Arecagyan : Everything one needs to know about Areca Nut

1. What is Betel Nut? 

Betel Nut or Areca Nut is the nut of the Areca Palm tree, which is chewed either alone or in combination with the Betel Leaf and Slaked lime.

 

2. What are its different preparations? 

Different preparations:

Paan, Vettalai paaku, Surti, Pan Masala (even marketed as mouth freshner), Gutkha, Supari, Khaini, Naswaar, Zardaa, Mawa, Mishri, Pin Lang, Buyo, Gudaku, Lao-hwa (Taiwan), Mainpuri, Tamol, etc.

 

3. What are the chemical constituents of the betel quid and what effects do they have?

    

Contents:

Betel quid contains Areca nut, Betel leaf, and Slaked lime and may contain tobacco, catechu, spices, sweeteners and essences.

 

Areca nut: contains Alkaloids like arecoline, arecaidine, guvacine and guvacoline, polyphenols (Flavonols and tannins) and Betel nut specific nitrosamines (mainly Saffrole) as its main constituents.

 

Effects:

Ø  Areca nut chewing results in

o   Oral Submucous Fibrosis (OSF) a pre-cancer [lesion which appears before cancer and can change into cancer with persistence of the causative agent, in this case Areca nut]

o   White patch [Leukoplakia] or Red patch [Erythroplakia] in the mouth both of which are Premalignant lesions or Pre-cancers

o   Oral cancer as a result of progression of the above lesions

o   Hepatocellular cancer

o   Still birth

o   Heart disease

 

Ø  Slaked lime or Chuna aids in the Cancer causing property of Areca nut by:

o   Resulting in increase in Alkalinity thereby helping in action of the carcinogens in Areca nut

o   Causing caustic damage to the oral tissues making them more susceptible to the cancerous agents

 

 

4. Can chewing Areca nut cause cancer?

     Yes. Chewing areca nut has been proven to cause cancer in a dose dependent manner. Risk of cancer increases with the frequency and duration of chewing. It commonly results in Oral submucous fibrosis which most times progresses to cancer, specially on continuing chewing of the areca nut.

 

5. It is culturally recommended as a digestive after food. How can that be harmful?

 

    Digestive properties of Betel quid are due to the increase in Salivation and stimulation of smooth muscles caused by Areca nut. However, it is associated with an increased incidence of Peptic ulcers apart from the many other health risks mentioned above and hence not recommended.

 

6. Is it safe to consume the quid in small quantities? Eg, only in festivals & marriage parties.

 

    Consumption of Areca nut or its preparations is NOT SAFE. Consumption of a single Betel Quid or a single sachet of Pan masala or Ghutka increases the risk of Oral pre-cancer.

 

7. During Pregnancy and Post childbirth, women in India are advised to eat foods rich in oil, ghee, fried foods, etc; followed by the betel quid as long as she is feeding the child. It is supposed to prevent ailments in the newborn. Is this valid?

 

    Betel nut is not safe to consume during pregnancy as it has been proven to be associated with adverse health effects like low birth weight, premature delivery, stillbirth, spontaneous abortions.

 

    It has been suggested that post childbirth consumption of the Betel nut may lead to disorders in liver function in the suckling neonate. Hence, not advised.

 

8. I am healthy and fit. I chew betel quid once a day. Am I at risk?

 

    Yes you are at risk. There is no safely tolerated quantity or frequency of consumption of Areca Nut. In addition, the risk of cancer increases with increase in frequency and duration of chewing.

 

9. Is Pukka supari (Ripe Betel nut) less harmful than Kuccha supari (Unripe Betel nut)? 

 

    Unripe betel nut has highest tannin (See # 3) content which decreases as it ripens. Hence, the unripe nut has a greater potential of causing Oral Submucous fibrosis. This however does not imply that the ripe form is safe. All forms of Areca nut are potentially carcinogenic.

 

10. I eat only pan and supari without tobacco. Am I still at risk?

    Yes. Supari contains Areca nut, which has Arecoline and Nitrosoamine compounds, which are carcinogenic.

 

11. What changes would betel quid chewing cause in my mouth?

 

o   Fibrous White Bands form in the oral mucosa or lining membrane of the mouth. This results in tightening of the mucosa and restricted mouth opening to as less as 1 finger space or completely closed. This is called Oral Submucous Fibrosis.  It may start with painful mouth, burning sensation in the mouth on intake of even mildly spicy foods, intolerance towards hot foods or an ulcer, which lasts over a longer period.

o   Narrowing of the vestibule of the mouth

o   Bald tongue

o   Dental changes include : Attrition or wearing out of teeth, brown, red or black discolouration of teeth, Cavitation of teeth, Gingivitis, Periodontitis, Sharp edges.

 

12. What is the timeframe for Pan Masala or Betel Quid chewing to give me any Precancer changes or Oral Cancer?

·        Oral Cancers from chewing Areca nut preparations are almost always preceded by Pre-cancer lesions.

·        Pan masala, Mawa, Ghutka and such preparations have resulted in Oral Submucous Fibrosis (OSF) in 2-3 yrs of chewing

·        Betel Quid has shown to give rise to OSF in 8-11 yrs of chewing

·        Oral Submucous Fibrosis has a Malignant potential of 7.6 – 95%

·        Leukoplakia has a malignant potential of 2 – 12%

·        Erythroplakia has a malignant potential of 15 – 40 %

Click link to see the source of the values mentioned  

 

13. Does it apply similarly to everyone?

    Cancer results from genetic mutations causing the cells to multiply in an uncontrolled manner. Hence, each individual’s susceptibility varies according to his genetic makeup.

 

14. I am told I have Oral Submucous Fibrosis, can these changes be reverted to normal? If so, how?

    Oral Submucous Fibrosis (OSF) cannot always be reverted back to normal. However, many cases respond to the following treatment:

 

o   QUIT THE HABIT OF ARECA NUT CHEWING! Without this, all other efforts are in vain!

o   Local injections of chymotrypsin, hyaluronidase, and dexamethasone

o   Submucosal placement of fresh human placental grafts

o   Oral physiotherapy – Conch exercises, ultrasound treatment

o   In resistant cases, surgical excision of the fibrotic bands

 

 

15. In which age-group is Oral cancer from Areca nut chewing more prevalent?

o   Addiction to Pan Masala and its like preparations is greater prevalent in younger age groups on account of the low cost, easy availability, misleading advertising, artificial flavouring and attractive packaging. It is popular amongst children and adolescents.

o   As mentioned in # 12, the occurrence of OSF is quicker with consumption of Pan Masala as against Betel Quid. This however does not imply that the consumption of the Quid is safe.

o   A dose–response relationship has been observed for oral cancer versus age at starting the habit of chewing areca nut, with a higher risk for starting at a younger age.

o   Oral cancers from Areca nut chewing are thereby more prevalent in the youth and middle–aged.