Betel Quid Habit Linked to Emerging Health Risks of Diabetes and Other Insulin Resistance Diseases in Poor Young South Asian Populations

Betel quid is traditionally prepared with areca nut, betel leaf, and slaked lime. The habit of betel quid chewing has existed for millennia and until recently, has been largely centered around cultural, medicinal, and ceremonial activities, particularly in South Asian countries. However, discovery of its psychoactive, euphoric, and aphrodisiac properties contributed to the global spread and abuse of betel quid, which now is widely consumed as a social lubricant and source of financial profit. Unfortunately, victims of the profit motive include young girls and boys who get addicted due to high rates of habitual consumption. Furthermore, the alarming practice of incorporating tobacco in quid preparations has grown and is particularly problematic for pregnant women. Long-term serious health concerns linked to habitual quid chewing include increased rates of malignancy, oral pathology, and cardiovascular, hepatic, fertility, metabolic, and neuropsychiatric disorders. Metabolic disorders and insulin resistance disease states such as type 2 diabetes, obesity, and metabolic syndrome have significant adverse effects due to their contributions to cognitive impairment and neurodegeneration. Mechanistically, the areca nut/betel quid constituents are metabolized to N-nitroso compounds, i.e., nitrosamines, which at high doses are carcinogenic, but at chronic lower levels, they cause insulin resistance diseases. Epidemiological data have highlighted rising tides of obesity, diabetes, and dementias, each of which has been linked to insulin resistance states that now disproportionately burden poor countries. Public health measures are needed to impose socially and ethically responsible barriers that curb commercialization strategies to enhance betel quid access and thereby reinforce practices that contribute to global health disparities.