Addicted To Supari? Study Says Betel Nut Raises Heart, Cancer And Metabolic Risks

In many parts of South Asia, chewing betel nut, also known as supari or areca nut, is a culturally ingrained habit. In India, supari is often added to paan, which is served up in many regions as an after-meal digestif. But new research suggests the practice is far from harmless. A recent comprehensive review published in Translational Psychiatry summarises how betel nut addiction can elevate the risk of systemic diseases, including heart disease, certain cancers and metabolic disorders. This is apart from the fact that supari has been linked to mouth cancer causation too.

Betel nut is classified as the fourth most commonly used psychoactive substance globally, after caffeine, tobacco and alcohol, and is traditionally valued for its mild stimulant effects and social significance. However, scientists now warn that long-term and excessive chewing can lead to structural damage in the mouth, addictive behaviour and physiological effects that go well beyond oral health. The medical community has tied habitual use to chronic inflammation, cardiovascular dysfunction, insulin resistance and a much higher likelihood of developing precancerous and cancerous conditions of the oral cavity.

Understanding the difference between occasional use and addiction, and recognising whether supari chewing poses a personal health risk, is crucial for prevention.

What Is Betel Nut (Supari)?

Betel nut refers to the seed of the areca palm (Areca catechu), often chewed with betel leaf, slaked lime and sometimes tobacco. This concoction, commonly called betel quid or paan, is widely used across South Asia, Southeast Asia and parts of East Africa.

Globally, about 600 million people chew betel nut, with India having among the largest user populations. The nut contains psychoactive compounds such as arecoline, which act on the central nervous system and can produce mild stimulant effects. These properties contribute to its addictive potential, often making occasional chewing evolve into frequent habitual use.

Strong Evidence For Cancer Risk

The cancer risk associated with betel nut chewing is among the most well-established health hazards. The International Agency for Research on Cancer (IARC), part of the World Health Organization, has classified betel quid and areca nut as Group 1 carcinogens to humans. This means there is convincing evidence that chewing them causes cancer.

A major concern is oral submucous fibrosis (OSF), a precancerous condition characterised by stiffening of the oral mucosa. Over time, OSF can progress to oral squamous cell carcinoma, one of the most common oral cancers in South and Southeast Asia. The continuous chewing motion, exposure to carcinogenic alkaloids, and chronic injury inside the mouth create a biologically conducive environment for cellular mutations and cancer development. 

Link To Heart Disease And Cardiovascular Risks

Although cancer risk is well known, growing evidence suggests that betel nut use also contributes to cardiovascular disease, a risk that many users overlook. Observational studies have found associations between habitual chewing and increased incidence of hypertension (high blood pressure), atherosclerosis (hardening of arteries) and ischemic heart disease.

In one large analysis combining more than 400 000 individuals, regular betel quid chewers had a significantly higher relative risk of cardiovascular disease and all-cause mortality compared with non-users. These associations persisted even after adjusting for other lifestyle factors.

Mechanistically, compounds in betel nut such as arecoline may activate the sympathetic nervous system, increasing heart rate and blood pressure and impairing endothelial (vessel lining) function, both risk factors for heart disease.

Metabolic Syndrome, Diabetes And Obesity

Emerging evidence also links betel nut chewing with components of metabolic syndrome, a cluster of conditions that raise the risk of heart attack and stroke. Observational studies have shown higher odds of central obesity, high blood sugar (hyperglycaemia), dyslipidemia (abnormal fats) and insulin resistance among habitual chewers. 

In one study, betel nut users had up to a 1.6-fold increased risk of metabolic syndrome compared to non-users, even after controlling for age, sex and socioeconomic factors. Metabolic syndrome itself is a precursor to type 2 diabetes, which is a major global and Indian public health challenge.

Neurobiological And Addictive Properties

The addictive nature of betel nut is partly rooted in neurobiology. The review in Translational Psychiatry found that arecoline and related alkaloids act as agonists at muscarinic acetylcholine receptors in the brain, leading to stimulant and reward effects akin to nicotine or caffeine.

These compounds modulate dopamine pathways, reinforcing repeated use and making cessation difficult for many individuals. This pharmacologic reinforcement, combined with cultural, social and occupational factors, contributes to long-term dependence that mirrors other substance use disorders.

Public Health And Prevention Challenges

Unlike cigarette smoking, which is widely recognised as harmful, betel nut chewing is often culturally accepted and perceived as relatively benign, particularly in South Asian communities. That cultural acceptance makes public health messaging difficult.

Yet the mounting evidence for systemic risks, from oral cancer to cardiovascular disease and metabolic disorders, underscores the need for stronger education, regulation and support for cessation. Public health agencies and clinicians are now advocating for community programmes, screening and targeted interventions to reduce initiation and promote quitting.

While supari chewing is a long-standing cultural practice for millions, accumulating scientific evidence paints a stark picture: betel nut addiction is more than a social habit. It is linked to higher risks of cancer, heart disease, metabolic syndrome and systemic inflammation. The active compounds in betel nut contribute to physiological changes that can harm cardiovascular health and elevate metabolic risk over time.

Recognising these risks and adopting early prevention strategies, including quitting chewing, routine health screening and community support, is essential to protect long-term health. As research continues to unfold, health professionals emphasise that even habits deeply rooted in tradition can have serious consequences when they involve addictive and carcinogenic substances.

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