I found the following message in another message board and saved it. My daughter’s renin had come back as elevated. We were giving florinef in the am. Then we switched and gave her the same amount but split between am and pm AND we give our daughter 1 licorice a day, it has to be the real kind like Panda’s for it to do any good. Since these changes her levels have been right on target and we didn’t increase the florinef!! Oh, and we discussed this with her endo! Good luck! Julia

There is certainly quite a bit of misinformation about licorice. For instance licorice does NOT stimulate the adrenal
glands to produce cortisol - if anything it has a suppressive effect.. For anyone who is taking hydrocortisone, licorice acts
much like Florinef. True licorice (not anise flavored candy) contains glycyrrhizin which is converted by the intestinal
flora of the body into glycrrhetinic acid. A metabolite of glycyrrhetinic acid inhibits the enzyme (11beta-hydroxysteroid
dehydrogenase) that converts ACTIVE cortisol (hydrocortisone) to INACTIVE cortisone in the kidneys. This causes
hydrocortisone to remain active longer and since it is not being inactivated, hydrocortisone is able to act on the kidneys in
the same way that aldosterone does. The consumption of large amounts of licorice by non CAH people is well know for
causing the same symptoms that they would get if they took Florinef (ie salt and water retension, potassium loss and
elevated blood pressure). This is why I said that while glucocorticoids can’t replace Florinef, hydrocortisone in
combination with licorice can do a pretty fair job.

There was even a a study in which a licorice derivative called carbenoxolone was used in the treatment of CAH.
Clin Endocrinol (Oxf) 1999 Sep;51(3):285-91
"Effect of carbenoxolone on the plasma renin activity and hypothalamic pituitary-adrenal axis in congenital adrenal
hyperplasia due to 21-hydroxylase deficiency."
Irony I, Cutler GB.
OBJECTIVE: "To test the hypothesis that carbenoxolone, an inhibitor of 11beta-hydroxysteroid dehydrogenase, might
augment the ACTH-suppressing and mineralocorticoid activities of hydrocortisone without a corresponding increase in
peripheral hydrocortisone effects"
From the RESULTS: "The addition of carbenoxolone (with or without concurrent fludrocortisone administration)
produced statistically significant decreases of 20-50% in mean plasma 17-hydroxyprogesterone, androstenedione, and
renin activity. Since carbenoxolone also decreased the apparent metabolic clearance rate of cortisol by 20%, other
measures of systemic glucocorticoid activity were examined. Carbenoxolone did not produce a cushingoid appearance or
increase body weight, blood pressure, blood glucose or plasma insulin levels."
CONCLUSION: "Carbenoxolone can augment the adrenal androgen suppressing activity of hydrocortisone in patients
with 21-hydroxylase deficiency. These observations support the hypothesis that selective inhibition of enzymes that
metabolize cortisol may lead to new approaches to improve the treatment of congenital adrenal hyperplasia."
.
These two links contain accurate information about licorice:
http://www.primenet.com/~camilla/licorice.html
http://www.friedli.com/herbs/phytochem/glycosides.html#licorice

Licorice is beneficial for an impressive number of ailments but because of its potent mineralcorticoid effect the
glycyrrhizin is oftened removed and the result is called DGL (Deglycyrrhizinated) Licorice. The DGL form of
licorice does not have a mineralcorticoid effect on the body and may not be as beneficial as the natural form.

I have been taking licorice root powder for about five years. Since I also take hydrocortisone I have been able to cut my
Florinef down to .05mg a day. It is important to understand that hydrocortisone is a powerful mineralcorticoid that is
normally inactivated in the kidneys and licorice prevents that inactivation. Prednisone may be similarly affected by
licorice but dexamethasone is definitely not. In any case I DON’T recommend licorice for CAH children without an
endocrinologist’s supervision because it can have such potent effects on their CAH therapy.

I hope this was not too confusing.