Licorice Toxicity in an Ultramarathon Trail Runner

ABSTRACT: For centuries, licorice has been used for its medicinal and sweetening properties. Today, it is widely used globally in the herbal medicine, food, tobacco, and cosmetic industries. However, excessive consumption of licorice's bioactive metabolite, glycyrrhizic acid, has led to numerous reports of life-threatening complications. We present the case of a 51-year-old ultramarathon trail runner who initially experienced menopausal symptoms, and then extreme fatigue, edema, weight gain, paresis, systolic hypertension, and lose stool from chronic consumption of herbal teas and a supplement containing licorice. After 10 months, she was diagnosed with licorice-induced pseudohyperaldosteronism, a condition that suppresses the renin-angiotensin system. Approximately 2 months after cessation of all licorice products, she made a full recovery. This case highlights the importance of taking a thorough patient history, including knowledge of foods, fluids, supplements, herbal remedies, and cosmetics used. Increased public awareness of the potentially life-threatening hazards of licorice consumption is necessary.