A 45-year-old woman presented to her general practitioner with a 4-month history of hot flushes, sweating and headaches. On examination, she was found to be hypertensive, and blood tests revealed mild hypokalaemia [low potassium].
While awaiting the results of further investigation into the cause of her elevated blood pressure, the patient conducted her own research and identified liquorice tea [licorice tea] as the potential cause of her symptoms. The patient had been drinking up to six cups of liquorice tea per day as a substitute for caffeinated tea and fruit-based infusions.
The patient immediately stopped consuming the drink and within 2 weeks her symptoms, hypertension and hypokalaemia, had entirely resolved.
This case report, Hypertension induced by liquorice tea, is eye-opening because this woman had always had low blood pressure and so she ignored the small print on the box that states “not advised for people with hypertension.”
I often see this caution about avoiding licorice if you have high blood pressure (hypertension). But I have yet to see a warning on a box of tea about the fact that licorice can actually cause high blood pressure with high consumption – even when your blood pressure is low or normal. I feel the latter aspect is not as well known, which is the reason for this blog.
I’m also sharing this case report and additional information because something similar has just happened to me (more on my story below).
Here are a few more facts about this patient’s case:
- She went to her doctor “with a history of hot flushes, night sweats and headaches. These symptoms had started over the preceding 4 months. The patient suspected that her symptoms were due to the onset of menopause.”
- Initially her blood pressure was 162/82 and “Repeat blood pressure measurement confirmed ongoing hypertension of 150/80 mm Hg”
- “Blood tests demonstrated mild hypokalaemia” (i.e. low potassium of 3.3 mmol/L).
- Two weeks after she stopped drinking the licorice tea, “repeat blood pressure measurement was 128/84 mm Hg and her hypokalaemia (and other symptoms) had resolved.”
I encourage you to read the entire published case report to get an understanding of the mechanisms of licorice mediating “its effect on blood pressure via the action of glycyrrhizin on the kidney.” And the impacts on sodium, potassium, aldosterone, cortisol/cortisone and blood pressure. I will add that this is one of many such case reports in the published research.
My story with elevated blood pressure after drinking Yogi Throat Comfort tea
As I mentioned above, I’m sharing this case report because something similar has just happened to me! I had been drinking Yogi Throat Comfort tea for just over a week to soothe my throat and help after my voice loss. It contains licorice root as well as slippery elm and other herbs.
My blood pressure is typically low at 110/80 or less (sometimes as low as 102/80) and last Friday it was 130/80 which is the highest it had ever been.
I didn’t make the connection to licorice right away because I had just flown internationally from Hawaii to Australia and we were sprayed with insecticide on the plane when we landed in Australia. We all had to sit there in the toxic soup for 10 minutes. (I’ll be sharing more about all this in a future blog).
I suffered severe vertigo the next day and it was at the doctor’s office that I found out my blood pressure was 130/80. I was very surprised but he felt it could be due to the travel or vertigo or voice issues. I also know that bereavement can have major physiological impacts and increased blood pressure is one of them (I was in Hawaii for my darling mom’s memorial).
I finally made the connection when my blood pressure measured 137/84 a few days later and stopped drinking the tea immediately. Over the next few days it came down to 127/93 and then 121/90 and then 118/84. I expect it to continue to come back down to my normal low blood pressure and will update this blog when it does.
As far as symptoms, I was just not feeling myself and had a strange feeling of apprehension, spaciness and breathlessness when talking too much. These are much improved having stopped the tea. My naturopath also recommended eating a banana each day to increase my potassium levels and to have epsom salt baths to help regulate the electrolytes in my body.
I will admit there are the above confounding/contributing factors – grief, voice loss, travel, vertigo, insecticide exposure – so I can’t be sure it’s only the licorice in the tea, and I’m not willing to test it out right now.
(Update Oct 13, 2023: A week later and it’s now pretty much back to my usual low blood pressure. Over the course of this last week it measured 125/82, 118/91, 127/84, 118/85 and today it’s 112/85. I will continue to track.)
How much licorice tea is too much?
The authors of the above case report mention this about the dose of glycyrrhizin:
- Experimental studies have shown that the rise in blood pressure caused by liquorice follows a linear dose–response relationship. Doses of as little as 75 mg of glycyrrhizin (equivalent to 50 g of standard liquorice confectionery) given daily for a 2-week period have been shown to cause a significant increase in systolic blood pressure (the first number).
- In a survey of 33 brands of liquorice tea, the mean glycyrrhizin content was found to be 126 mg/L (range 2–450 mg/L). A cup of liquorice tea with a volume of 250 mL could therefore be expected to contain, on average, approximately 31.5 mg of glycyrrhizin.”
