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Ceccuzzi G, Rapino A, Perna B, Costanzini A, Farinelli A, Fiorica I, Marziani B, Cianci A, Rossin F, Cesaro AE, Spampinato MD, De Giorgio R, Guarino M. Liquorice Toxicity: A Comprehensive Narrative Review. Nutrients 2023; 15:3866. [PMID: 37764649 PMCID: PMC10537237 DOI: 10.3390/nu15183866] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 08/26/2023] [Accepted: 09/03/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Renowned since ancient times for its medical properties, liquorice is nowadays mainly used for flavoring candies or soft drinks. Continuous intake of large amounts of liquorice is a widely known cause of pseudo-hyperaldosteronism leading to hypertension and hypokalemia. These manifestations are usually mild, although in some cases may generate life-threatening complications, i.e., arrhythmias, muscle paralysis, rhabdomyolysis, and coma. In addition, liquorice has an important estrogenic-like activity. METHODS We summarized the current knowledge about liquorice and reviewed 104 case reports in both the English and Italian languages from inception to June 2023 concerning complications due to an excess of liquorice intake. RESULTS In contrast to most published data, female sex and old age do not appear to be risk factors. However, hypertension and electrolyte imbalance (mainly hypokalemia) are prevalent features. The detection of glycyrrhetinic acid in blood is very uncommon, and the diagnosis is essentially based on an accurate history taking. CONCLUSIONS Although there is not a significant mortality rate, liquorice toxicity often requires hospitalization and therefore represents a significant health concern. Major pharmaceutical drug regulatory authorities should solicit public awareness about the potentially dangerous effects caused by excessive use of liquorice.
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Affiliation(s)
- Giovanna Ceccuzzi
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy; (G.C.); (A.R.); (B.P.); (A.C.); (A.F.); (I.F.); (B.M.); (A.C.); (F.R.); (A.E.C.); (M.D.S.); (M.G.)
| | - Alessandro Rapino
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy; (G.C.); (A.R.); (B.P.); (A.C.); (A.F.); (I.F.); (B.M.); (A.C.); (F.R.); (A.E.C.); (M.D.S.); (M.G.)
| | - Benedetta Perna
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy; (G.C.); (A.R.); (B.P.); (A.C.); (A.F.); (I.F.); (B.M.); (A.C.); (F.R.); (A.E.C.); (M.D.S.); (M.G.)
| | - Anna Costanzini
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy; (G.C.); (A.R.); (B.P.); (A.C.); (A.F.); (I.F.); (B.M.); (A.C.); (F.R.); (A.E.C.); (M.D.S.); (M.G.)
| | - Andrea Farinelli
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy; (G.C.); (A.R.); (B.P.); (A.C.); (A.F.); (I.F.); (B.M.); (A.C.); (F.R.); (A.E.C.); (M.D.S.); (M.G.)
| | - Ilaria Fiorica
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy; (G.C.); (A.R.); (B.P.); (A.C.); (A.F.); (I.F.); (B.M.); (A.C.); (F.R.); (A.E.C.); (M.D.S.); (M.G.)
| | - Beatrice Marziani
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy; (G.C.); (A.R.); (B.P.); (A.C.); (A.F.); (I.F.); (B.M.); (A.C.); (F.R.); (A.E.C.); (M.D.S.); (M.G.)
| | - Antonella Cianci
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy; (G.C.); (A.R.); (B.P.); (A.C.); (A.F.); (I.F.); (B.M.); (A.C.); (F.R.); (A.E.C.); (M.D.S.); (M.G.)
| | - Federica Rossin
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy; (G.C.); (A.R.); (B.P.); (A.C.); (A.F.); (I.F.); (B.M.); (A.C.); (F.R.); (A.E.C.); (M.D.S.); (M.G.)
| | - Alice Eleonora Cesaro
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy; (G.C.); (A.R.); (B.P.); (A.C.); (A.F.); (I.F.); (B.M.); (A.C.); (F.R.); (A.E.C.); (M.D.S.); (M.G.)
| | - Michele Domenico Spampinato
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy; (G.C.); (A.R.); (B.P.); (A.C.); (A.F.); (I.F.); (B.M.); (A.C.); (F.R.); (A.E.C.); (M.D.S.); (M.G.)
