Areca nut and betel quid without tobacco are neither harmful nor carcinogenic: scientific evidences
DOI:
https://doi.org/10.18203/2320-6012.ijrms20262677Keywords:
Arecanut, Betel nut, Areca catechu, Betel quid, Non carcinogenic activityAbstract
Arecanut, the seed of Areca catechu palm, is the most popular chewing substance in most parts of the world. This nut is also called as betel nut in several countries as it is invariably chewed along with the leaf of betel (Piper betle) vine and lime (calcium hydroxide). This chewing mixture is popularly called betel quid. Lots of scientific papers and reports highlight arecanut chewing as carcinogenic to humans. If such observations are really true, the results should be repeatable and consistent in other identical studies. Strangely, several researchers could not arrive at that conclusion in similar studies. Such research papers are retrieved and presented in this review. While going through several reports which highlighted arecanut chewing as dangerous or carcinogenic, it was observed that in most of such papers the conclusions were drawn hastily and lots of lacunae observed in the methodology. Most important one is that in several such studies, data were collected on mixtures of chewing substances such as betel quid, pan masala, gutkha, etc but the authors wrongly titled the paper as arecanut or betel nut chewing as if all such chewing mixtures contain only arecanut. Contamination and adulteration of arecanut, the dosage of arecanut extract used in such experiments were some of the other factors for this ambiguity. These findings underscore the need for specific interventions to address the issue more scientifically.
References
IARC-WHO. Monographs on the evaluation of carcinogenic risks to humans: Betel quid and arecanut chewing and some arecanut derived nitrosamines. 85 IARC, Lyon, France. 2004;37-293.
Changrani J, Gany FM, Cruz G, Kerr R, Katz R. Paan and gutka use in the United States: A Pilot Study in Bangladeshi and Indian-Gujarati Immigrants in New York City. J Immigr Refug Stud. 2006;4(1):99-110.
Rooney D. Betel chewing traditions in South-East Asia. Oxford University Press, Kuala Lumpur, Malaysia. 1993;12-21.
Oxenham MF, Locher C, Cuong NL, Thuy NK. Identification of Areca catechu (betel nut) residues on the dentition of Bronze age inhabitants of Nui Np, Northern Vietnam. J Archaeol Sci. 2002;29(1):1-7.
Kirtikar KR, Basu BD, An ICS. Indian Medicinal Plants. In: Blatter E, Caius JF, Mhaskar KS, eds. Bishen Singh Mahendra Pal Singh, Dehra Dun, India. 1918;2793.
Shizhen L. Compendium of Materia Medica, Book IV, Category of fruits (III). Foreign Languages Press, Beijing, China. 2003;31:2805-10.
Rahmatullah M, Mukti IJ, Haque AKMF, Mollik MAH, Parvin K, Jahan R, et al. An ethnobotanical survey and pharmacological evaluation of medicinal plants used by the Garo tribal community living in Netrakona district, Bangladesh. Ad Nat Appl Sci. 2009;3:402-18.
Tavera THPD. The Medicinal Plants of the Philippines. P. Blakiston’s Son and Co., Walnut Street, Philadelphia. 1901;234-6.
WHO. Areca catechu L. In: Medicinal Plants of Papua New Guinea. World Health Organization, Geneva, Switzerland. 2009;30-1:258.
Rashid M, Shamsi S, Zaman R, Ilahi A. Areca catechu: enfolding of historical and therapeutical traditional knowledge with modern update. Int J Pharmacognosy. 2015;2(5):221-8.
KeshavaBhat S. Arecanut (Areca catechu L): A storehouse of medicines. Ind J Arecanut Spices Med Plants. 2019;21(1):40-55.
KeshavaBhat S, SukeshBhat. Anticancer property of arecanut (Areca catechu L.): A review. Int J Life Sci Biotech Pharma Res. 2024;13(2):128-32.
Kumari HL, Sirsi M, Bhargava MK. Inhibitory activity of Areca catechu on the development of mouse skin tumors induced by the chemical carcinogen 3.4, benzpyrene. J Plantn Crops. 1974;2(1):23-9.
Mori H, Matsubara N, Ushimaru Y, Hirono I. Carcinogenicity examination of betel nuts and Piper betle leaves. Experientia. 1979;35(3):384-5.
Rao AR, Das P. Evaluation of the carcinogenicity of different preparations of arecanut in mice. Int J Cancer. 1989;43:728-32.
Pai SR, Shirke AJ, Gothoskar SV. Long term feeding study in C17 mice administered saccharin coated betel nut and 1,4- dinitrosopiperazine in combination. Carcinogenesis. 1981;2(3):175-7.
Wong TY, Jin YT, Chen HO, Lin LM. Studies on Taiwan betel quid carcinogenicity in Hamster cheek pouch. Chinese Dent J. 1992;11(4):155-62.
Wei PL, Hung CS, Lu HH, Batzorig U, Huang CY, Chang YJ. Areca nut extract (ANE) inhibits the progression of hepatocellular carcinoma cells via activation of ROS production and activation of autophagy. Int J Med Sci. 2021;18(15):3452-62.
Sari LM, Novita CF, Andriany P, Sari DK. The chemotherapeutic activity of areca nut extract increased stromal tumor-infiltrating lymphocytes in 4-nutriquinoline-1-oxide-tumor-induced Sprague-Dawley rats. F1000Research. 2023;11:1571.
Sukirtha R, Krishnan M, Ramachandran R, Kamalakkannan S’ Kokilavani P, Ganesh DS, et al. Areca catechu Linn. derived silver nanoparticles: A novel antitumor agent against Dalton's Ascites Lymphoma. Int J Green Nanotech. 2011;3:1-12.
