C O V E R
S T O R Y
COMPLICATIONS CAN LAST YEARS
“A
lot of people think that food poisoning is nothing more than
a case of the green-apple two-step,” says Food and Drug
Administration food-safety expert Morris Potter. He’s talking about
diarrhea.
Yet in a certain percentage of cases (researchers aren’t sure how
high), a bout of food poisoning can lead to arthritis, kidney damage,
or temporary paralysis.
The kidney damage—which affects mostly young children—is the
result of hemolytic uremic syndrome. The paralysis is a symptom of
Guillain-Barré Syndrome. And the arthritis isn’t the typical osteoarthritis that strikes so many older people or the less-common rheumatoid
arthritis that can cripple victims as young as six months. It’s called
reactive arthritis—an inflammation in the joints that’s triggered by an
infection and that can last anywhere from several weeks to a lifetime.
It’s hard to get a handle on the long-term complications of food poisoning. Symptoms may not appear until weeks after a person recovers
from the initial diarrhea or other GI distress. A new study suggests
that the problem may be more serious than anybody suspected. A
month after a 1994 Salmonella food-poisoning outbreak in Washington
state, some one out of five victims complained of arthritis pain.1
Photo: FoodPix.
“We don’t do a good job of predicting which people who develop
an acute food-borne infection will go on to develop chronic complications,” says Potter.
Guillain-Barré Syndrome
“It was devastating to lose control over
my body so quickly and so completely,”
remembers George Jones of Piscataway,
New Jersey. “I was having breakfast
with my daughter five years ago when I
felt a tingling in my fingertips and toes
that progressed up my arms and legs.
Within two days, I couldn’t walk, and
it just continued to get worse and
worse until two weeks later I was completely paralyzed. I couldn’t move my
arms or legs or head. Just my eyelids.
“The terror of being utterly helpless
was unimaginable. But gradually I got
better, and after six weeks in the hospital and in rehabilitation I was able to
go home. I was lucky. I made about a
98 percent recovery. Some people suffer lifelong problems from GBS.”
GBS, or Guillain-Barré Syndrome,
strikes an estimated 3,000 to 6,000
people a year in the U.S. It’s a terrifying disease in which the body’s
immune system strips away the sheathing that protects the nerves that
extend out from the brain and spinal
cord. What begins as a tingling sensation in the arms and legs can
progress—sometimes within days—to
paralysis.
Five to ten percent of GBS victims
die, and another 15 to 20 percent are
left with nerve damage that, in some
cases, leaves them unable to care for
themselves. One in five victims temporarily need ventilators to keep them
breathing while their bodies fight off
the disease. There is no known cure.
While scientists don’t know what
causes Guillain-Barré Syndrome, they
do know that more than half the cases
occur soon after a bacterial or viral
infection. That could be anything
from a sore throat to food poisoning.
“Evidence is growing that the most
important trigger of GBS is the bacterium Campylobacter jejuni, which
causes the greatest number of foodborne illnesses in the U.S. each year,”
says Ban Mishu Allos of the Vanderbilt
University School of Medicine in
Nashville.
“At least 30 to 40 percent of GBS
patients have been infected with
Campylobacter during the two weeks
before the start of their illness,” she
adds. That’s based on studies in six different countries.2
Worse still, the people whose
Guillain-Barré Syndrome is triggered by
Campylobacter instead of a virus,
another bacterium, or some other
mechanism, are likely to suffer greater
nerve damage.2
How do people get Campylobacter
infections? “More than 70 percent of
( C o n t i n u e d on page 4 )
NUTRITION ACTION HEALTHLETTER ■ M A Y 2 0 0 2
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C O V E R
the cases are associated with eating
chicken,” says Allos.
In fact, that package of chicken you
drop into your shopping cart is probably already contaminated. In the summer of 2000, Consumer Reports magazine tested four national brands of
poultry. Seventy percent of the samples were contaminated with
Campylobacter.
Fortunately, thorough cooking
destroys Campylobacter. And even if
you do get food poisoning, your odds
of coming down with Guillain-Barré
S T O R Y
Syndrome are slim.
