October 28, 2020 - Podcast

Episode 51—Safe Halloween, and cautions about black licorice

Since the start of the pandemic, parents have struggled to keep their children safe. So, with Halloween approaching, many are trying to decide whether to allow their children to take part in trick or treating. Dr. Aaron Carroll, of the IU School of Medicine, says children have suffered enough, and guidance on Halloween from the Centers for Disease Control and Prevention – that traditional trick-or-treating is a high-risk activity - is a bridge too far. Carroll says if he had to design an activity for children that might be safe during a pandemic, nothing would be better than trick-or-treating. It’s outside, it can be socially distanced, the food is individually wrapped (before anyone partakes, parents can wipe down the candies while kids wash their hands), and it’s the one night a year when kids will not argue at all about wearing masks. To help ensure safety, Carroll says homeowners can easily place the candy bowl six feet from the door and admire kids’ costumes from afar. Candies also could be laid out on platters and replenished, so kids don’t have to root around in a big bowl. Because Halloween is on a Saturday this year, Carroll says neighborhoods also could commit to starting earlier so that kids aren’t all out at once. While traditional trick-or-treating activities can be done safely, Carroll says some Halloween activities such as indoor get-togethers, bobbing for apples, haunted houses that ask kids to touch things or bump into each other, and large groups of kids on a hayride are not safe. As we struggle to make our way through this pandemic, Carroll says our goal should be to evaluate each activity and ask, “How can we do this as safely as possible?” When it comes to Halloween, he says we can make trick-or-treating safer for kids if we make it all about them and less about us.

For some people, nothing says Halloween like black licorice. But while black licorice may look and taste like an innocent treat, the candy has a dark side. On Sept. 23, 2020, it was reported that black licorice was the culprit in the death of a 54-year-old man in Massachusetts. Overdosing on licorice sounds like a twisted tale, but Bill Sullivan, professor of pharmacology and toxicology at the IU School of Medicine, says the tale is not an anomaly. There are similar case reports in medical journals in which patients experience hypertension crisis, muscle breakdown or even death after eating black licorice. Adverse reactions are most frequently seen in people over the age of 40 who are eating far more black licorice than the average person and in those consuming the product for prolonged periods of time. How does a flowering plant native to parts of Europe and Asia become deadly? Glycyrrhizin (also called glycyrrhizic acid) is the chemical in black licorice that gives the candy its signature flavor, and it can also lead to its toxic effects, Sullivan says. Glycyrrhizin mimics the hormone aldosterone, which is made when the body needs to retain sodium and excrete potassium. Sodium and potassium work together as a kind of cellular battery that drives communication between our nerves and the contraction of muscles. Too much glycyrrhizin upsets that communication, which can raise blood pressure and disturb the heart’s rhythm. Examination of the man who died from consuming too much licorice revealed that he had dangerously low levels of potassium, consistent with glycyrrhizin toxicity. Sullivan says because glycyrrhizin has the distinct licorice flavor and is 50 times sweeter than sugar, it’s used in other types of candy, soft drinks, tea, Belgian beers, throat lozenges and tobacco. This can make it challenging to keep track of how much glycyrrhizin you may have consumed, and a combination of these products could trigger adverse effects. Sullivan says people with certain preexisting conditions are more susceptible to black licorice overdose. But if you’re a fan of black licorice, there is no need to ban it from your pantry, he says. Eaten in small quantities from time to time, licorice poses no significant threat to otherwise healthy adults and children, as long as you monitor your intake.