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Areca nuts wrapped in betel leaves, appearing as they are commonly prepared and
sold in Taiwan.
The areca nut is the seed of the areca palm (Areca catechu), which grows in much
of the tropical Pacific, Asia, and parts of east Africa. It is commonly referred
to as betel nut, as it is often chewed wrapped in betel leaves.
The International Agency for Research on Cancer has concluded that chewing areca
nut is carcinogenic to humans. It made this conclusion after reviewing the
published scientific studies related to health effects of chewing areca nut.
The areca nut is not a true nut, but rather a drupe. It is commercially
available in dried, cured and fresh forms. While fresh, the husk is green and
the nut inside is soft enough to be cut with a typical knife. In the ripe fruit,
the husk becomes yellow or orange and, as it dries, the fruit inside hardens to
a wood-like consistency. At that stage, the areca nut can only be sliced using a
special scissors-like cutter (known as aḍakattera in Telugu, adake kattari
in Kannada,bajjeai in Tulu, adakitta [अडकित्ता]
in Marathi, giraya in Sinhala, jaanti in Bengali, paakkuvetti in Malayalam and
Tamil, sarautaa in Hindi, and sudi in Gujarati).
Usually for chewing, a few slices of the nut are wrapped in a betel leaf along
with lime (not to be confused with the citrus fruit named lime) and may include
clove, cardamom, catechu (kattha) and/or other spices for extra flavouring.
Betel leaf has a fresh, peppery taste, but it can also be bitter to varying
degrees depending on the variety. The combination of areca nut with betel leaf
is called tamul (তামূল/ "তামোল")in
Assamese, kavala in Kannada, tambulam in Sanskrit, bajjai in Tulu, and paan in
Hindi, Marathi, Punjabi, and Urdu.
Areca nuts are chewed with betel leaf for their effects as a mild stimulant,
causing a warming sensation in the body and slightly heightened alertness,
although the effects vary from person to person. The effect of chewing betel
leaf and areca nut together is relatively mild, and could be compared to
drinking a cup of coffee.
The areca nut contains the tannins arecatannin and gallic acid; a fixed oil gum;
a little terpineol; lignin; various saline substances; and three main alkaloids
— arecoline, arecaidine and guvacine — which all have vasoconstricting
properties. The betel leaf chewed along with the nut contains eugenol, another
vasoconstrictor. Many chewers also add small pieces of tobacco leaf to the
mixture, thereby adding the effect of nicotine, which causes greater addiction
than the drugs contained in the nut and the betel leaf.
In almost all neutrality is disputed] parts of India, Sri Lanka and southern
China, areca nuts are not only chewed along with betel leaf, but are also used
in the preparation of Ayurvedic and traditional Chinese medicines. Powdered
areca nut is used as a constituent in some dentifrices. Other medicinal
uses include the removal of tapeworms and other intestinal parasites by
swallowing a few teaspoons of powdered areca nut, drunk as a decoction, or by
taking tablets containing the extracted alkaloids. Recently it is reported that
areca nut powder extract is capable of reducing silver ion to silver
nanoparticles which may be useful as antimicrobial agent.
Areca nut and betel leaf consumption in the world
Chewing the mixture of areca nut and betel leaf is a tradition, custom or ritual
which dates back thousands of years in much of the geographical areas from South
Asia eastward to the Pacific. It constitutes an important and popular cultural
activity in many Asian and Oceanic countries, including Pakistan, the Maldives,
India, Nepal, Sri Lanka, Bhutan, Bangladesh, Burma (Myanmar), China, Laos,
Thailand, Malaysia, Indonesia, Cambodia, Vietnam, Taiwan, the Philippines,
Palau, Yap, Guam, Papua New Guinea, the Solomon Islands, and Vanuatu. It is not
known how or when the areca nut and the betel leaf were first combined into one
psychoactive drug. Archaeological evidence from Thailand, Indonesia and the
Philippines suggests they have been used in tandem for at least 4000 years.
