Taiwan: Beating the betel

31 Mar 2019 by Michael Allen
Bridge crossing mountain, Taiwan

Fifty-two-year-old Mr Liu likes to bet in underground gambling dens. Chewing betel nut helps him keep focused. He can easily get through 200 nuts per day – four whole packs. The nuts, which come from the areca palm, give users a buzz familiar to coffee drinkers and cigarette smokers. One of the major downsides: chewing betel nut stains your mouth, lips, teeth – and even your stools – an unattractive shade of red. It can also lead to at least five types of cancer.

A habitual user like Mr Liu – who sells peanut wraps to tourists visiting the Wufongci scenic area in Jiaoxi, a hot-spring town in the northeast of the country – doesn’t seem to be concerned, though. Indeed, he is proud to show off and even let me photograph his vermillion tongue, flecks of the nut still stuck to it.

If you’re travelling to Taiwan for business and only visiting Taipei, you probably won’t see many people chewing betel nut (also known as areca nut). Middle-class Taiwanese regard it as a rather coarse habit. “That’s for uneducated people. That’s why you don’t see many shops selling betel nuts in Taipei city. It’s mostly for labourers,” says Wang Ting-chun, who works for a public relations firm in Taipei. But on Taiwan’s mostly rural east coast, it seems to be everywhere.

Some argue betel nuts are an essential part of eastern Taiwan’s cultural fabric and say many people depend on growing the nuts for their livelihoods. Nonetheless, betel nuts have been classified as Group 1 carcinogens by the International Agency for Research on Cancer (IARC), the World Health Organization’s specialised cancer agency. This is the same category as asbestos and tobacco smoking. In fact, betel nut use goes hand in hand with cigarette smoking, as nearly 90 per cent of betel nut users also smoke, according to Dr Hahn Liang-Jiunn, professor emeritus and former dean of the school of dentistry, college of medicine at National Taiwan University.

Betel nuts

Besides oral cancer, betel nut chewing can also lead to oropharyngeal cancer, ypopharyngeal cancer, esophageal cancer, liver cancer, cirrhosis, diabetes, dental attrition and periodontal disease, adds Dr Hahn.

Yet despite the host of health issues that the nuts cause, betel nut usage remains stubbornly popular in this part of Taiwan, partly due to cultural reasons. “In some countries in South Asia and Southeast Asia, there is a kind of ‘betel nut culture’. From the cultural perspective, betel nuts are used as sacrificial offerings in rituals, or are presented as something valuable at weddings. What’s more, when there are disputes or conflicts, they are also used as reconciliation gifts,” says Dr Hahn.

“The reason why betel nut is especially popular in the eastern parts of Taiwan is that there are more indigenous Taiwanese people living there, and this kind of so-called ‘betel nut culture’ is more deeply rooted in their daily life.”

Indigenous Taiwanese make up only around 2.3 per cent of the overall population, but they are mostly concentrated in the eastern portion of the island, according to the Council of Indigenous Peoples, a ministry-level body in Taiwan.

Given its potential for harm, one might expect that such a dangerous substance would be strictly controlled, especially considering that Taiwan has strict drug laws, including the death penalty for drug trafficking.

But buying betel nuts is surprisingly easy, including for a foreigner. During the one-hour drive from Hualien train station to a hotel in the Taroko National Park, I saw many roadside shops selling betel nuts, and it wasn’t long before I was the proud owner of a plastic baggie of around 20 nuts. Even our driver was an ex-betel nut user, having started chewing when he was young and continued for 30 years, before quitting for health reasons.

Mr Liu, 52, a peanut roll seller and habitual betel nut user

One shop that we pulled up to on the Zhongbu Cross Island Highway was run by Zhu Yu Ying, who had worked there for the past 21 years, selling as many as 100 bags of betel nut per day, mostly to local drivers who use its stimulating effect to maintain their concentration while navigating the treacherous mountain passes of the Taroko National Park.

“In Taiwan, many long-distance drivers chew betel nut to help them stay awake and quench their thirst while driving,” says Dr Hahn, explaining that chewing the nuts can stimulate salivation and therefore make users feel less thirsty.

Indeed, one false move on this road winding tortuously through the Taroko Gorge could easily lead to a car’s occupants plunging hundreds of metres to their deaths; I would probably take to chewing betel nut if I had to drive on this road every day.

However, Dr Hahn, who also serves as the chairperson for the Taiwan Alliance for areca nut control and oral cancer prevention, argues there are better ways to keep oneself alert. “It’s just not necessary to take such a fatal measure in order to achieve the desired effects. Sometimes, when we educate people about the negative effects of betel nut, some say that it’s just a kind of culture in Taiwan and ask us not to say bad things about it. However, though we admit that it’s part of local culture, it’s not good for personal health and the environment, so we shouldn’t encourage people to continue to do this,” he says.

Still, from spending time at Ms Zhu’s shop, it’s clear that there is a voracious demand for the nuts. Almost the moment we arrive, a customer rolls up to purchase a bag. Forty-year-old Wu Zhi Wen, a concrete industry worker, says he has a two-bag-a-day betel nut habit, despite knowing it is bad for his health.

Seller Zhu, too, is well aware of the negative health consequences of consuming her product, saying that the high levels of calcium hydroxide (slaked lime) can cause oral cancer. Still, the trade is thriving; in many areas, betel nut shops compete so fiercely that it is common for stores to be run by “Betel Nut Beauties”, attractive and scantily clad women designed to lure the mostly male clientele to buy the nuts.

Zhu Yu Ying, a betel nut seller

But Zhu is so confident in her product’s desirability that she does not believe she needs to behave like those women. “I’m not like them. I’m the most traditional type. Customers buy just because they want to eat, not because of those beautiful girls. And it’s not exactly the case that they sell much more than me just because they are more beautiful and dressed more sexily,” she says.

For those with a serious betel nut habit, like Mr Liu the peanut roll seller, it doesn’t make economic sense to buy from Betel Nut Beauties, who tend to charge a premium for what is essentially the same product.

“For frequent consumers like me, no, I wouldn’t buy from them. They are more expensive. You can only buy seven betel nuts from them with NT$50 (US$1.6), while you can get 14 for the same price from other sellers,” he says.

There is a clear gender divide between betel nut consumption and sales: attractive women selling the nuts to an overwhelmingly male customer base. “Some betel nut addicts may tend to mistakenly think they present a manly and heroic image when they chew betel nut. These people, influenced by their peers, began to gather and hang out with others like them from their adolescence. An old saying may help explain: ‘Birds of a feather flock together’,” says Dr Hahn.

The Taiwanese government is far from blind to the problem of betel nut consumption. In 1997, December 3 was officially designated as “Betel Nut Control Day”.

And there has been a big drop in betel nut consumption. In 2007, 17.2 per cent of the male population chewed betel nut – this was down to 6.1 per cent in 2017, according to data from Taiwan’s Health Promotion Administration of the Ministry of Health and Welfare. Betel nut production also decreased from 160,118 metric tons in 1996 to 102,165 metric tons in 2017.

“Our strategy of betel nut control is different from that of tobacco control. For the latter, we usually take direct action against the big tobacco companies, like blaming them,” says Dr Hahn. “However, we don’t want to go against those individuals who grow or sell betel nuts, because they are relatively more vulnerable compared to the large tobacco companies. Instead, we’ve adopted other measures by educating betel nut addicts about the negative effects and persuading them not to chew, while appealing to those who have never chewed betel nut not to cultivate this habit. Thus, the population of betel nut addicts is expected to decline. And so will the demand.”

Additional reporting and translation by Jackie Chen

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