Liquorice Dose: Essential New Information

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In relation to adrenal hormone support, low blood pressure, fatigue, asthma and all other autoimmune disorders

 This article discusses the role of Liquorice in overcoming chronic fatigue, low blood pressure, adrenal insufficiency, asthma and other autoimmune disorders. Also discusses hydrocortisone (cortisol) and steroid needs.
Previously we have posted articles on Liquorice herb that includes information on how it can help the production of hydrocortisone in the body and hence play an important role in autoimmune disorders, fatigue and low blood pressure resolutions.
We have also posted an article on the use of physiological amounts of hydrocortisone (see the further reading tab) in the same regard. The reason for the use of physiological amounts of hydrocortisone is for those with chronic adrenal insufficiency, a state where the adrenal glands are incapable of producing enough cortisol to maintain health, either on a daily basis or occasionally when under stress. Stress, in this sense, can include the introduction of new supplements, infections, autoimmune flare up amongst other things.
In these situations the adrenal glands may only just produce adequate daily cortisol when not under stress, about 40mg daily but are often unable to produce the amounts required when under stress up to 120mg or more daily.
Liquorice, however can enable sufficient production and conservation of hydrocortisone in adrenal insufficient cases, but its effect is limited by the dose taken. As liquorice is known, in some cases, to cause high blood pressure or increase a pre-existent high blood pressure when used at high doses, it has been commonly used in low doses (such as 1g daily or less) in "western medicine" although traditional Chinese medicine often uses it in higher doses. For many (but not all) of those who suffer from adrenal insufficiency there is also a tendancy towards low blood pressure and postural hypotension (testing for such is discussed towards the end of this article). It is known that abnormally low blood pressure, with its typical symptoms of fatigue, dizziness when standing up and a dislike of standing for long periods, is due to excessive loss of sodium and reduced blood volume from the body due to the failure to produce enough of another adrenal hormone called aldosterone. This is not surprising since the production of both hydrocortisone and aldosterone from the adrenal cortex is stimulated by the pituitary hormone ACTH.
It is often a failure of the pituitary gland to produce enough ACTH that is one of the causes of adrenal insufficiency. As luck, or in this case nature, would have it Liquorice helps the production/conservation of both hydrocortisone and has aldosterone mimicking effects. Liquorice is an adaptogen which helps regulate the hypothalamic-pituitary-adrenal axis. Optimising both of these hormones together for those suffering from low blood pressure and adrenal insufficiency - a relatively common condition, especially in all auto-immune disorders and chronic fatigue - can have a powerful effect in health restoration. More than just gaining energy from blood pressure normalisation (and that is very important overall as the cells and organs need sufficient blood pressure to do their jobs and maintain health) it can be a most vital component in overcoming autoimmune disorders.
If there are other significant factors in maintaining the autoimmune disorder then results will only be partial. Please refer to the Autoimmune Protocols for further details. The "usual" other factor is chronic infection, known or unknown, such as Candida infestation. Infections can be eliminated with the infection protocol here, Most commonly with the use of Lugol's Iodine and/or Colloidal Silver. However, the first place to start is with Liquorice, as this also enables the body to deal with the stresses of detoxification from any other supplements such as Iodine. Activated Charcoal is also a useful adjunct in these situations.
Using moderate to high doses of Adrenal Boost, our new (August 2014) Liquorice product, and adjusting the dose to ones needs may also offer the gradual restoration of the adrenal glands themselves. However if ACTH insufficiency is an important aspect then the correct dose of liquorice may be needed for life, unless a way is found to restore adequate ACTH levels.
So what about the possible danger/side effects of moderate to high doses of liquorice for extended periods of time? These can be avoided by careful monitoring:

