Don't chew betel nut

Cost

Free, and it takes no time; you also save the money you would spend on betel nut. The hard part is breaking the chewing habit.

What you get

Pooling 17 Asian studies with 388,000 (38.8万) people, people who chewed betel nut had about 21% higher risk of death than people who didn't (relative risk 1.21, P=0.02). The death figure is based on 179,600 (17.96万) of those people. The risk of diabetes was about 47% higher (1.47). The risk of metabolic syndrome was about 51% higher (1.51). Betel nut itself is also a known risk factor for mouth cancer and esophageal cancer. Mouth cancer: pooling 50 studies, in the Indian subcontinent, chewing betel nut without tobacco put the risk of mouth and oropharyngeal cancer at about 2.56 times that of non-chewers (95% CI 2.00–3.28). With tobacco added it was about 7.74 times (5.38–11.13). In Taiwan, chewing betel nut without tobacco, it was about 10.98 times (4.86–24.84). In India and Taiwan, the more chewed each day and the more years chewed, the higher the risk. Esophageal cancer: pooling 12 Asian studies, betel nut chewers had about 3.05 times the risk of esophageal squamous cell cancer of non-chewers (2.41–3.87). Those who both chewed betel nut and smoked had about 6.79 times (4.71–9.79). After quitting: pooling 13 studies, people who quit betel nut with tobacco had about 34% lower risk of head and neck cancer than those still chewing (RR 0.66, 0.54–0.81). Those who quit betel nut without tobacco had about 27% lower (RR 0.73, 0.56–0.95). Those who had quit for 20 years or more had about 63% lower (RR 0.37, 0.22–0.61)

Notes

The more years you have chewed and the more you chew each day, the higher the risk of mouth cancer. After quitting, the risk goes down over time. In the Indian studies, betel nut that contains tobacco is more dangerous than betel nut without it. Most betel nut chewed in Taiwan is without tobacco, and the risk there is also very high.

Evidence grade

A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.

Sources

1. Yamada T, Hara K, Kadowaki T (2013). Chewing betel quid and the risk of metabolic disease, cardiovascular disease, and all-cause mortality: a meta-analysis. PLoS One, 8(8), e70679. https://doi.org/10.1371/journal.pone.0070679
2. Guha N, Warnakulasuriya S, Vlaanderen J, Straif K (2014). Betel quid chewing and the risk of oral and oropharyngeal cancers: a meta-analysis with implications for cancer control. International Journal of Cancer, 135(6), 1433-1443. https://doi.org/10.1002/ijc.28643
3. Akhtar S (2013). Areca nut chewing and esophageal squamous-cell carcinoma risk in Asians: a meta-analysis of case-control studies. Cancer Causes & Control, 24(2), 257-265. https://doi.org/10.1007/s10552-012-0113-9
4. Shah K, Boffetta P, Seyyedsalehi MS (2025). Reversal of head and neck cancer risk after the cessation of use of smokeless tobacco and betel quid use: meta-analysis. Cancer Epidemiology, Biomarkers & Prevention, 34(5), 619-626. https://doi.org/10.1158/1055-9965.EPI-24-1502

Translated from the Chinese original. Original book, section 2, tip 8. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer