Melanie Cole, MS (Host): As the holidays approach, are you taking the right steps to ensure you or your loved ones don't contract a foodborne illness? Today, we're going to talk about how to avoid foodborne illnesses and maintain good health during the holidays. Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital.

I'm Melanie Cole and joining me today, we have a fan favorite, Dr. Anirudh Rai. He's a Primary Care physician at Henry Mayo Newhall Primary Care. Dr. Rai, it's always such a pleasure to have you join us today. So foodborne illnesses, I'm like a psycho when it comes to leaving mayonnaise out and potato salad, especially in the summer. But as we think about the holidays, people set up these lavish buffets and food sitting out. First of all, how common is this? Is it more common than we maybe do realize?

Anirudh Rai, MD: Yeah, it's a great question. According to the CDC, it's a pretty common illness. And that fact you brought up the holidays, actually, that is the, the most highest times we get more foodborne illnesses come up. According to the latest data I came across, actually Thanksgiving is actually the peak time where foodborne illnesses occur.

Host: Okay. So, I mean, it does make sense because as I'd said, we have these buffets spread out and everybody puts out so much food and sometimes food sits out for quite a long time. What foods are most commonly associated with this type of illness? People think mayonnaisey things, but that's in the summer and in the heat and outside. What are we looking at, Dr. Rai?

Anirudh Rai, MD: That's another good question, and they did do a survey actually, there was a survey of what are the most common food groups that are associated with foodborne illnesses, and this was a survey done in 2017. They found the highest was indeed turkey, and that was usually due to the Thanksgiving time, but the next one was actually chicken, poultry, those kind of dishes, pork was third, and fourth was actually beef. So you could tell by just the survey they took, uh, it was mostly meat based products that are the most common causes of foodborne illnesses.

Host: Well, I was thinking about the stuffing, you know, there's even that West Wing episode where he says you have to cook the stuffing outside of the bird because otherwise you could get a foodborne illness and people cook their stuffing inside, but it's got to get to a certain temperature. So meat, it's because we're not cooking it enough, right? It's not that it's bad meat necessarily. It's that we're maybe not cooking it to the temperatures that it needs to be cooked to?

Anirudh Rai, MD: That's a pretty complex question. The best way to describe is,

Host: I know. You can, you got this.

Anirudh Rai, MD: The best way to describe it is, I guess, the kind of inform people about the history of how food processing kind of came about. Back in the day, there were more of these small, I guess, organizations that distributed meat. Nowadays, we have pretty much centralized distribution kind of centers and where you have one contamination, it's a pretty massive effect that you feel throughout, either a state or even the nation from time to time. The thing about meats is it could occur in multiple ways. Usually, according to some other surveys they've done, the most common cause is actually when those who are handling food, essentially, butchers or meatery associates that when they handle food, that's where the most contamination occurs.

The other ones are cross contamination when the meat touches other things that are in there that they are not supposed to touch. That's usually the start of where you get some of these organisms on top of your food. The next step when it comes to the consumer, what can we do? Ideally it would be, like you mentioned, cooking at the right temperature and storing in the right places and not leaving it out so that other foodborne illnesses could be going on top of your product is another main thing to do, but it's a pretty complex sort of multifactorial system that is associated with foodborne illnesses and cooking is just one of them.

Host: Well, that does kind of freak me out a little when you talk about how it's processed, the evolution of how our food gets to us, because it can happen anywhere along that way. And there's nothing we could do about it. Now, how do we tell? Okay. So first we know, and you're going to give us great information, Dr. Rai, about not leaving our food out and that sort of thing. But how can we tell if rainbow meat, or if food has gone bad, or if there's some reason it's not cooked, or if an egg has not been processed or cooked thoroughly, or how do we know? Unless it's just that we wait to get sick, which is not ideal way.

Anirudh Rai, MD: That's another good question. I agree. I mean, there's a lot of different ways our food essentially could tell the consumer that it's bad or it's not in the right sort of place. I mean, the obvious ones, of course, are smells. And when things go bad, you could easily tell by the odor that's in the air. The other thing is if there's visual markers, if there are fungal growths or any kind of discharge, that's not associated with that food, that's another sign. These are kind of simple things that you can look for and

Host: Discharge? Did you really just say that? Okay, go on.