- Department of Emergency, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy
| | - Roberto De Giorgio
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy; (G.C.); (A.R.); (B.P.); (A.C.); (A.F.); (I.F.); (B.M.); (A.C.); (F.R.); (A.E.C.); (M.D.S.); (M.G.)
| | - Matteo Guarino
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy; (G.C.); (A.R.); (B.P.); (A.C.); (A.F.); (I.F.); (B.M.); (A.C.); (F.R.); (A.E.C.); (M.D.S.); (M.G.)
- Department of Emergency, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy
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Francini F, Gobbi L, Ravarotto V, Toniazzo S, Nalesso F, Spinella P, Calò LA. The Dietary Approach to the Treatment of the Rare Genetic Tubulopathies Gitelman's and Bartter's Syndromes. Nutrients 2021; 13:nu13092960. [PMID: 34578838 PMCID: PMC8467039 DOI: 10.3390/nu13092960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/19/2021] [Accepted: 08/24/2021] [Indexed: 02/06/2023] Open
Abstract
Gitelman’s (GS) and Bartter’s (BS) syndromes are rare, inherited autosomal recessive tubulopathies characterized by hypokalemia, metabolic alkalosis, renal sodium, chloride, and potassium and magnesium-wasting. While the treatment based on potassium, sodium, chloride, and magnesium supplementation in addition to other pharmacologic options are widely established, recommendations about the dietary approach to GS and BS still remain generic. In this review we focus on the dietary strategies to increase sodium, potassium, and magnesium intake in GS and BS patients. Potassium and magnesium-rich foods and supplements are considered together with those that may reduce through different mechanisms the potassium and magnesium plasma level. Magnesium supplementation is often poorly tolerated, causing abdominal pain and diarrhea in most patients. New formulations using liposome and, in particular, sucrosomial technology have been recently proposed for magnesium supplementation in order to increase magnesium supplement tolerability and intestinal absorption. The dietary approach to GS and BS may be very important in the therapeutic approach to these syndromes. Due to the relevance of the dietary approach to these syndromes, a nutritional counseling should always be recommended and the nutritionist should join nephrologists in the follow-up of GS and BS patient care.
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Affiliation(s)
- Francesco Francini
- Department of Medicine (DIMED), Clinical Nutrition, University of Padova, 35128 Padova, Italy; (F.F.); (S.T.); (P.S.)
| | - Laura Gobbi
- Nephrology, Dialysis and Transplantation Units, Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy; (L.G.); (V.R.); (F.N.)
| | - Verdiana Ravarotto
- Nephrology, Dialysis and Transplantation Units, Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy; (L.G.); (V.R.); (F.N.)
| | - Silvia Toniazzo
- Department of Medicine (DIMED), Clinical Nutrition, University of Padova, 35128 Padova, Italy; (F.F.); (S.T.); (P.S.)
| | - Federico Nalesso
- Nephrology, Dialysis and Transplantation Units, Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy; (L.G.); (V.R.); (F.N.)
| | - Paolo Spinella
- Department of Medicine (DIMED), Clinical Nutrition, University of Padova, 35128 Padova, Italy; (F.F.); (S.T.); (P.S.)
| | - Lorenzo A Calò
- Nephrology, Dialysis and Transplantation Units, Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy; (L.G.); (V.R.); (F.N.)
