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Areca catechu is a first-class carcinogen. Why do people still eat?
Refutation of eat areca's Carcinogenic Literature

The food safety problem of betel nut products has a long history, which has caused people's doubts and misjudgments for many years. In 2003, some media reported that cancer in eat areca was caused by arecoline, and the information came from the World Health Organization. There are also negative information about betel nut products. During the 20 12 session, Member Chinese People's Political Consultative Conference and Vice Chairman of Hunan Provincial Committee of Zhi Gong Dang submitted the Proposal on Standardizing Areca Industry as soon as possible to Chinese People's Political Consultative Conference. After receiving this information, the author (then the director of Betel nut Research Institute of Hunan Huangye Food Co., Ltd.) was more sensitive to his career. Immediately, a group of technicians were organized to trace the source of this report (the report of the World Health Organization). The query results show that the information source of the World Health Organization is true, but there is no scientific experiment or data of betel nut carcinogenesis in the original text. The original text is the investigation report, and the conclusion is inferred [1].

Ling (Professor of Stomatology, Chief Physician, Hunan Provincial Government Counselor, Second Xiangya Hospital of Central South University) is a well-known expert in this field in China. Tang Jieqing (secretary of Xiangtan Stomatological Hospital, chief physician, engaged in oral clinical specialty for more than 30 years, focusing on oral mucosal diseases, and once presided over clinical research on oral submucosal fibrosis); Chun Xinchun (director, doctoral supervisor and professor of Xiangya Hospital of Central South University) [2].

In an interview with the reporter of Legal Weekly, Tang Jieqing said, "My research direction is mainly the difference between fresh fruits in India and Taiwan Province Province and dried fruits in Hunan. Strangely, from the current data, the incidence of oral cancer in Indian and Taiwan Province provinces is higher than that in Hunan, which chews dried fruits. " According to Tang Jieqing, the investigation on betel nut and oral diseases has been going on for 15 years. Three authoritative experts have concluded for many years that chewing betel nut for a long time is harmful to the oral cavity, and there is no other direct conclusion [2].

In fact, as early as 2007, Dr. Zhang Xiaolin from Peking University College of Stomatology published a paper in the English edition of Oral Oncology Abroad-a summary of Chinese mainland's betel nut chewing habits and oral cancer and precancerous lesions [3], which mentioned that the oral cancer prevalence rate in Chinese mainland was relatively lower than that in India and Southeast Asia, and thought that the research results at that time could not clearly and accurately explain the reason why the oral cancer prevalence rate in Chinese mainland was quite low.

From August, 20/kloc-0 to August, 20/kloc-0, some experts from Xiangtan Center for Disease Control and Prevention, Xiangtan Health Supervision Office, Hunan Areca Industry Association and Hunan Center for Disease Control and Prevention conducted an epidemiological investigation on the chewing of betel nut by urban and rural residents in Hunan Province, and studied the changes of chemical composition and toxicology of betel nut before and after processing. 20 1 1 In July, the Journal of Practical Preventive Medicine published an epidemiological study of edible areca nut in Hunan. One of the important conclusions is that Xiangtan people have been chewing betel nut for more than 400 years, and 50% people chew betel nut at 28. 1 ~ 54.3 g/d, and the mortality rate of oral cancer is at the national average level.

As far as we know, there are three main forms of betel nut eaten in the world at present. One is to eat fresh betel nuts. The eating method is to cut seven or eight ripe fresh betel nuts (green) into several pieces, then coat them with white ash (a kind of lime slurry from shells), and then wrap them with leaves, as shown in the following figure:

Fresh betel nut leaves and shell powder

Fresh betel nut before packaging, fresh betel nut with betel nut leaves, betel nut leaves and shell powder.

