July 10, 2007 / 11:27 PM / 12 years ago

FEATURE-Betel nut cancer link takes buzz out of Taiwan tradition

By Ralph Jennings

KAOHSIUNG, Taiwan, July 11 (Reuters) - For centuries, hundreds of millions of people across Asia, from Pakistan to Palau, have chewed the spicy date-like fruit of the betel palm for a quick buzz.

Then four years ago, a World Health Organisation study found that chewing betel nuts can cause oral cancer and that the rate of these malignant mouth tumours was highest in Asia where the betel nut is a widely used stimulant.

Despite the cancer link, betel nut addicts are chewing on in many parts of Asia. But in Taiwan, the findings have spurred a government health campaign against the nut which is grown on palm trees across the sub-tropical island southeast of China.

"If you don’t want oral cancer, the most direct way is to quit chewing betel nuts," Wu Chien-yuan, chief of cancer prevention in the Taiwan health ministry, told Reuters.

Betel nut, which contains an addictive stimulant similar to nicotine, is widely used in parts of Southeast Asia, India, Pakistan and the South Pacific as a breath freshener, a hunger antidote, a substitute for cigarettes and as a way to get high.

Users often chew it all day long, causing all sorts of unpleasant side-effects such as red-stained teeth and pavements covered with red spittle as many users spit out the betel nut’s remnants as they chew.

"Whether it harms you is an individual thing," said Kaohsiung betel chewer Wan Chin-hsian, 35. "It’s healthy to spit it out."

Under pressure from the government health drive, betel nut traders and growers are seeking new uses for the nut — such as soap — as the industry seeks to stay in business.

There is a lot at stake for betel nut growers as the nut is the island’s second biggest crop after rice and provides more than 20,000 jobs.

"Betel nut is in dispute, but the sellers still have to make a living," said Lee Su-ming, an organiser of a betel nut festival in the southern Taiwan city of Kaohsiung last month.


Aware of the cancer link, some merchants are wrapping betel quids with less lime, a leaf-to-nut bonding additive that some in the industry believe to be the most noxious ingredient.

Growers in Taiwan now use almost every bit of the betel nut stick palms that grow all over the island.

They turn it into chicken soup, chicken feed and hard liquor for as much as T$12,000 ($366) per bottle. Some advocate eating betel flowers instead of chewing the kernels. Many consume a combination of betel nut and tobacco.

For those who still chew, sellers say they consistently hand out paper cups to discourage spitting the red pulp onto public streets, an act that outrages a sanitation-conscious public.

Betel controversy first hit Taiwan in the 1990s, when the government made farmers stop clearing mountains to grow betel palms and required growers to plant grass to prevent mudslides.

Then nut’s popularity in Taiwan began to wane after the WHO cancer study came out. The study prompted Taiwan government health warnings against betel nut in schools, churches and on tissue boxes at gas stations. Chewers can be fined the equivalent of US$36 for spitting.

"Oral cancer appears to be the most prevalent and serious health effect of concurrent use of (betel) nut and tobacco in the region," said a WHO report.

Government statistics show that the oral cancer rate rose from 1,790 to 4,754 between 1994 and 2004, with deaths going from 779 to 1,593 cases over that period. Taiwan officials blame betel nuts. The WHO says 58 percent of the world’s 390,000 oral cancers come from Asia, where the betel nut is widely consumed.

"The government is always putting pressure on us," said grower Yang Hui-hsiung. "If you see the reports on it, they’re all negative."


The Taiwan Department of Health anti-cancer bureau says betel flowers and other parts of the palm also contain an alkaloid that causes cancer. It wants Taiwan to phase out betel completely, replacing it with healthier crops.

Betel nut chewers are 28 times more likely to get oral cancer than non-users, according to health officials.

In India, where the betel nut is sometimes used as offerings in religious ceremonies, some states have begun regulating the betel nut industry due to a growth in adolescent users. The WHO predicts a reduction in oral cancer in those regions.

Other countries are letting betel run its course. In the South Pacific, 63 percent of Micronesian high school students chew it, the WHO says, adding that about 20 percent of Micronesian users get mouth diseases such as oral cancer.

Experts doubt that health officials will be able to cut the use of betel across the region as the nut is embedded in many cultures and the industry is lucrative and provides jobs.

But in Taiwan at least, the government’s publicity campaign shows signs of paying off. About 9 percent of Taiwan’s 16.7 million adults chew betel, down from 10.9 percent in 1996.

"It’s gross, and not just in terms of sanitation," said Tsai Chia-che, 20, a security guard at a recent betel nut festival in Kaohsiung.

($1=T$32.8) (Additional reporting by Tan Ee Lyn in Hong Kong)

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