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Thursday, September 23, 2010

2.5 Safe Eating/Avoid Toxins/Mad Cow Prion Diseases

Physician's Notebooks 2 - http://physiciansnotebook.blogspot.com - See Homepage
2.5: Food Poisoning - Updated 26 Aug. 2018
These contents are in the order they appear. Use for search & find or scrolling down.
 Wash hands! Wash hands! Wash hands! 
Warning: Plastic Forks
Canned food  
Restaurant Eats 
Berry, fruit and green
Hunted, Killed Eats 
Meat
Safe Eating Technique
Botulism
Staphylococcal Poisoning
Bacterial or Virus Food-borne Illness
Cholera
Fish & Shellfish Poisoning
Hives from shellfish
Plant Poisoning – Mushroom
Delayed Infection from Prion in Food & Drink, Mad Cow
Metal Poisoning
Wash raw fruit and veg well in hot water
Biotech Genetically Altered Food

“Organic”, “natural”, “chemically free

Before touching food you prepare or eat: Wash hands ! Wash hands ! Wash hands ! 
   Limit raw food you eat to fruit and edible vegetable and wash everything (Note: in Japan sashimi, or uncooked raw fish, is relatively safe; it is frequent and tasty and has low cholesterol benefit so it may be eaten without worry over health as long as you get it from an authorized store or restaurant); other foods boil or microwave not less than 2 minutes; eat meat well-done; and serve heated drink and soup “pipin’ hot" (to 70 degree C) well below boil.
Warning: Plastic Forks: The fork prongs occasionally break (It just happened again); it has happened to me 3 or 4 times. A broken off, free prong may inadvertently be swallowed and, like a swallowed toothpick, become a dangerous sharp in the GI tract causing perforation and abscess and ruining or ending a life. The U.S. novelist, Sherwood Anderson is a case: Anderson died in 1941, at the age of 64. He had been feeling abdominal discomfort for a few days, which was later diagnosed as peritonitis. He died on March 8th. An autopsy revealed he had accidentally swallowed a toothpick, it perforated his intestine, and resulted in infection and then peritonitis. He was thought to have swallowed it in the course of eating the olive of a martini or hors d'oeuvres.
Canned food: If any sign of damage, do not eat. Once you open a can – empty the uneaten part into dish, cook and eat or cover and immediately refrigerate.
Restaurant Eats: Be vigilant, No open buffet and well cooked; no raw food except sashimi from a clean, Japanese restaurant or market. If oversea tourist, prefer Class-A hotel restaurant.
Berry, fruit and green:  Stick to familiar known plant; wash well.
Hunted killed animal eats: Avoid eating because risk of trichinosis and other parasite, and mad cow disease.
Meat: Tend toward being vegetarian. Most to least order of safe is seafood (but not from polluted waters), fowl, red meat. Well cooked.

Safe-eating technique: Delay ! Slow ! Slow ! Slow ! Put off eating ! Be last at table to put food into mouth ! Start with test bite and small, slow swallow. Keep vigilant for strange appearance, odor, taste, the feel of a sharp or anything unusual and be ready to suddenly spit out partly chewed food if slightest strangeness noted. (18 July 2013 Patna India fatal mass poisonings from free school lunch that could have been prevented by safer eating) Avoid esoteric food.

