Betel Nut: A mouthful of controversy

Eighty-two year old Vicente Iginoif has been chewing betel nut since he was eight years old. “It gives me a light feeling. I just stop for a while when I’m sick because it makes me cough,” he said.

Still looking very strong for his age, Iginoif has ignored all the warnings about betel nut chewing.

Rep. Melvin Faisao, a Carolinian, started chewing betel nut at the age of seven. He remembers how grandma would prepare a small bag with two pieces of betel nut cut into four with leaf and lime for his daily consumption.

At age 17, he started mixing betel nut with tobacco. Now in his early 30s, Faisao said he is as healthy as ever. “There’s this warm feeling rushing into my face, for two to three minutes my heart beats faster and then it goes back to normal. I just love that feeling,” he said.

Japanese diver Toshio Takemura learned how to chew betel nut from his local friends when he came to Saipan eight years ago. “It makes me feel warm because I am in the water most of the time,” he said.

An estimated 300 million people chew betel nut in a variety of ways. Many people simply mix the nut with a white-lime paste, wrap it in betel leaf and pop it in the mouth for a satisfying crunch. Others however, have started mixing it with cigarette or tobacco.

Concern

Due to increasing concerns raised by health officials on the island about betel nut chewing, the Food and Nutrition Council decided to invite Dr. Linda Randall, a resident dental hygienist of the Seventh-Day Adventist Dental Clinic.

A sensitive issue in the community, the Council wanted to get an expert’s opinion before making a stand on whether or not betel nut chewing should be banned.

Since she arrived on the island four years ago, Randall has been actively involved in educating her patients and students about the dangers of betel nut chewing and mixing it with tobacco.

The tannins found in betel nut is an astringent compound often used in leather tanning and dyeing. Research has shown that tannins in betel nut when used with lime does genetic damage to the cells.

According to Randall, betel nut chewing should be considered equally harmful as tobacco because it causes damage to the cells and genes. Betel nut use alone does carry cancer risks.

“This is quite serious when the addiction to betel nut often begins in children as early as three years of age,” she said.

Betel nut and tobacco can cause leukoplakia which can lead to oral cancer. It occurs in over half of all users in the first three years of use.

Another study conducted by Dr. Stuart Gansky, Division of Oral Epidemiology, University of California, San Francisco, said betel nut could cause mouth cancer because of its high copper content.

But when betel nut, which already contains cancer-producing agents, is mixed with tobacco, the risks of having oral cancer increases 10 times, Randall said. In fact, she recently discovered that one of his male patients who is in his early 30s has oral cancer.

The man has been chewing betel nut with tobacco for the past five years. He will be sent to Hawaii for operation.

Tradition

Even before Randall raised the alarm, Public Health Secretary Joseph Kevin Villagomez has warned the people against chewing of betel nut with cigarette as the Commonwealth Health Center has discovered cases of oral cancer on the island. “The alarming thing is that we have younger people now who are chewing betel nut with tobacco. Nicotine is addictive whether you chew it or smoke it, ” he said.

Betel nut is deeply ingrained in the lives of the people, woven into rituals and interpersonal relationships. It is used to mend broken relationships or meet new friends and in tribal warfare, it is offered as a final seal upon peace treaties.

Dilemma

Despite the health risks enumerated by Randall, there is no way, the Council can issue a statement recommending the ban on chewing of betel nut, said Thomas Camacho, vice chairman of FNC.

He noted that many locals have invested on planting betel nuts for their source of livelihood.

Camacho said he will recommend that a study be made on the effects of betel nut chewing in the CNMI since Randall only cited cases which she has seen in her clinic. He said the Council can carry out educational campaign to educate the people on the ill effects of betel nut chewing and mixing it with tobacco.

“It is the tobacco that’s dangerous, not betel nut. Has there been someone who chewed betel nut and went out to commit murder? Compare it with an “ice” user who hallucinates and in some cases kill people,” said Faisao.

Gloria Hunter, special assistant for programs and legislative review, raised doubts on the studies which have been done in connection with betel nut. When the U.S. Customs stopped her betel nut package from entering the mainland in 1984, Hunter, who has been chewing betel nut at age seven, cried foul. She wrote to the U.S.

Customs in Guam and Hawaii questioning their decision, which said that betel nut was poisonous.

“The federal government has a tendency of wanting to ban anything that they don’t subscribe to. For example, they want to ban dog eating and betel nut chewing because they find these practices disgusting,” she said.

Among Randall’s long list of recommendations is banning the use of betel nut in all public schools. “Although cultural traditions associated with betel nut chewing can’t be ignored, they must be weighed against the health hazards in future policy decisions,” she said.