View source for Betel nut

== Also known as ==

Areca nut, paan, paan-gutkha pinlang, pinang, supari, areca palm, areca catechu, catechu, katha, betel creeper, piper betle, betel leaf, betel chew, betel paan, betel pan.

== Classification ==

Mild stimulant
[[Category:Stimulants]]
== Overview ==

The areca tree is a feathery palm that grows to approximately 1.5 m in height and is widely cultivated in tropical India, Bangladesh, Japan, Sri Lanka, south China, the East Indies, the Philippines, and parts of Africa. The tropical palm trees bear fruit all year. The nut may be used fresh, dried, or cured by boiling, baking, or roasting. The quid is a mixture of areca nut, tobacco, and lime wrapped in the leaf of the betel vine (Piper betel L. Family: Piperaceae) <ref name="1194a">'''Betel Nut''', 2017, https://www.drugs.com/npc/betel-nut.html</ref>.

The Areca palm is a tall palm, which produces seed pods. These seed pods are cropped and used as a stimulant. These are variously called Areca, Catechu or betel nuts. The Betel creeper is a slim vine with dark green, glossy, heart-shaped leaves. These are grown as a crop for their leaves and are often used alongside betel nuts.

The Hindi word for betel is paan and this terms is also used for the preparation of leaf and nut widespread across India.

Increasingly popular, preparations of betel nut are also chewed with tobacco, both in India and elsewhere. These colourfully-wrapped packages are sold from numerous shops and stalls and has increasingly replaced traditional betel stalls. This 'smokeless tobacco' is called ''Gutkha'' in India and is known as ''Mawa'' and other names elsewhere. Repeated allegations are made that the products, with their packaging, sweet flavourings and images, are targeted at young users, and some Indian states have restricted their sale <ref name="1195a">'''Areca and Betel''', 2017, http://www.kfx.org.uk/drug_facts/drug_facts_betel.php</ref>.

== Medical usage ==

Limited clinical applications exist <ref name="1194a"/>.

== What does it look like? ==

Betel nuts are hard, brown seeds; whole seeds are about the size of a walnut. Leaves from the betel vine are glossy green, heart-shaped leaves. Prepared paan will take the form of a mixture of spices, betel nut and lime in a folded leaf <ref name="1195a"/>.

== Street price ==

100g of Betel nut can be purchased from on-line sellers for around £2. It is not illegal to possess and supply and is widely available from shops serving Indian, Pakistani and Bangladeshi communities. Both whole nuts and prepared paan can be purchased <ref name="1195a"/>.

== Why take it? ==

=== Sought after effects ===

* mild euphoria,
* greater energy,
* reduced fatigue,
* talkativeness,
* excitability <ref name="1195a"/>.

=== Undesired effects ===

* discolouration of teeth and gums, sometimes turning them reddish-brown,
* mouth ulcers and gum disease,
* oral cancers or sub mucous fibrosis,
* stomach ulcers,
* heart disease <ref name="1202a">Shrihari, J. and Blank, M. and Balaster, R. and Nichter, M. and Nichter, M., '''Areca nut dependence among chewers in a south indian community who do not also use tobacco''', ''Addiction'', 2010, 105, 7, 1303-1310, https://dx.doi.org/10.11112Fj.1360-0443.2010.02952.x, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3143027/</ref>.

== Mode of use ==

The seed is separated from the outer layer of the fruit and may be used fresh, dried, boiled, baked, roasted or cured <ref name="1196a">Gupta, P. and Ray, C., '''Epidemiology of betel quid usage''', 2004, http://annals.edu.sg/pdf200409/V33N4p31S.pdf</ref>.

Betel nut is chewed, on its own, with herbs and spices, or with tobacco. Generally some sort of lime is added as this makes the active compounds far more effective. Without the use of lime, betel can still be chewed for its taste and mouth freshening properties but will have a less marked stimulant effect <ref name="1195a"/>.

The most common method of using betel nut is to slice it into thin strips and roll it in a betel leaf with slaked lime (powder) or crushed seashells. This leaf package is known as a betel quid, betel nut chew, betel chew, betel pan or betel paan (India) <ref name="1198a">WHO, '''Review of areca (betel) nut and tobacco use in the Pacific: a technical report''', World Health Organisation, 2012, http://www.wpro.who.int/tobacco/documents/201203_Betelnut/en/</ref>.

Betel quids may also contain tobacco and other additives such as cloves, cardamom, nutmeg, aniseed, coconut, sugar, syrups and fruit extracts, to enhance the flavour <ref name="1198a"/>.

