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E. coli and you

Saturday, June 4th, 2011

This is a "bug" you don't want

I've seen several articles in The New York Times and the Wall Street Journal in the past few days about diseases caused by an extremely toxic new strain of the common bowel bacteria, E. coli. More then 1,800 people in Europe have been infected with this food-bourne illness and some have died from an unusual kidney complication it can lead to.

The "bug" itself appears to be highly resistant to antibiotics and experts in the United States feel the wrong approach is being taken in Europe. One professor from Washington University is quoted as saying, "If you give antibiotics and the strain is (already) resistant, then you give that bacteria a competitive advantage..."

Here the recommended strategy is not to treat E coli infections with antibiotics at all. American doctors give IV fluids to help keep the kidneys functioning. They dialyze patients who develop acute kidney failure. On both side of the Atlantic physicians agree that people who develop bloody stools should be admitted to a hospital in an isolation room/ward. Otherwise a person who has an E. coli-caused diarrheal illness can easily infect others.

But dialysis can save your life

The rare, but deadly kidney disease that these food-bourne bacteria can cause is called hemolytic-uremic syndrome (HUS). The NIH PubMed website defines it as a disorder that usually occurs when an infection in the digestive system produces toxic substances that destroy red blood cells, causing kidney injury.

Hemolytic-uremic syndrome (HUS) often occurs after a severe gastrointestinal infection with E. coli bacteria (Escherichia coli O157:H7). However, the condition has also been linked to other gastrointestinal infections, including shigella and salmonella, as well as infections outside the GI system.

In America HUS is most often seen in children and is the commonest cause of acute kidney failure in them. Several large outbreaks in 1992 and 1993 were linked to undercooked hamburger meat contaminated with E. coli.

But in this case we're not talking about meat, but rather vegetables. In the past American outbreaks have been associated with contaminated tomatoes, lettuce and cucumbers.

So should we be worried? Thus far there have been only four cases identified in the US. Those people had traveled to the northern part of Germany recently and that's been identified as the epicenter of this E. coli outbreak. Germany has had 1,733 cases in the most recent count I could find. Initially Spanish cucumbers were blamed, but now it appears clear that Germany is the source.

The FDA is closely monitoring lettuce, cucumbers and tomatoes imported from Germany and Spain, but those countries account for <0.2% of our imported produce.

My family is about to start our 26-week season eating locally produced organic vegetables from Grant Family Farms, the CSA we joined last year. That improves my comfort zone enormously. I think the rest of you should consider farmers' markets, CSAs and other sources for vegetables that are grown relatively near your homes.

I've been saying that for a while; this outbreak just reinforces my thoughts on the subject.

Posted in CSAs & Farmers' Markets, Food Choices, Food-related disease, Governmental Efforts, Healthy food shopping, Holiday/travel eating, Publications | No Comments »

Gluten appears to cause more problems than we thought

Thursday, March 31st, 2011

Ah, that wheat beckons or does it?

My wife handed me an article the other day that she had clipped from the March 15, 2011 edition of The Wall Street Journal. The title was "Clues to Gluten Sensitivity." We've got several friends who have adopted gluten-free diets. When I went through medical school, in the Dark Ages, I only learned about celiac disease (CD), an autoimmune response to gluten. I hadn't thought about CD in years, but after finding a number of articles in the web-based medical literature, I realized there was an analogy between CD and severe lactose intolerance.

Some people lack the enzyme necessary to successfully drink cow's milk. They have bloating, pass gas and may have diarhea after drinking milk. Others, like me, can drink some milk, but have symptoms if they drink it in quantity. Still others may have a normal level of lactase, the enyzyme that allows digestion of lactose (the main sugar in cow's milk), but have an allergy to a protein in milk.

