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Betel Nut (Areca catechu L.)


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Betel Nut (Areca catechu L.)

Background

Betel nut use refers to a combination of three ingredients: the nut of the betel palm ( Areca catechu ), part of the Piper betel vine, and lime. Anecdotal reports have indicated that small doses generally lead to euphoria and increased flow of energy while large doses often result in sedation. Although all three ingredients may contribute to these effects, most experts attribute the psychoactive effects to the alkaloids found in betel nuts

Betel nut is reportedly used by a substantial portion of the world's population as a recreational drug due to its CNS stimulant activity. Found originally in tropical southern Asia, betel nut has been introduced to the communities of east Africa, Madagascar, and the West Indies. There is little evidence from adequately controlled studies to support clinical use of betel, but the constituents have demonstrated pharmacological actions. The main active component, the alkaloid arecoline, has potent cholinergic activity.

Constituents of areca are potentially carcinogenic. Long-term use has been associated with oral submucous fibrosis (OSF), pre-cancerous oral lesions and squamous cell carcinoma. Acute effects of betel chewing include asthma exacerbation, hypotension, and tachycardia.

Synonyms

Amaska, areca nut, arecoline, arequier, betal, betelnusspalme, betel quid, chavica etal, gutkha, hmarg, maag, marg, mava, mawa, pan, paan, Palmaceae (family) , pan masala, pan parag, pinang, pinlang, Piper betel Linn. (leaf of vine used to wrap betel nuts), pugua, quid, Sting® (Tantric Corporation), supai, ugam.

Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Uses based on scientific evidenceGrade*Stimulant
Betel nut use refers to a combination of three ingredients: the nut of the betel palm ( Areca catechu ), part of the Piper betel vine, and lime. It is believed that small doses can lead to stimulant and euphoric effects, and betel nut chewing is popular due to these effects. Although all three ingredients may contribute to stimulant properties, most experts believe that chemicals in the betel nuts (alkaloids) may be responsible. Other substances that may be combined with betel nut chew, such as tobacco, may also contribute. However, chronic use of betel nuts may increase the risk of some cancers, and immediate effects can include asthma exacerbation, high or low blood pressure, and abnormal heart rate. Based on the known toxicities of betel nut use, the risks may outweigh any potential benefits.

C

Stroke recovery
Several poor-quality studies report the use of betel nut taken by mouth in patients recovering from stroke. In light of the potential toxicities of betel nut, additional evidence is needed in this area before a recommendation can be made.

C

Schizophrenia
Preliminary poor-quality studies in humans suggest improvements in symptoms of schizophrenia with betel nut chewing. Effects may be due to arecoline, a chemical in betel nut that acts on the brain as a neurotransmitter. However, side effects such as tremors and stiffness have been reported. More research is necessary before a firm conclusion can be drawn.

C

Anemia
Preliminary poor-quality research reports that betel nut chewing may lessen anemia in pregnant women. Reasons for this finding are not clear, and betel nut chewing may be unsafe during pregnancy.

C

Dental cavities
In the past, toothpaste that contained betel nut was believed to offer protection against tooth decay and strengthen gums. Poor-quality research does report fewer cavities in betel nut chewers, and laboratory studies show betel to act against some bacteria. However, betel chewing may actually have a harmful effect on the gums. Due to the known toxicities of betel nut use and the availability of other proven products for dental hygiene, the risks of betel nut may outweigh potential benefits.

C

Ulcerative colitis
Currently, there is a lack of satisfactory evidence to recommend the use of betel nut for ulcerative colitis. Based on the known toxicities of betel nut use, the risks may outweigh any potential benefits.

C

Saliva stimulant
Betel nut chewing may increase salivation. However, it is not clear if this is helpful for any specific health condition. Due to known toxicities from betel nut use, the risks may outweigh any potential benefits.

C

ya you betcha

* Key to grades
A:
Strong scientific evidence for this use;
B:
Good scientific evidence for this use;
C:
Unclear scientific evidence for this use;
D:
Fair scientific evidence against this use (it may not work);
F:
Strong scientific evidence against this use (it likely does not work).

Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Alcoholism, aphrodisiac, appetite stimulant, asthma, blindness from methanol poisoning, cough, dermatitis (used on the skin), intestinal worms, digestive aid, diphtheria, diuretic, ear infection, excessive thirst, excessive menstrual flow, fainting, gas, glaucoma, impotence, joint pain/swelling, leprosy, respiratory stimulant, toothache, veterinary uses (intestinal worms).

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

Oral (by mouth) : Betel nut can be chewed alone, but is often chewed in combination with other ingredients (called a "quid"), including calcium hydroxide, water, catechu gum, cardamom, cloves, anise seeds, cinnamon, tobacco, nutmeg, and gold or silver metal. These ingredients may be wrapped in a betel leaf, followed by sucking the combination in the side of the mouth. It is reported that ingestion of 8 to 30 grams of areca nut may be deadly.

