Intro: It's Your Health Radio, a special podcast series presented by Henry Mayo Newhall Hospital. Here's Melanie Cole.

Melanie Cole, MS (Host): It seems like not even a week goes by when there isn't some news of a food safety recall or a widespread illness caused by tainted food. But what steps can we take to ensure the food we're eating is even safe?

Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Joining me as always, fan favorite, Dr. Anirudh Rai. He's a primary care physician at Henry Mayo Newhall Primary Care. Dr. Rai, always great to have you on with us. As I said in the intro, gosh, we're seeing just news story after news story. In my news feed, there's always a whole section on food recalls. So, tell us a little bit about what's going on in the country. What are you seeing?

Anirudh Rai, MD: Absolutely. Yeah. I mean, it's always a pleasure to be on and giving a bit more information. And as you mentioned, we are seeing more of these upticks of what we call foodborne illnesses, meaning any kind of condition where you eat some certain type of food and you become sick. And we are seeing that happen more often, particularly during the winter and holiday eras.

The reason for that is pretty straightforward, honestly, during those holiday seasons, we have people traveling, getting together with family, eating together more often. And in those environments, it's very easy to get these foodborne illnesses, whether it be through your meat, through vegetables, breads. It is very common around the holiday era just because of that. And the fact that it's colder outside does make it a little bit easier for some of these bacteria to thrive as well. So, it is something we see and something we do prepare for.

Melanie Cole, MS: Okay. I hear what you're saying. But also, it's been a lot lately, and it was just the summer, and the things that we're hearing is from certain grocery stores or now my daughter won't even eat lunch meat anymore, because of the Boar's Head thing. So, that had nothing to do with the weather, right? But that was like E. coli. What do we do about stuff like that when you hear that kind of news?

Anirudh Rai, MD: Before we get into that, I think it's important to get to a little bit of the history about how we get the food in our plate. There are certain steps that we in society have taken. There's the production phase of our food, which is essentially the farmers growing the food, making it ready for us to consume. Then, there's the processing era where we kind of do our best to take off all the bacteria and the viruses and to make sure the food is clean and safe for consumption. After that would be the distribution phase in which the food is distributed to our markets. And then, finally, it's the preparation where we get it in front of our table, the chef prepares it, and essentially we get it to eat.

In between these phases, there's multitude of ways where we have pathogens such as bacteria and viruses, and even some cases, some parasites enter into that area. The production area is usually the first step. And usually, that would be most commonly caused by if the soil is either contaminated or there's an outbreak of localized infections in either the cows or the herbs and vegetables in that area.

In the processing area, we could also have an introduction of either bacteria or viruses because it's humans and machines handling the food. And that's where we get introduced to things like salmonella, things like listeria. There's lots of bacteria and viruses that can also be introduced in the processing area.

And distribution, again, we have humans handling it. And in these whole stages, that's where we see basically where the contamination occurs. Thankfully, we do have the FDA and we do have CDC who do a really good job of containing these sorts of contaminants. Thankfully, they do that maybe a bit, I would say unseemly, but they actually test the wastewaters of the area that are contaminated to actually get a localized area of the outbreak. So, we do a really good job of actually finding out where the outbreaks are and actually nailing it before they get worse.

Melanie Cole, MS: That was such a great explanation. So, I understand what you're saying. There's just so many steps and so many places where these things can go wrong. But, I mean, even big ones like McDonald's, with the problem that they just had with, I think, the quarter pounder onions or something. What do we do, Dr. Rai? How do we know? Are there any red flags of things we should be on the lookout when we're purchasing food, produce specifically? Because that's where we seem to see a bunch of this, the spinach and broccoli, that sort of thing. Is there anything we can be looking for?

Anirudh Rai, MD: That's a great question. Generally speaking, when you go to a restaurant or fast food, and there's not really much control you as a consumer has in that environment. Because from your understanding or whoever goes to a certain restaurant, they're aware that when you go to a restaurant, you're putting your health at the risk of a certain degree because you don't know how they're prepared, but you take it at their word, and of course at the inspections word, that's saying the food was prepared well, the food was grown well, we have good suppliers. So, there's not much we could control when it comes to consuming food in the restaurant and the fast food area. It would be basically based on the localized inspections and the sanitation records of that particular place.

On the other hand, when you purchase foods from the grocery store and how you store them, that's where you have a lot more control. Particularly for meats, usually you want to have them either frozen if you're not using them. But if you are going to use them, you have to actually practice proper thawing techniques as to avoid essentially keeping some areas cold, some areas warm. Bacteria tend to thrive on warmer environments. So, cooking your meats properly is one of the best ways to assure that you have no bacteria growing on it.

