Health

‘Island of Widows’: Mysterious Disease of Epidemic Proportions Killing Thousands in Central America

Central American Disease Killing Thousands in Central America | Confusing Scientists

A disease with epidemic effects is killing thousands upon thousands of Central American men. (Photo: AP)

CHICHIGALPA, Nicaragua (The Blaze/AP) — Jesus Ignacio Flores started working when he was 16, laboring long hours on construction sites and in the fields of his country’s biggest sugar plantation.

Three years ago his kidneys started to fail and flooded his body with toxins. He became too weak to work, wracked by cramps, headaches and vomiting.

On Jan. 19 he died on the porch of his house. He was 51. His withered body was dressed by his weeping wife, embraced a final time, then carried in the bed of a pickup truck to a grave on the edge of Chichigalpa, a town in Nicaragua’s sugar-growing heartland, where studies have found more than one in four men showing symptoms of chronic kidney disease.

Central American Disease Killing Thousands in Central America | Confusing Scientists

Jesus Ignasio Flores was watched after by his mother. (Photo: AP)

A mysterious epidemic is devastating the Pacific coast of Central America, killing more than 24,000 people in El Salvador and Nicaragua since 2000 and striking thousands of others with chronic kidney disease at rates unseen virtually anywhere else. Scientists say they have received reports of the phenomenon as far north as southern Mexico and as far south as Panama.

Last year it reached the point where El Salvador’s health minister, Dr. Maria Isabel Rodriguez, appealed for international help, saying the epidemic was undermining health systems.

Wilfredo Ordonez, who has harvested corn, sesame and rice for more than 30 years in the Bajo Lempa region of El Salvador, was hit by the chronic disease when he was 38. Ten years later, he depends on dialysis treatments he administers to himself four times a day.

“This is a disease that comes with no warning, and when they find it, it’s too late,” Ordonez said as he lay on a hammock on his porch.

Many of the victims were manual laborers or worked in sugar cane fields that cover much of the coastal lowlands. Patients, local doctors and activists say they believe the culprit lurks among the agricultural chemicals workers have used for years with virtually none of the protections required in more developed countries. But a growing body of evidence supports a more complicated and counterintuitive hypothesis.

The roots of the epidemic, scientists say, appear to lie in the grueling nature of the work performed by its victims, including construction workers, miners and others who labor hour after hour without enough water in blazing temperatures, pushing their bodies through repeated bouts of extreme dehydration and heat stress for years on end. Many start as young as 10. The punishing routine appears to be a key part of some previously unknown trigger of chronic kidney disease, which is normally caused by diabetes and high-blood pressure, maladies absent in most of the patients in Central America.

Central American Disease Killing Thousands in Central America | Confusing Scientists

Pouch with liquid to hydrate workers. (Photo: PRI's The World)

“The thing that evidence most strongly points to is this idea of manual labor and not enough hydration,” said Daniel Brooks, a professor of epidemiology at Boston University’s School of Public Health, who has worked on a series of studies of the kidney disease epidemic.

Because hard work and intense heat alone are hardly a phenomenon unique to Central America, some researchers will not rule out manmade factors. But no strong evidence has turned up.

“I think that everything points away from pesticides,” said Dr. Catharina Wesseling, an occupational and environmental epidemiologist who also is regional director of the Program on Work, Health and Environment in Central America. “It is too multinational; it is too spread out.

Central American Disease Killing Thousands in Central America | Confusing Scientists

In this Thursday, Jan. 26, 2012 photo, relatives mourn for Segundo Zapata Palacios inside his home in Chichigalpa, Nicaragua. Zapata, who worked as a sugar cane cutter for 20 years at the San Antonio sugar plantation, died of chronic kidney disease on Jan. 26 at the age of 49. A mysterious epidemic is devastating the Pacific coast of Central America, killing more than 24,000 people in El Salvador and Nicaragua since 2000 and striking thousands of others with chronic kidney disease at rates unseen virtually anywhere else. Many of the victims were manual laborers or worked in the sugarcane fields that cover much of the coastal lowlands. (AP Photo/Esteban Felix)

“I would place my bet on repeated dehydration, acute attacks everyday. That is my bet, my guess, but nothing is proved.”

Dr. Richard J. Johnson, a kidney specialist at the University of Colorado, Denver, is working with other researchers investigating the cause of the disease. They too suspect chronic dehydration.

