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LETTERS: Chetan Trivedy, Saman Warnakulasuriya, and Timothy J Peters Areca nuts can have deleterious effects BMJ 1999; 318: 1287 [Full text]

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Areca nuts can have deleterious effects

Sujata D Gandhi   (21 May 1999)

Areca nuts can have deleterious effects 21 May 1999
Sujata D Gandhi Send response to journal: Re: Areca nuts can have deleterious effects	Dear Editor I read with interest letter by Dr. C. Trivedy and T. Peters.1 They are quite right to reiterate the fact that consumption of raw or processed betel-nuts (Areca catechu) and quid is linked with medical, pathophysiological and psychological effects. Dr. Trivedy has discussed the possible mechanism of ischemic heart disease in betel nut chewers. Another proposed mechanism could be the alkaloids in betel nut, such as arecoline. It may play a contributing role in coronary artery spasm inducing parasympathomimetic effects on vessels with abnormal endothelium.2 Chewing betel nuts may instantly induce a high concentration of arecoline. Our hospital in East London, serves a large population of Bangladeshi patients who are habitual betel nut and quid chewers. Many of these patients are unusually difficult to intubate. Exposure of buccal mucosa fibroblasts to arecoline alkaloid, in vivo may contribute to the accumulation of collagen resulting in submucous fibrosis(SF).3 SF could result in restricted jaw mobility, fibrosis in soft tissues around larynx resulting in immobile epiglottis and difficult laryngoscopy. Areca nuts could be one of the contributing factors causing possible difficult intubation in the habitual betel nut chewers. In vitro, the effect on human buccal mucosa fibroblasts suggests that [3H]-arecoline, the major alkaloid in these nuts was metabolized predominantly to [3H]-arecaidine. This is accompanied by a concentration-dependent stimulation of collagen synthesis and cell proliferation.3 It has been demonstrated that the incorporation of lime and tobacco to the betel leaves quid increases the incidence of mucosal changes.4 Polyphenolic compounds (PPC)have been isolated from betel nuts. It has been demonstrated that PPC can modify the yield of endogenously formed N-nitroso compounds, and may thus effect the carcinogen burden in man.5 In our hospital we encounter quite a few children who have inhaled betel nuts accidentally. Though allergies are not common with betel nut inhalation, it can cause respiratory distress and lung collapse if it is left in the small airways for too long. Yours sincerely Dr Sujata D GANDHI Specialist Registrar Department of Anesthesia Royal London Hospital Whitechapel London E1 1BB 1 Trivedy C, Peters,TJ. Areca nuts can have deleterious effects. BMJ 1999; 318:1287 (8 May) 2 Hung DZ, Deng JF. Acute myocardial infarction temporally related to betel nut chewing. Veterinary & Human Toxicology. 40(1): 25-8, 1998 Feb. 3 Harvey W. Scutt A, Meghji S, Canniff JP. Stimulation of human buccal mucosa fibroblasts in vitro by betel-nut alkaloids. Archives of Oral Biology. 31(1):45-9, 1986. 4 Awang MN. Fate of betel nut chemical constituents following nut treatment prior to chewing and its relation to oral precancerous & cancerous lesion. Dental Journal of Malaysia. 10(1):33-7, 1988 May. 5 Stich HF, Dunn BP, Pignatelli B, Ohshima H, Bartsch H. Dietary phenolics and betel nut extracts as modifiers of N-nitrosation in rat and man. IARC Scientific Publications. (57):213-22, 1984.