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U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption

U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption. Allen L. Mozek, MPH IFPTI 2012-13 Fellow New York State Department of Agriculture Division of Food Safety & Inspection. Areca catechu. Processed edible seed kernel. Fruiting palm tree.

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U.S. Food Regulators’ Perceptions of Areca Nut as Food and Religious Exemption

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  1. U.S. Food Regulators’ Perceptions of ArecaNut as Food and Religious Exemption Allen L. Mozek, MPHIFPTI 2012-13 FellowNew York State Department of AgricultureDivision of Food Safety & Inspection

  2. Areca catechu • Processed edible seed kernel • Fruiting palm tree

  3. Triune of Paan (Betel Quid) • Areca nut • Betel leaf • Slaked lime (calcium hydroxide)

  4. Food Condiments and Tobacco Are Optional

  5. Religious Ritual (puja) Non-Food Item in Hinduism, Buddhism, and Animism

  6. Background • Areca nut and betel quid (with and without tobacco) cause oral cancer, oral submucous fibrosis (OSF) and other precancerous lesions. (WHO International Agency for Research on Cancer, 2004). • OSF is an unconventional chronic foodborne disease. • OSF has a 7 to 30% malignant transfer rate. • Areca nut is only etiologic agent for OSF.

  7. Constant irritation causes chronic inflammation;Alkaloid absorption in the mouth causes fibrosis

  8. OSF is observable—scarlet stained teeth and restrictive mouth opening (trismus) Role of areca alkaloids in OSF (Ghom & Mhaske, 2008).

  9. Background (continued) • 600 million people (10 – 20 % of the world’s population) practice areca nut chewing culture on the subcontinent of India and in South East Asia—including immigrants and refugees in the U.S. • Areca nut (with natural alkaloids including arecoline) is the fourth most common addictive substance in the world after; alcohol, tobacco, and caffeine.

  10. Problem Statement • U.S. food regulators may not be aware of areca nut or paan. • May not consider areca nut or paan as food. • May not consider areca nut exempt from adulteration if labeled: For Religious Purposes Only – Not For Human Consumption.

  11. Methodology • Food regulators in 20 metro areas (22 states) with largest Asian populations surveyed. • (19 of 108 (17.6%) responded). Questions: • Have you heard of betel nut (areca nut)? • Have you heard of paan (betel quid)? • Do you consider betel nut a food? • Do you consider paan a food? • Would you consider a religious exemption?

  12. Heard of Betel Nut/Paan? Are They Food? (%)

  13. Religious Exemption if Labeled?

  14. Conclusions • There is a lack of awareness amongst U.S. food regulators regarding areca nut and paan (betel quid). • Regulators are unsure if areca nut and paan are food. • Only 10.5% of regulators would consider a religious exemption.

  15. Recommendations • Provide food regulators with evidence of the serious harm caused by areca nut chewing; with and without tobacco. • Examine oral submucous fibrosis (OSF) as an unconventional chronic foodborne disease caused by consumption of areca nut. • Educate immigrants and refugees concerning the health effects from consuming areca nut products.

  16. Recommendations (continued) • Inform health providers, serving at risk populations, about the likelihood of diagnosing OSF and other precancerous lesions and conditions. • Regulate areca nut as an adulterated food. • Exempt whole areca nut for religious worship when packaged and labeled; Not For Human Consumption – Religious Purposes Only.

  17. Ancient Areca Nut (Betel Nut) Chewing Culture is where… • Cultural anthropology meets food safety. • The definition of food is challenged. • Religious exemption is unique. • Areca nut addiction (betelmania) meets tobacco addiction. • U.S. food regulators can mitigate oral cancer and oral sub mucous fibrosis (OSF) disease worldwide insofar as U.S. policy has a ripple effect worldwide.

  18. References • Auluck, A., Hislop, G., Poh, C., Zhang, L., & Rosin, M. P. (2009). Areca nut and betel quid chewing among South Asian immigrants to western countries and its implications for oral cancer screening. Rural Remote Health, 9,1118–1125. • Awang, M. N. (1986). Estimation of arecoline contents in commercial areca (betel) nuts and its relation to oral precancerous lesions. Singapore Medical Journal, 27, 317-320. • Aziz, S. R. (2010). Coming to America: Betel nut and oral submucous fibrosis. Journal of the American Dental Association, 141(4), 423-428. • Changrani, J., Gany, F. M., Cruz, G., Kerr, R., & Katz, R. (2006). Paan and gutka use in the United States: A pilot study in Bangladeshi and Indian-Gujarati immigrants in New York City. Journal of Immigrant & Refugee Studies, 4(1), 99-109.

  19. References (continued) • Gupta, P. C. & Warnakulasuriya, S. (2002). Global epidemiology of areca nut usage. Addiction Biology, 7, 77-83. • International Agency for Research on Cancer. (2004). Betel-quid and areca-nut chewing and some areca nut related nitrosamines. IARC Monograph, 85, 1-334. • Stanley, J. (2010). Confessions of a white, middle-aged paan eater. Retrieved from http://nypress.com/confessions-of-a-white-middle-aged-paan-eater/ • Sullivan, R. J. & Hagen, E. H. (2002). Psychotropic substance-seeking: Evolutionary pathology or adaptation? Addiction, 97, 389-400. • U.S. Census Bureau. (2012). The Asian population: 2010. Retrieved from http://www.census.gov/prod/cen2010/briefs/c2010br-11.pdf

  20. Acknowledgements • IFPTI mentors; James Sevchik, Dr. Preston Hicks, and Joseph Corby • Erin Sawyer, NYS Department of Agriculture, Division of Food Safety and Inspection • Dr. Ross Kerr, Director, Oral Mucosal Disease Service, NYU College of Dentistry • Prakash C. Gupta, Director, Healis– Sekhsaria Institute for Public Health, Navi, Mumbai, India • Dr Pankaj Chaturvedi, Head and Neck Surgeon, Tata Memorial Hospital, Parel, Mumbai, India

  21. Questions?

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