Betel-chewing
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Betel nut chewing, also called betel quid chewing or areca nut chewing, is a practice in which
areca nut The areca nut ( or ) or betel nut () is the fruit of the areca palm (''Areca catechu''). The palm is originally native to the Philippines, but was carried widely through the tropics by the Austronesian migrations and trade since at least 15 ...
s (also called "betel nuts") are chewed together with
slaked lime Calcium hydroxide (traditionally called slaked lime) is an inorganic compound with the chemical formula Ca( OH)2. It is a colorless crystal or white powder and is produced when quicklime ( calcium oxide) is mixed with water. Annually, approxim ...
and
betel leaves Betel (''Piper betle'') is a species of flowering plant in the pepper family Piperaceae, native to Southeast Asia. It is an evergreen, dioecious vine, with glossy heart-shaped leaves and white catkins. Betel plants are cultivated for their leav ...
for their
stimulant Stimulants (also known as central nervous system stimulants, or psychostimulants, or colloquially as uppers) are a class of drugs that increase alertness. They are used for various purposes, such as enhancing attention, motivation, cognition, ...
and
narcotic The term narcotic (, from ancient Greek ναρκῶ ''narkō'', "I make numb") originally referred medically to any psychoactive compound with numbing or paralyzing properties. In the United States, it has since become associated with opiates ...
effects, the primary psychoactive compound being
arecoline Arecoline is a cholinergic agent, stimulant, and natural product, naturally occurring alkaloid found in areca nut, areca (betel) nuts of the areca palm (''Areca catechu'') found in South Asia, South and Southeast Asia. Its effects, depending on ...
. The practice is widespread in
Southeast Asia Southeast Asia is the geographical United Nations geoscheme for Asia#South-eastern Asia, southeastern region of Asia, consisting of the regions that are situated south of China, east of the Indian subcontinent, and northwest of the Mainland Au ...
,
Micronesia Micronesia (, ) is a subregion of Oceania, consisting of approximately 2,000 small islands in the Northwestern Pacific Ocean. It has a close shared cultural history with three other island regions: Maritime Southeast Asia to the west, Poly ...
,
Island Melanesia Island Melanesia is a subregion of Melanesia in Oceania. It is located east of New Guinea island, from the Bismarck Archipelago to New Caledonia.Steadman, 2006. ''Extinction & biogeography of tropical Pacific birds'' See also Archaeology a ...
, and
South Asia South Asia is the southern Subregion#Asia, subregion of Asia that is defined in both geographical and Ethnicity, ethnic-Culture, cultural terms. South Asia, with a population of 2.04 billion, contains a quarter (25%) of the world's populatio ...
. It is also found among both
Han Chinese The Han Chinese, alternatively the Han people, are an East Asian people, East Asian ethnic group native to Greater China. With a global population of over 1.4 billion, the Han Chinese are the list of contemporary ethnic groups, world's la ...
immigrants and indigenous peoples of
Taiwan Taiwan, officially the Republic of China (ROC), is a country in East Asia. The main geography of Taiwan, island of Taiwan, also known as ''Formosa'', lies between the East China Sea, East and South China Seas in the northwestern Pacific Ocea ...
,
Madagascar Madagascar, officially the Republic of Madagascar, is an island country that includes the island of Madagascar and numerous smaller peripheral islands. Lying off the southeastern coast of Africa, it is the world's List of islands by area, f ...
, and parts of southern China. It was introduced to the
Caribbean The Caribbean ( , ; ; ; ) is a region in the middle of the Americas centered around the Caribbean Sea in the Atlantic Ocean, North Atlantic Ocean, mostly overlapping with the West Indies. Bordered by North America to the north, Central America ...
in colonial times. The preparation combining the areca nut,
slaked lime Calcium hydroxide (traditionally called slaked lime) is an inorganic compound with the chemical formula Ca( OH)2. It is a colorless crystal or white powder and is produced when quicklime ( calcium oxide) is mixed with water. Annually, approxim ...
, and betel (Piper betle) leaves is known as a betel quid (also called ''paan'' or ''pan'' in South Asia), but the exact composition of the mixture varies geographically. It can sometimes include other substances for flavoring and to freshen the breath, like
coconut The coconut tree (''Cocos nucifera'') is a member of the palm tree family (biology), family (Arecaceae) and the only living species of the genus ''Cocos''. The term "coconut" (or the archaic "cocoanut") can refer to the whole coconut palm, ...
,
dates Date or dates may refer to: * Date, the fruit of the date palm (''Phoenix dactylifera'') * Jujube, also known as red date or Chinese date, the fruit of ''Ziziphus jujuba'' Social activity *Dating, a form of courtship involving social activit ...
, sugar,
menthol Menthol is an organic compound, specifically a Monoterpene, monoterpenoid, that occurs naturally in the oils of several plants in the Mentha, mint family, such as Mentha arvensis, corn mint and peppermint. It is a white or clear waxy crystallin ...
,
saffron Saffron () is a spice derived from the flower of '' Crocus sativus'', commonly known as the "saffron crocus". The vivid crimson stigma and styles, called threads, are collected and dried for use mainly as a seasoning and colouring agent ...
,
cloves Cloves are the aromatic flower buds of a tree in the family Myrtaceae, ''Syzygium aromaticum'' (). They are native to the Maluku Islands, or Moluccas, in Indonesia, and are commonly used as a spice, flavoring, or fragrance in consumer products, ...
,
aniseed Anise (; '), also called aniseed or rarely anix, is a flowering plant in the family Apiaceae native to the eastern Mediterranean region and Southwest Asia. The flavor and aroma of its seeds have similarities with some other spices and herbs, ...
,
cardamom Cardamom (), sometimes cardamon or cardamum, is a spice made from the seeds of several plants in the genus (biology), genera ''Elettaria'' and ''Amomum'' in the family Zingiberaceae. Both genera are native to the Indian subcontinent and Indon ...
, and many others. The areca nut can be replaced with tobacco or the two chewed together, and the
betel leaves Betel (''Piper betle'') is a species of flowering plant in the pepper family Piperaceae, native to Southeast Asia. It is an evergreen, dioecious vine, with glossy heart-shaped leaves and white catkins. Betel plants are cultivated for their leav ...
