A Massachusetts construction worker, aged 54, experienced a fatal cardiac arrest, and the killer was something most wouldn't expect—black licorice. The man was having dinner at a restaurant when he unexpectedly gasped, started trembling wildly, and lost consciousness. The emergency responders attended to him, gave him CPR, and administered medication to regulate his heartbeat. Though he regained consciousness for a short while, his condition worsened, and he died from multiorgan failure 32 hours after hospital admission.What was interesting about this case was the cause. The gentleman had no other known medical condition that would have precipitated such a violent cardiac event. What was revealed through closer inspection of his diet was a shocking revelation: he had changed from eating fruit-flavored candy to eating black licorice and consumed one to two large packets daily for several weeks. His very high intake precipitated severely low potassium levels in his bloodstream, which arrested his heart.Central to this medical puzzle is a substance within actual licorice known as glycyrrhizin. A naturally occurring inhibitor of an enzyme in the kidneys that helps regulate sodium, potassium, and water balance in the body, glycyrrhizin leads to sodium and water retention and potassium elimination—a mineral vital for healthy heart functioning—if taken in excess.Low levels of potassium, or hypokalemia, can cause dangerous cardiac side effects, such as irregular heart rhythm, high blood pressure, and weakness in muscles, and even cardiac arrest in severe cases. The U.S. Food and Drug Administration (FDA) warns that eating even 2 ounces (56 grams) of black licorice every day for two weeks may lead to an irregular heart beat, especially for those above the age of 40 years.How Much Licorice is Too Much?Numerous individuals consume licorice-tasting candy with impunity, but all in moderation. The FDA only allows a content of 3.1% glycyrrhizic acid in foods, but the majority of licorice candies do not label the actual quantity they carry. This open lack of labeling might make it complicated for customers to estimate acceptable usage levels.Dr. Neel Butala, a Massachusetts General Hospital cardiologist, pointed out that even small quantities of licorice might elevate blood pressure somewhat. Regular overconsumption, though—such as munching on a bag and a half per day, as in this instance—will substantially alter electrolyte balance and result in extreme health hazards.Who is Most at Risk?Although anyone with a high intake of black licorice is at risk of side effects, some populations are especially susceptible:Adults above 40: Since metabolism and cardiovascular health vary with age, older people are more prone to the heart-related complications of licorice intake.People with existing heart conditions: Those with hypertension, heart disease, or electrolyte disturbances should be particularly careful.Individuals on certain medications: Licorice interacts adversely with diuretics, blood pressure drugs, corticosteroids, and certain other medications, worsening health conditions.FDA Warnings and Medical RecommendationsThe FDA warns consumers to watch out for black licorice consumption, especially over an extended period of time. The agency cautions that consuming even 2 ounces a day for two weeks might lead to hospitalization because of abnormal heart rhythms.Here are precautions recommended by medical experts:Check labels closely: Certain products of licorice include genuine glycyrrhizin, but others make use of anise oil, a flavor substitute, which carries no such threat.Watch out for portion sizes: Infrequent intake in limited portions is safe most of the time, but one should stay away from it otherwise.Keep watch for symptoms: If you develop dizziness, muscle weakness, irregular pulse, or swelling upon consuming licorice, then immediately visit the doctor.Safer Alternatives to Black LicoriceFor individuals who enjoy the flavor of licorice but prefer to be cautious about their health, safer alternatives are available:Anise-flavored items: Numerous licorice-flavored sweets in the United States contain anise oil rather than actual licorice root.Natural sweeteners: Choosing healthier snacks that contain natural sweeteners and flavors can assist in curbing the desire for high-sodium, high-sugar foods.Balanced diets: Maintaining sufficient potassium levels through a diet high in bananas, spinach, avocados, and beans will counteract any slight loss of potassium from periodic licorice use.Black licorice, when eaten in large amounts over time, can have life-threatening effects due to its ability to deplete potassium levels and disrupt heart function.