Effects of betel chewing on the central and autonomic nervous systems


Betel chewing has been claimed to produce a sense of well-being, euphoria, heightened alertness, sweating, salivation, a hot sensation in the body and increased capacity to work. Betel chewing also leads to habituation, addiction and withdrawal. However, the mechanisms underlying these effects remain poorly understood. Arecoline, the major alkaloid of Areca nut, has been extensively studied, and several effects of betel chewing are thought to be related to the actions of this parasympathomimetic constituent. However, betel chewing may produce complex reactions and interactions. In the presence of lime, arecoline and guvacoline in Areca nut are hydrolyzed into arecaidine and guvacine, respectively, which are strong inhibitors of GABA uptake.Piper betle flower or leaf contains aromatic phenolic compounds which have been found to stimulate the release of catecholamines in vitro. Thus, betel chewing may affect parasympathetic, GABAnergic and sympathetic functions. Betel chewing produces an increase in heart rate, blood pressure, sweating and body temperature. In addition, EEG shows widespread cortical desynchronization indicating a state of arousal. In autonomic function tests, both the sympathetic skin response and RR interval variation are affected. Betel chewing also increases plasma concentrations of norepinephrine and epinephrine. These results suggest that betel chewing mainly affects the central and autonomic nervous systems. Future studies should investigate both the acute and chronic effects of betel chewing. Such studies may further elucidate the psychoactive mechanisms responsible for the undiminished popularity of betel chewing since antiquity.

This is a preview of subscription content, access via your institution.


  1. 1

    Abramson LB, Brown AJ, Sitaram N. A cardioacceleratory response to low-dose arecoline infusion during sleep in patients with major depression disorder: Relationship to REM sleep induction. Psychiatry Res 19:189–198;1985.

    Article  Google Scholar 

  2. 2

    Burton-Bradley BG. Papua and New Guinea transcultural psychiatry: Some implications of betel chewing. Med J Aust 2:744–746;1966.

    PubMed  Google Scholar 

  3. 3

    Burton-Bradley BG. Arecaidinism. Betel chewing in transcultural perspective. Can J Psychiatry 24:481–488;1979.

    PubMed  Google Scholar 

  4. 4

    Calogero AE, Kamilaris TC, Gomez MT, Johnson EO, Tartaglia ME, Gold PW, Chrousos GP. The muscarinic cholinergic agonist arecoline stimulates the rat hypothalamic-pituitary-adrenal axis through a centrally-mediated corticotrophin-releasing hormone-dependent mechanism. Endocrinology 125:2445–2453;1989.

    PubMed  Google Scholar 

  5. 5

    Cawte J. Psychoactive substances of the South Seas: Betel, kava and pituri. Aust NZ J Psychiatry 19:83–87;1985.

    Google Scholar 

  6. 6

    Chen KC. The problem of betel chewing (in Chinese). Sci Mon 9:718–728;1995.

    Google Scholar 

  7. 7

    Christie JE, Shering A, Ferguson J, Glen AIM. Physostigmine and arecoline: Effects of intravenous infusions in Alzheimer presenile dementia. Br J Psychiatry 138:46–50;1981.

    PubMed  Google Scholar 

  8. 8

    Chu EC, Chu NS. Patterns of sympathetic skin response in palmar hyperhidrosis. Clin Auton Res 7:1–4;1997.

    PubMed  Google Scholar 

  9. 9

    Chu NS. Cardiovascular responses to betel chewing. J Formos Med Assoc 92:835–837;1993.

    PubMed  Google Scholar 

  10. 10

    Chu NS. Effects of betel chewing on electroencephalographic activity: Spectral analysis and topographic mapping. J Formos Med Assoc 93:167–169;1994.

    PubMed  Google Scholar 

  11. 11

    Chu NS. Sympathetic skin responses to betel chewing. J Formos Med Assoc 93:260–262;1994.

    PubMed  Google Scholar 

  12. 12

    Chu NS. Effect of betel chewing on performance reaction time. J Formos Med Assoc 93:343–345;1994.

