While reports indicate that aflotoxin can directly cause liver cancer, more studies need to be conducted to confirm that the chronic liver diseases in Bhutan are caused by the toxin.
Maize products like ara (alcohol) and kharang (beaten maize) were found to contain Aflotoxin, a deadly chemical which caused the death of hundreds of chickens in Pemagatshel earlier this year, as per a study conducted by the Ministry of Agriculture and Forest (MoAF).
The bird feed contained aflotoxin but what is more alarming is that the study which was conducted between the years 2010 and 2011 by a Thai consultant revealed higher levels of the toxin in ara and kharang.
Samples of the said product, mostly from the East were taken.
According to a researcher, the study was initiated after a high content of aflotoxin was reported in the animal feed which mainly uses maize.
Since the staple diet of people in the East is maize, a quick study was done to authenticate the aflotoxin content in the maize products.
However, he added that that the information needs to be further authenticated before making it public.
Agriculture Specialist with Department of Agriculture (DoA), Ganesh Chhetri said, “The study indicated that the toxin content was higher than tolerable limits. It is a concern but there is need for more studies.”
To add to it, higher levels of aflotoxin is directly attributed as the cause of liver cancer.
It has been reported that high level of aflotoxin exposure produces acute liver failure which later results in cirrhosis and other diseases. No animal species including human beings are immune to the acute toxic effects. However, adults have high tolerance.
The maximum alfotoxin level for human consumption and grains intended for immature animals is 20 parts per million (PPM) as per internet sources.
While the number of patients diagnosed with chronic liver disease in the Mongar Referral Hospital (ironically it is the referral for the east where maize is commonly used) was 97 last year, there were five cases of liver cancer and of the total, six died. The hospital recorded the highest morbidity rate related to chronic liver diseases across the country.
These figures are not inclusive of Hepatitis B and C.
A medical specialist in the Mongar hospital said that they assumed all the cases were because of alcohol consumption, looking at the history of the patients.
“But we do not have the capacity to say that aflotoxin was the cause though that could be a possibility,” he said adding that in order to check for other causes liver biopsy must be done.
Another medical specialist at the Jigme Dorji Wangchuck National Referral Hospital said that alfotoxin is strongly associated with liver tumor (liver cancer) and to make such diagnosis, the hospital would need to set up a good laboratory.
The diagnosis of liver tumor is associated to Hepatitis B virus to some extent and dietary causes especially when there are carcinogens in the diet.
“If it is validated that the agriculture ministry has found high levels of aflotoxin in food through its surveillance, then there is a high risk factor. Public action has to be taken,” said the specialist.
The agriculture perspective
Fungus growth in grains which is said to contribute to aflotoxin production occurs when grains are not stored properly and in some cases it starts from the field. If the grains are not cleaned and dried properly, the fungus is bound to grow, said Ganesh Chhetri.
Following the study, he said the ministry has been implementing a lot of post-harvest storage, proper drying and processing. However, so far it has not been assessed if these activities actually help reduce the toxin content.
The Agriculture Secretary, Sherub Gyeltshen said it is a concern because it relates to health.
He also added that metal bins are being provided; storage facilities improved and farmers are being advised to dry and stores grains in metal bins. In the 11th Five Year Plan, the ministry is stepping up the post-harvest services and activities.
The issue was discussed during the three-day regional agriculture review and planning meeting at Renewable Natural Resources (RNR) Research and Development Center at Bajo starting from 26 Jan this year.
The relevant agencies including Department of Agriculture (DoA) and Council of RNR Research of Bhutan (CoRRB) were asked to pursue the issue. It was noted that while the problem had been acknowledged and confirmed through studies and consultancies, a systematic follow up on addressing and managing the problem was lacking, as per the resolution of the meeting.