- Correspondence: ; Tel.: +39-04-9821-3071
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Bioactive Candy: Effects of Licorice on the Cardiovascular System. Foods 2019; 8:foods8100495. [PMID: 31615045 PMCID: PMC6836258 DOI: 10.3390/foods8100495] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 10/07/2019] [Accepted: 10/09/2019] [Indexed: 12/15/2022] Open
Abstract
Licorice, today chiefly utilized as a flavoring additive in tea, tobacco and candy, is one of the oldest used herbs for medicinal purposes and consists of up to 300 active compounds. The main active constituent of licorice is the prodrug glycyrrhizin, which is successively converted to 3β-monoglucuronyl-18β-glycyrrhetinic acid (3MGA) and 18β-glycyrrhetinic acid (GA) in the intestines. Despite many reported health benefits, 3MGA and GA inhibit the 11-β-hydrogenase type II enzyme (11β-HSD2) oxidizing cortisol to cortisone. Through activation of mineralocorticoid receptors, high cortisol levels induce a mild form of apparent mineralocorticoid excess in the kidney and increase systemic vascular resistance. Continuous inhibition of 11β-HSD2 related to excess licorice consumption will create a state of hypernatremia, hypokalemia and increased fluid volume, which can cause serious life-threatening complications especially in patients already suffering from cardiovascular diseases. Two recent meta-analyses of 18 and 26 studies investigating the correlation between licorice intake and blood pressure revealed statistically significant increases both in systolic (5.45 mmHg) and in diastolic blood pressure (3.19/1.74 mmHg). This review summarizes and evaluates current literature about the acute and chronic effects of licorice ingestion on the cardiovascular system with special focus on blood pressure. Starting from the molecular actions of licorice (metabolites) inside the cells, it describes how licorice intake is affecting the human body and shows the boundaries between the health benefits of licorice and possible harmful effects.
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Brown AC. Heart Toxicity Related to Herbs and Dietary Supplements: Online Table of Case Reports. Part 4 of 5. J Diet Suppl 2017; 15:516-555. [PMID: 28981338 DOI: 10.1080/19390211.2017.1356418] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The purpose of this review was to create an online research summary table of heart toxicity case reports related to dietary supplements (DS; includes herbs). METHODS Documented PubMed case reports of DS appearing to contribute to heart-related problems were used to create a "Toxic Table" that summarized the research (1966 to April, 2016, and cross-referencing). Keywords included "herb," "dietary supplement," and cardiac terms. Case reports were excluded if they were herb combinations (some exceptions), Chinese herb mixtures, teas of mixed herb contents, mushrooms, poisonous plants, self-harm (e.g. suicide), excess dose (except vitamins/minerals), drugs or illegal drugs, drug-herbal interactions, and confounders of drugs or diseases. The spectrum of heart toxicities included hypertension, hypotension, hypokalemia, bradycardia, tachycardia, arrhythmia, ventricular fibrillation, heart attack, cardiac arrest, heart failure, and death. RESULTS Heart related problems were associated with approximately seven herbs: Four traditional Chinese medicine herbs - Don quai (Angelica sinensis), Jin bu huan (Lycopodium serratum), Thundergod vine or lei gong teng (Tripterygium wilfordii Hook F), and Ting kung teng (Erycibe henryi prain); one an Ayruvedic herb - Aswagandha, (Withania somnifera); and two North American herbs - blue cohosh (Caulophyllum thalictroides), and Yohimbe (Pausinystalia johimbe). Aconitum and Ephedra species are no longer sold in the United States. The DS included, but are not limited to five DS - bitter orange, caffeine, certain energy drinks, nitric oxide products, and a calming product. Six additional DS are no longer sold. Licorice was the food related to heart problems. CONCLUSION The online "Toxic Table" forewarns clinicians, consumers and the DS industry by listing DS with case reports related to heart toxicity. It may also contribute to Phase IV post marketing surveillance to diminish adverse events that Government officials use to regulate DS.