can be excluded. In West Papua, the leaf may be replaced with stem and inflorescence of the ''Piper betle'' plant. The preparation is not swallowed but is spat out after chewing. Chewing results in permanent red stains on the teeth after prolonged use. The spit from chewing betel nuts, which also results in red stains, is often regarded as unhygienic and an eyesore in public facilities in certain countries. Betel nut chewing is addictive and causes adverse health effects, mainly
oral The word oral may refer to: Relating to the mouth * Relating to the mouth, the first portion of the alimentary canal that primarily receives food and liquid **Oral administration of medicines ** Oral examination (also known as an oral exam or ora ...
and
esophageal cancer Esophageal cancer (American English) or oesophageal cancer (British English) is cancer arising from the esophagus—the food pipe that runs between the throat and the stomach. Symptoms often include dysphagia, difficulty in swallowing and weigh ...
s, and cardiovascular disease. When chewed with additional tobacco in its preparation (like in
gutka Gutka, ghutka, or guṭkha () is a type of betel quid and chewing tobacco preparation made of crushed areca nut (also called betel nut), tobacco, catechu, paraffin wax, slaked lime (calcium hydroxide) and sweet or savory flavourings, in India ...
), there is an even higher risk, especially for oral and
oropharyngeal cancer Oropharyngeal cancer, also known as oropharyngeal squamous cell carcinoma and tonsil cancer, is a disease in which abnormal cells with the potential to both grow locally and spread to other parts of the body are found in the oral cavity, in the t ...
s. With tobacco it also raises the risk of fatal
coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), or ischemic heart disease (IHD), is a type of cardiovascular disease, heart disease involving Ischemia, the reduction of blood flow to the cardiac muscle due to a build-up ...
, fatal stroke, and adverse reproductive effects including
stillbirth Stillbirth is typically defined as fetus, fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without vital signs, signs of life. A stillbirth can often result in the feeling of guilt (emotio ...
,
premature birth Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is betwee ...
and
low birth weight Low birth weight (LBW) is defined by the World Health Organization as a birth weight of an infant of or less, regardless of gestational age. Infants born with LBW have added health risks which require close management, often in a neonatal inten ...
. The practice of betel nut chewing originates from Southeast Asia where the plant ingredients are native. The oldest evidence of betel nut chewing is found in a burial pit in the Duyong Cave site of the
Philippines The Philippines, officially the Republic of the Philippines, is an Archipelagic state, archipelagic country in Southeast Asia. Located in the western Pacific Ocean, it consists of List of islands of the Philippines, 7,641 islands, with a tot ...
, an area where
areca palm Areca palm is a common name for several plants and may refer to: *''Areca'', a genus of palms *''Dypsis lutescens'', a palm which is a popular houseplant *''Areca catechu ''Areca catechu'' is a species of palm native to the Philippines culti ...
s were native, dated to around 4,630±250 BP. Its diffusion is closely tied to the
Neolithic The Neolithic or New Stone Age (from Ancient Greek, Greek 'new' and 'stone') is an archaeological period, the final division of the Stone Age in Mesopotamia, Asia, Europe and Africa (c. 10,000 BCE to c. 2,000 BCE). It saw the Neolithic Revo ...
expansion of the
Austronesian peoples The Austronesian people, sometimes referred to as Austronesian-speaking peoples, are a large group of peoples who have settled in Taiwan, maritime Southeast Asia, parts of mainland Southeast Asia, Micronesia, coastal New Guinea, Island Melan ...
. It was spread to the Indo-Pacific during prehistoric times, reaching
Micronesia Micronesia (, ) is a subregion of Oceania, consisting of approximately 2,000 small islands in the Northwestern Pacific Ocean. It has a close shared cultural history with three other island regions: Maritime Southeast Asia to the west, Poly ...
at 3,500 to 3,000 BP,
Near Oceania Near Oceania is the part of Oceania that features greater biodiversity, due to the islands and atolls being closer to each other. The distinction of Near Oceania and Remote Oceania was first suggested by Pawley & Green (1973) and was further el ...
at 3,400 to 3,000 BP;
South India South India, also known as Southern India or Peninsular India, is the southern part of the Deccan Peninsula in India encompassing the states of Andhra Pradesh, Karnataka, Kerala, Tamil Nadu and Telangana as well as the union territories of ...
and
Sri Lanka Sri Lanka, officially the Democratic Socialist Republic of Sri Lanka, also known historically as Ceylon, is an island country in South Asia. It lies in the Indian Ocean, southwest of the Bay of Bengal, separated from the Indian subcontinent, ...
by 3,500 BP;
Mainland Southeast Asia Mainland Southeast Asia (historically known as Indochina and the Indochinese Peninsula) is the continental portion of Southeast Asia. It lies east of the Indian subcontinent and south of Mainland China and is bordered by the Indian Ocean to th ...
by 3,000 to 2,500 BP;
Northern India North India is a geographical region, loosely defined as a cultural region comprising the northern part of India (or historically, the Indian subcontinent) wherein Indo-Aryans (speaking Indo-Aryan languages) form the prominent majority populati ...
by 1500 BP; and
Madagascar Madagascar, officially the Republic of Madagascar, is an island country that includes the island of Madagascar and numerous smaller peripheral islands. Lying off the southeastern coast of Africa, it is the world's List of islands by area, f ...
by 600 BP. From India it spread westwards to
Persia Iran, officially the Islamic Republic of Iran (IRI) and also known as Persia, is a country in West Asia. It borders Iraq to the west, Turkey, Azerbaijan, and Armenia to the northwest, the Caspian Sea to the north, Turkmenistan to the nort ...
and the
Mediterranean The Mediterranean Sea ( ) is a sea connected to the Atlantic Ocean, surrounded by the Mediterranean basin and almost completely enclosed by land: on the east by the Levant in West Asia, on the north by Anatolia in West Asia and Southern ...
. It was present in the
Lapita culture The Lapita culture is the name given to a Neolithic Austronesian peoples, Austronesian people and their distinct material culture, who settled Island Melanesia via a seaborne migration at around 1600 to 500 BCE. The Lapita people are believed t ...
, based on archaeological remains dated from 3,600 to 2,500 BP, but it was not carried into
Polynesia Polynesia ( , ) is a subregion of Oceania, made up of more than 1,000 islands scattered over the central and southern Pacific Ocean. The indigenous people who inhabit the islands of Polynesia are called Polynesians. They have many things in ...
.