“This is a new concept, but there’s some evidence supporting it,” Johnson said. “There are other ways to damage the kidney. Heavy metals, chemicals, toxins have all been considered, but to date there have been no leading candidates to explain what’s going on in Nicaragua …

“As these possibilities get exhausted, recurrent dehydration is moving up on the list.”

Central American Disease Killing Thousands in Central America | Confusing Scientists

(Image: BBC)

In Nicaragua, the number of annual deaths from chronic kidney disease more than doubled in a decade, from 466 in 2000 to 1,047 in 2010, according to the Pan American Health Organization, a regional arm of the World Health Organization. In El Salvador, the agency reported a similar jump, from 1,282 in 2000 to 2,181 in 2010.

It has killed so many that one Nicaraguan community, according to PRI’s The World, calls itself La Isla de las Viudas – “The Island of the Widows.”

Farther down the coast, in the cane-growing lowlands of northern Costa Rica, there also have been sharp increases in kidney disease, Wesseling said, and the Pan American body’s statistics show deaths are on the rise in Panama, although at less dramatic rates.

While some of the rising numbers may be due to better record-keeping, scientists have no doubt they are facing something deadly and previously unknown to medicine.

In nations with more developed health systems, the disease that impairs the kidney’s ability to cleanse the blood is diagnosed relatively early and treated with dialysis in medical clinics. In Central America, many of the victims treat themselves at home with a cheaper but less efficient form of dialysis, or go without any dialysis at all.

At a hospital in the Nicaraguan town of Chinandega, Segundo Zapata Palacios sat motionless in his room, bent over with his head on the bed.

“He no longer wants to talk,” said his wife, Enma Vanegas.

His levels of creatinine, a chemical marker of kidney failure, were 25 times the normal amount.

His family told him he was being hospitalized to receive dialysis. In reality, the hope was to ease his pain before his inevitable death, said Carmen Rios, a leader of Nicaragua’s Association of Chronic Kidney Disease Patients, a support and advocacy group.

“There’s already nothing to do,” she said. “He was hospitalized on Jan. 23 just waiting to die.”

Zapata Palacios passed away on Jan. 26. He was 49.

Central American Disease Killing Thousands in Central America | Confusing Scientists

Segundo Zapata Palacios (Photo: AP)

Working with scientists from Costa Rica, El Salvador and Nicaragua, Wesseling tested groups on the coast and compared them with groups who had similar work habits and exposure to pesticide but lived and worked more than 500 meters (1,500 feet) above sea level.

Some 30 percent of coastal dwellers had elevated levels of creatinine, strongly suggesting environment rather than agrochemicals was to blame, Brooks, the epidemiologist, said. The study is expected to be published in a peer-reviewed journal in coming weeks.

Brooks and Johnson, the kidney specialist, said they have seen echoes of the Central American phenomenon in reports from hot farming areas in Sri Lanka, Egypt and the Indian east coast.

“We don’t really know how widespread this is,” Brooks said. “This may be an under-recognized epidemic.”

Jason Glaser, co-founder of a group working to help victims of the epidemic in Nicaragua, said he and colleagues also have begun receiving reports of mysterious kidney disease among sugar cane workers in Australia.

Despite the growing consensus among international experts, Elsy Brizuela, a doctor who works with an El Salvadoran project to treat workers and research the epidemic, discounts the dehydration theory and insists “the common factor is exposure to herbicides and poisons.”

Nicaragua’s highest rates of chronic kidney disease show up around the Ingenio San Antonio, a plant owned by the Pellas Group conglomerate, whose sugar mill processes nearly half the nation’s sugar. Flores and Zapata Palacios both worked at the plantation.

According to one of Brooks’ studies, about eight years ago the factory started providing electrolyte solution and protein cookies to workers who previously brought their own water to work. But the study also found that some workers were cutting sugar cane for as long as 9 1/2 hours a day with virtually no break and little shade in average temperatures of 30 C (87 F).

In 2006, the plantation, owned by one of the country’s richest families, received $36.5 million in loans from the International Finance Corp., the private-sector arm of the World Bank Group, to buy more land, expand its processing plant and produce more sugar for consumers and ethanol production.

In a statement, the IFC said it had examined the social and environmental impacts of its loans as part of a due diligence process and did not identify kidney disease as something related to the sugar plantation’s operations.

