Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Liquorice-induced rise in blood pressure: a linear dose-response relationship

Journal of Human Hypertension volume 15, pages 549–552 (2001)Cite this article

Abstract

To clarify the dose-response and the time-response relationship between liquorice consumption and rise in blood pressure and explore the inter-individual variance this intervention study was designed and executed in research laboratories at University hospitals in Iceland and Sweden. Healthy, Caucasian volunteers who also served as a control for himself/herself consumed liquorice in various doses, 50–200 g/day, for 2–4 weeks, corresponding to a daily intake of 75–540 mg glycyrrhetinic acid, the active substance in liquorice. Blood pressure was measured before, during and after liquorice consumption. Systolic blood pressure increased by 3.1–14.4 mm Hg (P < 0.05 for all), demonstrating a dose-response but not a time-response relationship. The individual response to liquorice followed the normal distribution. Since liquorice raised the blood pressure with a linear dose-response relationship, even doses as low as 50 g of liquorice (75 mg glycyrrhetinic acid) consumed daily for 2 weeks can cause a significant rise in blood pressure. The finding of a maximal effect of liquorice after only 2 weeks has important implications for all doctors dealing with hypertension. There does not seem to be a special group of responders since the degree of individual response to liquorice consumption followed the normal distribution curve.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Lucas R Nature's Medicines (the folklore, romance, and value of herbal remedies). Awards books, A916N. 1976: New York (Universal-Award House, c1966) pp 89–94

  2. Blachley JD, Knochel JP Tobacco chewer’s hypokalemia: licorice revisited N Engl J Med 1980 302 784–785

    Article  CAS  Google Scholar 

  3. Sigurjonsdottir HA, Ragnarsson J Hathrystingur af völdum lakkriss Laeknabladid/The Icelandic Med J 1993 79 87–91

    Google Scholar 

  4. Folkerssen L, Knudsen NA-L, Teglbjaerg PS Licorice. A basis for precautions one more time Ugeskr Laeger 1996 158 7420–7421

    Google Scholar 

  5. van der Zwan A Hypertension encephalopathy after liquorice ingestion Clin Neurol Neurosurg 1993 95 35–37

    Article  CAS  Google Scholar 

  6. de Klerk GJ, Nieuwenhuis MG, Beutler JJ Hypokalaemia and hypertension associated with use of liquorice flavoured chewing gum BMJ 1997 314 731–2

    Article  CAS  Google Scholar 

  7. Dellow EL, Unwin RJ, Honour JW Pontefract cakes can be bad for you: refractory hypertension and liquorice excess Nephrol Dial Transplant 1999 14 218–220

    Article  CAS  Google Scholar 

  8. Sigurjonsdottir HA et alIs blood pressure commonly raised by moderate consumption of liquorice? J Hum Hypertens 1995 9 345–348

    CAS  PubMed  Google Scholar 

  9. van Uum SHM et alThe role of 11 beta-hydroxysteroid dehydrogenase in the pathogenesis of hypertension Cardiovasc Res 1998 38 16–24

    Article  CAS  Google Scholar 

  10. Walker BR, Edwards CRW Licorice-induced hypertension and syndromes of apparent mineralocorticoid excess Endocrinol Metab Clin North Am 1994 23 359–377

    Article  CAS  Google Scholar 

  11. Farese Jr RV et alLicorice induced hypermineralcorticoidism N Engl J Med 1991 325 1223–1227

    Article  CAS  Google Scholar 

  12. Störmer FC, Reistad R, Alexander J Glycyrrhizic acid in liquorice – evaluation of health hazard Food Chem Toxicol 1993 31 303–312

    Article  Google Scholar 

  13. Palermo M et alUrinary free cortisone and the assessment of 11 beta-hydroxysteroid dehydrogenase activity in man Clin Endocrinol (Oxf) 1996 45 605–611

    Article  CAS  Google Scholar 

  14. Epstein MT et alLiquorice toxicity and the renin-angiotensin-aldosterone axis in man BMJ 1977 1 209–210

    Article  CAS  Google Scholar 

  15. Hollifield JW Clinical significance of plasma renin activity J Tenn Med Ass 1973 66 947–948

    CAS  Google Scholar 

  16. Megia A et alAngiotensin I-converting enzyme levels and renin-aldosterone axis recovery after cessation of chronic licorice ingestion Nephron 1993 65 329–330

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank Mr O Petursson, the Drift liquorice sweet factory in Iceland and the Malaco sweet factory in Sweden for kindly supplying all liquorice, and to Sverker Jern head of the Clinical Experimental Laboratory, Sahlgrenska University Hospital/Östra for constructive discussion and statistical help. This study was supported by a grant from the Science Fund of the Reykjavik City Hospital and The Göteborg Medical Society. (Competing interests: None declared.)

Author information

Authors and Affiliations

  1. Department of Medicine, Sahlgrenska University Hospital/Östra, Göteborg, Sweden

    H Á Sigurjónsdóttir, K Manhem & S Wallerstedt

  2. Department of Chemical Pathology, Reykjavik City Hospital, University of Iceland, Iceland

    L Franzson

  3. Department of Medicine, Reykjavik City Hospital, University of Iceland, Iceland

    J Ragnarsson & G Sigurdsson

Authors
  1. H Á Sigurjónsdóttir
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L Franzson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K Manhem
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J Ragnarsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G Sigurdsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S Wallerstedt
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sigurjónsdóttir, H., Franzson, L., Manhem, K. et al. Liquorice-induced rise in blood pressure: a linear dose-response relationship. J Hum Hypertens 15, 549–552 (2001). https://doi.org/10.1038/sj.jhh.1001215

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jhh.1001215

Keywords

This article is cited by

Search

Advanced search

Quick links