Culture

One of the earliest firsthand accounts of betel nut chewing by western authors was from
Ibn Battuta Ibn Battuta (; 24 February 13041368/1369), was a Maghrebi traveller, explorer and scholar. Over a period of 30 years from 1325 to 1354, he visited much of Africa, the Middle East, Asia and the Iberian Peninsula. Near the end of his life, Ibn ...
. He describes this practice as follows: An early European description of betel chewing is from the
Magellan Expedition The Magellan expedition, sometimes termed the MagellanElcano expedition, was a 16th-century Spanish Empire, Spanish expedition planned and led by Portuguese Empire, Portuguese explorer Ferdinand Magellan. One of the most important voyages in th ...
to the
Philippines The Philippines, officially the Republic of the Philippines, is an Archipelagic state, archipelagic country in Southeast Asia. Located in the western Pacific Ocean, it consists of List of islands of the Philippines, 7,641 islands, with a tot ...
in 1521.
Antonio Pigafetta Antonio Pigafetta (; – c. 1531) was a Venetian scholar and explorer. In 1519, he joined the Spanish expedition to the Spice Islands led by Portuguese explorer Ferdinand Magellan, the world's first Magellan's circumnavigation, circumnavigation, ...
describes the practice of betel nut chewing among the natives of the
Rajahnate of Butuan Butuan, sometimes referred to as the Kingdom of Butuan (; Butuanon: ; ; ), was a precolonial Bisaya Hindu polity (''lungsod'') centered around northeastern Mindanao island in present-day Butuan, Philippines. It was known for its gold mining, ...
. Betel quid chewing constitutes an important and popular cultural activity in many Asian and Oceanic countries, including
India India, officially the Republic of India, is a country in South Asia. It is the List of countries and dependencies by area, seventh-largest country by area; the List of countries by population (United Nations), most populous country since ...
,
Bangladesh Bangladesh, officially the People's Republic of Bangladesh, is a country in South Asia. It is the List of countries and dependencies by population, eighth-most populous country in the world and among the List of countries and dependencies by ...
,
Myanmar Myanmar, officially the Republic of the Union of Myanmar; and also referred to as Burma (the official English name until 1989), is a country in northwest Southeast Asia. It is the largest country by area in Mainland Southeast Asia and has ...
,
Cambodia Cambodia, officially the Kingdom of Cambodia, is a country in Southeast Asia on the Mainland Southeast Asia, Indochinese Peninsula. It is bordered by Thailand to the northwest, Laos to the north, and Vietnam to the east, and has a coastline ...
, the
Solomon Islands Solomon Islands, also known simply as the Solomons,John Prados, ''Islands of Destiny'', Dutton Caliber, 2012, p,20 and passim is an island country consisting of six major islands and over 1000 smaller islands in Melanesia, part of Oceania, t ...
,
Thailand Thailand, officially the Kingdom of Thailand and historically known as Siam (the official name until 1939), is a country in Southeast Asia on the Mainland Southeast Asia, Indochinese Peninsula. With a population of almost 66 million, it spa ...
, the
Philippines The Philippines, officially the Republic of the Philippines, is an Archipelagic state, archipelagic country in Southeast Asia. Located in the western Pacific Ocean, it consists of List of islands of the Philippines, 7,641 islands, with a tot ...
,
Laos Laos, officially the Lao People's Democratic Republic (LPDR), is the only landlocked country in Southeast Asia. It is bordered by Myanmar and China to the northwest, Vietnam to the east, Cambodia to the southeast, and Thailand to the west and ...
, and
Vietnam Vietnam, officially the Socialist Republic of Vietnam (SRV), is a country at the eastern edge of mainland Southeast Asia, with an area of about and a population of over 100 million, making it the world's List of countries and depende ...
. Chewing betel was once common in
Malaysia Malaysia is a country in Southeast Asia. Featuring the Tanjung Piai, southernmost point of continental Eurasia, it is a federation, federal constitutional monarchy consisting of States and federal territories of Malaysia, 13 states and thre ...
, but the practice has long since died out. Betel nut kits (''tepak sirih'') made of silver and other precious metals, once featured in royal regalia and presented as wedding gifts, have become collectors' items, and a ''tepak sirih'' set is featured on the 1989–2012 series Malaysian 20-sen coin. In urban areas, chewing betel quid is generally considered a nuisance because some chewers spit the betel quid juice out in public areas – compare
chewing gum ban in Singapore The sale of chewing gum in Singapore has been illegal since 1992. Some motivations for the ban included stopping the placement of used chewing gum in inappropriate and costly places, such as the sensors of subway doors, inside lock cylinders, an ...
and
smoking ban Smoking bans, or smoke-free laws, are public policies, including criminal laws and occupational safety and health regulations, that prohibit tobacco smoking in certain spaces. The spaces most commonly affected by smoking bans are indoor employ ...
. The red stain generated by the combination of ingredients when chewed are known to make a colourful stain on the ground. This is becoming an unwanted eyesore in Indian cities such as Mumbai, although many see it as an integral part of Indian culture. This is also common in some of the Persian Gulf countries, such as the UAE and Qatar, where many Indians live. Recently, the Dubai government has banned the import and sale of betel quid and the like. According to traditional
Ayurvedic medicine Ayurveda (; ) is an alternative medicine system with historical roots in the Indian subcontinent. It is heavily practised throughout India and Nepal, where as much as 80% of the population report using ayurveda. The theory and practice of ayur ...
, chewing betel leaf is a remedy against bad breath (
halitosis Bad breath, also known as halitosis, is a symptom in which a noticeably unpleasant breath odour is present. It can result in anxiety among those affected. It is also associated with depression and symptoms of obsessive compulsive disorder. Th ...
).


Cambodia, Laos and Thailand

The chewing of the product is part of the
culture of Cambodia Throughout Cambodia's long history, religion has been a major source of cultural inspiration. Over nearly two millennia, Cambodians have developed a unique Cambodian culture and belief system from the syncreticism of indigenous animistic belie ...
,
Laos Laos, officially the Lao People's Democratic Republic (LPDR), is the only landlocked country in Southeast Asia. It is bordered by Myanmar and China to the northwest, Vietnam to the east, Cambodia to the southeast, and Thailand to the west and ...
, and
Thailand Thailand, officially the Kingdom of Thailand and historically known as Siam (the official name until 1939), is a country in Southeast Asia on the Mainland Southeast Asia, Indochinese Peninsula. With a population of almost 66 million, it spa ...
. Cultivation of areca nut palm and betel leaves is common in rural areas of these countries, being a traditional
cash crop A cash crop, also called profit crop, is an Agriculture, agricultural crop which is grown to sell for profit. It is typically purchased by parties separate from a farm. The term is used to differentiate a marketed crop from a staple crop ("subsi ...
, and the utensils used for preparation are often treasured. Now, many young people have given up the habit, especially in urban areas, but many, especially older people, still keep to the tradition.


Bangladesh

In
Bangladesh Bangladesh, officially the People's Republic of Bangladesh, is a country in South Asia. It is the List of countries and dependencies by population, eighth-most populous country in the world and among the List of countries and dependencies by ...
, ''paan'' is chewed throughout the country by all classes and is an important element of Bangladeshi culture. It is the Bengali 'chewing gum', and usually for chewing, a few slices of the betel nut are wrapped in a betel leaf, almost always with sliced areca nuts and often with calcium hydroxide (slaked lime), and may include cinnamon, clove, cardamom, catechu (khoyer), grated coconut and other spices for extra flavouring. As it is chewed, the peppery taste is savoured, along with the warm feeling and alertness it gives, similar to drinking a fresh cup of coffee. Paan-shupari (shupari being Bengali for areca nut) is a veritable Bangladeshi archetypal imagery, employed in wide-ranging contexts. Prior to British rule, it was chewed without tobacco, and it is still rarely chewed with tobacco. Betel leaves are arranged aesthetically on a decorated plate called paandani. During the
zamindari A zamindar in the Indian subcontinent was an autonomous or semi-autonomous Indian feudalism, feudal lord of a ''zamindari'' (feudal estate). The term itself came into use during the Mughal Empire, when Persian language, Persian was the offi ...
age, paan preparation and the style of garnishing it on a plate (paandani) was indeed a recognised folk art. In Bangladesh paan is traditionally chewed not only as a habit but also as an item of rituals, etiquette and manners. On formal occasions offering paan symbolized the time for departure. In festivals and dinners, in pujas and punyas paan is an indispensable item. Hindus make use of paans as offerings in worship. Dhakai Khilipan, a ready pack of betel leaf processed in Dhaka is famous in the sub-continent. Old Dhakaites have a rich heritage of creating the best khili paan with many complexes, colourful, aromatic and flavorful ingredients. Although 'paan' has been a staple Bengali custom for ages, a number of high-end stores with premium quality paan has become available in recent times. Paan Supari is perhaps the first such brand, which offers a wide range of khili paan. They also offer a khili paan for diabetic patients called the "paan afsana". The sweet paan of the Khasi tribe is famous for its special quality. Paan is also used in
Hindu Hindus (; ; also known as Sanātanīs) are people who religiously adhere to Hinduism, also known by its endonym Sanātana Dharma. Jeffery D. Long (2007), A Vision for Hinduism, IB Tauris, , pp. 35–37 Historically, the term has also be ...
puja and wedding festivals and to visit relatives. It has become a ritual, tradition and culture of Bangladeshi society. Adult women gather with paandani along with friends and relatives in leisure time. Total cultivated area under the crop in Bangladesh is about 14,175 ha and the total annual production is about 72,500 tons. The average yield per acre is 2.27 tons. There are usually three crops during the twelve months, and they are locally called by the name of the respective months in which they are harvested. Paan leaf is usually plucked in Kartik, Phalgun and Ashad. The Kartik paan is considered by consumers to be the best and Ashad paan the worst. When plucking, it is a rule to leave at least sixteen leaves on the vine. Different varieties of betel leaf are grown, and the quality differs in shape, bleaching quality, softness, pungency and aroma of leaf. Tamakh paan, a betel leaf blended with tobacco and spices. Supari paan, another variety of white leaf, Mitha paan, a sweet variety, and Sanchi paan are common varieties of betel leaves. Almost every paan-producing district has its own special variety of betel leaf of which consumers are well acquainted. In the past, the best quality of elegant camphor-scented betel leaf named Kafuri paan was produced in the Sonargaon area of Narayangonj district. It was exported to Calcutta and Middle Eastern countries. The next best is the Sanchi paan grown in Chittagong hill tracts. This variety is not very popular among Bangali people. It is exported to Pakistan for the consumers of Karachi. The commoner varieties are called Desi, Bangla, Bhatial, Dhaldoga, Ghas paan. Bangla paan, is also known as Mitha paan, Jhal paan or paan of Rajshahi. At present, this variety is becoming extinct, due to emergence of more profitable and lucrative fast-growing varieties of paan crops. Normally, betel leaves are consumed with chun, seed cinnamon, cardamoms and other flavored elements.


