Betel Nut- A slow poison for Southasians!

Betel Nut chewing is a very normal thing to do, all day or after lunch or dinner in the Southasian subcontinent. Betel Nut chewing goes back centuries and is still a very normal thing in Toronto, Canada amongst people of Southasian decent. Most southasian stores carry betel nuts. However, what starts as a cool thing to do in Pakistan or India by the masses, is actually a slow poison that contributes to high calcium levels, high-creatinine levels, kidney failure, hypercalcaemia, heart attacks, milk alkali syndrome and many other issues including tooth decays and cancers.

Betel-nut use is associated with metabolic syndrome and obesity. However, the association between betel-nut chewing and risk for chronic kidney disease (CKD) is linked due to the fact that calcium absorptions are increased when chewing the Betel Nut and hence puts a strain on the kidneys which can lead to Chronic Kidney disease.

To describe an uncommon case of milk alkali syndrome from betel nut chewing. A 60-year-old Pakistani woman was referred to the Endocrinology Clinic for hypercalcemia. She reported a history of type 2 diabetes mellitus, hypothyroidism, anxiety, and renal stones. She denied symptoms of hypercalcemia. However, her serum calcium levels were noted to be above the upper end of reference range but consistently below 11 mg/dL. She was noted to have alkalosis and low parathyroid hormone levels, despite a normal renal function. A 24-hour urine stone profile revealed high-normal urine calcium and low urine citrate levels. Upon further history, it was noted that she avidly chewed betel nut up to 15 times a day, along with lime paste and tobacco paste. She was physically and psychologically addicted to this process. She was also taking calcium supplementations. On exam, she was noted to have dark pigmentation of her tongue from chronic use of lime paste and retention of betel nut in her mouth.

Chewed betel nut produces a stimulant response that, in low doses, is similar to caffeine or nicotine. In high doses, betel nut produces cocaine-like effects including elevated heart rate, high blood pressure, dilated pupils, anxiety, insomnia and cardiac arrhythmia.

Betel nut chewers report feeling happier, more energetic and more alert when using the product due to its to its euphoric side-effects. Regular betel nut chewing to cancers of the mouth and esophagus. Additionally, compounds in betel nut can encourage the growth of liver, lung, cervix, stomach, mouth and prostate cancers. Betel nut may be teratogenic, or disruptive to the development of a fetus. Doctors warns pregnant women to avoid chewing betel nut because it can damage an unborn baby’s DNA and harm its development.

Paan is the Betel Leaf that contains betel nuts and a chalky paste and people have the same effect as its still chewing betel nuts with the betel leaf.