Welcome to Dr. Warrick's podcast channel. Warrick is a practicing cardiologist and author with a passion for improving care by helping patients understand their heart health through education. Warrick believes educated patients get the best health care. Discover and understand the latest approaches and technology in heart care and how this might apply to you or someone you love. Hi, my name is Dr. Warrick Bishop, and I'd like to welcome you to my podcast and videocast station. Today, I'd like to take the opportunity to talk about licorice. The thing to ask is, well, what is it, and how can it be a problem? Well, licorice is a root, and it's a root of a plant, which I'll try and say. Glizira glabra plant and licorice is the root of that particular plant and it gives the flavor to that sweet treat confectionery that we enjoy. I've got some notes here and I will just refer to those from time to time to make sure I don't miss anything. Well licorice we've all enjoyed we've had licorice all sorts, licorice bullets, straight licorice etc etc and it's very very tasty. We can also get licorice in tea, and people do take it for therapeutic reasons, particularly for digestion and keeping regular. But can there be a problem from consuming too much licorice? Well, it turns out there can. Of course there is, otherwise I wouldn't be talking about it. The problem that we can see with too much licorice is a syndrome. called pseudo hyper aldosteronism. Well, let's step through that so that you know what it means. Pseudo means it appears or it's not real. So sham or fake, if you like, hyper increased aldosteronism, aldosterone being a hormone, ism being the expression of that. So a false elevation of a hyperaldosterone type phenomena. Well, what is aldosterone? So that we know what pseudo-hyperaldosteronism means. Well, aldosterone is a hormone that's produced by the body. And the body has these fantastic hormones and regulators that constantly... keep us in fluid check and fluid balance, supporting both the fluid within our body and the blood pressures or pressures that we hold within our body. Now, I'm going to take a quick trip down an evolutionary lane and take you back several million years when our ancestors used to wander the equivalent of the African plains. Now, during that time, if we were to have blood loss, or some sort of stress on our body. And I don't mean the emotional stress of our boss wanting us to finish a particular job by five o'clock on a Friday night. No, I mean physical stress, such as an infection, such as blood loss, such as dehydration, stresses that really would lower the blood pressure within the body and put strain on the kidneys because our kidneys need to remove the toxic chemicals from our body on a constant basis or it builds up. People without kidneys die pretty quickly. For your kidneys to work well, you need good blood pressure. Think of any filtration system you've got. If you're not putting a good pressure into that filter, then there's a good chance that filter won't work properly. Well, aldosterone is... part of the body's response to the stresses of low blood pressure. Let me walk you through it. Within the kidney, right next to the area that filters the blood and starts the process of production of urine, is an area that's called the juxtaglomerular apparatus. Now, I don't expect you to remember that, but juxta means beside glomerular is the name. the name that we give to the filtration unit in the kidney and apparatus means it's a device or a functioning tool so juxtaglamellular apparatus is this little functioning tool if you like right next to the filtration unit within the kidney now these are microscopic but the juxtaglamellular apparatus senses the pressure of the urine of the blood as the urine is being filtered in the early stages now if you're still with me if the pressure drops the juxtaglamea apparatus acts by saying whoa we want to keep the pressure up within the kidney we want to make sure this body is able to still filter properly and so the juxtaglamea apparatus puts in train a process where it releases a chemical, a small hormone if you like, called renin. Now renin is released into the bloodstream and drifts around the body and bumps into a protein called angiotensinogen. It turns angiotensinogen into angiotensin 1. Angiotensin 1 floats around the body, passes through the lungs and is converted into angiotensin 2. Angiotensin 2 then has a role for increasing the blood pressure within the body and also... floats around to the adrenal glands, those little glands that sit just above the kidneys and incite the adrenal glands to release stress hormones, which are cortisone and aldosterone. So low blood pressure, the response to low blood pressure is the release of cortisone and aldosterone. So pseudo hyperaldosteronism. is going to be a process that looks like the body's responding to lack of blood flow or some sort of stress but in a situation where it shouldn't be. Now aldosterone retains fluid within the body it holds salt at the kidneys with water so that the body doesn't lose fluid and that therefore keeps the pressure within the vasculature elevated and aldosterone also acts on the blood vessels to keep them from relaxing. It keeps them, if you like, tensioned, taut, keeps them tight and keeps the blood pressure up