KAOHSIUNG: For centuries, hundreds of millions of people across Asia, from Pakistan to Palau, have chewed the spicy date-like fruit of the betel palm for a quick buzz.

Then, four years ago, a World Health Organization study found that chewing betel nuts can cause oral cancer and that the rate of these malignant mouth tumors was highest in Asia where the nut is a widely used stimulant.

Despite the cancer link, betel nut addicts are chewing on in many parts of Asia. But in Taiwan, the findings have spurred a government health campaign against the nut, which is grown on palm trees across the subtropical island in East China.

"If you don't want oral cancer, the most direct way is to quit chewing betel nuts," Wu Chien-yuan, chief of cancer prevention at the Taiwan "health ministry", said.

Betel nuts, which contain an addictive stimulant similar to nicotine, are widely used in parts of Southeast Asia, India, Pakistan and the South Pacific as a breath freshener, a hunger antidote, a substitute for cigarettes and as a way to get high.

Users often chew them all day long, causing all sorts of unpleasant side effects, such as red-stained teeth and pavements covered with red spittle as many users spit out the betel nut's remnants as they chew.

"Whether it harms you is an individual thing," Kaohsiung betel chewer Wan Chin-hsian, 35, said. "It's healthy to spit it out."

Under pressure from the government health drive, betel nut traders and growers are seeking new uses for the nut - such as soap - as the industry seeks to stay in business.

There is a lot at stake for the growers as the nut is the island's second biggest crop after rice and provides more than 20,000 jobs.

"Betel nut is in dispute, but the sellers still have to make a living," Lee Su-ming, the organizer of a betel nut festival held in the southern Taiwan city of Kaohsiung last month, said.

Aware of the cancer link, some merchants are wrapping betel quids with less lime, a leaf-to-nut bonding additive that some in the industry believe to be the most noxious ingredient.

Growers in Taiwan now use almost every bit of the betel nut stick palms that grow all over the island.

They turn it into chicken soup, chicken feed and hard liquor for as much as T$12,000 ($365) per bottle. Some advocate eating betel flowers instead of chewing the kernels. Many consume a combination of betel nut and tobacco.

For those who still chew, sellers say they consistently hand out paper cups to discourage spitting the red pulp onto public streets, an act that outrages a sanitation-conscious public.

"Oral cancer appears to be the most prevalent and serious health effect of concurrent use of (betel) nut and tobacco in the region," a WHO report said.

Government statistics show the oral cancer rate rose from 1,790 to 4,754 between 1994 and 2004, with deaths going from 779 to 1,593 cases over the same period. Taiwan officials blame betel nuts.

The WHO says 58 percent of the world's 390,000 oral cancers come from Asia, where the betel nut is widely consumed.

"The government is always putting pressure on us," grower Yang Hui-hsiung said. "If you see the reports on it, they're all negative."

The Taiwan Department of Health anti-cancer bureau says betel flowers and other parts of the palm also contain an alkaloid that causes cancer. It wants Taiwan to phase out betel completely, replacing it with healthier crops.

Betel nut chewers are 28 times more likely to get oral cancer than non-users, health officials said.

Experts doubt that health officials will be able to cut the use of betel across the region as the nut is embedded in many cultures and the industry is lucrative and provides jobs.

But in Taiwan at least, the government's publicity campaign is paying off.

About 9 percent of Taiwan's 16.7 million adults chew betel, down from 10.9 percent in 1996.

Agencies

(China Daily 07/12/2007 page5)