Pacific Family Health Journal: Article 2 – Betel Nuts & Heart Attacks

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Pacific Family Health Journal with Dr Rodney Itaki

Betel nut chewing can cause a heart attack!

Betel nut chewing is not unique to Papua New Guinea (PNG). This habit is practiced in Asia and other Pacific Island countries.  For example betel nut is chewed in India, Thailand, Indonesia, Vietnam, Taiwan and Cambodia to name a few. Betel nut is also chewed in other Pacific Island countries like Fiji, Federated States of Micronesia, Palau and Marshall Islands. However, migrants from these countries into Europe, Canada and the United States have taken the habit with them and it is also practiced in other countries outside the Asia-Pacific region. Although the method of chewing varies between countries, the main ingredients remain the same.

In Asia, betel nut is chewed with tobacco leaves and other spices in a mixture. There are now commercial preparations of betel nut that can be purchased in shops much like how coffee is packaged, Taiwan in particular.

The link between mouth cancer and betel nut chewing is now well established. Betel nut chewing will lead to mouth cancer. In fact, in 2003, World Health Organisation published a monograph catergorising betel nut chewing with or without tobacco as a carcinogen. A carcinogen is any chemical compound that can cause cancer. However, little is known about the link between betel nut chewing and heart diseases and that link between betel nut chewing and heart disease, heart attack to be specific, has only been recognised in the last 20 years.

Some of the early medical research work in PNG to find any link between betel nut chewing and heart diseases were done by yours truly at the Sir Buri Kidu Heart Institute, housed within the Port Moresby General Hospital. My research supervisor was Sir Professor Isi Kevau, cardiologist and professor of internal medicine at the University of Papua New Guinea.

As a third year medical student in 1997-1998, I conducted research into the link between betel nut chewing and heart attack among Papua New Guineans under the supervision of Sir Professor Isi Kevau. We showed that betel nut chewing increases the heart rate very quickly – within 2 minutes and takes up to 15 minutes to come back to normal. But the blood pressure goes up in some people while in others it goes down.

Two other third year medical students after me (Dr Guboro Urae, Physician and Dr Joshita Jothimanikam, Malayasian-Indian doctor studying in PNG at the time) also working with Sir Professor Isi Kevau showed that betel nut chewing decreases the blood supply to the heart muscles and causes chest pain, similar to what happens just before someone has a heart attack.

There have been reports of people in PNG collapsing and dying soon after chewing betel nut. Sudden death following betel nut chewing has also been reported in the medical literature from Asian countries as well. And we think that the rise in heart rate combined with the decrease in blood supply to the heart muscles caused by betel nut chewing can lead to a heart attack. So in PNG, betel nut chewing not only causes mouth cancer but can also cause sudden death from a heart attack.

So how can we know if someone will have a heart attack or not from chewing betel nut? The answer is we can’t. However, some risk factors that doctors look for are – if you are overweight, if you smoke, no exercise, drink too much alcohol and chew betel nut as well, you may be at high risk. Some early warning signs are feeling dizzy and chest discomfort soon after chewing betel nut so If you or know someone who experiences chest pain or feels dizzy when chewing betel nut, it would be advisable stop the habit and seek professional medical advice and get a checkup.

Your next betel nut could be your last.

Dr Rodney Itaki, MBBS, BMedSci

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