Holiday Food Poisoning
Protect yourself and your guests
As you party into the wee hours this holiday season, think twice before you do that late-night nibbling at the buffet table, particularly if it has been sitting out for a while. One bite of crab dip or deviled eggs gone bad, and you may be moving the party to the bathroom—or the hospital. While food poisoning is often associated with summer barbecues and potato salad, the holiday season is just as risky.
The gift that keeps on giving
Food poisoning or intestinal infection happens when bacteria, viruses, parasites or toxins contaminate food. Harmful bacteria cause most outbreaks. Given the right conditions—an unwashed cutting board or serving dish left out too long—these bacteria may grow and multiply in your food, and make you sick to your stomach.
The most common bacteria that cause foodborne infections are Campylobacter, Salmonella and E. coli. Both Campylobacter and Salmonella are commonly found in raw poultry. Salmonella, which may also contaminate eggs and seafood, has even been found in produce such as lettuce.
E. coli is usually found in undercooked beef, but has also been found in produce. The harmful bacteria Vibrio vulnificus is a common cause of life threatening infection from shellfish and oysters usually in persons with underlying medical conditions.
Most cases of foodborne disease caused by these bacteria feel similar to the "stomach flu" and may start a few hours after eating the offending dish or as long as nine days later.
“The difference (in the onset of food poisoning after eating the food) is the dose,” says infectious disease and travel medicine expert Herbert L. DuPont, MD, director of the Center for Infectious Diseases at The University of Texas School of Public Health, a part of The University of Texas Health Science Center at Houston (UTHealth). “The more bugs or toxins you swallow, the shorter the incubation period. The fewer you swallow, the longer the incubation period.”
Symptoms of foodborne disease can range from mild to serious and include abdominal cramps, nausea, vomiting, diarrhea, fever and dehydration. The illness is not usually a big deal for most healthy people. In fact, if you have had an unexplained case of diarrhea once this year, you have probably had a foodborne illness.
“But for debilitated or elderly persons, AIDS patients or infants, it can be life threatening,” DuPont says. “You have got to be careful when preparing foods for these people.”
Other serious sources of foodborne disease include Listeria monocytogenes—found in unpasteurized dairy products, ready-to-eat meats and certain soft cheeses—which can cause some pregnant women to miscarry. Clostridium botulinum (causing the disease, botulism), usually caused by improper canning, can cause death.
A small percentage of people who get bacterial food poisoning also develop long-term illnesses as a result. For example, certain strains of E. coli can cause kidney failure in young children and infants. Salmonella can lead to reactive arthritis and serious infections. Listeria can cause meningitis and Campylobacter may lead to Guillain-Barre syndrome, a nervous system disorder that can cause paralysis that may produce permanent disability.
Protect your holiday guests
Thankfully, most cases of foodborne disease can be avoided. By properly preparing and serving food, you can protect your guests and your reputation as a gracious and conscientious host.
Keep it clean
- Prepare all food on a clean and disinfected surface.
- After handling potentially contaminated food like poultry, wash your hands with simple soap (for at least 15 seconds.)
- Carefully clean surfaces that come in contact with food often, especially when preparing raw meat, poultry and seafood. Bacteria can spread in the kitchen and get on cutting boards, knives, sponges and countertops.
- Use hot water and soap to clean work areas.
- Use the gift of gravity: hold knives, forks, cutting boards at an angle under running hot water so that the food matter runs downhill into the sink.
Buy quality meat and cook it well
Buy the best quality meat you can afford, the leaner the better. When cooking ground beef, cook until it is no longer pink inside. If you like your meat a little on the rare side, choose a solid cut of meat, like a steak, DuPont says, because cooking the meat kills the bacteria that grows on the surface of the meat.
“You can have a rare steak, but not a rare hamburger, because the surface of the meat is inside the hamburger,” he says.
When in doubt of whether the meat is safely cooked, use a meat thermometer. Cook fresh pork to at least 160 degrees Fahrenheit, poultry to at least 165 degrees F., and ground beef to 160 degrees F. To check, insert the thermometer in the middle of the cut of meat.
For poultry, insert the thermometer into the thickest, meatiest part of the thigh, being careful to avoid the bone. For other cuts of meat, consult your recipe or The United States Department of Agriculture’s chart or internal meat cooking temperatures.
Cook, then chill
Promptly refrigerate the foods you cook, to keep harmful bacteria from growing and multiplying. For instance, if you have just made a huge vat of hot stew and its very presence in your refrigerator will heat up your colder foods, place the entire pot in a sink full of ice and water to speed cooling. Then, get it in the refrigerator as soon as possible.
Think about what you drink
Some foods are more risky for food poisoning than others. Love eggnog? Buy the pasteurized version from the grocery store to be on the safe side. Traditional recipes for eggnog call for raw eggs, which can contain Salmonella. While your head's in the cooler, pick up some pasteurized apple cider. Unpasteurized juice may contain harmful bacteria.
Open that food gift early
Be careful when serving mail-order food gifts that include meat, fish or other perishables like cheese, fruit and cheesecake. Refrigerate these gifts immediately when you receive them. Also, if the food is labeled, "keep refrigerated," make sure it is still in a chilled state when it arrives.
Keep hot food hot, cold food cold
Food should not be left out for more than two hours in settings where the temperature runs from 40 degrees to 140 degrees Fahrenheit. Use a food thermometer to check. Some warming trays or chafing dishes will only hold food at 110-120 degrees F. Cold foods should be kept at 40 degrees F. or colder. Put plates of cold food on ice if food is going to stay on the buffet table longer than two hours.
