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Fact Sheet

Betel Quid with Tobacco (Gutka)

(updated February 2007)


Betel quid with tobacco, also known as gutka (ghutka or gutkha) is a dry, relatively nonperishable commercial preparation that consists of betel leaf (Piper betle), tobacco, areca nut (Areca catechu), catechu (extract of the Acacia catechu tree), and slaked lime (calcium hydroxide). Spices—such as cardamom, saffron, cloves, anise seeds, turmeric, and mustard—or sweeteners are also added as flavorants.1,2 Gutka is available in sachets and tins. It is consumed by placing a pinch of the mixture in the mouth between the gum and cheek and gently sucking and chewing. The excess saliva produced by chewing may be swallowed or spit out.3

Gutka is primarily consumed in the Indian subcontinent (India, Pakistan and Bangladesh). Betel quid without tobacco is widely used in Southeast Asian countries (Taiwan, Myanmar, Thailand, China, Papua New Guinea, and Guam).3,7 In the Indian subcontinent, nonperishable, commercially manufactured preparation of betel quid without tobacco is known as pan masala, and a freshly prepared betel quid (with or without tobacco) is known as pan.

Health Effects

Scientific studies examining the health effects of betel gutka have found it to be carcinogenic to humans. Specifically the following cancers and conditions have been associated with using gutka:

Current Estimates of U.S. Prevalence

Gutka use is currently not monitored in the United States.


  1. Gupta PC, Hamner JE III, Murti PR, editors. Control of Tobacco-Related Cancers and Other Diseases. Proceedings of an international symposium January 15–19, 1990 [cited 2007 Feb 27]; Bombay, India: Tata Institute of Fundamental Research: Oxford University Press; 1992.
  2. National Cancer Institute, Centers for Disease Control and Prevention, Stockholm Centre of Public Health. Smokeless Tobacco Fact Sheets. 3rd International Conference on Smokeless Tobacco; Stockholm. September 22–25, 2002 [cited 2007 Feb 27].
  3. International Agency for Research on Cancer (IARC). Betel-Quid and Areca-Nut Chewing and Some Areca-Nut-Derived Nitrosamines; Volume 85Link to nonfederal Web site. (PDF–44KB) September 2004 [cited 2007 Feb 27]. Available from:
  4. Gupta PC, Ray CS. Smokeless Tobacco and Health in India and South Asia. Respirology 2003; 8(4):419–31 [cited 2007 Feb 27].
  5. Nair U, Bartsch H, Nair J. Alert for an Epidemic of Oral Cancer Due to Use of the Betel Quid Substitutes Gutkha and Pan Masala: A Review of Agents and Causative Mechanisms. Mutagenesi 2004: 19(9): 251–62 [cited 2007 Feb 27].
  6. Gupta PC, Ray CS. Epidemiology of Betel Quid Usage. Annals Academy of Medicine Singapore. 2004; July 33(Suppl): 31S–36S [cited 2007 Feb 27].
  7. World Health Organization. Tobacco: Deadly in Any Form or DisguiseLink to nonfederal Web site. (PDF–257KB) Geneva; 2006 [cited 2007 Feb 27]. Available from:

For Further Information

Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Office on Smoking and Health
Phone: 1-800-CDC-INFO

Media Inquiries: Contact CDC's Office on Smoking and Health press line at 770-488-5493.


Page last reviewed 02/28/2007
Page last modified 02/28/2007