Betel quid and health

  • By Dr. Thein Tun
    (People’s Health Foundation)

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Do you know?
Which is the most tobacco consuming region in the world?
Although every country has tobacco chewers, 89 percent of them live in Southeast Asia.

Which countries consume betel quid most?
Betel quid chewing is an age-old tradition in Pakistan, India, Nepal, Sri Lanka, Bangladesh, Myanmar, Thailand, Laos Cambodia, Vietnam, Malaysia, Chinese Taiwan, southern China, Indonesia, Philippines and Pacific Island countries . Some countries are seeing drop in the number of betel quid chewers among youths, especially in the cities, while others facing an increase in their population. The biggest betel quid chewers are in Palau (a Pacific Island country), Bangladesh and Myanmar.

Do you know the Myanmar’s betel consumption rate?
According to 2009 national statistics, 29.7 percent of adults chew betel quid in Myanmar where 51.4 percent of men are betel quid chewers. As for women, the percentage is 16.1. Sadly, the consumption rate increased to 43.2 percent of all adults in 2014. In gender-wise, 62.2 percent of men is betel quid chewers while the percentage of their female counterparts is 24.1.

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What are Health hazards of tobacco an ingredient of betel quid
Normally, a roll of cigarette has 0.5 gram to 1.0 gram of tobacco or 10 milligrams of nicotine. The amount of tobacco contained in a betel quid depends on the varied choice of taste of the chewer. It is possible that more nicotine enters into the blood of a betel quid chewer than a smoker. It is believed that a small amount of nicotine can make a person fresh and alert, while larger amount may stabilize the mind and reduce anxiety. Moreover this chemical agent can give a pleasant feeling. So, some people are addicted to nicotine. Addiction to nicotine is the same as the cocaine or heroin addiction. Nicotine can increase the pulse rate from 10 to 20 in a minute and increase blood pressure from 6 mmHg to 10 mmHg.
It also increases cholesterol in the blood, and worsens the heart problem. Nicotine is related to abortion, and other adverse effects such as pre- and postnatal growth and increases the risk of fetal mortality, morbidity, cognitive development, and behavior of children and adolescents. Tobacco-specific Nitrosamines, a chemical agent contained in tobacco can cause several types of cancers including mouth and oral cancers. Cancer risk due to tobacco use depends on the amount of Nitrosamines it contains. But no tobacco is risk free. Even in a country like Sweden where tobacco is processed to make it germ free, the containment of Nitrosamines in one gram of tobacco is from 601 to 585 nano-grams. The amount of Nitrosamines is three times higher than Sweden in the US where tobacco is processed under Factory Fermentation System, and the amount of Nitrosamines is from 170 to 500 times higher than Sweden in Sudan, an African country, where tobacco is treated under Compost Pile Fermentation method. More Nitrosamines volume means greater cancer risk.
Many studies have shown a convincing link between betel nut use and cancer of the mouth and esophagus. Another study reports that betel nut users are at a higher risk for oral sub-mucous fibrosis. This incurable condition can cause stiffness in the mouth and eventually the loss of jaw movement.
Regular chewing of betel nut can also cause gum irritation and tooth decay. Teeth may become permanently stained deep red or even black.

Do you think betel quid without tobacco is safe?
Arecoline that contains in betel nut or areca nut is a chemical agent like the Nitrosamines that can be addicted. A wrong belief is that Arecoline can give greater concentration, activeness and pleasure. In fact, betel nut worsens bronchitis and heart problems, accelerates pulse, and causes diabetes and low birth weight. Moreover, Areca Nut-Specific Nitrosamine is related to various types of cancers including the development of mouth cancer (oral squamous cell carcinoma) and its precursors such as leukoplakia and submucous fibrosis. Papua New Guinea where the young and old have the habit of chewing betel nut without tobacco has a high oral cancer rate.

To what degree of health hazard betel quid consumption can cause?
According to the statistics collected in 2014, out of 100 male adults 43.2 in Myanmar chew betel quid. Latest census indicates that the country’s adult population is 33.7 million. So the country has 14.5 million betel quid chewer adults. Actual number can be higher. According to a research, 85 percent of chewers prefer tobacco-added quid. Moreover, signs of oral cancer development can be found in 8.5 percent of the chewers. Similarly, a research jointly conducted by Japanese experts and Myanmar Dental Association in Mawlamyine and Hpa-an in 2015-2016 showed that 7.6 percent of chewers has signs of oral cancer development. If not properly treated in the early stage they can be turned into dreadful cancer disease.
These figures show the extent of cancer problem in Myanmar. Cancer development rate of tobacco-added betel quid chewers is 29 times higher than the non-chewers and the tobacco-free chewers six times higher. Over 250,000 people die of tobacco consumption in the world annually before suffering from chronic illness. As chewers are likely to die early or suffering from chronic disease without earning money, they will become an economic burden for the family.
The nation has more cancer patients than the numbers that treatment centres and hospital wards can accommodate and cure for them. If the betel quid chewing rate increase continues at the current rate, health problem will be a big burden for the country in the future. So we all should make collective efforts to discourage and reduce the betel quid chewing habit.
(Translated by TMT)

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