(J Clin Hypertens (Greenwich). 2008;10:153-157) e xcessive dietary intake of liquorice can cause a syndrome mimicking hypermineralocorticoidism, characterized by hypertension, hypokalemia, alkalosis, low renin activity, and hypoaldosteronism.1-4 The active ingredient in liquorice, glycyrrhizin (glycyrrhizic acid, glycyrrhizinate, glycyrrhetinic acid), induces pseudohyperaldosteronism by inhibiting the 11b-hydroxysteroid dehydrogenase type 2 (11b-HsD2), which converts active glucocorticoid cortisol to locally inactive cortisone. 5 This inhibition results in activation of renal mineralocorticoid receptors by cortisol. The net effect of renal mineralocorticoid receptor activation is Na + reabsorption and K + excretion with transient hypernatremia, persistent hypokalemia, and metabolic alkalosis, leading to a phenotype similar to that of the syndrome of apparent mineralocorticoid excess. 4,6 We report the case of a patient with resistant hypertension and hypokalemia who had been consuming excessive quantities of liquorice daily for 4 years following smoking cessation. The significance of this case relates to the fact that liquorice is increasingly being used in herbal medicines and teas as a laxative and as a flavoring agent in candies, chewing gums, breath fresheners, and food products. Considering the growing use of liquorice and the potential adverse clinical effects, physicians are encouraged to obtain detailed dietary and drug histories when patients present with hypokalemia and hypertension.Case RepoRt a 55-year-old woman was referred to the hypertension clinic by her family doctor for uncontrolled resistant hypertension. she had been diagnosed with hypertension 2 years previously. Despite multiple antihypertensive drugs, her blood pressure remained elevated . at the time of presentation to the clinic, she was taking the maximal recommended doses of an angiotensin-converting enzyme (aCe) inhibitor (enalapril) and a calcium channel blocker (amlodipine) and 12.5 mg of a thiazide diuretic. risk factors for hypertension included a positive family history for cardiovascular disease and hypertension,

BackgroundObjective binge eating (OBE) is common among individuals with type 1 diabetes (T1D) and may have negative consequences for glycemic control. Recent studies have suggested that diabetes distress (i.e., emotional distress specific to diabetes and living with the burden of management) is a distinct emotional experience among individuals with diabetes. Preliminary studies have found diabetes distress is associated with eating disorder symptoms and poor glycemic control. The aim of the current study was to examine real-time emotional precursors and consequences of OBE in adults with T1D (i.e., general negative affect, specific emotional states and diabetes distress) using ecological momentary assessment methods. We also explore the impact of OBE on 2-h postprandial glycemic control relative to non-OBE eating episodes.MethodsAdults with T1D (N = 83) completed 3-days of ecological momentary assessment assessing mood and eating behavior using a telephone-based survey system. Participants were prompted to rate momentary affect, including level diabetes distress, at random intervals and reported on eating episodes. Participants also wore continuous glucose monitors allowing for ongoing assessment of glycemic control. Multi-level modeling was used to examine between- and within-person effects of momentary increases in emotions prior to eating on the likelihood of OBE and the impact of OBE on postprandial blood glucose. Generalized linear mixed models examined whether change in post-meal affect differed between OBE and non-OBE episodes.ResultsParticipants were predominately middle-aged (Mean = 42; SD = 12.43) Caucasian (87%) females (88%) reporting clinically significant eating disorder symptoms (76%). Nearly half of the sample (43%) reported OBE during the 3-day study period. The between-person effect for negative affect was significant (OR = 1.93, p < .05), indicating a 93% increased risk of OBE among individuals with higher negative affect compared to individuals with average negative affect. Between-person effects were also significant for guilt, frustration and diabetes distress (OR = 1.48–1.77, ps < .05). Analyses indicated that mean change in post-meal negative affect was significantly greater for OBE relative to non-OBE episodes (B = 0.44, p < .001). Blood glucose at 120 min postprandial was also higher for OBE than for non-OBE episodes (p = .03).ConclusionsFindings indicate that individuals who tend to experience negative affect and diabetes distress before eating are at increased risk of OBE at the upcoming meal. Results also suggest that engaging in binge eating may result in greater subsequent negative affect, including diabetes distress, and lead to elevated postprandial blood glucose levels. These findings add to a growing literature suggesting diabetes distress is related to eating disordered behaviors among individuals with T1D.

Findings suggest that insulin restriction may be less likely in the morning, and that late afternoon is a potentially important time for additional therapeutic support. Results also suggest that systematic clinical assessment and treatment of overnight eating might improve T1D management.

Background Eating disorders (EDs) among individuals with type 1 diabetes (T1D) increase the risk of early and severe diabetes-related medical complications and premature death. Conventional eating disorder (ED) treatments have been largely ineffective for T1D patients, indicating the need to tailor treatments to this patient population and the unique conditions under which ED symptoms emerge (in the context of a chronic illness with unrelenting demands to control blood glucose, diet and exercise). The current study was a pilot open trial of iACT, a novel intervention for EDs in T1D grounded in Acceptance and Commitment Therapy (ACT). iACT was based on the premise that ED symptoms emerge as individuals attempt to cope with T1D and related emotional distress. iACT taught acceptance and mindfulness as an alternative to maladaptive avoidance and control, and leveraged personal values to increase willingness to engage in T1D management, even when it was upsetting (e.g., after overeating). A tailored mobile application (“app”) was used in between sessions to facilitate the application of ACT skills in the moment that individuals are making decisions about their diabetes management. Methods Adults with T1D who met criteria for an ED completed 12 sessions of iACT (with three optional tapering sessions). In addition to examining whether treatment was acceptable and feasible (the primary aim of the study), the study also examined whether iACT was associated with increased psychological flexibility (i.e., the ability to have distressing thoughts/feelings about diabetes while pursuing personally meaningful values), and improvements in ED symptoms, diabetes management and diabetes distress. Results Treatment was acceptable to T1D patients with EDs and feasible to implement. Participants reported increased psychological flexibility with diabetes-related thoughts/feelings, and less obstruction and greater progress in pursuing personal values. There were large effects for change in ED symptoms, diabetes self-management and diabetes distress from baseline to end-of-treatment (Cohen’s d = .90–1.79). Hemoglobin A1c also improved, but the p-value did not reach statistical significance, p = .08. Conclusions Findings provide preliminary evidence for iACT to improve outcomes for T1D patients with EDs and support further evaluation of this approach in a controlled trial. Trial registration NCT02980627. Registered 8 July 2016.