What is 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?

This red residue is the telltale sign of the betel nut, which is chewed by millions of people across the globe. In its most basic form, betel nut is a seed of the Areca catechu, a type of palm tree. It’s commonly chewed after being ground up or sliced and wrapped in leaves of the Piper betle vine that have been coated with lime. This is known as a betel quid. Tobacco or flavorful spices may also be added.

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, in fourth place 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.

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.

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.

According to one study published in the journal Cancer Prevention Research, betel nut has cancer-fighting properties. An Indian study suggests it may help with cardiovascular and digestive issues and have anti-inflammatory and wound-healing properties. However, a study in the South East Asia Journal of Cancer points to the lack of follow-up studies. It also says that more research is needed to confirm any of the betel nut’s benefits. A medical review of the nut’s effects published in the Indian Journal of Medical and Paediatric Oncology concludes that it’s an addictive substance with many more harmful effects than benefits.

Research has revealed some serious health risks of betel nut. The WHO classifies betel nut as a carcinogen. Many studies have shown a convincing link between betel nut use and cancer of the mouth and esophagus. A study in the Journal of the American Dental Association reports that betel nut users are at a higher risk for oral submucous fibrosis. This incurable condition can cause stiffness in the mouth and eventually the loss of jaw movement. Regular chewing of betel nut can also cause gum irritation and tooth decay. Teeth may become permanently stained deep red or even black.

An early study published in the American Society for Clinical Nutrition found a strong connection between betel nut and an increased risk of cardiovascular disease, metabolic syndrome, and obesity.

Betel nut may interact with other drugs or herbal supplements. It could cause toxic reactions in the body or reduce 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.

The U.S. Food and Drug Administration (FDA) does not consider betel nut safe for chewing or eating. It has placed the nut on its Poisonous Plants Database. A fact sheet on betel nut with tobacco issued by the Centers for Disease Control and Prevention (CDC) warns of the following medical conditions associated with betel nut use with tobacco:

  • oral submucous fibrosis
  • oral cancer
  • addiction
  • reproductive issues, including low birth weight in newborns

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 the following measures to curb the practice:

  • policy
  • public awareness campaigns
  • community outreach

Chewing betel nut has a long history reaching back 2,000 years, and some cultures claim to have found benefits associated with it. However, modern research shows many health risks associated with the practice. Regular chewing of the betel nut has been linked to cancer of the mouth and esophagus, oral submucous fibrosis, and tooth decay. The WHO has classified betel nut as a carcinogen and initiated an action plan to reduce its use. In the United States, both the FDA and the CDC have issued alerts on health risks associated with betel nut chewing. Reducing risk factors such as those presented by betel nut chewing is important for public health around the globe.