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Overview: Betel nut refers to the fruit of the Areca palm tree. Although it is technically the “areca nut,” it is known as the betel nut because it is commonly wrapped in betel leaves. Betel nut is a recreational stimulant that may cause serious health problems. Common side effects include dizziness, headache, breathing problems, changes in heart rate or blood pressure, nervousness, trouble sleeping, nausea, or vomiting. Serious side effects may include dependence and withdrawal, changes in behavior and mood, kidney damage, heart attack, stroke, and cancer in the mouth, esophagus, or liver. Speak to a health care provider before using betel nut for any reason.

Uses

What is betel nut used for?

Betel nut is used recreationally to increase energy, improve mood, or feel “high.”

Note: The FDA has not reviewed betel nut for safety and effectiveness. In the U.S., betel nut may not be legally sold or marketed as a food or dietary supplement.

How does betel nut work (mechanism of action)?

Betel nut refers to the fruit of the Areca palm tree (Areca catechu). Since it comes from the Areca tree, the accepted name is actually “areca nut.” It became known as betel nut because it is commonly wrapped in betel leaves, which come from the betel plant (Piper betle).

Betel nuts contain a chemical called arecoline that can act as a stimulant in the body, increasing energy levels and causing an intense feeling of excitement or happiness (euphoria) for a short time. The nuts are often wrapped in betel leaves and mixed with other natural substances to make “betel quid.” The quid is then chewed or placed between the gum and the lip.

The stimulant and euphoric effects of betel nut can become addictive, leading to dependence. In fact, in the parts of the world where Areca trees naturally grow, betel nuts are a common substance of abuse and have become a serious health problem. In addition to the serious risks that occur with all addictive stimulants, betel nut can increase your risk for certain cancers. See the Side Effects section for more information.

Herbal products, such as betel nut, naturally contain many different chemicals. The amounts of each chemical in a specific betel nut product may vary. Some, none, or all of these chemicals may have effects on the body. These effects may change depending on how much of each chemical is found in the product you are using.

How should I store betel nut?

You should store betel nut according to the product label. Most natural products should be kept in a cool, dry location that is out of the reach of children and pets and not in direct sunlight.

Side Effects

What are the most common side effects of betel nut?

The most common side effects of betel nut are listed below. These side effects may vary depending on how it is made and how much you use. Tell your health care provider if you have any of these side effects that bother you.

  • Dizziness
  • Headache
  • Breathing problems
  • Fast heartbeat
  • High or low blood pressure
  • Nausea or vomiting
  • Nervousness or anxiety
  • Stained or blackened teeth

There may be other side effects of betel nut that are not listed here. Contact your health care provider if you think you are having a side effect. In the U.S., you can report side effects to the FDA at www.safetyreporting.hhs.gov or by calling 888-SAFEFOOD (888-723-3366). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of betel nut?

While less common, the most serious side effects of betel nut are described below, along with what to do if they happen.

Severe Allergic Reactions. Betel nut may cause allergic reactions, which can be serious. Stop using betel nut and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching or skin rash
  • Bumps on the skin calledhives that can be red, pink, white, or brown depending on your skin tone
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Dependence and Withdrawal Reactions. Some people who use betel nut may develop physical dependence, which means the body comes to rely on it. This risk is higher in people who use betel nut regularly. If you stop betel nut suddenly, it could lead to withdrawal symptoms. Your health care provider may be able to help you stop betel nut in a way that will reduce the risk of having withdrawal reactions. Speak to your health care provider if you have any of the following symptoms of withdrawal.

  • Headaches
  • Nausea, vomiting, or stomach pain
  • Irritability, anger, or aggression
  • Nervousness or anxiety
  • Sleep problems or restlessness
  • Tremors
  • Fast heartbeat or high blood pressure
  • Depression or low mood

Behavior, Thought, or Mood Changes. Betel nut can have stimulant-like effects. This may cause or worsen psychotic-like behaviors, such as hallucinations or mania. People who already have a mental health condition, such as bipolar disorder, may be at higher risk of these side effects. Tell your health care provider right away if you have any of the following symptoms, or if you have been told by others you have these symptoms.

  • Hearing, seeing, smelling, tasting, or otherwise perceiving things that others do not
  • Delusional thoughts, such as false beliefs that you are being controlled
  • Disorganized thoughts, such as jumping between topics or having a hard time focusing
  • Sudden decline in self-care, such as personal hygiene or academic/work performance
  • Aggressive behavior
  • Very high energy
  • Significant trouble sleeping
  • Racing, fast-paced thoughts
  • Reckless behavior
  • Unusually grand ideas
  • Excessive happiness or crankiness
  • Talking more or faster than usual

Heart Attack and Stroke. Betel nut can increase your risk of a heart attack or stroke that can lead to death. This risk is higher in people who already have heart disease, who use betel nut regularly for a long time, or who do heavy physical activity. Get emergency help if you have any of the following symptoms of a heart attack or stroke.