Fan J, Lin R, Xia S, Chen D, Elf SE, Liu S, et al. Tetrameric acetyl-CoA acetyltransferase 1 is important for tumor growth. Molecular Cell. 2016;64(5):859-74.
Shanta V, Krishnamurthi S. A study of aetiological factors in oral squamous cell carcinoma. Br J Cancer. 1959;13(3):381-8.
Shanta V, Krishnamurthi S. Further study in aetiology of carcinomas of the upper alimentary tract. Br J Cancer. 1962;17(1):8-23.
Nandakumar A, Thimmasetty KT, Sreeramareddy NM, Venugopal TC, Rajanna, Vinutha AT, et al. A population-based case-control investigation on cancers of the oral cavity in Bangalore, India. Br J Cancer. 1990;62:847-51.
Wasnik KS, Ughade SN, Zodpey SP, Ingole DL. Tobacco consumption practices and risk of oro-pharyngeal cancer: a case-control study in central India. 1998. Southeast Asian J Trop Med Public Health. 1998;29(4):827-34.
Phukan RK, Ali MS, Chetia CK, Mahanta J. Betel nut and tobacco chewing: potential risk factors of cancer of oesophagus in Assam, India. Br J Cancer. 2001;85(5):661-7.
Thomas SJ, Bain CJ, Battistutta D, Ness AR, Paissat D, Maclennan R. Betel quid not containing tobacco and oral cancer: a report on a case-control study in Papua New Guinea and a meta-analysis of current evidence. Int J Cancer. 2007;120:1318-23.
Lan TY, Chang WC, Tsai YJ, Chuang YL, Lin HS, Tai TY. Arecanut chewing and mortality in an elderly cohort study. Am J Epidemiol. 2007;165:677-83.
Chue AL, Carrara VI, Paw MK, Pimanpanarak M, Wiladphaingern J, Vaugt M, et al. Is areca innocent? The effect of areca (betel) nut chewing in a population of pregnant women on the Thai-Myanmar border. Int Health. 2012;4:204-9.
Hazarey VK, Erlewad DM, Mundhe KA, Ughade SN. Oral Submucous Fibrosis: study of 1000 cases from central India. J Oral Pathol Med. 2007;36(1):12-7.
Shrihari JSB, Blank MD, Balster RL, Mimi N, Mark N. Areca nut dependence among chewers in a South Indian community who do not also use tobacco. Addiction. 2010;105:1303-10.
Sarode SC, Mahuli A, Sarode GS, Mahuli S. Why only arecanut chewing cannot cause oral submucous fibrosis? Med Hypotheses. 2013;81:47-9.
Jose CT, KeshavaBhat S, Chandran KP, Jayasekhar S, Gowda A. Traditional chewing of arecanut / betel quid and human health-a survey report. Indian J Arecanut Spices Med Plants. 2020;22(1):3-15.
KeshavaBhat S, SukeshBhat, Jagadish, Khandige SN, Kumar P. Chewing farm fresh Betel Quid: a healthy practice in major arecanut (Areca catechu L.) growing region of South India. IOSR J Pharmacy Bio Sci. 2020;15(5):10-21.
Sumanth KN. Pitfalls in research about the role of arecanut in oral diseases. In: Future of arecanut. Varmudy V. ed. Arecanut Research and Development Foundation, Mangaluru, India. 2008;280-6.
KeshavaBhat S, Ashwin D, Mythri S, SukeshBhat. Betel nut chewing and Human Health: Certain glaring lacunae in Research. IOSR J Dental Medical Sci. 2018;17(5):9-15.
KeshavaBhat S, SukeshBhat. How arecanut chewing was made the cause for oral submucous fibrosis and oral cancer: an analysis. Int J Health Sciences Res. 2025;15(6):262-70.
KeshavaBhat S, SukeshBhat, Kumar PK. Effects of arecanut (Areca catechu L) chewing on Human Health: Misleading titles lead to wrong notions. Int J Science Res Methodol. 2021;17(3):95-109.
Murti PR, Bhonsle RB, Gupta PC, Daftary DK, Pindborg JJ, Mehta FS. Etiology of oral submucous fibrosis with special reference to the role of areca nut chewing. J Oral Path Med. 1995; 4: 145-52.
Wu MT, Wu DC, Hsu HK, Kao EL, Lee JM. Relationship between site of oesophageal cancer and areca chewing and smoking.in Taiwan. British J Cancer. 2003;89:1202-4.
Kumar T, Khan M, Gupta CP, Faisal S, Akhtar N, Shrivastava D. Prevalence of Oral Submucous Fibrosis among betel nut chewers dental patients of Patna. Int J Current Res Review. 2017;9(13):62-5.
Warnakulasuriya S, Trivedi C, Peters TJ. Areca nut use: an independent risk factor for oral cancer. BMJ Clin Res. 2002;324(7341):799-800.
Trivedy CR, Craig G, Warnakulasuriya S. The oral health consequences of chewing areca nut. Addiction Biol. 2002;7(1):115-25.
Gupta A, Rao LN. Areca nut an ignored carcinogen of Asian continent in a nutshell. J Global Oral Health. 2021;4(1):67-8.
Warnakulasuriya S, Chen THH. Areca nut and oral cancer: evidence from studies conducted in humans. J Dental Res. 2022;101(10):1139-46.
Rumgay H, Nethan ST, Shah R, Vignat J, Ayo-Yusuf O, Chaturvedi P, et al. Global burden of oral cancer in 2022 attributable to smokeless tobacco and areca nut consumption: a population attributable fraction analysis. Lancet Oncol. 2024;25(11):1413-23.
Downloads
Published
How to Cite
Issue
Section