China


India

In a 16th-century cookbook, ''Nimatnama-i Nasiruddin-Shahi'', describes Ghiyas-ud-din Khalji, the Sultan of
Mandu Mandu may refer to: Geographic toponyms * Mandu River, a river in Minas Gerais, Brazil * Mandu, Democratic Republic of the Congo, a village * Mandu, Madhya Pradesh, a ruined city in Dhar district, Madhya Pradesh, India * Mandu, Jharkhand, ...
(r. 1469–1500), watches as tender betel leaves of the finest quality are spread out and rosewater is sprinkled on them, while saffron is also added. An elaborate betel chew or paan would contain fragrant spices and rose preserves with chopped areca nuts. It is a tradition in South India and nearby regions to give two Betel leaves, areca nut (pieces or whole) and Coconut to the guests (both male and female) at any auspicious occasion. Even on a regular day, it is the tradition to give a married woman, who visits the house, two Betel leaves, areca nut and coconut or some fruits along with a string of threaded flowers. This is referred to as ''thamboolam''. Paan is symbol of Prosperity in indian tradition and part of most of rituals followed. Betel leaf used to make paan is produced in different parts of India. Some states that produce betel leaf for paan include West Bengal, Bihar, Assam, Andhra Pradesh, Uttar Pradesh. In
West Bengal West Bengal (; Bengali language, Bengali: , , abbr. WB) is a States and union territories of India, state in the East India, eastern portion of India. It is situated along the Bay of Bengal, along with a population of over 91 million inhabi ...
, two types of betel leaves are produced. These are "Bangla Patta (Country Leaf)" and Mitha Patta (Sweet Leaf)". In West Bengal, ''Bangla patta'' is produced mainly in district of Dinajpur, Malda, Jalpaiguri, and Nadia. ''Mitha patta'' is produced in places such as Midnapur and South 24 Parganas. The skilled paan maker is known as a ''paanwala'' in North India. In other parts, ''paanwalas'' are also known as ''panwaris'' or ''panwadis''. At North India, there is a tradition to chew paan after Deepawali puja for blessings. In the Indian state of Maharashtra, the paan culture is widely criticised due to the cleanliness problems created by people who spit in public places. In Mumbai, there have been attempts to paint pictures of Hindu gods in places where people commonly tend to spit, in the hope that this would discourage spitting, but success has been limited and there is need a solution at root to avoid peek. One of the great Marathi artists P L Deshpande wrote a comic story on the subject of ''paanwala'' (paan vendor) and performed a televised reading session on
Doordarshan Doordarshan (), abbreviated as DD, is India's State-owned enterprise, state-owned public broadcasting, public television broadcaster. Established by the Government of India on 15 September 1959, it is owned by the Ministry of Information and B ...
during the 1980s in his unique style. Paan is losing its appeal to farmers because of falling demand. Consumers prefer chewing tobacco formulations such as
gutka Gutka, ghutka, or guṭkha () is a type of betel quid and chewing tobacco preparation made of crushed areca nut (also called betel nut), tobacco, catechu, paraffin wax, slaked lime (calcium hydroxide) and sweet or savory flavourings, in India ...
over paan. Higher costs,
water scarcity Water scarcity (closely related to water stress or water crisis) is the lack of fresh water resources to meet the standard water demand. There are two types of water scarcity. One is ''physical.'' The other is ''economic water scarcity''. Physic ...
and unpredictable weather have made betel gardens less lucrative. According to StraitsResearch, The India pan masala market is expected to reach US$10,365 million by 2026 at the CAGR of 10.4% during the forecast period 2019–2026. The India pan masala market is driven by significant switching of consumers from tobacco products to pan masala, aggressive advertising and convenient packaging, and Maharashtra State's revocation of the ban over pan masala products.


Assam

In
Assam, India Assam (, , ) is a state in Northeast India, northeastern India, south of the eastern Himalayas along the Brahmaputra Valley, Brahmaputra and Barak River valleys. Assam covers an area of . It is the second largest state in Northeast India, nor ...
, betel nut is traditionally offered as a mark of respect and auspicious beginnings. ''Paan-tamul'' (betel leaves and raw areca nut) may be offered to guests after tea or meals, served in a brass plate with stands called bota. The areca nut also appears as a fertility symbol in religious and marriage ceremonies. When showing respect to elders or asking for forgiveness, people, especially newlyweds place a pair of ''paan-tamul'' on a
xorai The ''Xorai'' (), a manufactured bell metal product is one of the traditional symbols of Assam, which is considered as an article of great respect by the people of Assam. In simplistic terms it is an offering tray with a stand at the bottom which ...
, place it in front of the ''elder'' and bow to show respect. Guests may be invited to a wedding reception by offering a few areca nuts with betel leaves. During
Bihu Bihu is an important cultural festival unique to the Indian state of Assam and is of three types – 'Rongali' or ' Bohag Bihu' observed in April, 'Kongali' or ' Kati Bihu' observed in October or November, and 'Bhogali' or ' Magh Bihu' observe ...
, the husori players are offered areca nuts and betel leaves by each household while their blessings are solicited. ''Paan-tamul'' is also offered to guests after the end of every feast, usually the ''paan-tamul-soon'', or slaked lime with cardamom pods in it to freshen the breath.


Banarasi Pan

''Banarasi'' ''Pan'' of Banaras (Varanasi) is widely famous among Indians and tourists visiting India.


Indonesia and Malaysia

''Bersirih'', ''nyirih'', or ''menginang'' is a historical Malayonesian tradition of chewing materials such as
nut Nut often refers to: * Nut (fruit), fruit composed of a hard shell and a seed * Nut (food), a dry and edible fruit or seed, including but not limited to true nuts * Nut (hardware), fastener used with a bolt Nut, NUT or Nuts may also refer to: A ...
,
betel Betel (''Piper betle'') is a species of flowering plant in the pepper family Piperaceae, native to Southeast Asia. It is an evergreen, dioecious vine, with glossy heart-shaped leaves and white catkins. Betel plants are cultivated for their lea ...
, gambier, tobacco,
clove Cloves are the aromatic flower buds of a tree in the family Myrtaceae, ''Syzygium aromaticum'' (). They are native to the Maluku Islands, or Moluccas, in Indonesia, and are commonly used as a spice, flavoring, or Aroma compound, fragrance in fin ...
, and
limestone Limestone is a type of carbonate rock, carbonate sedimentary rock which is the main source of the material Lime (material), lime. It is composed mostly of the minerals calcite and aragonite, which are different Polymorphism (materials science) ...
. In the
Malay Archipelago The Malay Archipelago is the archipelago between Mainland Southeast Asia and Australia, and is also called Insulindia or the Indo-Australian Archipelago. The name was taken from the 19th-century European concept of a Malay race, later based ...
, the ''menginang'' or betel nut chewing has become a revered activity in local tradition; being a ceremoniously conducted gesture to honour guests. A complete and elaborate set of ''sirih pinang'' equipment is called '' tepak'', ''puan'', ''pekinangan'', or ''cerana''. The set is usually made of wooden lacquerware, brass or silverwares; and it consists of the ''combol'' (containers), ''bekas sirih'' (leaf container), ''kacip'' (press-knife to cut areca nut), ''gobek'' (small pestle and mortar), and ''ketur'' (spit container).


