Nowadays, steroids can be found everywhere: there is a multitude of steroids having a myriad of uses. For example, there are anabolic steroids which we see bodybuilders inject, mimicking the testosterone hormone to help with muscle growth and body mass. Moreover, steroids also have medical uses and can be used to treat illnesses such as hives, asthma and eczema. However, if used inappropriately, anabolic steroids can cause severe, long-lasting, and in some cases, irreversible damage. They can lead to early heart attacks, strokes, liver tumors, kidney failure, and psychiatric problems [1].
This concern regarding steroids initially arose, due to companies adding steroids in their products to help boost its efficacy, which are then imported across the world. However, everything that is imported into Singapore is strictly monitored under the Health Sciences Authority (HSA).
If Chinese Proprietary Medicine is strictly regulated in Singapore, do TCM herbs contain steroids?
Let’s take 甘草 as an example. Also known as Radix Glycyrrhizae or Licorice, it is a herb that can be commonly found in many TCM formulas. It commonly exists in two forms: unprepared licorice root (生甘草) which is more cooling and has the ability to clear heat and detoxify; and processed licorice root (炙甘草) which is warmer than its unprepared form, and is able to alleviate pain, tonify the Spleen, augments Qi and nourishes the Heart. These two herbs also have the ability to moderate and harmonize the properties of other herbs.
Moreover, the Chinese name of Licorice Root, 甘草, when directly translated, means sweet grass! And as the name suggests, licorice is sweet, in fact 50x sweeter than sucrose (table sugar) as it contains glycyrrhizin, allowing it to be commonly used in cooking as a popular flavoring agent[2].
Why is there a correlation between steroids and licorice?
It comes about as licorice contains glycyrrhizin[3], which has a similar chemical structure and function to steroids; increasing the production of cortisol, a natural steroid hormone.
Consuming large amounts of licorice root or taking licorice root supplements for an extended period of time can lead to an accumulation of glycyrrhizin and hence cortisol in the body. This causes a condition called pseudoaldosteronism. ‘Pseudo’ means ‘fake’ or 'mimics', and ‘aldosteronism’ means elevated levels of aldosterone (a type of steroids) in the body. This condition, as the name suggests, mimics the actions of steroids, where symptoms such as high blood pressure, low potassium levels, and fluid retention may occur.
However, under the right amounts, glycyrrhizin has shown to contain hepatoprotectivity properties, possibly being beneficial to the treatment of alcoholic liver diseases:
glycyrrhizin has a low bioavailability (the proportion of a drug or other substance which enters the circulation when introduced into the body and so is able to have an active effect) and minimal side effects. These have further benefits on the increase in uptake of nanoparticles when paired with licorice glycyrrhizin under conditions of long-term alcohol uptake [4].
licorice may help alleviate chronic alcohol-induced fatty liver injury due to licorice’s anti-inflammatory activity and enhancement of its antioxidant defense [4].
licorice is commonly used as a cure for digestive disorder and detoxification agent, having a possible hepatoprotective effect in inhibiting translocation of Bad (BH3 domain-containing protein) to the mitochondria based on animal studies [5].
To sum up, what are the similarities and differences between glycyrrhizin in licorice and steroids?
| Glycyrrhizin | Steroids |
Mechanism of action | Anti-inflammatory, anti-oxidant, anti-viral, immunomodulatory [5,6] | Anti-inflammatory, immunosuppressive, hormone-like effects [7] |
Targeted pathways | Inhibits inflammation (Inhibit corticosteroids), oxidative stress, viral replication | Modulate immune response and inflammation |
Side effects | Consumption in high dosages and or long durations result in hypertension, edema, electrolyte imbalance Hypertension and hypokalemia-induced secondary disorders | Various effects depending on the type of steroid. (ie. Hormonal imbalance, Weight gain, Mood swings, Immune system suppression) |
Medical uses | Used mainly in traditional medicine for its various benefits. Studied heavily for its potential health benefits Ie. Inhibit corticosteroids, relieve menopausal symptoms and infertility | In Western practice, it is widely used for its ability in helping asthmatics, people suffering from autoimmune disorders, inflammatory diseases and hormone replacement therapy [8] |
Regulation | Generally considered safe for consumption in appropriate dosage, but should only be consumed under professional guidance and with caution | Regulated substance requiring prescription for most cases |
Natural VS Synthetic | Derived naturally from Licorice roots | Synthesised chemically from laboratories |
In conclusion, is licorice root (甘草) safe to use?
Yes, it is. Although it may contain compounds and have effects which are close to their steroid counterparts, they do not contain steroids. Moreover, it is commonly used and is present in a multitude of TCM formulas. At the right amounts, this coupled with the beneficial effects aforementioned, it is a safe herb to use with its benefits. However, all of this has to be done with the supervision of a medically trained physician. After all, licorice is a medical herb, and just like any other medication, it is advisable not to self-medicate, but only do so under the instruction of a licensed physician. Should you have any doubts with regards to licorice or any questions for that matter, feel free to approach any medically licensed physician.
References:
[1] Bonetti, Antonio, et al. "Side effects of anabolic androgenic steroids abuse." International journal of sports medicine (2007): 679-687.
[2] Namozov, O. M. (2018). Glycyrrhizic acid and its production. Karakalpak Scientific Journal, 2(2), 29-33.
[3] Lauren, D. R., Jensen, D. J., Douglas, J. A., & Follett, J. M. (2001). Efficient method for determining the glycyrrhizin content of fresh and dried roots, and root extracts, of Glycyrrhiza species. Phytochemical Analysis: An International Journal of Plant Chemical and Biochemical Techniques, 12(5), 332-335.
[4] Kleiner, D., Hegyi, G., Urbanics, R., Dézsi, L., Robotka, H., Fehér, E., ... & Blázovics, A. (2016). Hepatoprotective liposomal glycyrrhizin in alcoholic liver injury. European journal of integrative medicine, 8, 23-28.
[5] Lee, J. R., Park, S. J., Lee, H. S., Jee, S. Y., Seo, J., Kwon, Y. K., ... & Kim, S. C. (2009). Hepatoprotective activity of licorice water extract against Cadmium-induced toxicity in rats. Evidence-Based Complementary and Alternative Medicine, 6(2), 195-201.
[5] Ming, L. J., & Yin, A. C. Y. (2013). Therapeutic effects of glycyrrhizic acid. Natural product communications, 8(3), 1934578X1300800335.
[6] Li, X. L., Zhou, A. G., Zhang, L., & Chen, W. J. (2011). Antioxidant status and immune activity of glycyrrhizin in allergic rhinitis mice. International journal of molecular sciences, 12(2), 905-916.
[7] Edelman, I. S. "Mechanism of action of steroid hormones." Journal of steroid biochemistry 6.3-4 (1975): 147-159.
[8] Deakin, M. J. "Current dangers and problems in the topical use of steroids." Medical Journal of Australia 1.5 (1976): 120-121.
Author: Edwin Chia, John Chiang & Chester Ng
Animation: Physician Eunice Aw
Chong Hoe Healthcare
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