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.”