In Vietnam, the areca nut and the betel leaf are such important symbols of love
and marriage that in Vietnamese the phrase "matters of betel and
areca" (chuyện trầu cau) is synonymous with marriage. The
tradition of chewing areca nuts starts the talk between the groom's parents and
the bride's parents about the young couple's marriage. Therefore, the leaves and
juices are used ceremonially in Vietnamese weddings. The folk tale explaining
the origin of this Vietnamese tradition is a good illustration of the belief
that the combination of areca nut and the betel leaf is ideal to the point they
are practically inseparable, like an idealized married couple.
Display of the items usually included in a chewing session: The betel leaves are
folded in different ways according to the country and most have a little calcium
hydroxide daubed inside. Slices of the dry areca nut are on the upper left hand
and slices of the tender areca nut on the upper right. The pouch on the lower
right contains tobacco, a relatively recent introduction.
Malay culture and tradition hold betel nut and leaves in high esteem.
Traditionally, guests who visit a Malay house are presented with a tray of areca
nuts and betel leaves, in much the same way as drinks are offered to guests in
many cultures around the world. There is even a Malay proverb about the betel
nut, "bagaikan pinang dibelah dua", loosely translated, like a betel
nut divided in half. It usually refers to newlyweds, who are compatible to each
other, just like a betel nut when divided in half. The proverb is analogous to
the English "two peas in a pod".
In the Indian subcontinent, the chewing of betel and areca nut dates back to the
pre-Vedic period Harappan empire Formerly, in both India and Sri Lanka, it was a
custom of the royalty to chew areca nut with betel leaf. Kings had special
attendants whose duty it was to carry a box with all the necessary ingredients
for a good chewing session. There was also a custom for lovers to chew areca nut
and betel leaf together, because of its breath-freshening and relaxant
properties. A sexual symbolism thus became attached to the chewing of the nut
and the leaf. The areca nut represented the male principle, and the betel leaf
the female principle. Considered an auspicious ingredient in Hinduism and some
schools of Buddhism, the areca nut is still used along with betel leaf in
religious ceremonies, and also while honoring individuals in much of southern
In Assam, it is a tradition to offer pan-tamul (betel leaves and raw areca nut)
to guests, after tea or meals, served in a brass plate with stands called bota.
Among the Assamese, the areca nut also has a variety of uses during religious
and marriage ceremonies, where it has the role of a fertility symbol. A
tradition from Upper Assam is to invite guests to wedding receptions by offering
a few areca nuts with betel leaves. During Bihu, the husori players are offered
areca nuts and betel leaves by each household while their blessings are
Spanish mariner Álvaro de Mendaña reported observing Solomon Islanders chewing
the nut and the leaf with caustic lime, and the manner in which the habit
stained their mouths red. He noted the friendly and genial chief Malope, on
Santa Isabel Island, would offer him the combination as a token of friendship
every time they met.
Bhutan: In Bhutan areca nut is called doma. The raw areca nut, which is soft and
moist is very potent and when chewed can cause palpitation and vasoconstricting.
This form is eaten in the lower regions of Bhutan and in North Bengal, where the
nut is cut into half and put into a local paan leaf with a generous amount of
lime. In the rest of Bhutan the raw nut, with the husk on, is fermented such
that the husk rots and is easy to extract. The fermented doma has a putrid odour,
which can be smelled from miles. Traditionally, this fragrant nut is cut in half
and placed on top of a cone made of local betel leaf, which has a dash of lime
put into it. 'Myth has it that the inhabitants of Bhutan traditionally known as
Monyul, the land of Monpas where Buddhism did not reach lived on raw flesh,
drank blood and chewed bones. After the arrival of Guru Rinpoche in the 8th
century, he stopped the people from eating flesh and drinking blood and created
a substitute which is betel leaf, lime and areca nut. Today, chewing doma has
become a custom. Doma is served after meals, during rituals and ceremonies. It
is offered to friends and is chewed at work places by all sections of the
society and has become an essential part of Bhutanese life and culture.
