2. Health benefits of areca nut and its products as per Traditional Chinese Medicine system

 

Traditional Chinese medicine (TCM) has evolved over thousands of years. TCM practitioners use various psychological and/or physical approaches (such as acupuncture and tai chi) as well as herbal products to address health problems. Areca nut is an important ingredient in Traditional Chinese medicine. Traditional Chinese medicine system believes that areca nut has the effects of "killing parasites, breaking accumulation, reducing qi and stagnation, and promoting hydration". Areca nut has been used to treat tapeworms, hookworms, roundworms, worms, ginger worms and other parasitic infections.

"Compendium of Materia Medica" records that areca nut has many effects such as "down edema, joint joints, spleen tone, and heartache accumulation". Areca nut also has the functions of treating glaucoma, increasing blood pressure, stopping diarrhea and treating diarrhea, reducing inflammation and swelling, removing phlegm and asthma, purging qi and water, and killing parasites.

Binglong (areca nut ) Pill is frequently used for reinforcing vital energy. The combination of pumpkin seed and areca is most widely used, which comes from the prescription of ‘Qu Tao Tang’ (Cestode-expelling Decoction). The constituents of ‘Qu Tao Tang’ (Cestode-expelling Decoction) are very simple, 60–120 g fresh pumpkin seeds and 30–60 g areca. Areca is ground with a pestle, soaked for a few hours in 400 ml of water, decocted to 100 ml, and filtered, and the debris of the decoction are discarded. The treatment procedure consists of two steps: first, chewing up fresh pumpkin seeds or taking the powder form of it ground in advance and then drinking the decoction of areca 2 h later. Anhydrous sodium sulphate is used as laxative along with this. The worm was quickly paralyzed from head to tail with a mixture of betel nut and pumpkin seed water extract. Worm bodies would be discharged along with diarrhoea 4–5 h later.

More than 31 different formulations are being used for treating dysentery, abdominal distension, dyspepsia, parasitic diseases and constipation etc. The raw areca and charred areca nuts are the most common clinically used forms. The Charred areca nut is commonly prepared by stir-baking to a yellowish colour, stir-baking to dark brown, or carbonizing by stir-frying.

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1. Health benefits of areca nut / Tambula as per ancient Indian treatises

 

One of the earliest references describing the good qualities of Tambula is found in charter 77 of the Brhatsamhita of Varāhamihira believed to be written in 500 CE in Sanskrit. It says, “Tambula stimulates love, sets off the physical charm, creates popularity, gives good smell to the mouth, strengthens the body and dispels diseases arising from the phlegm”.

Areca nut has been mentioned in several ancient treatises such as Charaka Samhita, Susruta Samhita, Astanga Hridayam, Bhavaprakasa, Harivamsa, and Varahapurana. These classical texts consider areca nut as astringent and slightly sweet (kasaya), cold in potency (hima), helps taste (rucya), Removes moisture and dirt of the mouth (asyakleda malapaha) and bad taste (vaktravairsaya), creates dryness (ruksa), heavy for digestion (guru), stimulates digestion (dipana), it is purgative (bhedi) and intoxicant (mohana). Choorna of areca nut has been prescribed with several other medicinal ingredients for treating liver ailments as per Charakasamhita, which was believed to be written during 100 BCE to 200 CE.

As per Vatsayana’s Kamasutra, a noble person (nāgaraka) cleans his/her teeth and perfumes himself/herself in the morning, uses mouthwash, and chew some Tambula (Mixture of areca nut with slacked lime smeared betel leaf) to make himself / herself presentable. The Tambula chewing is considered as an integral part of an elaborate sexual act as per the Kamasutra. In the Kāmasūtra, it is suggested that a lover should use Tambula both as a precursor to sexual relations, at various points during the sexual act, and as a post-coital activity marking a ritualistic finish and freshening of the breath.

Jyotirnibandha written by Shivraj in AD 1524, prescribes that three parts nut, two parts betel leaf, one-part catechu and lime make an ideal Tambula. Apparently, the composition prescribed is based on weight. As per this treatise, the Tambula prepared as per this formula, shall produce pungency, bitterness, heat, sweetness, saltiness, power to remove Vata, possess antiseptic character, remove phlegm, excite passion, beautify the mouth, purify the mouth, and remove all bad odour from the mouth. The work also indicates that different numbers of areca nuts confer differing outcomes: one produces happiness; two bears fruit; three brings loss; four causes pain of misery; five brings long life; six causes death.

