Betel Nut health benefit and risk of chewing, side effects by Ray Sahelian, M.D.
Information on chewing areta catechu
Betel nut side effects can occur with daily use for several years

April 12 2014

Betel nut (areca catechu) is a psychoactive drug of the Asian continent, popular in the South Pacific islands, Southeast Asia, Pakistan, and Bangladesh. It is chewed in New Zealand and Australia by immigrants from India now dwelling in these countries. Betel nut has been used extensively since antiquity. People chew it for stress reduction, feelings of well-being, and heightened awareness. It contains three major alkaloids: arecoline, pilocarpine, and muscarine. Betel nut chewing is associated with increased risk of cardiovascular disease.

Risk of betel nut chewing
This nut is chewed regularly by at least 10% of the world population, imported by immigrant users wherever they settle, and is the fourth most widely used addictive substance. It is thought, by users, to soothe the digestion and to be a stimulant and its use has a major role in social situations. Specific arecal alkaloids act as competitive inhibitors of GABA receptors and have widespread effects in the body, including actions on the brain, cardiovascular system, lungs, gut and pancreas. Nitrosated derivatives of arecal alkaloids, proven carcinogens inducing tumors throughout the upper gut and foregut derivatives in animals, are also associated with increased tumor risks in man. Increased central obesity is found in association with betel usage in man as well as increases in circulating markers of inflammatory and cardiovascular damage. The effects of chronic betel usage in man are at least as diverse as those of smoking and the habit increases the risks of ill health.

Betel Nut and Oral Cancer
Betel quid chewing is a strong independent risk factor for pharyngeal cancer (cancer of the back of the throat), but not laryngeal cancer (cancer of the voice box), according to findings published in the International Journal of Cancer. Chewing betel quid, which consists of betel leaf from the Piper betle vine, is popular in many parts of Asia. Betel quid is chewed for its stimulant effects, to satisfy hunger and as a social and cultural practice.
  
For centuries, billions of people across Asia, from Pakistan to Palau, have chewed the spicy date-like fruit of the betel palm for a quick buzz. However, a World Health Organization study has found that chewing betel nuts can cause oral cancer and that the rate of these malignant mouth tumors was highest in Asia where the betel nut is a widely used stimulant. Betel nut, which contains an addictive stimulant similar to nicotine, is widely used in parts of Southeast Asia, India, Pakistan and the South Pacific as a breath freshener, a hunger antidote, a substitute for cigarettes and as a way to get high. Users often chew it all day long, causing all sorts of unpleasant side-effects such as red-stained teeth and pavements covered with red spittle as many users spit out the betel nut's remnants as they chew.

Breast cancer
Mutat Res. 2010. Betel quid chewing as an environmental risk factor for breast cancer. Institute of Pathology, ICMR, Safdarjung Hospital Campus, New Delhi, India. Northeast region of India shows high incidence of tobacco-related cancer with widespread consumption of betel quid and tobacco in different forms. Our study suggests betel quid chewing as a significant risk factor for developing breast cancer.

Betel Nut side effects
Excessive use leads to palpitations, warm sensation, increased pulse rate, sweating, . Prolonged use for many years may increase the risk for oral cancers. The regular use of betel will, in time, stain the mucosa, gums, and teeth. Betel nut is not recommended for those with heart conditions.

Betel Nut chewing and transgenerational effect, effect on offspring
Exposure to paternal betel quid chewing increases the risk of early manifestation of metabolic syndrome x in human offspring in a dose-dependent manner.

I live in a community that has a large Karen population I work in an OB/GYN office and we are finding that they are chewing the Betel Nut. We are wondering if you have any information regarding its effects of on an unborn child. And do you have any experience on miscarriage and any testing that can be done on a patient do determine the blood levels in their system.
   Here are two recent studies which show conflicting results, therefore I do not have a good answer at this time.
   Reprod Toxicol. 2012. Tobacco and areca nut chewing- Reproductive impairments: An overview. Division of Reproductive and Cyto-toxicology, National Institute of Occupational Health, (ICMR), Ahmedabad, India. The existing studies suggest that tobacco and areca nut chewing alone, together or with other ingredients had reproductive toxic potential. Pregnant women using smokeless tobacco during pregnancy also had adverse effect on pregnancy and its outcome. Thus pregnant women must avoid consumption of any mixture containing areca nut and tobacco in order to protect the pregnancy and outcome.
   Int Health. 2012 Is areca innocent? The effect of areca (betel) nut chewing in a population of pregnant women on the Thai-Myanmar border. Shoklo Malaria Research Unit, Thailand ; Faculty of Tropical Medicine, Mahidol Universit, Bangkok Thailand ;  Eight manuscripts have specifically examined the effects of areca (betel) nut use in pregnant women, seven of which have documented adverse effects on birth weight, newborn neurological status, gender ratio and pregnancy outcomes such as anaemia and miscarriage following areca nut use during pregnancy. A retrospective cohort analysis of migrant and refugee pregnant women attending antenatal clinics along the Thai-Myanmar border was conducted to examine the adverse effects of areca nut use routinely recorded on enrolment. Adverse pregnancy effects were not observed in areca nut users compared with non-users. Smoking, but not areca nut use, had a dose-related effect on miscarriage. Areca nut use in conjunction with smoking reduced the adverse effects of smoking on birth weight, further supporting a lack of effect of areca nut. Areca (betel) nut-related adverse pregnancy outcomes were not observed in this population, whereas smoking was clearly harmful.

