Man dies of an overdose of black liquorice — NEJM

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A US construction worker’s love of black liquorice cost him his life after eating a bag and a half every day for a few weeks caused caused dangerously low potassium and electrolyte balances, then cardiac arrest associated with ventricular fibrillation, notes a New England Journal of Medicine case report.

He never regained consciousness after his collapse and died about 24 hours after he arrived at Massachusetts General Hospital.

“We almost didn’t believe it when we figured it out,” said Dr. Jacqueline B. Henson, who treated the man while she was a resident at the hospital. “We were all shocked and surprised.”

Medical Xpress reports doctors reported. “Even a small amount of liquorice you eat can increase your blood pressure a little bit,” said Dr Neel Butala, a cardiologist at Massachusetts General Hospital who described the case.

The problem is glycyrrhizic acid, found in black liquorice and in many other foods and dietary supplements containing liquorice root extract. It can cause dangerously low potassium and imbalances in other minerals called electrolytes.

Eating as little as 2 ounces of black liquorice a day for two weeks could cause a heart rhythm problem, especially for people over 40, the US Food and Drug Administration warns.

“It’s more than liquorice sticks. It could be jelly beans, liquorice teas, a lot of things over the counter. Even some beers, like Belgian beers, have this compound in it,” as do some chewing tobaccos, said Dr Robert Eckel, a University of Colorado cardiologist and former American Heart Association president. He had no role in the Massachusetts man’s care.

The report says the death was clearly an extreme case. The man had switched from red, fruit-flavoured twists to the black liquorice version of the candy a few weeks before his death last year.

The FDA permits up to 3.1% of a food’s content to have glycyrrhizic acid, but many candies and other liquorice products don’t reveal how much of it is contained per ounce, Butala said. Doctors have reported the case to the FDA in hope of raising attention to the risk.


Full Medical Xpress report


NEMJ article (Registration required)

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