Gutkha is a highly addictive and toxic product, owing to the amount of
nicotine and tobacco content in it. India currently has the highest
number of oral cancer cases in the world. The areca nut or betel nut
used in the preparation of gutkha is a serious health hazard and a known
carcinogenic substance. Areca nut is consumed widely in India in the
form of paan or supari under the mistaken belief that it is actually a
mouth freshener, stress reliever or that it aids in digestion.
Areca nut, just like tobacco is a psycho stimulant and an addictive
substance. Areca nut is in fact estimated to be the fourth most common
addictive substance (after tobacco, alcohol and caffeine). The World
Health Organization’s International Agency for Research on Cancer lists
areca nut as a Group-I carcinogen. Even without adding tobacco, areca
nut chewing is known to cause cancers of the larynx, stomach, lung and
cervix in humans. Apart from cancer, areca nut addiction has also been
found to be cause of heart attacks, arrhythmia, metabolic syndrome and
diabetes. Children born to mothers who habitually chew areca nut are
seen to be smaller in size and usually have withdrawal syndrome.
Apart from containing areca nut, gutkha contains several toxic and
harmful chemicals such as Eugenol, N-Nitrosamines, Sodium Carbonate,
Ammonium Carbonate, Ammonia, etc. Apart from these, they contain high
levels of heavy metals such as lead, arsenic that cause cancer, organ
failure and various nervous diseases.
The Indian Institute of Environmental Medicine estimates that on an
average, tobacco contains at least 19 known carcinogens and at least 30
metallic compounds comprising of heavy metals. Further, the Cancer
Tobacco Research Institute (affiliate of the Indian Council of
Agricultural Research) estimates that the popular brands of gutkha and
pan masala such as Manikchand, Rajnigandha, Chaini Khaini, etc. all
contain nicotine and gives the percentage of nicotine content in the
various brands of gutkha and pan masalas available.
Gutkha or chewing tobacco is a known carcinogen and it is known to
cause oral cancer and cancer of the esophagus, pharynx, larynx, stomach,
and pancreas. Apart from cancer, tobacco also results in various health
problems such as Gum Disease, Peripheral Vascular Disease,
Hypertension, Peptic Ulcer Disease, and Coronary Artery Disease.
Health hazards of Gutkha
1. It is estimated that tobacco results in the death of over 10
lakh Indians a year. Further, around 75,000 to 80,000 new cases of oral
cancer annually is registered in India and this creates a huge strain on
the public and private health care system. India currently has the
highest number of oral cancer cases in the world.
2. Apart from cancer, tobacco results in various health problems
such as Gum Disease, Peripheral Vascular Disease, Hypertension, Peptic
Ulcer Disease and Coronary Artery Disease.
3. Gutkha leads to Oral sub-mucous fibrosis (SMF), a pre-cancerous
disease that is a first step to cancer. This has increased 20 to 30
times across the country. It also leads to throat, esophageal cancers.
4. Loss of appetite
5. Pregnant women in India who used gutka had a threefold increased risk of having a low birth weight infant.
Indian Scenario
According to Global Adult Tobacco Survey (GATS) India, the estimated
number of tobacco users in India is 274.9 million of which 25.9% are
users of smokeless tobacco while 5.7% are cigarette smokers and 9.2%
smoke bidi. This reveals that more Indians (almost 75%) consume
smokeless forms of tobacco that includes pan, gutka, pan masala and
khaini, mawa. Slowly and gradually the use of chewing tobacco is
reaching at dangerously endemic levels in the country with 8% of all
adults in the country chewing gutka.
India has the highest prevalence of oral cancer globally, with 75, 000
to 80, 000 new cases of oral cancers being reported every year. Nearly
80% of all oral cancer cases are due to the consumption of tobacco
products like Gutka, pan masala, betel quid with tobacco and khaini.
According to a study released in March 2012, by Tata Memorial Hospital,
about 1.2 lakh deaths in 2010 occurred due to tobacco alone and most
number of deaths--nearly 84,000 in men and 36,000 in women were from
oral cancer due to smokeless tobacco.
India spends approximately Rs 300 billion annually in both public and
private spending on treatment of tobacco related illness, accounting for
roughly one fourth of all health spending. According to the WHO, the
total economic cost of tobacco use in India for 2004 amounted to $1.7
billion, which is 16 percent more than the total excise tax revenues
collected from all tobacco products in India in the financial year
2003-04 ($1.46 billion).
The Global Adult Tobacco Survey (GATS) India 2009 – 10 released by
Ministry of Health & Family Welfare (MoHFW) conveys that about
(26.6%) population of Jammu & Kashmir is using tobacco product in
one or the other of its form. Jammu & Kashmir has 8.0% use smokeless
tobacco, 12% cigarette smokers and 3.8% bidi smokers.
Considering the health hazards related to chewing tobacco, which causes
mouth, throat cancer, 14 Indian states Madhya Pradesh, Kerala, Bihar,
Maharashtra, Rajasthan, Haryana, Jharkhand, Chhattisgarh, Punjab,
Gujarat, Mizoram, Delhi have banned gutka.
These 14 states have banned the sale, manufacture and distribution of
gutka, khaini, pan masala containing tobacco, based on the regulation
issued on 1 August 2011 by the Food Safety and Standards Authority of
India (FSSAI), a statutory body under the health ministry to handle food
related issues. According to the rule 2.3.4 of the Food Safety and
Standards (Prohibition and Restrictions on Sales) Regulations, 2011,
“product not to contain any substance which may be injurious to health:
Tobacco and nicotine shall not be used as ingredients in any food
products”.
With 13 states & 1 Union Territory announcing the ban on gutka and
pan masala containg tobacco/nictotine, the bans have impacted about 38
million gutka users across the country. The % usage is based on Global
Adult Tobacco Survey (GATS) 2010 and the population numbers are based on
2011 census.
The author is Media Officer, Tobacco Control, Voluntary Health Association of India