What do millions of Indians habitually chew, leaving their mouths red—and neighbourhood walls scarlet splodged? It is usually a mix of areca nut, slaked lime, a variety of individually chosen ingredients, and tobacco, all skillfully wrapped inside a verdant green leaf.
A less elaborate and hassle-free version involves dried ground tobacco and areca nut, massaged thoroughly in the palm before being tossed into the mouth.
In recent decades, tobacco has earned notoriety for its much-publicised carcinogenic qualities. Areca nut, on the other hand, has been flying under the radar.
Consumed by more than 600 million people, mainly in southern Asia, areca nut—more popularly, betel nut—is a stimulant. And a carcinogen in itself.
The areca nut palm grows in the tropical Pacific, south and southeast Asia, and parts of east Africa like in Kenya. Indigenous to Indonesia, the species arrived in India sometime in the 4th century and became a mainstay.
“Such is its effectiveness, that alongside nicotine, alcohol and caffeine, betel nuts are believed to be one of the most popular mind-altering substances in the world,” BBC reported in 2015. Some reports even rank it the “fourth most popular” in the category.
Yet, instead of curbing its use, India is becoming an ever bigger supplier.
In the early 1990s, India produced under 250,000 tonnes of areca nuts, according to the UN Food and Agriculture Organization. By 2019, it was over 900,000 tonnes or nearly half the global output.
Besides being chewed in raw or dried forms by around 30% of Indian men and 7% of Indian women, the nut is used in ayurvedic medicines and in Hindu religious ceremonies, as offerings to gods or tokens during births, marriages, and even death.
Thanks to its many uses, demand has been rising faster than supply. In September 2021, prices hovered around Rs500-525 ($6.74-7.09) per kilogram, up from Rs200-250 ($2.70-3.37) two years earlier.
Areca nut farmers’ fortunes improved particularly in the 1980s as manufacturers began making and selling gutka, or betel quid, which is a mixture of tobacco and crushed areca nuts. Paan masala, its tobacco-free version, is generally deemed harmless and consumed by the young and old alike.
In 2022, the crop can fetch an average of Rs4.5 lakh ($6,071) per acre per year compared to the Rs60,000 ($809) for peanuts.
And unlike perishable crops like tomatoes and potatoes, areca nuts can be stored for years once processed.
There is, however, a flip-side to all this.
Betel nut addiction is spawning a major health crisis.
Not only has it been classified as a group 1 carcinogen, chewing it, with or without tobacco, is also shown to damage vital organs to cause liver cirrhosis, type II diabetes, cardiovascular disease, and other serious ailments. The US food and drug authority has listed it among poisonous plants; Australia considers it a prescription-only medicine, illegal to possess or sell without permission.
Yet few talk about it like they do about tobacco. If anything, in the past decade, Bollywood stars like Shah Rukh Khan and Priyanka Chopra have earned millions advertising paan masala (This also serves as a surrogate for gutka ads, otherwise banned.)
In a feeble attempt, the Delhi government, in January 2016, asked celebrities to refrain from endorsing paan masala brands. “If it is proven that paan masalas contain areca nuts, which is supposed to be a cancer-causing agent, why is the government not banning the sale of paan masalas?” asked marketing professional Amitava Mitra.
In China, another country where betel nuts are widely produced and consumed, the government did go for such a ban on ads. In India itself, several states have acted against tobacco products like gutka while steering clear of betel nuts.
Local farmers are also protected from imports and smuggling of substandard Indonesian areca nuts via the Bangladesh and Myanmar borders. India had allowed tariff-free import of the nuts from Myanmar since 1994 but in 2018 it began to levy a 40% tariff.
In countries like India, besides curbs on areca nut production, awareness drives and de-addiction programmes are key. However, they are rare, presumably because those affected by this addiction are mostly poor.
It is largely people in the lower educational and economic groups—farmers, fishermen, truckers—who chew areca nut since it is a cheaper alternative to cigarettes.
Additionally, in societies where cigarette smoking is “socially unacceptable” for women, “chewing tobacco is seen as traditional and accepted,” says Pankaj Chaturvedi, a head and neck surgeon at leading public cancer hospital Tata Memorial in Mumbai.
The habit is also a “hidden gateway” to tobacco use among the youth. More than 45% of school-going kids in rural India have developed the habit, with the likelihood increasing among government school students.
“Betel quid addiction is predominantly a second or third world disorder and, therefore, likely flies under the radar. If a medication was developed to address this problem, it’s quite likely that those most affected would not be able to purchase the medication,” says Andrew Lawrence, head of mental health research at Melbourne University.
“From an economic perspective, the drive to develop a medication may not be as high as, for example, antidepressants or antihypertensives, which are sold widely around the first world.”