conditions, it is crucial to be vigilant about both the quantity and frequency of your licorice consumption to protect your health.

The Bottom Line

Black licorice and various other sources of licorice contain a compound known as glycyrrhetinic acid. When consumed in excessive quantities, this particular acid can inhibit an enzyme that is crucial for allowing more active cortisol to bind effectively to its receptor. Consequently, indulging in too much licorice or consuming it too often can lead to elevated blood pressure, reduced potassium levels, and other symptoms associated with pseudohyperaldosteronism. This condition poses serious risks, particularly for individuals with preexisting heart or kidney issues.

The World Health Organization (WHO) advises that most healthy adults can safely consume up to 100 mg of glycyrrhizic acid daily, which translates to approximately 60-70 grams (about 2-2.5 ounces) of licorice.