He has not had any coronary heart issues previously. He often went for walks together with his canine and, in accordance with his docs, labored as a bodily demanding building employee.
Then, in January 2019, he collapsed at a McDonald’s and died.
The probably offender? Black licorice, in accordance with the docs who handled it, who this week printed their outcomes on the bizarre case within the New England Journal of Drugs.
In response to the report, the person, an unidentified 54-year-old from Massachusetts, had consumed one or two giant luggage of black liquorice a day for 3 weeks. This behavior induced his potassium ranges to drop sharply, inflicting cardiac arrest, in accordance with the examine. He by no means regained consciousness after his collapse and died about 24 hours after arriving at Massachusetts Common Hospital.
“We virtually did not imagine it after we discovered,” stated Dr. Jacqueline B. Henson, who handled the person when she was within the hospital. “We had been all shocked and stunned.”
Aspiring docs in medical faculty are studying that black licorice comprises glycyrrhizic acid, a plant extract usually used as a sweetener in sweet and different meals that may result in dangerously low potassium ranges if consumed in sufficiently excessive doses. But it surely hardly ever occurs that somebody dies from ingesting an excessive amount of sweet, stated Dr. Henson.
The Massachusetts man had a poor weight loss plan and, in accordance with his family and friends, smoked a pack of cigarettes a day, his docs stated. But it surely was a swap from crimson to black liquorice three weeks earlier than he died that docs stated was deadly.
Dr. Henson stated she interviewed the person’s family and friends members, and the docs ran a number of laboratory assessments that confirmed the person’s potassium ranges had been properly beneath regular.
They studied his medical historical past, which included heroin use although he had not used opiates for 3 years. There was no household historical past of coronary heart illness or some other medical situation that led to low potassium ranges, stated Dr. Henson, who’s now a Fellow at Duke College Faculty of Drugs in Durham, NC.
“We had no different clear cause why his potassium ranges had been so low,” she stated.
The case “poses a public well being drawback that consuming giant quantities of licorice might be dangerous,” stated Dr. Neel M. Butala, one of many examine’s authors and a employees member within the Interventional Cardiology Division at Massachusetts Common Hospital.
Dr. Butala stated shoppers must be knowledgeable concerning the degree of glycyrrhizic acid of their merchandise from sweet and different meals producers.
He additionally reported the case to the Meals and Drug Administration.
In a press release, the F.D.A. declined to remark particularly on the report and referred to its coverage of not discussing particular person instances.
“The FDA is dedicated to defending public well being and guaranteeing the security of our nation’s meals provides,” the company stated in an electronic mail. “We perceive that the naturally occurring compound in black licorice can have adversarial well being results . “
The F.D.A. warns folks 40 and over that consuming two ounces of black liquorice a day for not less than two weeks could cause “coronary heart rhythm or arrhythmia”.
The company warns shoppers on its web site concerning the risks of an overdose of black licorice. The compound glycyrrhizin, which is constructed from licorice root, could cause potassium ranges within the physique to drop and, in accordance with the company’s warning, result in irregular coronary heart rhythms, hypertension, edema, lethargy and coronary heart failure.
The docs’ outcomes have been fastidiously researched and will function a public well being warning, stated Dr. Keith C. Ferdinand, an unrelated heart specialist at Tulane College Medical Faculty, who learn the article within the New England Journal of Drugs.
Whereas it appeared “a really uncommon case”, it ought to function a warning to the general public to “bear in mind that any substance taken into the physique, particularly in extra, can have actual physiological results” stated Dr. Ferdinand, who can be the Gerald S. Berenson Endowed Chair for Preventive Cardiology.
“It’s all the time troublesome to discover a trigger and impact when an individual has a sudden catastrophic occasion,” he stated.
However the components on this case – the affected person’s low potassium ranges, the affected person’s arrhythmias, the truth that he was tremendous till he collapsed – all sign that the licorice was “probably the supply” of his finally deadly situation, stated Dr. Ferdinand.
Different research have raised the alarm about overeating licorice. In 2012, docs at Mercy Hospital and Chicago Medical Heart printed a examine entitled “Licorice Abuse: Time to Ship an Alert.” It suggested docs to warn sufferers towards ingesting an excessive amount of licorice and urged the F.D.A. regulate using it.
“Every day consumption of licorice is rarely justified as a result of its advantages are small in comparison with the adversarial results of continual consumption,” the examine says. The case of a 35-year-old Egyptian man with no underlying well being issues has been recognized who quickly misplaced management of his motor features after consuming a liter of liquorice-flavored water throughout Ramadan.
“There are quite a few licorice-containing merchandise which might be available in on a regular basis use and that may be inadvertently consumed by the general public in beneficiant quantities, with the chance of issues,” she famous.
Dr. Henson stated individuals who want to have a bit of licorice every so often should not be alarmed by the Massachusetts case.
Black liquorice is not poison, she stated.
“It is okay to soak up small quantities, hardly ever,” stated Dr. Henson. “However when taken often, it could actually result in these issues.”