Sometimes areca nuts are rolled in leaves other than betel leaf, such as a leaf from the rubiaceous plant (Mitrogyna speciosa), nutmeg tree (Myristica fragrans), or the pepper plant used in kava (Piper methysticum) <ref name="1197a">'''Betel nut''', 2017, http://adf.org.au/drug-facts/betel-nut/</ref>.

== Signs of usage ==

Betel use causes distinctive staining to lips and teeth, and the combined use with tobacco can cause unsightly brown staining to teeth <ref name="1195a"/>.

== Effects ==

The effects of betel nut are not fully understood and further research is needed <ref name="1199a">Lingappa, A. and Nappalli, D. and Sujatha, G. and Prasad, S., '''Areca Nut: To chew or not to chew?''', 2011</ref>. The active compounds in betel nut act as a mild stimulant <ref name="1195a"/>. However, people who have used the drug have reported the following effects -

* mild [[euphoria]],
* feelings of wellbeing,
* feeling alert,
* fast heart rate,
* palpitations,
* high blood pressure,
* red face,
* feeling warm,
* sweating <ref name="1199a"/>,
* greater energy,
* reduced fatigue,
* talkativeness,
* excitability <ref name="1195a"/>.

People who use betel nut for the first time, and people who have used it before who take a large amount or a strong batch, may experience the following -

* tremors <ref name="1200a">Hafeman, D. and Hibibul, A. and Islam, T. and Louis, E., '''Betel quid: Its tremor-producing effects in residents of Araihazar, Bangladesh''', ''Movement disorders'', 2006, 21, 4, 567-571, http://onlinelibrary.wiley.com/doi/10.1002/mds.20754/abstract</ref>,
* dizziness,
* upset stomach,
* diarrhoea,
* vomiting,
* psychosis <ref name="1201a">Huang, Z. and Xioa, B. and Wan, X. and Li, Y. and Deng, H., '''Betel nut indulgence as a cause of epilepsy''', ''Seizure'', 2003, 12, 6, 406-408, https://doi.org/10.1016/S1059-1311(02)00377-1, http://www.sciencedirect.com/science/article/pii/S1059131102003771</ref>.

=== Long-term effects ===

Regular, heavy use of betel nut may eventually cause -

* discolouration of teeth and gums, sometimes turning them reddish-brown,
* mouth ulcers and gum disease,
* oral cancers or sub mucous fibrosis (a pre-cancer condition),
* stomach ulcer,
* heart disease <ref name="1202a"/>,
* needing to use more to get the same effect,
* dependence on betel nut,
* financial, work and social problems <ref name="1197a"/>.

== Risks ==

Betel use has a number of health benefits attributed to it; it is reputed to assist digestion, reduce [[flatulence]] and freshen the breath. However there is growing recognition internationally that betel use can have a damaging effect on health.

Research has suggested a high correlation between betel nut chewing and oral cancers and the risk is increased when betel is chewed alongside tobacco. Other problems related to chewing include damage to teeth and gums and cavities. Betel use causes distinctive staining to lips and teeth, and the combined use with tobacco can cause unsightly brown staining to teeth <ref name="1195a"/>.

== Legality ==

Betel is legal in the UK, and is widely used amongst populations from India, Pakistan, Banglasdesh and other countries where betel use is indigenous. There has been little research in to extent or problems relating to betel use in the UK <ref name="1195a"/>.

== Mixing with other drugs ==

The effects of taking betel nut with other drugs - including over-the-counter or prescribed medications - can be unpredictable and dangerous, and could cause -

* '''Betel nut + tobacco''' - greatly increases the risk of developing oral cancers <ref name="1198a"/>.

== Statistics ==

Around 10% - 20% of the world's population chews betel nut in some form. This makes it the 4th most widely-used psychoactive substance, after nicotine, alcohol and caffeine <ref name="1198a"/>, <ref name="1204a">Ashock, L. and Deepika, N. and Sujatha, G. P. and Shiva P. S., '''Areca nut: To chew or not to chew?''', ''e-Journal of Dentistry'', 2011, 1, 3, 46-50</ref>.

== History ==

The chewing of betel nut quids dates to antiquity. In the 1st century AD, Sanskrit medical writings claimed that betel nut possessed 13 qualities found in the region of heaven. It is pungent, bitter, spicy, sweet, salty, and astringent. It expels wind, kills worms, removes phlegm, subdues bad odors, beautifies the mouth, induces purification, and is said to kindle passion <ref name="1194a"/>.

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== References ==

<references />

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