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• Overview of the Betel Nut
• Dependency and Addiction
• Betel Nut Chewing: The Plants and Preparation
• Cultural Roots of Betel Nut Chewing
• History and Global Spread of Betel Nut Chewing
• Health Benefits, Issues and Significance for Early Micronesian
• References

Overview of the Betel Nut

The betel nut is a seed of the Areca catechu palm tree, widely used in many cultures for its psychoactive and stimulant effects. However, it is classified as a carcinogen due to its link to oral cancer. Betel nut, also known as the areca nut that looks like nutmeg is extensively chewed in many cultures across Southeast Asia, Micronesia, South Asia, China, and Taiwan. It has been classified as a Group 1 carcinogen (by the International Agency for Research on Cancer (IARC), meaning it poses significant health risks to humans. Despite the significant health risks associated with betel nut chewing, an estimated 600 million people consume it worldwide. 

Betel nut chewing is a widespread cultural practice in Papua New Guinea, which has resulted in significant health challenges, including increased rates of mouth cancer. This practice has also been introduced by Indian communities in New Zealand, leading to similar future health issues. To combat these challenges, comprehensive strategies are needed, including cultural understanding, public health education, and improved healthcare access.

Using betel nut can quickly become addictive due to its psychoactive effects. The practice induces euphoria, reduces appetite, and counteracts fatigue, possibly linked to inhibited GABA uptake. Users typically experience distinctive physical and psychological effects: facial flushing, euphoria, heightened alertness, increased sweating and salivation, a sensation of heat in the body, and enhanced work capacity. The psychoactive effects of betel nut are due to the presence of arecoline, which has properties like those of nicotine. 

Betel nut chewing involves the use of two plants, namely the betel and areca plants. The betel (Piper betel) is a species of flowering plant belonging to the pepper family and is primarily cultivated for its leaves, commonly used as flavoring agents in chewing areca nut preparations. The areca nut comes from the areca palm, also known as the betel palm. Areca palms are tall trees with thick trunks that produce nut-like fruits. The nut can be consumed fresh or dried, fermented, boiled, baked, roasted, or crushed and wrapped in betel leaves, sometimes with slaked lime. 

Betel Nut Wrap

This chewing practice holds deep-rooted cultural significance and prevalence in many societies, along with the availability of betel nut at its low cost, making it a traditional and socially acceptable behavior in specific communities and making it challenging to address this addiction. Moreover, Areca nut chewing habit is often used as a means of group identification, where individuals engage in the practice to align themselves with their cultural or ethnic group. This cultural significance has contributed to the continued use and difficulty of quitting of betel nut chewing in various communities. For example, in regions like Guam and Southeast Asia, including India, specific ethnic groups have higher rates of betel nut consumption than others despite its availability nationwide. 

Circa 1500: Illustration of How Aristocats Used to Chew Betel Nut in India During Mughal Era

Taiwan’s Contemporary Betel Nut Booths

The roots of betel nut chewing trace back to Southeast Asia, where its plant ingredients originated. Early humans discovered accidentally that the betel palm nut contains alkaloids, a chemical that releases arecoline when combined with calcium hydroxide. Various pieces of evidence have been found regarding early humans using seashells to crush Areca nuts, which probably released calcium that combined with alkaloids in the nuts. Archaeologists uncovered betel nut chewing dating back over 10,000 years ago. Spirit Cave in Thailand and caves in eastern Timor reveal proof of betel nut consumption from 13,000 to 4,000 years ago. Similarly, remains of the areca nut were found in Kuala Selingsing in Peninsular Malaysia, dating back to 5,000 years ago, further supporting the long history of betel nut chewing in the region.

The historical consumption and spread of Betel nut among Micronesian communities hint at potential health benefits like reduced dental caries that served as a strategic counterbalance to high sugar and starch diets. Moreover, its role in appetite suppression could have been crucial during times of scarcity and endurance, especially during extensive inter-island voyages. Although these hypotheses still need to be tested, betel nut chewing was an important social activity that fostered interpersonal relationships, facilitated contact with the supernatural, and had medicinal qualities, as is documented elsewhere in parts of South and Southeast Asia.

Another piece of evidence is linguistic evidence, as many regional languages have specific words and phrases related to betel nut chewing. For instance, in Malay, the word for betel nut is “pinang,” and in Tamil, it is “vethalai.” Such linguistic evidence suggests that the practice has been deeply ingrained in these cultures for a long time. 

Over time, the practice of chewing betel nuts has spread across Southeast Asia, Micronesia, South Asia, China, and Taiwan, becoming deeply ingrained in the culture and tradition of many societies. Today, an estimated 600 million people worldwide still consume betel nuts despite the significant health risks associated with their use.

Courtesy BBC Man chewing Betel Nut in Papua New Guinea

Papua Guinea, where 9 million people chew betel nut, reportedly experiences 15,000 to 25,000 deaths per year, according to the New England Journal of Medicine.

Chewing betel nut does have some oral health benefits. It involves using slaked lime, which can help neutralize the acids produced by bacteria in the mouth, reducing the risk of tooth decay. It can also help freshen the breath and stimulate the production of saliva, which can help wash away food particles and bacteria. However, it is important to note that these benefits are only applicable when done in moderation and with proper oral hygiene practices. Excessive betel nut chewing can lead to various significant health issues, including gum disease, oral cancer, oral precancer and cancer, metabolic syndrome, bronchospasm, and myocardial infarction link. 

Interestingly, despite the apparent health risks involved in chewing betel nuts, scientists are interested in discovering the psychedelic properties of the nut that can help treat some mental health issues. In the early seventies, it was hypothesized that areca could be used as an antipsychotic for treating schizophrenia. Current clinical studies suggest that areca consumption may provide some benefits for schizophrenic patients.

References:

“Coppola, Maurizio, et al. ‘Areca Alkaloids and Schizophrenia.’ Neuropathology of Drug Addictions and Substance Misuse, edited by Victor R. Preedy, Academic Press, 2016, pp. 794-802.”

“Photos shine a light on Taiwan’s ‘betel nut beauties’ | CNN.” CNN, Cable News Network, 11 Dec. 2015, www.cnn.com/2015/12/11/asia/taiwan-betel-nut-girls/index.html.

“The Prehistoric Chewing of Betel Nut (Areca catechu) in Western Micronesia.” Journal of Archaeological Science, vol. 30, no. 6, 2003, pp. 803–821., doi:10.1016/s0305-4403(02)00208-4.

“Sociocultural Factors that Affect Chewing Behaviors among Betel Nut Chewers and Ex-Chewers on Guam.” Pacific Health Dialog, vol. 19, no. 2, 2012, pp. 125–137.

“Antioxidant, Anti‐inflammatory, and Chemoprotective Properties of Acacia catechu Heartwood Extracts.” Journal of Food Science, vol. 77, no. 11, 2012, doi:10.1111/j.1750-3841.2012.02951.x.

Aronson, Jeffrey K. “Plant Poisons and Traditional Medicines.” Manson’s Tropical Infectious Diseases, 23rd ed., 2014. ScienceDirect, doi:10.1016/b978-0-7020-5101-2.00009-6.

“Betel nut chewing, oral premalignant lesions, and the oral microbiome.” Journal of Dental Research, vol. 93, no. 3, 2014, pp. 201–206., doi:10.1177/0022034513511152.

“Betel Nut Chewing.” Wikipedia, Wikimedia Foundation, 20 Oct. 2021, en.wikipedia.org/wiki/Betel_nut_chewing.