Emergency Use of Liquorice and Reducing to Maintenance Use

Emergency use is indicated when there is a "flare up" of a pre-existing autoimmune condition, such as asthma; or for those with chronic autoimmune disorders (that don't "flare up" as such, as this does not necessarily occur in all autoimmune conditions). To quickly abort the immune attack. (within 1-5 days) and provided one does not have overly high blood pressure, 2 to 3 capsules of Adrenal Boost should be taken three times daily. Monitor blood pressure twice daily and reduce dose as soon as the average daily systolic readings start to exceed your initial readings. Systolic is the first or upper reading on the monitor. If your initial readings were in the range of 120-150 systolic, as soon as they consistently rise above this rate, then reduce the dose to maintain your previous level. If your initial readings are above this range, then do not use Adrenal Boost. If they are below, then start to taper your dose to achieve systolic of around 120-125.
I found that after 19 days of 2 to 3 caps three times a day my blood pressure had risen from excessively low to between 130 and 138 systolic. I then stopped liquorice for one day and tapered down the dose until I found my personal maintenance dose of 1 capsule twice daily.
John Claydon, Founder of Regenerative Nutrition
Some will do well on only 1 capsule daily whilst others may need more. As long as blood pressure is consistently monitored the best personal dose can be ascertained.
Salt, Water and Blood Pressure
When there is insufficient circulating aldosterone the kidneys release too much salt into the urine, and possibly other minerals. The lack of salt and possibly other minerals will be partly compensated for by loss of water, thereby increasing the relative salt content.
This results in a reduction in blood pressure and a reduction in blood volume. There is a need for supplemental salt in the general population to maintain health, the false information that consuming salt should be avoided is doing much harm (see the article Celtic Ocean Sea Salt and links within to population studies showing long term health is related to sufficient salt consumption). Those with adrenal fatigue/low aldosterone production are in even greater need of unrefined salt. Vegetarians (especially if there is not sufficient salt added to their food) are at great risk in this area. It will come as a surprise to many that several huge population studies indicate that a minimum of 6g of salt daily should be consumed to avoid physiological stress, and that the reverse of the mainstream information is true - those who consume adequate salt in the range of 6 to 12 gram daily have less heart disease and mortality from all causes. Aldosterone is involved here, if less than the optimal amount of salt is consumed, aldosterone is increased to retain salt provided of course there is no ‘adrenal insufficiency.' If adequate salt is ingested then the aldosterone production is reduced so that salt does not have to be retained to such a high degree.
So the importance of adequate salt consumption should not be underestimated and even more crucially for those who cannot retain sufficient salt, due to aldosterone insufficiency. Another harmful effect of inadequate aldosterone is loss of the body's mineral reserves. So, for adrenal hormone insufficiency liquorice and salt are the cornerstones of improved physiological balance.
Vitamin B5 also known as pantothenic acid, can help nourish the adrenal glands and in some cases return the hydrocortisone production back to normal. Vitamin B5 converts into a substance called acetyl co-enzyme A, a precursor to all the steroid hormones. Not all individuals benefit from taking the vitamin, although those that do typically respond best when using between 500 to 1,000mg daily (RN do not supply this).