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Affiliation(s)
- Amy C Brown
- a Complementary and Alternative Medicine, John A. Burns School of Medicine , University of Hawaii at Manoa , Honolulu , HI , USA
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Di Lorenzo C, Ceschi A, Kupferschmidt H, Lüde S, De Souza Nascimento E, Dos Santos A, Colombo F, Frigerio G, Nørby K, Plumb J, Finglas P, Restani P. Adverse effects of plant food supplements and botanical preparations: a systematic review with critical evaluation of causality. Br J Clin Pharmacol 2015; 79:578-92. [PMID: 25251944 DOI: 10.1111/bcp.12519] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/17/2014] [Indexed: 01/05/2023] Open
Abstract
AIMS The objective of this review was to collect available data on the following: (i) adverse effects observed in humans from the intake of plant food supplements or botanical preparations; (ii) the misidentification of poisonous plants; and (iii) interactions between plant food supplements/botanicals and conventional drugs or nutrients. METHODS PubMed/MEDLINE and Embase were searched from database inception to June 2014, using the terms 'adverse effect/s', 'poisoning/s', 'plant food supplement/s', 'misidentification/s' and 'interaction/s' in combination with the relevant plant name. All papers were critically evaluated according to the World Health Organization Guidelines for causality assessment. RESULTS Data were obtained for 66 plants that are common ingredients of plant food supplements; of the 492 papers selected, 402 (81.7%) dealt with adverse effects directly associated with the botanical and 89 (18.1%) concerned interactions with conventional drugs. Only one case was associated with misidentification. Adverse effects were reported for 39 of the 66 botanical substances searched. Of the total references, 86.6% were associated with 14 plants, including Glycine max/soybean (19.3%), Glycyrrhiza glabra/liquorice (12.2%), Camellia sinensis/green tea ( 8.7%) and Ginkgo biloba/gingko (8.5%). CONCLUSIONS Considering the length of time examined and the number of plants included in the review, it is remarkable that: (i) the adverse effects due to botanical ingredients were relatively infrequent, if assessed for causality; and (ii) the number of severe clinical reactions was very limited, but some fatal cases have been described. Data presented in this review were assessed for quality in order to make the results maximally useful for clinicians in identifying or excluding deleterious effects of botanicals.
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Affiliation(s)
- Chiara Di Lorenzo
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, via Balzaretti 9, 20133, Milano, Italy
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Chen HY, Lin YH, Huang JW, Chen YC. Chinese herbal medicine network and core treatments for allergic skin diseases: Implications from a nationwide database. JOURNAL OF ETHNOPHARMACOLOGY 2015; 168:260-7. [PMID: 25865681 DOI: 10.1016/j.jep.2015.04.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/26/2015] [Accepted: 04/01/2015] [Indexed: 05/20/2023]
Abstract
ETHNO-PHARMACOLOGICAL RELEVANCE Chinese herbal medicine (CHM) is commonly used to treat skin diseases, but CHM prescription patterns are difficult to understand due to their complexity and inter-connections. This study aimed to demonstrate CHM core treatments and network for treatment of allergic skin diseases by analyzing a nationwide prescription database. MATERIALS AND METHODS All CHM prescriptions made for atopic dermatitis (with age limitation ≤ 12 years) and urticaria for the entire year of 2011 were included. Association rule mining (ARM) combined with social network analysis (SNA) were used to analyze CHM prescriptions and explore the CHM prescription pattern and network. RESULTS A total of 27,350 and 97,188 prescriptions for atopic dermatitis and urticaria, respectively, were analyzed. Xiao-Feng-San (XFS) was the most commonly used CHM (32% of prescriptions for atopic dermatitis and 47.4% for urticaria) and was the core treatment for both diseases. Moreover, 42 and 82 important CHM-CHM combinations were identified to establish the CHM network, and XFS with Dictamnus dasycarpus Turcz was the most prevalent (6.4% for atopic dermatitis and 9.1% for urticaria). Traditional Chinese Medicine heat syndrome was most prevalent cause. Extensive anti-inflammation, anti-allergy, anti-oxidation, and anti-bacterial effects were also found among the CHMs. CONCLUSIONS Network analysis on CHM prescriptions provides graphic and comprehensive illustrations regarding CHM treatment for atopic dermatitis and urticaria. The CHM network analysis of prescriptions is essential to realize the CHM treatments and to select suitable candidates for clinical use or further studies.
