Betel nut (Areca catechu L.)
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.