Traditional use of Liquorice in Chinese Medicine

Why is liquorice included in many traditional Chinese herbal mixtures? It is said to harmonise the herbal blend, and improve the result. Understanding the role of the adrenals in management of the body's adaptation to stress or even just life itself and how this needs support in many people is revealed by this statement by Therese Vernon  Adrenal Fatigue: All chronic illness includes chronic fatigue and adrenal fatigue, whether you feel tired or not. Therefore, it is suggested to follow ancient Chinese herbal wisdom and include some liquorice in a daily supplement regimen. It is not necessary to take blood pressure readings if consuming just 1 capsule (equivalent of 1.5g) daily, unless ones readings are typically over 150 Systolic. However it is highly recommended that blood pressure is monitored at anything over this level, and absolutely essential if taking 4 or more capsules daily. It is pertinent to add here that most cases of high blood pressure are resolved with adequate Celtic Ocean Sea Salt use.
Some of those who are taking high dose Adrenal Boost may experience a rise in blood pressure above the desired levels, whilst also using 4 to 8 g of salt daily (including Celtic Ocean Sea Salt). If these individuals wish to remain on a high (or even medium) dose of liquorice, then reducing salt intake to a lower level of 1 to 2g daily may result in a drop to normal blood pressure levels. This is because liquorice has a sodium retention action, so less salt is needed.
Normally the body will self regulate the amount of salt it retains and insufficient salt can be stressful so we still recommend at least 6 g of Celtic Ocean Sea Salt daily for general use and where blood pressure is not affected. 
Just over two years ago in May 2012 I came down with a serious asthmatic episode. I have tended to get these about every 3years, I am 65 years old. I had asthma a lot when I was a baby and up to the age of 14, it then returned with a vengeance when I was 28. That then sparked my interest in natural or so called alternative medicine and therapies. I used a variety of remedies to get out of the crisis each time it occurred. Visits to hospitals where luckily and studiously avoided.
On this occasion 2 years ago, due to age and weakening or constitutionally weak adrenals/adrenal hormone output; a hospital visit was only just averted. I was in an asthmatic crisis for about two weeks and visiting my acupuncturist for treatment. Normally, the last few years I have been able to get out of these severe episodes using Gerald Greens Asthma and Bronchitis herbal formula, but it can take a few weeks to work drinking it 3 times a day in serious/elderly cases. I had made an improvement , but suddenly deteriorated with the addition of infection like symptoms (later I learned that very low hydrocortisone levels could leave one susceptible to, and with a poor competence for dealing with, infections). My acupuncturist warned that unless I take ‘steriods' (cortisone patented derivatives such as prednisolone) I would most likely have to be admitted to hospital. He also revealed he was a lifelong asthma sufferer since childhood and had nearly died several times and had frequent trips to hospital in the past. He had found by using a low dose prednisolone via inhalation he had managed to keep the asthma at bay for many years without side effects. (Although one could see he was not totally free of histamine excess) This combination of information made me decide to take a week's course of steroids that I had studiously avoided in the past due to fear of sliding down a lifelong slippery slope of dependency and more.
The local doctor duly obliged with the standard treatment for asthma; a week's course of high potency prednisolone. I only took them for 3 days and by that time had come out of the asthmatic and immune crisis, although I was left with marked weakness and fatigue for weeks (another symptom of adrenal hormone inadequacy). A few weeks later I read about the use of physiological doses of cortisol (bio-identical hydrocortisone) and began using it to stop the ever lurking asthma from taking hold and also to help reduce the mild fatigue I have had most of my life. I remained on bio-identical cortisone at high physiological doses of around 30 mg daily. Each time I tried to reduce the dose the asthma would begin creeping back. I also found that I had to eliminate all wheat from my diet completely and this reduced the tendency to mild breathlessness.
It was about 18 months after that asthmatic episode that I had another one even though I was taking hydrocortisone at around 25 mg daily. Understanding from the detailed information from the world's leading authority on the use of hydrocortisone, Professor William Jefferies Safe Uses of hydrocortisone (second edition), that much higher doses are needed during times of stress including infections or major physiological changes I increased the dose to around 60 - 80mg a day. My lungs were tightening and acute asthma symptoms where occurring with great difficulty in breathing. It became obvious that my body was producing loads of histamine as the end result of an overactive immune system. I kept changing the dose but never going very high due to cautionary fears. It took me a month to find out that I needed to raise the dose to around 120 to 150mg daily (equivalent to 30-38 mg daily prednisolone) for two days to shut down the immune/histamine storm. Using fairly high doses of 80 mg a day in the situation I was in could never could win the battle. Later I found out that histamine and hydrocortisone fight each other directly so moderate amounts of hydrocortisone were neutralizing some of the histamine but not enough and the longer the histamine was allowed to inflame the lungs the more the immune system wanted to attack them with more histamine!
So I had learnt that at the first sign of any asthmatic relapse I had to quickly take high doses for one or two days then reduce gradually each day to try to get down to regular physiological amounts, otherwise various side effects and over dependency may develop. I found it difficult to reduce the dose to physiologic levels in a few weeks, even getting down to 60 mg daily mild asthma was present. I began to wonder if my body was producing so much histamine on a regular basis that maybe it was neutralizing hydrocortisone to the point that my physiological needs where much higher. However, I could find nothing about this in the literature. I also thought about the possibility that hydrocortisone resistance may be an issue, but that did not answer my question. Would continuing at doses above the regular physiological doses of 30 mg a day would eventually create problems?
I had been monitoring my blood pressure regularly, as this can indicate how much hydrocortisone one needs to some extent. Generally, even while I was taking hydrocortisone my blood pressure in this period was on the low side with some postural hypo-tension. Then I had one of those rare "ahh!" moments. I realised that need to keep liquorice dose low (around 1-2g daily) as in some people it can cause high blood pressure could be exceeded provided one monitored ones blood pressure. Reading up on this issue it almost immediately became obvious, as discussed above, that aldosterone was an important issue, and for those with adrenal insufficiency and low blood pressure, restoration of aldosterone levels (or at least mimicking the effects of adequate aldosterone) and hydrocortisone at the same time could be a winner. So I began to take liquorice at equivalent of 3g three times a day. The first night I experienced a great sensation of healing and the overall feeling of well-being increased every day. All signs of remaining mild lung inflammation disappeared (I also began to take quercetin 1 capsule three times a day after a few days on the liquorice and this seemed to remove the final bit on inflammation from the lungs) My blood pressure improved up to typically optimum levels (average around 120/80) and I reduced the hydrocortisone from 80 mgs daily to zero in 11 days, this after taking hydrocortisone for two years and wondering if I could ever get off it.
The actual feeling of the effect of one's optimal dose of liquorice is far superior to hydrocortisone alone. So I may not need to use hydrocortisone again. I have been taking DHEA 40mg daily for a few months and Pregnenolone 50mg daily for about 7 months now and see no reason for not continuing these adrenal support hormones that we tend to need as we age.

Shortly after this experience a friend with intermittent chronic fatigue and very low blood pressure was able to come off hydrocortisone by switching over to initially high dose liquorice, which normalized his blood pressure and eliminated much of his fatigue within a few days.

John Claydon, Founder of Regenerative Nutrition, June 2014
The use of bio-identical hydrocortisone may only be required in a minority of cases and could be taken at lower amounts if also taking Adrenal Boost (Liquorice).
Adrenal Boost will, generally (for most people), give better clinical results in reducing auto-immune reactions, excess histamine and inflammation and further, raising low blood pressure than hydrocortisone (cortisol) will; IF TAKEN AT OPTIMAL DOSES. In some cases, physiological doses of hydrocortisone (up to 20 mg daily) alongside liquorice for serious adrenal hormone insufficiency may be required. However, in emergency cases, such as the rapid onset of autoimmune crisis, it makes sense to try/use high doses of liquorice for a limited period of time in preference to high doses of hydrocortisone. If this works well in such a crisis, this will give confidence of use for any future crisis.