In recent years, there is a kind of red ash with food additives added to white ash. The main components of food additives are sweeteners and a small amount of essence. This fresh betel nut is called red-gray betel nut, which is generally included in this edible betel nut. This way of eating is mainly popular in Taiwan Province Province, Hainan and Southeast Asia. This way of eating will produce Maillard reaction in the mouth, which will make the mouth of the consumer red, and the remaining betel nut residue will also be red. Red ash has a strong dyeing ability and can dye a large area of the ground red, so some local governments in Hainan, Fujian and Guangdong have issued some administrative regulations prohibiting this kind of betel nut.

The second kind is betel nut chews mainly produced in India, as shown below. Also known as Indian areca nut, it consists of betel nut core with high maturity (that is, the seed of betel nut is also the access part of Chinese herbal medicine, and Chinese herbal medicine is also called flower slice), betel nut powder, tobacco leaves and flavors and fragrances. Some countries in Southeast Asia also mainly eat this kind of betel nut, and the edible betel nut chews mentioned by the World Health Organization also refer to this kind of betel nut. (The photo of betel nut in the picture was provided by relatives and friends in Malaysia, and the real Indian betel nut was brought back by a colleague when he visited the Indian betel nut industry on 20 12).

Mature betel nut. Mature betel nut.

Packaging and content of edible betel nut in Malaysia and India

The third kind is Xiangtan betel nut, which is unique to China. Dried areca nut is made from seven to eight ripe fresh fruits by deactivating enzymes and drying. Then making essence, smothering fragrance, gluing, slicing, removing core, pickling, cooling, and packaging into finished products. The edible part is the fiber shell of betel nut, and the essence is the seed coat, that is, the seed coat. Because fresh fruit is not fully developed and betel nut is very small, it is treated as waste during processing. The picture on the right shows the fresh betel nut, and the picture below shows the dried betel nut.

Seven to eight ripe fresh betel nuts and dried betel nuts.

In the processing of Hunan areca nut, the semi-finished product is the finished product of Hunan areca nut.

Table of main components of three kinds of betel nut:

Ingredients of fresh betel nut Indian betel nut Hunan betel nut

Eat the seeds of seven to eight mature betel nuts and dry the shells of seven to eight mature betel nuts.

The presence or absence of betel leaves

Alkaline lime (shell powder) is available.

Are there any tobacco leaves?

No/no flavors and fragrances.

As can be seen from the above table, the edible betel nut processed in China and Hunan has never been added with carcinogens. All kinds of reports mentioned the carcinogenicity of betel nut, and the data came from the research report of the World Health Organization, but none of them specifically mentioned which report or attached the original text, let alone scientific experiments or data explanations, and the evidence was obviously insufficient.

Based on the research reports of South Asia, Southeast Asia and Taiwan Province Province, it was found that most of the components of betel nut were detected and analyzed in these reports, mainly betel nut kernel and betel nut shell [3]. The report of the World Health Organization says that the carcinogenesis of betel nut is basically based on the literature and market situation in the above three places. Therefore, according to these reports, it is untenable to say that Hunan betel nut also causes cancer, which is a concept of stealing. In recent years, many domestic scholars have also published some research reports on the consumption of betel nut in China and Hunan [4] [5] [6] [7]. These reports positively prove that Hunan betel nut raw materials are non-toxic and no carcinogens are added during processing. The conclusion is that Hunan areca nut is not carcinogenic food [4], which is basically invisible to foreign researchers because it is published in Chinese. From these published articles, domestic researchers have noticed the difference between Hunan betel nut and foreign betel nut. To the author's great regret, for some reason, people who advocate eat areca's carcinogenicity have confused this key link.

After searching, the author found some related reports. After translating the original text, the main points of the report of the World Health Organization are: fresh betel nut contains betel nut leaves, and the main components of betel nut leaves contain a strong carcinogen, so fresh betel nut has a strong carcinogenic effect, while Indian betel nut contains tobacco, and the carcinogenic factors in tobacco are mainly nitrosamines, including the special nitrosamine 4- (methyl) -65438 in tobacco. This statement has also been confirmed by health survey reports in India, Southeast Asia and Taiwan Province Province. The betel nut in Xiangtan, Hunan, China does not have the above two strong carcinogens, which also proves that Dr. Tang Jieqing's confusion is normal from one side.