Micronesia

Betel nut chewing is common among the native ethnic groups of
Micronesia Micronesia (, ) is a subregion of Oceania, consisting of approximately 2,000 small islands in the Northwestern Pacific Ocean. It has a close shared cultural history with three other island regions: Maritime Southeast Asia to the west, Poly ...
. They can be grouped into two different traditions. The betel nut chewing tradition of the
Chamorro people The Chamorro people (; also Chamoru) are the Indigenous peoples of Oceania, Indigenous people of the Mariana Islands, politically divided between the Territories of the United States, United States territory of Guam and the encompassing Norther ...
of the
Mariana Islands The Mariana Islands ( ; ), also simply the Marianas, are a crescent-shaped archipelago comprising the summits of fifteen longitudinally oriented, mostly dormant volcanic mountains in the northwestern Pacific Ocean, between the 12th and 21st pa ...
( Chamorro: ''pugua) prefer ripe (red) areca nuts. The betel nut chewing tradition of the Chuukese, Palauan, and
Yapese people The Yapese are a Micronesian ethnic group indigenous to the main island of Yap. Yapese culture is based on the maxims of respect and responsibility. Aspects of traditional Yapese culture are still important in modern Yapese culture. History Be ...
, on the other hand, prefer unripe (green) areca nuts. Betel leaf and lime are included in the quid, and commonly tobacco. Flavoring ingredients like
ginger Ginger (''Zingiber officinale'') is a flowering plant whose rhizome, ginger root or ginger, is widely used as a spice and a folk medicine. It is an herbaceous perennial that grows annual pseudostems (false stems made of the rolled bases of l ...
,
cardamom Cardamom (), sometimes cardamon or cardamum, is a spice made from the seeds of several plants in the genus (biology), genera ''Elettaria'' and ''Amomum'' in the family Zingiberaceae. Both genera are native to the Indian subcontinent and Indon ...
, and
vodka Vodka ( ; is a clear distilled beverage, distilled alcoholic beverage. Its varieties originated in Poland and Russia. Vodka is composed mainly of water and ethanol but sometimes with traces of impurities and flavourings. Traditionally, it is ...
are also sometimes added. Areca palms have been grown traditionally in
Guam Guam ( ; ) is an island that is an Territories of the United States, organized, unincorporated territory of the United States in the Micronesia subregion of the western Pacific Ocean. Guam's capital is Hagåtña, Guam, Hagåtña, and the most ...
,
Palau Palau, officially the Republic of Palau, is an island country in the Micronesia subregion of Oceania in the western Pacific Ocean. The Republic of Palau consists of approximately 340 islands and is the western part of the Caroline Islands ...
, and
Yap Yap (, sometimes written as , or ) traditionally refers to an island group located in the Caroline Islands of the western Pacific Ocean, a part of Yap State. The name "Yap" in recent years has come to also refer to the state within the Federate ...
since ancient times. It spread to Chuuk in modern times. Betel nut stains have been found in ancient remains of the Chamorro people, indicating that the practice was carried into Micronesia by their Austronesian ancestors in Island Southeast Asia.


