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Glycyrrhiza: Licorice and AIDS

by Paul Bergner

Medical Herbalism 2(4):4-5

Glycyrrhizin, a constituent of Licorice root (Glycyrrhiza glabra, radix), has been found effective in the treatment of AIDS, and in the prevention of progression of HIV+ patients to AIDS in several Japanese clinical trials. Glycyrrhizin is also used routinely in Japan to treat liver dysfunction, a benefit for many AIDS patients.

Glycyrrhizin showed antiviral properties in initial laboratory tests. It inhibited replication of the HIV virus, interfered with virus binding to cell walls, inhibited cell-to-cell infection, suppressed the clumping of infected cells and induced interferon activity (James). Interferon raises cell resistance to infection. These clinical trils are the first in humans. Although the number of clinical trials is small, with a small number of patients in each, results are consistent in all of them. See the accompanying table. Notice that two studies used only intravenous glycyrrhizin, but a third used oral glycyrrhizin for more than a year.

Whole root delivers effective dose

Although adminstration of glycyrrhizin itself gives a more consistent dose, taking the whole root may have advantages. Reports of the glycyrrhizin content of the whole root vary. The Merck Index lists it as 6% to 14% (Merck), and the official German monograph lists it as 4% to 5.3%. The German monograph says that a dose of 5g–15g a day delivers 200mg to 800 mg of glycyrrhizin to the digestive tract. This will deliver a consistent dose at or above the dose range used by Ikegami with HIV+ patients.

Advantages to the whole root

Having the antiviral and liver-protecting effects of its constituent glycyrrhizin, the whole root is also an expectorant for coughs and bronchitis, and has anti-inflammatory properties. Its isoflavone and saponin constituents also have antiviral and anti-bacterial properties (Wichtl), and could help with secondary infections in AIDS.

Licorice and traditional Chinese medicine

Licorice is well-matched to AIDS in Chinese medicine. It is a “chi tonic”, improving energy levels in deficient conditions and benefiting the digestion. (Bensky) It is traditionally used in the following syndromes, many of which are common in AIDS patients.

Deficient chi—A pattern of the following: general weakness and lethargy, weak pulse, shallow respiration, quiet voice, poor appetite, pale tongoue, pale, puffy face, spontaneous daytime sweating. 
 

Deficient blood—The Chinese concept of “blood” is not identical with that of Western medicine. Pale face, tongue and lips; thinness and emaciation; “thin” pulse (feels narrow like a thread); dizziness; scanty menses; dry skin and hair; poor vision and spots before the eyes.

Deficient Spleen—poor appetite, weak pulse, lethargy, loose stools, edema, abdominal distension with pain.

Risks with long term use

The oral therapeutic dose of licorice root puts HIV+ and AIDS patients on a collision course with the possible side effects of high blood pressure, edema and salt imbalances. Patients taking licorice in doses over 3-5 grams a day for more than 6 weeks should monitor their blood pressure and blood electrolyte balance, and watch for symptoms of swelling and edema. One simple office-based test for high blood sodium could pinpoint developing problems at an early stage (see below “The Koenigsburg urinary chloride test”).  Patients should also eat more high-potassium foods such as bananas or dried apricots.

Clinical research: glycyrrhizin and AIDS

    Dose            Duration     Patients    Outcome    Reference

    150-225 mg/day oral.    1-2 years    10 HIV+,     none progressed to symptoms;                                         (Ikegami)

                        In controls,     2 progressed to AIDS; 1 to ARC

    200-800 mg/day i.v.    8 weeks    9 HIV+,     Increased T4, improved T4/T8                                         ratio. (Mori, 11/89)

                                Improved liver function.

    400-1600 mg/day i.v.    30 days.    6 AIDS.    P24 antigen reduced or gone in                                         5/6 (Hattori)

The Koenigsburg urinary chloride test

This simple test can detect the onset of glycyrrhizin-induced toxicity from long-term licorice intake. It is suitable for office use, or with proper instruction, for self-monitoring by patients on long-term glycyrrhizin therapy. Blood pressure should also be monitored.

Urinary chloride is directly proportional to urinary sodium. Glycyrrhizin toxicity causes sodium retention, so urinary sodium and chloride would drop as toxicity developed. 
  
  
 

Procedure: Place 10 drops of the patient’s first morning urine specimen in a test tube. Add 1 drop of a 10% solution of potassium chromate and shake. Add, drop by drop, while counting, 0.74% silver nitrate until a brick-red color develops.Shake after every few drops. Record the number of drops it takes to maintain the brick-red color.

Interpretation. The normal range is 17-25 drops of silver nitrate to maintain the color change. Less than 17 drops indicates high activity of the hormone aldosterone, and possible glycyrrhizin toxicity.

Licorice Root: (Glycyrrhiza glabra)

Dose: 3-15g a day, in the form of a tea or powder. Delivers 120 to 800 mg of glycyrrhizin to the digestive tract.

Side Effects: High doses (50g/day) or long duration (>six weeks) can cause high blood pressure, edema, high blood sodium, and low blood potassium. The effects are reversible if herb use is stopped. (Wichtl, Bensky)

Contraindications: Licorice in contraindicated with any weakening of heart or kidney function, in chronic liver inflammation, cirrhosis, high blood pressure, and low blood potassium. (Wichtl)

Chinese contraindications: “Excess dampness,” nausea or vomiting. Excess dampness is a pattern that may include: thick coat on tongue; reduced thirst; feeling of fullness; poor appetite; sore, stiff joints; full headache; distention in chest or abdomen; slow pulse; nausea; diarrhea; and general heaviness and stagnation. (Bensky) (Diarrhea alone is not necessarily a contraindication).

Drug interactions: Licorice or glycyrrhizin can interact with cardiac glycosides (digitalis, lily-of-the-valley) Its action may also be stronger when given with diuretics. (Wichtl)

References

Bensky D, Gamble A. Chinese Herbal Medicine Eastland

Press, 1986.

Hattori T, Ikematsu S, Koito A, Matsushita S, et al.

“Preliminary evidence for inhibitory effect of glycyrrhizin on HIV replication in patients with AIDS.” Antiviral Research Jun-Jul 1989 11:(5-6):255-261.

Ikegami N, et al. “Clinical evaluation of glycyrrhizin

on HIV-infected asymptomatic Hemophiliac patients in Japan. V International Conference on AIDS. Abstract W.B.P. 298, June 1989. As cited in AIDS Treatment News #103 May 18, 1990.

James, J. AIDS Treatment News #103 May 18, 1990.

Mori K, Sakai H, Suzuki S, Akutsu Y, et. al. “The 
 

present status in prophylaxis and treatment of HIV infected patients with hemophilia in Japan." Rinsho Byori Nov 1989. 37(11):1200-8

Mori K, Sakai H, Suzuki S, Sugai K, et. al. “Effects

of glycyrrhizin in hemophilia patients with HIV infection." Tohuku J Exp Med May 1989. 158:(1):25-35.

The Merck Index. Eleventh Edition. Merck and

Company. Rahway, NJ. 1989.

Wichtl, M. Teedrogen Wissenshaftliche Veragsgesel-

lchaft. mbH Stuttgart. 1989