Nutrition Action Healthletter
July/August 1996

How to Avoid Food Poisoning


BY DAVID SCHARDT & STEPHEN SCHMIDT.

"I want to tell you about what it's like to survive a severe attack of Salmonella, because there are too many people who have died and can't tell you what it is like.

"I got Salmonella from something I ate. The most likely culprits are a chicken sandwich and an undercooked egg salad sandwich. I first got diarrhea which lasted for days and days. Then quite suddenly, the diarrhea stopped. Soon I felt as if there was a red hot brick inside me.

"It was the most awful thing I had ever experienced. I knew that I had to go to the hospital. And I knew that I was going to need surgery to live...."

Washington, D.C., businessman Bill Adler, Jr. almost died in 1990 after eating Salmonella-contaminated food.

"Fifty-five thousand dollars later, I'm as healthy as I was before this happened," he says. The only casualties: the colostomy he had for nearly a year and the four inches that were cut from his colon.

Adler was lucky. He lived. Twenty-five Americans will die today--and another 16,000 will become ill--from something they ate.

Here are the foods that are most likely to make you sick. (The list doesn't include seafood, which we'll cover in an upcoming article.)

Chicken and Turkey

Russian roulette. If you're among the most susceptible, one out of every four chickens--and one out of every seven turkeys--has enough Salmonella to make you sick...or kill you. It's that simple.

And while cooking destroys the bacteria (see "The Safe Food Kitchen"), that message doesn't always get through. The U.S. Department of Agriculture estimates that anywhere from 350,000 to 2.5 million Americans are taken ill--and 350 to 2,500 die--every year after eating Salmonella-contaminated poultry and meat (about one percent of all cattle is also infected).

The estimates are so broad because most food poisoning cases are never reported to health authorities. "For every one we hear about, there are 20 to 100 that go unreported," says Tom Gomez, a USDA epidemiologist at the Centers for Disease Control (CDC) in Atlanta.

Poultry producers don't deny that at least a quarter of the chickens they send to market carry dangerous bacteria. But they downplay the risk.

"Ninety percent of chickens found with Salmonella have fewer than 30 bacteria on the whole bird," says Kenneth May, the scientific advisor for the industry's National Broiler Council.

"Thirty bacteria probably won't make you sick if you're a healthy person in the prime of your life," agrees Gomez. "But it could if you're one of those most susceptible to food poisoning" (see "Who's Most Vulnerable?").

Like children. In 1994, the Schwan's Ice Cream that made an estimated 224,000 people sick (most of them were youngsters) contained only six Salmonella bacteria per half cup.1 (One of the ice cream's ingredients had been transported in tanker trucks that had previously carried contaminated raw eggs.)

Is skinless, kosher, or "free-range" chicken any less likely to be contaminated? No good studies have been done.

And that's for the best-studied bacterium. Others--Campylobacter, for example--aren't being monitored as closely.

"Campylobacter causes more illnesses than Salmonella, though it doesn't get as much notoriety," says Gomez. "It should."

In other words, chalk up another two million or so illnesses every year...and who knows how many deaths.

The problem, says Gomez, is that "local diagnostic labs don't test for Campylobacter, and state health departments aren't required to report it to the CDC. They should."

Based on the results of a pilot surveillance program, CDC Director David Satcher was able to tell a congressional committee in May that Campylobacter is "the most frequently isolated foodborne bacterium from persons with diarrhea." Not too comforting.

Eggs

How many people were felled last year by contaminated eggs? Nobody knows.

"We have incomplete data after 1994," says the CDC's Tom Gomez. Congress is to blame, at least in part. In 1995, in the name of cost-cutting, it terminated the federal control program for Salmonella enteritidis (EN-terr-ID-ih-diss). (Enteritidis is the strain of Salmonella that's most likely to affect eggs.)

But there's no reason to think that 1995 or 1996 is any different than 1994, when Americans probably suffered from "between 200,000 and 800,000 actual infections" caused by Salmonella enteritidis, CDC Director Satcher testified in May.

The culprit? "Shell eggs accounted for 80 percent of those outbreaks for which a vehicle was determined," said Satcher. Even scarier: Most tainted eggs are contaminated within the hens' ovaries before their shells form. So washing the eggs before cracking them open is no guarantee that they'll be clean.

While no deaths from outbreaks caused by Salmonella-contaminated eggs were reported to federal authorities in 1994, disease-control experts remain concerned.

"The big news is that the number of infections has tripled in Southern California," says CDC epidemiologist David Swerdlow, who adds that California now accounts for about 25 percent of all Salmonella infections in the country.

