Dr. Amarasiri de Silva (AS), a retired anthropologist, has made a provocative contribution (Colombo Telegraph 15-11-2017 ) on chronic kidney disease of unknown origin (CKDu) that goes counter to main-stream scientific discourse (e.g., by Dr. Tilak Abesekera, Daily News, 9-3-2017), while strongly echoing the beliefs immensely popular with a section of the wider public. A young Swedish student named Wiveca Stegeborn (WS) who prepared a social-anthropology thesis on the Vanniye-Attho, i.e, “Veddahs”, is his main source of information. We are told that the Vanni-Attho contracted CKDu when they joined the Mahaweli settlements, adopted urban foods, and became farmers using “toxic agrochemicals”.
If AS and WS also imply that DDT and GMO seeds are being used, then we have some truly astounding claims in the article. AS pushes to extremes the seemingly credible public view of agrochemicals creating a toxic environment and causing chronic diseases. Accordingly, (i) the use of agrochemicals since the 1970s has poisoned the soil, the water and the diet; (ii) the NCP gets a `double whammy’ because the agrochemical runoff from the tea estates gets to the NCP via the Mahaweli irrigation system. The NCP farmers get chronic kidney disease (CKDu) in due course.
The present author held similar views prior to 2012. They had to be drastically modified during 2012 to 2014 when important field studies appeared. The first was the NSF-funded WHO study which medically bench-marked CKDu, and also showed that toxins in the soil, water and the diet were well below the maximum allowed limits (MALS) for toxicity and hence safe. There was no arsenic or glyphosate, as claimed by the “Natha Deviyo” devotees linked to Dr. Jayasumana.
Dr. Sarath Amarasiri, a retired Director General of agriculture points out that when farmers tilled the land, vast flocks of egrets (“Kokku”) follow the ploughs to eat the exposed earthworms and other bugs. If the soil had become toxic, it will not be teeming with organisms, and if they are toxic, the egrets should also get sick. Clearly, the NCP soil and water are not “awash with toxins”.
The present writer used to ask, if the people in some NCP villages get sick, why not the cows? If it is a presence of cadmium in the rice, the cows get even more of it from the straw and the grass which also accumulate cadmium. Today many scientists think that they understand these puzzles, and why some Rajarata villagers get CKDu while their cows don’t, while other villagers and their cows also don’t get CKDu!
Studies of the blood and urine of the patients showed that 97% of them had no significant traces of glyphosate, the most commonly used herbicide. A mild warning was raised in the WHO-NSF report about possibly elevated levels of cadmium in the diet, but this was also true of the diet used in the rest of the country that does not have CKDu. The traces of cadmium found in the rice are amply counteracted by the presence of other substances like zinc and selenium (just as is the case with cadmium-containing shell fish sold in Europe).
The lack of toxic agents in the soil and water was confirmed by independent research including a Japanese-Sri Lankan study led by Dr Nanayakkara. A National Water Board (NWB) study by Dr. Pathmakumara Jayasinghe showed that the canals, rivers and reservoirs in the NCP had clean water, and that expensive Reverse-Osmosis (RO) machines are “cleaning” water which is already clean! The poor farmers, frightened by the threat of CKDU and toxins buy bottled RO water at Rs 2-3 per litre while Colombo gets water for pennies.
Dr AS has ignored the good work of the local medics and scientists. The NSF-WHO study, the Japanese study, the NWB study etc. , have been summarized in popular articles by Dr. Waidyanatha, Dr. Tilak Abesekera and others. The young Swedish student prepared her thesis on the Vanniye-Aettho, but not on the chemistry of the local environment.
Social anthropologists like AS and WS should study the two adjacent villages named Badulupura and Saaragama, both in Girandurukotte, with common life styles, food, and kinship. And yet Badulupura has CKDu, while Saaragama is healthy. The Badulupura residents who use their private well water get CKDu, while neighbouring Saarapura , being closer to the agricultural land, gets its water from irrigation canals or private wells connected to the groundwater of the paddy fields. Research groups like CERTKID of the Kandy Hospital and the University find that the consumption of water in isolated shallow household wells may be causing CKDu.
Peradeniya Chemists like Prof. Illeperuma, and Geologists like Professors Dissanayake, Chandrjith and others had noted that the endemic areas have hard water and a geology rich in fluoride. The present author and several colleagues argued (in a research paper) that Panabokke’s redox mechanism worked in the stagnant wells to progressively leach out fluorides and other mineral salts (known as Hofmeister-active salts) into the well water.
Hard water has dissolved magnesium and calcium. If hard water containing fluorides were the cause of CKDu, one can immediately explain why the people in Badulupura got CKDu, and why those in Saaragama are healthy. We also understand why the cows don’t get CKDu. The cows do not drink water from wells, but drink surface water in canals and fields connected to the agricultural system. AS and SW claim agricultural water to be contaminated, where as it is not.