- The European Scientific Committee on Food advises that regular glycyrrhizin doses of 100 mg/day present a risk to health, and advocate a safe average daily intake of no more than 10 mg/person/day. This is an amount equivalent to less than half a cup of liquorice tea or just 6 g of liquorice confectionery daily.
In the above published case, the patient had been “averaging around 4–6 cups per day, and had been consuming the licorice tea for about a year.” She was “unwittingly consuming daily volumes of liquorice tea containing up to 190 mg of glycyrrhizin, well in excess of the recommended limit” of 10 mg per day. It was 8 months before she started to notice the adverse effects, but I do wonder how long she had high blood pressure.
We have a home blood pressure monitor but I haven’t used it for ages and if I hadn’t gone in to the doctor for my vertigo, my elevated blood pressure may have gone unnoticed for a while too.
How much did I consume: a total of 10 Yogi Throat Comfort tea bags over the course of a week. The day before leaving I had a few cups of hot tea and was thrilled to be able to talk on my last day there. I then drank it all day on the 15+ hour flight back: I had 2 tea bags in my 2 liter / 2 quart water bottle and filled it up a few times with cold water. And I continued to do this once I was home, having it next to my bed if I woke up coughing in the night. I was probably getting 3 or 4 times more than the safe average daily intake of 10 mg/person/day.
I love licorice tea and drink it from time to time, maybe 2-4 cups a month. I’m quite surprised it affected me so quickly but have never consumed this amount and in such a concentrated time period.
Will I drink Yogi Throat Comfort tea or other herbal teas that contain licorice?
For now, I think I will – the Throat Comfort tea helped so much with my voice – but when I do I will monitor my blood pressure carefully and then make a final decision.
I also plan to dig a bit further into some of the confounding factors I mention above to see how they could possibly have made me more susceptible.
I do also have dietary oxalate issues so this could play into the effects of glycyrrhizin on the kidney. I’m finding mixed results on the oxalate content of licorice: some papers say high and some say low. But I didn’t have any of my typical oxalate reactions such as painful feet or eyes. I have, however, noticed some stiffness in my left hip the last few days so will be looking further into this aspect.
(Update Oct 13, 2023: Licorice tea is listed as low oxalate on the Trying Low Oxalates Facebook group but they will be updating their spreadsheet based on a paper I just shared with them – Oxalate in Foods: Extraction Conditions, Analytical Methods, Occurrence, and Health Implications “Licorice was the highest-oxalate food reported in this review with 3569.3 mg total oxalate/100 g FW (fresh weight).” (this is higher than spinach, sweet potatoes and rhubarb which are really high oxalate)
My takeaway messages – a warning and listen to your body
There is no licorice hypertension warning on this Yogi Throat Comfort tea box (or my Tulsi Licorice tea) and I do feel there should be 2 warnings: the usual warning about licorice if you have high blood pressure AND a general warning that licorice may also affect you if you have low or normal blood pressure.
My other takeaway message is this: listen to your body and get checked out when things don’t seem as they should be.
Has something like this happened to you? How much licorice tea did you consume, which brand and over what period?
Do you typically have low blood pressure and were you also caught by surprise?
Did you know about the caution to avoid licorice if you have high blood pressure?
And what about the fact that licorice may also affect you if you have low or normal blood pressure?
Feel free to share and ask your questions below.
Yes….I don’t like the taste of licorice in my teas and I find that it’s in a lot of teas…especially the organic ones….maybe if we all take to writing letters to the companies they would substitute it with something else.
G
Yes it’s added to many herbal tea blends because it’s naturally sweet. From the case report: “The natural sweetness of liquorice accounts for its popularity as a base for confectionary and beverages, and derives from the bioactive component of the root, glycyrrhizin (glycyrrhizic acid). Glycyrrhizin has been estimated to be up to 50 times as sweet as sugar.”
I actually enjoy the taste but I feel we do need options that don’t include licorice root. Writing letters is a great approach. I’ll certainly be reaching out to a number a companies because of my experience and the experiences of those in my community.
Feel free to share a few brands/blends that you’ve noticed contain licorice root.
Does DGL do the same thing? For indigestion?
Carollyn
I’ve been taught that DGL does not cause the same issues… “A processed licorice extract, deglycyrrhizinated licorice (DGL), which is used in the treatment of peptic and aphthous ulcers, is made by removing the glycyrrhizin molecule” and it “produces equally effective results compared with glycyrrhetinic acid but is free from any side effects.”