What's more, most of the Southern California infections are due to a new, worrisome form of Salmonella enteritidis called "phage type 4." (Bacteria can be distinguished from one another by the phages, or viruses, that infect them.)

"Phage type 4 has been a more virulent form of Salmonella in Europe, but we don't know yet whether that will also be true in the United States," says Richard Gast, a microbiologist at the U.S. Department of Agriculture's Southern Poultry Research Laboratory in Athens, Georgia.

"So far, we haven't been able to determine in the lab whether it's a nastier bacteria," Gast adds. "If we can't, we may be reduced to watching what happens in the western United States." Phage type 4 has now also been detected in Utah and Arizona.

So who's minding the egg carton? Nobody. There is no nationwide program that systematically monitors bacteria levels in eggs. But a new USDA survey suggests that the rate may be rising.

"Our analysis of eggs sent to processing plants for pasteurization in the Northeast showed that 39 percent of the samples were contaminated with Salmonella enteritidis in 1995, compared with 20 percent in 1991," says USDA animal scientist Allan T. Hogue. "And in the West," he adds, "12 percent were contaminated in 1995 versus six percent in 1991."

Many restaurants--and most high-risk sites like hospitals and nursing homes--use pasteurized eggs because the process kills disease-causing bacteria. Unfortunately, nobody knows whether the high rate of Salmonella contamination of eggs destined for pasteurization applies to the eggs sold in local supermarkets.

Beef

Remember E. coli O157:H7? That's the bug that made more than 700 people ill--and sent four children to their graves--in 1993 in Washington State, California, Idaho, and Nevada. The source was undercooked fast food hamburgers.

E. coli O157:H7 does its damage by producing a substance called "Shiga toxin," which causes the bloody diarrhea that strikes most victims. "The toxin leads to kidney failure in about five percent of the victims, and then death in about five percent of those whose kidneys fail," says microbiologist David Acheson of the New England Medical Center in Boston.

Since cooking beef to 165 kills the bacteria, E. coli on the surface of steaks and roasts is easily destroyed, even if they're eaten rare. But when raw beef is ground up, any bacteria on its surface can become incorporated into the mix. If the burger isn't cooked thoroughly, the E. coli that's on the inside can escape destruction.

And escape destruction is what O157:H7 bacteria continue to do.

"In 1994 and 1995, 64 more outbreaks involving about 1,000 people--but no deaths--were reported to us," says Phyllis Sparling, a USDA epidemiologist at the CDC.

The real toll is probably far higher. That's because the CDC numbers only count outbreaks, which involve two or more people who become sick from the same food. Individual cases aren't included in the official tally.

So the CDC never knew about the death last year of two-year-old Elizabeth Paige Hall, for example. The toddler died at the Cleveland Clinic Hospital four weeks after attending a cookout at which she ate a tainted hot dog. It picked up the O157:H7 from raw hamburger meat that had sat on the same plate.

After the 1993 outbreaks, the USDA started regularly testing raw ground beef for bacterial contamination.

"Each year, we analyze about 5,000 samples of ground beef from retail stores and processing plants for the presence of E. coli O157:H7," says Glenn Morris, director of epidemiology and emergency response at the USDA's Food Safety and Inspection Service (FSIS). "Since 1994," he adds, "only about one in 1,700 samples has tested positive."

That's good, but it may lull authorities into a false sense of security. A new study concludes that O157:H7 may not be the only culprit.

When David Acheson analyzed ground beef from 12 supermarkets in Boston and Cincinnati, he found Shiga toxin in a quarter of the samples. "Even more alarming," he says, "is that none of the toxin came from E. coli O157:H7. It was all produced by other kinds of E. coli.

"That has huge implications, because the USDA only looks for E. coli O157:H7 in ground beef."

"The other E. coli could be responsible for up to half the cases of bloody diarrhea and kidney failure caused by Shiga toxin in North America," says Mohamed Karmali, a microbiologist at the Hospital for Sick Children in Toronto.

And nobody's looking for those other bacteria in ground beef. That needs to change (see coupon to the USDA).


To: Dan Glickman, Secretary of Agriculture

U.S. Department of Agriculture

14th St. & Independence Ave., S.W.

Washington, D.C. 20250


From: The Center for Science in the Public Interest


Name________________________________

Address_____________________________

Address_____________________________


Consumers shouldn't have to worry about contaminated meat and poultry. The new HACCP program is good, but it doesn't go far enough. Please expand the USDA's laboratory testing to include Campylobacter, Listeria, and potentially deadly strains of E. coli other than O157:H7. Also, please require the meat and poultry industries to test their own products for harmful bacteria.