But once the bug strikes, there’s no
way to lower your risk of developing
GBS. Within a few weeks, you’ll either
get it or you won’t. “So consumers
should do their best to avoid Campylobacter in the first place,” says Allos.
(See “Safe at the Plate.”)
Reactive Arthritis
When the Pope visited Ontario,
Canada, in 1984, 432 of the police officers who helped provide security fell ill
from Salmonella food poisoning. Over
“I su re wou ld lov e m y
o ld life and b ody ba ck”
Eight months prior to getting sick, I went on a diet
of only vegetables, fruit, and chicken, tons of
chicken. My children teased me about sprouting
wings. In January of 1996, I celebrated my 36th
birthday and felt like I was in the prime of my life.
On February 14, I noticed that my feet were both
tingling, as if they were in a deep sleep and
wouldn’t wake up. Eight hours later, I collapsed
and could not bear weight on my legs. By
February 16, I was fully paralyzed to my waist. After a spinal tap, doctors
confirmed that I had Guillain-Barré Syndrome. Every day I became much
worse. I was moved to the Intensive Care Unit and put on life-support, for I
could no longer breathe on my own and was totally paralyzed. All I could
move were my eyes and the tip of one finger. I couldn’t believe the amount
of pain I was in, didn’t know it was humanly possible. There were so many
tubes and machines—nothing in my body was working anymore. I nearly
died three times. I wasn’t expected to live.
After 21/2 or so months I started getting a little better, but the pain was still
extreme. I was finally weaned off the ventilator, feeding tube, etc. I started
relearning how to move my arms and hands. It was very hard and humiliating to once again learn how to eat, drink, etc. No one expected that I’d
ever write again, and walking someday seemed to not be possible. Over the
Photo courtesy Mary Milne.
months I got better. I now do everything I used to. It’s just a lot harder.
I sure have a fear of poultry, no matter how properly it is handled or
cooked. I sure would love my old life and body back.
—Mary Milne, 42
FAIRY GLEN, SASKATCHEWAN, CANADA
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NUTRITION ACTION HEALTHLETTER ■ M A Y 2 0 0 2
the next three months, 27 of them
developed reactive arthritis. Five years
later, 18 still showed symptoms, and
four had become too incapacitated to
work as police officers.
In 1994, 800 people attending a
company-sponsored Thanksgiving banquet in the Tacoma, Washington, area
ate turkey and dressing that were contaminated with Salmonella enteritidis
bacteria. Of the 400 who became sick,
one in three had diarrhea for more
than a week, and one in ten got it so
bad that they ended up at the
hospital.1 But for many, diarrhea
turned out to be the least of their problems.
“Within one month of getting sick,
29 percent of those who came down
with food poisoning reported pain,
swelling, or redness at their joints,”
says Mark Dworkin, now at the Illinois
Department of Public Health in
Chicago. As with Guillain-Barré
Syndrome, those who had the worst
bouts of food poisoning were the most
likely to get reactive arthritis.
The investigators didn’t follow the
people for more than a month, so it’s
impossible to know how many continued to suffer. But in other studies,
joint pain brought on by food poisoning lasted for years.3 And other bugs—
like Shigella, Yersinia, Campylobacter,
and Clostridia—can also cause lasting
joint pain.4
Hemolytic Uremic Syndrome
The Jack in the Box food poisoning
outbreak of 1993 is a distant memory
for most of us. But that may not be
true for the 700 people in Washington,
California, Nevada, and Idaho who
became ill after eating undercooked
hamburgers made from ground beef
that was contaminated with E. coli
O157:H7 bacteria.
Four children died and dozens were
hospitalized with kidney problems and
bleeding. One young victim required a
kidney transplant. Three others had
their gallbladders removed.
Brianne Kiner, now a teenager, suffered the worst of those who survived.
Six weeks in a coma left Brianne so disabled that she needed five years of
rehabilitation before she could return
to school. Her pancreas shut down, so
she has to inject herself with insulin
C O V E R
every day for her diabetes. Her large
intestine was removed and her kidneys
were so weakened that she will be
unable to have children. And she has
to take anticonvulsants to control her
seizures and antacids because her stomach lining is damaged.
