Betel Quid with Tobacco (Gutka)

Betel quid is a combination of betel leaf, areca nut, and slaked lime.

In many countries, tobacco is also added, and the product is known as gutka, ghutka, or gutkha.

Other ingredients and flavorants are also added according to local preferences and customs (e.g., sweeteners, catechu, or spices such as cardamom, saffron, cloves, anise seeds, turmeric, and mustard).

Gutka is commercially available in foil packets and tins and is consumed by placing a pinch of the mixture in the mouth between the gum and cheek and gently sucking and chewing. The excess saliva produced by chewing may be swallowed or spit out.²

Use

• Betel quid and gutka use is reported to have stimulant and relaxation effects.²
• Global estimates report that up to 600 million men and women use some variety of betel quid.²
• Betel quid with or without tobacco is widely used in the Indian subcontinent (i.e., Bangladesh, India, Pakistan) as well as throughout Asia and the Pacific region (e.g., Cambodia, China, Indonesia, Malaysia, Philippines, Taiwan, Thailand).^1,2,3,5

Health Effects

The following conditions have been associated with betel quid/gutka use:

Precancerous conditions

• Oral precancerous lesions, including erythroplakia (a reddened patch in the mouth) and leukoplakia (a white patch on the mucous membranes in the mouth that cannot be wiped off).^2,6
• Oral submucous fibrosis (OSF), a precancerous lesion that stiffens the soft pink tissue that lines the inside of the mouth (i.e., oral mucosa).

Cancer

• Oral cancers—predominantly carcinomas of the lip, mouth, tongue, and pharynx^2,6,8
• Cancer of the esophagus²

Other health effects

• Reproductive health outcomes such as increased risk of having a low birth-weight infant⁷
• Nicotine addiction⁴

References

1. National Cancer Institute, Centers for Disease Control and Prevention, Stockholm Centre of Public Health. Smokeless Tobacco Fact Sheets. Third International Conference on Smokeless Tobacco; Stockholm. September 22–25, 2002 [cited 2015 Nov 27].
2. World Health Organization. Betel-Quid and Areca-Nut Chewing and Some Areca-Nut-Derived Nitrosamines; Volume 85 [PDF–7.44 MB]. Lyon (France): World Health Organization, International Agency for Research on Cancer, 2004 [accessed 2015 Nov 27].
3. Stanfill SB, Connolly GN, Zhang L, Jia LT, et al. Global Surveillance of Oral Tobacco Products: Total Nicotine, Unionised Nicotine and Tobacco-Specific N-nitrosamines. Tobacco Control 2011;20:e2, May 1, 2011 (10.1136/tc.2010.037465) [cited 2015 Nov 27].
4. World Health Organization. Tobacco: Deadly in Any Form or Disguise
   [PDF–2.58 MB]. Geneva: World Health Organization, 2006 [accessed 2015 Nov 27].
5. Centers for Disease Control and Prevention. Use of Cigarettes and Other Tobacco Products Among Students Aged 13–15 Years—Worldwide, 1999–2005. Morbidity and Mortality Weekly Report 2006;55(20):553–6 [accessed 2015 Nov 27].
6. Nair U, Bartsch H, Nair J. Alert for an Epidemic of Oral Cancer Due to Use of the Betel Quid Substitutes Gutkha and Pan Masala: A Review of Agents and Causative Mechanisms. Mutagenesi 2004;19(9):251–62 [accessed 2015 Nov 27].
7. Gupta PC, Ray CS. Smokeless Tobacco and Health in India and South Asia. Respirology 2003;8(4):419–31 [cited 2015 Nov 27].
8. Gupta PC, Ray CS. Epidemiology of Betel Quid Usage [PDF–43.77 KB]. Annals Academy of Medicine Singapore 2004;33(Suppl):31S–36S [accessed 2015 Nov 27].