Similarly, about 1% of our population has CD as a genetic disease which causes severe symptoms after ingestion of gluten, a protein found in wheat, rye and barley. They can be diagnosed (while on a normal diet) with blood tests and a biopsy of the small bowel. The blood tests show the presence of certain antibodies and the biopsy shows the flattening of the usual villi, tiny finger-like projections that are crucial for the absorption of foods. CD doesn't go away, but a gluten-free diet can allow them to lead a normal, healthy life. The incidence of CD appears to have risen markedly over the last half century, perhaps because of alterations in modern wheat that increase the amount of gluten.

Now physicians at the University of Maryland Center for Celiac Research, Johns Hopkins and several Italian medical schools have found a much more common gluten sensitivity (GS) disorder. Those people don't have damaged villi or positive blood tests and may have a host of symptoms that relent when gluten is removed from their diet.

Whole wheat bread, my favorite, but not for everyone

The estimates I've read range from 6 to 10% of our population as having GS. They don't appear to be reacting in the same way as those with CD. At present there's no definitive test for GS, but a gluten-free diet relieves the multitude of symptms that may be associated with this disorder.

Then, just to complicate things a bit further, there is also wheat allergy, a condition that is relatively rare (less than 1% of kids and some adults after exercise). That can cause severe problems with hives, nasal congestion or even anaphylactic shock.

The new disorder, GS, raise lots of questions with few answers, so stay tuned in and think about your own tolerance for gluten.

 

Posted in Food-related disease, medically-oriented background info | 1 Comment »

Good fish, bad fish: a cautionary tale

Monday, March 21st, 2011

This fish is in trouble

I've learned something about fish food poisoning these past few weeks. Perhaps I knew about it  in medical school, but that was a long time ago. We love fish, consider it a treat, eat it several times a week and, once in a while, partake of other marine creatures. I like mussels as long as they're cooked,  and will eat sushi, but never raw oysters.

So four people we know have had apparent fish-related food poisoning recently. They didn't eat at the same place or the same fish. That got me curious and I started to hunt down types of food poisoning related to eating fish and other marine critters. I found two that aren't the usual bacterial- or viral-caused forms (I'll write about those another time).

So what happened in the first instance was at a play when a close friend got suddenly and violently ill. He collapsed, was "out of it" for perhaps thirty seconds (I thought cardiac arrest or major stroke), then sat up and vomited copiously over himself and his spouse. Then he seemed weak, but otherwise normal. I went with hin to the ER where he was monitored for cardiac rhythm changes for four hours, got blood work and had a brain scan. All those were essentially normal, but he vomited four more times in the ER and once more as I was driving him home.

Over the next two weeks he had a cardiac workup with an echocardiogram, a stress test and a 24-hour Holter monitor for rhythm disturbances. All those were negative. He was previously reasonably healthy for his age of 72 and had no history of any seizure disorder.

A few other tests are pending, but then I spoke to a friend who had suffered a similar illness and heard of two others in the community. I went hunting for odd forms of food poisoning as none of these folk had diarrhea and none had sequelae of their short-term illness.

I finally heard the term scromboid fish food poisoning. All four had eaten fish and several had eaten shellfish.

Scromboid turns out to fit better than other diagnoses. It's typically associated with the consumption of fish, especially Scombridae fish like tuna or mackerel. It has a rapid onset, is marked by abdominal symptoms and or prostration, headache, palpitations, or flushing., sometimes tachycardia (rapid heart beat) and low or high BP and usually is self limited. It is caused by a toxin which is not inactivated by cooking and may be associated with spoiled meat.

The CDC says it's the most common chemically-related food poisoning in the United States., but at that only causes 5% of the food-related illness reported. It's much less nasty than ciguatera, the other fish related illlness I found. That one is also toxin-related, heat-resistent, can cause somewhat similar symptoms, but can lead to months ort even years of problems.

After reading of these I'll still go back to our favorite fish restaurant; they had no other patrons with similar symptoms. Scromboid seems to be relatively uncommon & mild in retrospect. On the other hand some speculate that ciguatera caused the migration of the Polynesians between 1,000 and 1,400 CE.

