Positive and Negative Health Effects of Long-term Chewing Areca Nut

The habit of chewing areca is a habit of great antiquity. Areca is mainly used as food, medicine, social and religious purposes. It is the fourth most commonly used social drug, ranking after nicotine, ethanol, and caffeine. Areca preparations and specific ingredients differ by the cultural group and individual user. For example, areca nut may be consumed in association with other ingredients mainly tobacco, lime, catechu and all are wrapped in a betel leaf.

A growing body of research evidence over the past few years, mainly in the form of large-scale epidemiological and experimental studies has shown that areca nut taken along with tobacco and/or lime is known to have a deleterious effect of the oral cavity to the extent of causing oral cancer. Both laboratory level and animal studies have confirmed that areca nut alkaloids such as arecoline and its hydrolyzed product arecaidine have the ability to induce oral cancers but the mechanisms by which this occurs are not fully understood. Thus, more research is required to identify the role of arecoline on oral cancer development.

Furthermore, it is important to highlight that chewing areca for up to 20 minutes releases significant amounts of soluble copper to the saliva in the oral cavity. This has led to increased tissue copper which may increase the activity of the copper-dependent enzyme lysyl oxidase. This enzyme activity has been linked in the pathogenesis of several fibrotic disorders, including oral fibrosis.

Moreover, areca in the absence of tobacco may be an independent risk factor for the development of cheek cancers and tongue cancers even though the carcinogenic potential of areca in the absence of other ingredients is less clear.

Based on these research findings it is important to highlight that the chronic chewing of areca may not only result in severe wear of tooth surfaces but also the enamel covering. Moreover, dental root fractures have also been revealed in chronic areca chewers and this could be a consequence of the increased masticatory load that is placed upon the teeth during areca chewing. Several epidemiological studies have also shown that the prevalence of areca-induced lesions on the tongue, particularly in elderly Asian people who have been chronic chewers for long durations. This may lead to taste disturbance and flattening of the palate.

Interestingly, areca nut is beneficial to some extent. Arecoline, the principal alkaloid in areca nut, acts as an agonist primarily at muscarinic acetylcholine receptors. It stimulates the central and autonomic nervous system. This leads to the subjective effects of increased well-being, alertness, and stamina. In addition to that, it is known to improve concentration and relaxation, with other reported effects including the lifting of mood, a sense of well-being, heightened alertness, staving off hunger, aphrodisiac properties and as postprandial digesting.

It has also been shown to have cariostatic property. For example, some research findings suggested that the betel stain, which often coats the surface of the teeth, may act as a shielding polish. Thus, some epidemiological studies carried out in South East Asia suggest that the prevalence of dental caries in areca chewers is lower than in non-chewers. Moreover, the tannin content of areca may have a direct antimicrobial effect against bacteria, including Streptococcus mutans, Streptococcus salivarius and various other microorganisms in the oral cavity that may confer protection against microbial invasion of the tooth. Furthermore, the process of chewing areca stimulates profuse amounts of saliva secretion to the mouth. In the presence of added lime might enhance the pH in the oral surrounding and this may act as a buffer against acid formed in plaque on teeth. Buffering the acid content may also associate with lower dental caries development.

Areca was touted as a folk medicine for digestive health. It was used to facilitate bowel movements and reduce intestinal worms (as used in Ayurvedic medicine).

In conclusion, the use of areca nut chewing has been of centuries old. The general effects of chewing areca nut have much impact not just on the oral cavity but also on the general health of an individual. However, many times, the deleterious effects can outweigh the general effects to a large extent when it becomes a habit. Unfortunately, the habit is becoming prominent among younger individuals. This is the key problem in the food industry because they need to hire employees who do not chew areca nut in order to concern about food hygiene. In such cases, it is very difficult to restrict usage, and it becomes mandatory to curb the habit as “habits die hard”.

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References

Dave, B.J., Trivedi, A.H., & Adhvaryu, S.G. (1992). Role of areca nut consumption in the cause of oral cancers. Cancer, 70, 1017-1040.

Howden, G. F. (1984). The cariostatic effects of betel chewing. PNG Med J, 27, 123-154.

Jeng, J.H., Lan, W.H., Hahn, L.J., Hsieh, C.C. & Kuo, M.Y. (1996). Inhibition of the migration, attachment, spreading, growth and collagen synthesis of human gingival fibroblasts by arecoline, a major areca alkaloid, in vitro. J Oral Pathol Med, 25, 371-376.

Lee, K.W. & Chin, C.T. (1970). The effects of betel-nut chewing on the buccal mucosa: a histological study. Br J Cancer, 24, 433-474.

Trivedy, C. R., Craig, G., & Warnakulasuriya, S. (2002). The oral health consequences of chewing areca nut. Addiction Biology, 7(1), 115-125.

Trivedy, C., Baldwin, D., Warnakulasuriya, S., Johnson, N. W., & Peters, T. (1997). Copper content in Areca catechu (betel nut) products and oral submucous fibrosis. Lancet, 347, 1447.