WATCH OUT FOR JELLY BEANS.
The 51-year-old man showed up at the emergency ward in crisis.
He’d been suffering abdominal pain for three days, then appetite loss, vomiting and dry mouth. Tests showed he had both dangerously high blood pressure and hypokalemia — low potassium levels that can lead to lethal heart arrhythmia.
And yet the reasons were a mystery — he had no history of hypertension or of conditions that commonly cause blood-pressure spikes.
Finally, doctors at a southwestern Ontario hospital hit on the unlikely culprit — jelly beans. The man had developed a ferocious habit for licorice-flavoured versions of the candy, draining a 50-bean bag of them daily. Even in dire health, he couldn’t resist the sweets, “which he continued to eat in hospital,” says a case study just published by his physicians.
What he didn’t know and what the recently published study underscored is that licorice can cause high blood pressure and potassium imbalance in some people, the food’s active ingredient, glycyrrhetinic acid, triggering both conditions.
The Ontario patient was advised to end his jellybean habit, and within days his potassium levels had climbed back to normal and his blood pressure dropped to a safe zone.
Had doctors not uncovered the cause of his condition, the man might have stayed permanently on an array of drugs, says Dr. Tamara Spaic, an endocrinologist at London’s Western University called in to help with the case.
“He would likely require long-term anti-hypertensive treatment,” she said in an email response to questions. “There would likely be a need to use multiple medications, which would increase the risk of developing various side-effects, as well as the unnecessary high cost of treatment and regular followups.”
The patient’s hometown and hospital were not identified to protect his confidentiality.
Spaic said she and her colleagues have seen such cases before, but southwestern Ontario probably has less than one a year. Though the phenomenon is well-established — sometimes even called “licorice poisoning” — it is so rare that physicians can miss it or mistake it for something else, she said.
It has likely become even more uncommon in recent years given that many products called licorice contain just flavouring, the paper in the journal Postgraduate Medicine said.
Yet medical literature is still full of individual case studies, some of them documenting severe consequences for the patients.
A 2015 German case describes a patient who developed acute vision impairment because of hypertension sparked by a “considerable consumption of licorice.”
In Italy, a young boy came to hospital after suffering a sudden cluster of tonic-clonic seizures that were blamed on swelling of the brain related to hypertension. He had been eating licorice toffees for four months, ingesting 72 mg of glycyrrhetinic acid a day, according to another 2015 study.
A 47-year-old Spanish woman showed up in emergency with swelling around her eyes and lower limbs linked to hypokalemia and high blood pressure. It took a week, but she finally revealed to doctors she had been consuming “several sachets of raw licorice lollies” obtained from a herbalist.