Posted in food and food-producing animals, Food Choices, Food producers and less-healthy foods, Food-related disease, medically-oriented background info, Unhealthy eating | 1 Comment »

Fish, fish and more fish

Tuesday, March 15th, 2011

Sardines by the dozen

I've been looking at three articles  on which fish we should be eating. One came from a newspaper, one from a health.usnews.com website and the third from the Environmental Defense Fund website.

One of the dietary changes we've heard repeatedly over the last few years, besides eating more fruits and veggies and less red met, is to eat more fish. We're fortunate to have a wonderful restaurant here that's simply titled "Fish." We eat there fairly frequently, especially before attending plays (but that's another story). We also cook fish at home at least once and usually twice a week.

So which kind of fish should we be eating? That leads to the questions of sustainability, heart health and contaminants. To those, based on a recent experience, I'd add the risk of toxins (I'll write a blog post about that some other time).

The article from the Wall Street Journal (March 2, 2011) focused on salmon, talking about Wild Alaskan, Wild Pacific, Farmed Atlantic and Closed Tank-Framed varieties. The Farmed Atlantic salmon raised many enivronmental concerns and both Seafood Watch and Greenpeace decry salmon farming, stating it takes three pounds of  wild-caught fish to produce one pound of salmon.

The Wild Alaskan salmon got kudos from Seafood Watch, although another group noted that 40% of "wild" salmon caught in the state's waters were actually raised in hatcheries. Wild Pacific slamon raised sustainability concerns from some groups, but not all.

Confusing, huh? Well then I turned to the online health.usnews.com piece. This had three distinct sections: the AHA wants us to consume more omega-3s and recommends mackerel, lake trout, herring, sardines, albacore tuna and salmon as good sources. Yet in the contaminant section it's noted that albacore tuna, high on the food chain, carry the risk of mercury and PCBs.  There's debate as to the risk for most adults, but pregnant women (or those who are at risk of pregnancy) should clearly avoid this fish choice.

And farmed salmon, high up on the list of omega-3s, is tough to raise in a sustainable fashion.

The Environmental Defense Fund suggests we eat wild salmon from Alaska, pink shrimp from Oregon, talapia from the US, farmed rainbow trout, alabacore tuna from the US or Canada, yellowfin from the US. The EWG website led me to a Mark Bittman article (New York Times November 16, 2008) where Mark lauds wild-caught fish; he finds the flavor better and the environmental concerns lessened.

So what are we to do? I'd suggest eating more fish, trying to eat some fatty fish, eating less farmed fish and reading more about the issues involved. I may try more sardines.

The real question is whether there will be enough wild fish for all.

Posted in Food Choices, Food-related disease, Healthy eating, Healthy food shopping | No Comments »

They're finally here!

Tuesday, February 1st, 2011

I woke up at 6:30 AM this morning and weighed myself: 149.6 pounds, right in the middle of my goal weight.  I've been working on my life style changes, more exercise and less food, since May 2009 and, although I bounce up and down 2-3 pounds, I'm basically lean.

Breakfast was a quart of "lime water" (I squeeze fresh limes three times a day), a cup of regular coffee for Lynnette and of Cafix for me (a blend of barley, rye, chicory and sugar beets; I avoid caffeine), a banana and a home-made oatmeal dish with millet, brown sugar, sunflower seeds, walnuts, and ground flaxseed to complement the commercial oatmeal. There's no salt in any of the above and we added fat-free milk (Lynnette) or soy milk (Peter) to our oatmeal. We'll eat our big meal of the day at noon and at home.

The Wall Street Journal's Personal Journal section had an article titled "New Dietary Guidelines: Less Food, Less TV." The June 2010 DGAC version from the advisory committee of sceintists and nutrition experts had gone through the expected round of commentary, largely from food indusrty sources and the final products, as always is considerably watered down. You can find it online at www.dietaryguidelines.gov if you want to read the entire document, or skim through portions.

