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Number 092
June 29, 2011
Robert Fusco, MD Robert Fusco, MD
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Summer Food Safety

by Robert Fusco, MD

It must have been the chicken! Certainly, something has turned my world upside down with fever, chills, nausea, and diarrhea - all out of the blue. How can you so quickly go from being a perfectly healthy person one day to a "bed-and-bathroom ridden" individual the next? I think I have just been added to the estimated 76 million of Americans who come down with food poisoning each year. Hopefully, this will pass quickly as I have to be at work tomorrow. Well, at least, this attack gave me an idea to update this topic for this issue of our office newsletter - summer food safety.

-- Dr Fusco --

In the past, when we were primarily an agricultural society, the majority of our food was produced locally. Now, as most of our population has moved to an urban setting, we must produce food more efficiently. This industrialization of food production has led to amazing advances in the volume of food produced per acre of land. Cheap and rapid transportation has extended the geographic area from which our food is harvested. Now we can have fresh fruits and vegetables all year long - even when they are out of season. The price we pay, of course, is less local control of our food chain. This mass production has made us all more vulnerable to a breakdown in food safety and an increase in attacks of so-called food poisoning. Most are isolated occurrences like mine, but every day you read in the news of more and more wide-spread epidemics. The most recent was in northern Germany where an attack of E. coli affected over 3000 people, killing 37 otherwise healthy individuals. You can't see or smell infected food. What can you do to protect your family?


The problem is that it catches you by surprise. One moment you are feeling fine and then you unexpectedly experience a bout of crampy abdominal pain, then comes the urgency and diarrhea, and perhaps some nausea. You feel just terrible, but in a day or two, it all passes and you tell your friends you probably just had a case of "intestinal flu." Actually, your diagnosis may be wrong as many of these episodes can be traced to food poisoning. Believe it or not, despite all of our efforts in public health and sanitation, food poisoning is becoming more and more common in this country with millions of cases diagnosed each year. Of course, many millions more go unreported.

What Is Food Poisoning?
Most of the food that you eat is not sterile. All raw foods and cooled cooked foods contain bacteria, or "germs." Normally, these bacteria are present only in small numbers and are destroyed by your body's natural defense system before you even know they are there. However, if the conditions are right, these few bacteria will rapidly multiply within the food and before you know it, that piece of chicken has become a weapon. The end result is a case of so-called "food poisoning," more properly termed food-borne illness.

This is especially true if the germs happen to be disease-causing bacteria such as Salmonella, E. coli, and Campylobacter. Crampy abdominal pain, diarrhea, and nausea usually develop within a few hours of eating. Symptoms may be mild or severe depending upon the degree of contamination and your body's natural immunity. Cases of food poisoning are seen all year round, but summer is a prime time, because bacteria multiply faster in the warmer temperatures.

According to the Center for Disease Control (CDC) Director Thomas Frieden, food poisoning is on the rise. He recently stated that, "Despite our best efforts, we have made virtually no progress against salmonella," an organism that sickened over 1 million Americans last year. This common cause of food poisoning can be found almost anywhere, including meat, eggs, fresh greens, and fruits.

E. coli is a common bacterium that lives in the digestive tracts of humans and animals. Some E. coli strains sicken people; one strain -- E. coli O157 -- is highly toxic, causing bloody diarrhea and severe cramps and sometimes even kidney damage or death. The Centers for Disease Control and Prevention estimate E. coli 0157 sickens up to 250,000 Americans each year. Another problems is that bacterial organisms can evolve much faster than our ability to deal with them. It was a new strain of E. coli that was responsible for the recent outbreak in Germany.

Why Does It Happen?
Health officials usually give two answers: improper food storage by consumers and poor personal hygiene of food handlers - a rather unpleasant thought. Even though outbreaks occurring in restaurants are what make the nightly news, the truth is that most cases of food poisoning occur because of improper food handling and sloppy hygiene in the home itself.

Who Is At Risk?
We all are - but, some more so than others. While anyone can develop symptoms of food poisoning: the young, the pregnant, the elderly are much more susceptible. While those with chronic illnesses and weakened immunity have a higher risk, the majority of cases of food poisoning occur in healthy individuals.

