A man has died after eating licorice every day for three weeks, highlighting a danger of the terrible sweet that you might not be aware of.
In a case report in the New England Journal of Medicine (NEJM), doctors outline how a classic sweet led to the death of a 54-year-old man from Massachusetts. When the patient arrived at Massachusetts General Hospital, he was unresponsive following cardiac arrest. He had been in his "usual state of health" that day until he collapsed shaking to the ground in a fast-food restaurant around midday, when he lost consciousness.
After attempting cardiopulmonary resuscitation (CPR) at the scene, he was moved to the emergency room with an irregular heartbeat of just 40 beats per minute, before being placed on a mechanical ventilator in the cardiac intensive care unit (ICU).
During investigations, he was found to be low in potassium, and medical history was taken from his friends and family. The construction worker had been in good health, with no history of chest pain, shortness of breath, or any other symptoms of heart failure or abnormal heart rhythm. None of his friends were ill, and he showed no other signs of ill health himself.
However, he did have a poor diet and would consume several packets of candy a day. Furthermore, he had switched the type of candy he was eating just 3 weeks earlier, from fruit-flavored soft candy (red licorice) to black licorice-flavored, finally giving the medical team a clue about what had caused his condition, especially given his low potassium levels. Black licorice contains glycyrrhizic acid, which can cause changes to levels of potassium, disrupt electrolytes, and increase levels of cortisol, which can lead to hypertension, hypokalemia, metabolic alkalosis, fatal arrhythmias, and renal failure, all of which was seen in the patient.
According to the US Food and Drug Administration, for people 40 or older, eating just 56 grams (2 ounces) of black licorice a day for at least two weeks could land you in the hospital with irregular heart rhythm or arrhythmia. The death here however was clearly an extreme case.
"The goals of care were discussed with his family, who declined renal replacement therapy, and the patient was subsequently transitioned to comfort measures only," the authors wrote in the report. "He died comfortably with his family at his bedside, 32 hours after presentation."
If you must insist on eating licorice – let's be honest here, it tried to warn you it was dangerous with its flavor – be assured that this man's consumption was excessive, and you are extremely unlikely to eat enough to cause your own ill health. However, that's not to say it's risk-free.
“Even a small amount of licorice you eat can increase your blood pressure a little bit,” Dr Neel Butala, a cardiologist at Massachusetts General Hospital told Associated Press.
Maybe try a remotely edible candy instead.