The above is from a chapter in the Textbook of Natural Medicine by Michael T. Murray, ND https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7348626/
However another recent case report documents similar problems with DGL: “The patient had been ingesting a significant quantity of deglycyrrhizinated licorice for many years to alleviate postprandial epigastric pain.” He was consuming a very high dose: “He admitted that for the past 6-8 months he was consuming up to 20 licorice root 760 mg tablets a day, well exceeding the acceptable daily allowance (2280 mg).” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8369979/
Based on this I’d recommend discussing long-term intake with the doctor and/or naturopath and monitoring blood pressure, potassium levels and symptoms.
Yep. Happened to me years ago.
Merry
I’m sorry to hear – thanks for sharing. Feel free to share any details – I am curious how much you consumed and if your blood pressure was low or normal?
I do not remember how much tea I drank. Did not seem like a lot. My BP runs low.
This is a miracle article! I was having HORRENDOUSLY worse hot flashes lately. I had an acupuncturist who RECOMMENDED I drink fennel and licorice tea for digestion. So I had been drinking about a quart a day for a month! It had a tablespoon of licorice in it. Yikes!! I finally stopped a few days ago and immediately my hot flashes have started to improve.
I stopped because I started to have weird electrolyte symptoms, like my legs getting tight and swelled up which I know is an imbalance for me. I supplement with a lot of potassium and eat a potassium-optimized diet (lots of beans and squash) but it was no match for the licorice.
Thank you for this article! I knew licorice is problematic but had no idea just how impactful it can be. I feel very validated that I stopped that tea. I also have licorice in another herbal blend I make, and I will certainly be reducing it in that blend as well. It’s delicious, but nothing is worth having worse hot flashes and electrolyte imbalances!
Melissa
I’m so glad this article is helpful and validating for you. Good for you for listening to your body.
I’m not sure what you mean by a tablespoon of licorice – actual dried licorice root?
I am curious if your blood pressure is typically low or normal? And if you measured it when you started to have symptoms and now that you’re feeling better?
Yes, the quart of tea I was drinking had a tablespoon of dried licorice root (glycyrrhiza glabra). Luckily I only drank that for a few weeks / a month at most– but whoah! Too much licorice.
My blood pressure is usually extremely low — 88/64, 94/70, 104/76 are some records I have on file. My family has such low blood pressure my sibling was almost denied entry to the military for low blood pressure.
I haven’t measured my blood pressure lately though. I’ll update if I do!
Melissa
Thanks for sharing this update. I look forward to hearing what your blood pressure is now
I use various Traditional Medicinals brand teas as I found they are sustainably sourced and very reputable. They have warnings on every box as to who should or should not consumer.
As for licorice, the DGL variety would not cause a rise in blood pressure or potassium loss because the component “Glycyrrhizin is taken out or no more than perhaps 1% to help avoid any potential effect on blood pressure. You can chew the tablets usually indicated for digestive relief and heartburn yet it also help with throat issues. Not sure how effective as compared to licorice tea. I have used a DGL supplement for 1-2 months for indigestion due to anxiety issues and It helped me. It is sometimes difficult to find one that doesn’t contain all the fillers etc like sorbitol which could cause digestive issues (gas etc) if your body can’t break them down.
Herbs are great healers yet I am learning to respect mother nature since even natural methods can have side effects if you are not informed enough about them. I try to trial them to see how I feel especially if taking other prescription meds or supplements. And yes, perhaps check with an informed herbalist or doctor who would know or perhaps the Natural Medicine Database.
Just my two cents worth since I am a very curious person who likes to learn 🙂 Hope this helps someone.
Mary
I also love Traditional Medicinals and am with you on having a healthy respect for mother nature and herbs. And agree, herbs are great healers.
Their Throat Coat is one I have used in the past (it’s similar to the Yogi Throat Calm I used) but based on what I see on the site, I don’t feel their warning is sufficient https://www.traditionalmedicinals.com/collections/teas/products/throat-coat-tea
“Warnings: Consult your healthcare practitioner prior to use if you have low potassium levels; if you are taking diuretics, corticosteroids, cardiac glycosides such as digoxin, potassium depleting medications or if you are pregnant or breastfeeding. Do not use this product if you have high blood pressure, heart disease, or impaired kidney or liver function; or if you are allergic to plants in the parsley (Apiaceae) family. Not recommended for use with children under 12 years of age.”
They warn about high blood pressure but no mention that it could be an issue with low or normal blood pressure in some folks.
Elsewhere they state “Enjoy 4-6 cups per day.”
Good to hear you’re benefiting from DGL. Please also see my feedback for Carollyn re DGL.
Much gratitude for your reply Trudy. I did read your response to Carollyn re DGL. I used Nature’s Way with Gutgard and never exceeded the dosage and only for a couple months until my anxiety was becoming more controlled.