The addition of tobacco leaf to the chewing mixture is a relatively recent
innovation, as tobacco was not introduced from the American continent until the
Effects on health
Areca nut vendor with red mouth from areca consumption preparing betel leaves
The International Agency for Research on Cancer (IARC) regards the chewing of
betel and areca nut to be a known human carcinogen. The media has reported that
regular chewers of betel leaf and areca nut have a higher risk of damaging their
gums and acquiring cancer of the mouth, pharynx, esophagus and stomach. Studies
have found tobacco and caustic lime increase the risk of cancer from areca nut
Studies have been conducted on the use of a "pure" paan preparation:
areca nut, betel leaf, and lime only. One study found that unprocessed areca
nuts, even at high doses, displayed only a very weak carcinogenicity, whereas
use of processed areca nuts, as commonly used in paan preparations, causes
cancer. Since 1971, many studies have showed areca nut extracts to cause cancer
in rodents. In 2003 the International Agency for Research on Cancer (IARC)
reached the conclusion that there is sufficient evidence that the habit of
chewing betel quid, with or without tobacco, is carcinogenic to humans. Support
for this conclusion is provided by a recent study which found that paan, even
without concurrent tobacco use, is a risk factor for oral cancer. The Merchant
et al. study further determined that paan, when consumed with and without
tobacco, increased oral cancer risk by 9.9 and 8.4 times, respectively, compared
to those who do not consume paan.
Chewing areca nut alone has been linked to oral submucosal fibrosis. According
to Medline Plus, "Long-term use [of betel-areca preparations] has been
associated with oral submucosal fibrosis (OSF), pre-cancerous oral lesions and
squamous cell carcinoma. Acute effects of betel chewing include asthma
exacerbation, hypertension, and tachycardia. There may additionally be a higher
risk of cancers of the liver, mouth, esophagus, stomach, prostate, cervix, and
lung with regular betel use. Other effects can include a possible effect on
blood sugar levels, which may in turn increase the risk of developing type 2
The use of areca nut paste to clean teeth is mentioned in fiction, notably in
James Joyce's Ulysses, set in 1904. However, the increase in mouth ulcers and
gum deterioration caused by chewing areca nut and betel may outweigh any
Use of areca nut has been associated with deterioration of psychosis in patients
with preexisting psychiatric disorders
According to traditional Ayurvedic medicine, chewing areca nut and betel leaf is
a good remedy against bad breath (halitosis).
In October, 2009, 30 scientists from 10 countries met at the International
Agency for Research on Cancer (IARC), a World Health Organization sponsored
group, to reassess the carcinogenicity of various agents including areca nut,
and mechanisms of carcinogenesis. They concluded there is sufficient evidence
that areca nut, with or without tobacco, can cause cancer.[
Effects of chewing areca nut during pregnancy
Scientific teams from Taiwan, Malaysia and Papua New Guinea have reported that
expectant mothers who chew paan (and/or other areca nut and betel leaf
formulations) during pregnancy significantly increase adverse outcomes for the
baby. The effects were similar to those reported for mothers who consume alcohol
or tobacco during pregnancy. Incidences of lower birth weight, reduced birth
length and early term were found to be significantly higher.
In India (the largest consumer of areca nut) and Pakistan, the preparation of
nut with or without betel leaf is commonly referred to as paan. It is available
practically everywhere and is sold in ready-to-chew pouches called pan masala or
supari, as a mixture of many flavours whose primary base is areca nut crushed
into small pieces. Pan masala with a small quantity of tobacco is called gutka.
The easily discarded, small plastic supari or gutka pouches are a ubiquitous
pollutant of the South Asian environment. Some of the liquid in the mouth is
usually disposed of by spitting, producing bright red spots wherever the
expectorate lands. The Shimoga District in Karnataka is presently the largest
producer of betel nut in India.
In the Maldives, areca nut chewing is very popular, but spitting is frowned upon
and regarded as an unrefined, gross way of chewing. Usually, people prefer to
chew thin slices of the dry nut, which is sometimes roasted. Kili, a mixture of
areca nut, betel, cloves, cardamom and sugar is sold in small home-made paper
pouches. Old people who have lost their teeth keep "chewing" by
pounding the mixture of areca nut and betel with a small mortar and pestle.