Anirudh Rai, MD: The other thing overall, I would say is, these foodborne illnesses, they typically occur in what they call ready made foods, foods that are just ready, and you just pick up and eat without cooking. Sushi is common for that, although we've come a long way to maintain that sort of status. Salads are another common cause of that, since, like you mentioned, buffet lines, people just get the salad and kind of just start eating it. And typically, in those situations, as soon as you consume it, that's when you kind of determine if you did get a foodborne illness. And there are different ways to determine what type of foodborne illnesses you may have gotten at that point.

Host: Yeah, I mean, it's obvious if you see rainbow meat. It's got a little rainbow on there. You're eating lunch meat and you know it's not supposed to have that. And salads are another one because that's an important one too, Dr. Rai, because we clean and wash our vegetables, or we're supposed to. But sometimes they do come inside with, as you say, a fungus or a mold or a bug or a something on there. So we want to make sure to clean it, but okay, so now we're looking, we're smelling, we're using our senses to be hopefully commonsensical about that. Now, what happens? We, if once we realize uh oh, something's not right here.

Anirudh Rai, MD: That's another good question.

Host: the worst part, right?

Anirudh Rai, MD: When you consume it and you get the symptoms, that is the worst part. That itself is another complex sort of I guess thing to talk about in general. There are many ways to kind of consume something. Like we mentioned before, there's a bacteria, a fungus, a toxin, a virus. There's different ways the world around us could actually contaminate us in many different arenas, so to speak, and most of the time, I would say, it goes with the cross contamination of how people handle a food. That's one of the most common ways these kind of contaminants get introduced into our system.

And ideally, the best way to kind of know what happens is how often or how fast the symptoms have, I guess, been given to you, so to speak. So when you consume a food, how quickly you get the symptoms is usually a sign of whether it's going to resolve a bit faster or whether you might beor whether you might be in here for the long run, so to speak. For example, if you ingest a toxin versus the actual organism, the symptoms are pretty quick, and they resolve pretty quickly, too, because your body wants to get rid of that as soon as it can, and it's easy to that. If you consume an organism, it does take a while for the organism to actually divide and grow inside of your stomach, so to speak. And when that happens, that's when your body starts reacting. So there's these timeframes, we, we as physicians kind of keep an eye on saying, Hey, did you consume a toxin? Which is essentially if you leave food out, the bacteria and start producing a toxin that you ingest that toxin versus a bacteria or an organism itself, which is just the actual organism you ingest and it's now dividing.

And now you have the symptoms. This gives us a lot of information about what to expect as you probably are know, the cruise lines are very common or a choice to have viral foodborne illnesses and norovirus is what they call it as the most common cause is very common to have in those sort of scenarios. So that's usually a very timeframe sensitive sort of event. And we as physicians keep an eye on that when we ask our patients about, hey, what happened, what did you eat and how long did this last for or occur?

Host: The worst part is when you hear about those cruises where like 200 people got sick. So then you know something was going on with that food situation. Now what do we do? Once we realize that terrible thought in our head, uh oh, it's happened pretty quick, something's not right in my stomach. What do we do? Do we just, do we go hide away? Do we start hydrating? Do we toddle off to the urgent care? What do we do?

Anirudh Rai, MD: That's a good question. This is actually a simpler answer actually. So this one, I would say the best way of, I would say majority of the time when you have a foodborne illness, that's actually self resolving, meaning that as long as you hydrate, as long as you're essentially keeping track of your fluids, because most of the time you're losing fluids rather than solids in these cases, so drinking plenty of fluids, making sure you're well hydrated, and if you can't take down those fluids or if you're losing too much fluids, I would say definitely go to the urgent care. Go to the emergency room, any place where they could hydrate you. Ideally, getting proper hydration and letting your body take care of it for the majority of the time does resolve these issues.

