The electrolyte mystery

Did you know that the active ingredient (glycyrrhizinic acid) in liquorice (the real stuff, not twizzlers) can cause hypokalemia?

I didn't until recently! Apparently, licorice and anything made with anise contain a potent and long lasting aldosterone inhibitor (it's more complicated, but I'll keep it simple). Aldosterone is a corticosteroid hormone that acts on the distal tubules and collecting ducts of your nephrons. In other words, it is a hormone that out adrenal gland makes that helps us to regulate electrolytes. So, if your body senses that you need to hold onto your potassium and sodium, your kidneys usually don't let you excrete more than you should be. At the most basic level, aldosterone stops you from peeing out all of your electrolytes.

There are warnings about licorice use for people on dialysis because of the risk of hypokalemia. A simple internet search provides that much. However, nobody ever said a thing about licorice until a month ago when my new primary care provider asked whether I ate it. And, I do love licorice.

 I continue to be suprised at how something so seemingly important as electrolyte balance and nutrition were never addressed by any of the hospital staff, my GI doc, or my previous primary care physician. It has only been at my own request that I have had any type of attention to nutritional deficiencies, and my health plan has never covered a nutritional consult. One might think that these types of information would be necessary for a person without the majority of their intestines!

Here's a project that I would love to have the time to take on: A campaign for the adoption of nutritional counseling as a standard of care for those with an ileostomy, or even IBD without an ileostomy. This type of intervention has been the standard of care for diabetics and heart disease patients upon diagnosis for years. It is time that people with digestive disorders receive the same attention.

I should mention that I do see a nutritionist, specifically a sports dietician who is herself a pro iron-man (woman?) competitor. She's awesome and while there haven't been many competative cyclists with exactly my circumstances, was excited about the challenge of getting me back on track. However, those consultations have been all out of pocket expenses, and the only person who has ever asked me to get a nutritional consult is my coach.   I recognize that I am fortunate to have a smart coach who could refer me correctly, the motivation and education to be able to stick to a plan, and the financial priveledge to afford nutritional advice.

Licorice... a contributor to my problems with hypokalemia!