Liquorice Health Check, Oro-Dental Implications, and a Case Report

Touyz, Louis Z. G.

A 55-year-old women presented with a brown/black tongue for routine dental check and maintenance. (See Figure 3) . There was neither history of antibiotic use nor any current tobacco abuse. She had been diagnosed with hypertension two years previously. Despite multiple antihypertensive drugs, her blood pressure remained elevated. Preoperative dental of vital signs revealed blood pressure (BP) measures of Systolic 160 mm Hg/Diastolic 125 mm Hg. Although this was attributed to a possible "white-coat hypertension" phenomenon, she was referred to the hypertension clinic for further investigation and management of hypertension. Other than prescribed blood pressure-lowering drugs (diuretics, an ACE inhibitor and Beta-blocker), she was not taking any other medication or herbal products. She exercised regularly, denied excessive alcohol intake and consumed a "healthy" diet. On examination, casual sitting blood pressure was high, despite treatment. Routine laboratory investigations revealed hypokalemia. The diuretic was discontinued, K + supplements were given and she was advised to consume a K +rich diet. Two weeks after stopping the diuretic, plasma K + was still low and hypertension was uncontrolled. The patient was investigated for hyperaldosteronism. Plasma aldosterone and rennin levels were very low. In light of hypokalemia and reduced plasma aldosterone levels, a diagnosis of pseudohyperaldosteronism was made. A detailed dietary history revealed that since the patient stopped smoking 4 years ago, she started eating liquorice regularly every day. This helped her relieve her cravings for tobacco. She always enjoyed eating liquorice, but since quitting smoking she consumed at least one pack of 200-250 g or more of black liquorice daily. The patient was advised to stop eating liquorice and to continue her K + -rich diet and K + supplementation. Three months later K + blood level was normal. Eighteen months after presentation at the hypertension clinic and after stopping liquorice consumption, her blood biochemistry remained normal and her blood pressure was controlled to within normal limits. Much lower doses of drugs than originally used kept her BP stable and she was clinically well.