Nonetheless, the statement said, “we are concerned about this disease that affects not only Nicaragua but other countries in the region, and will follow closely any new findings.”

Ariel Granera, a spokesman for the Pellas’ business conglomerate, said that starting as early as 1993 the company had begun taking a wide variety of precautions to avoid heat stress in its workers, from starting their shifts very early in the morning to providing them with many gallons of drinking water per day.

Associated Press reporters saw workers bringing water bottles from their homes, which they refilled during the day from large cylinders of water in the buses that bring them to the fields.

Glaser, the co-founder of the activist group in Nicaragua, La Isla Foundation, said that nonetheless many worker protections in the region are badly enforced by the companies and government regulators, particularly measures to stop workers with failing kidneys from working in the cane fields owned by the Pellas Group and other companies.

Many workers disqualified by tests showing high levels of creatinine go back to work in the fields for subcontractors with less stringent standards, he said. Some use false IDs, or give their IDs to their healthy sons, who then pass the tests and go work in the cane fields, damaging their kidneys.

“This is the only job in town,” Glaser said. “It‘s all they’re trained to do. It’s all they know.”

The Ingenio San Antonio mill processes cane from more than 24,000 hectares (60,000 acres) of fields, about half directly owned by the mill and most of the rest by independent farmers.

The trade group for Nicaragua’s sugar companies said the Boston University study had confirmed that “the agricultural sugar industry in Nicaragua has no responsibility whatsoever for chronic renal insufficiency in Nicaragua” because the research found that “in the current body of scientific knowledge there is no way to establish a direct link between sugar cane cultivation and renal insufficiency.”

Brooks, the epidemiologist at Boston University, told the AP that the study simply said there was no definitive scientific proof of the cause, but that all possible connections remained open to future research.

In comparison with Nicaragua, where thousands of kidney disease sufferers work for large sugar estates, in El Salvador many of them are independent small farmers. They blame agricultural chemicals and few appear to have significantly changed their work habits in response to the latest research, which has not received significant publicity in El Salvador.

In Nicaragua, the dangers are better known, but still, workers need jobs. Zapata Palacios left eight children. Three of them work in the cane fields.

Two already show signs of disease.

Comments (68)

1 2
  • linearnonlinear
    Posted on February 14, 2012 at 10:06am

    Perhaps it’s linked to the Train Derailment in LeRoy NY

    Report Post »  
    • Itsjusttim
      Posted on February 14, 2012 at 11:06am

      Yep, that must be it.

      Report Post » Itsjusttim  
    • ChiefGeorge
      Posted on February 14, 2012 at 11:08am

      Its part of the depopulation plan. No way is this merely related to working long hours in the sun alone. These people are climatized and their bodies are too accustomed to this for this to be merely related to dehydration. Whatever they have been using for rehydration may be the culprit.

      Report Post » ChiefGeorge  
    • Itsjusttim
      Posted on February 14, 2012 at 11:09am

      People and science will scramble to explain it away, and even grasp for unreasonable things rather than say God is behind things.

      Report Post » Itsjusttim  
  • ThurstonHowellIV
    Posted on February 14, 2012 at 9:52am

    How could any situation be aggravated by working in an environment full of poison. Don’t you know, all those pesticides on our food are perfectly safe– Big Government says so. I’m opening a bottle of water and drinking it right now.

    Report Post » ThurstonHowellIV  
    • mils
      Posted on February 14, 2012 at 1:32pm

      nothing new here…pesticides, bad water, polluted air..what else can we expect.
      it is important to eat as organic as possible, monitor water sources etc… It is difficult. We found a coop that we now buy 90% of our good through… and because it is a community thing, it is NOT more, in fact less, than food in stores with pesticides.
      Also, Monsanto has run amuck and we can’t seem to do anything about the GMO etc inour food system. We weren’t ment to eat or work with these things…

      Report Post »  
  • Carlinpa
    Posted on February 14, 2012 at 9:46am

    Are we going to build a secure border now? We really don’t know what this is? Is it contagious?

    Report Post »  
    • hatchetjob
      Posted on February 14, 2012 at 12:19pm

      And the deaths have only been occuring since 2000. Something is fishy.

