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Complementary & Alternative Medicine
Index of Herbal Medicines, Supplements and Therapies
The decision to use products containing or claiming to contain betel nut should be carefully considered.
Betel Nut (Areca catechu)
Be aware that the U.S. Food and Drug Administration does not strictly regulate herbs and dietary supplements. There is no guarantee of strength, purity or safety of products containing or claiming to contain betel nut. Decisions to use herbs or supplements should be carefully considered. Individuals using prescription drugs should discuss taking herbs or supplements with a pharmacist or health care professional before starting.
Betel nut use refers to a combination of three ingredients: the nut of the betel palm (Areca catechu), part of the Piper betel vine and lime. Scientists have studied betel nut for the following health problems:
Central nervous system stimulant
Betel nut may cause stimulant and euphoric effects. As a result, it is sometimes used recreationally. However, the known toxicities of chewing betel nut likely outweigh any possible benefits.
Betel nut has been studied for use after cerebrovascular accidents or stroke. Although some studies have suggested that betel nut extract may improve speech, bladder control and muscle strength, these studies have been small, with flaws in their designs. It is not clear if the possible benefits are worth the risks associated with betel nut use.
Early studies suggest that chewing betel nut may provide benefits for people diagnosed with schizophrenia. However, there are no well-designed studies evaluating this claim in humans, and it is not clear whether the possible benefits of chewing betel nut are worth the risks.
One study suggests that chewing betel nut may reduce the risk of anemia in pregnant women, but it is not clear what effect betel nut truly has in this setting. It is not recommended that pregnant women chew betel nut because of a risk of cancer or birth defects.
Betel nut was once used in toothpaste to prevent cavities. Laboratory studies suggest that betel nut may have antibacterial effects, which may reduce the development of cavities. However, other therapies to prevent tooth decay are safer, and the risks associated with betel nut likely do not outweigh the possible benefits.
Although betel nut has been suggested as a therapy to prevent or protect against ulcerative colitis, it is unlikely that the benefits are worth the risks.
Betel nut has been shown to produce large amounts of saliva in people who chew betel nut. However, the toxic effects associated with its use probably do not outweigh the benefits.
Betel nut has been suggested for many other uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially very serious and even life-threatening. You should consult a health care professional before taking betel nut for any unproven use.
Veterinary treatment for worms
People should avoid betel nut if they have a known allergy to betel nut or any member of the Palmaceae plant family. Signs of allergy may include rash, itching or difficulty breathing.
Although betel nut is used recreationally, it is not considered safe, especially when used in high doses or for long periods of time. Some people may experience abnormal skin color after handling betel leaves. Vision abnormalities may also occur. Betel nut may cause or worsen conditions that involve tremors, muscle stiffness, involuntary mouth and face movements or difficulty moving parts of the body. Seizure has been reported with high doses.
Some people may experience increased body secretions, including increased production of saliva, tears, sweat, diarrhea, nausea, vomiting and stomach cramps. Or betel nut use may lead to urinary incontinence, fever and flushing.
Use of betel nut has been associated with confusion, difficulty walking, memory lapse and anxiety. Some of these symptoms may be worse in people who have used betel nut for long periods of time and stop abruptly. In theory, chewing betel nut may cause seizures or even death. Chest pain, heart attacks, irregular heart rhythms, rapid heartbeat and altered blood pressure have occurred after chewing betel nuts. People may become dependent on the effects of the herb.
People who use betel nut have a greater tendency to have periodontal disease, fibrous tissue in the mouth and throat and inflammation and cancer in the mouth. There is also an increased risk of liver cancer, cervical cancer and cancer in the stomach, prostate, lungs and sweat glands. Some people experience difficulty breathing or worsening of asthma. Some of these adverse effects may be caused by betel nut allergies. Other side effects may include kidney abnormalities, increased skin temperature, abnormal thyroid function or altered blood sugar levels. Betel nut chewers may have a higher risk of developing type 2 diabetes. Caution is advised if you take prescription drugs to control your blood sugar levels. Some betel nuts may be contaminated with harmful substances, including aflatoxin or lead. Urinary stones have been associated with betel nut.
