When Food Poisoning Strikes with Dr. Christine Lee

Podcast Transcript

Nada Youssef: Hi. Thank you for joining us. I'm your host Nada Youssef. And today we're talking with a Cleveland Clinic expert about foodborne illnesses, such as listeria, norovirus, salmonella, and much, much more. So make sure you guys stay tuned in. And to answer your questions about this topic, we have with us Dr. Christine Lee, a gastroenterologist here at Cleveland Clinic Digestive Disease and Surgery Institute. Thank you so much for coming back.

Dr. Lee: Thank you for having me.

Nada Youssef: And before we begin, please remember this is for informational purposes only and is not intended to replace your own physician's advice. Many different disease causing germs can contaminate foods, so there are many different foodborne infections and based on the CDC, Centers for Disease Control and Prevention, researchers have identified that more than 250 foodborne diseases are out there. It also estimated that each year, 48 million people get sick from a foodborne illness, with 128,000 people hospitalized and 3,000 die from this disease. First of all, let's talk about, how should you know about a foodborne illness? How do you know that it's existing and what's causing it?

Dr. Lee: You mean if you feel that they have the disease themselves?

Nada Youssef: Yeah. And how do we even know about it as an announcement? How do people know about the foodborne illnesses?

Dr. Lee: Generally, the CDC has a communication line with either the restaurants or the supermarket where they shop. So if you had purchased an item that's on recall, especially if you signed up for one of those rewards program where they have access to your email or your phone number, you will get a computerized automated messaging message that will be sent to you, either the email that you have listed or the phone number that you have listed. Otherwise, you may have to rely on local news, where they let people know, especially if there's outbreaks in a particular community or a particular site. Oftentimes what I've seen, when I do go to my grocery stores, they'll have a sign out that says romaine lettuce from such and such date are on recall. A lot of times it's either at the local supermarkets or the restaurants that you've purchased or consumed products at. Or your email or phone number or social media.

Nada Youssef: Social media. That's where I find my stuff.

Dr. Lee: That's where I find my stuff as well.

Nada Youssef: So what causes foodborne illnesses? The germs, bacteria?

Dr. Lee: Foodborne illnesses is just a very broad terminology that encompasses many different ... Which divides into many different sub categories. It could be bacterial, which is a bacteria that can make you ill. There's another subset that's virus related. And then there's parasites. And there's also just toxins from bacteria that produces toxins. So there's different categories.

Nada Youssef: So it is the way that something is ... Is it the farm? Where is it originating from? How is our food or our products getting contaminated?

Dr. Lee: Depending on the organism, like the bacteria, E. coli is a common factor. Those are usually fecal oral. So if the cows or the animals that are on the pastures that roam around have fertilized the soil naturally, and they round up the vegetables, or the lettuce, or the produce, and it gets transported in mass transit to your local stores, it really is up to the consumers responsibility to make sure you wash your produce and wash them well.

Nada Youssef: Great. Great. And we'll get to that, about prevention, here in a bit. But first I want to talk about what is considered an outbreak?

Dr. Lee: An outbreak is when you have more than one case or more cases than what's normally expected in a certain community or an area, that's out of the norm.

Nada Youssef: So an outbreak could be two or more people?

Dr. Lee: Definitely, yes. Yes. Especially if it's something really rare, that it's not common to even have one case. If there's two or more in a small group of area or a community, than it can be considered as an outbreak.

Nada Youssef: Okay. So let's say I'm on social media, and just like recently, I think, just the end of 2018, they were talking about Goldfish crackers that could be contaminated with, I believe, salmonella. And when I think of salmonella, I think of raw chicken. I think of food not being handled properly. But something like Goldfish, what is the first thing to do when you see something like that? And especially if you know that you're giving it to your children or your family?

Dr. Lee: Sure. So when there is a concern, most of the time when they do make public announcement they will tell you, it's a lot ... They'll give you a lot number or an expiration date number, because crackers or any food items that are produced in mass production, they have lot numbers or they have the same expiration date. So they'll say, if you purchased Goldfish crackers, or whatever the food item might be, from June to November, and has an expiration date of, and they'll tell you the exact expiration date, if you have them, then you can just throw them out or return them to the store that you purchased them in.

Nada Youssef: And if I already know that I consumed them, or gave them to someone, should I go get checked out right away, or if I'm okay, I'm good to go?

Dr. Lee: In general, if you're okay, you might have dodged a bullet. A lot of times when these recalls are sent out, they're being extra precautionary. So even if it was one or two cases, they'll just recall the entire batch, or the entire production line, because they could have been cross contaminated during packaging process. Therefore, when they do have a recall, most of them is not all contaminants, but they just do that on a safety precautionary ...

Nada Youssef: Measures?

Dr. Lee: Measures. So the safest thing is just throw it out.

Nada Youssef: Throw it out? Okay.

Dr. Lee: Yeah.

Nada Youssef: And there's no way that I can tell if something is contaminated by just looking at it, correct?

Dr. Lee: Sometimes you can. I mean, if you bought sausages, let's say, for an example, and then you brought it home, and they're usually all vacuum sealed, airtight, but if yours is bubbling gas, then that's a good sign that that's pretty contaminated, and you should probably not even bother opening, and just throw that out.

Nada Youssef: Throw that out. Okay. If I eat something and I feel sick to my stomach, how do I know it's food poisoning vs. something else with similar symptoms?