So here's a section of what it says:

• Reduce daily sodium intake to less than 2,300 milligrams (mg) and further reduce intake to 1,500 mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease. The 1,500 mg recommendation applies to about half of the U.S. population, including children, and the majority of adults.

• Consume less than 10 percent of calories from saturated fatty acids by replacing them with monounsaturated and polyunsaturated fatty acids. • Limit the consumption of foods that contain refined grains, especiallyrefined grain foods that contain solid fats, added sugars, and sodium.

How do we translate that into simple English? More than 1/2 your plateful should be vegetables and fruits, buy lower salt products and don't add any when you cook or at the table; eat less red meat. Eat real food, not food products; read labels carefully when you shop. I'd add: eat out less and exercise more.

I read Dr, David Katz's column, "New Dietary Guidelines: A Physician's Perspective" on the Huffingtonpst.com website (Katz is the Director of Yale's Prevention Research Center). He agrees that the feedback gave a politicized spin to the final document, but liked the new emphasis on obesity and chronic disease prevention (roughly 1/6 of our kids and 1/3 of our adults are obese). He didn't care as much for the continued emphasis on dairy and meat consumption with less attention paid to plant-based diets.

So this version of the Dietary Guidelines isn't all that much different from prior versions, unless you read carefully and, in some cases, between the lines. I found a section (Chapter one, page 3) on "The Heavy Toll of Diet-related Chronic Diseases that I'll comment on at another time.

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Posted in Food-related disease, Governmental Efforts, Healthly lifestyle, Healthy eating, medically-oriented background info, Obesity, our kids and their weight issues | No Comments »

More on salt; is it addictive?

Friday, December 31st, 2010

Salt for your addiction

Finished with shoveling snow for the second time in twenty-four hours, I sat down to eat hot oatmeal with pumpkin, a treat Lynnette dreamed up recently. In her mail stack I noted a copy of Prevention, a magazine I seldom read, but this particular issue had a story with an intriguing title "The Food Addiction That's Making you Fat,"

After reading the article, which I regraded as strong on suggestions, but light on references, I went back to the medical literature trying to discover if the basic premise, that salt can cause a spike in the level of dopamine, a chemical that stimulates our brain's "pleasure center" made medical sense. It took a while, but I found a 2008 article on PubMed Central (part of the National Library of Medicine's website that offer access to abstracts and full-text articles), and discovered the background data for the statement.

In 2008, in the journal Physiology and Behavior, a University of Iowa group published an article titled "Salt Craving: The Psychobiology of pathogenic sodium intake." I won't bore you with the details, but the 46-page article was well=written and the data seemed sound.

The abstract mentioned that salt is essential to our physiological functions and generally is regarded as "highly palatable." Other sources say it brings out flavor in many foods and a humorous Time Magazine article on that subject that I found  (Josh Ozersky May 17, 2010) said a New York legislator had recently proposed banning all salt use in restaurant kitchens, making the author think of fleeing to Canada. He called salt "cocaine for the palate."

That made me delve into the body of the much longer article. The data and studies quoted did point to the dopaminergic mechanism being involved in salt depletion experiments. But that's salt depletion and our typical diet is a long ways from leading to that state.

I think the bottom line is salt enhances taste and we get conditioned to expect it as a learned behavior. Newborns either dislike salt or don't care; we're two or three before the baby-food industry or our parents get us hooked on salt.

But hooked most of us are; that's the bad news. The good news is that addiction can be broken, starting with removing salt shakers form your dining area and coking without salt. We now use many other spices, not spice mixes which may have salt as a major ingredient...and get by just fine.

The bottom line is that many things can be regarded as addictive: drugs of course, but also fats, chocolate, carbs, sex and voluntary exercise. And with that note, I think it's time to go to the gym. Now there's an addiction I enjoy.

