Are licorice candies popular in the US
Pseudohyperaldosteronism: consumption of licorice with consequences
POLITICS: Medical Report
Many people who love sweets but have to avoid sugar - be it for dietary reasons or because of diabetes mellitus - sooner or later get the taste of liquorice. Liquorice is made from the liquorice root, which is not wrongly named, as the main ingredient glycyrrhizin has a sweetening power 50 times stronger than cane sugar. The fact that glycyrrhizin and other substances contained in liquorice can have other undesirable effects is hardly known to the general public. For doctors, too, cases of licorice intoxication are always astonishing, as in the case of a 37-year-old patient who is admitted to the hospital with attacks of dizziness, cardiac arrhythmias, weakness and muscle wasting. The laboratory examination shows massive hypokalemia, for which there is initially no explanation until the anamnesis reveals a daily consumption of two bags of gummy pastilles with licorice extract. Other typical symptoms of licorice poisoning are arterial hypertension, headache, edema of the ankles or face. Popular in Denmark
Up to three percent of all hypertension diseases are said to be due to the consumption of licorice. Danish scientists therefore recommend hypertensive patients to avoid licorice. The sweetener is very popular in the neighboring country, and licorice with a high glycyrrhizine concentration of 0.2 g / 100 g or more is available everywhere there. According to pharmacist Jens Bielenberg (Westerhorn), Danish strong liquorice also occasionally ends up in German supermarkets, which is a violation of the provisions and traffic rules for sugar confectionery and related products of the Federal Food Law and Food Science, which restricts the sale of strong liquorice to pharmacies. Liquorice has a tradition there as a natural remedy. According to Hunnius (Pharmaceutical Dictionary) it is recommended as an expectorant and taste corrector as well as for the treatment of gastric ulcers. Chemically closely related to liquorice is carbenoxolone, which used to be a popular prescription-only stomach preparation that could only be prescribed with regular monitoring of potassium levels. Liquorice lovers are not subject to appropriate precautionary measures, although they may consume dose-equivalent amounts of glycyrrhizin when consuming liquorice.
The problem is known to consumer advocates. Most recently, the Federal Institute for Consumer Health Protection and Veterinary Medicine urged caution in February 1999. From a consumption of 50 g strong lavender, health problems must be expected. As early as February 1991, the Federal Ministry of Health recommended the Federal Association of the German Confectionery Industry, the Association for Food Law and Food Science and the Association of the German Essence Industry to print warning notices on the packaging of liquorice preparations. The limit value should be a daily consumption of 100 mg glycyrrhizin. The mechanism of action of licorice is not exactly known. It has long been assumed that licorice inhibits delta-5b reductase. The enzyme is responsible for breaking down aldosterone and hydrocortisone. The decrease in plasma aldosterone often observed in licorice intoxication speaks against this hypothesis. Inhibition of 11-b-hydroxy teroid dehydrogenase has recently been discussed. The enzyme breaks down cortisol. The mineralocorticoid effect of cortisol could explain the clinical symptoms. It corresponds to that of Conn's syndrome (primary hyperaldosteronism). Since the plasma aldosterone level is low, it is more precisely referred to as pseudoaldosteronism. The main symptom is hypokalemic hypertension due to an increase in the intravascular fluid volume. Hypokalaemia can be exacerbated by the use of cardiac glycosides, loop and thiazide diuretics, and non-electrolyte-neutral laxatives. It would therefore be desirable if warnings were included in the medication package inserts. An interaction with ACE inhibitors is also conceivable. The consumption of licorice leads to a blockade of the renin-angiotensin-aldosterone reaction cascade. Renin levels can drop sharply. Rüdiger Meyer
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