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FOODBORNE DISEASE: A NEEDLESS EPIDEMIC The following is a condensed version of an article by NOHA Honorary Member Beatrice Trum Hunter in Clinical Ecology, Volume V, Number 1, 1987; the article included 105 references. The condensation has been approved by the author, and the material has been reprinted with permission of the publisher. Permission to copy all or part must be obtained from Clinical Ecology Publications, Inc., 109 West Olive, Fort Collins, Colorado 80524; (303) 482-6001. Illness from foodborne disease has reached epidemic proportions in the United States, even though many cases are mistaken for intestinal flu. Foodborne diarrheal disease may be life-threatening or may have long-term consequences such as autoimmune disorders (including rheumatoid arthritis), cardiovascular disease, and allergies. It can damage the structure and function of the intestines, leading to malabsorption, and can weaken the body’s immune system. Formerly, most foodborne illness resulted from foods prepared within the home, but now the major portion is caused by foods eaten away from home and by factory-prepared foods.
Changed agricultural practices are part of the problem. Antibiotic use in farm animals is the primary cause of the increase in salmonellosis, now a major foodborne disease. For years, critics warned that the resultant development of antibiotic-resistant bacteria could be followed by animal-to-human transmission. But cattlemen and agricultural officials demanded proof. Proof has now been supplied by several carefully conducted studies tracing human salmonellosis back to resistant bacteria in meat. Modern restaurant practices, such as intentional undercooking of flesh foods, also contribute to foodborne disease. Salmonellosis and other disease outbreaks have been caused by deliberately undercooking factory-prepared roast beef (patrons prefer rareness and redness), by raw or undercooked eggs in Monte Cristo sandwiches and Caesar salad dressings, and by the storing of boiled rice at room temperature for some time to prevent grain clumping. The holding of foods at improper temperatures, as in salad bars, on airplanes, and on cruise ships, often causes food poisoning. Investigators found that about 20 percent of foods such as steak, chicken, fish, and milk were loaded and stored on airplanes at improper or uncontrolled temperatures. On food safety inspections, some cruise ships scored as low as 10 points out of a possible 100. In day care centers, a foodborne pathogen, Giardia lamblia, frequently causes diarrheal illness in infants and toddlers if the caregivers change diapers then handle food without scrubbing hands.
Botulism, formerly associated chiefly with home-canned foods, now results mainly from increased use of factory-prepared foods and from some current restaurant practices. Improperly processed foods causing botulism in the last decade have included canned soups, mushrooms, beef stew, and salmon; smoked, vacuum-packed fish; and fresh mushrooms in airtight packaging. In one reported outbreak, 28 people were hospitalized after eating patty-melt sandwiches in a restaurant. Sautéed onions had been covered with a thick layer of melted margarine and kept at room temperature. Later, without being reheated, they were added to the sandwiches. The gentle heat from sautéing was insufficient for spore destruction. Trichinosis is of special concern to the environmentally ill, for animal meats that may be infected with trichinae include exotic meats, such as boar, bear, and walrus, that may be used with a diversified rotation diet. If these meats are eaten, they should be handled as carefully as raw pork, the main source of trichinae. Contrary to common thought, government inspection does not insure safe pork; most trichinosis outbreaks in the United States in recent years have occurred with government-inspected pork. Techniques to improve government controls are now being explored. Other gaps occur in state and federal sanitation laws, which do not always require butchers to grind pork in separate grinders. The seriousness of cross-contamination is indicated by the case of a man who became badly infected with trichinosis merely by eating a piece of bread that had been buttered with an unwashed knife, used previously to slice raw sausage. Trichinosis pork may be present in convenience foods such as ready-to-eat sausages, which then may not be re-heated to adequately high temperatures. Pork tapeworm may also be present in undercooked pork.
Toxoplasmosis, another foodborne disease, results from a protozoan sometimes present in raw or undercooked meats. Cooking methods in fast-food restaurants may be inadequate to destroy toxoplasmic cysts if present in the raw meat. The microwave oven is another factor in foodborne disease. The uneven heat in roasting a large piece of meat or poultry is more likely to occur in a microwave oven than in a traditional oven. In experiments, microwave ovens failed to inactivate all pathogens in pork roasts and in whole poultry. Current food trends contribute to foodborne disease – fads such as steak tartare, marinated raw beef, undercooked goose liver, rare duck breasts, and, especially, undercooked or raw fish; the incidence of infections from the latter two is increasing in the United States. All of these present serious health problems. Fish tapeworm infections have not been associated with properly canned commercial fish, but the larval parasite can survive up to 400 days in iced fish. To kill the tapeworms, one must either cook all finfish thoroughly, with all parts reaching 145° F for at least five minutes; or freeze it at -4° F for 72 hours; or brine the fish for at least three weeks; or smoke it and then cook it at 150 to 180° F ("hot smoking"). Commercial smoked salmon (lox) is judged safe, but gravlax and belly lox are potentially dangerous. Through cooking of finfish kills roundworms. The internal temperature of the fish must reach 145° F. The current recommendation is to cook 13 minutes at 450° F for each inch of thickness of fish. This practice offers greater safety than the previous recommendation of 10 minutes. Roundworms are commonly found in cold-water fish such as Pacific Salmon, Atlantic cod, pollack, mackerel, herring, and Atlantic plaice, some of which are being recommended for their omega 3 fatty acids. Roundworms also have been found in commercial gourmet frozen fish dinners, which should be cooked thoroughly.
Raw or undercooked shellfish can produce viral gastroenteritis, an ailment thought to be grossly underreported and underestimated in the United States. Adequate cooking of all shellfish is essential. Health officials now suggest that restaurateurs be required to steam clams four to six minutes, rather than the common practice of allowing only one minute for opening them. Louisiana state law requires that seafood be boiled for a minimum of seven minutes; a recent infection outbreak in that state apparently resulted from cooking batches of shrimp in hot, but not boiling water. Radiation-preservation of food does not appear to guarantee control of foodborne diseases. Radiation can kill or reduce some pathogens; but to kill others, higher than permissible radiation levels would need to be used. In the fierce competition of pathogens, resistant ones could proliferate and, in the absence of milder ones, could become even more virulent. Also, post-radiation contamination could occur, thus making traditional food preservation methods still necessary. What is to be done? Do the following:
Advocate the following:
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