    PubMed  Google Scholar 

  13. 13

    Chu NS. Effect of betel chewing on RR interval variation. J Formos Med Assoc 94:106–110;1995.

    PubMed  Google Scholar 

  14. 14

    Chu NS. Betel chewing increases the skin temperature: Effects of atropine and propranolol. Neurosci Lett 194:130–132;1995.

    Article  PubMed  Google Scholar 

  15. 15

    Chu NS. Sympathetic response to betel chewing. J Psychoactive Drugs 27:183–186;1995.

    PubMed  Google Scholar 

  16. 16

    Chu NS, Chang CF. On the culture of betel chewing in Taiwan (in Chinese). Evergreen Mon 130:78–81;1994.

    Google Scholar 

  17. 17

    Deahl M. Betel nut-induced extrapyramidal syndrome: An unusual drug interaction. Mov Disord 4:330–334;1989.

    Article  PubMed  Google Scholar 

  18. 18

    Frewer LJ. The effect of betel nut on human performance. PNG Med J 33:143–145;1990.

    Google Scholar 

  19. 19

    Haubrich DR, Watson DR. Effects of pilocarpine or arecoline administration on acetylcholine levels and serotonin turnover in rat brain. J Pharmacol Exp Ther 181:19–27;1972.

    PubMed  Google Scholar 

  20. 20

    Huang A. Betel nuts, better not. Free China Rev 47:18–27;1997.

    Google Scholar 

  21. 21

    Huang LS, Wang CK, Sheu MJ, Kao LS. Phenolic compounds ofPiper betle flower as flavoring and neuronal activity modulating agents. In: Ho CT, Lee CY, Huang MT, eds. Phenolic Compounds in Food and Their Effects on Health. American Chemical Society Series 506. Washington, American Chemical Society, 200–213;1992.

    Google Scholar 

  22. 22

    Johnston GAR, Krogsgaard-Larsen P, Stephanson A. Betel nut constituents as inhibitors of γ-aminobutyric acid uptake. Nature 258:627–628;1975.

    PubMed  Google Scholar 

  23. 23

    Ko YC, Chiang TA, Chang SJ, Hsieh SF. Prevalence of betel quid chewing habit in Taiwan and related sociodemographic factors. J Oral Pathol Med 21:261–264;1992.

    PubMed  Google Scholar 

  24. 24

    Lodge D, Johnston GAR, Curtis DR, Brand SJ. Effects of the Areca nut constituents arecaidine and guvacine on the action of GABA in the cat central nervous system. Brain Res 136:513–522;1977.

    Article  PubMed  Google Scholar 

  25. 25

    Low MD. Psychology, psychophysiology, and the EEG. In: Niedermeyer E, Lopes da Silva F, eds. Electroencephalography, ed 2. Baltimore, Urban & Schwarzenberg, 541–548;1987.

    Google Scholar 

  26. 26

    Mathias CJ, Christensen NJ, Corbett JL, Frankel HL, Spalding JM. Plasma catecholamines during paroxysmal neurogenic hypertension in quadriplegic man. Circ Res 39:204–208;1976.

    PubMed  Google Scholar 

  27. 27

    Molinengo L, Fundaro AM, Cassone MC. Action of a chronic arecoline administration on mouse motility and on acetylcholine concentrations in the CNS. J Pharm Pharmacol 40:821–822;1988.

    PubMed  Google Scholar 

  28. 28

    Nelson BS, Heischober B. Betel nut: A common drug used by naturalized citizens from India, Far East Asia, and the South Pacific islands. Ann Emerg Med 34:238–243;1999.

    Article  PubMed  Google Scholar 

  29. 29

    Nieschulz O. Zur Pharmakologie des Wirkstoffes des Betels. Arzneimittelforschung 20:218–229;1970.

    PubMed  Google Scholar 

  30. 30

    Nurnberger JI, Jimerson DC, Simmons-Alling S, Tamminga C, Nadi NS, Lawrence D, Sitaram N, Gillin JC, Gershon ES. Behavioral, physiological, and neuroendocrine responses to arecoline in normal twins and ‘well state’ bipolar patients. Psychiatry Res 9:191–200;1983.