Host: Yeah, and if it doesn't, when do we then say, you know what, this is not going away? Because I have a fear of some of these foodborne illnesses that actually turn into something else or become some sort of an infection. And I'm not trying to scare anybody because it's pretty, pretty rare, I'm guessing. But what do we do if it doesn't go away? How long is it that we wait around and say, okay, we should probably call our doctor now?

Anirudh Rai, MD: Yeah, that's a good question. That goes on a, I guess, patient to patient basis, depending on what their, I personally look at factors like how much do they weigh, are they taking enough food, or I would say take enough water intake that kind of matches the loss that they're having. Ideally, the best way I would say is if you're not able to keep down the fluids you're taking during these events for about a day. I'll say 12 to 24 hours. If you can't really take anything down, you're like, this is getting too much. You're having symptoms of dizziness. You're feeling very weak, very tired. These are signs that your body's not able to stay hydrated to keep up with expelling the toxin. At that point, I would say go to your doctor, go to the emergency room, or go to the urgent care, any place where you can get evaluated to see like they could do more of a workup to determine, hey, what's the cause of this? Like we mentioned, it's very rare to actually get a foodborne illness that requires, let's say, antibiotics or any other kind of intervention. And there is a select number of organisms that do that, and we, as physicians, do keep an eye on that.

But when it comes to that point, I would say go to the emergency room if you're feeling dizzy, you can't, or you're essentially vomiting, or, or losing it from the other end; whatever you take in, just go straight to the urgent care or the emergency room, wherever you get hydrated and get evaluated by someone who can determine if something else needs to be done. It's very rare to need antibiotics in these cases.

Host: Yeah, and I'm glad you said that, but it is important to keep hydrated, and if you do have to go to the emergency room, then they will hook you up and get you hydrated without it causing that nausea, so if you can't hold it down. So how can we avoid this, Dr. Rai? Some, I mean, it seems like some are things we can control, like modifiable and non-modifiable risk factors here. What do you want to tell us as we wrap up, the most important bits of advice so that we can stay healthy during the holidays and really during the summer and whenever we're eating food around people and these things, how do we avoid these foodborne illnesses?

Anirudh Rai, MD: Yeah, there are many ways to actually do that. Definitely hand hygiene is probably important. Definitely wash your hands as much as you can, keep an eye on your kids because they typically don't do that for the most part. So definitely hygiene is, I would say the number one and most important factor when it comes to these foodborne illnesses. When it comes to cooking and when you're in the kitchen, definitely make sure the food is cooked properly at the proper temperatures that are associated with each food group that you're cooking. If it's multi, uh, if it's multiple ingredients, such as, like you mentioned, turkey, when there's multiple factors associated, make sure that each ingredient itself is, is well cooked and served in the proper manner as well.

The other thing is, afterwards, once everyone's done eating, making sure that each food is taken away and put in the proper container so there's no cross contamination and no, I guess no further foodborne illness associated with that. That being said, if you do go to a place or go to dine in a place where there's like a ready made food, the food that is not, ideally not meant to be cooked properly, such as like sushi or these kind of very rare meats.

Do be aware of that, that is a risk that you, you as a consumer are willing to take. And, in a sense, anyone who does consume those kind of things, I think they have a sense like, yeah, that is a risk I'm associated with that. And, just be cautious about when you do partake in those risks, because is something that we as physicians and as human beings do want to keep an eye out for, because these foodborne illnesses kind of creep up in, in places and areas where you least suspect.

Host: And it really is awful to have one. It really takes it out of you. It ruins the holiday day and the next day after that. And, and it can turn you off to certain food groups for quite a long time. I mean, it really, takes its toll. So hopefully we will all hear everything that you said, Dr. Rai, because all of it was so important and such good information.

You are really just such an awesome guest. Every time you come on, you give us so much information and education that we can use and take to our daily lives. So thank you again for that one. And you can visit the Henry Mayo New Hall Hospital Health Library for more tips on avoiding foodborne illnesses at library.henrymayo.com. That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Please always remember to subscribe, rate, and review this podcast and all the other Henry Mayo Newhall Hospital podcasts. It's so important that you do that for us. Thanks so much for listening, till next time.