Introduction:
Areca nut, or betel nut, is a berry that is widely grown in tropical countries. It can be addictive due to frequent usage; in fact, it remains one of the most widely used masticators in rural parts of India. It is estimated by the World Health Organization (WHO) that around 600 million people worldwide use some form of betel nut or arecanut. Many individuals chew arecanut to experience the energy boost it provides. The evidence of health benefits of arecanut is limited. The berry contains alkaloids that have great potential for oro-systemic carcinogenicity and multisystemic ill effects.
How Is Areca Nut Consumed?
The knowledge about areca nut and its effects has now been elucidated with oncologic research, and the awareness is now increasing rapidly with publications and case evidence that are being presented globally by oral surgeons, oncologists, and clinical researchers.
Areca nut grows from Areca catechu seeds, typically found in the tropical Pacific regions, parts of Asia, and also some parts of East Africa. It is commonly called betel nut as, mostly, it is chewed after being wrapped with betel leaves (called paan) or if mixed with tobacco (called betel quid).
The composition and the mode of usage vary across populations and countries. Areca nut remains the fourth most widely consumed addictive substance globally after nicotine, ethanol, and caffeine, consumed by nearly 10 percent of the world's population. Chewing areca nuts is a detrimental habit that begins from a younger age, and children can be seen freely consuming the same, especially in the rural belts.
What Is the Role of Areca Alkaloids?
Though other substances are also part of areca nuts, like tannins, polyphenols, catechins, etc., the highest concentration of compounds in this nut is that of alkaloids. The polyphenols present, such as safrole, can also contribute to metabolite toxicity in addition to the alkaloid effects.
Areca nut is perceived as a harmless substance by many individuals, given its easy and wide availability, and is advertised as such by most manufacturers. Ayurveda specialists often recommend areca nut chewing to many people owing to its anti-inflammatory, antioxidant, analgesic, antiulcer, and neuroprotective properties as a means to balance the Pitta and Kapha doshas (components of ayurvedic treatment). The central and peripheral pathways usually mediate the analgesic effect of areca nut. However, its detrimental impact worsens or aggravates systemic side effects making its use completely counterproductive and avoidable due to its potential carcinogenicity.
There are four forms of alkaloids present in areca nuts that are:
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Arecoline.
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Arecaidine.
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Guvacoline.
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Guvacine.
The role of these alkaloids has been implicated by research as an important causative of oral cancer in predisposed individuals and regular areca nut users. Nitrosamines, formed as byproducts of the areca alkaloids, such as methylnitrosamino propionitrile, are the most carcinogenic compounds. Research has yielded substantial evidence for potential carcinogenicity linked directly to oral and esophageal cancers.
What Are the Systemic Effects of Areca Nut?
Carcinogenicity: The IARC review concludes that the areca nut is carcinogenic, especially on regular or repeated use. It is primarily linked to cancers of the oral cavity, the pharynx, and the esophagus. Recent research sheds light on the potential link between habitual areca nut consumption and hepato-biliary and uterine cancers.
Endocrine System: Areca nut has the ability to impact the endocrine system negatively and is linked to risks of individuals developing hypothyroidism, prostate hyperplasia, infertility, etc.
Immune system: The immune system is also impacted because of the ability of the areca nut to suppress normal T-cell activity. This subsequently leads to decreased cytokine release, ultimately altering healthy immunity.
In Pregnancy: Intrauterine exposure to areca nut induces potential issues in pregnancy and delivery, such as the possibility of low birth weight in infants, preterm birth, and even neonatal withdrawal syndrome.
Dependency and Withdrawal Syndromes: Areca nut use is also associated with these syndromes, as areca nut is associated with addiction, mild euphoria, a state of relaxation, mental satisfaction, etc. The key characteristics of withdrawal syndrome are related to the further effects of insomnia, mood swings, etc. The affected individuals may also feel irritable and anxious. The effects may be comparable to Amphetamine use (which produces similar effects in the CNS).
Cardiovascular System: Heart palpitations, increased blood pressure and body temperature, frequency of flushing, and sweating within minutes of areca nut consumption have also been reported in clinical studies.
Studies demonstrate that an increase in facial temperature by 0.5 to 2 degree Celsius is directly related to the consumption of areca nut, with pronounced effects within a few minutes after consumption.
On Stress and Adrenal Gland Hormones: Areca nut can induce adrenal chromaffin cells to release catecholamines that can contribute to systemic stress.
Pre-existing Systemic Disease Aggravation: Clinical research implicates that areca nut consumption may aggravate pre-existing conditions like myocardial infarction, neuronal injury, obesity, cardiac arrhythmias, hepatic toxicity, asthma, type-II diabetes, hyperlipidemia, metabolic disorders, etc.
Conclusion:
Globally, India has one of the highest incidences of oral cancers, approximately up to 30 percent of the total cases of cancer. Dentists and maxillofacial surgeons should hence spread awareness about the potentially detrimental effects and oro-systemic negative impact of areca nut. With its carcinogenic capacity, it is one of the predisposing risk factors for oral cancer load. To conclude, areca nut is indeed an addictive substance consumed globally with widespread indulgence through different age groups and populations. Oral physicians and health care providers should educate the general public about the detrimental health impact of regular areca nut consumption to combat the global disease load of oral cancer and its multiorgan effects.