that way. So how does all this tie in with licorice? Well, one of the enzymes within licorice, which is called glycerin, because remember our plant is called glyceriza glabra. Well, glycerizin is the active ingredient within licorice. Now that chemical breaks down, but its breakdown products can then act on the enzymes in the kidney to deactivate the... breakdown enzymes which convert active cortisone to inactive cortisone so if you're blocking active to inactive you're increasing your active component of cortisone and aldosterone type drugs and so licorice will lead to the potential increase of cortisone aldosterone type hormones within the body leading to fluid retention leading to salt retention leading to increased blood pressure. Fascinating. So what amount of licorice do you need to consume for that to happen? Well, it turns out it's not very much. It's about 100 milligrams of glycerin. 100 milligrams of glycerin. Well, what does that mean in bags of licorice or licorice bullets? Well, for those of us, who are Australian and grew up eating Darryl Lee licorice, a standard bag of Darryl Lee soft licorice is about 300 grams. Now there's about 100 milligrams of glycerin in 50 grams of licorice. So those bags of Darryl Lee, there are six servings in there that if you exceed those six servings, you're exceeding that 100 milligrams of glycerin, and there's a very good chance that you would start to impact the enzymes that break down the cortisol and aldosterone so that you could end up with significant problems if you ate that amount of licorice or more on a regular basis. So maybe not too much licorice on a regular basis, but... The other thing to note is that if you are enjoying licorice for bowel and other health potential benefits, then licorice tea seems to have even more glycerin in it than you'd imagine. And a single licorice tea bag can have as much as 100 milligrams of glycerin in it straight off the bat. So any more than one licorice tea a day could certainly... drive this process of pseudo hyperaldosteronism. This licorice blocking the breakdown of the hormones that raise blood pressure by holding on to salt, particularly sodium and letting go of potassium into the urine. So be wary of your licorice. Enjoy it in moderation and be careful just not to overdo it, particularly if you've got high blood pressure. So a little bit here and there, probably keep your bowels nice and regular, but too much, clearly a bit of a problem. Well, of course, are there other things that we need to be aware of? And there are plenty of other bits and pieces that I'll just share with you in terms of what could impact your health when you're taking it for what you think might be reasons that could otherwise be for your own benefit. Things like garlic and ginkgo, which we often take for cholesterol or we take for blood vessel health, cardiovascular reasons, these agents can thin the blood. So if you're already on something like warfarin or aspirin, it can increase the likelihood of bleeding. So be wary of that. Echinacea, which we know for coughs and colds, can also thin the blood as well. St John's Wort, which is sometimes used for mood but also for blood pressure, can decrease the absorption of some medications, particularly beta blockers and statins, and so you might just want to check with your pharmacist if you're taking any of those. A couple of other agents like green tea and alfalfa, which will often take for lowering cholesterol, these agents have a bit of vitamin K in there. And so if you were on that old-fashioned blood thinner warfarin, which is really not being used quite as much anymore, then these agents could impact the way that the warfarin works. And if you're taking variable amounts, then that could have a variable impact on your warfarin dosing. Ginger can affect clotting. Ginseng can affect warfarin and reduce its efficacy. And one of the important ones that pops up is grapefruit. And for those of us who have been on a cholesterol-lowering agent, we are probably aware that grapefruit can impact and... limit the function of one of the enzymes in the liver that breaks statins down. And so if you're taking regular significant doses of grapefruit, there's a chance, if you're doing that in combination with your statin, that the statin levels will go up. And if for some reason you were intolerant or had an idiosyncratic reaction to the statins, those higher levels could end up being problematic. So care, enjoying grapefruit and your statin. together well i hope that makes a bit of sense i hope that this presentation has given you something to ponder on i hope you still enjoy licorice but perhaps not too much on a regular basis and although it's really complicated the way the renin aldosterone blood pressure axis works You've now got an insight into the fantastic intricacies of blood pressure control. Well, I'm going to wish you the very best for now. Thank you so much for joining me. Please drop us a note if you have any queries or questions. I look forward to you sharing our next podcast. Take care. Bye for now. And please don't die from a heart attack. Goodbye. You have been listening to another podcast from Dr. Warrick. Visit his website at drWarrickbishop.com for the latest news on heart disease. If you love this podcast, feel free to leave us a review.