Posted in Food Additives, Food-related disease, medically-oriented background info, Unhealthy eating | 2 Comments »

Too much cheer for the holidays and other times

Friday, November 26th, 2010

We had a family Thanksgiving dinner for nineteen people yesterday and served beer, wine, non-alcoholic punch with fresh fruits and some sparkling fruit drinks. I had a glass of Riesling and later tried some of the fruit punch, I didn't pay much attention to what others were drinking, all but four were adults ranging in age from early twenties to mid-seventies.

Fat Tire beer, my favorite

When we cleaned up later, it seemed there were a lot of beer bottles, but I realized at least five adult men drank beer and nobody had more than two bottles. I don't usually drink beer myself (although I'll make an exception for Fat Tire, a superb locally-brewed beverage) and normally have one glass of wine with a meal three times a week. Once in a great while, if we're at home, I'll have a second glassful.

I realize we don't drink much compared to some of our friends, but haven't seen anyone drink to excess or appear drunk at any of the parties we've been to in years.

Then I read the December issue of the Harvard Heart Letter and saw that a South Korean study had revealed the hazards of binge drinking. I'd thought of that as primarily a problem for college students; we live in a university town and over the years have read of several binge drinking tragedies.

I found the original article online in a publication called Science News and then followed a link to another article, this one an Irish study. Both were sobering, to say the least.

I've read a number of articles that say drinking in moderation may be heart-healthy. The key word is moderation and we're talking about one drink a day for women and two for men. Binge drinking implies much more alcohol consumption, four to five or more drinks a day or six at any time.

It's not just an issue for teens and college students; a CDC study said one in seven adults admitted to binge drinking.

The Korean study focused on men with poorly controlled hypertension and said their risk of cardiovascular death or  stroke was markedly increased, more so if they drank very heavily. It followed over six thousand people for twenty-one years.

The Irish study compared middle-aged men's drinking patterns in Belfast and France, with the Irish men drinking two to three times as much. Those who were binge drinkers had almost twice the risk of a heart attack or death from heart disease over a ten-year followup period.

The French more typically drink wine with meals; The Irish drink more beer and spirits and I would think they do so in pubs without much food being consumed.

So I personally think it's okay for most adults to drink in moderation (that's assuming they don't have a personal or family alcohol problem and understand what moderation means).

But drinking to excess, especially binge drinking, is a totally different matter. These new studies show yet another hazard for those who overly imbibe.

So if you plan to have a glass of holiday cheer, keep it at a minimum and, of course, don't drive if you drink.

Posted in beverages, Food-related disease, medically-oriented background info | No Comments »

I'd never heard of the ketogenic diet

Friday, November 19th, 2010

Reading the New York Times breaking news on my Kindle this afternoon, I came across a diet that was new to me, one that most of us will never go on. But for a small group of kids it can have an incredible impact.

The story was about a nine-year-old boy who has severe epilepsy. In his case his seizures were resistant to all the major drugs that might usually have been effective. He was having them as frequently as 150 times a day.

His parents were desperate until they finally found Dr, Elizabeth Thiele at the Massachusetts General Hospital for Children. She's a specialist in pediatric neurology, an Asoociate Professor at Harvard Medical School and heads up a program for pediatric epilepsy.

One of her interests is keto as the diet is called. When children have drug-resistent seizures, keto can be effective in a significant percentage of cases.

The diet is high-fat, quite the opposite from many of those used by adults for weight loss. The kids on it start in the hospital, starving for a relatively brief period. But our bodies only have enough glucose, our primary source of energy, to last about 24 hours.

After that we burn fat reserves and our livers convert those fats into fatty acids and ketones. The latter pass into the central nervous system and become the brain's source of energy. Somehow, it's not exactly known how, that can reduce how often epileptic seizures occur.

