Does Licorice Increase Intraocular Pressure?
0
Entering edit mode
1 day ago
david 4.3k
@david_fe

Does Licorice Increase Intraocular Pressure? I attempted to answer this question in 2009 and it came up again in our email discussion group a few years ago.

Immediately below is the information I gathered last time I looked at this question. (NOTE: Below this post, in a reply, is a newer, 2025, update.)

  1. Glycyrrhizin is the main sweet tasting compound from liquorice root.

  2. A derivative of glycyrrhizin is glycyrrhetinic acid.

  3. Glycyrrhetinic acid inhibits 11β-HSD1 (11β-hydroxysteroid dehydrogenase type 1)

  4. 11β-HSD1 is an NADPH-dependent enzyme highly expressed in the liver and adipose tissue.

  5. Selective and topical inhibitors of 11ß-HSD1 could provide a novel treatment for patients with glaucoma due to their ability to lower intraocular pressure. (See below.)

Licorice can increase blood pressure, but so far I have found no published studies that indicate licorice can increase intraocular pressure. (If you know of such information, please post an answer here.)

Is it possible that licorice compounds or derivatives could lower intraocular pressure? It appears that some researchers are attempting to answer a closely related question. See the abstract below.

Q J Med 2003; 96: 481-490

Inhibition of 11ß-hydroxysteroid dehydrogenase type 1 lowers intraocular pressure in patients with ocular hypertension

Authors: S. Rauz1,2, C.M.G. Cheung1, P.J. Wood3, M. Coca-Prados4, E.A. Walker2, P.I. Murray1 and P.M. Stewart2

Background:

Intraocular pressure (IOP) is maintained by a balance between aqueous humour (AH) production (dependent on sodium transport across a ciliary epithelial bi-layer) and drainage (predominantly through the trabecular meshwork). In peripheral epithelial tissues, sodium and water transport is regulated by corticosteroids and the 11ß-hydroxysteroid dehydrogenase (11ß-HSD) isozymes (11ß-HSD1 activating cortisol from cortisone, 11ß-HSD2 inactivating cortisol to cortisone).

Aim:

To analyse expression of 11ß-HSD in the human eye and investigate its putative role in AH formation.

Design:

Multipart prospective study, including a randomized controlled clinical trial.

Methods:

The expression of 11ß-HSD1 in normal human anterior segments was evaluated by in situ hybridization (ISH). RT-PCR for 11ß-HSDs, glucocorticoid and mineralocorticoid receptors (GR, MR) was performed on human ciliary body tissue. AH cortisol and cortisone concentrations were measured by radioimmunoassay on specimens taken from patients with primary open-angle glaucoma (POAG) and age-matched controls. Randomized, placebo-controlled studies of healthy volunteers and patients with ocular hypertension (OHT, raised IOP but no optic neuropathy) assessed the effect of oral carbenoxolone (CBX, an inhibitor of 11ß-HSD) on IOP.

Results:

ISH defined expression of 11ß-HSD1 in the ciliary epithelium, while RT-PCR analysis of ciliary body tissue confirmed expression of 11ß-HSD1, with additional GR and MR, but not 11ß-HSD2 expression. In both POAG patients and controls, AH concentrations of cortisol exceeded those of cortisone. The CBX-treated healthy volunteers who demonstrated the largest change in urinary cortisol metabolites, indicative of 11ß-HSD1 inhibition, had the greatest fall in IOP. Patients with OHT showed an overall reduction of IOP by 10% following CBX administration, compared to baseline (p<0.0001).

Discussion:

CBX lowers IOP in patients with ocular hypertension. Our data suggest that this is mediated through inhibition of 11ß-HSD1 in the ciliary epithelium. Selective and topical inhibitors of 11ß-HSD1 could provide a novel treatment for patients with glaucoma.

dietary-supplements iop:intraocular-pressure Licorice • 967 views
ADD COMMENTlink
0
Entering edit mode
9 days ago
david 4.3k
@david_fe

Here's a 2025 update.

While inhibition of 11β-HSD1 specifically within the eye can lower IOP, as discussed in the main post above, systemic inhibition of 11β-HSD2 by glycyrrhizin in licorice can have the opposite effect by increasing systemic cortisol levels and blood pressure, which may contribute to increased IOP.

Elevated cortisol can activate mineralocorticoid receptors, causing hypertension and potentially increasing IOP indirectly through systemic blood pressure elevation.[2-3]

In summary, the hypertensive effect of glycyrrhizin-containing licorice can contribute to increased intraocular pressure, as systemic hypertension is a known risk factor for elevated intraocular pressure. Chronic licorice ingestion has been associated with significant increases in both systolic and diastolic blood pressure, which can indirectly affect intraocular pressure.