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Affiliation(s)
- Hsing-Yu Chen
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Hsuan Lin
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Cosmetic Science, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Jen-Wu Huang
- Department of Surgery, National Yang-Ming University Hospital, I-Lan, Taiwan
| | - Yu-Chun Chen
- Department of Medical Research and Education, National Yang-Ming University Hospital, I-Lan, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Chen HY, Lin YH, Wu JC, Hu S, Yang SH, Chen JL, Chen YC, Lo SS. Use of traditional Chinese medicine reduces exposure to corticosteroid among atopic dermatitis children: a 1-year follow-up cohort study. JOURNAL OF ETHNOPHARMACOLOGY 2015; 159:189-196. [PMID: 25449448 DOI: 10.1016/j.jep.2014.11.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 11/07/2014] [Accepted: 11/08/2014] [Indexed: 06/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Atopic dermatitis is a prevalent dermatologic disease in children. Corticosteroid is an important treatment but side effects caused by long-term and excessive use heavily concern patients. Traditional Chinese medicine (TCM) is potentially an alternative treatment and might cause less adverse effects. This nationwide retrospective cohort study aimed to examine the hypothesis that TCM use is associated with lower exposure to corticosteroid. MATERIALS AND METHODS Children under 12 years of age with ICD-9 codes 691.8 and 692.x were identified as atopic dermatitis patients from 2007/1/1 to 2007/12/31. Corticosteroid use was compared between TCM users and non-users for one-year follow-up by using a general estimation equation model with propensity-score matching. RESULTS A total of 9012 TCM users were identified and the use of corticosteroid after treatment was compared with matched TCM non-users. Use of TCM significantly reduced exposure to corticosteroids after 1-year follow-up. Among TCM users, the exposure to any corticosteroids was lower (42.1% reduction in TCM users versus 34.5% increase in TCM non-users, relative risk: 0.36; p-Value<0.001), the duration was shorter (relative risk for using corticosteroid more than 14 days: 0.37; p-Value<0.001), and the rate of frequent visits with steroid prescription was also lower. CHM was the most commonly used TCM modality (98.5% of all visits) and Xiao-Feng-San was the most commonly used CHM (33% of all prescriptions) with extensive coverage for pathogenesis of atopic dermatitis. CONCLUSIONS Lower use rate of corticosteroid can be found after TCM treatment, which can be considered as an integrative therapy for atopic dermatitis. Further studies are warranted on the basis of this study.
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Affiliation(s)
- Hsing-Yu Chen
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Hsuan Lin
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Cosmetic Science, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Pharmacology, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Sindy Hu
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Cosmetic Science, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Sien-Hung Yang
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jiun-Liang Chen
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Chun Chen
- Department of Medical Research and Education, National Yang-Ming University Hospital, I-Lan, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Su-Shun Lo
- Department of Surgery School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Influence of Herbal Complexes Containing Licorice on Potassium Levels: A Retrospective Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 2014:970385. [PMID: 25045393 PMCID: PMC4089197 DOI: 10.1155/2014/970385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 05/01/2014] [Accepted: 05/19/2014] [Indexed: 12/02/2022]
Abstract
To observe the influence of these complexes on potassium levels in a clinical setting, we investigated the influence of herbal complexes containing licorice on potassium levels. We retrospectively examined the medical records of patients treated with herbal complexes containing licorice from January 1, 2010, to December 31, 2010. We recorded the changes in the levels of potassium, creatinine, and blood urea nitrogen and examined the differences between before and after herbal complexes intake using a paired t-test. In addition, we investigated the prevalence of hypokalemia among these patients and reviewed such patients. We identified 360 patients who did not show significant changes in the levels of potassium and creatinine (P = 0.815, 0.289). We observed hypokalemia in 6 patients. However, in 5 patients, the hypokalemia did not appear to be related to the licorice. Thus, we could suggest that herbal complexes containing licorice do not significantly influence the potassium levels in routine clinical herbal therapies. However, we propose that follow-up examination for potassium levels is required to prevent any unpredictable side effects of administration of licorice in routine herbal medicine care.