Heart disease
Betel-quid chewing is a contributory cause of metabolic syndrome in humans, which implies a greater likelihood of developing cardiovascular disease among those with the betel habit. Betel quid ( Areca catechu ) is used by close to 10% of the world's population. Betel quid use is associated with the metabolic syndrome, a risk factor for heart disease. At least one study has shown that Betel-quid use is independently associated with heart disease. American Journal of Clinical Nutrition, Vol. 85, No. 5, 1229-1235, May 2007.

Compounds in Betel nut and their physiological effects
Betel nut is chewed regularly by at least 10% of the world population, imported by immigrant users wherever they settle, and is one of the top most widely used addictive substance. It is thought to soothe the digestion and to be a stimulant and its use has a major role in social situations. Specific arecal alkaloids act as competitive inhibitors of GABA receptors and have widespread effects in the body, including actions on the brain, cardiovascular system, lungs, gut and pancreas. Nitrosated derivatives of arecal alkaloids, proven carcinogens inducing tumours throughout the upper gut and foregut derivatives in animals, are also associated with increased tumour risks in man. Increased central obesity is found in association with betel usage in man as well as increases in circulating markers of inflammatory and cardiovascular damage. The effects of chronic betel usage in man are at least as diverse as those of smoking and the habit increases the risks of ill health. Betel nut contains three major alkaloids: arecoline, pilocarpine, and muscarine.

Betel Nut research, how it works
There's a link between increased betel nut quid nut production and consumption and a substantial rise in the incidence of head and neck cancers among Taiwanese men, says a National Taiwan University Hospital study.

Presence of cholinomimetic and acetylcholinesterase inhibitory constituents in betel nut.
 Life Sci. 2004.
We report the presence of cholinomimetic and acetylcholinesterase (AChE) inhibitory constituents in betel nut, the most commonly used drug in the world after tobacco, ethanol and caffeine. The study provides first evidence for the presence of AChE inhibitory constituents in betel nut, though additional direct muscarinic stimulatory effect cannot be ruled out and this study provides sound scientific basis for some of the folkloric uses associated with betel nut chewing.

Cerebral hemodynamic responses to betel nut chewing: a Doppler study.
Clin Neuropharmacol. 2002.
We sought to evaluate cerebral hemodynamic responses to betel nut chewing. Thirty healthy male volunteers, ten new betel nut chewers, ten occasional chewers, and ten chronic betel nut chewers were included in this study. We used carotid duplex sonography and transcranial Doppler to measure the flow velocities and flow volume (FV) of the common carotid (CCA), internal carotid (ICA), external carotid (ECA) arteries, and the flow velocity of middle cerebral artery (MCA). Blood pressure (BP) and heart rate (HR) were recorded simultaneously. All subjects were asked to chew fruit-flavored chewing gum for 10 minutes. Blood flows of the above vessels were measured four times at baseline and at the 2nd, 6th, and 12th minute after chewing. A repeated study was followed in the same subject but substituted with betel nut. Chronic chewers had delayed onset time and shortened vanishing time of facial-flushing sensation. Systolic and diastolic BPs were mildly elevated during gum chewing, whereas diastolic BP was dropped during betel nut chewing. Heart rate increased prominently during betel nut chewing, especially in new and occasional chewers. The peak systolic, end diastolic velocities, and FV in ECA and CCA increased significantly during betel nut chewing. The blood flows in the ICA and MCA had no significant changes during gum or betel chewing. Betel nut chewing has a central sympathetic effect resulting in accelerated HR, increased blood flows in ECA and CCA, but has a peripheral cholinergic effect resulting in a drop of diastolic BP. Intracranial cerebral hemodynamics is not affected during betel nut chewing. The inotropic and chronotropic effect to the heart from betel nut chewing is probably an unfavorable risk for patients with ischemic heart disease. betel nut beauty betel nut.

Appetite suppression
Areca nut, energy metabolism and hunger in Asian men.
Ann Hum Biol. 2003.
The nut of the Areca catechu palm has long been attributed effects on hunger and the digestive process. The objectives were to assess experimentally effects of areca nut (betel nut) on fasting and postprandial energy metabolism, substrate utilization and hunger. Two randomized, placebo-controlled, double-blind studies were undertaken. In study 1, eight Indian men received bioadhesive gels delivering arecoline to the buccal sulcus after an overnight fast. In study 2, 15 Indian men received gels delivering arecoline after consuming a 2.5 MJ meal, and the same protocol was then applied as in study 1. Carbohydrate (CHO) utilization rates rose after areca nut compared to placebo. Hunger varied across doses, being lowest after 10 mg and highest after 20 mg, and was influenced by interaction of dose with delta resting energy expenditure. In study 2, areca dose interacted with fat-free massto lower by 5.4 the thermic effect of a meal, and retarded peak 'digestive-phase' thermogenesis by 60 min. Postprandial delta CHO utilization was greater, and hunger was lower, after betel nut. The betel nut altered relationships of hunger to thermic effects of the meal, and to delta substrate utilization, in ways consistent with appetite suppression. Betel nut constituents modulate metabolic signals regulating appetite in man.

Betel nut inquiries
I am discussing the issue of 'tobacco control in India' with my friends. In this context, we wish to shed some light on the specific effect of 'paan chewing' or betel leaf chewing. Does the paan leaf per se have any direct adverse health effect, or is it only what is put inside a betel leaf that affects health?
     Sorry but this is not an area I have studied in detail.

Bettle nut is a popular nut to chew here in Micronesia. It seems to cause a lot of side effects including oral diseases. Can we receive permission from you to publish in our quarter The News and Updates one of your article on side effect on Bettle Nut Chewing (mouth, heart, etc.) We would greatly appreciate your favorable response. Nena S. Nena Administrator MiCare Health Insurance Plan.
    Yes, that would be fine as long as you list the source.

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