DOMA (fermented betel nut)

Don't chew your way to cancer, say no to “SUPARI”

ADVERSE EFFECTS OF DOMA (FERMENTED BETEL NUT) CHEWING

What is Doma –? 

Betel nuts are commonly chewed in Asia.  It is known with various names across the globe e.g. Supari (India). The fermented betel nut is especially used in North Eastern states. It is known as “Bura Tamul” in Assam. The same fermented betel nut is known as “Doma” in Bhutan. The western name for Doma is Areca Nut. The abundant alkaloid present in Areca nut is Arecholine. Arecholine produces various effects on human body. It is an agonist at both muscarinic and nicotinic acetylcholine receptors. It causes slowing of heart rate, tremors, sweating and various effects on autonomic nervous system.  It is used as a vermifuge(anti-helminthic), in veterinary practice. It has been used as a euphoriant in the Pacific Islands. The concentration of arecholine increases several times in fermented betel nuts as compare to raw one. It is carcinogenic and mutagenic to human cells. It is a highly addictive substance and should be called as a Drug.

How does it get fermented-?

It is prepared in a 4-5 feet hole in the ground where ripe betel nuts are left for 2-3 months covered with bark from the betel tree, cow dung and soil. During the period of fermentation the outer fibrous shell of the nuts decays. Chopped or crushed nuts at different stages of ripening are wrapped in betel leaf and chewed with or without tobacco.

                                                                                                  

Adverse effects of Doma chewing-

Risk of Cancer – International Agency for Research on Cancer declared that Areca Nut was carcinogenic to human. 

1.   Cancers of Oral Cavity –

          Betel nut chewing is associated with Oral cancer. The risk increases when it is   combined with tobacco. Against the popular myth that consuming betel nut would do no harm, studies have proved that Supari is much more harmful than tobacco. 10% of the betel nut chewers tracked by Tata Memorial Hospital for over a decade developed cancer. 

2.   Cancer of Oesophagus (food pipe) – 

           Betel nut chewing also causes cancer of food pipe especially when it is combined with alcohol and tobacco.  As addicts combine the all three toxic substances, these group of people are at risk of multiple cancers.

3.  Liver Cancer – 

         A study from Taiwan has proved that the betel nut chewing increases cancer risk for Liver by three fold. Although in Taiwan the betel nut is not consumed along with tobacco.

4.  Gastric cancer- 

        There is significant higher proportion of Helicobacter pylori (a bacterium) in betel chewers. Helicobacter pylori is the commonest cause of Duodenal and Gastric ulcer. The prevalence of Peptic ulcer is quite common in Bhutan. Commonly known as gastric or ulcer problem in the country. The H pylori is also associated with Gastric ulcer. So Betel nut or Doma chewing is associated with gastric ulcer too.

Areca Nut Chewer's Syndrome or Gutka Syndrome - 90% of betel nut chewers struggled with mouth problems like disfigured mouth, altered speech and altered taste sensation. 

Ischemic Heart Disease – Doma chewing with or without tobacco is associated with Ischemic Heart Disease (Heart attack). Doma chewing may impose a greater Heart Disease risk than smoking. The diabetic patients who chew Doma are at higher risk of Ischemic Heart Disease as compare to other who don’t chew Doma. 

Obesity – Betel nut chewing is independently associated with obesity in men.

Abotifacient Action- 

The ethanolic extract of Betel nut at doses of 100 and 300 mg/kg has antiovulatory and abortifacient effects in rats. Some authors have reported adverse pregnancy outcomes like low birth weight, spontaneous abortions and preterm births among ladies who chew betel nut. Though no definitive human studies are done, it is speculated that it may be a harmful and dangerous to foetus if pregnant women chews Doma.

The addiction of betel nut may be more dangerous than smoking but it is under reported and lassitude of Indian and South Asian literatures. Multiple studies from Taiwan and India have proven that habit is carcinogenic, addictive and dysaesthetic. It is point out that Supari/ Doma/ Areca nut should not be labeled a food product and it should not escape any regulation. It is urgent for policy makers to implement programs on health education to the younger generation to curb the increasing prevalence of Doma chewing and its associated health problems.