Myanmar

''Kwun-ya'' ( óːn.jà is the word for betel quid in
Myanmar Myanmar, officially the Republic of the Union of Myanmar; and also referred to as Burma (the official English name until 1989), is a country in northwest Southeast Asia. It is the largest country by area in Mainland Southeast Asia and has ...
, formerly Burma, where the most common configuration for chewing is a betel vine leaf ('' Piper betel''), areca nut (from ''
Areca catechu ''Areca catechu'' is a species of palm native to the Philippines cultivated for areca nuts. It was carried widely through the tropics by the Austronesian migrations and trade since at least 1500 BCE due to its use in betel nut chewing. ...
''), slaked lime (calcium hydroxide) and some spices, although many betel chewers also use tobacco. Betel chewing has very long tradition in Burma, having been practised since before the beginning of recorded history. Until the 1960s, both men and women loved it and every household used to have a special
lacquerware Lacquerware are objects decoratively covered with lacquer. Lacquerware includes small or large containers, tableware, a variety of small objects carried by people, and larger objects such as furniture and even coffins painted with lacquer. Before ...
box for betel quid, called ''kun-it'' (), which would be offered to any visitor together with
cheroot The cheroot is a filterless cylindrical cigar with both ends clipped during manufacture. Since cheroots do not taper, they are inexpensive to roll mechanically, and their low cost makes them popular. The word 'cheroot' probably comes via Portug ...
s to smoke and
green tea Green tea is a type of tea made from the leaves and buds of the '' Camellia sinensis'' that have not undergone the withering and oxidation process that creates oolong teas and black teas. Green tea originated in China in the late 1st millenn ...
to drink. The leaves are kept inside the bottom of the box, which looks like a small hat box, but with a top tray for small tins, silver in well-to-do homes, of various other ingredients such as the betel nuts,
slaked lime Calcium hydroxide (traditionally called slaked lime) is an inorganic compound with the chemical formula Ca( OH)2. It is a colorless crystal or white powder and is produced when quicklime ( calcium oxide) is mixed with water. Annually, approxim ...
, cutch,
anise Anise (; '), also called aniseed or rarely anix, is a flowering plant in the family Apiaceae native to the eastern Mediterranean region and Southwest Asia. The flavor and aroma of its seeds have similarities with some other spices and herbs, ...
seed and a nut cutter. The sweet form (''acho'') is popular with the young, but grownups tend to prefer it with cardamom, cloves and tobacco. Spittoons, therefore, are still ubiquitous, and signs saying "No betel quid-spitting" are commonplace, as it makes a messy red splodge on floors and walls; many people display betel-stained teeth from the habit. Betel quid stalls and kiosks used to be run mainly by people of Indian origin in towns and cities. Smokers who want to quit would also use betel nut to wean themselves off tobacco.
Taungoo Taungoo (, ''Tauñngu myoú''; ), also spelled Toungoo and formerly Toung-ngú, is a district-level city in the Bago Region of Myanmar, 220 km from Yangon, towards the north-eastern end of the division, with mountain ranges to the east a ...
in
Lower Burma Lower Myanmar (, also called Lower Burma) is a geographic region of Myanmar and includes the low-lying Irrawaddy Delta ( Ayeyarwady, Bago and Yangon Regions), as well as coastal regions of the country ( Rakhine and Mon States and Tanintharyi ...
is where the best areca palms are grown indicated by the popular expression "like a betel lover taken to Taungoo". Other parts of the country contribute to the best betel quid according to another saying "
Tada-U Tada-U () is a town in central Myanmar about from the provincial capital of Mandalay and is the principal town of Tada-U Township and Tada-U District. There is an air force An air force in the broadest sense is the national military ...
for the leaves, Ngamyagyi for the tobacco, Taungoo for the nuts,
Sagaing Sagaing (, ) is a town in the Sagaing Region of Myanmar. It is located on the Irrawaddy River, to the south-west of Mandalay on the opposite bank of the river. Sagaing, with its numerous Buddhist monasteries, is an important religious and ...
for the slaked lime,
Pyay Pyay, and formerly anglicised as Prome, is the principal town of Pyay Township in the Bago Region in Myanmar. Pyay is located on the bank of the Irrawaddy River, north-west of Yangon. It is an important trade center for the Ayeyarwady Delta, Centr ...
for the cutch". ''Kun, hsay,
lahpet Lahpet, also spelled laphet, laphat, lephet, leppet, or letpet in English (, ), is Burmese for fermented or pickled tea. Myanmar is one of the few countries where tea is consumed both as a drink and as an eaten delicacy, in the form of pickled ...
'' (betel quid, tobacco and pickled tea) are deemed essential items to offer monks and elders particularly in the old days. Young maidens traditionally carry ornamental betel boxes on a stand called ''
kundaung ''Kundaung'' (, ;"betel leaf holder") is an offertory commonly carried in Burmese celebrations, such as shinbyu (novitiation) and ear-boring procession ceremonies. The bearers are known as ''kundaungkaing'' (ကွမ်းတောင်ကိ ...
'' and gilded flowers (''pandaung'') in a ''
shinbyu Shinbyu (; , also spelt shinpyu) is the Burmese term for a novitiate, novitiation ceremony (pabbajja) in the tradition of Theravada, Theravada Buddhism, referring to the celebrations marking the Śrāmaṇera, sāmaṇera (novitiate) monastic or ...
'' (novitiation) procession. Burmese history also mentions an ancient custom of a condemned enemy asking for "a betel quid and a drink of water" before being executed. An anecdotal government survey indicated that 40% of men and 20% of women in Myanmar chew betel. An aggregate study of cancer registries (2002 to 2007) at the
Yangon Yangon, formerly romanized as Rangoon, is the capital of the Yangon Region and the largest city of Myanmar. Yangon was the List of capitals of Myanmar, capital of Myanmar until 2005 and served as such until 2006, when the State Peace and Dev ...
and
Mandalay General Hospital Mandalay General Hospital (; abbreviated MGH) is a major teaching hospital in Mandalay, Myanmar, with a bed capacity of 1,500. It serves as the primary teaching institution for University of Medicine, Mandalay, alongside Mandalay Workers' Hospita ...
s, the largest hospitals in the country, found that
oral cancer Oral cancer, also known as oral cavity cancer, tongue cancer or mouth cancer, is a cancer of the lining of the lips, mouth, or upper throat. In the mouth, it most commonly starts as a painless red or white patch, that thickens, gets ulcerated ...
was the 6th most common cancer among males, and 10th among females. Of these oral carcinoma patients, 36% were regular betel quid chewers.
University of Dental Medicine, Yangon The University of Dental Medicine, Yangon ( ), is the leading university of dental medicine, located in Yangon, Myanmar. The university, along with the University of Dental Medicine, Mandalay, is one of only two universities of dental medicine i ...
records from 1985 to 1988 showed that 58.6% of oral carcinoma patients were regular betel chewers. Since the 1990s, betel chewing has been actively discouraged by successive governments, from the
State Law and Order Restoration Council State most commonly refers to: * State (polity), a centralized political organization that regulates law and society within a territory **Sovereign state, a sovereign polity in international law, commonly referred to as a country **Nation state, a ...
(SLORC) onward, on the grounds of health and tidiness. In April 1995, the
Yangon City Development Committee Yangon City Development Committee (, abbreviated YCDC) is the administrative body of Yangon, the largest city and former capital of Myanmar (Burma). It consists of 18 departments, with headquarters in the Yangon City Hall. The committee's chairman ...
banned betel in
Yangon Yangon, formerly romanized as Rangoon, is the capital of the Yangon Region and the largest city of Myanmar. Yangon was the List of capitals of Myanmar, capital of Myanmar until 2005 and served as such until 2006, when the State Peace and Dev ...
(Rangoon), in anticipation of Visit Myanmar Year 1996, a massive effort to promote the country as a tourist destination. Effective 29 July 2007, betel chewing, along with smoking, has been banned from the
Shwedagon Pagoda The Shwedagon Pagoda (, ; ), officially named ''Shwedagon Zedi Daw'' (, , ), and also known as the Great Dagon Pagoda and the Golden Pagoda, is a gilded stupa located in Yangon, Myanmar. The Shwedagon is the most sacred Buddhist pagoda in Myanma ...
, the country's most important religious site. In 2010, the
Ministry of Education An education ministry is a national or subnational government agency politically responsible for education. Various other names are commonly used to identify such agencies, such as Ministry of Education, Department of Education, and Ministry of Pub ...
's Department of Basic Education and Burma's Anti-Narcotics Task Force collaborated to prohibit betel shops from operating within of any school.


Nepal

Paan is chewed mainly by
Terai The Terai or Tarai is a lowland region in parts of southern Nepal and northern India that lies to the south of the outer foothills of the Himalayas, the Sivalik Hills and north of the Indo-Gangetic Plain. This lowland belt is characterised by ...
people, although migrants in Terai have also taken up chewing paan in recent times. Throughout Terai, paan is as common as anywhere in northern India. There is some local production, generally not commercial, but most leaves are imported from India. Although not as ubiquitous as in the Terai, most residents of Kathmandu occasionally enjoy paan. A sweet version of paan called ''meetha paan'' is popular amongst many who do not like the strong taste of plain (''sada'') paan. Some parents allow their children to consume meetha on special occasions because it is tobacco-free.


Pakistan

The consumption of ''paan'' has long been a very popular cultural tradition in
Pakistan Pakistan, officially the Islamic Republic of Pakistan, is a country in South Asia. It is the List of countries and dependencies by population, fifth-most populous country, with a population of over 241.5 million, having the Islam by country# ...
, especially in the port city of Karachi, although the tradition is dying among the younger generation. In general, though, ''paan'' is an occasional delicacy thoroughly enjoyed by many, and almost exclusively bought from street vendors instead of any preparations at home. Pakistan grows a large variety of betel leaf, specifically in the coastal areas of
Sindh Sindh ( ; ; , ; abbr. SD, historically romanized as Sind (caliphal province), Sind or Scinde) is a Administrative units of Pakistan, province of Pakistan. Located in the Geography of Pakistan, southeastern region of the country, Sindh is t ...
, although ''paan'' is also imported in large quantities from
Bangladesh Bangladesh, officially the People's Republic of Bangladesh, is a country in South Asia. It is the List of countries and dependencies by population, eighth-most populous country in the world and among the List of countries and dependencies by ...
and
Sri Lanka Sri Lanka, officially the Democratic Socialist Republic of Sri Lanka, also known historically as Ceylon, is an island country in South Asia. It lies in the Indian Ocean, southwest of the Bay of Bengal, separated from the Indian subcontinent, ...
. The culture of chewing ''paan'' has also spread in
Punjab Punjab (; ; also romanised as Panjāb or Panj-Āb) is a geopolitical, cultural, and historical region in South Asia. It is located in the northwestern part of the Indian subcontinent, comprising areas of modern-day eastern Pakistan and no ...
, where a ''paan'' shop can be found in almost every street and market. In the famous '' Anarkali Bazar'' in
Lahore Lahore ( ; ; ) is the capital and largest city of the Administrative units of Pakistan, Pakistani province of Punjab, Pakistan, Punjab. It is the List of cities in Pakistan by population, second-largest city in Pakistan, after Karachi, and ...
a street called ''paan gali'' is dedicated for ''paan'' and other Pakistani products. The rate of
oral cancer Oral cancer, also known as oral cavity cancer, tongue cancer or mouth cancer, is a cancer of the lining of the lips, mouth, or upper throat. In the mouth, it most commonly starts as a painless red or white patch, that thickens, gets ulcerated ...
has grown substantially in Pakistan due to chewing of ''paan''.