      Report Post » hatchetjob  
  • Tri-ox
    Posted on February 14, 2012 at 9:08am

    Uh, manual labor and dehydration are nothing new for the human race – how can this epidemic be a “new” phenomenon?

    Report Post » Tri-ox  
    • One of the Quiet Ones
      Posted on February 14, 2012 at 9:36am

      One more evil of global warming is exposed.

      Isn’t exposure to agrochemicals part of the environment?
      “Some 30 percent of coastal dwellers had elevated levels of creatinine, strongly suggesting environment rather than agrochemicals was to blame, Brooks, the epidemiologist, said. The study is expected to be published in a peer-reviewed journal in coming weeks.”

      Report Post »  
  • captainbars
    Posted on February 14, 2012 at 8:57am

    I worked in a factory for 14 years, ten of those as line assembler; we had to beg the person on “set up” to take our place to use bathroom. Using bathroom before break time was discouraged and some supervisors said they didn’t have to do it, according to company rules, said it was a courtesy. Some lines I worked on, it was like pulling teeth to get someone to take my place so I could use toilet, and many times I’d be in pain. All the assemblers had same problem; one pregnant woman began bleeding cos supervisor wouldn’t allow her to toilet; her mother cussed him out and he was shamed into allowing her to toilet when needed. The old buzzard is dead now. Another woman simply didn’t drink water at work cos the whole thing was too much trouble. That was 19 yrs ago and my left side still hurts if I hold my water too long. Makes me angry all over again just thinking of the neanderthal way we were treated. But when you‘re the sole supporter of your family you can justify things that are dangerous to one’s health and life.

    Report Post » captainbars  
    • Walkabout
      Posted on February 14, 2012 at 11:11am

      It is why we still need unions. Too bad the unions are not up to the task, but are a new religious elite. Local AFL CIO building is literally labeled a “Labor Temple”

      Report Post »  
    • PAINESMAN
      Posted on February 14, 2012 at 12:25pm

      To walk about: The last thing they need is a union. Unions dont give a crap about the workers.All they want is the dues they need to finance thier own useless jobs. 14 years experience in the carpenters union taught me all I need to know. Besides, if you introduce a union the employer will find a way to do the job with machines and that will be the end of the labor force. Hello poverty.

      Report Post »  
  • Concerned1
    Posted on February 14, 2012 at 8:03am

    My guess is that this is caused by long acting insecticides. The sugar is sprayed. The workers get it on/in them and then it starts to wreak havoc on their system. I think it’s the human equivalent of colony collapse disorder.

    Report Post »  
    • Susie
      Posted on February 14, 2012 at 8:52am

      Good grief. Yes the big bad chemical companies killing us off. (Every sarcasm intended)
      Read the article. The facts DO NOT point to any chemical relationship.

      Report Post »  
    • martinzzz7
      Posted on February 14, 2012 at 4:17pm

      Susie = Sheeple

      Report Post »  
  • Gonzo
    Posted on February 14, 2012 at 7:37am

    If hard work and manual labor is the cause, America is safe.

    Report Post » Gonzo  
  • smalldog
    Posted on February 14, 2012 at 7:25am

    Google “How to eat sugar cane” Apparently, it is tasty and can be squeezed for juice.

    It’s hard to believe that anyone can work all day without a water break. What if all your liquids contained massive amounts of sugar?

    Report Post »  
  • ThoreauHD
    Posted on February 14, 2012 at 7:15am

    Dehydration sneaks up on you when you live in a sweltering sweat pit. I can see why they get a few dehydration deaths.

    Report Post » ThoreauHD  
  • Bot
    Posted on February 14, 2012 at 5:07am

    Can the Blaze get rid of the pop ups. If I want to read the next story, I’ll go back to the main page. I don‘t need an interruption to what I’m reading

    Report Post » Bot  
  • LeadNotFollow
    Posted on February 14, 2012 at 2:16am

    …
    This strange disease is only killing approx. 2,200 people per year in (Central America) El Salvador and Nicaragua, and it makes the news. There have been less deaths (24,000) in their total of eleven years, than in just one year of flu deaths (36,000) in America.

    The flu kills approx. 36,000 Americans per year, and it is hardly ever mentioned in the news. In eleven years, that would be approx. 396,000 American deaths.

