Betel nut (Areca catechu L.)

 
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Betel nut
Betel nut

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 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 worsening of asthma, low blood pressure, and rapid heart beat.

 

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 evidence Grade*
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

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
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
Schizophrenia

Preliminary poor-quality studies in humans suggest improvements in symptoms of schizophrenia with betel nut chewing. However, side effects such as tremors and stiffness have been reported. More research is necessary before a firm conclusion can be drawn.

C
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 worsening of asthma, 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
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

 

*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;
F: Strong scientific evidence against this use.

 

Grading rationale

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), digestive aid, diphtheria, diuretic, ear infection, excessive thirst, excessive menstrual flow, fainting, gas, glaucoma, impotence, intestinal worms, 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 heartbeats, 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 alters 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. Betel nut chewers may have a higher risk of developing type 2 diabetes. 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. Betel nut may cause metabolic syndrome, immunosuppression and liver toxicity.

 

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

 

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. 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.

Interactions with Drugs
The effects of anticholinergic drugs may decrease when used in combination with betel nut or its constituent arecoline. Use with cholinergic drugs may cause toxicity (salivation, increased tearing, incontinence, sweating, diarrhea, vomiting, or fever). Betel nut may slow or raise the heart rate, and could alter the effects of drugs that slow the heart, such as beta-blockers, calcium channel blockers, or digoxin.

 

Betel nut may alter blood sugar levels. Caution is advised when using medications that may also alter blood sugar. Patients taking drugs for diabetes by mouth or using insulin should be monitored closely by a qualified healthcare provider. Medication adjustments may be necessary.

 

Betel nut may increase the effects of monoamine oxidase inhibitors (MAOIs), angiotensin-converting enzyme (ACE) inhibitors, phenothiazines, cholesterol-lowering drugs, stimulant drugs or thyroid drugs. Betel may increase or decrease the effects of anti-glaucoma eye drops. Reliable human study is lacking in these areas.

 

Interactions with Herbs and Dietary Supplements
Taking betel with other cholinergic herbs may cause toxicity (salivation, tearing, urinary incontinence, sweating, diarrhea, vomiting, facial flushing and fever) due to the chemical arecoline. Examples include American hellebore, jaborandi, lobelia, pulsatilla, and snakeroot. Betel may reduce the effects of herbs with possible anticholinergic properties, such as belladonna, henbane ,  hyoscyamine, and  Swertia japonica  Makino.

 

Betel may alter blood sugar levels. Caution is advised when using herbs or supplements that may also alter blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

 

Betel may inhibit monoamine oxidase and therefore may increase the effects of herbs and supplements that may also inhibit monoamine oxidase. Betel nut may also interact with cardioactive agents like hawthorn or oleander or agents that effect thyroid levels like bladderwrack.

 

Betel nut extracts may lower blood cholesterol levels and may increase the effects of agents that lower cholesterol levels, such as fish oil, garlic, guggul, and niacin.

 

Betel may cause stimulant and euphoric effects and add to the effects of stimulants such as caffeine, guarana or ephedra (ma huang).

 

Betel has been reported to deplete an essential vitamin (thiamine), and theoretically may cause neurologic damage including Wernicke-Korsakoff syndrome (confusion, poor muscle coordination, eye movement problems, and amnesia). Theoretically, simultaneous long-term use of betel and alcohol may lead to an increased risk of oral cancer.