When to Get Help

Food poisoning usually involves nausea, vomiting, or diarrhea. Most cases clear up by themselves within a day or two without medical care. But if you get any of these symptoms, says infectious diseases specialist William Bishai of the Johns Hopkins School of Public Health, you need to call the doctor:

If you get food poisoning, report it to your local health department. That's the only way to get it into the official count. And drop us a note (CSPI--Food Poisoning Registry, Suite 300, 1875 Connecticut Ave., N.W., Washington, D.C. 20009).

Who's Most Vulnerable?

"Some people are more likely to get food poisoning and more likely to come down with a bad case of it," says William Bishai of the Johns Hopkins School of Public Health:

Also, people who've had some of their stomach or intestines surgically removed may not be able to efficiently sweep harmful bacteria out of their bodies.


Duel of the Cutting Boards

Which is safer: wooden or plastic cutting boards?

Until 1993, the conventional wisdom was that plastic was easier to keep free of bacteria. Then along came Dean Cliver of the University of Wisconsin at Madison.

The microbiologist smeared nine wooden and four plastic boards with chicken juice or broth that he had spiked with E. coli, Listeria, or Salmonella. Then he waited. After three minutes, the surfaces of the plastic boards had up to 23 times more bacteria than the surfaces of the wooden boards. More amazingly, within ten minutes the wooden boards had completely absorbed the bacteria, and Cliver couldn't recover them.

"On wooden boards, bacteria are absorbed down into the wood fiber and remain beneath the surface," Cliver explains. "On plastic boards they cling to the surface, where they can more easily rub off onto other objects like food."

In 1994, Food and Drug Administration microbiologist Ben Tall weighed in with his own cutting board study.

"Wood seems to be more forgiving, in that the bugs get down deep and it's probably harder for them to come back out," agrees Tall. But that was only true of new wooden boards, or of "freshly cleaned" boards that had been "sanitized through a dishwasher."

"A used wooden cutting board, which is what most people have in their homes," he adds, "probably would act more like a plastic board." In other words, it would be more likely to spread bacteria.

Until the question is settled, the best advice is to use either kind of board...as long as you keep it clean.

And if any board really gets hacked up, toss it.


The Safe Food Kitchen

Eight tips to make your kitchen safer:

1. Handle raw meat, poultry, seafood, and eggs as if they were contaminated. Even if they don't start out with enough bacteria to make you sick, mishandle them and you could be in trouble. Don't let the raw juices touch other foods, whether raw or cooked. After you handle raw meat, etc., wash your hands, utensils, and all surfaces that touched the raw food thoroughly with hot, soapy water.

2. Never eat shellfish like oysters, clams, or mussels, unless they've been thoroughly cooked. They could contain bacteria and viruses that cause food poisoning or hepatitis.

3. Marinate raw meat and poultry in the refrigerator, not on the counter. And don't baste your food with the uncooked marinade or serve the marinade unless you've cooked it.

4. Stuff raw poultry just before cooking it. Better yet, cook your poultry and stuffing separately.

5. Cook meats thoroughly, but don't overcook them. Heat kills bacteria, but too much heat causes meat, poultry, and fish to form possibly carcinogenic heterocyclic aromatic amines (HAAs).

To reduce the formation of HAAs, microwave your meat, poultry, or fish on "high" for 30 to 90 seconds or until the juices start to flow. Then pour off the juice before you start cooking.

6. Don't let your eggs run. They're safe when the whites are completely firm and the yolks are just beginning to thicken. Don't lick any batter that contains raw eggs.

7. Microwave your sponges on high for 30 to 60 seconds. That will keep them clean, says microbiologist Dean Cliver.

8. Antibacterial sponges, soaps, and sprays don't make up for sloppy kitchen hygiene. Until we can evaluate any published independent tests, we can't vouch for whether these products work...or are safe:


Where to Get Help

* USDA Meat & Poultry Hotline (800-535-4555). How long does it take to cook a 17-lb. turkey? Can you re-thaw meat or chicken that you've defrosted in the refrigerator? Everything you want to know.

* FDA Seafood Hotline (800-332-4010). If it lived in water, they know about it. They can also answer non-seafood food safety questions.

* Safe Tables Our Priority (800-350-STOP). A consumer group formed by the parents of E. coli O157:H7 victims. It provides information on foodborne illnesses and will refer you to support groups, physicians, scientists, or lawyers.

* Safe Food: Eating Wisely in a Risky World. Practical tips and suggestions on how to avoid food poisoning and other contamination at home and when you eat out. Co-authored by CSPI executive director Michael Jacobson. (To order the 234-page, 1991 softcover, call 1-800-237-4874, $9.95.)


Nutrition Action Healthletter