Do not befriend the Betel-Nut

Do not befriend the Betel-Nut

Millions of people in India chew the betel-nut (areca). It is a favourite after dinner stimulant and digestive. It is so popular that it forms an essential ingredient of many religious ceremonies.Betel-nut is chewed either alone, as mawa (mixture of lime, tobacco and betel-nut), in commercial

preparations, or wrapped in pan. Many believe it to be a benign alternative to tobacco or alcohol. However, there is growing evidence that betel- nut chewing is a risk factor and may cause oral sub mucous fibrosis (OSF), a pre-malignant condition associated with oral cancer. Betel- nut chewing is also being implicated as a risk factor for cardiovascular diseases and in asthma.

Oral Submucous Fibirosis: A recent house-to-house survey conducted in Bhavnagar district of Gujarat by the Tata Institute of Social Sciences, Mumbai, revealed that out of 164 cases of OSF identified, 160 chewed the betel-nut. Nearly 11 per cent of mawa users suffered from this condition. Nearly 85 per cent of those found to be chewing betel-nut and those with OSF were below 35 years of age!Researchers calculated that the age-adjusted relative risk amongst betel-nut users was about 60. This means that after considering age (as age is also a risk factor for OSF), the incidence of OSF among betel- nut users is 60 times higher than amongst non-users. The relative risk increased to about 75 times in mawa users as it contains tobacco, a known carcinogen. Thus, chewing betel-nut with tobacco further increases the risk of oral cancer.According to a report in British Medical Journal, the amount of copper found in betel-nut preparations is 10 times higher than the amount found in nuts (such as peanuts). This high copper content could be the reason why betel-nut is associated with OSF. Researchers tested the saliva of people who chewed a commercial betel-nut preparation and concluded that regular chewers would have up to 5 mg of copper released in their mouth every day. That is five times the amount of copper normally available in food. Ideally, daily diet should not contain more than 1.5 to 3 mg of copper. Although it is not clear how high copper levels can induce fibrosis, it is known that copper is associated with other fibrotic diseases such as seleroderma and liver fibrosis.Cardiovascular Diseases:

A study in the Asian population in London found raised homocysteine and reduced folate concentrations in 170 betel-nut chewers. High homocysteine levels is a known cardiovascular risk factor. A metabolite of the amino acid methionine, homocysteine in high levels can damage the inner lining of arteries and promote atherosclerosis. High levels of copper in betel-nut can also increase the activity of an enzyme known aslysyl oxidase which has a role in the formation of atheromatous plaques in major blood vessels. Alkaloids in betel-nut, such as arecoline, may play a contributing role in coronary artery spasm and predisposing to myocardial infarction.

Asthma: The alkaloid arecoline is a major constituent of betel-nut and causes euphoric effects. Its high concentration in the circulation while chewing betel-nuts is believed to cause broncho-constriction in some asthmatic patients. Laboratory tests have revealed that arecoline causes dose-related contraction of human bronchial smooth muscle strips. In a double-blind study, inhalation of arecoline caused bronchoconstriction in all the asthmatic patients and in five controls.In Britain, the rate of hospital admission for acute asthma is higher among Asians than other groups in the population; betel-nut chewing is being perceived as one of the several factors that affect asthma control and severity of attacks.With these observations being made, there is a need to educate people about the problems they are likely to encounter if they befriend the betel-nut.

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