Attached are excerpts from the original report of the World Health Organization and its Chinese translation (excerpts from references [1]):

All forms of tobacco discussed above can induce malignant tumors in experimental animals. There are many carcinogens in tobacco, including nitrosamines, including tobacco-specific nitrosamine 4- (methyl nitrosamine)-1-(3- pyridyl)-1- butanone (NNK) and n-nitroso nornicotine (NNN). Tobacco smoke also contains carcinogens as combustion products, such as aromatic amines, polycyclic aromatic hydrocarbons and volatile organic compounds. Most of the results are unclear. The possible exceptions are NAT2 in bladder cancer and breast cancer, and GSTM 1 alone or in combination with CYP 1A 1 in lung cancer. Smoking, secondhand smoke and smokeless tobacco are all recognized as carcinogenic to human beings (1 group), as well as NNK and NNN.

All forms of tobacco discussed above have caused malignant tumors in experimental animals. Many carcinogens in tobacco are mainly nitrosamines, including special nitrosamines 4- (methyl)-1-3- pyridine-1- butanone (NNK) and N'- nitroso (NNN). Like by-products of combustion, tobacco smoke also contains carcinogens such as aromatic amines, polycyclic aromatic hydrocarbons and volatile organic compounds. Many scholars have also studied the possible relationship between carcinogen metabolism genes and tobacco-related cancers; Most research results are uncertain. The possible exceptions are that NAT2 acts on bladder cancer and breast cancer, and GSTM 1 alone or in combination with CYP 1A 1 acts on lung cancer. Like NNK and NNN, smoking, secondhand smoke and smokeless tobacco were once again identified as human carcinogens (group I).

It is estimated that there are about 600 million people chewing betel nuts in India and Southeast Asia (the prevalence rate is as high as 80% in some parts of India). Areca nut block is usually composed of areca nut, areca leaf, catechu, hydrated lime and tobacco. Carcinogenic nitroamine comes from betel nut, the main component of betel nut, which is formed in the saliva of chewers. Areca nut can induce oral precancerous diseases and easily develop into cancer. 12 reconfirmed the classification of areca nut blocks (with or without tobacco) and areca nut in 1 group. There is enough evidence that betel leaves without tobacco can cause esophageal cancer, 13, but the evidence for liver cancer is limited. 14

According to statistics, there are about 600 million people chewing betel nut in India and Southeast Asia (the prevalence rate in some parts of India is nearly 80%). Betel nut chews include betel nut, betel nut leaves, catechu, hydrated lime and tobacco leaves. Nitrosamine, the main component of betel nut leaves, can be obtained and formed in chewing saliva. Areca catechu causes oral disorder before the onset of tumor. As a strong addiction, it promotes the onset of cancer. In the classification of the first group, betel nut and betel nut with and without tobacco (as carcinogens) were confirmed again. At present, there is enough evidence that chewing gum without tobacco can cause oral cancer, and limited evidence also proves that it can cause liver cancer.

As far as I know, the World Health Organization did not come to China to investigate the consumption of betel nut in Hunan. The author looked up the existing literature about arecoline, including online search, materials published in professional conferences [5], monographs on betel nut cultivation [7] and processing [6], and never found direct evidence of carcinogenicity of arecoline (the active substance in betel nut shell).

Generally speaking, the World Health Organization reports that the carcinogenicity of betel nut is not caused by betel nut itself, but by betel nut chews added with tobacco or betel nut leaves, and that the source of carcinogens is tobacco leaves or betel nut leaves. However, the domestic report on the innocuity of pure betel nut dried fruit did not appear in the report of the World Health Organization for language reasons, so it is obviously a crime to blindly quote the report of the World Health Organization that betel nut in Hunan, China is also carcinogenic.