“My life has changed immensely due
to what happened nine years ago,” says
Brianne. “If I had never become ill, I
never would have had to deal with diabetes. If I had never become ill, I
never would have had this sense of
constant supervision. I’m always going
to feel like I’m under a piece of glass
because other people are afraid of what
is going to happen to me because they
don’t know how my body is going to
react.”
E. coli O157:H7 is one nasty bug.
According to the Centers for Disease
Control and Prevention (CDC), five to
ten percent of the young children who
become sick from the bacterium
develop hemolytic uremic syndrome
(HUS). Bloody diarrhea is usually the
first sign that the disease has started
destroying red blood cells, damaging
blood vessel walls, and attacking the
kidneys.
Ninety percent of hemolytic uremic
syndrome cases occur in children
under the age of three. About one in
20 children who get it suffer a slow and
agonizing death, as one organ after
another stops functioning. For those
who survive, one in three sustain permanent kidney damage and close to
one in ten develop other lifelong complications like high blood pressure or
recurring seizures.
“The only way to prevent hemolytic
uremic syndrome from striking children is to prevent the E. coli infection
in the first place,” says Philip Tarr of
the University of Washington in
Seattle. “Once diarrhea occurs, it’s
quite likely futile to try to stop HUS
from developing, because the bacteria’s
toxin is already damaging the blood
vessels.”
While you’re most likely to come
across E. coli O157:H7 in undercooked
ground beef, you can also get it from
lettuce, which can become contaminated with manure through fertilizer or
tainted water, says the CDC. Other
sources: steaks and roasts, unpasteurized fruit juice and cider (the FDA
S T O R Y
requires that they carry a warning
label), and unpasteurized milk (it’s
legal, as long as it doesn’t cross state
lines). ■
S A F E
AT
1
Clinical Infectious Diseases 33: 1010, 2001.
Infect. Dis. Clin. N. Amer. 12: 173, 1998.
3
Ann. Rheum. Dis. 56: 516, 1997.
4
Amer. Fam. Physician 60: 499, 1999.
2
T H E
P L AT E
AT THE STORE
■
Don’t let juice from raw meat, poultry, or fish drip on to your hands or
■
Shop for cold and frozen foods last and put them in the refrigerator or
■
Avoid unpasteurized milk and juice, as well as foods that could contain
any fresh foods in your grocery cart (or in your kitchen).
freezer as soon as possible.
raw or undercooked eggs (among them: homemade or some restaurants’ mayonnaise, eggnog, Caesar salad dressing, ice cream, mousse,
meringue, or Béarnaise or Hollandaise sauce). And if your cookie or
cake recipes call for eggs, make sure you don’t eat—or let kids eat—
any of the raw dough.
IN THE KITCHEN
■
Always wash your hands in hot, soapy water before and after handling
raw meat, poultry, seafood, or eggs.
■
Keep your refrigerator at 40°F or less and your freezer at 0°F.
■
Don’t store raw or defrosted fish, poultry, or ground beef for more
than two days, and other raw meats for more than five days.
■
Thaw frozen foods in the fridge or defrost them in the microwave, not
■
Cook meats thoroughly. Use a meat thermometer in the thickest part
at room temperature.
of the meat, but don’t insert it until the outside is seared (if not, the
thermometer could carry bacteria from the surface of the meat to the
interior). The U.S. Department of Agriculture says to cook your meat
at least to these internal temperatures:
145°F—beef, lamb, veal
160°F—ground beef, lamb, veal; all pork cuts
165°F—ground poultry
170°F—chicken breast
180°F—other chicken parts, whole chicken or turkey
(measured in the thigh)
■
Always heat your marinades before basting meat or poultry.
■
To keep bacteria from growing, put your sponge or scouring pad in
the dishwasher every time you run it.
■
People at high risk for food-borne disease (children,
the elderly, and people with compromised
immune systems) shouldn’t eat raw alfalfa or
beans sprouts. If you are a healthy adult,
only buy sprouts that are refrigerated, and
rinse them thoroughly with water before
you use them.
NUTRITION ACTION HEALTHLETTER ■ M A Y 2 0 0 2
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