The Long-Term Hazards of Eating In February, the Department of Agriculture issued a nation-wide recall of 144 million

pounds of suspect beef. It was the largest recall in U.S. history. Apparently, some of the beef had been prepared from sick or “downer” cattle and much of the meat had been shipped to federal food assistance programs such as the National School Lunch Program. The Department later issued a press release noting, “The United States enjoys one of the safest food supplies in the world.” Despite that assurance, food-related illnesses remain a significant public health problem. Each year in the U.S. there are approximately 80 million cases of food-borne illness. An estimated 300,000 people are hospitalized by “food poisoning” and 5,000 deaths occur annually. All of us have experienced a day or two of an illness we attributed to something we ate. These awful episodes usually are brief and without any lasting consequences. But that’s not always the case. Sometimes a cheeseburger or a piece of sushi can become a life-altering event. Between brief illness and unexpected death are a number of possible chronic after-effects or “sequelae.” These lingering conditions include arthritis, renal disease, neurological complications, and gastrointestinal disorders. It is estimated that chronic sequelae may occur in 2-3% of all food-borne illnesses. The best-known example may be E. coli O157, which has been found in contaminated hamburger meat. This bacterial strain produces a powerful toxin that ruptures red blood cells, damages kidneys, and causes a condition called Hemolytic Uremic Syndrome (HUS). It is the principal cause of kidney failure in children under the

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age of five. Dialysis is often required during recovery, and lifelong complications may include blindness, paralysis, and abnormal kidney function. Many types of bacteria normally associated with food-borne illnesses also can cause arthritis by spreading into joints to cause inflammation and permanent joint damage. Other food-borne bacteria such as Salmonella, Campylobacter, Shigella, and Yersinia may cause a “reactive arthritis” after infection. This type of arthritis seems to an immunologic reaction between certain genetic strains of bacteria and genetically predisposed individuals. For example, people with a genetic marker called HLA-B27 have an 18-fold greater risk of developing reactive arthritis following a food-related infection. Another serious complication is Guillain-Barré Syndrome (GBS). It is usually caused by a bacterium called Campylobacter jejuni, which is frequently found in undercooked poultry. GBS often begins with tingling sensations and muscle weakness in the feet and legs. Progressive muscle weakness may lead to difficulty speaking and swallowing, back pain, low blood pressure, and paralysis of the respiratory muscles. About 30% of patients require a ventilator in order to maintain normal respiration. GBS is a type of autoimmunity in which the patient’s own antibodies attack peripheral nerves following exposure to Campylobacter. Treatment involves removing harmful antibodies from the blood (plasmapheresis) or giving high doses of pooled antibodies (IVIG) to block the patient’s auto-antibodies. Recovery may take weeks or years, and about 30% of GBS patients still have residual weakness three years later.

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Various bacteria, amoebas, parasites, and rotaviruses may cause severe cases of diarrhea lasting for months or years. This chronic stress on the gastrointestinal system leads to loss of fluids, anorexia, and poor absorption of vital nutrients. Toxins also are important causes of food poisoning and chronic sequelae. One of the best known is Ciguatera, which is often found in barracuda, jacks, snappers and groupers. The toxin is produced by tiny plankton drifting in the warm oceans of the world. The plankton and toxins are ingested by small fish, which are eaten by larger fish, which are eventually eaten by people. The principle Ciguatera toxin is resistant to heat, stomach acid, drying, salting, smoking and marinating. Initial symptoms are typical of most food poisoning cases, but chronic symptoms may include serious neurological symptoms that may be mistaken for chronic fatigue, multiple sclerosis, or even brain tumors. Treatment and full recovery are both difficult. Similarly, the toxin that accumulates in shellfish during “red tide” algal blooms also survives cooking to cause serious and persistent neurological sequelae. As with Ciguatera, treatment is difficult. Sometimes some foods are dangerous, but we still have to eat. Given that reality, the Centers for Disease Control and Prevention (CDC) set up two national networks (FoodNet and PulseNet) to detect new outbreaks of food-borne illnesses. A patient advocacy group (www.safetables.org) also started a national registry of patients with long-term, food-related health problems. Earlier this month, CDC’s food expert, Robert Tauxe, was quoted as saying, “…if [the registry] stimulates interest and suggests that there are possible long-term health effects that haven’t been considered, then it is potentially useful.”

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