Botulism: Symptom may come on early or take up to 36 hrs after eating from jar or can food or beverage contaminated with botulinus toxin from Clostridium botulinum spore that germinates in improperly processed food. Also occurs from eating esoteric foods from foreign country restaurants. It is more often due to home-preserve than to commercial product. Vegetable (Recent recall of canned green bean) and home-cured ham most. In infant, it has followed the ingestion of natural (raw) honey that has C. botulinum spore, with toxin being produced in stomach over several hours. Note recent botulism from container carrot juice, processed “organically.” All juice you drink should be pasteurized.
California, Washington, Colorado, New Mexico, and Oregon account for more than half reported botulism in U.S. because their location mostly high above sea level allows water to boil below 212F (100C). 
Flash ! I discovered a botulism from an Asian restaurant in Salinas California during which 7 Japanese-tourists came down with acute diarrhea and one went on to develop complete paralysis starting within the 24 hours after eating. The main difference between the botulism patient and his fellow diners was that he ate pilaf that had crab, shrimp and whitefish in it. (Note: pilaf is rice that is cooked in seasoned broth with onion, a mix of spices, and also meat, vegetables and dried fruits from cans; this last is a usual cause of the botulism) Time of eating was 12 noon, 10 April 2015 and first important symptom - diplopia (double vision) noted by his wife 12 Noon, 11 April, and he was admitted to hospital on 12 April and became totally paralyzed, being kept alive on ventilator through tracheotomy. 
The botulinum toxin is relatively resistant to heat, but 15-minute boil at sea level should deactivate it. Botulism is one reason not to eat from home food-preserve in jar or can unless boiled prior to eating; and also a reason not to eat esoteric food in foreign restaurants.
Once a symptom develops, botulism has high fatality rate because of widespread paralysis. Quickly giving botulinum trivalent antitoxin, available from Center for Disease Control  & Prevention in Atlanta Georgia USA and usually stocked in major medical center, will save botulism victim but diagnosis must be made on symptom very soon. When non-human animal anti-serum is used, always have pre skin test for allergy. At onset, botulism may be confused with stomach flu because of initial headache, nausea and vomiting. As it worsens, victim complains of “weird eyes” – blurred and double vision, inability to lift eyelid and the cross-eyed look – and it gets misdiagnosed as stroke. Suspect it with recent eating of unusual canned or bottled food, strange salad, or “organically” processed food.

Staphylococcal Poisoning occurs where bacteria produce toxin in food just before it is eaten. A few staph bacteria get in food and multiply to produce toxin that causes illness if eaten after a few hrs. (A 2-minute hi-W microwave heat will prevent) The toxin-forming staphylococci are normal inhabitants on human skin so the contaminator is often healthy.
   It starts as explosive nausea and vomiting, upper belly cramp and diarrhea soon after eating – early as 15 minutes. Victim is prostrated but recovery rapid after one has ‘vomited one’s gut out’. Death is infrequent, mostly in the old or chronically ill; diabetics are at special risk because the vomiting and diarrhea leads to acidosis.
   Treatment is with intravenous hydration at ER of hospital. Often poisoning strikes large group after eating buffet. Be vigilant to catered food, especially creamy cake, custard, cream soup, food with mayonnaise and similar creamy stuff. The stuffing of a turkey is common offender. Smorgasbord, salad bar, buffet, and Viking-style food are asking for it. Considering that well-cooked, immediately eaten and refrigerated food is usually proof against staph food poisoning, a preventive aphorism for the discriminating diner is “Keep it hot, keep it fridge-cold or eat it right away.”

Bacterial or Virus Food-borne Illness: In this set are normal intestine germs like E. coli that contaminate food and give symptom of colicky (builds to peak then lets up at regular several minute intervals) central abdomen pain, diarrhea, and foul-smell flatus. Due to bad food. Advice – Be selective before putting food into mouth, especially avoid cheap stuff; wash hands, cook food well and eat promptly.

Cholera is spread by vibrio bacteria-contaminated water from river, seashore and can get into the drinking water, and occurs as the weather warms in spring. It is deadly because its toxin causes massive diarrhea that rapidly and severely dehydrates and puts patient into collapse shock. Today it is only a rare risk in U.S or Japan. But consult HIFIT (US government travel health book) if you will travel off the beaten track. The older injection cholera vaccine has been abandoned as U.S. traveler advice because of low effectiveness. A new oral cholera vaccine (Dukoral) is available in medical centers on request and should be used if you plan to travel to at-risk areas. Treatment is rehydration solution that can be taken orally.

