With Halloween coming up next month, an article in the New England Journal of Medicine describing the death of a middle-aged construction worker from eating black licorice is a grim reminder to control your cravings for the chewy treat.
The Food and Drug Administration said Thursday that it was aware the naturally occurring compound found in black licorice can have adverse health effects. In 2017, the agency warned on its website “If you’re 40 or older, eating 2 ounces of black licorice a day for at least two weeks could land you in the hospital with an irregular heart rhythm or arrhythmia.”
The FDA advises that no matter what your age, you should not eat large quantities of black licorice; if you have muscle weakness or an irregular heartbeat, you should stop eating it and call your doctor. And you should consult your doctor about interactions it may have with your other medications.
In the case of the 54-year-old Massachusetts construction worker, described Wednesday in the medical journal, eating one or two large bags a day for three weeks threw his nutrients out of whack and caused his heart to stop. He collapsed at midday at a fast-food restaurant.
“The key message here for the general public is that food containing licorice can potentially be hazardous to your health if eaten in large quantities," said Dr. Neel Butala, a cardiologist at Massachusetts General Hospital who was one of the authors of the case study. “I don’t think people realize it. It’s not labeled that way.”
The problem is glycyrrhizic acid, found in black licorice and in many other foods and dietary supplements containing licorice root extract. It can cause dangerously low potassium and imbalances in other minerals called electrolytes.
“It’s more than licorice sticks. It could be jelly beans, licorice teas, a lot of things over the counter. Even some beers, like Belgian beers, have this compound in it,” as do some chewing tobaccos, said Dr. Robert Eckel, a University of Colorado cardiologist and former American Heart Association president. He had no role in the Massachusetts man’s care.
The team of doctors at MGH wrote: “On the basis of additional history obtained from his family, the patient was eating one or two large packages of soft candy daily. Three weeks before [he collapsed], he had switched from eating fruit-flavored soft candy to eating licorice-flavored soft candy that contained glycyrrhizic acid.”
The doctors treating him found he had dangerously low potassium, which led to heart rhythm and other problems. Emergency responders did CPR and revived him but he died the next day.
Butala cautioned that it doesn’t take a whole bag of licorice to have an impact on your health.
Even a smaller amount “every single day for a long period of time can lead to higher blood pressure,” which can have long-term ill effects, he said. “It’s not an inconsequential amount of effect on the blood pressure.”
The FDA permits up to 3.1 percent of a food’s content to have glycyrrhizic acid. It’s hard for consumers to know how much they are getting because “no candy tells you how much is in it,” Butala said. Doctors have reported the case to the FDA in hopes of raising attention to the risk.
Jeff Beckman, a spokesman for Hershey Co., which makes the popular Twizzlers licorice twists, said in an e-mail that “all of our products are safe to eat and formulated in full compliance with FDA regulations” and that all foods, including candy, “should be enjoyed in moderation.”
Jeremiah Manion of the Globe staff contributed to this report. Material from The Associated Press was included. The AP Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for its content.
Martin finucane can be reached at firstname.lastname@example.org.