A milestone in Sri Lankan CKDu research was the work of Dr. Wasana, Dr. Bandarage et al. of the IFS, Kandy. They fed HARD water containing fluoride to laboratory rats, and established a dose dependent causal relationship between damaged kidneys in the rats, the fluoride, and hard water. If the water was free of fluoride, or if the water was soft, no kidney damage! Both hardness and fluoride were simultaneously necessary. The present write provided evidence that the magnesium in hard water joined itself to the fluoride forming a pair. Magenisum is not toxic; but it synergistically augments the toxicity of fluoride. Independent experiments by Dr. Tammityagoda et al. (veterinary science) used water from endemic village wells and showed that mice fed on such water contracted CKDu, while mice given normal water remained healthy. These experiments, the geology of the endemic villages and the chemistry of the well water led most scientists to conclude that CKDu in the NCP is caused by consuming hard water containing fluoride. Professor Gamini Rajapaksa’s Moneragala studies confirmed these conclusions. Provision of cheap clean water by harvesting rain water has been launched in many areas.
Scientists have shown that farmers are using agrochemicals in excess, especially with the free market in 1977 cutting out the agriculture department’s control on agrochemicals. Such excessive use leads to algae blooms and environmental problems associated with phosphates, nitrates etc., in the water. The belief that the “heavy metal” toxins found in small amounts (parts per million) in mineral fertilizers is
adding toxins to the soil is largely unsubstantiated. Simple calculations show that even with the highly contaminated (30 times more contaminated in Cd than what is allowed in Sri Lanka) Nauru phosphate used in New Zealand, even if used in Sri Lanka will take millenia to bring up the soil cadmium levels to levels exceeding the WHO soil-Cd levels (for details see sec. 7 of the present writer’s research paper in Environmental Geochemistry and Health ).
Sri Lanka’s department of agriculture (DOA) has issued 25 booklets for the 25 districts, indicating where fertilizers are NOT needed, or how much is needed. The fertilizers and agrochemicals applied should be designed for each soil. The DOA also indicates the locations inside districts where organic fertilizer is adequate, and when phosphates are not needed because the soil is already over-saturated due to previous excessive use of fertilizers. So the knowledge base is there, and the technical information needs to be broadcast and agrochemical sales have to be regulated for their optimal use. Unfortunately, agricultural policy is controlled from the Presidential secretariat by Ven. Ratana and others who have their own unscientific beliefs about how agriculture should be done in Sri Lanka. Their policies have made the effect of the prevailing drought even more serious, and the output from the agricultural sector (from tea to paddy to vegetables) across the board has dropped by 40%.
Agrochemicals are used thorough out the country, and especially in the hill plantations. But no CKDu and other diseases attributed to agrochemicals have been detected. We now understand why some villagers get CKDu while their cows stay healthy, or why other villagers escape the illness. Fluoride and hard water are not found together in the hill country, or in Jaffna where there is heavy agrochemical usage, and so there is no CKDu in those areas. The water in Jaffna is very hard (rich in calcium and magnesium), but there is no (significant amounts of) fluoride to cause a synergistic action with fluoride or cadmium residues and cause nephrotoxicity.
Finally, let us look at the Swedish student’s views on the rural food culture, since they apply equally well to most of the country without CKDu.
(quote)… with time diabetes started to spread. It came with junk food, and with Cokes, Seven-Ups and Fantas … welfare coupons for sugar and white flour… The tea was no longer taken with honey or hackuru [Kithul jaggery], it was with refined sugar. …This is a common ailment among indigenous people introduced to a ‘western’ excessive food culture (end quote).
There is a tendency among the public to believe that “natural” foods, or “traditional” foods are safe while modern foods are “chemicals” and hence unsafe. In fact, everything is a chemical. If a food has been used traditionally, it has a very good chance of being safe when consumed by healthy people in moderate quantities. But there is never any guarantee that traditional preparations are safe according to modern criteria of heath risks until so proven.
Honey and jaggery are nearly as bad as refined sugar. Sugar is 50% fructose and 50% glucose, while honey (i.e., bee’s vomit) contains 40% fructose, 30% glucose while the remaining 30% is water, pollen and bio-matter from the bee. Honey has some 31% more calories than sugar. The pollen can cause botulism especially in children younger than 12. Honey has similar effects as sugar on blood glucose levels, causing problem for diabetics, whether they are Vanniye-Attheo or not. The digestive tract absorbs fructose poorly, and the fructose end up in the liver, leading to metabolic problems including type-II diabetes. The American Diabetes Association regards palm sugars (e.g, Jaggery) to be no better than pure sugar.
The embrace of “western food culture”, or the equally unhealthy “Kalu dodol, Kaevum, athiraha, kiri-paeni, ala dosi” or “baedum, ghee rice” etc by the Vanni-Aetto or anybody else reflects the lack of nutritional education in Sri Lanka. There were no courses on food science, environmental science etc., in any Sri Lankan university until the mid 1970s. The present writer, as a Professor of Chemistry and as a Vice Chancellor of the Vidyodaya (SJP) University worked to introduce them to the university curriculum. Course units in nutrition, health and environmental science are badly needed even in our schools.