Keep the food coming
When preparing a buffet, keep portions small, so food doesn't sit out long. Store cold back-up dishes in the refrigerator and keep hot dishes in the oven, set at 200-250 degrees. Replace all empty food bowls and platters with new, fresh ones. Don't add new food to an old serving dish. The dish was probably touched many times by your guests, and could be contaminated.
As a guest, you can do your part to reduce your risk for developing food poisoning. For example, wash your hands often and avoid lukewarm foods if they are meant to be hot or cold.
Also, steer clear of foods like raw meats and fish and undercooked meats. Food containing a mix of several ingredients, such as potato salad, egg salad and tuna salad are often risky if they are not kept cold.
If you do get sick...
If you feel sick from something you ate and your symptoms are severe, see a doctor or get emergency help. This is especially important for those who are immune-compromised, diabetic, heart patients, or have medical conditions that make you more vulnerable to food poisoning.
For mild cases of food poisoning, drink plenty of liquids and food with salt to replace or prevent dehydration, DuPont says.
“Soups are really good for diarrhea and vomiting,” he adds, “They have both salt and fluid in them.”
He also recommends eating bland foods such as saltine crackers, applesauce and bananas.
“Once the advice was not to feed people with diarrhea, but the intestinal lining has to renew itself, and calories from food provide energy to do that.”
Vomiting and diarrhea is the body’s defense mechanism against bacteria and toxins, “to a point,” he adds. They help get the bad stuff out of the body. But continuous diarrhea and vomiting is a nuisance for most people in westernized countries and can kill people in the undeveloped world. Medicines such as Pepto-Bismol and Imodium can significantly cut the amount of diarrhea a person with foodborne disease experiences, and make recovery much more pleasant. But remember, if blood can be seen in stools that are passed or there is fever, search out a medical evaluation.
What you always wanted to know, but were too afraid to ask
Are eggs safe? Should we hold the mayo? Herbert L. DuPont, MD, answers your burning questions about food safety, so you can approach your holiday feasts without fear.
Q: There have been a lot of egg recalls because of salmonella. So are sunny-side up and soft boiled eggs a thing of the past?
Contamination of eggs with Salmonella is actually rare—we are talking about 1 in 20,000 eggs. The problem is that Salmonella is the normal flora in a chicken. It can get directly inside the eggs. What we recommend is not to eat raw eggs. Cook your eggs and don’t use raw eggs in Caesar salad and milk.
You can have eggs soft-boiled. As long as you heat them up, they should be OK.
Q: Why is pork so maligned?
Pork has a bad reputation, and it is probably no longer valid. We had a problem with trichinosis (a roundworm infection that can invade the muscle tissue of the heart, lungs and brain) some decades ago, but now it is almost extinct in the United States. If you cook pork thoroughly you will be sure of food safety.
Q: Which is more dangerous when left out on the counter: mayonnaise or butter?
Mayonnaise is one of those things like trichinosis. It was very common for it to contain Salmonella, but now it is commercially made and it is extremely safe, so Salmonella in commercial mayonnaise is virtually never a problem. Watch out for homemade mayo, however. It needs to be refrigerated whenever possible.
Butter has been pasteurized and it has a very low bacteria count, and it takes a long time for it (bacterial growth) to be a problem.
Q: What about bagged lettuce and spinach? The bag says it is triple washed. Can we trust it?
No. My granddaughter actually did a study once on contamination in lettuce. Organic, inorganic, all over the city, she found contamination rates in all of her samples.
The E. coli, if it is present, is internalized in the root system; it is in the whole plant. This particular E. coli is a “low dose” pathogen. That means you only have to swallow a few to make you sick. It is hard to clean your lettuce and spinach, but everything in infectious disease is a dose reduction. The smaller the dose of E. coli, the less chance you will get sick.
Give anything that is potentially contaminated—grapes, lettuce, strawberries, and anything with an intact skin—a “bath and a shower”. Put it in a big tub of water and swish it around and then put it in a colander and hit it with the water faucet several times.
Q: What about pre-chopped vegetables that we can buy already cut-up?
I think if you are going to cook it, you don’t have to worry about it. But if you are going to eat it raw, give it a bath and shower.
Q: My grandmother always washed off the meat—particularly the chicken—in running water. Should we?
I don’t think washing it matters because we cook the meat. If you are making sushi and steak tartar, do everything you can to make it clean.
Q: Why do some bugs make you sick within an hour and others sick within three days?
There are two kinds of foodborne infectious disease, the first is food poisoning and comes from swallowing a poison, a toxin, produced by bacteria. For example, Staphylococcus aureus in food produces a toxin that causes severe vomiting. You get enough toxin in the food, it is indestructible. It goes through the stomach and produces vomiting and diarrhea two and four hours later.
Foodborne infections come from other bacteria and viruses, such as Salmonella, Nororviruses (which cause an estimated 23 million cases of gastroenteritis a year and half of foodborne infectious disease a year), Shigella and Campylobacter. They have to get through the stomach and then attach to the gut and invade the bloodstream. All that takes time. For these foodborne infections the onset is more than 14 hours, usually two to three days, and as long as nine days.
Q: If you get sick from food poisoning while you’re traveling—like overseas—what do you do?
All travelers going to high-risk countries should be armed with antibiotic therapy—and get it beforehand. It should start working pretty quickly. But if they don’t improve, they should go see someone for medical help. Hopefully when they come home, the antibiotics should work if they get the right kind.