Philippines

Betel nut chewing was formerly widespread among the
ethnic groups of the Philippines The Philippines is inhabited by more than 182 Ethnolinguistic group, ethnolinguistic groups, many of which are classified as "Indigenous Peoples" under the country's Indigenous Peoples' Rights Act of 1997. Traditionally-Muslim minorities from ...
. The country is where the areca palm (''
Areca catechu ''Areca catechu'' is a species of palm native to the Philippines cultivated for areca nuts. It was carried widely through the tropics by the Austronesian migrations and trade since at least 1500 BCE due to its use in betel nut chewing. ...
'') is originally native to and where the tradition started before being spread via the Austronesian expansion (see #History, history section). The Philippines also has the highest genetic diversity in ''
Areca catechu ''Areca catechu'' is a species of palm native to the Philippines cultivated for areca nuts. It was carried widely through the tropics by the Austronesian migrations and trade since at least 1500 BCE due to its use in betel nut chewing. ...
'' populations and is home to several closely related ''Areca'' palm species, including a couple of endemic species that are used as (inferior) substitutes for ''Areca catechu'', these are ''Areca caliso'' (known as ''kaliso'' or ''sakolon'') and ''Areca ipot'' (known as ''ipot'' or ''saksik''). Several varieties of ''Areca catechu'' nuts were also known in the Philippines, distinguished chiefly by the shape of the fruits. Betel nut chewing was described as being a "universal" practice among older people in the early 1900s. The most common configuration of the quid combines areca nut with slaked lime (usually made from heating crushed sea-shells) and betel leaves (''tambul'' or ''siri''). Tobacco may or may not be added. In modern times, it has grown out of favor and has been replaced by cigarettes and chewing gum. The practice only survives among more remote ethnic groups like the Cordillerans of Luzon, and the Lumad people, Lumad and Moro people of Mindanao. In the native languages of the Philippines, betel nut chewing is known variously as ''buyo'', ''bunga'', ''hitso'', or ''ngangà'' in Tagalog language, Tagalog, Bikol language, Bikol, and the Visayan languages; ''dapiau'' in Ivatan language, Ivatan; and ''bua'', ''mama'' or ''maman'' in Ilocano language, Ilocano; ''luyos'' in Kapampangan language, Kapampangan; ''pasa'' in Basilan; and ''lugos'' in Zamboanga peninsula, Zamboanga; among other names.


Taiwan

In Taiwan betel quid is sold from roadside kiosks, often by the so-called Betel nut beauty, betelnut beauties although these are becoming fewer and fewer () – scantily clad girls selling a quid preparation of betel leaf, betel nuts, tobacco and lime. It is a controversial business, with critics questioning entrapment, exploitation, health, class and culture.


Vietnam

In Vietnam, the areca nut and the betel leaf are such important symbols of love and marriage that in Vietnamese the phrase "matters of betel and areca" (''chuyện trầu cau'') were historically synonymous with marriage. Areca nut chewing starts the talk between the groom's parents and the bride's parents about the young couple's marriage. Therefore, the leaves and juices are used ceremonially in Vietnamese weddings.


Health effects

Chewing betel quids and areca nut causes multiple forms of cancer and cardiovascular disease, with or without tobacco. Betel nut chewing causes an increased risk of head and neck cancers and
esophageal cancer Esophageal cancer (American English) or oesophageal cancer (British English) is cancer arising from the esophagus—the food pipe that runs between the throat and the stomach. Symptoms often include dysphagia, difficulty in swallowing and weigh ...
. Betel quid affects almost all parts of the human body, including the brain, heart, lungs, gastrointestinal tract and reproductive organs. It can cause myocardial infarction, cardiac arrhythmias, Hepatotoxicity, liver damage, asthma, type II diabetes, hyperlipidemia, metabolic syndrome, hypothyroidism, Benign prostatic hyperplasia, prostate hyperplasia and infertility. When chewed with additional tobacco in its preparation (like in
gutka Gutka, ghutka, or guṭkha () is a type of betel quid and chewing tobacco preparation made of crushed areca nut (also called betel nut), tobacco, catechu, paraffin wax, slaked lime (calcium hydroxide) and sweet or savory flavourings, in India ...
), there is an even higher risk for cancer, especially for Oral cancer, oral and
oropharyngeal cancer Oropharyngeal cancer, also known as oropharyngeal squamous cell carcinoma and tonsil cancer, is a disease in which abnormal cells with the potential to both grow locally and spread to other parts of the body are found in the oral cavity, in the t ...
s. With tobacco it also raises the risk of fatal
coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), or ischemic heart disease (IHD), is a type of cardiovascular disease, heart disease involving Ischemia, the reduction of blood flow to the cardiac muscle due to a build-up ...
, fatal stroke and non-fatal ischaemic heart disease Women who chew areca nut formulations, such as ''paan'', during pregnancy significantly increase adverse outcomes for the baby. Betel quid chewing can cause
stillbirth Stillbirth is typically defined as fetus, fetal death at or after 20 or 28 weeks of pregnancy, depending on the source. It results in a baby born without vital signs, signs of life. A stillbirth can often result in the feeling of guilt (emotio ...
,
premature birth Preterm birth, also known as premature birth, is the birth of a baby at fewer than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks. Extreme preterm is less than 28 weeks, very early preterm birth is betwee ...
,
low birth weight Low birth weight (LBW) is defined by the World Health Organization as a birth weight of an infant of or less, regardless of gestational age. Infants born with LBW have added health risks which require close management, often in a neonatal inten ...
. It is estimated that around 600 million people worldwide regularly use this drug preparation. Attempts by the World Health Organization to control betel nut chewing remain problematic, as the custom is deeply rooted in many cultures, including possessing religious connotations in some parts of Southeast Asia and India. Despite being associated with adverse health outcomes, this practice is not included in the list of risk factors examined by the Global Burden of Diseases, Injuries, and Risk Factors (GBD). A recent study introduced the "betel year," a novel metric designed to quantify lifetime exposure to betel quid chewing and enhance oral cancer risk prediction through personalized assessment. This tool helps identify high-risk individuals and supports targeted public health initiatives, including awareness campaigns and early detection programs. It may also inform policy development and ongoing epidemiological research. As an initial pilot effort, the betel year is a starting point, with further studies needed to explore the carcinogenic potential of other additives globally and refine the metric for wider use.


