Is Betel Nut Chewing All That Bad?

I am doing some studies into larvicide properties of oils derived from plants that can be used to control mosquitoes and consequently malaria and was doing a literature search. And I came across an article regarding the use of essential oil extracted from betel leaf (daga leaf).

The study was done to find out if oil from betel leaf can treat cutaneous or wound infection caused by Chrysomya megacephala(oriental latrine fly). This fly species is also found in PNG. The experiments were set up to treat larvae of the fly with oil extracted from daga leaf. The result was the oil from daga leaf was toxic to oriental latrine fly larvae. Concentrations of 4-3% of daga leaf oil killed all the larvae exposed (100%) after exposure to 3 1/2 hours. The researchers concluded that oil from daga leaf has medicinal properties which can be further developed. The study was done in Sri Lanka.

After reading this I just thought of betel nut chewing in PNG. Betel nut chewing has been associated with mouth cancer. And more recently studied done at the Sir Buri Kidu Heath Institute has shown that betel nut chewing can cause a heart attack in susceptible individuals. I did part of the study. We showed that betel nut chewing reduces the blood supply to the heart which may precipate irregular heart beats which can cause a heart attack or can cause a sudden spasm of the heart blood vessels causing an heart attack. And on top of that betel nut chewing increases the heart rate which can complicate this process. A 70% narrowing of the lumen of the heart blood vessel is enough to cause chest pain!I think this explains why recently there have been many people in PNG collapsing and dying while chewing betel nut.

Betel nut chewing can also precipitate an acute attack of asthma in asthma patients. This is due to the action of betel nut on the smooth muscle of the bronchi (windpipe) probably by the same mechanism which causes smooth muscles of the blood vessels of the heart to go into sudden spasm. Studies on this were also done in PNG.

Than there were the other studies showing the good side of betel nut chewing. Betel nut chewing has been proposed to protect the teeth and gums. The change in  pH of the mouth and the extra calcium may have an effect here. And betel nut chewing can also be a treatment for hook worm infection. I think the mechanism here is also because of the effect of betel nut chewing on the gut smooth muscles – betel nut chewing irritates in the bowels  and can cause diarrhoea. If you are not a betel nut chewer and tried once, you probably had this experience.

Although there are many chemicals in betel nut the active chemical in buai is called Arecoline. This chemical is similar in structure to a naturally occurring chemical in the body called Acetylcholine. Arecoline is therefore called a “natural analogue” of  Acetlycholine compared to many”synthetic analogues”. This is because there are many drugs and chemicals that also have a similar structure to Acetylecholine.  

Acetylcholine has many functions but more importantly one of the main areas in the body where it acts is on smooth muscles. So Arecoline from buai which is similar to Acetylcholine will naturally also have an effect on smooth muscles of blood vessels, windpipe or the bowels. This makes sense and explains the observed effects of betel nut chewing. The other thing is that the chemical reaction between betel nut, daga and lime causes an increase in pH, which occurs in the mouth of chewers. This change in pH increases the rate at which Arecoline is absorbed from the mouth straight into the blood stream thus the effects can be immediate (and sometimes fatal).

With the association between mouth cancer and betel nut chewing, I have asked myself this question many times and the question is, “bifo tru taim ol tumbuna bin kaikai buai, ol bin gat mouth cancer tu o nogat?” (Did our ancestors had mouth cancer from chewing betel nut?) Things like lack of records (though legends and stories may help), dying at an earlier age and maybe the method of chewing betel nut or method of production of lime may have an influence. Or is it because it was present all alone but we are more aware and diagnosing this disease that there seem to an apparent increase.

