Betel quid is a combination of betel leaf, areca nut, and slaked lime. In many countries, tobacco is also added to the product, and we will review this variety known as gutka, ghutka, or gutkha. It originated in the Indian Subcontinent, where gutka consumption is very popular today, and spread from there to areas with a large Indian population. Like other tobacco products, gutka is potentially addictive and cancerous, and in India, some moves have been made to attempt to restrict the availability of gutka to address health concerns.
Gutka is available commercially in sachets and tins. This is taken orally and the mixture is placed between gum and cheek. This mixture is sucked and chewed slowly. Sucking and chewing causes the formation of saliva which is either swallowed or spit. Generally the first few parts of saliva are spit and then when the saliva becomes lighter, it is swallowed.
Like other betel nut chews, gutka is highly staining, leaving a characteristic reddish to orange stain on the lips, tongue, and teeth, and it also stains the streets and sidewalks when people spit it out.
Why it is popular?
Some practitioners of Ayurveda (a traditional Indian system of medicine) advocate the use of gutka as a treatment for fatigue and depression, and the product is also sold as a breath freshener.
But mostly, gutka is so popular because of its affordability. It can cost as little as half a rupee - which means one could buy 90 sachets for the price of US$1.
It is very popular among children. Some Gutka are chocolate flavored; others are sold as mouth fresheners. In addition, some manufacturers package Gutka as if it is a sweet - bright colors and children's faces decorate the wrappers. In Mumbai, India's commercial capital, they are sold by street vendors virtually everywhere. They are popular with street children and teenagers can go through up to 15 packets a day. According to health officials, some children like Gutka because it's an appetite suppressant.
Street vendors (known as “Gutka Barons”) throughout India sell Gutka in brightly colored, rectangular pouches. While the law technically prohibits Gutka Barons from selling within 100 yards of any school, usage among kids has increased nonetheless. In fact, a recent survey determined that the number of teen tobacco chewers in India has doubled from a decade ago.
Gutka primarily consists of:
- Betel leaf or Piper betel
- Areca nut (Areca catechu)
- Catechu (an extract from Acacia catechu tree)
- Slaked lime (calcium hydroxide)
- Spices (cardamom, saffron, cloves, anise seeds, turmeric, mustard)
While in other tobacco products, the most harmful ingredients list nicotine and tar, gutka has more to add to the health threatening facts through its other unique components. The cancer research body of the World Health Organization has categorized areca nut – the main ingredient of gutka – also as carcinogenic or cancer- causing. Betel nut is suspected to elevate the risk of cancer of the gums, mouth, throat, lung, liver, stomach, prostate and esophagus. The carcinogenic (cancer causing agents) alkaloids in betel nut are made even more dangerous by the inclusion of tobacco and lime in gutka. Specific arecal alkaloids act as competitive inhibitors of GABA receptors and have widespread effects in the body, including actions on the brain, cardiovascular system, lungs, gut and pancreas. Nitrosated derivatives of arecal alkaloids, proven carcinogens inducing tumors throughout the upper gut and foregut derivatives in animals, are also associated with increased tumor risks in man. Increased central obesity is found in association with betel usage in man as well as increases in circulating markers of inflammatory and cardiovascular damage. The effects of chronic betel usage in man are at least as diverse as those of smoking and the habit increases the risks of ill health. Betel nut contains three major alkaloids: arecoline, pilocarpine, and muscarine.
The Betel Nut research shows that there’s a link between increased betel nut quid nut production and consumption and a substantial rise in the incidence of head and neck cancers among Taiwanese men, says a National Taiwan University Hospital study. The presence of cholinomimetic and acetylcholinesterase (AChE) inhibitory constituents in betel nut, the most commonly used drug in the world after tobacco, ethanol and caffeine.
The most serious side effect associated with prolonged gutka use is an increased risk of cancer. Betel nut is suspected to elevate the risk of cancer of the gums, mouth, throat, lung, liver, stomach, prostate and esophagus. The carcinogenic (cancer causing agents) alkaloids in betel nut are made even more dangerous by the inclusion of tobacco and lime in gutka. An increase cancer risk has only been documented in people who chew or consume gutka on a regular basis.
Large doses of gutka can cause a cocaine-like state of intoxication. Symptoms of gutka intoxication include dilated pupils, amnesia, psychosis, confusion, impaired judgment and euphoria. While some gutka users seek the product because of its euphoric, stimulant effects, it can cause serious long-term psychological problems. After long-term use, many users become addicted to gutka’s effects on brain chemistry. Withdrawal symptoms include insomnia, dry mouth, amnesia, insomnia, cognitive problems and fatigue.
Like most stimulants, gutka can adversely affect the cardiovascular system. The National Institutes of Health warn that betel nut is associated with abrupt changes in blood pressure, which can lead to unpleasant side effects such as dizziness and blurred vision. Palpitations and cardiac arrhythmia are also very common in people using gutka on both a long-term and short-term basis. More seriously, gutka use is associated with an elevated risk of chest pain, heart attack and stroke. Gutka should be avoided entirely by smokers and anyone with a history of heart disease.
Gutka has been known to cause many gastrointestinal side effects. Nausea, vomiting, acid reflux, abdominal pain and diarrhea are common in gutka users. Rarely, these side effects may be so severe that they lead to a life-threatening state of dehydration, which may require hospitalization. Gastrointestinal side effects may last several hours, days or even weeks following the ingestion of gutka. It has also been known to cause users to lose control of the bowels and/or bladder.
Other Side Effects
The National Institutes of Health report dozens of potential side effects associated with betel nut and tobacco, two of the primary components of gutka. Gutka is acutely toxic to the liver and kidneys and can cause life-threatening fluctuations in blood sugar for people with diabetes. It also frequently causes a reddish staining of the gums, teeth and lips. Less commonly, routine gutka users develop a sallow (PALE COMPLEXION) complexion. Though gutka is widely used by children, it is considered to be unsafe for those under 18 years of age; its toxic effects also make it contraindicated for women who are pregnant and nursing.
Another illness, associated with Gutka, is sub-mucous fibrosis (SMF) brought on by Areca nut, a substance mixed with the tobacco. SMF produces a hardening of the mouth lining which can develop into oral cancer. People suffering from this disease find it progressively more difficult to open their mouths. In the worst cases, patients are unable to eat and drink liquidized food through a small opening in their mouths.
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