Licorice abuse: time to send a warning message

Abstract

Licorice extract has always been recognized as a sweetener and a thirst quencher. Its nutritive value is overrated by many who consume significant amounts and are prone to complications. Glycyrrhetic acid, the active metabolite in licorice, inhibits the enzyme 11-ß-hydroxysteroid dehydrogenase enzyme type 2 with a resultant cortisol-induced mineralocorticoid effect and the tendency towards the elevation of sodium and reduction of potassium levels. This aldosterone-like action is the fundamental basis for understanding its health benefits and the wide spectrum of adverse effects. Herein, we present a comprehensive review of licorice along with the reported complications related to excess intake. Despite its apparent use in a few clinical scenarios, the daily consumption of licorice is never justified because its benefits are minor compared to the adverse outcomes of chronic consumption. The review highlights the importance of investigating the dietary habits and herbal remedies which are being used worldwide on cultural and habitual bases rather than reliable scientific evidence. Licorice is a US Food and Drug Administration (FDA) approved food supplement used in many products without precise regulations to prevent toxicity. Increased awareness among the public is required through TV commercials, newspapers, internet sites, magazines and product labels regarding the upper limit of ingestion and health hazards associated with excess intake. We hope that this review will serve as a warning message that should be transmitted from physicians to patients to avoid excessive licorice intake as well as a message to the FDA to start regulating the use of this substance.

Role of Glycyrrhizin in the Reduction of Inflammation in Diabetic Kidney Disease

“…A high dose of GLC also affects the retention of water and salt in GLC-treated rats, which is due at least in part to the increased expression of aquaporin 2 and 3 water channels in the renal inner and outer medulla of the kidney, which may be associated with the mineralocorticoid receptor [35,36] . Previous studies have reported that a higher dose of GLC administration (200 mg/kg/day) ameliorates both renal function defects, especially the renal concentrating ability, and structural lesions in renal tissues in rats in the early-phase of ischemia-induced acute renal failure [37] .…”

Identification of Key Licorice Constituents Which Interact with Cytochrome P450: Evaluation by LC/MS/MS Cocktail Assay and Metabolic Profiling

“…For instance, licorice could lower the risk of apthous ulcers caused by anti-inflammatory drugs like aspirin (2); reduce side effects of spironolactone (3); improve the efficacy and lower the adverse effects of glucocorticoids (4); improve excretion rates and decrease side effects of nitrofurantoin in patients with urinary tract infections (5); and treat cough, asthma, and gastric ulcer during chemotherapies (6). While licorice shows synergistic effects with some drugs, it could also decrease the therapeutic effects of other drugs, or even lead to side effects (7,8). One major reason for these herb-drug interactions (HDI) is cytochrome P450 enzymes.…”

Comparison of the Exposure of Glycyrrhizin and its Metabolites and the Pseudoaldosteronism after Intravenous Administration of Alpha- and Beta-glycyrrhizin in Rat

“…Of its 2 isomers, α-GL seems to show a lower incidence of adverse eff ects which encouraged us to compare the PK profi les and adverse eff ects of α-and β-GL when administered separately. Pseudoaldosteronism is the major adverse eff ect of GL which can be severe or even fatal if ignored [ 15 ] . It is mainly caused by GA and 3MGA, the major metabolites of GL, and accordingly, the metabolism of α-and β-GL will dictate the relative safety of the 2 compounds.…”