Thread by @Andy_Tattersall

Christmas is coming and many of us are going to get a little bit over indulgent over the next few weeks. So here is a serious thread about licorice which I have been meaning to write. If you eat it regularly, or know older people who indulge in eating it - then please read on...

Earlier this year I discovered by accident that I had dangerously high blood pressure - Systolic blood pressure scores of over 200. I was naturally quite shocked, especially as I felt fine. I was regularly getting scores of about 190/110

After speaking to my GP over the phone and having blood tests, my wife remembered a connection between licorice and blood pressure. After a quick search we found it is truly terrible for your heart and blood pressure, really quite terrible.

I'd been eating about 2 x 200g bags a week as a treat after work and as alternative to chocolate (as many people eat it for that reason). Without much of a search I found several case studies that highlighted how bad it was.

The papers also highlighted that you do not need a lot of it to do the damage, just about 50g per day for two weeks can give you dangerously high blood pressure. In one paper it was 25g per day doing the damage (1/8th of a typical bag)

This paper captured the problem succinctly - "The FDA should start regulating the use of this substance and create public awareness through the media about its health hazards." ncbi.nlm.nih.gov/pmc/articles/P…

Of course, we can all talk about 'everything in moderation" But the FDA report that: "If you’re 40 or older, eating 2 ounces of black licorice a day for at least two weeks could land you in the hospital with an irregular heart rhythm or arrhythmia." - A typical bag is about 6-8oz

Even the @TheBHF and @NHSuk have pages highlighting liquorice's danger bhf.org.uk/informationsup… nhs.uk/common-health-…

This does not extend to just licorice but also licorice tea, which is also pretty bad for you. As highlighted by @BloodPress_UK bloodpressureuk.org/resources/real…

Here's another one about licorice tea ncbi.nlm.nih.gov/pmc/articles/P… - "Excessive consumption of liquorice tea can induce hypertension in previously normotensive patients, and present with a clinical picture similar to primary hyperaldosteronism."

According to what you read, 'excessive' might be as low as 10g a day - 1/10th of a typical bag. The thing to look for is whether it contains Glycyrrhizin which is 50 times sweeter than sugar.

Even @holland_barrett who sell licorice products highlight that it can be bad for you in several circumstances - but I have not seen warnings on most supermarket products hollandandbarrett.com/the-health-hub…

So what does licorice do? What did it do to me? It removed potassium in my body that helps regulate my heart and blood pressure. It also made my kidneys retain salt and water. ncbi.nlm.nih.gov/pmc/articles/P…

I felt fine, but my blood pressure was scarily high for a few weeks and has dropped considerably since to about 120/85 and thereabouts. I started to have muscle weakness and didn't feel that well once I stopped eating it.

My GP and blood nurse were not aware of the connection but it seems prudent to ask any patients who present with high blood pressure about licorice intake, especially when it's a common Xmas gift.

Even my blood nurse commented that her grandmother had a mysteriously high blood pressure and loved licorice - now she knows why. Thanks to my wife, I'd probably keep eating it and increasingly risk of stroke etc

It does have some positive health properties, but in moderation means 'eat very little amounts' if you want to prevent a similar scenario that I and others have had. If you are giving it as a gift to elderly family or friends, think again.

There seems to be an inconsistency on supermarket sites as @Morrisons @sainsburys @Tesco have warnings on licorice tea - but not on sweets. Tesco recommend "For all consumers we recommend not exceeding 1 cup per day." For all...not just elderly etc

When searching for further information and case studies I didn't need to search far to find papers and news reports - even a 2017 Tweet from @trishgreenhalgh about how bad it can be for your health

I do wonder how many GPs and primary care centres know about licorice (given my GP and nurse didn't) given how popular it is (especially with the elderly). In some of the case studies, it was the patient who diagnosed the problem, as did my wife for me.

Do the likes of very high profile public health experts know how bad licorice is and can they broadcast the message. @bengoldacre @doctor_oxford @felly500 @olliehart7 et al.

Obviously, I do worry about the licorice lobby coming after me 😉but this really is a serious point and hopefully it will get through to a few people and prevent them from being rushed to A&E this winter when services are stretched.