What Is The Treatment?
The usual treatment is to get plenty of rest and drink a lot of fluids like Gatorade to prevent dehydration. The diet should be restricted for a few days to "rest the bowel." Many people follow the BRAT diet for a day or two - bananas, rice, applesauce, and toast. Two nonprescription remedies, Pepto-Bismol and Imodium AD, may be used to control mild to moderate diarrhea. However, if symptoms of severe diarrhea, fever over 102 degrees F., persistent vomiting, severe weakness, and any passage of blood develop, seek medical care promptly. Rarely are antibiotics necessary. A relatively new antibiotic, Xifaxan (rifaximin) has been very effect in treating more difficult cases. It has also been for short-term prevention for those who must visit high-risk countries, such as Mexico.

How Can You Avoid Food Poisoning?
You can't. Unless you live in a sterile bubble, you are always exposed to some bacteria and the risk of food poisoning. But, if you are healthy and the number of bacteria in your food is small, your natural immune system can protect you - most of the time. The trick is to avoid eating foods that contain so many harmful bacteria that you overwhelm your body's defense system and become ill.

Most of us are too trusting of our American food safety system. Our food chain is now much longer than it was in the past, and many strangers come in contact with our food before it ever reaches our table. You can no longer be complacent and assume your food is safe. You must take the opposite approach. The most important thing you can do to prevent food poisoning is to adopt a "food-is-dangerous" attitude. You should handle all raw meat, poultry, seafood, and eggs as if they were contaminated.

They often are. For example, up to 80% of supermarket chickens that you bring into your home are contaminated with Salmonella or Campylobacter because of the mechanized de-feathering and evisceration processes in which infected feces splatters the skins of other birds.

Food Safety Tips
The best treatment is still prevention. Whether you are planning an elaborate dinner or a simple cookout on the grill, it is important that you add the most important ingredient - food safety. Below are some tips that can improve your odds:

  1. Wash your hands with an antibacterial soap like Palmolive or Dial Antibacterial Soap and hot water before and after handling raw meats. Rub your hands together for at least 15 seconds - (as long as it takes to sing two verses of Row-Row-Row-Your-Boat). Don't forget the back of your hands, between fingers, base of thumbs, and wrists. Rinse thoroughly

  2. Consider all animal products and their juices dangerous. Don't let the juices touch other foods, whether raw or cooked. Wash utensils and all surfaces that touched raw food with hot, soapy water or run them through the dishwasher.

  3. Marinade raw meat and poultry in the refrigerator, not on the counter. While you may think that the acidic ingredients in marinades, such as lemon juice or vinegar, will maintain the food's freshness, bacteria can still grow if the meat is not refrigerated. Never reuse a marinade used on raw meat, poultry, or fish as a sauce to baste cooked food. If you don't cook the marinade juices, throw them out.

  4. Cook turkey and chicken stuffing separately, if possible. If you want to stuff the bird, do it no more than 15 minutes before cooking. Even if you refrigerate a stuffed bird, the cavity provides a cozy environment for bacterial growth. This mistake has ruined many a holiday weekend.

  5. Never eat shellfish like clams and oysters raw. They may harbor bacteria or viruses that can cause food poisoning or even hepatitis.

  6. When at the grill, cook ground meat thoroughly. Know that completely browned meat isn't necessarily fully cooked. Use a meat thermometer and stick it in the thickest part of the patty. To be safe, internal temperatures of the burger must reach 160 degrees F. A common error in cookouts is carrying the cooked burgers to the dinner table in the same unwashed platter that was used when they were raw. Always use a fresh serving plate.

  7. Rinsing or washing meat does not remove the risk. Thorough cooking is the only way to destroy all harmful bacteria. Use a meat thermometer. When cooking meat, poultry, or fish in the oven, the temperature should be set no lower than 325 degrees F. Cooking at a lower temperature invites bacterial growth. To be sure all bacteria are killed, meat should be cooked to an internal temperature of 160 degrees F as measured with a meat thermometer. An exception is that solid-muscle cuts of non-pork meats can be cooked to only 145 degrees F (medium rare) as long as the outside is well cooked.

