Principal Proposed Uses
A member of the pea family, licorice root has been used since ancient times both as food and as medicine. In Chinese herbology, licorice is an ingredient in nearly all herbal formulas for the traditional purpose of "harmonizing" the separate herbs involved. The herb licorice contains a substance called glycyrrhizin. When taken in high enough amounts, glycyrrhizin produces effects similar to those of the natural hormone aldosterone, causing fluid retention, increased blood pressure, and loss of potassium. 1-4 To prevent this, manufacturers have found a way to remove glycyrrhizin from licorice, producing the safer product deglycyrrhizinated licorice (DGL).
What Is Licorice Used for Today?DGL has shown some promise for the treatment of ulcers . 7 Weak evidence hints that it might also help prevent ulcers caused by anti-inflammatory drugs. 8 Licorice, in the form of a dissolving patch, is also sometimes recommended for relieving the discomfort of canker sores and other mouth sores. 29,30 Creams containing whole licorice (often combined with chamomile extract) are advocated for a variety of skin diseases, including eczema , psoriasis , and herpes , but as yet there is only supporting evidence for the first of these uses. (See What is the Scientific Evidence for Licorice ? ). Whole licorice, not DGL, is used as an expectorant for respiratory problems such as coughs and asthma . Licorice has been suggested as a treatment for chronic fatigue syndrome (CFS) , based on the observation that people with CFS appear to suffer from low levels of certain adrenal hormones. The glycyrrhizin portion of licorice may relieve symptoms by mimicking the effects of these hormones. However, this is a fairly dangerous approach to treatment that should be tried only under medical supervision. In addition, studies of drugs that even more closely imitate adrenal hormones have not found benefit. Licorice extracts are used intravenously in Japan for treatment of viral hepatitis . 27,28 However, there is no definite evidence that this treatment is effective; even if this were established, it would not imply that oral licorice would have a similar effect; furthermore, the high dosages used for treatment of chronic hepatitis may cause an elevation of blood pressure and other serious medical problems. Warning : Do not inject preparations of licorice designed for oral use.
What Is the Scientific Evidence for Licorice?
EczemaCreams containing whole licorice (often combined with extract of chamomile) are in wide use as "natural hydrocortisone creams." However, there is only preliminary supporting evidence for this use. In one double-blind, placebo-controlled trial of 30 people, licorice gel at 2% was more effective than placebo or 1% gel for reducing symptoms of eczema . 22 Licorice has constituents that increase the activity of naturally occurring (or artificially supplied) corticosteroids, 12 and this might explain some of the benefits seen. In addition, licorice contains licochalcone A, a substance hypothesized to have anti-inflammatory effects. 26
Ulcer TreatmentTwo controlled studies suggest that regular use of DGL in a combination product also containing antacids can heal ulcers as effectively as drugs in the Zantac family. 9,10 Unfortunately, these studies do not prove that DGL was effective; antacids themselves can help heal ulcers, and in any case the studies were not double-blind . (For information on why this matters, see Why Does This Database Rely on Double-blind Studies? ) Furthermore, if it does work, DGL would have to be taken continuously to avoid ulcer recurrence. In some cases, drug treatment can prevent the recurrence of ulcers permanently by eradicating the bacteria Helicobacter pylori . There is no evidence as yet that DGL can do the same.
Ulcer PreventionA very preliminary study suggests that DGL might help prevent ulcers caused by aspirin and related medications (such as ibuprofen). 8
DosageFor supportive treatment of ulcer pain along with conventional medical care, the standard dose is two to four 380-mg tablets of DGL taken before meals and at bedtime. The same tablets can be allowed to slowly dissolve in the mouth for possible relief of mouth sore pain.A typical dose of whole licorice is 5 to 15 g daily. However, we do not recommend the use of doses this high for more than a few weeks. For long-term consumption, about 0.3 g of licorice root daily should be safe for most adults. (See Safety Issues.) Individuals who wish to take a higher dose should do so only under the supervision of a physician.For the treatment of eczema, psoriasis, or herpes, 2% licorice gel or cream is applied twice daily to the affected area.