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Omar HR, Komarova I, El-Ghonemi M, Fathy A, Rashad R, Abdelmalak HD, Yerramadha MR, Ali Y, Helal E, Camporesi EM. Licorice abuse: time to send a warning message. Ther Adv Endocrinol Metab 2012; 3. [PMID: 23185686 PMCID: PMC3498851 DOI: 10.1177/2042018812454322] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Licorice extract has always been recognized as a sweetener and a thirst quencher. Its nutritive value is overrated by many who consume significant amounts and are prone to complications. Glycyrrhetic acid, the active metabolite in licorice, inhibits the enzyme 11-ß-hydroxysteroid dehydrogenase enzyme type 2 with a resultant cortisol-induced mineralocorticoid effect and the tendency towards the elevation of sodium and reduction of potassium levels. This aldosterone-like action is the fundamental basis for understanding its health benefits and the wide spectrum of adverse effects. Herein, we present a comprehensive review of licorice along with the reported complications related to excess intake. Despite its apparent use in a few clinical scenarios, the daily consumption of licorice is never justified because its benefits are minor compared to the adverse outcomes of chronic consumption. The review highlights the importance of investigating the dietary habits and herbal remedies which are being used worldwide on cultural and habitual bases rather than reliable scientific evidence. Licorice is a US Food and Drug Administration (FDA) approved food supplement used in many products without precise regulations to prevent toxicity. Increased awareness among the public is required through TV commercials, newspapers, internet sites, magazines and product labels regarding the upper limit of ingestion and health hazards associated with excess intake. We hope that this review will serve as a warning message that should be transmitted from physicians to patients to avoid excessive licorice intake as well as a message to the FDA to start regulating the use of this substance.
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Affiliation(s)
- Hesham R Omar
- Internal Medicine Department, Mercy Hospital and Medical Center, 2525 South Michigan Avenue, Chicago, IL 60616, USA
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Jordan MA, Foste K, Gandhi A, Mohebbi N, Tehrani L. Assessment of herbal weight loss supplement counseling provided to patients by pharmacists and nonpharmacists in community settings. J Am Pharm Assoc (2003) 2011; 51:499-509, 1 p following 509. [PMID: 21752773 DOI: 10.1331/japha.2011.09233] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To assess the extent of appropriate counseling provided to patients by pharmacists and nonpharmacists in retail settings regarding herbal dietary supplements for weight loss. DESIGN Descriptive, exploratory, nonexperimental study. SETTING Phoenix, AZ, metropolitan area, from June 2008 to January 2009. PARTICIPANTS Pharmacists and nonpharmacists (e.g., cashiers, sales clerks, pharmacy technicians) working in retail locations selling herbal dietary supplements (e.g., grocery stores, health food stores, pharmacies). INTERVENTION Investigators posing as patients sought herbal weight loss supplement product recommendations and counseling on potential safety, drug interaction, and adverse effect issues from pharmacists or nonpharmacists. MAIN OUTCOME MEASURES Level of knowledge regarding safety and efficacy of herbal dietary supplements for weight loss. RESULTS 52 sites were visited, and 27 unique product recommendations were given. In general, counseling provided to investigators/patients by pharmacists versus nonpharmacists varied significantly (P < 0.05) except when participants were asked about expected weight loss (P = 0.39) or use of herbal supplements during pregnancy (P = 0.07) and breast-feeding (P = 0.48). Pharmacists were more reluctant to recommend herbal products for weight loss than nonpharmacists and tended to question the safety and/or efficacy of these products or refer the patient to an alternate health care provider. CONCLUSION The counseling that investigators/patients received regarding herbal products for weight loss in various retail settings from both pharmacists and non-pharmacists varied greatly. Efforts are needed from the medical and herbal communities to ensure that patients are adequately informed about herbal products at the point of purchase.
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Affiliation(s)
- Melanie A Jordan
- College of Pharmacy, Midwestern University, Glendale, AZ 85308, USA.
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