In Papua New Guinea and the Solomon Islands, fresh areca nut, betel leaf or
'fruit leaf' (daka in PNG) and lime are sold on street corners. In these
countries, dried or flavoured areca nut is not popular. Areca nut chewing has
recently been introduced into Vanuatu, where it is growing in popularity,
especially in the northern islands of the country. In Guam and the neighboring
Northern Mariana Islands, betel and areca nut chewing is a social pastime as a
means to extend friendship, and can be found in many, if not most, large
gatherings as part of the food display.
In Palau, betel nut is chewed with lime, piper leaf and nowadays, with the
addition of tobacco. Older and younger generations alike enjoy the use of betel
nut, which is readily available at stores and markets. Unlike in Papua New
Guinea and the Solomon Islands, where the inner areca nut is used, in Palau, the
areca nut's skin is chewed along with lime, leaf and tobacco and the juice is
not swallowed but spat out.
In Taiwan, bags of 20 to 40 areca nuts are purchased fresh daily by a large
number of consumers. To meet the steady year-round demand, Two kinds of
betel-nut shops sell betel and nuts, as well as cigarettes and drinks, including
beer: Small mom and pop shops, often poorly maintained and often do not stand
out from other stores nearby, and shops which often consists of nothing more
than a single, free-standing room, or booth. The latter is usually elevated one
meter above the street, and measures less than 3 by 2 m. Large picture windows
comprise two or more of the walls, allowing those who pass by a complete view of
the interior. The interior is often painted brightly. Within such a shop, a
sexily dressed young woman, a "betel nut beauty, can be seen preparing
betel and areca nuts. Shops are often identified by multicoloured (commonly
green) fluorescent tubes or neon lights that frame the windows or that are
arranged radially above a store. Customers stop on the side of the road and wait
for the girls to bring their betel and areca nut to their vehicles. The habit of
chewing betel nut is often associated with blue-collar labor industries such a
long-haul transportation, construction, or fishing. Workers in these
labor-intensive industries use betel nut for its stimulating effect, but it also
becomes a tool for socializing with coworkers. For example, studies have shown
chewing betel nut is prevalent among taxi, bus and truck drivers, who rely on
the stimulating effect of betel nut to cope with long work hours. For these
reasons, oral cancer has been identified as a leading cause of death in
professions with high betel nut-chewing rates.
In Hainan and Hunan Province, China, where Xiangtan is a center of use and
processing, a wide range of old and young people consume areca nut daily. Most,
though, consume the dried variety of the nut by itself, without the betel
leaves. Some people also consume the areca nut in its raw, fresh form with or
without the betel leaves. Betel nuts are sold mostly by old women walking around
trying to sell it, but the dried version can be found in most shops which sell
tea, alcohol and cigarettes.
In Thailand, the consumption of areca nut has declined gradually in the last
decades. The younger generation rarely chews the substance, especially in the
cities. Most of the present-day consumption is confined to older generations,
mostly people above 50. Even so, small trays of betel leaves and sliced tender
arecanut are sold in markets and used as offerings in Buddhist shrines.
In the Philippines, chewing the areca nut and betel leaf was a very widespread
tradition in the past. Now, though, this tradition is almost dead among the
urban people in the cities and big towns, and has largely been replaced by
chewing gum and cigarettes. Nowadays, older people are the only ones chewing
betel nuts. But in rural areas, betel nut-chewing is very much alive.
In the United States, areca nut is not a controlled or specially taxed substance
and may be found in some Asian grocery stores. However, importation of areca nut
in a form other than whole or carved kernels of nuts can be stopped at the
discretion of US Customs officers on the grounds of food, agricultural, or
medicinal drug violations. Such actions by Customs are very rare. In the United
Kingdom, areca nut is readily available in Asian grocery stores and even in
shredded forms from the World Food aisles of larger Tesco supermarkets.
Possession of betel nut or leaf is banned in the UAE and is a punishable