Welcome to another e-newsletter from the Center for Digestive Health & Nutrition. Our physicians, nurse practitioner, and registered dietician provide this information to help improve awareness in matters of health and nutrition. Each issue - which now goes out to over 13,000 readers - focuses on a particular topic that we feel will be of interest. I want to thank our readers for their positive feedback and suggestions for future topics.

While the American food supply is among the safest in the world, the Federal government estimates that there are more than 76 million cases of foodborne illness annually, resulting in 325,000 hospitalizations and 5,000 deaths - meaning that roughly 13 men, women and children die every day because of foodborne illness. Modern transportation has expanded our food chain beyond our borders - often to countries with lower standards of hygiene. To help protect yourself and your family you should assume that all food is somewhat contaminated and follow the suggestions below.

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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 just had a "twenty-four hour virus." 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 over 200,000 cases diagnosed every day. 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 rapidly multiply within the food and before you know it, that piece of chicken has become a weapon.

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 contaminated food. 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. E. coli is a common bacteria 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 110,000 Americans each year, killing several hundred.

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, and 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 BRATT diet for a day or two - bananas, rice, applesauce, tea, and toast. Two nonprescription remedies, Pepto-Bismol and Imodium AD, may be used to control mild to moderate diarrhea. However, if severe diarrhea, fever over 102 degrees F., persistent vomiting, severe weakness occur or any passage of blood develop, medical care should be sought promptly.

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 that 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 - because 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.

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:

• Wash your hands with an antibacterial soap like Palmolive or Dial Antibacterial Soap before and after handling raw meats. Another effective way to reduce bacteria on the hands is the use of an instant hand sanitizer such as PURELL.
  
  
• 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.
  
  
• 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.
  
  
• 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.
  
  
• Never eat shellfish like clams and oysters raw. They may harbor bacteria or viruses that can cause food poisoning or even hepatitis.
  
  
• When at the grill, cook ground meat thoroughly. Understand 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. The internal temperature of a whole chicken should reach 180 degrees F, while chicken breasts should be cooked to a temperature of 170 degrees F.
  
  
• Rinsing or washing meat does not remove the risk. Thorough cooking is the only way to destroy all harmful bacteria. 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.
  
  
• Keep hot foods hot and cold foods cold. Bacteria can multiply in temperatures from 40 degrees F to 140 degrees F, so it's very important to store and serve foods safely. To keep bacteria in check, keep hot foods above 140 degrees F and cold foods below 40 degrees F.
  
  
• Obey the two-hour rule. 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. Within 2 hours either reheat or refrigerate.
  
  
• Wide spread pasteurization has reduced the risk of Salmonella in eggs to only one in 20,000. But that still leaves more than two million hazardous eggs in circulation each year. Often dishes made at restaurants are from pooled eggs which increases the risk. At home, keep eggs refrigerated. 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.) Casseroles and other dishes containing eggs should be cooked to 160 degrees F. Use a food thermometer to be sure.
  
  
• 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.
  
  
• 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. Skip the sniff test and trash whatever meat you haven't eaten in a week.
  
  
• 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.
  
  
• 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.)
  
  
• 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 2 minutes at the end of the day. Paper towels are much safer.
  
  
• When eating at home, you have control. When eating out, your fate is in someone else's hands. If you didn't make the food personally, you have no way of knowing how careful the preparation was. 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. Beware of lukewarm foods, especially buffets and salad bars. If food is supposed to be cold, it should feel cold.
  
  

  Two Common Invaders Up Close
  Here is a single salmonella bacteria magnified thousands of times under a microscope. Salmonella is a harmful bacteria found in many places. It is often seen in contaminated chicken, raw meats, eggs, milk and dairy products, but can also be found in fish, shrimp, yeast, coconut, sauces and salad dressing, cake mixes, cream-filled desserts and toppings, dried gelatin, peanut butter, cocoa, and chocolate. Eating as little as 20 bacteria can cause an acute case of nausea, vomiting, diarrhea, and fever within 12 - 72 hours. It is estimated that from 2 to 4 million cases of salmonella food poisoning occur in the U.S. annually. Most individuals recover completely within a few days, but some go on to become chronic carriers. More information can be found here.	Giardia (GEE-are-DEE-uh) is a one-celled microscopic parasite found in contaminated water. It is the most common cause of non-bacterial diarrhea in North America. The parasite is found in every region of the United States and throughout the world. Symptoms generally begin 1-2 weeks after being infected. Normally the illness lasts a few weeks, but some cases can become chronic. Five outbreaks have been traced to food contamination by infected or infested food handlers, and the possibility of infections from contaminated vegetables that are eaten raw cannot be excluded. The diagnosis is made by examining a stool specimen under a microscope and looking for the parasite. Once the diagnosis is made, specific antibiotics such as Flagyl can usually eradicate a chronic infection.

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