Betel nut consumption has an extensive negative effect on the cardiovascular system. It increases the heart rate by affecting the central sympathetic system and decreases the diastolic blood pressure because of the peripheral cholinergic effect of betel nut on the other hand the systolic blood pressure increases in non-habitual consumers (Garg, Chaturvedi and Gupta 2014)
 

Areca nut does not alter the cerebral blood flow as there is not much significant increase in blood flow of the internal carotid artery and middle cerebral artery.[15-17] Arecoline has a blocking effect on the high-density lipoprotein receptor and inhibits the uptake of low-density lipoprotein by the liver thus leading to enhanced atherogenesis and its parasympathomimetic effect leading to spasm of the coronary arteries, both of which predispose to coronary artery diseases”( Garg, Chaturvedi and Gupta 2014, p. 5).

It is hepatotoxic and causes several liver diseases such as cirrhosis of the liver, necrosis, and hepatocellular carcinoma, with the longer consumption of betel nuts. The damage to the liver happens because of the increases in serum transaminases and alkaline phosphatase which occurs due to liver injury on both cholestatic and hepatocellular bases (Garg, Chaturvedi and Gupta 2014).
 

Furthermore, chances of hypertriglyceridemia, hyperlipidemia, metabolic syndromes, and type II diabetes, are more common in betel nut chewers as arecoline which is a metabolite, inhibits adipose tissue differentiation, interferes with insulin-promoted glucose uptake and causes lipolysis in 3T3-L1 adipocytes (Garg, Chaturvedi and Gupta 2014).

Areca nut chewers are highly prone to neoplastic changes in blood cells due to the destruction of p53 genes which leads to the destruction of DNA and overall cancerous growth of blood cells in the addictive population (Garg, Chaturvedi and Gupta 2014).

Betel nut also suppresses T-cell activation leads to serious effects on the immune system
of the person (Garg, Chaturvedi and Gupta 2014).

Areca nut increases testosterone levels and significantly decreases sperm count, and sperm mobility which may lead to infertility in males for long-term use (Garg, Chaturvedi and Gupta 2014).

“Areca nut leads to an increased concentration of sialic acid in the seminal vesicle and fructose in the coagulating gland and increased expression of androgen receptors on prostate leading to hyperplasia and hypertrophy, causing problems of an enlarged prostate” (Garg, Chaturvedi and Gupta 2014, p. 6)

Arecoline, a metabolite in areca nut causes increased production of T3 and T4 hormones whereas, it decreases TSH production which leads to hypothyroidism (Garg, Chaturvedi and Gupta 2014).

“Various case reports from different parts of the world have shown that the areca nut metabolite arecoline causes aggravation of disease in asthamatics by increasing bronchoconstriction in a dose-dependent manner and decreasing the forced expiratory volume in 1 second (FEV1) by 30%; also, the rate of hospitalization is higher in asthamatics who chew areca nut” (Garg, Chaturvedi and Gupta 2014, p. 7)

Betel nut is highly carcinogenic and belongs to group I carcinogen. It causes oral cancer, lung cancer, oesophageal cancer, pancreatic cancer, etc (Athukorala, Tilakaratne and Jayasinghe 2021). “Alkaloids of areca nut are considered to be its main carcinogenic constituent. Arecoline, arecaidine, guvacine, andguvacoline are 4 major alkaloids discovered during studies. Apart from alkaloids, tannins and some of the polyphenols such as safrole, hydroxychavicol, and cate-chins are also proven as carcinogens. Several research works conducted using animal models found that areca nut products and its derivatives can induce neoplastic changes in animals” (Athukorala, Tilakaratne and Jayasinghe 2021, p. 2)