  • Chest pain or pressure
  • Fast or abnormal heartbeat
  • Trouble breathing
  • Pain in your back, jaw, throat, or arm
  • Sweating, upset stomach, vomiting, or dizziness
  • Sudden weakness on one side of your body
  • Sudden and severe headache
  • Slurred speech or trouble understanding speech

Mouth or Esophagus Cancer. Using betel nut can increase your risk for cancer in the mouth or esophagus. This risk is higher in people who keep the betel quid in their mouth, between their gum and cheek, as well as in people who use betel nut regularly for a long time. This risk is also higher in people who drink alcohol and smoke cigarettes or use tobacco products. Speak to your health care provider right away if you have any of the following symptoms.

  • A sore on your lip or in your mouth that does not heal
  • A lump or thick patch inside your mouth or throat
  • White, red, or speckled (white and red) patches in your mouth or throat
  • Unexplained bleeding, pain, or numbness in your mouth
  • Trouble chewing or swallowing, speaking, or moving your jaw or tongue
  • Difficulty or pain when you swallow
  • Swelling, pain, or stiffness in your jaw
  • Weight loss
  • Indigestion that does not go away

Liver Cancer. Using betel nut can increase your risk for liver cancer. This risk is higher in people who keep the betel quid in their mouth, between their gum and their cheek, as well as in those who use betel nut regularly for a long time. This risk is also higher in people who drink alcohol or have other liver conditions, such as hepatitis. Speak to your health care provider right away if you have any of the following symptoms.

  • Pain, swelling, or tenderness in the upper right section of your stomach
  • Weight loss
  • Loss of appetite
  • Yellowing of the skin and whites of the eyes (jaundice)
  • Itching all over the body
  • Swollen legs

Kidney Damage. Using betel nut can cause kidney damage. Call your health care provider right away if you have any of the following symptoms of kidney damage.

  • Reduced need to pee
  • Swelling in your feet, ankles, or legs
  • Weakness or unusual tiredness
  • A hard time catching your breath or chest pain/pressure
  • Confusion
  • Nausea
  • Seizures

Warnings & Precautions

Who should not use betel nut?

Allergies to Ingredients. People who are allergic to any of the following should not use betel nut.

  • Areca nut
  • Betel nut
  • Betel quid
  • Any of the ingredients in the specific product

Ask your health care provider if you are not sure what ingredients are in a betel nut product.

What should I know about betel nut before using it?

Due to its high risk for misuse and potential to cause cancer, betel nut may not be legally sold or marketed as a food or dietary supplement in the U.S.

Keep betel nut out of the reach of children.

Betel nut can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how betel nut affects you.

Herbal products, such as betel nut, naturally contain many different chemicals. The amount of each chemical in a specific betel nut product can change for many reasons, including the area where the plant was grown, the weather during growth, the time of year it was harvested, and the way it was processed after it was harvested. If you switch to a new product or a different brand, you may not have the same effects or side effects because of this variability. Talk to your health care provider if you have questions or concerns.

Most people use betel nut in the form of a “quid.” Betel quid is made by wrapping the nut in a leaf from the betel plant. It is often wrapped up with other natural substances, such as slaked lime (calcium hydroxide) and tobacco. Betel quid may also contain spices such as cardamom, cloves, turmeric, or mustard. Regardless of the specific ingredients, betel quid is known to cause serious side effects. Each of these additional substances can also cause its own effects and side effects in the body.

What should I tell my health care provider before using betel nut?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. Also tell them if you have an upcoming surgery planned. Sharing this information will help your health care provider know if this or other supplements are right for you.

In particular, make sure that you discuss any of the following.

Current and Past Health Conditions. Tell your health care provider if you have any of the following.

Other Medicines and Supplements. Betel nut may interact with medicines and supplements. Before using betel nut, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. Betel nut may cause harm to a fetus. Tell your health care provider if you are pregnant or plan to become pregnant.

Breastfeeding. Betel nut may pass into breast milk and cause harm to a breastfeeding child. Tell your health care provider if you are breastfeeding or plan to breastfeed.

Interactions

Does betel nut interact with foods or drinks?

Betel nut can have stimulant-like effects. Using betel nut with caffeine, which is also a stimulant, may increase the risk of side effects. Caffeine is found in many common foods and drinks, such as coffee, tea, soda, chocolate, and some protein bars.

It is unknown if drinking alcohol will affect betel nut, but drinking alcohol while using betel nut may increase your risk for serious side effects. It is best to limit the amount of alcohol that you drink.

Does betel nut interact with medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using betel nut.

  • A stimulant, such as amphetamine, lisdexamfetamine, or methylphenidate, which is a medicine commonly used to treat attention deficit hyperactivity disorder (ADHD)
  • An anticholinergic medicine, which includes antihistamines and medicines commonly used for overactive bladder, Parkinson’s disease, or stomach problems
  • Any product that contains caffeine, which is often found in medicines used for reducing water weight (diuretics), staying awake, easing headaches, and relieving hangovers
  • Any other street drug, such as cocaine, heroin, or methamphetamine

The interactions between betel nut and medicines are not fully understood. As with most dietary supplements, the research on drug interactions with betel nut is incomplete. Always check with your health care provider before using betel nut with any medicines.

Overdose/Missed Dose

What should I do if I accidentally use too much betel nut?

If you or someone else has used too much betel nut, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

In the U.S., betel nut may not be legally sold or marketed as a food or dietary supplement because it is known to cause serious side effects and health problems. It is best to avoid the use of betel nut entirely.