There’s really no in-between when it comes to liking black licorice — you either love it or hate it.

If you love to eat black licorice, you may be distressed at the rumors of people dying from eating too much black licorice. Does this peppery, controversial candy have lethal consequences at high doses?

This article uncovers whether black licorice at high doses may be deadly, along with information on healthy portions, necessary precautions, and tasty alternatives to black licorice.

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Do people die from black licorice?

Reports of people dying from eating too much black licorice are few and far between, but they do exist.

Several case reports show that daily black licorice consumption leads to a condition called pseudohyperaldosteronism, which can be lethal if untreated.

The most recent report — published on Sept. 23, 2020 — involved a 54-year-old man who had been in a fast-food restaurant when he suddenly lost consciousness (1).

Emergency medical personnel arrived at the restaurant and identified that the man was experiencing ventricular fibrillation, a serious type of irregular heartbeat.

The man was rushed to the hospital but died 32 hours later after experiencing electrolyte imbalances and multiorgan failure.

The doctor concluded the patient died of pseudohyperaldosteronism, a medical condition wherein your body mimics the effects of elevated aldosterone with high blood pressure. This suggests that excess black licorice intake had triggered ventricular fibrillation.

Pseudohyperaldosteronism is a condition characterized by high blood pressure, low potassium blood levels, a disturbance in your body’s blood acid-base balance, and low levels of renin, an enzyme that regulates blood pressure (2).

A discussion with the man’s family revealed that 3 weeks prior, he had switched from snacking on fruit-flavored soft candy to black licorice. He was also eating 1–2 large packages per day.

An earlier case report from 2008 discussed a similar incident in which a 55-year-old woman arrived at a clinic with low potassium levels and high blood pressure. She proved unresponsive to blood pressure-lowering medications (3).

She reported eating 1–2 packages of black licorice daily for 4 years after she stopped smoking.

After further medical workup, the doctor diagnosed her with pseudohyperaldosteronism related to excessive black licorice consumption.

She was instructed to eliminate licorice from her diet and eat a potassium-rich diet and take potassium supplements to treat her low potassium levels.

She followed the doctor’s orders and several months later, her blood pressure was managed and her lab results — including potassium — were all within normal limits.

Summary

Several case reports have linked excessive daily black licorice consumption to a condition called pseudohyperaldosteronism, which can be deadly.

How do the compounds in black licorice affect your body?

Licorice contains a compound called glycyrrhizic acid. This acid gives licorice candy its sweetness.

Glycyrrhizic acid is reported to be 50 times sweeter than sucrose, or table sugar (3).

Your body converts glycyrrhizic acid to glycyrrhetinic acid, which medical specialists agree is relatively harmless in small amounts (1).

But in large amounts, glycyrrhetinic acid and its digestive by-products inhibit an enzyme that helps your body from converting active cortisol into inactive cortisone (4).

This leads more cortisol to bind to its receptor and exert its effects in the body that lead to pseudohyperaldosteronism.

In most cases, eliminating licorice from your diet can resolve pseudohyperaldosteronism within a few weeks or months. Still, high blood pressure may sometimes persist due to other causes (4).

Summary

Licorice contains glycyrrhizic acid, which your body converts to glycyrrhetinic acid. In large amounts, this acid inhibits an enzyme that eventually may lead to pseudohyperaldosteronism, a potentially fatal condition.

Recommended maximum dose

Licorice root has been used in traditional medicine for thousands of years to treat coughs, asthma, stomach pain, insomnia, and infections (5).

Indeed, licorice contains various beneficial plant compounds that contain anti-inflammatory, antioxidant, and antimicrobial properties (6).

Still, despite its long — and presumably safe — history of use, scientific organizations have urged caution against eating too much licorice due to its ability to increase blood pressure and cause electrolyte imbalances (7).

The World Health Organization (WHO) suggests that an intake of up to 100 mg per day of glycyrrhizic acid is safe for the majority of adults (8).

This amount equates to about 2–2.5 ounces (60–70 grams) of licorice.

Still, it’s difficult to provide a safe recommendation for black licorice candy consumption because the glycyrrhizic acid content can vary by as much as 30-fold from one product to the next (3).

The Food and Drug Administration (FDA) suggests that if you’re age 40 or older, eating 2 ounces (57 grams) of licorice per day for at least 2 weeks may cause an irregular heart rhythm that may require hospitalization (9).

Keep in mind that many herbal teas and dietary supplements contain licorice root extract.

To be clear, red licorice — despite its name — does not contain licorice root extract, so it doesn’t provide glycyrrhizin.

Products that contain licorice must be labeled. Manufacturers list licorice extract or glycyrrhizic acid in the ingredient list.

Summary

According to the WHO, up to 100 mg per day of glycyrrhizic acid, equal to about 2–2.5 ounces (60–70 grams) of licorice, is safe for the majority of adults.

What precautions should you take?

If you have a condition that adversely affects your heart or kidneys, be especially cautious with how much black licorice you eat — and the frequency with which you consume it.

Licorice has a long half-life, meaning that it stays in your body for a long time before you eliminate it (10).

This allows glycyrrhetinic acid to accumulate in your body the more frequently you eat licorice. This consistent buildup increases your risk of pseudohyperaldosteronism.

If you have a preexisting condition that affects your heart or kidneys, pseudohyperaldosteronism may be deadly.

Summary

If you have a preexisting heart or kidney condition, be extra cautious with the amount and frequency of licorice that you consume.

The bottom line

Black licorice and other sources of licorice contain glycyrrhetinic acid. In large amounts, this acid inhibits an enzyme that allows more active cortisol to bind to its receptor.

So, eating too much licorice — or too frequently — can result in high blood pressure, low potassium levels, and other signs of pseudohyperaldosteronism. This can be deadly, especially in people with preexisting heart or kidney conditions.

The WHO suggests that most healthy adults can safely eat up to 100 mg per day of glycyrrhizic acid, or about 2–2.5 ounces (60–70 grams) of licorice.

Just one thing

Try this today: If you can’t cut your licorice cravings, switch to red licorice. Twizzlers, perhaps the most popular licorice brand of all, boasts three delicious flavors — strawberry, chocolate, and cherry — that don’t contain glycyrrhetinic acid.

So long as you go easy on your sugar intake, you can munch away without concerns.