I heard a rumour a few years back that lime producers were mixing fibro (asbestos)with coral to produce lime. Was this rumour actually true? We may never know because no one bothered to do some random sampling of the lime from markets and test them for the presence of asbestos. If there was such a study I am not away of it. Fibro or asbestos is now a well established carcinogen ie asbestos directly causes cancer by damaging DNA. It causes a kind of cancer of the covering of the lung known as mesothelioma. Mouth is a place where cells are dividing continuously therefore the introduction of a chemical like asbestos will damage DNA there, no questions asked! Can this rumour and the presence of fibro explain a time when the rate of cases of mouth cancer in PNG seemed to increase at an unusually high rate? Fibro or asbestos is now an internationally banned product for housing.Remember the colonial houses built with fibro?

I think betel nut itself or daga by itself can not cause all these. In-fact daga is a spice that is highly sought for in Asia and other parts of the world. PNG just need to realise this and develop this natural plant of PNG. Daga leaf also has other medicinal properties apart from the one reported in the Sri Lankan study. Now the lime. I think the method of production, the kind of coral or shells lime is produced from may be an important factor here.

And finally it is the combination of these three simingly harmless products on their own that when used together produce the beneficial (protects teeth and gum, treats hook worm infection) and the dangers associated with betel nut chewing. I am sure you will agree that the dangers far out weigh the benefits – say maybe by 100 to 1? You can give your own figure.


About rodney itaki

Medical doctor and public health specialist from Papua New Guinea.
This entry was posted in Health. Bookmark the permalink.

32 Responses to Is Betel Nut Chewing All That Bad?

  1. Herman says:

    It’s really bad cause it makes PNG a filthy place. Especially urban areas.

  2. ipurush says:

    I’m a regular betel nut chewer, and I have noticed in the recent months, I have been having problems with pronunciations of certain words. My friend that this is because betel nut makes the tongue thicker. Is this true?

  3. rodney itaki says:

    Hi there, thanks for visiting my blog. No betel nut does not make the tongue thicker.

    The active ingredient in betel nut, Arecoline, increases blood flow. I think what is happening is when you chew there is increased blood flow to the tongue making it little bit more thicker than normal. This effect is not permanent. It is a transient one. So do not worry. Arecoline also stimulates nerves. The effect is not an increased but a decreased activity of the nerves. And I think Arecoline is causing some transient paralysis of the nerve supply to your tonge.

    My advice? If you are experiencing these sypmptoms. Stop chewing!

    Good luck

  4. Framey Sam says:

    it is true that most people who are addict in chew betel nut are mush happier than those who don’t take it? it ture?

    if somebody know this thing can somebody reply it to me at the http://www.intranet.majuro.cmi website. it is very important to know it. thank you.

  5. loni says:

    where i come from alot locals really love to chew and it’s really adictive to some us it really make’s the grass look ugly when people spit on it. although it’s our culture i think it should be banned because of people who will get cancer and other type sickness from betelnut.

    {Saipan 670}

    if you never heared of this place it’s because it’s not on any map. It’s an island in the middle of the pacific sea ;}

  6. Shondab says:

    Is there recovery treatment options for chewing betel nut. What are some possible withdrawal symptoms.

  7. Where I come from we the bigger one of all the nuts and people love and even love to display it because it is much bigger than the usual size of the betel nut.

    It is also the main cultural thing in the village. when people have to come for a meeting, the betel must be there in the midst. when there is disagreements between people they have betel nut together when it time to make peace again between the parties concern. The Island here described is Bougainville Island where the biggest betel nut on earth comes from..

    thank you.

    • Niat Hebwer says:

      Well my name is Nita Hebwer. I chewed but only at once. I think this is my first time to know that the betel nut can be the reason why conflicts resolve.

