Is your daily kwa/ pan making you diabetic, obese and a prime candidate for cancer?

Dr Nelson Loitongbam *

Betal Nut / Areca Nut/ Kwa - Snaps as taken by Sisir Banga

Our motherland is a strange place, every second person in our state seems to be a kwa/paan chewer. Our people are so much addicted to paan that the demand for it is phenomenal. Even in the time of grave crises when prolonged blockades or landslides cut-off the two lifelines of the state, when essential commodities were scarce and life saving medicines were in short supply it is common knowledge that most airlines were forced to lift betel leaf as cargo leaving behind those life saving medicines.

Areca nut (Areca catechu)/betel quid is said to be the fourth most commonly used psychoactive substance in the world and is chewed regularly by at least 10-20% of the world's population. Chewing areca nut, also known as betel nut, alone or as betel quid (betel nut rolled in betel leaf with slaked lime) is an important cultural practice in some regions in south and south-east Asia and the Asia Pacific. It is said to have effects such as mild euphoria and a sense of wellbeing, and increased alertness. It also gives a warm sensation in the body.

The effects of chewing betel nuts are mainly due to the nut's active ingredient arecoline, an alkaloid which affects the central and autonomic nervous systems. However, it also causes palpitations and increases heart rate and blood pressure, causes stomach upsets and dizziness; and in the long run, it can cause mouth ulcers, peptic ulcers and increases risk of heart disease.

But here comes the knockout punch, those who like chewing kwa (supari/ paan) now have another disease to worry about apart from cancer. Studies collated recently show that Kwa (supari, or areca nut) can also cause metabolic syndromes.

Metabolic syndrome is the name of group of risk factors - large waistline (abdominal obesity), high triglyceride levels, low HDL cholesterol levels, high blood pressure and high fasting sugar - that raises the risk of heart disease, diabetes and stroke.

People who chewed areca nut with tobacco additives were significantly more likely to have metabolic syndrome. The tobacco content of these nuts may be mediating some additional metabolic changes leading to metabolic syndrome.

Out of eight studies (conducted at a Saudi university for 6-20 years and in more than 50,000 individuals), two associated areca nut chewing with hyperglycemia and type 2 diabetes, while five reported an association with metabolic syndrome. Four studies related it with obesity and increased body mass index (BMI). Meanwhile, higher tri-acylglycerol levels were reported in one study among areca nut chewers compared to non-chewers," said the review.

A Taiwanese case study reported a positive association of milk-alkali syndrome with betel nut chewing. Milk-alkali syndrome is a condition in which there are high levels of calcium (hypercalcemia) and a shift in the body's acid/base balance towards alkaline, termed as alkalosis. High levels of vitamin D can worsen this condition.

Researchers at the Dow University of Health Sciences, Karachi, Pakistan studied 1070 individuals in Karachi through questionnaire, blood sampling and logistic regression analyses to investigate the relationship between areca nut chewing and metabolic syndrome.

They found that-

o Areca nut chewers who were less than 40 years of age were 4.3 times more likely to have metabolic syndrome after adjusting for social class, compared to non-chewers.

o Areca nut chewers who were 40 years or more were four times more likely to have metabolic syndrome after adjusting for social class, compared to non-chewers.

o Metabolic syndrome was significantly higher among female areca nut chewers compared with their male counterparts.

o Areca nut chewers with tobacco additives had higher odds of metabolic syndrome compared with raw areca users.

o Areca nut chewing was associated with increased odds of central obesity (1.46 times among raw areca nut users and 2.02 times among areca users with tobacco additives).

Another study, conducted in London and published in the British Journal of Nutrition showed a direct association between supari and waist size.

India has highest oral cancer cases, tobacco guilty, areca nut too

India has the dubious distinction of having the world's largest number of oral cancer patients with an annual age-standardised incidence of 12.5 per 1,00,000, says Dr Pankaj Chaturvedi, Associate Professor, Department of Head and Neck Oncology, Tata Memorial Hospital, Mumbai. He also said, "Many animal studies have shown that feeding areca nuts to young adult mice induces permanent glucose intolerance in a significant proportion of the animals."

Oral cancer accounts for 9.4 per cent of all cancers in India — oral cancer is not a common d disease in the west — and continues to be the major cause of cancer-related death in Indian men. Apart from tobacco, a lesser known reason for the epidemic proportion of oral cancer in India is also rampant use of areca nut chewing, he points out. Control over areca nut or betel nut is mandatory if India wants to reduce its cancer burden, especially oral cavity cancer, Chaturvedi says in the recent issue of the International Journal of Head and Neck Surgery. Like tobacco, areca nut or betel nut, a psycho-stimulant and an addictive substance, is a carcinogen.

The cancer causing properties of areca nut have been reported in various studies. The WHO and International Agency for Research on cancer classified areca nut as Group 1 human carcinogens with evidence of increased risk of precancerous oral lesions.

Drain on Economy

Almost all of the ingredients that go into making your poisonous Kwa matap are imported from other states. If we make a modest estimate that 30% of our population are habitual Kwa chewers that equates to approximately 7.5 lakh individuals and if they consume 2 pieces of Kwa @ Rs. 10/piece, then the total expenditure incurred daily is 1.5 crores of rupees and if they consume 5 pieces/ day the cost involved is a whopping 3.75 crores of rupees that how greatly it affects our state's economy. That's a huge drain on the economy of a poor state like Manipur. The time to act is now… Now we all know the harmful effects of this innocuous habit. Manipuris are a constant presence at the Tata Memorial Cancer Hospital, Mumbai. Our generation is obese, hypertensive, diabetic with huge waistlines and dying young. Our economy is in a shambles and adding to the woes is this useless habit, what more reminder do we need to kick this habit and root it out from our society.