Areca nut is widely consumed by all ages groups in many parts of the world, especially south-east Asia. The objective of this review is to systematically review and collate all the published data that are related to the systemic effects of areca nut. The literature search was performed by an electronic search of the Pubmed and Cochrane databases using keywords and included articles published till October 2012. We selected studies that covered the effect of areca nut on metabolism, and a total of 62 studies met the criteria. There is substantial evidence for carcinogenicity of areca nut in cancers of the mouth and esophagus. Areca nut affects almost all organs of the human body, including the brain, heart, lungs, gastrointestinal tract and reproductive organs. It causes or aggravates pre-existing conditions such as neuronal injury, myocardial infarction, cardiac arrhythmias, hepatotoxicity, asthma, central obesity, type II diabetes, hyperlipidemia, metabolic syndrome, etc. Areca nut affects the endocrine system, leading to hypothyroidism, prostate hyperplasia and infertility. It affects the immune system leading to suppression of T-cell activity and decreased release of cytokines. It has harmful effects on the fetus when used during pregnancy. Thus, areca nut is not a harmless substance as often perceived and proclaimed by the manufacturers of areca nut products such as Pan Masala, Supari Mix, Betel quid, etc. There is an urgent need to recognize areca nut as a harmful food substance by the policy makers and prohibit its glamorization as a mouth freshener. Strict laws are necessary to regulate the production of commercial preparations of areca nut.

Areca nut is an addictive substance consumed in many parts of the world by people of all the age groups. Apart from being carcinogenic to the oral cavity, pharynx, esophagus, liver and uterus, it has many diverse effects on the human body affecting almost all the organs. The systemic effects of areca nut are mainly due to the principle alkaloid arecoline. Areca nut causes euphoria, increase in heart rate, increased blood pressure, GABA inhibition and damage to neurons, but has no effect on concentration and memory. Areca nut causes hyperlipidemia, vasospasm and cardiac arrhythmias leading to an increased risk of myocardial ischemia. Arecoline interferes with the fat metabolism leading to Type II diabetes, metabolic syndromes and deranged blood lipid levels. Chronic areca nut consumption causes hypothyroidism, prostate hyperplasia, infertility and Vitamin D deficiency. Areca nut interferes with the immune system by interfering with the activation of T-cells and production of cytokines. Areca nut chewers are predisposed to asthma as it causes bronchoconstriction and decreased FEV1. Women who consume areca nut regularly have more incidences of low birth weight and preterm deliveries. Thus, it is evident that areca nut is a harmful and addictive substance that affects the whole human body, and its use must be tightly regulated for the welfare of the society.