Was it something you ate?

My patient was 52 and in her menopause. She weighed a steady eight and a half stone (54 kg) for her five feet three inches (1.6 m) height and was fit because she taught aerobics. She told me that she had suffered from “resistant high blood pressure” for two years. It varied, she said, between 219/119 mm Hg and 140/75 mm Hg. Her electrocardiographic and cholesterol results were normal, and her general practitioner had at first prescribed a diuretic, which had worked for a year, after which her blood pressure began to seesaw between 139/70 mm Hg and 196/80 mm Hg.

She was then prescribed β blockers, which made her dizzy and “spaced out,” but which had reduced her blood pressure to 130/50 mm Hg. As she could not tolerate these, she was prescribed α blockers, but, by the second batch, she was experiencing sleepless nights, abdominal pain, and more headaches than usual. (She had had mild to moderate migraine since she was 14.) She also had a congenital leaking aortic valve, which had not caused her any problems.

Her general practitioner then prescribed an angiotensin converting enzyme inhibitor, but this made her insomnia worse and caused extreme exhaustion. She tolerated this drug for only two weeks before discontinuing, with her doctor's consent. Her blood pressure resumed its former erratic pattern. Her doctor was concerned, and it was agreed that she should try homoeopathy if she wished to.

I took her history at some length and, not having found much of homoeopathic significance, asked her what she ate on an average day. For her lunch she had fruit and natural yoghurt, some nuts, and her favourite treat, two small (20 g) bars of an unnamed liquorice sweetmeat.

“Every day?” I asked.

“Yes, mostly,” and she smiled apologetically. “Sometimes I have three, but not often. It is my only sin: I don't smoke and only take an occasional drink and am very sparing with the salt. I have done this for years.”

I did not prescribe any homoeopathic remedy but asked her if she would stop eating the liquorice for three weeks and then have her blood pressure measured on three alternate days. She agreed, and when she returned she told me that it had been 121/78 mm Hg on average and was now (one month later) 126/82 mm Hg and steady. She felt much better and was sleeping well. She was taking no drugs, and her doctor was pleased.

The sweet bars contained liquorice extract and other common confectionery ingredients in unspecified amounts. Liquorice contains glycyrrhizinic acid, which may be an exogenous cause of a hypermineralocorticoid state. This is characterised by hypertension and hypokalaemia. I am not aware if she was investigated for the latter condition, but the marked and disabling fatigue she suffered from at the time I saw her may be indicative that this was the problem.

This potential adverse effect of the extract of the root of Glycyrrhiza glabra is well documented in the literature and should be more widely appreciated. It may exert this effect even at low doses in chewing gum flavoured with liquorice.¹

Medical practitioners may not appreciate that most complementary therapeutic consultations are not informed by NHS case notes or test results. One must make do with what is available, and I have learnt, to my cost, that it saves a lot of time if you ask a patient what he or she had for lunch early on in the interview.

The patient continues well without needing any drugs, and her energy for aerobic exercise is restored in full.

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