The areca nut, also called betel nut, is the seed of a palm belonging to the areca genus (Areca catechu). The palm is originally native to the Philippines, but was carried widely through the tropics by the Austronesian migrations and trade since at least 1500 BCE due to its use in betel nut chewing. It is widespread in cultivation and is considered naturalized in much of the tropical Pacific (Melanesia and Micronesia), South Asia, Southeast Asia, and parts of east Africa. It is not to be confused with betel (Piper betle) leaves that are often used to wrap it. The practice of betel nut chewing, often together with other herbs as a stimulant drug, dates back thousands of years, and continues to the present day in many countries.

Areca nut chewing is addictive due to the presence of areca alkaloids, primarily arecoline, and causes adverse health effects, mainly oral and esophageal cancers, as well as cardiovascular disease. When chewed with additional tobacco in its preparation (like in gutka), there is an even higher risk, especially for oral and oropharyngeal cancers. With tobacco it also raises the risk of fatal coronary artery disease, fatal stroke, and adverse reproductive effects, including stillbirth, premature birth, and low birth weight. Its consumption by around 600 million people worldwide, mainly of South and Southeast Asian origin, has been described as a neglected global public health emergency.

Etymology

The term areca originated from Dravidian languages, cognates of which are:

The terms dates back to the 16th century, when Dutch and Portuguese sailors took the nut from India to Europe.

Description

The areca nut is not a true nut, but rather the seed of a fruit categorized as a berry. It is commercially available in dried, cured, and fresh forms. When the husk of the fresh fruit is green, the nut inside is soft enough to be cut with a typical knife. In the ripe fruit, the husk becomes yellow or orange, and as it dries, the fruit inside hardens to a wood-like consistency. At that stage, the areca nut can only be sliced using a special scissors-like cutter.

Usually, for chewing, a few slices of the nut are wrapped in a betel leaf along with calcium hydroxide (slaked lime) and may include clove, cardamom, catechu resin (kattha), or other spices for extra flavouring. Betel leaf has a fresh, peppery taste, but it can also be bitter to varying degrees, depending on the variety.

Areca nuts are chewed for their effects as a mild stimulant, causing a warming sensation in the body and slightly heightened alertness, although the effects vary from person to person.

In parts of India, Sri Lanka, southern China, and Southeast Asia, areca nuts are not only chewed along with betel leaf, but are also used in the preparation of Ayurvedic and traditional Chinese medicines. Powdered areca nut is used as a constituent in some dentifrices. Other traditional uses include the removal of tapeworms and other intestinal parasites by swallowing a few teaspoons of powdered areca nut, drunk as a decoction, or by taking tablets containing the extracted alkaloids. According to traditional Ayurvedic medicine, chewing areca nut and betel leaf is a good remedy against bad breath.Naveen Patnaik, The Tree of Life Diplomat Edmund Roberts noted that Chinese people would mix areca nut with Uncaria gambir during his visit to China in the 1830s. After chewing a betel nut, the red residue is generally spat out. Accordingly, places have banned chewing this nut to avoid eyesores.

Chemistry The major alkaloid in betel nut is arecoline, a non-selective partial agonist of muscarinic and nicotinic acetylcholine receptors. There are other compounds, such as arecaidine, guvacine, isoguvacine, and guvacoline. Tannins present in betel nut are mainly proanthocyanidins along with catechins and arecatannin. Two new alkaloids were recently discovered and named acatechu A and acatechu B. Several non-alkaloid compounds including benzenoids, terpenes, carboxylic acids, aldehydes, alcohols, and esters were also identified.

Toxicity

Chewing areca nut increases the risk of multiple forms of cancer and cardiovascular disease, with or without added tobacco.

Betel nut chewing causes an increased risk of head and neck cancers and esophageal cancer. Betel quid affects almost all parts of the human body, including the brain, heart, lungs, gastrointestinal tract and reproductive organs. It can cause myocardial infarction, cardiac arrhythmias, liver damage, asthma, type II diabetes, hyperlipidemia, metabolic syndrome, hypothyroidism, prostate hyperplasia and infertility. Habitual chewing of areca nuts increases the risk of cirrhosis and hepatocellular carcinoma. Chewing areca nuts is a cause of oral submucous fibrosis, a condition which may progress to mouth cancer. It has also been linked to throat cancer.

When chewed with additional tobacco in its preparation (like in gutka), there is an even higher risk for cancer, especially for oral and oropharyngeal cancers. With tobacco, it also raises the risk of fatal coronary artery disease, fatal stroke and non-fatal ischemic heart disease

The harm caused by consumption of areca nuts worldwide was classified in 2017 as a "neglected global public health emergency".