References

1.     P. K. Gode (1950). Studies in the history of tāmbūla — history of the verse about the thirteen qualities of tāmbūla — between A.D 1200 and 1900, Annals of the Bhandarkar Oriental Research Institute, Vol. 31, No. ¼, pp. 138-142.

2.     Andrea Gutierrez (2015). Modes of betel consumption in early India, Religion and Food, Scripta Instituti Donneriani Aboensis, Vol 26, pp. 114–34

3.      Ahuja & Ahuja (2011). Betel Leaf and Betel Nut in lndia: History and Uses, Asian Agri-History Vol. 15, No. l, pp. 13-35.

4.      Kosambi D.D (1964). The Culture and Civilisation of Ancient India in Historical Outline. First edition. Taylor & Francis. Landon.

11. Some of the most criticized IARC reports: Alcoholic beverages, Part-III

 

IARC released a monograph on alcohol consumption in 2010 (Vol 96). This monograph was prepared by a working group comprising 27 members drawn from reputed labs of 16 different countries. The monograph focused on beer, wine and spirits (whiskey, brandy, rum, vodka, Scotch and Gin etc..). Working Group concluded that acetaldehyde, the primary metabolite of ethanol, is the carcinogen that leads to the formation of various type of cancer. Working Group concluded that a large body of evidence from epidemiological studies of different design and conducted in different populations consistently shows that consumption of alcoholic beverages is associated with a higher risk for both oral and pharyngeal cancer, and that the risk increases with increasing amounts of alcohol consumed. Compared with non-drinkers, regular consumption of about 50 g alcohol (ethanol) per day (equivalent to about 150 ml of distilled spirits) is associated with an approximately threefold increase in risk oral and pharyngeal cancer cancers, two-fold increase in laryngeal & esophagus cancer. These studies provide firm evidence that the consumption of alcoholic beverages are an independent risk factor for primary liver cancer. The working group found sufficient evidence in experimental animals for the carcinogenicity of ethanol and acetaldehyde (the ethanol metabolite).  

The working group gave an overall evaluation as follows, 

 ·       Alcoholic beverages are carcinogenic to humans (Group 1).

·        Ethanol in alcoholic beverages is carcinogenic to humans (Group 1).

As per the data presented in the same IARC monograph, in Eastern European block countries (Belarus, Estonia, Hungary, Kazakhstan, Latvia, Lithuania, Republic of Moldova, Russian Federation, Ukraine), 63.7 % men consume more than 40 g of pure alcohol (in the form of alcoholic beverages) per day. Incidence of cancer in that bloc is supposed to be substantially higher compared to other regions. However, the data presented in the same monograph doesn’t provide the evidence for the same. This appears to be a serious anomaly. 

10. Necessity to evaluate IARC reports on Areca nut and its products

 

Prof. Geoffrey Kabat, a cancer epidemiologist at the Albert Einstein College of Medicine New York, USA, observes that in its assessments of carcinogenicity, IARC places the greatest value on studies in humans, that is, evidence from epidemiologic studies. Interestingly, as per IARC’s own account, the evidence from epidemiological studies shows no indication of a positive association with any cancer with coffee. So, the obvious question is, why wasn’t coffee reassigned to Group 4: “unlikely to cause cancer in humans”?   Yet IARC chose to place coffee in Group 3, which essentially meant “The agent is not classifiable as to its carcinogenicity to humans”. Prof. Geoffrey Kabat observes that IARC’s process appears to be afflicted with a deeply-ingrained double standard. He opines that IARC’s assessments are placing too much weight on isolated findings that appear to suggest a risk, while ignoring more solid studies that do not support the existence of risk.

Interestingly, IARC stated in its monograph that “coffee may protect against cancer." But then it went on to justify its designation of “unclassifiable as to its carcinogenicity in humans.” This flagrant contradiction highlights the problems with IARC’s process, its classification scheme, and the messages it puts out to the public.

Looking into various controversies created over the years through its reports on coffee, meat and cell phones tec., Prof. Geoffrey Kabat observes that IARC is motivated more by the drive for publicity than by a concern for communicating useful information to the public (Courtesy: IARC Lets Coffee Off The Hook But Only Deepens The Confusion, Jun 18, 2016, Forbes magazine).