History

Based on archaeological, linguistic, and botanical evidence, betel chewing is most strongly associated with the
Austronesian peoples The Austronesian people, sometimes referred to as Austronesian-speaking peoples, are a large group of peoples who have settled in Taiwan, maritime Southeast Asia, parts of mainland Southeast Asia, Micronesia, coastal New Guinea, Island Melan ...
. Chewing betel requires the combination of areca nut (''Areca catechu, Areca catechu'') and betel leaf (''Piper betle''). Both plants are native from the region between Island Southeast Asia to Australasia. ''A. catechu'' is believed to be originally native to the
Philippines The Philippines, officially the Republic of the Philippines, is an Archipelagic state, archipelagic country in Southeast Asia. Located in the western Pacific Ocean, it consists of List of islands of the Philippines, 7,641 islands, with a tot ...
, where it has the greatest morphological diversity as well as the most closely related endemic species. The origin of the domestication of ''Piper betle'', however, is unknown, although it is also native to the
Philippines The Philippines, officially the Republic of the Philippines, is an Archipelagic state, archipelagic country in Southeast Asia. Located in the western Pacific Ocean, it consists of List of islands of the Philippines, 7,641 islands, with a tot ...
, the Lesser Sunda Islands, and Indochina. It is also unknown when or why the two plant products were combined, as areca nut alone can be chewed as a stimulant. In eastern Indonesia, leaves from other ''Piper'' species are sometimes used in place of betel leaves. The oldest unequivocal evidence of betel chewing is from the Philippines. Specifically that of several individuals found in a burial pit in the Duyong Cave site of Palawan island dated to around 4,630±250 BP. The dentition of the skeletons is stained, typical of betel chewers. The grave also includes ''Anadara'' shells used as containers of lime, one of which still contained lime. Burial sites in Bohol dated to the first millennium CE also show the distinctive reddish stains characteristic of betel chewing. Based on linguistic evidence of how the reconstructed Proto-Austronesian term ''*buaq'' originally meaning "fruit" came to refer to "areca nut" in Proto-Malayo-Polynesian, it is believed that betel chewing originally developed somewhere within the Philippines shortly after the beginning of the Austronesian expansion (~5,000 BP). From the Philippines, it spread back to
Taiwan Taiwan, officially the Republic of China (ROC), is a country in East Asia. The main geography of Taiwan, island of Taiwan, also known as ''Formosa'', lies between the East China Sea, East and South China Seas in the northwestern Pacific Ocea ...
, as well as onwards to the rest of Austronesia. There are very old claims of betel chewing dating to at least 13,000 BP at the Kuk Swamp site in New Guinea, based on probable ''Areca'' sp. recovered. However, it is now known that these might have been due to modern contamination of sample materials. Similar claims have also been made at other older sites with ''Areca'' sp. remains, but none can be conclusively identified as ''A. catechu'' and their association with betel peppers is tenuous or nonexistent. It reached
Micronesia Micronesia (, ) is a subregion of Oceania, consisting of approximately 2,000 small islands in the Northwestern Pacific Ocean. It has a close shared cultural history with three other island regions: Maritime Southeast Asia to the west, Poly ...
at around 3,500 to 3,000 BP with the Austronesian voyagers, based on both linguistic and archaeological evidence. It was also previously present in the
Lapita culture The Lapita culture is the name given to a Neolithic Austronesian peoples, Austronesian people and their distinct material culture, who settled Island Melanesia via a seaborne migration at around 1600 to 500 BCE. The Lapita people are believed t ...
, based on archaeological remains from Mussau dated to around 3,600 to 2,500 BP. But it did not reach
Polynesia Polynesia ( , ) is a subregion of Oceania, made up of more than 1,000 islands scattered over the central and southern Pacific Ocean. The indigenous people who inhabit the islands of Polynesia are called Polynesians. They have many things in ...
further east. It is believed that it stopped in the
Solomon Islands Solomon Islands, also known simply as the Solomons,John Prados, ''Islands of Destiny'', Dutton Caliber, 2012, p,20 and passim is an island country consisting of six major islands and over 1000 smaller islands in Melanesia, part of Oceania, t ...
due to the replacement of betel chewing with the tradition of kava drinking prepared from the related ''Piper methysticum''. It was also diffused into East Africa via the Austronesian settlement of
Madagascar Madagascar, officially the Republic of Madagascar, is an island country that includes the island of Madagascar and numerous smaller peripheral islands. Lying off the southeastern coast of Africa, it is the world's List of islands by area, f ...
and the Comoros by around the 7th century. The practice also diffused to the cultures the Austronesians had historical contact with. It reached the Dong Son culture via the Austronesian Sa Huỳnh culture of Vietnam at around 3,000 to 2,500 BP through trade contacts with Borneo. It is from this period that skeletons with characteristic red-stained teeth start to appear in
Mainland Southeast Asia Mainland Southeast Asia (historically known as Indochina and the Indochinese Peninsula) is the continental portion of Southeast Asia. It lies east of the Indian subcontinent and south of Mainland China and is bordered by the Indian Ocean to th ...
. It is assumed that it reached South China and Hainan at around the same time, though no archaeological evidence for this can be found as of yet. In
Cambodia Cambodia, officially the Kingdom of Cambodia, is a country in Southeast Asia on the Mainland Southeast Asia, Indochinese Peninsula. It is bordered by Thailand to the northwest, Laos to the north, and Vietnam to the east, and has a coastline ...
, the earliest evidence of betel nut chewing is from around 2,400 to 2,200 BP. It also spread to
Thailand Thailand, officially the Kingdom of Thailand and historically known as Siam (the official name until 1939), is a country in Southeast Asia on the Mainland Southeast Asia, Indochinese Peninsula. With a population of almost 66 million, it spa ...
at 1,500 BP, based on archaeobotanical evidence. In the Indian subcontinent, betel chewing was introduced through early contact of Austronesian traders from Sumatra, Java, and the Malay Peninsula with the Dravidian languages, Dravidian-speakers of
Sri Lanka Sri Lanka, officially the Democratic Socialist Republic of Sri Lanka, also known historically as Ceylon, is an island country in South Asia. It lies in the Indian Ocean, southwest of the Bay of Bengal, separated from the Indian subcontinent, ...
and southern India at around 3,500 BP. This also coincides with the introduction of Southeast Asian plants like ''Santalum album'' and ''Cocos nucifera'', as well as the adoption of the Austronesian outrigger ship and crab-claw sail technologies by Dravidian-speakers. Unequivocal literary references to betel only start appearing after the Vedic period, in works like ''Dipavaṃsa'' (c. 3rd century CE) and ''Mahavamsa, Mahāvaṃsa'' (c. 5th century). Betel chewing only reached northern India and Kashmir after 500 CE through trade with Mon-Khmer-speaking peoples in the Bay of Bengal. From there it followed the Silk Road to
Persia Iran, officially the Islamic Republic of Iran (IRI) and also known as Persia, is a country in West Asia. It borders Iraq to the west, Turkey, Azerbaijan, and Armenia to the northwest, the Caspian Sea to the north, Turkmenistan to the nort ...
and into the
Mediterranean The Mediterranean Sea ( ) is a sea connected to the Atlantic Ocean, surrounded by the Mediterranean basin and almost completely enclosed by land: on the east by the Levant in West Asia, on the north by Anatolia in West Asia and Southern ...
. Chinese records, specifically ''Linyi Ji'' by Dongfang Shuo associate the growing of areca palms with the first settlers of the Austronesian Champa polities in southern Vietnam at around 2,100 to 1,900 BP. This association is echoed in ''Nanfang Cao Mu Zhuang'' by Ji Han (c. 304 Common Era, CE) who also describes its importance in Champa culture, specifically in the way Cham hosts traditionally offer it to guests. Betel chewing entered China through trade with Champa, borrowing the Proto-Malayo-Chamic name ''*pinaŋ'' resulting in Chinese ''bin lang'' for "areca nut", with the meaning of "honored guest", reflecting Chamic traditions. The same for the alternate term ''bin men yao jian'', literally meaning "guest [at the door] medicinal sweetmeat".


See also

* Domesticated plants and animals of Austronesia * Betel container (Victoria & Albert Museum) * Betel chewing in Thailand * Betel chewing in China


References


External links


Nutritional composition of paan
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