Indian government and agriculture ministry is probing the IARC report as a misconception. Significant opposition and contradictions in the IARC report has been reported in India. One such contradiction being, Arecoline, one of arecanut's principal constituents, is classified under Group II B (possibly carcinogenic to humans). Hence CAMPCO an Indian farmer co-operative is recommending IARC to re-classify arecanut from Group I to Group II-B

During pregnancy Women who chew areca nut formulations, such as paan, during pregnancy significantly increase adverse outcomes for the baby. Betel quid chewing can cause stillbirth, premature birth, and low birth weight.

Using tobacco or areca nuts during pregnancy significantly increases adverse outcomes for the baby. The habit is associated with higher incidences of preterm birth and low birth weight and height. Biologically, these effects may be a consequence of the arecoline that is found in areca nuts. The habit also exposes the fetus to various other toxic components linked to cancer.

Production In 2023, world production of areca nuts was 2.3 million tonnes; India provided 60%, while Bangladesh and Myanmar were secondary producers, with the three countries together accounting for about 87% of the world total. The State of Karnataka in India alone produced 80% of country's overall production in 2020.

Consumption South Asia

In India (the largest consumer of areca nut) and the rest of the Indian subcontinent, the preparation of nut with or without betel leaf is commonly referred to as paan. It is available practically everywhere and is sold in ready-to-chew pouches called pan masala or supari, which is the dried form of the areca nut, as a mixture of many flavours whose primary base is dried areca nut crushed into small pieces. Poor people, who may eat only every other day, use it to stave off hunger pangs. Pan masala with a small quantity of tobacco is called gutka. The easily discarded, small plastic supari or gutka pouches are a ubiquitous pollutant of the South Asian environment. Some of the liquid in the mouth is usually disposed of by spitting, producing bright red spots wherever the expectorate lands.

In the Maldives, areca nut chewing is very popular, but spitting is frowned upon and regarded as an unrefined, repulsive way of chewing. Usually, people prefer to chew thin slices of the dry nut, which is sometimes roasted. Killi, a mixture of areca nut, betel, cloves, cardamom and sugar is sold in small home-made paper pouches. Old people who have lost their teeth keep "chewing" by pounding the mixture of areca nut and betel with a small mortar and pestle.

Southeast Asia

In Thailand, the consumption of areca nut has declined gradually in the last decades. The younger generation rarely chews the substance, especially in the cities. Most of the present-day consumption is confined to older generations, mostly people above 50. Even so, small trays of betel leaves and sliced tender areca nut are sold in markets and used as offerings in Buddhist shrines.

In the northern Philippines, particularly the Cordillera Administrative Region, betel nut chewing remains prominent to the point that restrictions and fines have been established in urban areas such as Baguio City in the Benguet province. These restrictions were made under the idea that momma or moma (betel nut) chewing and spitting are improper during public transportation drivers' work hours and are considered stains to the city roads and sidewalks. Despite these restrictions, betel nut thrives across the Cordilleran market. An example of its commerciality can be observed in Ifugao, one of the provinces of the Philippine Cordilleras, where betel nuts are high-demand products sourced from the province's different cities and municipalities.

In Indonesian, the act of chewing betel nut is known as makan pinang, while in the Papua Province of Indonesia, it is known simply as pinang. The Pinang scissor was developed specifically for cutting it.

Oceania In Papua New Guinea (PNG), betel nuts are referred to in Tok Pisin as buai, and grow abundantly on the northern coast, in Wewak and Madang. A controversial ban on selling and chewing betel nut in public places in Port Moresby, introduced in 2014 by the governor, was lifted in 2017. Because the popular nut continued to be smuggled in, prices rose dramatically. Police enforced the ban rigorously, and in 2015 two betel nut sellers died in Hanuabada after police reservists fired on a crowd. The governor of Port Moresby introduced another ban on the nut, restricted to an area in the business district of the city in July 2023. However many people make a living out of selling betel nut, so are resistant to bans in their areas. On Manus Island, young men are exposed to piracy when they use small boats to travel to the northern coast to purchase betel nuts to trade, and several have disappeared.

In Australia, the importation, use, and sale of areca nut is banned, but it has been sold illegally in several South Asian supermarkets.

East Asia

In Hainan and Hunan Province, China, where Xiangtan is a center of use and processing, a wide range of old and young people consume areca nut daily. Most, though, consume the dried variety of the nut by itself, without the betel leaves. Some people also consume the areca nut in its raw, fresh form with or without the betel leaves. Betel nuts are sold mostly by old women merchants, but the dried version can be found in shops that sell tea, alcohol, and cigarettes.