Thursday, October 20, 2011

Food Poisoning - You May Not Want To Be What You Eat

Food poisoning is an illness you can’t predict or really prepare for. You just have to eat something that was somewhere it shouldn’t be for as little as a few seconds in order to get ill. Before you even really know what is happening, you feel sick (nauseated, dizzy, vomiting, abdominal cramping, and diarrhea) and may not know what is happening or what to do next.

The nausea and vomiting you may experience is your body recognizing that there is a problem and trying to find a solution (in other words finding a way to get the “bad stuff” out).  For some kinds of food poisoning, you may experience diarrhea as the primary symptom and/or in addition to nausea and vomiting. Both symptoms are simply a means to an end, so to speak; that is, getting the offending piece of food (and accompanying poison) out of your body, usually as quickly as possible and by the nearest exit. Obviously, our first instincts are to stop our unpleasant symptoms as quickly as possible, but this is usually not be best idea in the long run; usually, the best way for your body to rid itself of the problem is to let nature take its course.

The real risks of food poisoning are not that you feel awful or that you spend a lot of time in the bathroom, the problem is the secondary complications. Some complications are obvious - you can get dehydrated from too much vomiting or diarrhea. Hence the deadly nature of cholera which causes diarrhea that is so severe that the accompanying dehydration is often fatal, especially in younger children. Other complications that are serious and potentially life threatening have to do with the type of microbe or poison that caused the food poisoning in the first place.

So what to do to protect yourself if you are unfortunate enough to suffer food poisoning?

Electrolytes and Dehydration - the first consideration

There is a serious risk of dehydration from either vomiting or diarrhea, especially when coupled with a high fever or sweating. Losing a lot of water and missing meals can easily cause dehydration. If you are dehydrated it can quickly become serious. You must prevent serious dehydration or it can become very dangerous. There are only two ways to properly prevent or treat dehydration - getting an intravenous (IV) solution (of fluid and electrolytes) or drinking something that accomplishes the same goal of rehydration.

If you live in a wealthier country then you may have access to a hospital and an IV if you really need it. On the other hand, if you live in a poorer or less developed country and/or you are able to drink some fluid, then you may be able to stay out of serious trouble if you know what to drink. Rehydrating is not as simple as just drinking water because plain water simply does not contain the electrolytes you need to properly rehydrate.

Oral Rehydration Salts - The World Health Organization’s Formula

For this reason, the World Health Organization (WHO) provides a formula specifically for oral re-hydration. This rehydration formula is called an Oral Rehydration Solution (ORS) and is designed to help rehydrate and improve electrolyte levels, especially during illnesses that cause vomiting or diarrhea. The Oral Rehydration Solution is one of the great medical breakthroughs of the twentieth century. The WHO ORS has saved countless children from dying of cholera and other devastating diseases. In other words, it is incredibly effective and valuable for anyone suffering from an illness involving diarrhea and/or vomiting.

The major ingredients in the WHO ORS are water, sugar, and salts (electrolytes). This formula for ORS is very precise and is measured to specifically rehydrate while providing electrolytes, preventing further dehydration. Any deviation from the specifications of the formula (too much or too little sugar or salt) could potentially make your dehydration worse. Your body needs the sugar to be able to absorb the salts (electrolytes) and, in the process, lots of water into your body. The basic formula for ORS is: 6 level tsp of sugar, 1/2 level tsp of salt, dissolved into 1 liter (4.25 Cups) of clean water.

While you can make the WHO formula on your own, you can also buy it online in premixed packages. I find the WHO ORS to actually be very difficult to drink (especially when you feel nauseated) because it has no flavoring added (this makes it incredibly inexpensive and cost effective in poorer countries). On the other hand, you can do what I do and have a tastier version of the WHO ORS available at home in case of a problem.

Alternatives to the WHO formula

You may be familiar with a product called Pedialyte for children. Pedialyte is actually the WHO ORS formulation with a small amount of added flavor and coloring. Kids tend to prefer Pedialyte popsicles because the flavor is bland and not terrific. My favorite ORS based product is called Hydralyte. Hydralyte matches the WHO formulation with a significantly better option of flavors added. Either Pedialyte or Hydralyte can be safely used for children or adults, as they both adhere to the WHO formulation.

Electrolytes in Sports Drinks - A Bad Option

If you think that Sports drinks are an option, forget it. While they advertise themselves as drinks that replenish electrolytes, they don’t usually have the same proportions of ingredients as the WHO formulation. Drinks like Gatorade and Powerade contain far too much sugar and can actually make dehydration worse by pulling water out of your body and causing more diarrhea. The specific formula of the WHO formula guarantees that you rehydrate and replenish electrolytes at the same rate, using the mechanisms of your stomach and intestines as the baseline for measuring the amounts of ingredients (glucose, salts, and water).

Carbonated Drinks to Calm an Upset Stomach?