    Comparison:
    11 years, total deaths in Central America, from strange disease = 24,000
    11 years, total deaths in America, from the flu = 396,000

    Americans are rarely warned of flu dangers. Lives could be saved by public service announcements and education. Merely advising/teaching good hand washing, good common sense hygiene, and staying home, and keeping away from others when sick and/or with fever.

    Oh the hypocrisy, on the part of the media. The media is as corrupt and evil as the Government.
    Is the flu being used as population reduction in America?

    I sympathize with the folks of Central America, but I think my own country of America, has a bigger health problem threat, and no one seems to give a crap.
    I’m passionate about flu deaths. I’ve lost loved ones to the flu.

    Report Post »  
    • Susie
      Posted on February 14, 2012 at 7:31am

      @ LEADNOTFOLLOW
      This is a News & Information web site and I for one am very interested in our world and what goes on in every corner of it. If the flu attacked only a certain section or group of any given population, that would indeed be an interesting medical anomaly, just like the one this story presents.
      Perhaps, since you feel better qualified to choose which News & Information articles the rest of us should read, you could start your own web site, hire multiple staff and set up a massive server to handle the traffic and the rest of us could just sit back and bask in the warm glow of your superior intellect.

      Report Post »  
  • Merrymix
    Posted on February 14, 2012 at 2:08am

    This is a condition normally seen in diabetics. These men cut down sugar cane every day all day long.
    Sugar on the skin can enter through the pores. DUH! Think maybe they could figure this one out???? Something as simple as protective clothing might be the solution.

    Report Post » Merrymix  
    • 4xeverything
      Posted on February 14, 2012 at 6:08am

      I like your thinking.

      Report Post » 4xeverything  
    • leftcoastslut
      Posted on February 14, 2012 at 2:40pm

      yes i think you’re right. also if this has only been going on since 2000, when did they increase growing the sugar cane for ethanol? since this is the only work in that town, i’m sure the landowners are realizing a larger profit and the workers are realizing longer hours being exposed to the cane.

      Report Post »  
    • valettie
      Posted on February 14, 2012 at 7:20pm

      You’d be surprized, that they DO wear long sleeves and hats…even if they aren’t fair skinned. So does it go through clothes? OR is thru the hands enough? Chemicals are much stronger.

      Report Post » valettie  
    • valettie
      Posted on February 14, 2012 at 7:21pm

      They do wear long sleeved shirts, long pants, n hats.

      Report Post » valettie  
  • KingCanon
    Posted on February 14, 2012 at 2:07am

    Biblical?

    Report Post » KingCanon  
  • Voteman
    Posted on February 14, 2012 at 12:01am

    Valis,
    The Blaze is an aggregate of information. that said it seems to be as long and speculative as the posts.
    And the spelling seems to be reviewed before posting. (something the Blaze needs to do more of.) I mean google docs is free man! Oh and for gods sake Blaze! No more Pop Ups! What the Heck!

    But I like the Blaze and I support Glenn…….

    Any way this is another story about it.
    V
    http://www.theworld.org/2011/12/kidney-disease-epidemic/

    Report Post » Voteman  
    • Bot
      Posted on February 14, 2012 at 5:08am

      I agree with your comment about the pop ups. The Blaze needs to get rid of them.

      Report Post » Bot  
    • 4xeverything
      Posted on February 14, 2012 at 6:10am

      Here here, no more pop ups!

      Report Post » 4xeverything  
    • jespasinthru
      Posted on February 14, 2012 at 6:33pm

      Stop complaining about the popups. The problem isn’t with the Blaze, it’s in your own computer. Pop-up generators target popular websites like this one, but they only come through on unprotected computers. Pop-up blockers are very easy to install, and they often come with the updates that your computer occasionally reminds you to install. A little computer literacy goes a long way.

      Report Post » jespasinthru  
    • valettie
      Posted on February 14, 2012 at 7:24pm

      If you Do not know how to handle the PopUps then take your PC to a computer technician.

      Report Post » valettie  
  • TJexcite
    Posted on February 13, 2012 at 11:57pm

    One would think that this has being going on for generations and even as long as the sugar trade itself. Back then people did not have the medicines and dialysis to treat anything so they died early on when the kidneys were week and not yet to the stage of full chronic damage. But now one is treated and continue living and working. All the time continuing to damage the kidneys for years when just 10 years ago they got no treatment and died. Now you get a large clusters of people who have chronic problems that where treated.