Pregnancy And Breast-Feeding
Betel nut is not recommended during pregnancy and breast-feeding because of the risk of birth defects or spontaneous abortion. Metabolic syndrome and withdrawal symptoms in babies have been associated with a mother's use of betel nut.
Interactions with drugs, supplements and other herbs have not been thoroughly studied. The interactions listed below have been reported in scientific publications. If you are taking prescription drugs, speak with a health care professional or pharmacist before using herbs or dietary supplements.
Interactions With Drugs
Some side effects associated with betel nut use, such as increased saliva, tears, sweating and diarrhea, may be increased if the herb is taken with bethanechol. Alternatively, some of the beneficial effects of betel nut may be reduced when the herb is used with drugs such as benztropine (Cogentin), atropine or scopolamine (Transderm-Scop). Betel nut may alter blood sugar levels. Caution is advised if you are taking prescription drugs that may affect blood sugar levels or if you are using insulin. Patients taking oral drugs for diabetes or using insulin should be monitored closely by a health care professional while using betel nut. Dosing adjustments may be necessary.
Adverse effects such as muscle stiffness and tremor may be increased when betel nut is used with drugs such as prochlorperazine (Compazine), and blood pressure may rise to dangerously high levels if betel nut is taken with phenelzine (Nardil). Because betel nut may cause the heart rate to become too slow, it should be used carefully with drugs such as digoxin (Lanoxin), propranolol (Inderal) or verapamil (Calan). Use of betel nut with drugs that lower cholesterol levels may increase their cholesterol-lowering effects, and use with drugs such as enalapril (Vasotec) may enhance blood pressure-lowering effects. Use of betel nut with other stimulants such as amphetamine or nicotine may increase the likelihood of adverse effects.
Alcohol, antibiotics, antidepressants, anti-inflammatories, antipsychotics, glaucoma drugs, immunosupressants and thyroid drugs may interact with betel nut.
Interactions With Herbs And Dietary Supplements
Some side effects associated with betel nut use, such as increased saliva, tears, sweating and diarrhea, may be increased if the herb is taken with lobelia (Lobelia inflata
). Alternatively, some of the beneficial effects of betel nut may be reduced when the herb is used with herbs such as belladonna.
Betel nut may alter blood sugar levels. People using other herbs or supplements that may alter blood sugar levels, such as bitter melon
), should be monitored closely by a health care professional while using betel nut. Dosing adjustments may be necessary.
Blood pressure may rise to dangerously high levels if betel nut is used with herbs that possibly inhibit monoamine oxidase, such as St. John's wort
). Because betel nut may have adverse effects on the heart, it should be used carefully with herbs that may also affect the heart, such as oleander
). Use of betel nut with herbs that lower cholesterol levels, such as red yeast,
may increase cholesterol-lowering effects. It is thought that betel nut may reduce the beneficial effects of vitamin B-1 (thiamine).
Use of betel nut with other stimulants such as caffeine or ephedra (Ma-huang) may increase the likelihood of adverse effects. Use of betel nut with alcohol may increase the risk of cancer in the mouth and throat. Antibiotics, antidepressants, anti-inflammatories, antipsychotics, glaucoma agents, immunosupressants, thyroid agents and vitamin D may interact.
The doses listed below are based on scientific research, publications or traditional use. Because most herbs and supplements have not been thoroughly studied or monitored, safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients even within the same brand. Combination products often contain small amounts of each ingredient and may not be effective. Appropriate dosing should be discussed with a health care professional before starting therapy; always read the recommendations on a product's label. The dosing for unproven uses should be approached cautiously, because scientific information is limited in these areas.
There are no standard or well-studied doses of betel nut, and many different doses are used traditionally. No preparations are recommended because of possible toxic effects.
Adults (Aged 18 Or Older)
Betel nuts are sometimes chewed alone, but they are usually chewed in combination with other ingredients wrapped in a betel leaf and stuck inside the cheek and gum. It has been reported that eight to 30 grams of betel nut may be deadly.