The reason may be that the origin of betel nut in Hunan, China is completely different from that in India, Southeast Asia, Taiwan Province Province of China and Hainan, China, so its processing and eating habits are completely different from other places, especially in Xiangtan, Hunan. According to Xiangtan County Records, the origin and development of edible betel nut in Xiangtan can be traced back to more than 300 years ago. According to Xiangtan County Records, in the first month of 1650 (six years of Shunzhi), the Qing soldiers slaughtered the city in Xiangtan for nine days. The population of the county is tens of thousands, and the remaining households are no more than twenty or thirty households, with less than a hundred people. An Anhui businessman named Cheng learned that an old monk chewed betel nuts to avoid the epidemic and collected the body. Since then, the habit of chewing betel nut has continued. 1779 (forty-four years of Qianlong), Xiangtan residents suffered from abdominal distension. Bai Jing, the county magistrate, chewed the medicinal betel nut for the patient, and the abdominal distension disappeared. Later, the original patients often chewed, so that patients stopped chewing. After a long time, it became a habit. As a result, Xiangtan betel nut was gradually developed. But we should pay special attention to one thing: from the beginning to the present, Xiangtan betel nut mainly eats betel nut shells, never eats nuts, and does not add betel nut leaves and tobacco. Perhaps because the origin of betel nut in Xiangtan is different from other places, it has formed a unique way to eat it.

To sum up, the betel nut chewing habits in Hunan are different from those in other parts of the world. It only uses the traditional food industry processing method to process betel nuts with shells and package them into products. It does not chew betel nut, does not swallow betel nut, and does not contain tobacco or betel nut leaves. Related toxicological experiments prove that dried betel nut is nontoxic [4], and food seasonings (maltose, gelatin, essence, spices, etc. ) used in betel nut processing are in line with the scope allowed by the national standard GB-2760. When writing this article, the author saw from the TV news that a so-called famous scholar in China put forward the view that "Hunan betel nut chewing gum contains alkaloids, which turn into ammonium nitrite through nitrosation, and then betel nut also causes cancer". The scholar did not point out the source of this view, but from his remarks that he often quoted the World Health Organization report, he guessed that it was probably from the so-called World Health Organization report. Because the author found an original text with similar views in the Report of the World Health Organization [2], translated as "nitrosamines, a carcinogen, can be obtained in betel nut, that is, the main components of betel nut are formed in chewing saliva" (see the original text and translation mentioned above), it is obvious that the report of the World Health Organization refers to the consumption of fresh betel nut and points out that the source of nitrosamines is betel nut. Therefore, it is obviously incorrect to extend this view to eating Hunan betel nut, and at the same time, there is no relevant scientific experiment or data in the literature consulted by the author to prove that this view is correct when eating Hunan betel nut. There is no nitrosamine (R2N-NO) group in the molecular structure of arecoline [7]. However, there is a ready-made disproof that it is wrong-that is, if eat areca in Xiangtan is correct, the cancer mortality rate of Hunan people should be much higher than that of other places in eat areca. However, the "Epidemiological Investigation Report on Eating Areca catechu" in Changsha, Yongzhou and other places in Hunan Province suggests that the cancer mortality rate of people is not higher than that in other places, which is exactly the confusion of Dr. Tang Jieqing. Logically speaking, there are only two possibilities. First, Hunan people have special health care and anticancer effects-this is obviously absurd, so there is only one possibility left-that is, Hunan betel nut has no carcinogenic effect at all. Therefore, the author draws an inferential conclusion: Although betel nut eaten in China and Hunan is also called "betel nut", it is quite different from betel nut eaten in South Asia, Southeast Asia and Taiwan Province Province. In all its production and processing, there are no carcinogens such as tobacco, leaves and flowers, so it is relatively safe to eat Hunan betel nut. Because the work of proving the correctness of this inference from the front is far beyond the author's ability, I hope to ask relevant experts and scholars to give strict positive proof.