Are carbonated sodas okay? Some people drink 7-up, ginger-ale, or other sodas to calm their stomach down when they start to feel nauseated. Unfortunately, the large sugar content of these sodas can make dehydration and diarrhea worse. If the carbonation helps settle your stomach, consider drinking sparkling water or club soda instead. Carbonated drinks make you feel better by tricking your body into releasing the contents of the stomach into the small intestine sooner than normal. In doing so, it jump starts the digestive system back into the proper direction.

My suggestions for eating when you have food poisoning - Don’t, you need to wait...

  • 1st day: don’t eat anything (easy if you feel nauseated). At this stage, eating anything probably makes you feel like you need to throw up; you probably do. Eating may also aggravate diarrhea and may increase stomach cramping. On the other hand, slowly sipping a rehydration formula based on the WHO recommendations will help to prevent dehydration. If even small sips increase your vomiting, then wait until it does not cause an aggravation of your symptoms and try again.
  • Next: Once you have stopped vomiting and are able to keep down fluids in larger amounts. then you should have some home made chicken broth in addition to the WHO ORS. Some studies suggest that there are chemicals in chicken soup that reduce inflammation and help promote healing. It’s hard to test chicken soup against placebo, because what can you use that tastes, looks, and smells like chicken soup as a placebo? If nothing else, it is warm fluids, and contains protein. The evidence for chicken soup helping is based on home made chicken soup (put chicken or part of a chicken in water and boil it with salt and some carrots and celery). Drink the broth for a meal or two and save the chicken meat and vegetables for later.
  • After that:  The BRAT diet (no that’s not about someone you know or sausages). BRAT is an acronym which stands for Bananas, Rice, Apple sauce, and Tea. These foods are very easy to digest and provide “easy” energy to your body as it starts to heal. Black or green tea (with caffeine) can stimulate the digestive system to start working in the proper direction again. Along with these simple foods, you can continue re-hydrating using the ORS formula and your chicken broth.
  • When you really start to feel hungry, you can add in the chicken and well cooked vegetables to your diet. Also, avoid all dairy products and gluten for at least two weeks after your symptoms have subsided. Dairy and gluten are difficult enough to digest when you’re not sick, and the ability to properly digest them may become impaired from any damage to your intestines. You really should wait to feel hungry before you start eating, more because otherwise you may have a recurrence of your symptoms or cause too much stress on your stomach and intestines. Your gut needs time to heal, let it.
Treating the Symptoms

Do NOT take anti-nausea or anti-diarrhea medications. Your body is actively trying to get rid of the tainted food, don’t force it to stay inside you or you may get even more sick and your illness may actually last longer.

When should I start to feel better?

In most cases, your body will likely deal with whatever you ate on its own requiring no further treatment beyond making sure you stay well hydrated. If you can’t stay well hydrated because of the severity of the diarrhea, vomiting, or due to a high fever, then you should consider going to your local emergency department. Symptoms that may indicate you are becoming too dehydrated are severe dizziness while standing, fainting, and racing pulse especially in combination with a high fever. Furthermore, If vomiting or diarrhea lasts for more than 72 hours, you should immediately see your doctor for an assessment. Your doctor may order a stool sample to determine exactly which food-borne illness you are suffering from. If your diarrhea has blood or mucous in it (a lovely thought), you should immediately seek out the attention of your doctor, as the food poisoning could be from a more dangerous strain of bacteria that may actually require an anti-microbial or some other specialized course of treatment.

So what are the dangerous “bugs”?

There are a number of dangerous things to eat, all of which can cause food poisoning. There is no one type of food poisoning, but there are some notable types that are particularly dangerous.

E. coli O157:H7

E. coli O157:H7 is a particularly nasty variation of the E. coli bacteria. E. coli are normally present in our gut in small amounts to help us to process food we eat. However, when a dangerous strain such as O157:H7 starts to make its home there, the results can be deadly. Even small amounts of this bacteria can infect and cause severe illness. This particular strain is highly resistant to stomach and digestive acids and also to many common antibiotics.

E. coli O157:H7 infection often causes severe, acute hemorrhagic (with blood) diarrhea (although non-hemorrhagic diarrhea is possible) and abdominal cramps. Usually little or no fever is present, and the illness resolves in 5 to 10 days. It is important to be closely monitored, however, due to serious complications which can follow an infection.

Complications from E. coli can be worse than the actual food poisoning. It can cause Hemolytic Uremic Syndrome (HUS), in which red blood cells are destroyed and the kidneys start to fail. Approximately 2-7% of infections lead to this complication. In fact, HUS caused by E. coli is the number 1 cause of acute kidney failure in children in the United States.

Unfortunately, few options exist (or remain) for the treatment of E. coli O157:H7 as it is highly resistant to many types of antibiotics. Many scientists believe that this resistance is a direct result of farmers using antibiotic additives in animal feed. Simply eating organic will not guarantee avoidance of E. coli or its resistant subtypes like O157:H7; these bacteria are found in all cows, organic or not, in roughly equal amounts. The only defense is to make sure to thoroughly cook all meats, especially ground beef and steak.


About 142,000 (reported) Americans are infected each year with Salmonella enteritidis from chicken eggs, of which about 30 die. Most people infected with Salmonella develop diarrhea, fever, and abdominal cramps from 12 to 72 hours after infection. Symptoms usually last 4 to 7 days, and most people recover without treatment.