Unfortunately, Areca nut and its products are appeared to be the victims of such reports by IARC. Due to the stature and clout of IARC, Indian Govt. is forced to initiate action to curb the consumption of Areca nut. At the same time, any possible ban or the restriction on the consumption of areca nut or its products is going to threaten the lively hood of millions of areca farmers across India.

From this, it is amply clear that there is a necessity to evaluate and scrutinize all the reports of IARC on areca nut and Pan/Tambula from several perspectives. This becomes all the more important in case of areca nut, due to the diverse method of consumption (areca nut of different maturity, different ways of processing and different adjuncts including tobacco), frequency of consumption by an individual, complex mechanism of metabolism of areca nut constituents in human body (yet to be elucidated completely) etc. Being a member of IARC, Indian Government must initiate such action in liaison with IARC.   

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9. Some of the most criticized IARC reports: Coffee, Part-II

 

The International Agency for Research on Cancer (IARC) released a monograph in 1991 on the carcinogenic risks caused by coffee (Vol. 51). The monograph was an outcome of year long study and a weak long workshop held in 1990 in Lyon, by a working group comprising 23 experts drawn from 16 countries.  Based on the published literature available from reputed sources, the working group evaluated the reports on epidemiological and experimental studies on the carcinogenicity ln experimental animals, Structure-activity considerations, Absorption, distribution, excretion and metabolism, toxicity, Genetic and related effects, and evidence for carcinogenicity in humans. The working group in its monograph observed that,

·        There is limited evidence in humans that coffee drinking is carcinogenic in the urinary bladder.

·        There is evidence suggesting lack of carcinogenicity of coffee drinking in the human female breast and in the large bowel.

·      There is inadequate evidence in humans that coffee drinking is carcinogenic in the pancreas, ovary and other body sites.

·        There is inadequate evidence in experimental animals for the carcinogenicity of coffee.

The working group concluded that,

·        Coffee is possibly carcinogenic to the human urinary bladder (Group 2B).

This attracted widespread criticism on this report among the public, law makers and scientist's world over. This triggered an in-person enquiry of officials of the U.S. government’s health research agency, “National Institute of Health” by the Congressional committee of United States of America (USA), on its grants to the International Agency for Research on Cancer (IARC) (As per Reuters report dated October 6, 2016). As per the news agency Reuters, the briefing comes after the committee’s chairman added his voice to growing concerns among some senior U.S. lawmakers about the way IARC reviews and classification of substances such as coffee, mobile phones, processed meat and the weed killer glyphosate as carcinogenic. As per Reuters, the Chairman of the Committee on Oversight and Government Reform, Mr. Jason Chaffetz wrote a letter to the NIH Director, and alleged that “IARC’s standards and determinations for classifying substances as carcinogenic, and therefore cancer-causing, appear inconsistent with other scientific research, and have generated much controversy and alarm” and questioned NIH policy to fund IARC.

In 2016, IARC constituted a working group of 23 members drawn from 11 countries to reevaluate the carcinogenic risk posed by Coffee. They released report in 2016 and brought out a monograph on coffee in 2018 (Vol. 116).

The working group observed in its monograph that,

·       There is inadequate evidence in humans for the carcinogenicity of drinking coffee.

·      There is evidence suggesting lack of carcinogenicity of drinking coffee in humans for cancers of the pancreas, liver, female breast, uterine endometrium, and prostate. Inverse associations with drinking coffee have been observed with cancers of the liver and uterine endometrium.

·       There is inadequate evidence in experimental animals for the carcinogenicity of coffee.

The working group concluded that,

·        Drinking coffee is not classifiable as to its carcinogenicity to humans (Group 3).

The working group also observed that coffee drinking is associated with a beneficial effect on liver fibrosis and cirrhosis.

This triggered an allegation that IARC takes decisions in haste and retract their findings due to public pressure after the publication of monograph on coffee and glyphosate. IARC’s director, Chris Wild defended IARC’s evaluation of coffee and said that “The (coffee) report in 2016 was not a ‘retraction’ but a re-evaluation based on an additional 25 years of scientific evidence” (As per Reuters report). 

Nevertheless, this is a classic example where IARC has reversed its assessment on a most popular consumer item. 

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