The bitter truth behind Sweet Supari

KATHMANDU: What if we told you that a small, innocent-looking nut that you casually enjoy is actually a ticking time bomb? This seemingly harmless treat, shared at gatherings and deeply embedded in Nepalese culture, conceals a dangerous secret. Beneath its cultural charm lurks a carcinogen, quietly putting millions at risk of cancer. This is the hidden reality of Supari, also known as areca nut and betel nut, a cultural staple with a perilous dark side that we can no longer ignore.

Supari is ingrained in cultural and religious practices throughout Nepal and South Asia. Traditionally used in Hindu rituals and puja ceremonies, it is offered to deities as a symbol of auspiciousness, with its round shape representing the eternal cycle of life and death. In Nepali engagements, the groom’s family must send 12 pieces of Supari to the bride’s family for the “Swayamvar” ceremony before any wedding preparations can start. It also serves as a unique wedding invitation, where Suparis are sent along with an invitation card to guests, marking their inclusion in the celebration. Despite its deep cultural roots, Supari poses significant health risks.

Evidence from around 2660 BCE, including stained teeth and lime containers found in Duyong Cave, Philippines, highlights a long history of Supari chewing. Historically, Supari was valued for its supposed benefits like expelling wind, killing worms, removing phlegm, beautifying the mouth and enhancing oral freshness. However, modern research has revealed significant health risks associated with Supari. In 2004, the International Agency for Research on Cancer (IARC) classified it as a Group 1 carcinogen, linking its use to a high risk of oral cancer. Also, according to Neuropathology of Drug Addictions and Substance Misuse, Supari (areca nut) is the fourth most used addictive substance, following alcohol, tobacco, and cannabis.

The risk increases with more frequent and prolonged use, with areca nut chewing being a major contributor to oral cancer, especially in South Asian countries like Nepal. In 2020, 177,000 people died of oral cancer, and half of those cases in South Asia were linked to Supari and tobacco use. Additionally, supari’s addictive properties compound the problem, leading to continued use despite its risks. This conflict between its cultural value and health dangers underscores the urgent need for awareness and action.

You might be wondering: How does something as seemingly harmless as supari turn into a hidden risk for cancer?

Supari contains harmful chemicals, including arecoline, which are highly carcinogenic (cancer-causing). When chewed, arecoline is released and directly affects the cells in the mouth, especially damaging their DNA. This genetic damage disrupts normal cell functions. Additionally, the continuous irritation from chewing Supari causes ongoing inflammation of the mouth’s lining. Over time, this persistent irritation and DNA damage can lead to precancerous conditions, such as white patches in the mouth (leukoplakia). Eventually, these changes can develop into cancerous tumors in the mouth or throat. Also, it’s often mixed with slaked lime (calcium hydroxide) and tobacco, which significantly heightens cancer risk. Slaked lime reacts with Supari to form nitrosamines, a powerful carcinogen (cancer-causing agent), while tobacco introduces additional harmful substances that amplify the cancer-causing effects of Supari.

In 2016, the study “Prevalence of Areca Nut Chewing Habit Among High School Children of Parsa District of Nepal” revealed that awareness about supari’s cancer-causing and addictive properties was alarmingly low. Specifically, 59.8% of subjects in urban areas were unaware of these risks, while the situation was worse in rural areas, where 71.6% of subjects lacked awareness.

This lack of awareness is exacerbated by Supari’s deep cultural significance and widespread daily use in Nepal, which often obscures its serious health risks. The normalization of Supari consumption, combined with gaps in public health education and poorly targeted awareness campaigns, especially in rural areas with limited access to information, perpetuates high consumption rates. As traditional practices and social norms remain dominant, the harmful effects of Supari continue to be underestimated.

Addressing the health risks associated with Supari consumption is essential to prevent oral cancer and improve public health. Increased awareness and informed choices can help protect communities from the severe consequences of Supari use. Once the harmful effects of Supari are established, they can be difficult to reverse, making prevention and early intervention crucial. By educating the public and promoting healthier alternatives, we can safeguard future generations from the devastating impacts of this cultural staple.

If you or someone you know is affected by Supari addiction, you can take several practical steps to reduce or quit Supari consumption. Begin by setting a quit date and gradually decreasing your usage. Replace Supari with healthier alternatives like sugar-free gum and fresh fruits to help manage cravings. Cloves can also be a beneficial substitute, as their natural antibacterial properties may help curb cravings by providing a similar oral sensation. Staying occupied with engaging activities or hobbies can also help distract from the urge. Share your decision to quit with friends and family for additional support and encouragement.

Individuals can spread awareness by educating themselves and others about the health risks of Supari and supporting those trying to quit. Governments can launch public health campaigns, regulate sales, and integrate education into schools. The media can amplify the message through campaigns and success stories, while NGOs can provide community outreach, support services, and advocate for policy changes. Together, these efforts can make a powerful impact in combating this health crisis.

Now is the time to cast off the shadows and embrace a brighter, healthier tomorrow.

( The team is working on Supari research across Nepal to understand the patterns of Supari consumption in Nepali societies)