Black (Licorice) Death

You may have seen headlines for this.

A Massachusetts construction worker, age 54 and in good health, suddenly started to shake and then passed out while dining at a fast food restaurant. EMTs determined that he was having a severe heart arrhythmia, which caused loss of consciousness. He was treated, revived briefly, and then rushed to Mass General in Boston. He died the next day.

An interview with his family determined that he was eating a lot of soft candy, and two weeks previously has switched from a fruit-flavored treat to black licorice. And that’s a problem.

Real black licorice (there is an artificial variant that uses anise for flavoring) contains licorice root and a chemical derived from that root, glycyrrhizin. This chemical leaches potassium from the body, and potassium plays a key role in heart function.

Hypokalemia is generally defined as a serum potassium level of less than 3.5 mEq/L (3.5 mmol/L). Moderate hypokalemia is a serum level of 2.5-3.0 mEq/L, and severe hypokalemia is a level of less than 2.5 mEq/L. (1)

Hypokalemia is life threatening.

Potassium is an important electrolyte for nerve and muscle cell functioning, especially for muscle cells in the heart. Your kidneys control your body’s potassium levels, allowing for excess potassium to leave the body through urine or sweat.(2)

Basically, low potassium levels can disrupt the heart rhythm or cause a complete heart stoppage.

However, that’s not all. Glycyrrhizin, or glycyrrhizic acid, can also cause elevate sodium levels, push blood pressure to dangerously high levels, and trigger kidney failure.

Here’s the kicker. According to Medscape, if you consume more than two ounces of black licorice per day for 14 days, that may be sufficient to require hospitalization. The deceased was consuming more than that.

You are what your eat. Or maybe what you eat means you aren’t.

Sources:

  1. https://emedicine.medscape.com/article/242008-overview
  2. https://www.healthline.com/health/hypokalemia
  3. https://www.forbes.com/sites/brucelee/2020/09/24/man-dies-from-eating-too-much-black-licorice-what-is-glycyrrhizic-acid/#1f42520b49b9
  4. https://www.nejm.org/doi/full/10.1056/NEJM199110243251706this older article discusses the mechanics by which black licorice harms the body

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