Just a question for you but I have trialed a product from my physician called Tranquilent by Sanesco and found it to be somewhat help for my anxiety disorder at 1 chewable tablet in the evening. Have you every heard of it and the company as I am off any antidepressents and do not want to go back on them due to dependence and side effects of more anxiety esp when starting. They also mess with sleep.
Also any recommendations on quality sleep supplements to turn your circadian clock around would be appreciated. I belong to Fullscript and also could run it by by physician.
Mary
I prefer individual amino acids to proprietary formulations like Tranquilent where you have no idea how much of each you are getting and can’t adjust one up or down. I have cleints trial inositol, theanine and 5-htp separately to find the optimal doses.
For sleep issues caused by high cortisol I use Seriphos, lactium and/or magnolia – feel free to search the blog for various articles. Also melatonin and/or tryptophan.
Diet and gut health is key too – all explained in my book “The Antianxiety Food Solution” – real food, no gluten/sugar/caffeine, quality animal protein esp at breakfast for blood sugar control, parasites, digestion etc https://www.everywomanover29.com/blog/the-antianxiety-food-solution-by-trudy-scott/
I have enjoyed Yogi’s Egyptian Licorice tea for years and have not noticed any symptoms as I see in the article or comments. Has anyone experienced trouble with this particular tea?
Debbie
Good to hear you have not noticed any symptoms. May I ask how much you consume and if you monitor your blood pressure? And have potassium levels been checked recently as part of routine blood work?
Just a FYI – they do have this warning on the site for this product https://yogiproducts.com/teas/herbal-teas/egyptian-licorice/
“WARNING: Not recommended for use if you are pregnant or nursing, have high blood pressure or for daily use beyond 4-6 weeks. Consult your healthcare provider prior to use if you are taking any medication or if you have a medical condition.”
I see they warn about high blood pressure but no mention that it could be an issue with low or normal blood pressure in some folks.
Hi Trudy and thank you for your excellent work and mission to help us attain our best health and happiness. I have benefitted immensely from your work and I appreciate your kind spirit. To answer your question- I consume no more than one tea bag per day, sometimes in just a cup of water but also often in a 5 cup water bottle (along with a milk thistle tea bag) to sip on over the course of the morning. It is my favorite tea, so I estimate that I have 5 tea bags per week. I have historically had low blood pressure, though the last time it was measured it was in the 120/80 range (it used to be 100/60 decades ago). I will have my husband take my bp and start recording it on my food/mood log (that I started in Jan 2020 as a rec from your anxiety:gut-brain summit that I listened to in Nov 2019). I will stop the licorice tea and monitor the bp changes to see what effect it has. I am going for my annual doc appointment in two weeks, so I can ask then to have blood tests for potassium.
Thanks again for this article and your reply!
Debbie
Update on blood pressure- after 5 days of curtailing the Egyptian Licorice tea, my blood pressure (which measured 116/60 four days ago) is down to my normal baseline of 100/60. It didn’t take long to normalize, and I will stop drinking it everyday! Thanks again for this helpful information.
Debra
Thanks for sharing your update – glad to hear it’s back to your normal baseline
I drink liquorice tea years ago when I was trying to cut out caffeine. I had chronic fatigue syndrome and digestive problems and was advised to try liquorice tea for my IBS. I loved the taste so drank several mugs of the tea daily for several weeks. It helped my digestion but the fatigue continued so I consulted a herbalist. He gave me a remedy which also contained liquorice! Shortly after starting this I had a massive pain in my chest and was rushed to hospital by ambulance. It turned out after many tests and questions that I had severe hypokalaemia . The medical students were fascinated as they learn there is a link between high liquorice intake and potassium deficit but as never seen a real case!
Margaret
Sorry to hear you experienced this. I appreciate you for sharing as this is a very real issue with licorice and low potassium.
I hope you’re doing better now
Hmm! I have been taking Licorice root as a supplement (450mg SolarRay brand) daily for several months now – for perimenopausal symptoms – especially hot flashes.
I just checked my BP which is always on the low side for me, and, as you noted: mine is elevated. I wake up multiple times per night with a hot flash and am not sure if I wake up and then a night sweat hits or if I wake up because one is coming – so perhaps Licorice is the cause and not the solution. I do get the occasional headache during the day (I’m neither dehydrated nor in caffeine withdrawl as I stopped coffee about a year ago) so I am wondering if it is as easy as the Licorice.
I will stop immediately and report back in two weeks!
