Beneath the Green Leaf: the Complexities of Betel Chewing Culture
AUTHOR: YUNN CHAW NADI
Betel chewing presents a significant dilemma - even though it is important to many Southeast Asian cultures, it poses severe health risks. Understanding the impact of betel chewing on public health and culture is a crucial step in preserving this historical tradition while working towards a healthier future.
A betel quid consists of three ingredients: areca nut, betel leaf, and lime. It can turn the chewer’s teeth brownish-red as if their mouth is full of blood.
Betel chewing traces its roots across borders and oceans. Piper betel seeds dated to 5,500-7,000 were found in Northwest Thailand, and evidence from southern India suggests the arrival of areca palm and piper betel around 500 BCE. Through centuries of migration and maritime trade, betel chewing spread throughout Southeast Asia to the western Pacific, the Indian subcontinent, and even East Africa.
Geographical Distribution of Betel Chewing. Map from the book “Betel Chewing Traditions in Southeast Asia.”
Health Consequences
The reason people chew on betel quid lies in the areca nut's addictive nature. It contains the alkaloid arecoline, which produces a buzz similar to nicotine and stimulates the central and autonomic nervous systems. Slaked lime (calcium hydroxide), chewed along with the nut, creates numerous tiny cuts inside the mouth, allowing the arecoline to enter the bloodstream more effectively.
The basic elements of betel quid: areca nut, betel leaf, and lime. Photo from Shutterstock.
These cuts also allow cancer-causing chemicals to enter the mouth and throat tissues. A 2016 study by Taungoo General Hospital, Myanmar, showed that 87% of oral cancer patients habitually chewed betel quid. Bangladesh, Papua New Guinea, and India, where areca nut consumption is common among both adults and children, report the highest rates of oral cancer globally.
Social Dilemma
In Myanmar, 61.8% of men and 19.5% of women chew betel. The habit is common among individuals who are less educated and of lower socioeconomic backgrounds. 1 A potential explanation for this is that many of this group are engaged in labor-intensive jobs and turn to betel chewing as it enhances alertness and stamina.
Betel quids are sold at every street corner across Myanmar. Photo from Dave Grunebaum, VOA.
Furthermore, when asked about Myanmar's widespread betel consumption despite the risks, a local shop owner and habitual chewer from Mawlamyine answered, "Because everyone else does too." The habit of betel chewing has been widely normalized, such that even children are part of the consumer base.
Sharing betel quids is a key part of social and religious gatherings in Myanmar, particularly in rural areas. "Did you bring betel quids?" is an often-heard phrase, opening discussions and personal conversations. Ornamental offertory betel boxes are the essence of Buddhist ceremonies. Thus, we see how betel culture is deeply embedded in the social fabric.
Betel chewing is both a neglected global health emergency and an important cultural practice deeply rooted in many communities. Tackling this issue requires not only increased awareness of its health impacts, but also a thoughtful analysis of deeper socioeconomic elements.