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  9. j... says:

    am 23 years… chewing raw betel nut [which in dark red colour] for 8 to 9 years…and i know that am adicted to it…but now am realy get rid of chewing betel nut…am ready to quit it.. but my fear is,that,will i get any kind of cancer later after i get rid of this habit ///…i dont have any symtoms of having any affects cause by chewing it for 8 years….[ i chew 8 piece of bettle nut everyday] perfectly normal…but am so scared about that i got adicted ..thats y i want to get rid of this habbit now.. can plzzz any one tell that ,will i get any kind of oral or stomach cancer later ;[….also am scared about, will i get problem in getting pregnent becoz of habit for 8 years//

    • rodney itaki says:

      As long you stop the habit now, I dont think you will have any problem. Most cancer of the lips, cheeks and tongue from betel nut chewing develop from pre-cancerous growth. The sooner you stop chewing, the better it is stop the development of pre-cancerous growth. There is not concrete evidence to suggest adverse effect of betel nut chewing on fertility or to an unborn child, but I would advise to stop to it anyway.

      Rodney Itaki

    • Nita Hebwer says:

      well gud 4 u.. juz remember 2 stop or else ull die…

  10. Kaime says:

    Betel Nut trade is a lucrative million kina business in PNG in the informal sector for the last 15 years.
    Traditionally it is held significantly as a kind customary gesture. Today it has taken on a different meaning commercially and those who are involved are from the well-to-do to the bottom bracket.
    The buai business is revolutionizing the social attitudes and behavioral structure of humans to life in general.
    For example, years preceding 1995 buai marketing and consumption was done in moderation.
    Today and for the last 15 years it has really proved itself to be a valued commodity and at the same time causing more social problems.
    Buai has really changed the attitudes and behavior of those who are bound by it. Wisdom has also evaded those who sell and chew buai, by this I mean, those who chew have no common courtesy to refrain spitting in public venues and in front of other people. Considering the air borne disease and rise in unhygienic living this only adds to it.
    It is always an eye sore seeing buai traders doing their business in places that resembles are pigsty.
    Buai business has also fueled increase in other social problems such as prostitution, HIV/AIDS, marital problems, health concerns etc. The attitudes displayed by buai sellers and consumers are summarized as reckless, uncanny and no sense of obligation to environment and themselves.

    Also government regulatory bodies are at wits end to control this bunch of irresponsible knuckle heads who do not care and respect the law.

    Its all but an attitude problem and needs not only philosophical but more spiritual approach to address it.

  11. Nita Hebwer says:

    thankz 4 all dah info…

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  13. Margaret says:

    Hi!I am a great buai chewer and I have this round blister like sores on both my cheeks and it is painful when I drink something like coke or lemon water I feel this sharp pain. Could it be the beginning of cancer?

    • rodney itaki says:

      mmmm…should have it checked out! Mouth cancer usuallly start at the corner of the mouth but can also begin inside the cheeks. Like small ulcers but never really goes away.

  14. komala says:

    hi i am chewing better nut for past 7 yrs and i have been so week and my haemoglobin level is reached very low now so badly want to quit it but cant stop eating it.. pls tell me how to detoxify my body and stop eating it.

  15. I’m regular chewer of betel nut. And, recently i notice that i cant open my mouth more than half inch. Is it happened for chewing betel nut?

    • MP says:

      there is a commonly used check: your mouth should open wide enough for you to put 4 fingers in. if your mouth cannot open this wide, you need to get it checked (besides cancer, there are other conditions like fibrosis which damage muscles of the jaw).

  16. I’m regular chewer of betel out. Recently i find that i can’t open my mouth more than half inch. Is it happened for chewing betel nut ?

  17. HARJIT says:

    im betel nut chewer…more than 30 my age 38 n im facing diabetec it my diabetec cause by betel nut?pls help

  18. HARJIT says:

    my hb also very low..n medical reports show risk of anemia….i really wanna stop this bad habit

  19. arjun says:

    i don chew betel nuts frequently,i do it rarely and i don have them in my mouth for long periods of time, so can i continue to do this or will chewing in a limited way still affect my health

  20. Papua New Guinea, is that a cooler place than the Philippines? Can I retire there with my life’s savings of how many million pesos?

  21. Hello, all the time i used to check weblog posts here in the
    early hours in the break of day, as i like to gain knowledge of more and more.

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