Paan: From Traditional Usage to Effects on Health

By Raji Jayadev

Accredited Practising Dietician

Betel -quid or Paan in Hindi is a preparation combining betel leaf with slaked lime (chunnam or choona) paste and areca nut with or without tobacco. It is also known as beeda in Hindi, thaambola in Kannada, thambulum in Tamil and tambulam in Telugu.

Paan is very popular in India and has many variations. Some South Asian preparations include katha or kachu (Acacia catechu), cloves, cardamom, fennel seeds, anise seeds and sometimes gutka. It is the fourth most popular psychoactive substance in the world. Other three are caffeine, nicotine and alcohol. It is also an addictive and euphoria-inducing formulation with adverse health effects. Possession of betel nut or leaf is banned in UAE and is a punishable offense. Dubai government has banned the import and sale of paan.


Paan chewing is a custom or culture of India, Philippines, Myanmar, Pakistan, Cambodia, Laos, Thailand, Vietnam, Bangladesh, Nepal and Taiwan. Historically, habitual paan use was socially acceptable, even expected in Asian cultures, but now it’s use is tolerated but no longer widely encouraged.

The betel leaf and areca nut play an important role in Indian culture, especially among Hindus. They are used in many traditional ceremonies, auspicious beginnings and festivals.

In Sri Lanka and in some Indian states, a sheaf of betel leaves and areca nut is traditionally offered to elders as a mark of respect.

It is not known how and when the betel leaf, lime paste and the areca nut were combined together as one psychoactive drug. Archaeological evidence from Thailand, Indonesia and the Philippines suggests that they have been used in tandem for at least four thousand years. In the Indian subcontinent, the chewing of paan dates back to the pre-Vedic period Harappan Empire.

The betel plant (Piper betle): It is an evergreen perennial vine belonging to the family Piperaceae. It originated and cultivated in South and South East Asia. Betel leaves are used as a stimulant, an antiseptic, anti-parasitic and a breath-freshener.

Slaked lime (chunnum or choona): Calcium hydroxide, traditionally called slaked lime is obtained when lime or quicklime is mixed or “slaked” with water. The slaked lime acts to keep alkaloid stimulants in betel leaf and areca nut chemically available to enter bloodstream via sublingual absorption.

Areca nut: The areca nut known as Poogi phalam in Sanskrit and Supari in Hindi is the seed of the areca palm (Areca catechu). It is grown for its commercially important seed, the areca nut. India is the largest consumer of areca nut. The nut can be addictive and has direct link to oral cancers.

Effects on health

Habitual chewers of paan, with or without tobacco have a greatly increased risk of developing a range of serious diseases, including cancers of mouth, pharynx and oesophagus.

In 2003 and in 2009 the International Agency for Research on Cancer (IARC) and the World Health Organisation (WHO), reviewed published medical research on the harmful effects of paan. They reported that there is sufficient scientific evidence that the habit of chewing paan leads to cancers of mouth, pharynx, and oesophagus.

In 2004 WHO reported that the percentage of oral cancers diagnosed in hospitals in Asia has always been much higher compared to western countries, where the habit of chewing paan is virtually unknown.

The main cancer causing factor is believed to be areca nut. Areca nut contains three main psychoactive alkaloids – arecaidine, arecoline and guvacine. Various other chemical compounds in areca nut, along with eugenol in betel leaf, affect almost all organs of the human body, including brain, heart, lungs, liver and digestive tract. It aggravates pre-existing conditions such as heart disease, diabetes, asthma etc. It has harmful effects on the foetus if used during pregnancy.

Paan is an addictive psycho stimulating and euphoria-inducing formulation with adverse health effects most importantly mouth and throat cancers.

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