Betel Nut

Scientific Name(S): Areca catechu L. Family: Palmaceae

Common Name(S): Betel nut, areca nut, pinlang, pinang

Betel nut , also known as Pinang or Areca nut , is the seed of the Betel Palm ( Areca catechu ). Betel nuts are often chewed for their intoxicating effects, which are caused by the relatively high levels of alkaloids in the seed. Chewing Betel nuts is an important and popular cultural activity in many Asian countries.

Botany: The areca tree is a feathery palm that grows to approximately 15 meters in height. It is cultivated in tropical India, Sri Lanka, south China, the East Indies, the Philippines and parts of Africa. The nut is about 2.5 cm in length and is very hard.

History: The chewing of betel nut quids dates to antiquity. Betel nut is used in India and the Far East as a mild stimulant and digestive aid. The quid is generally composed of a mixture of tobacco, powdered or sliced areca nut and slaked lime often obtained from powdered snail shells. This mixture is wrapped in the leaf of the "betel" vine (Piper betel L. Family: Piperaceae). Users may chew from 4 to 15 quids a day with each quid being chewed for about 15 minutes. Because of its CNS stimulating effects, betel nut is used in a manner similar to the Western use of tobacco or caffeine. Chewing the nut stimulates salivary flow, thereby aiding digestion. The leaves have been used externally as a counterirritant and internally as an antitussive.

Uses of Betel Nut

Many Asians chew betel nut, usually along with other components in a quid. Betel nut is a CNS and salivary stimulant. The leaves may act as an antitussive and topically as a counterirritant.

Side Effects of Betel Nut

Oral cancer and precancerous conditions are common among users, possibly due to other components of the quid. Betel may exacerbate asthma and bring other ill effects such as periodontitis.

Toxicology: As with chewing or smoking tobacco, the long-term use of betel nut is not without health consequences. Leukoplakia, which is considered to be a precancerous lesion, and squamous cell carcinoma of the oral mucosa have been found with unusually high frequency in long-term users of betel nut. Studies in New Guinea have also shown that chewing a betel nut-slaked lime mixture has been associated with oral leukoplakia that is precancerous in up to 10% of the cases. By contrast, in persons chewing betel nut alone, such lesions are infrequent.

Experimental evidence indicates that arecaidine and arecoline have the greatest carcinogenic potential. When tested by an in vitro cell transformation assay, both alkaloids gave a positive response, implicating both as suspected human carcinogens. Other compounds, in particular NMPA, are also highly active in decreasing mucosal cell viability, colony-forming efficiency and in causing DNA strand breaks and cross-links in buccal cells in vitro. These effects indicate that these compounds may contribute to the oral carcinogenicity associated with chewing betel nut quid.

To confirm the carcinogenic potential of the plant, mice were fed daily doses of aqueous extracts of betel nut or betel leaf, the polyphenolic fraction of the nut or distilled water. Aqueous extracts of the nut induced tumors of the gastrointestinal tract, liver and lung in 58% of the treated mice. The polyphenolic fraction induced tumors in 17% of the mice. The aqueous extract of betel leaf and the water control did not induce tumors. Other studies by the same investigators indicate that betel leaf extract exerts an antineoplastic effect in mice when injected simultaneously with betel nut extract.

The clinical implications of these animal data are poorly understood. The incidence of oral cancers increasesamong heavy long-term chewers of betel quids; whether this is due to the alkaloids or to the associated tannin (which accounts for 15% of the nut weight) or to carcinogens in the tobacco that is often added to the quid, is unknown. What "protective" value chewing betel leaf has is also unknown.

The results of one small study of Filipino betel chewers found that dietary supplementation with retinol (100,000 IU/week) and beta-carotene (300,000 IU/week) for 3 months was associated with a threefold decrease (from 4.2% to 1.4%) in the mean proportion of oral cells with nuclear alterations suggestive of precancerous lesions.

Arecaine is poisonous and affects respiration, heart rate, increases intestinal peristalsis and can cause tetanic convulsions. Although doses of the seed in the range of 8 to 10 g have been reported to be fatal, others have suggested that doses up to 30 g may have a low toxicity potential.

Betel nut chewing has been associated with an aggravation of asthma, and a dose-response relationship may exist between the use of this drug and the development of asthmatic symptoms.

Summary: Betel nut is used widely in many parts of the tropical world as a stimulant. In the United States, the nut is available through many Oriental grocery stores. Most chewers are middle- or older-aged women who spend several dollars per day on the product. Health professionals should suspect betel chewing as a cause of changes in the oral mucosa, particularly in persons of Asian descent, who may not readily discuss their use of the nut.

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