Children (Younger Than 18)
There are not enough scientific data to recommend betel nut for use in children, and betel nut is not recommended because of potential side effects, including the risk of cancer, severe adverse effects on the heart and worsening of asthma.
Betel nut has been suggested as a treatment for many conditions. However, there is not enough scientific evidence to support the use of betel nut for any medical condition. Although betel nut is chewed recreationally, chewing or ingesting betel nut may cause many serious adverse effects, including cancer, effects on the heart and death. Betel nut should be avoided in pregnant or breast-feeding women and in children. Consult a health care professional immediately if you have any side effects.
The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.
- Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
- National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research
Selected Scientific Studies: Betel Nut
Natural Standard has reviewed all of the currently available medical literature to prepare the professional monograph from which this version was created.
Some of the more recent studies are listed below:
- Chitra S, Ashok L, Anand L, et al. Risk factors for esophageal cancer in Coimbatore, southern India: a hospital-based case-control study. Indian J Gastroenterol 2004;May-Jun, 23(3):117-118. Author reply, 118.
- Deng JF, Ger J, Tsai WJ, et al. Acute toxicities of betel nut: rare but probably overlooked events. J Toxicol Clin Toxicol 2001;39(4):355-360.
- Huang Z, Xiao B, Wang X, et al. Betel nut indulgence as a cause of epilepsy. Seizure 2003;12(6):406-408.
- Jeng JH, Chang MC, Hahn LJ. Role of areca nut in betel quid-associated chemical carcinogenesis: current awareness and future perspectives. Oral Oncol 2001;37(6):477-492.
- Kuruppuarachchi KA, Williams SS. Betel use and schizophrenia. Br J Psychiatry 2003;182:455.
- Liao CT, Chen IH, Chang JT, et al. Lack of correlation of betel nut chewing, tobacco smoking, and alcohol consumption with telomerase activity and the severity of oral cancer. Chang Gung Med J 2003;Sep, 26(9):637-645.
- Mannan N, Boucher BJ, Evans SJ. Increased waist size and weight in relation to consumption of Areca catechu (betel-nut): a risk factor for increased glycaemia in Asians in east London. Br J Nutr 2000;83(3):267-273.
- 8. Natural Standard Research Collaboration, Chief Editors: Ulbricht C, Basch E, Natural Standard Herb and Supplement Reference Evidence-Based Clinical Reviews, USA: Elsevier/Mosby, 2005.
- Phukan RK, Ali MS, Chetia CK, et al. Betel nut and tobacco chewing: potential risk factors of cancer of oesophagus in Assam, India. Br J Cancer 2001;85(5):661-667.
- Shiu MN, Chen TH, Chang SH, et al. Risk factors for leukoplakia and malignant transformation to oral carcinoma: a leukoplakia cohort in Taiwan. Br J Cancer 2000;82(11):1871-1874.
- Stoopler ET, Parisi E, Sollecito TP. Betel quid-induced oral lichen planus: a case report. Cutis 2003;71(4):307-311.
- Sullivan RJ, Allen JS, Otto C, et al. Effects of chewing betel nut (Areca catechu) on the symptoms of people with schizophrenia in Palau, Micronesia. Br J Psychiatry 2000;177:174-178.
- Sullivan RJ, Andres S, Otto C, et al. The effects of an indigenous muscarinic drug, Betel nut (Areca catechu), on the symptoms of schizophrenia: a longitudinal study in Palau, Micronesia. Am J Psychiatry. 2007 Apr;164(4):670-3.
- Tsai JF, Chuang LY, Jeng JE, et al. Betel quid chewing as a risk factor for hepatocellular carcinoma: a case-control study. Br J Cancer 2001;84(5):709-713.
- Tung TH, Chiu YH, Chen LS, et al. A population-based study of the association between areca nut chewing and type 2 diabetes mellitus in men (Keelung Community-based Integrated Screening programme No. 2). Diabetologia 2004;Oct, 47(10):1776-1781.
- Yin XM, Peng JY, Gao YJ. Clinical study on the relationship between tooth abrasion and the habits of chewing betel nut. Hunan Yi Ke Da Xue Xue Bao 2003;Apr, 28(2):171-173.
Last updated September 02, 2008
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