    Report Post » TJexcite  
  • Razorhunters
    Posted on February 13, 2012 at 11:51pm

    pesticides and poisons…chemtrails…chemicals in the water…

    we know what causes this.

    Report Post » Razorhunters  
  • Whirling Dervish
    Posted on February 13, 2012 at 11:46pm

    Better eat up those GMO’s :).

    Report Post » Whirling Dervish  
  • smalldog
    Posted on February 13, 2012 at 11:41pm

    From age 16 to 51 I imagine this man had a lot of jobs.

    Nicaragua has been part of a war zone for many years. Who knows what chemicals were left behind?

    Also have to wonder how many may have worked in the drug trade? Perhaps they ate contaminated food? I don’t think they have an FDA or Ag dept like in more developed countries. Could they have eaten contaminated foods like the problem with protein imported into the US a few years ago for dog food?

    What’s in the sugar imported to the US? All the snack foods coming from the south?

    I wonder how the studies are conducted and if they have an ongoing study of the failed kidneys. Who is paying for the studies?

    Rich family get’s millions from World Bank to expand…

    Report Post »  
  • pattybbb1
    Posted on February 13, 2012 at 11:21pm

    Thanks Blaze, I had not heard of this. Maybe it’s a combination of agricultural pesticides and dehydration. If a person doesn’t drink enough, then they can’t get rid of the toxins.

    Report Post »  
    • pamela kay
      Posted on February 14, 2012 at 1:04am

      PAYYTBBB1, I agree. Having faced renal failure myself I understand the importance of drinking water. I was guilty of not drinking enough fluids myself. It was not the cause of my condition but it influenced the progression of the disease. My heart breaks for these people and I hope this can be corrected. Renal failure makes every day life difficult. My prayers to the family and for those suffering from the disease.

      Report Post » pamela kay  
  • nighttrainno9
    Posted on February 13, 2012 at 11:19pm

    The CIA has probably been there. Just like with aids.

    Report Post »  
    • smalldog
      Posted on February 13, 2012 at 11:47pm

      If not the CIA, who? Al Queda? Terrorists?

      Report Post »  
  • VALIS
    Posted on February 13, 2012 at 11:19pm

    Is it standard practice at The Blaze to republish work written by other authors at Huffington Post or is this a one off piece of plagiarism?: http://www.huffingtonpost.com/2012/02/12/mystery-disease-central-america_n_1272286.html
    Oh, I see, you both bought the story from the AP, but that doesn‘t explain the different names credited on the stories’ bylines….

    Report Post »  
    • stang289
      Posted on February 13, 2012 at 11:57pm

      Like whos going to read Huff Po ? So Id rather see it here if its worth reading

      Report Post » stang289  
    • Windwalker
      Posted on February 14, 2012 at 2:09am

      Remember whose running this Blaze show….none other than Betsy Morgan, straight from the Huffington Post. Why Glenn Beck hired her, I’ll never know. Old habits die hard, Apparently, Morgan is addicted to the HP which is not only an old habit, but a bad habit.

      Report Post »  
    • valettie
      Posted on February 14, 2012 at 7:22pm

      I get it here, not there any way so I don’t care.

      Report Post » valettie  
  • Stoic one
    Posted on February 13, 2012 at 11:11pm

    IF the UN wanted to truly be useful this is something they could help cure. Oh wait the is no money to skim…..

    Report Post » Stoic one  
  • The Giver
    Posted on February 13, 2012 at 11:09pm

    This is probably a result of better record keeping. I hope this saves some lives. These poor men have probably been dying in the past from chronic dehydration and only now is there an alarm. The alarm is because sugar ( and all food) has to be completely regulated and controlled. Please go buy extra sugar.

    Report Post » The Giver  
  • smalldog
    Posted on February 13, 2012 at 11:04pm

    I wonder what these people eat today as compared to what their ancestors ate 100 years ago? Did the diet shift? More carbs? Alcohol?

    I wonder if the chemical cause group has too narrow a focus?

    The story reminds me of the increase in kidney failure and dialysis among Native Americans in the US. IIRC, the cause is linked to a high carb diet caused by alcohol and government commodities.

    Report Post »  
  • ZeroOff4impact
    Posted on February 13, 2012 at 10:49pm

    This will end up as evidence for the regulation of sugar by the BATFES.

    Report Post » ZeroOff4impact  
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