Safety IssuesUse of whole licorice has not been associated with significant adverse effects in the short term. However, two or more weeks of use may cause high blood pressure, fluid retention, and symptoms related to loss of potassium. 19-21,23 Such effects are especially dangerous for people who take the drug digoxin or medications that deplete the body of potassium (such as thiazide and loop diuretics ), or who have high blood pressure, heart disease, diabetes, or kidney disease. Current evidence indicates that individuals who wish to take whole licorice on a long-term basis without any risk of these side effects should not consume more than 0.2 mg of glycyrrhizin per kilogram of body weight daily. 20 For a person who weighs 130 pounds, this works out to 12 mg of glycyrrhizin daily. Based on a typical 4% glycyrrhizin content, this is the equivalent of 0.3 grams of licorice root. Whole licorice may have other side effects as well. For example, it appears to reduce testosterone levels in men. 11 For this reason, men with impotence , infertility , or decreased libido may wish to avoid this herb. Licorice may also increase both the positive and negative effects of corticosteroids such as prednisone and hydrocortisone cream. 12-14 In addition, some evidence suggests that licorice might affect the liver's ability to metabolize other medications as well, but the extent of this effect has not been fully determined. 15 Whole licorice possesses significant estrogenic activity, 16,24 and some evidence indicates that licorice increases risk of premature birth. 17,25 For these reasons, it shouldn't be taken by pregnant or nursing women, or women who have had breast cancer. Maximum safe doses for young children, nursing women, or those with severe liver or kidney disease have not been established.It is believed, but not proven, that most or all of the major side effects of licorice are due to glycyrrhizin. For this reason, DGL has been described as entirely safe. However, comprehensive safety studies on DGL have not been reported.
Interactions You Should Know AboutIf you are taking:
- Digoxin : Long-term use of licorice can be dangerous.
- Thiazide or loop diuretics : Use of licorice might lead to excessive potassium loss. 18
- Corticosteroid treatment : Licorice could increase both its negative and positive effects. Do not take licorice internally if using corticosteroids.
- Aspirin or other anti-inflammatory drugs : Regular use of DGL might help lower the risk of ulcers.
Stewart PM, Wallace AM, Valentino R, et al. Mineralocorticoid activity of liquorice: 11-beta-hydroxysteroid dehydrogenase deficiency comes of age. Lancet. 1987;2:821-824.
Conn JW, Rovner DR, Cohen EL. Licorice-induced pseudoaldosteronism. Hypertension, hypokaelemia, aldosteronopenia and suppressed plasma renin activity. JAMA. 1968;205:492-496.
Epstein MT, Espiner EA, Donald RA, et al. Effect of eating liquorice on the renin-angiotensin aldosterone axis in normal subjects. Br Med J. 1977;1:488-490.
Mantero F. Exogenous mineralocorticoid-like disorders. Clin Endocrinol Metab. 1981;10:465-478.
van Marle J, Aarsen PN, Lind A, et al. Deglycyrrhizinised liquorice (DGL) and the renewal of rat stomach epithelium. Eur J Pharmacol . 1981;72:219-225.
Johnston B, McIsaac RL. The effect of some anti-ulcer agents on basal gastric mucosal blood flow and transmucosal flux of hydrogen and sodium ions in the conscious dog. Br J Pharmacol . 1981;73:308.
Schulz V, Hansel R, Tyler VE. Rational Phytotherapy: A Physicians' Guide to Herbal Medicine . 3rd ed. Berlin, Germany: Springer-Verlag; 1998:185.
Rees WD, Rhodes J, Wright JE, et al. Effect of deglycyrrhizinated liquorice on gastric mucosal damage by aspirin. Scand J Gastroenterol. 1979;14:605-607.
Morgan AG, Pacsoo C, McAdam WA. Maintenance therapy: a two year comparison between Caved-S and cimetidine treatment in the prevention of symptomatic gastric ulcer recurrence. Gut . 1985;26:599-602.
