Editing Gutka (section)

== Health effects ==
Gutka is highly addictive, represents a major health risk, has no safe level use and is not a safe substitute for smoking.<ref name="WHO2017">{{cite web |year=2017 |title=Recommendation on smokeless tobacco products |url=http://apps.who.int/iris/bitstream/10665/42658/1/9241590556.pdf |publisher=[[World Health Organization]] |pages=1–9 |access-date=2 June 2024 |archive-date=8 August 2017 |archive-url=https://web.archive.org/web/20170808233908/http://apps.who.int/iris/bitstream/10665/42658/1/9241590556.pdf |url-status=live }}</ref><ref name="ACS015">{{cite web |date=13 November 2015 |title=Health Risks of Smokeless Tobacco |url=https://www.cancer.org/cancer/cancer-causes/tobacco-and-cancer/smokeless-tobacco.html |publisher=[[American Cancer Society]] |access-date=2 June 2024 |archive-date=6 July 2024 |archive-url=https://web.archive.org/web/20240706204005/https://www.cancer.org/cancer/risk-prevention/tobacco/health-risks-of-tobacco/smokeless-tobacco.html |url-status=live }}</ref><ref name="NCI2010">{{cite web |date=25 October 2010 |title=Smokeless Tobacco and Cancer |url=https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/smokeless-fact-sheet |publisher=United States Department of Health and Human Services |agency=[[National Cancer Institute]] at the National Institutes of Health |access-date=2 June 2024 |archive-date=31 May 2024 |archive-url=https://web.archive.org/web/20240531183504/https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/smokeless-fact-sheet |url-status=live }}{{PD-notice}}</ref><ref name="Group2002">{{cite book |author=Royal College of Physicians of London. Tobacco Advisory Group |url=https://books.google.com/books?id=fpUgCBGb5SwC&pg=PA5 |title=Protecting Smokers, Saving Lives: The Case for a Tobacco and Nicotine Regulatory Authority |publisher=Royal College of Physicians |year=2002 |isbn=978-1-86016-177-3 |pages=5– |access-date=2 June 2024 |archive-date=31 May 2024 |archive-url=https://web.archive.org/web/20240531183455/https://books.google.com/books?id=fpUgCBGb5SwC&pg=PA5 |url-status=live }}</ref> Globally smokeless tobacco products like gutka contribute to 650 000 deaths each year with a significant proportion of them in [[Southeast Asia]].<ref name="SinhaSuliankatchi2016">{{cite journal |last1=Sinha |first1=Dhirendra N |last2=Suliankatchi |first2=Rizwan A |last3=Gupta |first3=Prakash C |last4=Thamarangsi |first4=Thaksaphon |last5=Agarwal |first5=Naveen |last6=Parascandola |first6=Mark |last7=Mehrotra |first7=Ravi |year=2016 |title=Global burden of all-cause and cause-specific mortality due to smokeless tobacco use: systematic review and meta-analysis |journal=Tobacco Control |volume=27 |issue=1 |pages=tobaccocontrol–2016–053302 |doi=10.1136/tobaccocontrol-2016-053302 |issn=0964-4563 |pmid=27903956 |s2cid=10968200}}</ref><ref name=":3">{{Cite journal |last1=Chugh |first1=Aastha |last2=Arora |first2=Monika |last3=Jain |first3=Neha |last4=Vidyasagaran |first4=Aishwarya |last5=Readshaw |first5=Anne |last6=Sheikh |first6=Aziz |last7=Eckhardt |first7=Jappe |last8=Siddiqi |first8=Kamran |last9=Chopra |first9=Mansi |last10=Mishu |first10=Masuma Pervin |last11=Kanaan |first11=Mona |last12=Rahman |first12=Muhammad Aziz |last13=Mehrotra |first13=Ravi |last14=Huque |first14=Rumana |last15=Forberger |first15=Sarah |date=June 2023 |title=The global impact of tobacco control policies on smokeless tobacco use: a systematic review |url=https://linkinghub.elsevier.com/retrieve/pii/S2214109X2300205X |journal=The Lancet Global Health |language=en |volume=11 |issue=6 |pages=e953–e968 |doi=10.1016/S2214-109X(23)00205-X |pmid=37202029 |access-date=2 June 2024 |archive-date=3 June 2024 |archive-url=https://web.archive.org/web/20240603043722/https://linkinghub.elsevier.com/retrieve/pii/S2214109X2300205X |url-status=live |hdl=20.500.11820/e0442377-9f02-4360-8d09-292d86110e45 |hdl-access=free }}</ref>

