It is a February evening in London and not yet late. A dense fog lies across the street, punctuated by a single lamp. Five friends climb into a black cab. One of the party leans back in his seat, staring transfixed at the rear window with a vacant eye. He reports that a giant Star of David is following the cab as it progresses down the street. His mouth moves up and down as if he were a goat.
An hour passes, the party of friends become calm as they wind their way home. Their transport beckons and one of them obligingly climbs into the boot of the car, lies down, and shuts himself in. There he stays for the next hundred miles, oblivious to his surroundings.
In a Canadian city, given its name by the Algonquin people, two men fail to suppress laughter. Their limbs become heavy, as do their heads. One slumps onto the table while Bollywood music sounds in his ear.
On a different continent, a group move along dusty streets. At first they have some idea as to the direction of travel, but with limited knowledge of Hyderabad, they lose their bearings, gaining only a fleeting view of her labyrinth of streets. A short time later they lie down after being given a package by a secretive dealer. Their spirit seems to leave their body, flying upwards and over Hyderabad, giving them a bird’s eye view of the old city, while their body remains chained to the ground.
The events just described sound as if a new pandemic is spreading across the world. A pandemic that causes hallucinations, depression, and anxiety among those infected. It causes cancer, diabetes, liver damage, heart attacks, cardiovascular disease, and tragic birth defects. This pandemic might sound like something out of a science fiction novel, when in fact it was first recorded over two thousand five hundred years ago by the Sri Lankan Princess Maharamsa. Yet this paandemic is very real. All of these ill effects are caused by chewing paan masala, gutka, or supari, whether or not they contain tobacco. Make no mistake, chewing paan causes all these diseases and more. It is very much a pandemic that has spread across much of Asia and throughout communities in the West. According to the World Health Organisation between six hundred million and one billion people now chew paan. About one quarter of all India chew paan at some time or another. It is the fourth most commonly used psychoactive drug in the world after caffeine, nicotine, and alcohol.
It is a myth that tobacco is the only harmful substance in paan. It is not. Betel nut, found in every form of paan, including sweet paan, is dangerous to human health. It is betel nut that causes dependency and hallucinations. It is betel nut that causes a feeling of tranquillity, a loss of motivation, depression, and severe anxiety. This is because betel nut contains four psychoactive compounds that are at least as potent as nicotine and caffeine. These are arecoline, arecaidine, guvacoline, and guvacine. The first of these compounds, arecoline, is the most problematic and the subject of hundreds of clinical and laboratory studies.
Arecoline in betel nut inhibits an important neurotransmitter called GABA. It is the second most abundant neurotransmitter in the central nervous system, found primarily in the cerebral cortex, where thinking occurs. GABA helps communication between brain cells, regulating behaviour, cognition, and stress. When levels are low, various psychiatric illnesses start to happen. These illnesses range from anxiety and depression, to panic attacks, to seizures, and, in some cases, schizophrenia. Speech might become slurry, there is decreased drive, and there are alterations in consciousness. Without enough GABA nerve cells in the brain fire too quickly, leading to jumpiness and cognitive impairment.
When GABA levels are optimal, brain cells speak easily to each other, when they are low mental illness occurs, and when they are high a person has low energy, as if they have been tranquillised. It is a delicate balance: we need our GABA levels to be just right, not too high, nor too low. The problem is that the compounds in betel nut in paan attach to GABA receptors in the brain, lowering GABA levels, leading to hallucinations, like seeing a Star of David following you down the street. Even if a person is not prone to hallucinations it is impossible to be at one’s cognitive and emotional best while chewing paan.
But GABA and GABA receptors are not just in the brain. They are in the pancreas, and this little-known fact is important for Indian health. When a person chews paan the betel nut slowly releases arecoline into their body, which blocks GABA in the pancreas. When GABA is blocked in the pancreas there is a surge of the hormone glucagon. This surge triggers the release of insulin, resulting in short-term low blood sugar. As more paan is habitually chewed there is less GABA and more glucagon, with more frequent insulin spikes. This leads to diabetes. This is why paan chewers are much more likely to have diabetes. They are also more likely to be fat.
Diabetes is rampant in India, with the country having some of the highest rates of diabetes in the world. Paan is by no means the only cause of the disease. When a people eat white flour, slather food in vegetable oil, then fry it, while drinking Thumbs Up cola, all the time steadfast in their refusal to exercise, then obesity and diabetes will surely follow. But as Indians have an innate risk for diabetes, and when this risk is combined with an abundant middle-class diet and paan chewing, then the risk increases even more. The result is poor quality of life, limb amputations, blindness, and early death. All caused by too much insulin produced by poor lifestyle choices.
The thing is insulin doesn’t just cause diabetes. It causes rampant inflammation, heart attacks, cardiovascular disease, dementia, and Alzheimer’s disease. If you have diabetes or even pre-diabetes you have a very high chance of getting heart disease, which is yet another health problem rife among the people of the Sub-Continent.