Holly
Thanks for sharing. Please let us know what the shift in BP has been and how things change in 2 weeks. I’d also get potassium levels checked
Reporting back in 1 week because my BP is already back down to normal levels for me (which is a little on the low side historically) after stopping the licorice supplement which I was taking for menopause symptoms. I am sleeping better, my mind is not on overdrive and night sweats have mellowed (all the things I was told licorice would be good for). I barely had one “wake me up sweat” (and only one) last night! I have been taking a milk thistle – dandelion supplement to support my liver remove the licorice this week and doing Qi Gong for overall wellbeing. No random coincidence that I happened upon your Licorice Tea post. You saved me a lot of frustration. I feel much more settled now – more like myself. And – I do not regularly check my BP, so that was a really good heads up.
Holly
Thanks for reporting back with your much improved symptoms after a week – that’s wonderful!
Can you share your blood pressure before stopping the supplement and what it is now?
I also don’t regularly check my blood pressure because it runs nice and low. Going to the doctor for my vertigo was my wakeup call. I suspect many folks with low and normal blood pressure are caught by surprise too.
Be sure to read the blog just published – Licorice intake, the renin-angiotensin-aldosterone-system and licorice-induced adverse effects on the cardiovascular system https://www.everywomanover29.com/blog/licorice-intake-the-renin-angiotensin-aldosterone-system-and-licorice-induced-adverse-effects-on-the-cardiovascular-system/. And my advice: getting a thorough cardiovascular work-up for anyone who has observed high blood pressure and/or low potassium after consuming licorice for any duration.
Feel free to share which factors may have made you more susceptible to the adverse impacts of licorice intake.
I was taking MegaGuard by Microbiome Labs. I was following their SIBO support protocol: 1 capsule per meal initially, then 2 capsules per meal. It contains the DGL form of licorice.
After a couple months, I noticed that I was more anxious and kept slipping into a ‘fight or flight’ response really easily. My blood pressure is historically on the lower side and I did not see any alterations there, but my lab work revealed high cortisol and high aldosterone. I stopped taking MegaGuard and my symptoms improved. I also found some research showing that licorice is an MAO inhibitor, which may have also been contributing to my symptoms.
I’m so sorry about your mom, Trudy.
Gracie
Thanks for sharing – glad your symptoms have improved. I hope labs have normalized.
I see MegaGuard by Microbiome Labs has 75mg of DGL (https://microbiomelabs.com/home/products/megaguard/#gallery-2). On a side note DGL is only effective when chewed so won’t do much for digestive help in a capsule that is swallowed!
Feel free to share a link to what you read about licorice and MAO. I’ll be digging into this further too. This paper covers MAO and many other pathways/targets https://www.mdpi.com/1420-3049/24/16/2959 The authors conclude: “it is recommended to use licorice at the doctor’s advice and not to take large doses for a long time.”
Thanks for your sympathy – it’s been rough
Hi Trudy,
Are you aware of other herbs that raise cortisol as I have had a similar reaction when taking various combination herbal supplements/teas but still not 100% sure which one is the problem.
John
Licorice is the main one and 5-HTP can be an issue for some individuals who already have high cortisol
I love the taste of licorice tea but just one cup a day gives me headaches. It’s strange as my blood pressure is usually always on the low side and I rarely get headaches. I am often lowish on potassium intake due to food intolerances so this may be a factor for me.
Kat
Thanks for sharing. I’m curious if you have measured blood pressure when you have consumed licorice tea?
May I ask what food intolerances cause you to be lowish on potassium intake?
I’m so sorry to hear about your mom, it must be a very difficult time for you and your family. Rub a drop of rose essential oil on your heart chakra each day to heal your heart, it really does work, and thank you for your service to this community.
Jane
Thank you – I appreciate your support
I’ve historically had very low blood pressure— my doctor had me up my salt intake, and drink licorice tea regularly, which didn’t seem to do very much until recently (I have a TBI and my body doesn’t always respond to things in a typical way) Now that I am menopausal and on migraine meds, I am suddenly having higher blood pressure. Went from 110/60 to 140/90, which is uncomfortable and unnerving. I drink throat comfort tea regularly because it helps with IBS, and I’ve been taking a dgl aloe supplement. Definitely cutting down on that now, and limiting salt consumption.
Megan
Thanks for sharing and glad you made the connections. I now feel anyone using licorice tea and/or DGL should be checking BP weekly.
I was given licorice by a nurse practitioner without the bp warning. I took for two months. Ended up in the ER with BP of 220/142. Stopped ingesting it in March. My Bp has still not recovered fully after 6 months. It’s running 140/100. I had low to normal BP prior to investing the licorice supplement .
Joanna
I’m sorry to hear – thanks for sharing.