Using gutka can cause a number of adverse health effects such as [[head and neck cancer]],<ref name="NCI" /><ref name=":0" /> [[oral cancer]],<ref name="Arecanut as an emerging etiology of" /> [[oral submucous fibrosis]],<ref name="emro.who.int" /> [[Esophageal cancer|oesophagus cancer]], and [[pancreatic cancer]], [[cardiovascular disease]], and [[asthma]].<ref name="NiazMaqbool2017">{{cite journal |last1=Niaz |first1=Kamal |last2=Maqbool |first2=Faheem |last3=Khan |first3=Fazlullah |last4=Bahadar |first4=Haji |last5=Ismail Hassan |first5=Fatima |last6=Abdollahi |first6=Mohammad |year=2017 |title=Smokeless tobacco (''paan'' and ''gutkha'') consumption, prevalence, and contribution to oral cancer |journal=Epidemiology and Health |volume=39 |pages=e2017009 |doi=10.4178/epih.e2017009 |issn=2092-7193 |pmc=5543298 |pmid=28292008}}{{CC-notice|cc=by4|url=https://www.e-epih.org/journal/view.php?doi=10.4178/epih.e2017009|author(s)=Kamal Niaz, Faheem Maqbool, Fazlullah Khan, Haji Bahadar, Fatima Ismail Hassan, Mohammad Abdollahi}}</ref> It also raises the risk of fatal [[coronary artery disease]], fatal [[stroke]] and non-fatal ischaemic heart disease<ref name="VidyasagaranSiddiqi2016"/><ref name=":2"/> When a person chews gutka, the mixture directly enters the system through the oral cavity, which absorbs 28 cancer-causing chemicals.<ref name="Smokeless tobacco paan and gutkha" />

Gutka can cause adverse reproductive effects including [[stillbirth]], [[Preterm birth|premature birth]], [[low birth weight]]. Nicotine in gutka that are used during pregnancy can affect how a baby's brain develops before birth.<ref name="VidyasagaranSiddiqi2016"/>

Gutka use causes the production of various reactive [[radical (chemistry)|free radicals]] that induce [[oxidative stress]], particularly in oral tissues.<ref name = Prajapati2024>{{cite journal |vauthors=Prajapati RK, Joshi J, Karthikeyan S, Inder MP |title=Comparative evaluation of salivary, serum and urinary 8-OHdG in gutka-associated oral submucous fibrosis |journal=J Oral Maxillofac Pathol |volume=28 |issue=1 |pages=37–41 |date=2024 |pmid=38800434 |pmc=11126255 |doi=10.4103/jomfp.jomfp_442_23 |doi-access=free |url=}}</ref>  Gutka exposure can lead to the oxidation of [[guanine]] bases in [[DNA]] to form [[8-Oxo-2'-deoxyguanosine|8-hydroxy-2’-deoxyguanosine]] (8-OHdG or its tautomer 8-oxo-dG) as a major byproduct.<ref name = Prajapati2024/> Exposure to Gutka tends to be highest in [[saliva]] and [[urine]] as evaluated by measuring 8-OHdG in DNA.

Creative advertising by tobacco companies and lack of accessible information for the public leads to many gutka users being unaware of the dangers it can bring. Often users believe that gutka can act as a digestion aid, kill germs, and generally give a sense of well-being.<ref name="Smokeless tobacco paan and gutkha">{{cite journal |last1=Niaz |first1=Kamal |last2=Maqbool |first2=Faheem |last3=Khan |first3=Fazlullah |last4=Bahadar |first4=Haji |last5=Ismail Hassan |first5=Fatima |last6=Abdollahi |first6=Mohammad |title=Smokeless tobacco (paan and gutkha) consumption, prevalence, and contribution to oral cancer |journal=Epidemiology and Health |volume=39 |pages=e2017009 |publisher=US National Library of Medicine, National Institutes of Health |doi=10.4178/epih.e2017009 |pmid=28292008 |pmc=5543298 |date=9 March 2017}}</ref> In fact 34.4% of smokers have switched to smokeless tobacco use as way to quit<ref name="Sage Journals" /> but there is no scientific evidence that using gutka can help a person quit smoking.<ref name="NCI2010"/><ref name=":1">{{Cite web |last=ERS |date=2019-05-29 |title=ERS Position Paper on Tobacco Harm Reduction |url=https://www.ersnet.org/news-and-features/news/ers-position-paper-on-tobacco-harm-reduction-2/ |access-date=2024-05-30 |website=ERS - European Respiratory Society |language=en-GB |archive-date=30 May 2024 |archive-url=https://web.archive.org/web/20240530093952/https://www.ersnet.org/news-and-features/news/ers-position-paper-on-tobacco-harm-reduction-2/ |url-status=live }}</ref> As of 2015 it was the fourth most common addictive product worldwide.<ref>{{cite journal |last1=Wu |first1=Fen |last2=Parvez |first2=Faruque |last3=Islam |first3=Tariqul |last4=Ahmed |first4=Alauddin |last5=Rakibuz-Zaman |first5=Muhammad |last6=Hasan |first6=Rabiul |last7=Argos |first7=Maria |last8=Levy |first8=Diane |last9=Sarwar |first9=Golam |last10=Ahsan |first10=Habibul |author10-link=Habibul Ahsan |last11=Chen |first11=Yu |date=25 June 2015 |title=Betel quid use and mortality in Bangladesh: a cohort study |journal=Bulletin of the World Health Organization |publisher=World Health Organization |volume=93 |issue=10 |pages=684–692 |doi=10.2471/blt.14.149484 |pmc=4645429 |pmid=26600610}}</ref><ref>{{cite journal |last1=Javed |first1=Fawad |last2=Chotai |first2=Milisha |last3=Mehmood |first3=Abid |last4=Almas |first4=Khalid |date=1 June 2010 |title=Oral mucosal disorders associated with habitual gutka usage: a review |journal=Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology |publisher=Oral Surgery, Oral edicine, Oral Pathology, Oral Radiology, and Endodontology |volume=109 |issue=6 |pages=857–864 |doi=10.1016/j.tripleo.2009.12.038 |pmid=20382045}}</ref>