Some domestic scholars equate oral mucosal fibrosis (OSF) with oral cancer, which is also wrong. According to the World Health Organization and domestic research or investigation reports, in South Asia, Southeast Asia, Taiwan Province Province and other places, the proportion of OSF caused by eat areca is about 65,438 0.4%, while it is as high as 4.7% in China [7], which is the reason for this phenomenon. In South Asia, Southeast Asia, Taiwan Province Province and other places, betel nut has no hard fiber, but the proportion of oral cancer in eat areca abroad is higher than that in China. Dr Zhang Xiaolin mentioned in his paper [3] that this phenomenon cannot be explained. According to the analysis of domestic and foreign literatures, the reason may also be that the betel nut in Hunan, China has no tobacco leaves, so although the proportion of OSF in eat areca is high in China, the proportion of oral cancer from OSF is not higher than that in South Asia, Southeast Asia and Taiwan Province Province [1], and it has always been in the normal range [2] [9], which also proves that cancer is not directly related to betel nut in Hunan.

Some doctors in China equate the increase in the absolute number of OSF cases in daily work with the escalation of oral hazards caused by betel nut in Hunan, which is also wrong. Because the absolute number of OSF cases has increased, the total number of people who eat Hunan areca nut has also increased sharply, so from the survey and statistical reports in various places, the relative proportion has not increased [4] [8] [9]. The reason for this argument can only show that the people who put forward these arguments are at least not professional statistically, and then it is wrong to apply the report of the World Health Organization to say that OSF is a precursor of oral cancer. Because the report of the World Health Organization says that the premise of the high probability of OSF transforming into oral cancer is eating betel nut or betel nut leaves containing tobacco, which is not available in China, and the conclusions [4] [8] [9] of the Hunan survey report also show that there is no direct correlation between the two.

The author claims that although the information about the relationship between chewing betel nut and human health, the toxicological evaluation of betel nut on the market and the safety impact of betel nut processing is not perfect, the existing domestic research reports and health survey reports all point out that betel nut in Hunan market has no direct causal relationship with cancer, and more comprehensive information needs further research and enrichment. To solve these problems, we cannot rely on the World Health Organization and its report, because the "betel nut" mentioned in its report is not the same as the "betel nut" in China. We must also rely on our own scholars to carry out full and necessary investigation and study on the specific situation of our country, carry out the safety evaluation of edible betel nut as soon as possible, formulate the safety standards of edible betel nut, and provide legal guarantee for the development and utilization of betel nut planting, processing.

References:

[1] IARC monograph on human carcinogenic risk assessment Volume 85 Betel nut and chewing Betel nut and nitrosamines derived from some Betel nuts [D], 2003.

[2] Investigation report on the development of betel nut industry in China by the Betel nut industry investigation team of Agricultural Products Processing and Design Institute of Hainan Academy of Agricultural Sciences.

[3] Zhang Xiaolin, Peking University College of Stomatology, Peter Reichart, Humboldt University, Berlin, Germany, summary of betel nut chewing habits and oral cancer and precancerous lesions in Chinese mainland. The original paper was published in Oral Oncology (2007) at 43: 424–430.

Xiao Fuyuan, Sheng Yuan, Gui Zhuojia, et al. Epidemiological study on edible betel nut in Hunan Province [J] Practical preventive medicine 20 1 1,18 (7):1218-/kloc-.

[5] The First Wanning Areca Culture Festival and Areca Cultural Industry Development Forum of Wanning Municipal Government of Chinese Academy of Tropical Agricultural Sciences, Areca Science and Technology Essays, 20 1 1 year 65438+February.

[6] Zhang Zheng's Edible Areca Processing and Additives, Central South University Press, May 20 10/.

[7] Betel nut, edited by Qin and Fan Haikuo, published by China Agricultural University Press in 2065438+65438 00+0.

[8] Li Mindong, "Epidemiological investigation of betel nut chewing habits in Changsha, Hunan Province", Central South University, 20 10 master's degree thesis.

[9] Wang Dongmei, "Epidemiological investigation on betel nut chewing habits of urban and rural residents in Yongzhou, Hunan Province", Master's degree thesis of Central South University 20 1 1.