Be Afraid of Your Food: An Epidemiologist’s Sensible Advice

In the new issue of Lucky Peach, Amanda Kludt interviews her mother Patricia Kludt, head of the Epidemiology Program for Massachusetts Department of Public Health.

Amanda Kludt: What are the most common food-borne illnesses?

Pat Kludt: Illnesses from salmonella and campylobacter are probably the biggest by volume. Most chicken you purchase in the supermarket has one or both of these bugs. We also follow Listeria and toxin-producing bugs like E. coli O157:H7—the “raw hamburger” bug. Listeria is a more dangerous organism but it’s not something that attacks everyone equally.

Anything can spread widely in our present way of distributing food. It’s dangerous when our food is produced for mass distribution in one spot. If a single field is contaminated, then you have a whole lot of things contaminated and that spreads across the country. We see it more and more now. In the past we were never able to put cases together, but now we can look at the DNA of the organism and we get together and find the common thread.

Are vegetables as dangerous as meat?

Everything has its risk. As a whole, the food in the United States is really very safe, but there can be large countrywide outbreaks. We found salmonella in peanut butter. The peanut butter went into jars of peanut butter, crackers, cookies, and ice cream, among other products. There were just so many places this peanut butter went. It was very difficult to find out what everyone ate to get us back to the plant.

If people wash their fruit, will they be okay?

We found that people are less likely to become ill if they at least rinse their produce. Think about a watermelon. You get a whole watermelon, and you just bring it home from the store, and you slice into it. But you’ve now sliced whatever was on the outside of the watermelon into the inside.

If I pick up a container of blackberries in February, they’re coming from Ecuador or Guatemala. You wouldn’t eat those berries unwashed if you were in Guatemala or Ecuador, right? You would try to wash them; you would try to sanitize them in some way.

As an epidemiologist and my mom, what were some things you forbade my sister and me from eating as kids?

I didn’t come to this job until you were 8 and Megan was 12, so until then I had no idea, and that’s still a problem we face now—people having no idea. The first case of Shiga toxin-producing E. coli in burgers wasn’t even identified as a food problem until 1982, so it’s quite new. When I started the job in 1992 it was well established as a pathogen, and that was the end of pink burgers for you and for me. The Northeast had also just recently begun seeing salmonella in eggs. That was the end of runny eggs for us.

The E. colis that produce toxins can be especially bad in children. There are a number of them now besides E. coli O157. There was a large outbreak in 2011 that affected many countries, starting with Germany. It came with bean sprouts. But E. coli O157, which is found in the intestines of cattle, is still the most common. Slaughtering cattle is not a very clean process and meat can become contaminated from the intestines. That’s why we always want people to cook their hamburgers all the way through, especially for kids: they are the most at risk for deadly complications. If you’re going to eat a raw hamburger, fine, just don’t feed it to your kids. Make their burgers well done. With a steak, theoretically since it’s a slice of meat, any organisms from the intestines or outside of the meat won’t reach the inside of the steak. You can broil the top and the bottom, and you’ll be okay. But when you grind up meat for hamburger, it’s all mixed up—any contamination from the slaughter is going to be on the inside of the hamburger and on the outside. So you really want to treat that hamburger as if it’s full of contaminants.

I think people need to be willing to pay more for food. It costs more to operate a cleaner environment. It costs more to regulate the food industry to make sure safe practices are being followed.

What are the big things people need to do to avoid getting sick?

They need to cook most foods thoroughly, follow the directions on the packages, wash their hands.

We had an outbreak of E. coli O157 in raw cookie dough. You’re supposed to cook it before you eat it, so manufacturers don’t include a step to kill bacteria in production. No particular ingredient was a potentially hazardous food. But something got contaminated. And because there wasn’t that kill step, people got sick. It was interesting to see how many people ate it raw—a lot.

Another thing we’re seeing is that people don’t know the wattage of their microwaves. The instructions on microwavable dinners are for a particular wattage. Microwaves vary from model to model, and can range from about 300 watts to 1000 watts or more. People blindly following instructions may not realize they have microwaves with a wattage lower than the instructions specify. These people may not cook things long enough, to a safe internal temperature.

There are certain things I prefer not to eat. One in ten thousand eggs are contaminated with salmonella. I’ve had no problems ordering two eggs over easy, because what are my chances that one of those is the one in ten thousand? But, at a restaurant where they start cracking and beating eggs together at the beginning of a shift, your chances increase of getting that contaminated egg. If I’m making angel food cake with 10 to 12 eggs, I’m not going to let you lick the beater.

People who like drinking raw milk and eating rare burgers—are there any precautions they can take while still enjoying the thing they want?

Just know your farm. Know where it’s coming from. Feel comfortable with your food source. If you’re going to drink raw milk, go to the farm, talk to the people, trust them. Not that they can always know that their cows don’t have salmonella or E. coli, but at least you can feel comfortable that if they do know they have an unhealthy animal, they won’t give you that milk.

There are rules in place, because some states allow the sale of raw milk. Massachusetts allows it at the farm. Some states allow it in stores. There are rules about how it gets bottled and sold, but I would feel more comfortable if I could meet my milk producer down the road. And the smaller the herd, the better it’s going to be.

We have come a long way with milk to make sure it’s safe, mostly because of pasteurization. There are other opinions, and we respect those other opinions, but our opinion is that pasteurization prevents the spread of pathogens through milk.

What can we reasonably do to fix our current system and minimize the risks?

I think people need to be willing to pay more for food. It costs more to operate a cleaner environment. It costs more to regulate the food industry to make sure safe practices are being followed. The federal government needs to be more efficient when it comes to overseeing the food supply. Right now, the USDA oversees some things, the FDA others, and the interaction between the two does not always go smoothly. They only discovered the peanut-butter outbreak because there was an outbreak. The system is reactive and not proactive.

What are you worried about in general in terms of food safety? Where are we headed?

I am worried where the next outbreak is going to come from. It’s already showing up where we never expected: snack foods, peanut butter, leafy greens, cookie dough, tomatoes, peppers, cheese, apple cider, orange juice, berries, oysters. We can make a lot of people sick from just being stupid, careless, cheap, and greedy.

An excerpt from the “Apocalypse” issue of Lucky Peach magazine, published by McSweeney’s. To order, click here.