    Article  PubMed  Google Scholar 

  31. 31

    Nutt JG, Rosin A, Chase TN. Treatment of Huntington disease with a cholinergic agonist. Neurology 28:1061–1064;1978.

    PubMed  Google Scholar 

  32. 32

    Pickwell SM, Schimelpfening S, Palinkas LA. ‘Betelmania’. Betel quid chewing by Cambodian women in the United States and its potential health effects. West J Med 160:326–330;1994.

    PubMed  Google Scholar 

  33. 33

    Reichart PA. Toothpastes containing betel nut (Areca catechu L.) from England of the nineteenth century. J Hist Med Allied Sci 39:65–68;1984.

    PubMed  Google Scholar 

  34. 34

    Rinaldi F, Himwich HE. Alerting responses and actions of atropine and cholinergic drugs. Arch Neurol Psychiatr 73:387–395;1955.

    Google Scholar 

  35. 35

    Sato A. Somatosympathetic reflexes: Afferent fibers, central pathways, discharge characteristics. Physiol Rev 53:916–947;1973.

    Google Scholar 

  36. 36

    Shahani BT, Day TJ, Cros D, Khalil N, Kneebone CS. RR interval variation and the sympathetic skin response in the assessment of autonomic function in peripheral neuropathy. Arch Neurol 47:659–664;1990.

    PubMed  Google Scholar 

  37. 37

    Sitaram N, Weingartner H, Gillin JC. Human serial learning: Enhancement with arecoline and choline and impairment with scopolamine. Science 201:274–276;1978.

    Google Scholar 

  38. 38

    Stricherz ME, Pratt P. Betel quid and reaction time. Pharmacol Biochem Behav 4:627–628;1976.

    Article  PubMed  Google Scholar 

  39. 39

    Talonu NT. Observations on betel-nut use, habituation, addiction and carcinogenosis in Papua New Guineans. PNG Med J 32:195–197;1989.

    Google Scholar 

  40. 40

    Taylor P. Cholinergic agonists. In: Gilman AG, Goodman LS, Gilman A, eds. The Pharmacological Basis of Therapeutics, ed 6. New York, Macmillan, 91–99;1980.

    Google Scholar 

  41. 41

    Von Euler US. Quantification of stress by catecholamine analysis. Clin Pharmacol Ther 5:398–404;1964.

    Google Scholar 

  42. 42

    Von Euler US, Domeij B. Nicotine-like actions of arecoline. Acta Pharmacol 1:263–269;1945.

    Google Scholar 

  43. 43

    Wang CK, Hwang LS. Phenolic compounds of betel quid chewing juice (in Chinese). Food Sci 20:458–471;1993.

    Google Scholar 

  44. 44

    Wang CK, Hwang LS. Analysis of the phenolic compounds in betel quid (in Chinese). J Chin Agric Chem Soc 31:623–632;1993.

    Google Scholar 

  45. 45

    Wang CK, Hwang LS. Effect of betel quid on catecholamine secretion from adrenal chromaffin cells. Proc Natl Sci Counc Repub China B 21:129–136;1997.

    PubMed  Google Scholar 

  46. 46

    Wang CK, Lee WH, Peng CH. Contents of phenolics and alkaloids inAreca catechu Linn. during maturation. J Agric Food Chem 45:1185–1188;1997.

    Article  Google Scholar 

  47. 47

    Wiesner DM. Betel-nut withdrawal. Med J Aust 146:453;1987.

    Google Scholar 

  48. 48

    Wyatt TA. Betel nut chewing and selected psychophysiological variables. Psychol Rep 79:451–463;1996.

    PubMed  Google Scholar 

Download references

Author information



Rights and permissions

Reprints and Permissions

About this article

Cite this article

Chu, NS. Effects of betel chewing on the central and autonomic nervous systems. J Biomed Sci 8, 229–236 (2001). https://doi.org/10.1007/BF02256596

Download citation

Key Words

  • Betel nut
  • Betel nut chewing
  • Central nervous system
  • Autonomic nervous system
  • Addiction