    You can purchase inexpensive digital food thermometer for as little at $20, but I strongly recommend the Thermopen from Thermoworks. All the members of my family have used this device for years and have all been very satisfied.

    Although somewhat expensive at $90, what you get is a professional micro-thermocouple probe with an oversized digital display that will show you the temperature at the tip of that probe to within a single degree Fahrenheit within 3 seconds or less wherever you choose to put it. Nothing to distract you. Quick and accurate. Works every time. I figure food safety is worth the expense. It's certainly cheaper than a visit to the Emergency Room and several days lost from work.

  8. Obey the two hour rule. Never leave food out of refrigeration over 2 hours. If the temperature is above 90 degrees F, food should not be left out more than 1 hour. As soon as foods reach room temperature, the germs that cause disease begin to multiply. After two hours, there are probably enough bacteria to make you sick.

  9. Keep Food Out of the "Danger Zone (40 -140)." Keep hot foods hot and cold foods cold. To keep bacteria in check, keep hot foods above 140 degrees F and cold foods below 40 degrees F. Keep hot food hot - at or above 140 degrees F. Place cooked food in chafing dishes, preheated steam tables, warming trays, and/or slow cookers. Keep cold food cold - at or below 40 degrees F. Place food in containers on ice.

  10. Don't eat raw eggs or undercooked runny eggs. Eggs can harbor salmonella even if they are unbroken. When a recipe calls for raw eggs, use frozen pasteurized eggs, powdered eggs, or egg substitutes. Don't keep any egg or egg-rich food out of the refrigerator for more than two hours. Don't sneak a taste of any batter, cookie or cake dough that contains raw eggs. (Cookie dough ice cream uses pasteurized eggs and is safe.)

  11. Store cooked foods in your refrigerator at 40 degrees or colder. Cooked meat or poultry should be used within three or four days of refrigeration. Bacterial growth increases greatly after that. If possible, don't rewrap packaged meat before freezing. Rewrapping just means more handling and increased risk of contamination. If you must rewrap, use freezer containers, foil, or moisture-proof freezer wrap. Work in a clean area with clean hands.

  12. When in doubt, throw it out. If you are unsure about a food's freshness, don't taste it to see if it is OK. Most bacteria that cause food poisoning do not have a smell or taste.

  13. The safest way to thaw food is in the refrigerator or in the microwave. Thawing food on the counter is risky; bacteria can start multiplying on the outer layer of the food long before the inside thaws. Foods thawed in the microwave must be cooked immediately since defrosting this way leaves part of the meat warm and cozy where bacteria love to grow.

  14. The safest cutting board material is still being debated. Wooden and plastic cutting boards are about equally safe... as long as you keep them clean. Use a separate board for meat products and vegetables. Run them through the dishwasher after each use. Putting your wooden cutting boards in the microwave for five minutes is also a good way to disinfect them. (This does not work for plastic boards which don't get hot enough in the microwave, but using the dishwasher is safe.)

  15. Throw your kitchen sponges away. They provide a moist environment perfect for bacterial growth and are a sure way to spread disease across your countertop. If you must use a sponge, microwave it on high for 60 seconds at the end of the day. Paper towels are much safer.

  16. When eating out always ask that hamburger be served well done, never rare or medium. Send back any food that you think is undercooked - like chicken that is pink near the bone, for example. Be wary of buffets and salad bars. If you didn't make the food personally, you have no way of knowing how careful the preparation was.

  17. suggests these items for a safe barbecue:
    • Food thermometer
    • Several coolers: one for beverages (which will be opened frequently), one for raw meats, poultry, and seafood, and another for cooked foods and raw produce
    • Ice or frozen gel packs for coolers
    • Jug of water, soap, and paper towels for washing hands
    • Enough plates and utensils to keep raw and cooked foods separate
    • Foil or other wrap for leftovers
For more information, see the FDA's site and "Bad Bug Book" on the Internet.


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