How Dangerous is the Betel Nut

A deep red or purple smile is a common sight in many parts of Asia and the Pacific. But what’s behind it?

In its most basic form, betel nut is a seed of the Areca catechu, a type of palm tree. It is commonly chewed after being ground up or sliced, then wrapped in leaves of the Piper betle vine coated with lime. This is known as a betel quid. Tobacco or flavorful spices may also be added.

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History of a Habit

Betel nut has a long history in South and Southeast Asia and the Pacific Basin. In Guam and other Pacific islands, its use can be traced back as far as 2,000 years. A habit passed down through generations, chewing betel nut is a time-honored custom for 10-20 percent of the world’s population. Today, the World Health Organization (WHO) estimates that around 600 million people use some form of betel nut. It is one of the most popular psychoactive substances in the world (fourth only after nicotine, alcohol, and caffeine). But while betel nut is an important cultural and social tradition in many countries, growing evidence points to serious health effects from regular use.

A Burst of Energy

Many people chew betel nut for the energy boost it produces. This is likely due to the nut’s natural alkaloids, which release adrenaline. It may also result in feelings of euphoria and well being.

Betel nut practices vary widely across regions, but some traditional beliefs hold that it may offer relief for a range of ailments, from dry mouth to digestive problems. However, the drug has not been well tested in clinical trials, and evidence of any health benefits is limited.

There is weak evidence to suggest that betel nut may reduce the risk of ulcerative colitis and aid in stroke recovery. Research has also investigated a link between the drug and reduced anemia during pregnancy, as well as lessening of schizophrenia symptoms. However, the evidence is not strong for these uses, and the risks of betel nut may outweigh any potential health benefits.

Oral Cancer and Other Dangers

Research has revealed some serious health risks of betel nut. The World Health Organization classifies betel nut as a carcinogen. Many studies have shown a convincing link between betel nut use and cancer of the mouth and esophagus. Betel nut users are also at a higher risk for oral submucuous fibrosis. This incurable condition can cause stiffness in the mouth and eventually the loss of jaw movement.

Other studies have found a strong connection between betel nut and an increased risk of cardiovascular disease, metabolic syndrome, and obesity. Regular chewing of betel nut can also cause gum irritation and tooth decay. Teeth may become permanently stained deep red or even black.  

Betel nut may interact with other drugs or herbal supplements, causing toxic reactions in the body or reducing the effects of medications. More testing is needed to determine just how betel nut affects other drugs. Regular betel nut use may also lead to dependency and withdrawal symptoms.

In the United States, the U.S. Food and Drug Administration (FDA) does not consider betel nut safe for chewing or eating. The FDA has an import alert on any products containing betel nut and may prevent travelers from bringing the substance into the country.

Raising Awareness

Health organizations and governments around the globe are taking steps to increase awareness of betel nut risks. Taiwan has declared an annual “Betel Nut Prevention Day.” City officials in Taipei now fine anyone seen spitting betel nut juice and require them to attend withdrawal classes. In 2012, the WHO released an action plan designed to reduce betel nut use in the Western Pacific. It calls for a combination of policy, public awareness campaigns, and community outreach to curb the practice.

With oral cancer rates on the rise worldwide, reducing risk factors is important for public health around the globe.