Think twice before consuming large amounts of liquorice to avoid the risk of hypertension
Liquorice is used as an ingredient in certain food supplements and as a flavouring in beverages and foods. Following numerous reports of adverse effects, some of them severe, ANSES assessed the risks associated with the consumption of products containing liquorice. Its expert appraisal shows that repeated high consumption of beverages and foods containing liquorice can lead to hypokalaemia (a drop in blood potassium levels) and high blood pressure, thereby increasing cardiovascular risk. Some people are particularly sensitive: pregnant or breastfeeding women, children, people with cardiovascular problems (such as hypertension), or kidney or liver problems. ANSES recommends that food labels indicate the presence of liquorice or its main active ingredient, glycyrrhizinic acid, even in small quantities.
Liquorice is a plant regularly used in the formulation of food supplements, mainly because of the digestive properties attributed to its root. One of its constituents, glycyrrhizinic acid, and its ammonium salt, are authorised in the EU as food flavourings (E958).
A European directive requires them to be identified when their concentration exceeds a certain threshold in foods and beverages. The label must then state "contains liquorice – people suffering from hypertension should avoid excessive consumption".
More than a hundred cases of adverse effects analysed
ANSES analysed more than a hundred cases of adverse effects related to the consumption of products containing liquorice, reported under the nutrivigilance scheme and by poison control centres. These cases, along with others identified in the scientific literature, highlight symptoms of hypokalaemia and hypertension that can lead to cardiovascular complications. They were mainly associated with high and repeated consumption of beverages and confectionery containing liquorice.
Risks of interactions have also been described with several classes of medicinal products such as potassium-depleting diuretics, stimulant laxatives, glucocorticoids, digitalis (digoxin), antihypertensives and drugs that could potentially cause torsades de pointes, a heart rhythm disorder.
Provide better information on the risk of hypertension associated with liquorice consumption
Based on the maximum levels authorised in foods, ANSES found that around 60% of adults and over 40% of children consuming liquorice exceeded the toxicological benchmark (indicative toxicological value) established for this expert appraisal.
ANSES therefore recommends that consumers be informed of the presence of liquorice by mentioning it on the labels of foods containing even small quantities.
It also advises consumers to:
- avoid combining multiple sources of liquorice (alcoholic or non-alcoholic beverages such as pastis, syrups, confectionery, herbal infusions or food supplements);
- inform healthcare professionals about any liquorice consumption in cases of cardiovascular disease (particularly hypertension), kidney disease, liver failure or hypokalaemia, pregnancy or breastfeeding, as well as in the event of any doubt about possible drug interactions.