And above all, when you handle vegetables, when you handle meats, hygiene is going to be the clearest marker to prevent contamination, to prevent spread of disease. And often than not, it's very easy to take that for granted. Washing hands is sometimes harder for most if you're rushing and doing things, but that would be the best way. The other way is to make sure your environment, your kitchen, is kept clean and neat. Essentially, cross contamination, where you have certain meats in certain areas, certain vegetables in certain areas. And essentially, they meet, and you have the waters and the discharge essentially cross-contaminating those areas can easily lead to other bacteria infections and viral infections.

In fact, locally here, I would tell you there have been some cases where we did encounter it where cross-contamination has occurred and that led to these kind of outbreaks. So, hygiene is the number one thing we could do as consumers and even as preparers on the other hand to kind of maintain good proper health of not just our food, but also those who are consuming it.

Melanie Cole, MS: I love that you mentioned cross-contamination because as somebody who cooks every day and all the time, I'm really cognizant of wiping down the kitchen, wiping down the counters if I've just dealt with chicken and using some kind of a good antibacterial spray on the counter before I'm going to put my other cutting board or do anything else like that, and washing vegetables and fruits as well. Now, there's fruit and vegetable washes. Have you ever used any of those? I hesitate to use those. I just use water.

Anirudh Rai, MD: So far, I haven't actually personally used these kind of machines. But the concept is pretty much the same as you washing it ideally. What these machines will do essentially is maybe apply a bit more pressure so that a lot of the bacteria and the viruses are gone. But essentially, the process is the same. If you can't really get those machines, honestly just rinsing it well and thoroughly with your hands is just as good as using those machines.

Melanie Cole, MS: I agree with you. Now, if somebody does eat something, and then they feel a little bit sick, how do they know if it's a food-related condition? Does that even matter? Or could it be coincidentally that they're just getting the stomach flu, which again is from not washing your hands and pretty gross when you think about it. What should they do at that point?

Anirudh Rai, MD: That's a good question. And as you mentioned, as if someone gets sick with the common cold or the flu, it could also have symptoms similar to when you eat bad food. But typically, it's the timeframe. If you eat a certain food, depending on what you ingest, for instance, if you were to ingest, let's say, the toxins of a certain bacteria or virus, you tend to have a respond that's much quicker. Within a couple hours, your body wants to expel it because it knows it's really bad. But if you were to consume, let's say, the bacteria or the virus itself, usually your body does take a little time to identify that. That tends to be delayed by a couple more hours. And if it's generally something a bit more invasive, let's say something like a parasite, usually that'd be much longer. Timeframe is the key to kind of determine if it's something you've eaten that's causing it. And on the other hand, actually the symptoms do play a role as well. For instance, if you eat something, you feel nauseous and want to vomit, more often than not, it's likely something you've eaten. On the other hand, if you have some diarrhea as well, again, that could be something you've eaten. So, there's a lot of symptoms we as clinicians and doctors look for to determine if it's something you've eaten. And if it is that, we kind of pursue the course and be like, "Okay, what have you eaten? Have you eaten out somewhere? That gives us a clue about what may be the cause. If it's certain meats, certain vegetables, certain produce." And that, in fact, also lets us prepare if there's any other outbreak, so that we become more essentially cognizant about our environment as well. Because this can easily get out of control, I'll tell you.

Melanie Cole, MS: Dr. Rai, is there a difference between stomach flu, you know, that vomiting that we get and all that from when you get it from food or whatever, not washing your hands, as I said, and some sort of foodborne illness? Is that kind of the same thing?

Anirudh Rai, MD: The best way to describe it is the stomach flu is more of a misnomer. The stomach flu is more of a symptomology that someone gets. When someone says you have the flu, there's two ways you can look at it, or two ways that society has kind of given us the sign that is one or the other. The flu, of course, influenza is the most common cause of that, and we refer to that as the flu. But more often than not, we tend to tone it down and say, "Oh, have you got flu-like symptoms." More often than not, we're referring to what we call URI symptoms, meaning upper respiratory tract infection, like runny nose, a cough.

When it comes to the stomach flu, it's the same sort of category. Essentially, it's symptoms that are consistent with someone who has some sort of stomach bug, best way to describe it, whether it's a virus or a bacteria. Really, we can't determine that. We base it on the symptoms. And when someone says stomach flu, it's more often than not that someone has some sort of organism that's causing their stomach to behave abnormally. So, it's not really a specific way of saying someone has a certain organism or a condition. It's more of defining certain groups of clinical symptoms.

