February 22, 2012
La Isla Foundation would like to address some concerns that have been expressed in the wake of the Associated Press article, “Mystery Disease In Central America Kills Thousands,” by Filadelfo Aleman and Michael Weissenstein, published on 12 February 2012. We applaud the authors for increasing the visibility of this health crisis, and want to help clarify some of the points they made with respect to our investigations into pesticides and dehydration and the funding sources for these investigations.
Dr. Wesseling has been part of a group of scientists from the Program on Work, Health, and Environment in Central America (SALTRA), including the Regional Institute on Toxic Substances (IRET) at UNA-Heredia and the Center for Investigation in Health, Work, and Environment (CISTA) at the UNAN-Leon, investigating this epidemic for several years now in conjunction with La Isla Foundation. Dr. Brooks has been part of a separate Boston University working group also involved in the epidemic for several years, who has been working independently from us.
They and the other scientists working with them have conducted several studies investigating the roots of this CKD epidemic in Central America. These studies specifically addressed pesticide exposure as a risk factor for CKD. The data that emerged have not ruled out pesticides as a potential contributing factor to this epidemic. However, so far these data do not suggest that pesticides are a cause, and if they are involved they are almost certainly not the only cause.
We continue to investigate pesticide exposures as a causal factor. We are also in the process of analyzing samples from a study investigating heavy metals, which are an exposure known to be associated with the development of CKD and which are often found in agricultural fertilizers. Chemical causes of this epidemic are on our radar.
However, chronic dehydration is an important theory to pursue because it seems to fit the epidemiological characteristics of CKD in the region very well. It would help explain why the disease seems to be common in only hotter climates, and why it is also found among individuals working under similar heat-stress conditions.
Chronic dehydration for many of these workers is more than just laboring hard in hot conditions. Based on US Occupational Safety and Health Administration (OSHA) regulations, individuals working in the environment found in cane fields along the Pacific coast of Nicaragua and Costa Rica should only work for 15-30 minutes out of every hour to be able to maintain adequate, healthy hydration. These men (and in Nicaragua increasingly women and adolescents, as the men in the communities become unable to work because of their CKD) get hardly any breaks at all and are therefore subjecting themselves to severe acute kidney stress year-round.
Severe and chronic dehydration can exacerbate the effects of other chemical exposures on the kidneys. Additionally, there may be a dietary component to chronic dehydration as it relates to CKD. Consumption of fructose in large volumes, in conjunction with dehydration, may lead to kidney damage through a unique metabolic pathway being investigated by Dr. Johnson. Cane workers hydrate with soft drinks and chew sugar cane while working in order to keep up with the high energy demands their brutal working conditions impose; it could be that this high sugar intake is contributing to the destruction of their kidneys. Changing work practices and providing better energy sources for these individuals is a cornerstone goal in our efforts.
La Isla Foundation and the researchers we work with strive to make sure the funding sources for the various studies conducted investigating this epidemic are transparent. The dehydration study is funded in large part by a grant from Danone, who has an interest in showing their support for the importance of hydration in general but no direct commercial interest in the outcome of this study. The study into heavy metals is funded using a grant from the Mount Sinai School of Medicine Global Health Center. Other past investigations by the SALTRA researchers of our working group have been funded by various academic agencies, such as the Swedish International Agency for Development and by Central American universities.
We have never accepted study funding from entities that have a direct commercial interest in agriculture the region. We are considering future collaboration with the Boston University group and other researchers addressing this issue, but only under the condition that no study we are involved with will ever be conducted with financial support from any entity with a direct economic interest linked to sugar or ethanol production in the region.
Ultimately, it is likely that it is some combination of working conditions, diet, and chemical exposure that is causing the epidemic of CKD in areas of Central America. La Isla Foundation, and the fine researchers we are fortunate enough to work with, is dedicated to figure out what those causal factors are so we can work to end the spread of this disease. Our only interest is to protect the people suffering, not the economic elites who have been ignorant of or ignored this epidemic for nearly 30 years.
For more information on CKD in Central America, or to support our efforts, go to www.laislafoundation.org or feel free to write us directly at: laislafoundation @ gmail.com