Salmonella can survive for weeks outside a living body. Salmonella are not destroyed by freezing. Ultraviolet radiation and heat are the only two ways to effectively kill salmonella. The bacteria perish after being heated to 55°C (131°F) for one hour, or to 60°C (140°F) for half an hour. To protect against Salmonella infection, it is recommended that food be heated for at least ten minutes at 75°C (167°F) so that the entirety of the food reaches this temperature, inside and out.

Poultry, cattle, and sheep are the most frequent sources of salmonella contamination. Salmonella can be found in many types of food, especially in milk, meats, and sometimes in eggs which are cracked.

Salmonella can be treated with antibiotics, but will usually clear up without the need for them. However, the complications can be serious and you should be monitored by a doctor.


Recently, an outbreak of Listeria was found in
cantaloupes from Colorado.
You may have heard about a recent outbreak in Colorado of Listeria in cantaloupes. Listeria is one of the most common forms of food related illnesses in the world. Though much less widespread than before the advent of pasteurization, Listeria is still a dangerous and common food pathogen.

Listeria is an extremely dangerous bacteria that can easily kill you if you get infected. Listeriosis is a serious disease with a mortality rate greater than 25% in humans. The symptoms of listeriosis usually last anywhere from 7-10 days. The most common symptoms are fever, muscle aches, and vomiting. Diarrhea is another, but less common symptom. Side effects of infection can range from meningitis to convulsions. Since the Listeria bacteria shows a preference for nervous system tissues, serious mental issues (mood changes, etc.) are common. Seizures also occur in at least 25% of patients.

The Center for Science in the Public Interest has published a list of foods that have recently been the cause of outbreaks of Listeria: hot dogs, deli meats, raw milk, cheeses (particularly soft-ripened cheeses like feta, Brie, Camembert, blue-veined, or Mexican “queso blanco”), raw and even cooked poultry, raw meats, ice cream, raw vegetables, raw and smoked fish. Cantaloupe is also a leading carrier of Listeria bacteria and has been linked to a number of outbreaks in recent years.

Listeria can be treated with antibiotics, and the usual caveats about antibiotic resistance apply here as well. Unfortunately, symptoms may occur as much as two months after eating contaminated food. Those most at risk are pregnant women and infants. If you are pregnant, it is absolutely imperative that you get treated as soon as possible if you are exposed.

Ongoing Symptoms

If any of these symptoms occur, you should immediately let your doctor know, as they can be signs of a serious infection or illness. Any trace of bloody diarrhea that is dark colored is a sign that there may be damage to the upper part of the gastrointestinal tract such as ulcers or other physical damage. Continuous vomiting past the first day or so of the illness indicates that your body is unable to clear the toxins that caused the illness and is still trying. Blood or mucous found in your stool suggests that there is more likely to be a dangerous variant still in the gut.

Any of the above listed illnesses are considerably worse in young children and older people. Young children do not have a fully developed digestive (or immune) system. Children also have a larger surface area of intestine compared to their total body size, so they tend to absorb things more from food, including toxins. This also makes them more likely to get dehydrated and extremely sick or even die from food-borne illnesses. Older or immunocompromised (damaged immune system) individuals are also at greater risk than healthy adults and should be closely monitored by a doctor for any complications or secondary infections.

Could it be the Stomach Flu?

Many of the symptoms of food poisoning match up with those of the “stomach flu”. The stomach flu is caused by a virus called the rotavirus. The symptoms of a rotavirus (stomach flu) infection are vomiting, watery diarrhea, and low-grade fever. Once infected by the virus, there is an incubation period of about two days before symptoms begin to appear. Symptoms often start out with vomiting followed by about four to eight days of severe diarrhea. Dehydration is more common in rotavirus infection than in most of the illnesses caused by the above mentioned bacterial infections.

A good clue that you may be suffering from food poisoning (usually a bacteria or toxin) as compared to stomach flu (a virus) is that your symptoms tend to start at almost exactly the same time as any other family or friends who ate the same food as you did. Food poisoning generally strikes anywhere from 30 minutes to 48 hours after you ingest the contaminated food and symptoms may be more much more immediately severe than what you might expect from the stomach flu.

Be Prepared

I hope you don’t suffer from food poisoning, but it is always a good idea to be prepared in case you do. More importantly, knowing how to avoid get sick in the first place is a huge advantage. Avoid suspect foods from suspect establishments. Be careful eating in foreign countries. Be careful about drinking water that may not be clean or having your food washed with unclean water. Make sure you cook your food properly and thoroughly. If you do get sick, know how to prevent dehydration as well as be aware of what symptoms you should be concerned about if they develop. This could be the difference between serious complications and just a couple of uncomfortable days spent in the bathroom.

Researched and written by Dr. Rebecca Malamed, M.D. with assistance from Mr. Malcolm Potter.

1 comment:

  1. Stumbled upon your post by accident but leaving here with great knowledge of how to handle situations like diarrhea and food poisoning!! Good work!!!


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