Paan only worsens the chance of heart problems. There is a 3.5x higher risk of heart disease among paan chewers. There is increased atherosclerosis and high triglycerides. Platelets in the blood clump together producing clots, then causing strokes, paralysis, and brain damage. Blood lipid profiles are utterly deranged among paan chewers. One of these cardiovascular problems would be bad enough; paan causes all of them. It may as well be renamed to ‘heart disease in a leaf’.
All of these mental, emotional, and physical health problems are caused by the betel nut. They happen because the compounds in betel nut have a systemic, whole body effect. They affect just about every organ including the liver and kidneys. We haven’t even considered what happens when tobacco is added to paan, except to say all of the diseases we have mentioned get worse, much worse.
We also haven’t yet considered cancer because the risks of cancer from paan are much more familiar to many of you. If you want a see-through hole in your cheek from a tumour, take paan. Perhaps you want oral cancer, then chew paan. Fully ninety percent of oral cancer patients in some Asian countries are paan chewers, and India has one of the highest oral cancer rates in the world. Perhaps you’re a woman who would like to experience cervical cancer? Then take paan. In fact, oesophagus, liver, pancreas, larynx, stomach, prostate, and lung cancers are all caused by paan, because paan mutates DNA.
Perhaps people are not convinced. Perhaps hanging out with the paan is too enticing. Perhaps a consideration of our children might focus our minds a little. Firstly, if a person chews paan they will be lucky to have healthy children. It causes infertility by reducing sperm count. Those few sperm that remain are not as strong; they do not swim as well or as fast. Those sperm that heroically struggle onwards into the fallopian tubes are damaged. If sperm with DNA damage somehow manages to fertilise the egg then there is a high chance of a birth defect. We find in clinical reviews on the health consequences of paan that birth defects are more common when parents chew paan.
Children are also harmed in other profound ways by their paan-chewing parents. In 2015, a team of researchers from McGill University looked at the transmission of paan chewing from one generation to the next. They found that parents who chewed paan passed the habit onto their children, whether they intended to or not. By the age of fifteen most children of paan chewers had tried paan for themselves, in many cases leading to a lifetime of paan dependency. Think about this for a second. Such parents are passing on addiction, mental illness, heart disease, cancer, and possibly birth defects to those people they claim to love the most.
In the Sherlock Holmes novel ‘The Man with the Twisted Lip’ one of the main characters is addicted to opium. It leads to the wreck and ruin of a noble man who becomes a pity to his friends and relatives. The paan addict is like the opium addict, or even the internet addict, pornography addict, coffee addict, and messaging addict. He is of no use to anyone. He is feckless, weak, lacks respect, and is a trial for his family. He is not noble, nor an example of higher health. Hyderabad needs to be careful. Paan addiction has a long history, but more modern addictions, including hard drugs, are starting to appear, while opioid addiction is rife in other states, such as the Punjab. Put these drug addictions together with emerging technology, increased wealth, overeating, lack of exercise, and Thumbs Up and a crisis of health and spirit starts to emerge.
Beyond simply stopping paan, which is as easy or hard as giving up coffee and cigarettes, there are some practical measures that might be taken. The very best thing a person can do against any addiction, but specifically paan addiction, is exercise. Remember that paan lowers GABA and blocks receptors in the brain to cause mental illness and dependency. At the University of California, a team found that exercise regulates GABA, and that the amount produced was so potent it was deemed to be self-medicating. They found that exercise was the most demanding activity the brain encounters, more demanding and beneficial for neurotransmitters than calculus or chess. The amount needed was paltry. Just twelve minutes three times a week. Nor did it matter what type of exercise was done, just something that gets you out of breath. Do some kettlebell swings, walk up some hills, get on a treadmill, whatever you like doing. You can either chew paan for many minutes a week and harm your brain, body, and family, or you can exercise for a few minutes and benefit both your body and brain.
There are other indigenous practices that undo the harm of paan or to overcome a dependency. Local Hyderabadi yoghurt, curds, or whey all help. They protect against the oxidative damage that paan causes. These local milk products also help non-paan chewers, as they produce a master antioxidant called glutathione, which many Indian heritage people are deficient in. Glutathione protects against the pollution that is rife in so many Indian cities.
The upshot is that exercise can get rid of any addiction you may have, whether technological or physical. Any exercise. Just start moving. Do whatever you enjoy and can sustain. Eat local dairy products and eat as many vegetables as you can, as vegetables also counter the ill effects of paan, and do this whether you have a paan habit or not. Then, avoid white flour, sugar, and vegetable oil, while giving Thumbs Up the thumbs down. Doing so will help secure a healthy, happy old age, free of disease, full of vitality, nur, and baraka.