Children (younger than 18 years)

Betel is not recommended in children due to risks of toxicity, including worsening symptoms of asthma, effects on the heart, or cancer.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Breathing problems with betel nut use have been reported, although no allergic reactions are noted in the available scientific literature. Caution is warranted in people with allergies to other members of the Palmaceae family.

Side Effects and Warnings

Betel nut cannot be considered safe for human use by mouth. This is due to toxic effects associated with short or long-term chewing or eating of betel nut.

Betel nut and chemicals in betel leaves may cause skin color changes, dilated pupils, blurred vision, wheezing/difficulty breathing, and increased breathing rate. Tremors, slow movements, and stiffness have been reported in people also taking anti-psychotic medications. Worsening of spasmodic movements has occurred in patients with Huntington's disease. Seizure has been reported with high doses.

"Cholinergic" toxicity symptoms from betel use may include salivation, increased tearing, lack of urinary control (incontinence), sweating, diarrhea, and fever. Other problems may include confusion, problems with eye movement, psychosis, amnesia, stimulant effects, and a feeling of euphoria. Long-term users may form a dependence on the effects of betel, and discontinuing use may cause signs of withdrawal, such as anxiety or memory lapse.

Chewing betel nuts can also cause nausea, vomiting, diarrhea, stomach cramps, chest pain, irregular heart beats, high or low blood pressure, and irregular heart beats. A heart attack occurred in a man immediately after chewing betel nut. It is not clear if betel was the cause.

Betel chewing has been shown to have a harmful effect on the gums. The nut may cause the teeth, mouth, lips and stool to become red stained. Burning and dryness of mouth may occur.

Studies of Asian populations have linked pre-cancer conditions of the mouth and esophagus to betel use ("oral submucous fibrosis"). There may be a higher risk of cancers of the liver, mouth, stomach, prostate, cervix, and lung with regular betel use.

In animals, a chemical in betel nut lowers blood sugar levels. Although human study is lacking in this area, caution is advised in people with diabetes or glucose intolerance, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare provider, and medication adjustments may be necessary. Animal studies show mixed effects on thyroid function, and increased skin temperature. Other problems can include increased blood calcium levels and kidney disease ("milk alkali syndrome"), possibly due to calcium carbonate paste sometimes used for preparing betel nuts for chewing.

Some betel nuts may be contaminated with harmful substances, including aflatoxin or lead.

Pregnancy and Breastfeeding

Betel nut is not recommended during pregnancy and breastfeeding due to the risk of birth defects or spontaneous abortion.

References

1. Deng JF, Ger J, Tsai WJ, et al. Acute toxicities of betel nut: rare but probably overlooked events. J Toxicol Clin Toxicol 2001;39(4):355-360.

2. Huang Z, Xiao B, Wang X, et al. Betel nut indulgence as a cause of epilepsy. Seizure 2003;12(6):406-408.

3. Jeng JH, Chang MC, Hahn LJ. Role of areca nut in betel quid-associated chemical carcinogenesis: current awareness and future perspectives. Oral Oncol 2001;37(6):477-492.

4. Kuruppuarachchi KA, Williams SS. Betel use and schizophrenia. Br J Psychiatry 2003;182:455.

5. Lee CN, Jayanthi V, McDonald B, et al. Betel nut and smoking. Are they both protective in ulcerative colitis? A pilot study. Arq Gastroenterol 1996;33(1):3-5.

6. Mannan N, Boucher BJ, Evans SJ. Increased waist size and weight in relation to consumption of Areca catechu (betel-nut); a risk factor for increased glycaemia in Asians in east London. Br J Nutr 2000;83(3):267-273.

7. Phukan RK, Ali MS, Chetia CK, et al. Betel nut and tobacco chewing; potential risk factors of cancer of oesophagus in Assam, India. Br J Cancer 2001;85(5):661-667.

8. Shiu MN, Chen TH, Chang SH, et al. Risk factors for leukoplakia and malignant transformation to oral carcinoma: a leukoplakia cohort in Taiwan. Br J Cancer 2000;82 (11) :1871-1874.

9. Stoopler ET, Parisi E, Sollecito TP. Betel quid-induced oral lichen planus: a case report. Cutis 2003;71(4):307-311.

10. Sullivan RJ, Allen JS, Otto C, et al. Effects of chewing betel nut (Areca catechu) on the symptoms of people with schizophrenia in Palau, Micronesia. Br J Psychiatry 2000;177:174-178.

11. Tsai JF, Chuang LY, Jeng JE, et al. Betel quid chewing as a risk factor for hepatocellular carcinoma: a case-control study. Br J Cancer 2001;84(5):709-713.

January 01, 2004

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