References:

  1. Inhibition of 11beta-Hydroxysteroid Dehydrogenase Type 1 Lowers Intraocular Pressure in Patients With Ocular Hypertension.

Rauz S, Cheung CM, Wood PJ, et al.

QJM : Monthly Journal of the Association of Physicians. 2003;96(7):481-90. doi:10.1093/qjmed/hcg085.

Background: Intraocular pressure (IOP) is maintained by a balance between aqueous humour (AH) production (dependent on sodium transport across a ciliary epithelial bi-layer) and drainage (predominantly through the trabecular meshwork). In peripheral epithelial tissues, sodium and water transport is regulated by corticosteroids and the 11beta-hydroxysteroid dehydrogenase (11beta-HSD) isozymes (11beta-HSD1 activating cortisol from cortisone, 11beta-HSD2 inactivating cortisol to cortisone).

Aim: To analyse expression of 11beta-HSD in the human eye and investigate its putative role in AH formation.

Design: Multipart prospective study, including a randomized controlled clinical trial.

Methods: The expression of 11beta-HSD1 in normal human anterior segments was evaluated by in situ hybridization (ISH). RT-PCR for 11beta-HSDs, glucocorticoid and mineralocorticoid receptors (GR, MR) was performed on human ciliary body tissue. AH cortisol and cortisone concentrations were measured by radioimmunoassay on specimens taken from patients with primary open-angle glaucoma (POAG) and age-matched controls. Randomized, placebo-controlled studies of healthy volunteers and patients with ocular hypertension (OHT, raised IOP but no optic neuropathy) assessed the effect of oral carbenoxolone (CBX, an inhibitor of 11beta-HSD) on IOP.

Results: ISH defined expression of 11beta-HSD1 in the ciliary epithelium, while RT-PCR analysis of ciliary body tissue confirmed expression of 11beta-HSD1, with additional GR and MR, but not 11beta-HSD2 expression. In both POAG patients and controls, AH concentrations of cortisol exceeded those of cortisone. The CBX-treated healthy volunteers who demonstrated the largest change in urinary cortisol metabolites, indicative of 11beta-HSD1 inhibition, had the greatest fall in IOP. Patients with OHT showed an overall reduction of IOP by 10% following CBX administration, compared to baseline (p<0.0001).

Discussion: CBX lowers IOP in patients with ocular hypertension. Our data suggest that this is mediated through inhibition of 11beta-HSD1 in the ciliary epithelium. Selective and topical inhibitors of 11beta-HSD1 could provide a novel treatment for patients with glaucoma.

  1. A Review of the Pharmacological Efficacy and Safety of Licorice Root From Corroborative Clinical Trial Findings.

Kwon YJ, Son DH, Chung TH, Lee YJ.

Journal of Medicinal Food. 2020;23(1):12-20. doi:10.1089/jmf.2019.4459.

Since ancient times, licorice, the root of , has been known to have a wide spectrum of therapeutic effects. Glycyrrhizin is cleaved to glycyrrhizic acid, which is subsequently converted to glycyrrhetic acid by human intestinal microflora. Glycyrrhetic acid is a potent inhibitor of 11-hydroxysteroid dehydrogenase (11-HSD) and performs a range of corticosteroid-like activities. The pharmacologic effects of licorice contribute to its anti-inflammatory, antioxidative, anti-allergenic, and antimicrobial properties. Licorice has been used to treat liver disease, gastrointestinal disorders, oral disease, and various skin disorders and has been used in gum, candy, herbs, alcoholic beverages, and food supplements. Licorice and its extracts, especially glycyrrhizin, can be taken orally, through the skin (in the form of gels and oils), and intravenously. Licorice demonstrates mineralocorticoid-like activity not only by inhibiting 11-HSD2, but also by binding to a mineralocorticoid receptor, leading to potentially adverse risks of mineralocorticoid-like overactivity. Chronic use of licorice can lead to hypokalemia and hypertension, and some people are more sensitive to licorice exposure. Based on clinical trials, this review summarizes the positive effects of licorice and other reported side effects.

  1. Licorice Inhibits 11 Beta-Hydroxysteroid Dehydrogenase Messenger Ribonucleic Acid Levels and Potentiates Glucocorticoid Hormone Action.

Whorwood CB, Sheppard MC, Stewart PM.

Endocrinology. 1993;132(6):2287-92. doi:10.1210/endo.132.6.8504732.

ADD COMMENTlink

Login before adding your answer.

Traffic: 24 users visited in the last hour

Use of this site constitutes acceptance of our User Agreement and Privacy Policy.