Abstract
Betel quid, traditionally prepared with areca nut, betel leaf, and slaked lime, has been consumed for thousands of years, mainly in the form of chewing. Originally used for cultural, medicinal, and ceremonial purposes mainly in South Asian countries, its use has recently spread across the globe due to its psychoactive, euphoric, and aphrodisiac properties. Now it is widely used as a social lubricant and source of financial profit. Unfortunately, the profit motive has led to high rates of habitual consumption with eventual conversion to addiction among young girls and boys. Moreover, the worrisome practice of including tobacco in quid preparations has grown, particularly among pregnant women. Major health concerns include increased rates of malignancy, oral pathology, and cardiovascular, hepatic, fertility, metabolic, and neuropsychiatric disorders. Metabolic disorders and insulin resistance disease states such as type 2 diabetes, obesity, and metabolic syndrome contribute to cognitive decline and neurodegeneration. Mechanistically, the constituents of areca nut/betel quid are metabolized to N-nitroso compounds, i.e., nitrosamines, which are carcinogenic at high doses and cause insulin resistance following chronic low-level exposures. From an epidemiological perspective, the rising tide of insulin resistance diseases including obesity, diabetes, and dementias that now disproportionately burden poor countries has been propagated by rapid commercialization and enhanced access to betel quid. Public health measures are needed to impose socially and ethically responsible barriers to yet another cause of global health disparity.
Highlights
Epidemiological trends reflecting progressively increased prevalence rates of insulin resistance diseases including diabetes mellitus, non-alcoholic fatty liver disease, and Alzheimer’s diseaseInt
This article was generated by a systematic review of primary and summary historical, social, economic, demographic, chemical, epidemiological, and clinical literature pertaining to areca nut/betel quid uses and consumption from 1919 to 2019
Synergistic toxicity resulted when human epithelial type 2 cells were exposed to arecoline plus sodium nitrite compared with that for either agent alone [166] due to the enhanced nitrosation of arecoline by nitrite. These findings suggest that foods and food preparations could potentially modulate the toxicity of betel quid
Summary
Epidemiological trends reflecting progressively increased prevalence rates of insulin resistance diseases including diabetes mellitus, non-alcoholic fatty liver disease, and Alzheimer’s disease. The growing consumption of betel quid, by adolescents and young people, is noteworthy because one of its main constituents, areca nut, contains alkaloids that get metabolized to nitrosamine compounds. Low-dose nitrosamine exposures cause systemic insulin resistance diseases, cognitive impairment, and AD-type neurodegeneration [2,3]. The popular inclusion of tobacco in betel quid preparations could exacerbate the long-term metabolic and neurocognitive adverse effects of areca nut consumption in young people, as has been demonstrated previously in experimental models of low-dose tobacco nitrosamine exposures. This review was inspired by the need to assess the potential role of increased chronic consumption of betel quid, together with the co-consumption of tobacco, as sources of soaring nitrosamine exposures and driving forces for the rising rates of insulin resistance diseases including neurodegeneration in Southeast Asian populations
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