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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

Hints for Safe Summer Eating

January 24, 2013

Summer is the season for barbeques and picnics. Tradition holds that men take charge of the burgers, buns and beverages, while women tend to the potato salad, pie and precautions.

Food-borne illnesses are on the rise in America. They result in some 76 million food-borne infections in the United States each year; 350,000 are serious enough to require hospitalization. Five thousand people die each year. And food-borne illnesses add $7 billion to America's annual health-care costs just when we can afford it least.

So prevention belongs on everyone's menu. Here's what you should know and what you should do to protect against these increasingly common, increasingly serious infections.

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The Food Safety Crisis

Many things contribute to the food safety crisis.

  • Farming and food processing have become giant businesses. Foods are shipped large distances within the United States — and to the United States from around the world. Contamination in one place can produce infections far away. This makes it difficult to recognize an outbreak quickly, and even more difficult to find the source.
  • Farm animals are often crowded together, so harmful bacteria can spread quickly among them.
  • Antibiotics are added to animal feed, which makes these bacteria increasingly resistant to the drugs. As a result, infections are harder to treat in humans.
  • Americans are eating out more often, thus losing control over food handling and preparation.
  • And just when we need help the most, the nation's food safety agencies are underfunded, fragmented and overwhelmed.

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A Look at the Culprits

These are the most common food-borne infections.


Source/How it spreads



E. coli
Travelers' diarrhea
Water or food contaminated with human feces
Watery diarrhea, cramps, low-grade fever
Symptoms go away on their own in 2 to 4 days; antibiotics can shorten symptoms.
Bacillary dysentery
Spreads from contamination with human feces
Diarrhea with blood and mucus, vomiting, fever, cramps
Symptoms go away in a few days without antibiotics.
O157:H7 strain
Animals, especially cattle, infected with the strain; spreads by eating contaminated beef, undercooked hamburgers, unpasteurized milk and produce contaminated with cow manure
Watery diarrhea that turns bloody, severe cramps, little or no fever
Symptoms go away in 5 to 10 days but 5% to 10% of people develop hemolytic uremic syndrome (HUS), which causes kidney failure and low blood cell counts. Antibiotics and anti-diarrheal medicines increase risk of HUS and should not be given to patients suspected of having E. coli diarrhea.
Chickens, pigs and cattle infected with salmonella; infections in people have been traced to beef, pork, eggs, peanuts and jalapeno peppers
Cramps, diarrhea that may have blood and mucus in it
Symptoms usually go away in 4 to 7 days; antibiotics are only used to treat severe cases.
Undercooked poultry is major source; the bacteria live in the intestinal tract of most chickens but also cattle and other animals.
Cramps, fever, large amounts of diarrhea that may have blood
Most people recover in 7 to 10 days, but symptoms may return. Antibiotics can shorten the illness.
Unpasteurized milk, soft cheeses and other dairy products; processed meats and seafood
Watery diarrhea, vomiting and fever develop within 2 to 3 days of infection.
Most people recover quickly on their own; pregnant women, elderly people, people with diabetes or weakened immune systems can develop life-threatening infections. Because of these risks, doctors often prescribe antibiotics.
Water or food contaminated with tiny amounts of fecal material from someone with the infection
Nausea, vomiting and watery diarrhea; risk of dehydration
Most people recover in 1 to 3 days; antibiotics are not effective against a virus.

There are other culprits that can cause food-borne infections:

  • Viruses such as hepatitis A (often from contaminated shellfish)
  • Bacteria (Shigella, Vibrio species, and others)
  • Parasites (for example, Giardia and Cyclospora)
  • Prions ("mad cow disease" from contaminated beef)– There have been about 200 cases in humans worldwide, but none has originated in the United States.

It's enough to make you sick — and more than enough to spur you to take simple steps to reduce your risk.

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How To Protect Yourself

Food-borne infections are hardly new. Here's how to protect yourself and your family. Hint: It's all good advice your mother gave you.

  • Choose reputable markets and restaurants for shopping and eating out.
  • Wash your hands thoroughly before and after you prepare food, before you eat, and after you use the bathroom.
  • Wash your foods, including fruits and vegetables, poultry, fish and meats. Use a brisk stream of clean water to dislodge surface bacteria and rinse off chemicals. Whole fruits and vegetable are safer than packaged and pre-cut produce.
  • Wash your utensils and cutting boards using soap and water. Use your utensils for one food at a time; wash them before switching to another food to reduce cross-contamination.
  • Don't eat unpasteurized dairy products or juice or uncooked meat and poultry. Pregnant women and people with weakened immune systems should not eat raw fish, including sushi.
  • Cook your food thoroughly; use a meat thermometer to be sure the internal temperature of meat and poultry reaches at least 165° F (180° F for whole poultry). Cook eggs until the yolks are firm. Do not order rare meat or soft eggs at restaurants.
  • Refrigerate foods promptly, but always within two hours. (Make it one hour if food has been out at a room temperature of 90° F or more). Keep your refrigerator temperature at 40° F or lower, keep your foods covered, and don't save leftovers for more than a few days. Keep your freezer at 0° F or lower. Thaw foods in the refrigerator or microwave, not at room temperature.
  • Reheat foods thoroughly (until they are piping hot).
  • Don't eat food that looks, smells or tastes funny. When in doubt, throw it out.
  • People with food-borne illnesses should use disposable plates, cups and utensils until they're recovered. Bathroom areas should be thoroughly cleansed with bleach-based products.

Tips for Travelers

Travelers' diarrhea, or "turista," is a well-known hazard for visitors to developing countries where sanitation is less than ideal. Here are some tips to prevent intestinal infections:
  • Wash your hands with soap and water or an alcohol-based hand gel before you eat.
  • Avoid salads, uncooked vegetables and unpasteurized milk and cheese.
  • Only eat fruit that you've washed in clean water and peeled yourself.
  • Do not eat undercooked or rare food. Eat cooked foods while they are still piping hot. Be especially wary of food from street vendors.
  • Avoid the water unless you have boiled it yourself; chemical disinfectants and water filters are available for use in special circumstances. Don't use ice made from untreated water. Don't use untreated water to brush your teeth. In general, unopened bottled or canned beverages are safe, as is coffee or tea made from boiled water.
  • Ask your doctor about taking along antibiotics just in case.
  • Above all, suspect everything.

For more information on food safety, go to

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Beyond Contamination

Food safety is just the tip of the iceberg. The greatest danger in America comes not from the bad things in food but from the "good" things: an excess of calories, too much salt, sugar and saturated fat.

Food safety also means choosing the right foods, eating the right amounts and exercising enough to burn off excess calories.

All humans eat to live. Many in our rich society live to eat. Do it right and you can have it both ways.

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Harvey B. Simon, M.D. is an Associate Professor of Medicine at Harvard Medical School and a member of the Health Sciences Technology Faculty at Massachusetts Institute of Technology. He is the founding editor of the Harvard Men's Health Watch newsletter and author of six consumer health books, including The Harvard Medical School Guide to Men's Health (Simon and Schuster, 2002) and The No Sweat Exercise Plan, Lose Weight, Get Healthy and Live Longer (McGraw-Hill, 2006). Dr. Simon practices at the Massachusetts General Hospital; he received the London Prize for Excellence in Teaching from Harvard and MIT.

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