Melanie Cole, MS: So then, what do you do as doctors? Suppose somebody comes to you, and it's coming out both sides and they don't know what to do and they tell you that they've eaten somewhere. Do you then report that to some central agency, to the CDC or something so that we can kind of keep a handle on those outbreaks and then what are we supposed to do? Is there anything we can do?

Anirudh Rai, MD: That's a good question. So when we first get these cases, first thing is first, we definitely want to get a good history because that sometimes gives us a ton of information and honestly can also narrow down where the cost could be. I had a couple of cases like this occur too. Generally what you want to do in these scenarios, if you're essentially losing liquid from both ends, the mouth and the orifice of your rectum, then you want to actually first assess the patient.

Are they dehydrated? Usually, you want to see if you're drinking plenty of water. Are you able to kind of take your food down and keep it that way? Because if you're losing too much fluid, generally you want to go to either urgent care or to emergency room where you get hydration. The first things first, you want to make sure you're stable. After we know that you're doing okay or stable, we could also do some workup to kind of see what else is going on. If you're having diarrhea, particularly the very watery kind, not the muddy kind, very watery, we would want to actually get samples of that. More often than not, these organisms tend to have more of a presence in the stool. So, the best thing to do is to get a stool sample, run the PCR, run all the lab work for the stool, and that'll give us a better idea. In rare cases where a patient starts having fevers and they weren't being seen for a couple days to a week, it could actually end up going into the blood. In those cases, you would get blood cultures, seeing if the organisms grew in the blood.

 So, there's a lot of things we as physicians can do as patients, I would say, if you're not able to drink plenty of fluid, if you're not able to keep your food down, go to the doctor, go to the urgent care, because hydration and keeping you stable is the most important part. And we could definitely work things out because many of these diseases are treatable. And in fact, majority of them actually resolve on their own as well.

Melanie Cole, MS: So, what about kids? Are they more susceptible to these kinds of foodborne illnesses, and is there anything we can do as parents when we're preparing their lunches? I mean, you've given us a lot of good kitchen hygiene advice, and is that just pretty much the same advice for when we're preparing our children's food?

Anirudh Rai, MD: Ideally, yes. Preparation of food of all kind, I would recommend general hygiene across the board, honestly. But when it comes to our pediatric patients, they have a little bit different physiology, actually quite a bit of a different physiology. They're a little bit smaller, their heart beats a little bit faster, they breathe a little bit faster. And that, in turn, will affect them a bit more. So if they were to get these kind of illnesses, Generally, we see our pediatric patients tend to what we call decompensate, meaning they tend to get worse a lot quicker than if you're an adult. So, I would say if a child is having these symptoms, definitely take them to the urgent care, talk to your doctor right away, because a bit more severe for our pediatric patients versus our adults.

Melanie Cole, MS: This is really great information. If I were to ask you to summarize the key takeaways here, Dr. Ryan. You're just so full of knowledge to share. What would you tell us about being careful about these foodborne illnesses, paying attention to the food recalls when we see it, lunch meat, chicken nuggets, whatever it is, and if we're going even out to dinner? Is there any way to protect ourselves from these things? Give us your best advice here.

Anirudh Rai, MD: Absolutely. So, foodborne illness is very common. Generally, the CDC tells us about 48 million people have this and less than 1% end up in the hospital and even less than half a percent end up dying from it. It is something that we want to kind of reduce as much as possible. And hygiene is the best way to do that, making sure any kind of food you prepare is thawed well, is cooked well, and the kitchen is neat and clean.

When it comes to going to restaurants, I would say do your local homework, see if there's any outbreaks occur locally. If it's a restaurant you know and trust, definitely keep going there, but be cautious. Washing your hands. Keep an eye on your symptoms and those symptoms around you gives us more clues. When it comes to who gets these illnesses, pretty much anyone who's consumed these kind of food can get them and they occur in different stages of the preparation of the food production, processing, distribution, and preparation. So, clean hygiene is the best way to prevent any form of illness, especially foodborne illness, to be present in your body. And definitely, be cautious when it occurs to kids because they could definitely get much worse than adults. Stay well hydrated. Eat if possible, but definitely what we call the bland diet. Nothing too intense for your stomach until your body readjusts to it. And if all else fails, call your doctor. Go to urgent care because we want to make sure you're safe and sound, especially your kids, in these scenarios.

Melanie Cole, MS: Great advice. That was really educational, dr. Rai. Thank you so much. You're a great guest as always. And for more food safety tips, you can visit the free Henry Mayo Newhall Hospital online health information library at library.henrymayo.Com and choose Food Safety from the Explore Topics pull down menu.

That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. Please always remember to subscribe, rate, and review It's Your health Radio on Apple Podcasts, Spotify, iHeart, and Pandora. Until next time, I'm Melanie Cole.