Kassir ZA. Endoscopic controlled trial of four drug regimens in the treatment of chronic duodenal ulceration. Ir Med J. 1985;78:153-156.
Armanini D, Palermo M. Reduction of serum testosterone in men by licorice. N Engl J Med. 1999;341:1158.
Teelucksingh S, Mackie AD, Burt D, et al. Potentiation of hydrocortisone activity in skin by glycyrrhetinic acid. Lancet . 1990;335:1060-1063.
Kumagai A, Nanaboshi M, Asanuma Y, et al. Effects of glycyrrhizin on thymolytic and immunosupressive action of cortisone. Endocrinol Jpn. 1967;14:39-42.
Tamura Y, Nishikawa T, Yamada K, et al. Effects of glycyrrhetinic acid and its derivatives on delta-4-5-alpha- and 5-beta-reductase in rat liver. Arzneimittelforschung. 1979;29:647-649.
Budzinski JW, Foster BC, Vandenhoek S, et al. An in vitro evaluation of human cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures. Phytomedicine. 2000;7:273-282.
Zava DT, Dollbaum CM, Blen M. Estrogen and progestin bioactivity of foods, herbs and spices. Proc Soc Exp Biol Med. 1998;217:369-378.
Strandberg TE, Jarvenpaa AL, Vanhanen H, et al. Birth outcome in relation to licorice consumption during pregnancy. Am J Epidemiol. 2001;153:1085-1088.
Shintani S, Murase H, Tsukagoshi H, et al. Glycyrrhizin (licorice)-induced hypokalemic myopathy. Report of two cases and review of the literature. Eur Neurol. 1992;32:44-51.
Sigurjonsdottir HA, Franzson L, Manhem K, Ragnarsson J, Sigurdsson G, Wallerstedt S. Liquorice-induced rise in blood pressure: a linear dose-response relationship. J Hum Hypertens . 2001;15:549-552.
van Gelderen CE, Bijlsma JA, van Dokkum W, et al. Glycyrrhizic acid: the assessment of a no effect level. Hum Exp Toxicol . 2000;19:434-439.
Lin SH, Chau T. A puzzling cause of hypokalaemia. Lancet . 2002;360:224.
Saeedi M, Morteza-Semnani K, Ghoreishi MR. The treatment of atopic dermatitis with licorice gel. J DermatologTreat . 2003 Sep;14:153-157.
Yoshida S, Takayama Y. Licorice-induced hypokalemia as a treatable cause of dropped head syndrome. ClinNeurol Neurosurg . 2003;105:286-287.
Somjen D, Knoll E, Vaya J, et al. Estrogen-like activity of licorice root constituents: glabridin and glabrene, in vascular tissues in vitro and in vivo. J Steroid Biochem Mol Biol . 2004;91:147-155.
Strandberg TE, Andersson S, Jarvenpaa AL, et al. Preterm birth and licorice consumption during pregnancy. AmJ Epidemiol . 2002;156:803-805.
Kolbe L, Immeyer J, Batzer J, et al. Anti-inflammatory efficacy of Licochalcone A: correlation of clinical potency and in vitro effects. Arch Dermatol Res. 2006 Mar 22. [Epub ahead of print]
Orlent H, Hansen BE, Willems M, et al. Biochemical and histological effects of 26 weeks of glycyrrhizin treatment in chronic hepatitis C: A randomized phase II trial. J Hepatol . 2006 Jun 30. [Epub ahead of print]
Arase Y, Ikeda K, Murashima N, et al. The long term efficacy of glycyrrhizin in chronic hepatitis C patients. Cancer . 1997;79:1494-1500
Martin MD, Sherman J, van der Ven P, et al. A controlled trial of a dissolving oral patch concerning glycyrrhiza (licorice) herbal extract for the treatment of aphthous ulcers. Gen Dent. 2008;56:206-210;quiz 211-212,224.
As of 4/11/2011, additional research published on licorice does not warrant any changes to this article.
- Reviewer: EBSCO CAM Review Board
- Review Date: 09/2014
- Update Date: 09/18/2014