Fish & Shellfish Poisoning: Nine types in flesh of edible fish and mussel can kill due to nerve toxin. The symptom starts within minutes as typical abdominal cramping but rapidly changes to numbness, itching and pins and needles especially about the lips, and sometimes double vision. Most danger comes in eating raw or poorly cooked fish. Don’t be lulled by raw fish being a commonly eaten species like tuna or bonito. Common food fish may be poisonous depending on where caught. If you are a fisherman and catch a blow-fish, do not eat it; the flesh above the tail contains a deadly toxin that may not be deactivated by cooking. In Japan, the blow-fish tail (In Japanese, Fugu) is a specialty, cooked in restaurant and is safe.
             Also, keep in mind hepatitis virus contamination of shellfish.
Prevention: Avoid raw food except in Japan sashimi, and eat while fresh.
Hives from shellfish is hypersensitivity reaction. It is small pale skin wheal surrounded by red halo and itchy but in worst case, the victim can get deadly swelling about mouth and in throat that could block off windpipe. Any suggestion of that is reason to go to hospital ER at once!

Plant Poisoning – Mushroom and Large Fungi: Picking wild herb, grass or leaf to make salad is not wise because of the toxic ones like Digitalis sp. (eg, purple foxglove perennial flowering plant). More frequently dangerous, are contaminants like DDT and other chemical, acid rain pollutant, and excretions from dog and cat.
   Be careful eating uncooked small, round red color berry – Atropa belladonna (deadly nightshade) that will give acute atropinism (rapid heart rate, dilated pupil, nightmare and hallucination).
   Wild mushroom poisoning is more serious. If you must hunt wild edible mushroom, get a book (like Mushroom Identifier by Peter Jordan, at Bronx Botanical Garden) and become expert. Never eat raw, even as test. After eating poison mushroom, the poisoning occurs in stages: Between 6 to 24 hour sees onset of belly pain, nausea, vomiting and diarrhea so severe it can lead to collapse from dehydration. Initial symptom may then subside lulling into feeling you have passed the worst. But while you seem to feel OK, the poison is damaging kidneys and liver and – by 3 or 4 days, liver and/or renal failure develop, with dark urine, yellowing of skin, and severe itching; then convulsion, coma and death in 40-90%. With first suggestion of mushroom poisoning, rush to emergency medical center.

Delayed Infection from Prion in Food & DrinkMad cow disease and Kuru (in New Guinea natives), Creutzfeld-Jacob disease (CJD), spongiform encephalopathy (the brain looks like sponge) and other prion (proteinaceous infectious –on) disease, are due to non-living infectious meat protein (prion) from an animal's nervous system that causes dementia.
   Prevention: Avoid eating meat obtained by hunting wild animal or eating uncooked or poorly cooked meat, and especially from eating brain and spinal cord no matter how well cooked. The prion is relatively resistant to heat; it is a protein so it can be destroyed by well-done cooking or boiling more than 15 min, but not by usual food processing (salting, pickling) or by Pasteurization. It may be passed in mother's milk or living tissue like transplant (Cornea transplant most reported; also in growth hormone treatments). All meat well cooked.

Metal Poisoning: Be mindful of fluid you may drink regularly every day: tap water; tea and coffee; canned or bottled or boxed beverage. Even low nontoxic metallic ion concentration in beverage taken regularly for more than 20 yrs can build in body to toxic level. (But don't become paranoid about it) Preventive: Avoid habitual beverage, especially from metal container; tap water to run 30+ secs before collecting and then filter before drinking, use Pyrex glass container for drinking and boiling beverage and plates you eat on, have your blood metal levels and at some point, the water you chronically drink tested. Use purified water like that from office machine as much as possible

Wash raw fruit and veg well in hot water, and peel outer surface where practicable. Have edge against take-out and restaurant in favor of make-it-yourself and eat it right away; and avoid the exotic in favor of the homegrown.

Biotech Genetically Altered Food: No evidence or reason to worry that genetically altered food is dangerous.

“Organic”, “natural”, “chemically free”, as in health food store should be viewed with suspicion. Even with government or other seal of approval, no way to know if it is accurate; the terms are too imprecise. Food poisonings do come from eating organic. I steer the other way whenever I hear, see or read these words.

  To start the basic science section now, click 2.6a Introduction to the Science Section

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