EP195: Liquorice of All Sorts

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Introduction Dr. Warrick Bishop is a practicing cardiologist and author dedicated to patient education about heart health. In this episode, Dr. Bishop explores licorice—a common confectionery and herbal remedy—and explains the serious cardiovascular risks associated with excessive consumption, including how it can trigger pseudo-hyperaldosteronism and dangerous changes in blood pressure and electrolyte balance. Key Takeaways: Licorice is derived from the root of the Glyzira glabra plant and is consumed as candy, tea, or herbal supplement, often for digestive and bowel health benefits. Excessive licorice consumption can cause pseudo-hyperaldosteronism, a false elevation of aldosterone-like effects that mimics the body's stress response to low blood pressure. Aldosterone is a crucial hormone that regulates fluid balance, salt retention, and blood pressure through the renin-angiotensin system activated in response to physical stress or low blood pressure. Glycyrrhizin, the active ingredient in licorice, blocks enzymes that break down cortisol and aldosterone, leading to increased levels of these hormones in the body. Just 100 milligrams of glycyrrhizin can trigger problematic effects; a standard 300-gram bag of licorice contains six servings, each with 100 milligrams of glycyrrhizin. A single licorice tea bag can contain up to 100 milligrams of glycyrrhizin, meaning consuming more than one per day risks causing pseudo-hyperaldosteronism. Excess licorice leads to sodium retention, potassium loss, fluid retention, and elevated blood pressure, posing particular risks for those already suffering from hypertension. Other herbal supplements present cardiovascular risks: garlic, ginkgo, and echinacea can thin blood and increase bleeding risk when combined with anticoagulants; St. John's Wort reduces absorption of beta blockers and statins. Green tea, alfalfa, ginseng, and ginger can interfere with blood thinners like warfarin, while grapefruit can elevate statin levels to dangerous concentrations. Patients should consult their pharmacist before combining herbal supplements with prescription medications to avoid potentially serious drug interactions and adverse health effects.