Betel Nut
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Origins
Ranked fourth most widely addictive substances, Betel nut is used around the world.3 Betel nut is also widely known as Areca nut, which can be found in processed or unprocessed form. Processed betel nut comes in two form which are called Gutkha and Plain Pan Marsala. Gutkha means that the betel nut is accompanied by tobacco whereas Plain Pan Masala is the term used to describe betel nut without tobacco 5 The use of betel nut is known to be indigenous to India, Maldives, numerous islands in the South Pacific, SriLanka, Myanmar, Bangladesh, and Taiwan. Betel nut can be found abundantly in parts of Thailand, Malaysia, Laos, Cambodia, Indonesia, Philippines, Vietnam, China and throughout migrant communities originating from these countries. In South Asian as well as East Asia, areca nut is strongly related with local folklore, arts and crafts, social customs, cultural rituals and religious practices.6 When betel nut is in ripe form, its color is an orange-yellow shade while the seed is separate from the fibrous pericarp.
Pharmacology
Betel nuts are nuts that come from a palm tree that ranges in height from 40-100 feet called Areca Catechu.1 Areca nuts and betel nuts are terms that are used interchangeably. Betel nut is made up of nine alkaloids. Out of the nine alkaloids, arecoline is said to be the most abundant. Arecoline, a muscarinic agonist, crosses the blood- brain barrier which causes different parasympathetic effects to be induced.2
Epidemiology
Approximately 600 million people in the world use betel nut as a masticatory substance. Betel nuts are chewed in some form by an estimated 10-20% worldwide. It has been documented that researchers often face challenges when trying to record the prevalence of betel nut use. This is because betel nut is often used with other substances, such as tobacco, making it harder to gather accurate information in terms of prevalence. Therefore it is also difficult to record the frequency of betel nut usage among populations.6 In Taiwan, chewing betel quid (a form of betel nut which is oftentimes accompanied by tobacco or other substances such as slaked lime) has been viewed as a habit predominant among males. Within the residents of Kaohsiung, Taiwan the prevalence rates between women and men are 1.4% to 28.3%.6
Street Names
areca nut, supari, puwak, gua, mak, pinang, and daka.6
Typical Use
There are several different ways betel nut can be prepared. In South Asian, some people chew dried, fresh, or betel nuts that have been cured alone with slaked lime, tobacco leaves, and betel leaf.3 Betel nut can be prepared by baking, boiling, or roasting it.6
Effects
Harm
Betel nut chewing is not only said to be linked to the development of esophageal and oral cancer, but is also said to be linked to liver cirrhosis, hepatocellular carcinoma, obesity, hypertension, type 2 diabetes, chronic kidney disease, hyperlipidemia, and metabolic syndrome.3 It has been shown that habitual betel nut chewing can increase the chances of oral cavity cancer. This is because chronic chewing induces a pathological epidermal change within the mouth.4 In addition, the usage of betel nut by pregnant women can result in reproductive health effects. It also can result in the infant to have a smaller body weight and size.1 It has been found that the chewing of betel quid can be positively linked with oral lesions. The oral lesions that result can also have potential to have a malignant transformation.5 Studies have shown that the use of betel nut can also cause heart disease and asthma.5
Prevention Strategies
Consumption Measures
Addiction Screening Measures
References
1 Asotra, K (2008,April). Health Hazards of Chewing Areca Nut, Betel Quid, and Guthka. Burning Issues, 10, Retrieved 6/17/08, from http://www.trdrp.org/burningIssues/408/408newslttr.pdf
2 Sullivan, R, Allen, J, Otto, C, Tiobech, J, & Nero, K. Effects of chewing betel nut (areca catechu) on the symptoms of people with schizophrenia in Paulau, Micronesia. British Journal of Psychiatry 2000; 177:174-176.
3 Lin, W, Chiu, T, Lee, L, Lin, C, Huang, C, & Huang, K. Betel nut chewing is associated with increased risk of cardiovascular disease and all-cause mortality in Taiwanese men. American Journal of Clinical Nutrition 2008;87:1204-1211.
4 Lin, Y, Jen, Y, Wang, B, Lee, J, & Kang, B (2005). Epidemiology of Oral Cavity Cancer in Taiwan with Emphasis on the Role of Betel nut chewing. ORL 2005;67:230-236.
5 Rajan, G, Ramesh, S, & Sankaralingam, S. Areca Nut use in rural Tamil Nadu: A growing threat. Indian Journal of Medical sciences 2007;61:332-337.
6 Gupta, P & Warnakulasuriya, S. Global Epidemiology of areca nut usage. Addiction Biology 2002;7:77-83.
