A tough nut to crack

Prof. Ravi Mehrotra

Areca nut (supari in Hindi), the dried seed of the palm tree, Areca catechu, is the fourth most commonly used psychoactive substance in the world after caffeine, nicotine, and alcohol. An estimated 600 million people chew it, with southern Asia, especially India, Myanmar, Bangladesh and Pakistan, being high prevalence areas.

Areca nut consumption is not only culturally ingrained in India but has also acquired large commercial potential; it is used as a key ingredient in several kinds of smokeless tobacco (SLT) preparations. In addition, non-tobacco brand extensions are also aggressively marketed and advertised leading to higher areca nut use in India. The Global Adult Tobacco Survey India Report 2016-17, says 8% of the population ingests areca nut.

Health risks

Areca nut chewing produces a sense of euphoria, heightened alertness, sweating, salivation, a warm sensation in the body, and a feeling of having an increased capacity to work. Arecoline, the major alkaloid of betel nut, has been thought to be responsible for most of these claimed effects. Many labourers chew large amounts of areca nut while at work to enhance their productivity. It is suggested that chewing it leads to habituation, withdrawal, and addiction, although the underlying mechanisms remain under-researched and thus poorly understood.

Chewing areca nut is a risk factor for general and central obesity; it impairs blood sugar levels and delimits blood pressure control. Regular use stains the mucosa, gums, and teeth. It also acts as an abrasive and tends to wear off the tooth’s surface, causing fracture of a tooth in chronic chewers, besides, recession of gums and abrasion of exposed root surfaces. Some studies have shown that it causes anti-ovulatory and abortion-causing effects and affects newborns by causing a lower birth weight and reduced birth length. Available evidence suggests that areca nut is the cause of oral submucous fibrosis, a potentially cancerous condition in humans. Transformation of this disease to oral cancer has been estimated to be between 2% and 8%. It can also cause cancers of the liver, oesophagus, stomach, lung and cervix.

Need for regulation

In India, there are hardly any regulations on the use of areca nut. When used as an ingredient in smokeless tobacco, it was subject to regulations under the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003. However, the government took a positive step by introducing the Food Safety and Standards (Licensing and Registration of Food Businesses) Regulation, 2011, which prohibits tobacco and nicotine use as an ingredient in any food item. Considering that areca nut is classified as food, its use in chewing-tobacco products is now banned.

With its adverse health effects, and given the huge number of users, there is an urgent need to step up regulation of areca nut products and their use. Their advertisement, promotion and sponsorship should also be regulated to prevent access by minors and those most vulnerable.

There is consensus among experts on the following: ban on ‘pan masala’ and ‘supari’ advertisements under Food Safety and Standards Authority of India regulations; standardisation of all tobacco packs with minimum quantity for sale (in weight or unit as may be applicable); and an end to the sale of loose tobacco products. In addition, there should be research into the prevalence of spitting in public places and its impact on SLT and areca nut use and initiation, and a ban on spitting in public to meet the objectives of the national Swacch Bharat Mission. This calls for a national areca nut control programme.

Prof. Ravi Mehrotra and Dr. Amit Yadav are with the ICMR-National Institute of Cancer Prevention and Research, Noida

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