Betel nut chewing

"Paan" redirects here. For the city in Myanmar, see Pa-an.

Ghiyas al-Din eats a betel chew, illustration from the Nimatnama-i-Nasiruddin-Shahi. Malwa, c. 1500. British Library
The items used in a chewing session. The betel leaves are folded. Slices of the dry areca nut are on the upper left. Slices of the tender areca nut are on the upper right. The pouch on the right has tobacco, an optional element. On the lower right, there are dried cloves.
Betel leaves at a market in Mandalay, Burma
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Betel nut chewing, also called betel quid chewing or areca nut chewing, is a practice in which areca nuts (also called "betel nuts") are chewed together with slaked lime and betel leaves for their stimulant and narcotic effects, the primary psychoactive compound being arecoline. The practice is widespread in Southeast Asia, Micronesia, Island Melanesia, and South Asia. It is also found among both Han Chinese immigrants and indigenous peoples of Taiwan, Madagascar, and parts of southern China. It was introduced to the Caribbean in colonial times.[1][2]

The preparation combining the areca nut, slaked lime, and betel (Piper betle) leaves is known as a betel quid (also called paan or pan in South Asia), but the exact composition of the mixture varies geographically.[3] It can sometimes include other substances for flavoring and to freshen the breath, like coconut, dates, sugar, menthol, saffron, cloves, aniseed, cardamom, and many others. The areca nut can be replaced with tobacco or the two chewed together, and the betel leaves can be excluded. In West Papua, the leaf may be replaced with stem and inflorescence of the Piper betle plant.[4] The preparation is not swallowed but is spat out after chewing. Chewing results in permanent red stains on the teeth after prolonged use. The spit from chewing betel nuts, which also results in red stains, is often regarded as unhygienic and an eyesore in public facilities in certain countries.[1][5][6]

Betel nut chewing is addictive and causes adverse health effects, mainly oral and esophageal cancers, and cardiovascular disease.[6][1] When chewed with additional tobacco in its preparation (like in gutka), there is an even higher risk, especially for oral and oropharyngeal cancers.[7] With tobacco it also raises the risk of fatal coronary artery disease, fatal stroke,[8][9] and adverse reproductive effects including stillbirth, premature birth and low birth weight.[10]

The practice of betel nut chewing originates from Southeast Asia where the plant ingredients are native. The oldest evidence of betel nut chewing is found in a burial pit in the Duyong Cave site of the Philippines, an area where areca palms were native, dated to around 4,630±250 BP. Its diffusion is closely tied to the Neolithic expansion of the Austronesian peoples. It was spread to the Indo-Pacific during prehistoric times, reaching Micronesia at 3,500 to 3,000 BP, Near Oceania at 3,400 to 3,000 BP; South India and Sri Lanka by 3,500 BP; Mainland Southeast Asia by 3,000 to 2,500 BP; Northern India by 1500 BP; and Madagascar by 600 BP. From India it spread westwards to Persia and the Mediterranean. It was present in the Lapita culture, based on archaeological remains dated from 3,600 to 2,500 BP, but it was not carried into Polynesia.[11]

  1. ^ a b c IARC Working Group. Betel-quid and areca-nut chewing and some areca-nut-derived Nitrosamines (PDF). The World Health Organization. ISBN 9789283215851. Archived (PDF) from the original on 29 March 2018. Retrieved 13 October 2011.
  2. ^ Song, Han; Wan, Yi; Xu, Yong-Yong (2013). "Betel Quid Chewing Without Tobacco – A Meta-analysis of Carcinogenic and Precarcinogenic Effects". Asia-Pac J Public Health. 27 (2): NP47–NP57. doi:10.1177/1010539513486921. PMID 23666841. S2CID 21395319.
  3. ^ Cirillo, Nicola; Duong, Peter Hung; Er, Wee Teng; Do, Casey Thao Nhi; De Silva, Manikkuwadura Eranda Harshan; Dong, Yining; Cheong, Sok Ching; Sari, Elizabeth Fitriana; McCullough, Michael J.; Zhang, Pangzhen; Prime, Stephen S. (2 May 2022). "Are There Betel Quid Mixtures Less Harmful than Others? A Scoping Review of the Association between Different Betel Quid Ingredients and the Risk of Oral Submucous Fibrosis". Biomolecules. 12 (5): 664. doi:10.3390/biom12050664. ISSN 2218-273X. PMC 9138976. PMID 35625592.
  4. ^ Sari, Elizabeth Fitriana; Prayogo, Grace Puspita; Loo, Yit Tao; Zhang, Pangzhen; McCullough, Michael John; Cirillo, Nicola (1 October 2020). "Distinct phenolic, alkaloid and antioxidant profile in betel quids from four regions of Indonesia". Scientific Reports. 10 (1): 16254. doi:10.1038/s41598-020-73337-0. ISSN 2045-2322. PMC 7529777. PMID 33004929.
  5. ^ Price, Blair (2012). "Betel nut: underground economies" Archived 22 October 2016 at the Wayback Machine. PNGIndustryNews.net.
  6. ^ a b Risks of Betel Quid & Tobacco Use (PDF). Public Health Law Center, Tobacco Control Legal Consortium. July 2017. Archived (PDF) from the original on 9 May 2022. Retrieved 28 April 2022.
  7. ^ Gormley, Mark; Creaney, Grant; Schache, Andrew; Ingarfield, Kate; Conway, David I. (11 November 2022). "Reviewing the epidemiology of head and neck cancer: definitions, trends and risk factors". British Dental Journal. 233 (9): 780–786. doi:10.1038/s41415-022-5166-x. ISSN 0007-0610. PMC 9652141. PMID 36369568.
  8. ^ Vidyasagaran, A. L.; Siddiqi, K.; Kanaan, M. (2016). "Use of smokeless tobacco and risk of cardiovascular disease: A systematic review and meta-analysis" (PDF). European Journal of Preventive Cardiology. 23 (18): 1970–1981. doi:10.1177/2047487316654026. ISSN 2047-4873. PMID 27256827. S2CID 206820997.
  9. ^ Gupta, Ruchika; Gupta, Sanjay; Sharma, Shashi; Sinha, Dhirendra N; Mehrotra, Ravi (1 January 2019). "Risk of Coronary Heart Disease Among Smokeless Tobacco Users: Results of Systematic Review and Meta-Analysis of Global Data". Nicotine & Tobacco Research. 21 (1): 25–31. doi:10.1093/ntr/nty002. ISSN 1469-994X. PMC 6941711. PMID 29325111.
  10. ^ Vidyasagaran, A. L.; Siddiqi, K.; Kanaan, M. (2016). "Use of smokeless tobacco and risk of cardiovascular disease: A systematic review and meta-analysis" (PDF). European Journal of Preventive Cardiology. 23 (18): 1970–1981. doi:10.1177/2047487316654026. ISSN 2047-4873. PMID 27256827. S2CID 206820997.
  11. ^ Zumbroich, Thomas J. (2007–2008). "The origin and diffusion of betel chewing: a synthesis of evidence from South Asia, Southeast Asia and beyond". eJournal of Indian Medicine. 1: 87–140. Archived from the original on 23 March 2019. Retrieved 22 January 2019.