The diet has been around for over eighty years, but when anti-seizure medications were developed and shown to e efective in most kids, keto fell by the wayside.

In the mid 1990s a Holywood producer brought it back. His son had severe epilepsy and drugs weren't helping. Keto did and the producer started a foundation to promote the use of the diet. He got his friend Meryl Streep to star in a film called First Do No Harm and the foundation sponsored a scientific study of the diet.

Since then it's been offered by over 100 hospitals for kids with drug-resistant epilepsy and two randomized, controlled studies showed it can be effective.

The boy in the article eats four times as much fat as protein or carbohydates. He's on a tightly controlled program and even his snack are calcualted. One of those snacks included two slices of bacon, seven macadamia nuts and less than one eighth of an apple. His urine would be checked for ketones as in the slide.

There are diets to lose weight and gain health; there are also diets to help with specific medical problems. I'll never try keto and hopefully, like many kids, the boy in the article will outgrow his need for it.  For now it's been an wonderful asset for his health.

Posted in Food-related disease, medically-oriented background info, Unhealthy eating | No Comments »

Don't let your burger bug you

Sunday, October 3rd, 2010

Holstein cowThere was an interesting article in the Wall Street Journal yesterday. I read it, decided it good material for my blog and then hunted for background information. The title was "Beef Safety Tests aren't Being Used." It said there were a number of dangerous strains of E. coli in addition to the O157:H7 variety that thousands of people get sick from each year.

That one is well known, causes over 36,000 illness, 1,100 hospitalizations and 30 deaths a year. Our government agencies do test for that strain, but not all possible measures to reduce it are being used.

beef hamburgerFor instance at the huge Cargill plant at Fort Morgan, Colorado, every lot of ground beef has been tested for E. coli O157:H7 before it leaves the plant. Workers take 60 to 75 samples per 2,000-pound to 10,000-pound lot. The meat isn't shipped until it gets the all-clear, a process that takes about 18 hours.

That's pasted in from an article I found on beef testing; I'm amazed at the size of the lots and not overly impressed by the sampling. Cargill is also vaccinating cows for that E. coli strain, but giving two shots instead of the three that testing showed reduced the prevalence of the bacteria by  86% (two shots are cheaper than three, but only 50-60% effective).

They're also trying out some newer methods to cut the prevalence of that E. coli strain.

Then there is Kevin's law.

In 2005, Representative Anna Eshoo of California proposed this regulation nicknamed after a Colorado boy who died in 2001 after eating a hamburger contaminated with O157:H7. It was formally titled the Meat and Poultry Pathogen Reduction and Enforcement Act of 2003.

Kevin's Law would strengthen the U.S. government's ability to prevent contaminated meat and poultry from entering the food supply by:- Requiring the United States Department of Agriculture (USDA) to identify the pathogens that threaten human health (e.g. Salmonella, E. coli O157:H7, Listeria monocytogenes).

- Requiring the USDA to establish performance standards to reduce the presence of these pathogens in meat and poultry.

- Confirming that the USDA has the authority to enforce its own standards by shutting down plants that continually breach basic health standards. Courts have held that the USDA does not have this authority in the absence of explicit authorizing legislation.

Corporate meat processors have lobbied against Kevin's Law, arguing that it would increase the cost of food and is unnecessary.

Versions of the bill have been introduced in each subsequent Congress, but as of April 2010 have never been reported out of committee.

Now government officials say there are six E. coli strains that can be just as dangerous. One of those is E. coli O26 and there is a test for that and three of the others, but the USDA doesn't routinely use them. They did recall 8,500 pounds of raw ground beef that was found to be contiminated with E. coli O26 this year.

There's lots more to say on this subject, but I'll do so in a later post. For now it's suggested that you really cook your hamburgers; they shouldn't be at all pink inside. I used to eat rare hamburgers; I sure don't now.

Posted in Food-related disease, Healthy eating, medically-oriented background info | No Comments »

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