Dr. Lee: That can be kind of tricky. A lot of times, a lot of different factors can cause a little bit of upset stomach or nervous stomach or sick stomach. Usually things that are not serious will just kind of come and go. So if you have a little bit of what we call, my stomach's not feeling right, but as long as it's short lived, low intensity, and you get better on your own, then it's not anything to panic about. That being said, if you ... No one knows your body better than yourself. And if you realize, hey, something is definitely off. I've got fevers, I've got chills, I'm having horrible nausea, I'm vomiting, or terrible diarrhea, that's completely not your norm. And you have to have eaten a questionable item that may or may not have been on recall that you are aware of, those you might want get seen by your local physician and make sure that you're doing okay.

Nada Youssef: Okay. So that was gonna be my next question. I've been around people ... I have had food poisoning, and I've around people where we had to stop the car on the side of the highway, they were feeling sick, when is it okay to just go through it at home, and when is it time to go see a physician?

Dr. Lee: Sure. Our body is amazing. We have this incredible resilience. So many protective pathways that are actually built in within our body. Even starting with the contact of the saliva, we have digestive enzymes that start breaking down things, and even if you did ingest a bacteria that's potentially harmful for you, it really has to do with the load of ingestion, how much exposure you ingested, and the strength of your immune system. Most people have a pretty strong, intact immune system. So that would exclude the people that are on special circumstances, they're on immuno modulating agents, or medications that suppress their immune system, or they have other unfortunate medical conditions that suppress their immune system. Now that is a different category on your own. But for the most of us, who are out, active, without significant comorbidities, that are not taking immunosuppressive medication, most of the time, we can recover from any of these insults on our own. And it's probably safer to do so than to go to a hospital and get subjected to invasive tests that may have risks on its own.

Nada Youssef: So our body may be able to take care of it on its own?

Dr. Lee: Right.

Nada Youssef: But you're saying there is a chance that someone could be at a higher risk for developing this illness if they have a lower immune system, or kids, even?

Dr. Lee: Definitely. The extreme ends of the ages. So the very young and the very old tend to have ... For the young, obviously they have an immature immune system, so it tends to be a little bit weaker. And the elderly spectrum their immune system declines with age, so they're at risk. Pregnant patients, pregnant population, that in itself suppresses your immune system because your body's being taxed with growing a baby. Those patients who are unfortunate to have ... Suffer from cancer, who are on their chemotherapy agents, or another sub group have autoimmune disorders, that have medications that suppress their overactive immune system, they might be at higher risk.

Nada Youssef: I see. So it could be two people going to eat together and one of them gets really sick and one of them doesn't.

Dr. Lee: Absolutely.

Nada Youssef: It all depends on your immune system.

Dr. Lee: That's very, very common. Yes.

Nada Youssef: Okay. Let's talk about dietary restrictions or recommendations that are given to those suffering from these foodborne illnesses? Besides don't eat, and drink a lot of water.

Dr. Lee: Sure. In the setting of an acute illness, best is to just stick to a BRAT diet. That would be the breads, rice, rice pudding, applesauce, toast, bananas. Something bland. You want to stay away from food that is a little bit more challenging for your digestive track to digest. Simple foods that's easy to digest, like mashed potatoes, bananas that have a lot of potassium in it. You want to avoid high greasy fried spicy foods in that acute illness setting. Just to make your stomach or digestive tract less taxing to digest those foods.

Nada Youssef: So it's kind of like the same diet you would have with diarrhea [crosstalk 00:11:51]?

Dr. Lee: Exactly. Right. Or chicken noodle soup.

Nada Youssef: Yeah. Lots of water.

Dr. Lee: Lots of water. And the key is, not just water. Water is isotonic. If you are acutely ill and you're losing a lot of water through diarrhea, or insensible losses of water because you're having a fever and you're sweating, and you're losing a lot of fluids that way, the best replenishment isn't exactly water. It really should be a not isotonic fluid. That would be more of the fluids that has solutes in it, whether it's salt, sugar, or electrolytes.

Nada Youssef: Electrolytes, so something like Gatorade, pickle juice?

Dr. Lee: Sure. Gatorade, water with sugar in it, or what with salt in it. And that's why broth would be very helpful.

Nada Youssef: I see.

Dr. Lee: Because of the high solute content. What happens is when you consume that kind of fluid, then you tend to keep that fluid in your body, and it's less likely to just run off or go straight to your kidneys and you urinate it out or you have diarrhea output, or you have a fever, and so you lose a lot of insensible losses of fluid.

Nada Youssef: Okay. That makes sense. Okay. Let's talk about prevention. How do prevent this from happening? What food safety tips do you have here for us?

Dr. Lee: So our first line of barrier is actually your body. So you want to always try to take of your body. Make sure you sleep well, you eat well, you exercise, low stress, whatever you can do to keep your body in the fittest condition. The second thing would be any time you have any produce or any foods that you come in contact with, try to wash them. Especially if it's raw fruits or vegetables. Make sure you wash them, and wash them thoroughly. Oftentimes people see the sign organic and they feel that if it says organic they can just bite right into and just go right to it. Organic just means it's free from chemical pesticides. Cow manure is completely organic. And so, E. coli, salmonella, those are all organic, if you will. So if you do shop at those supermarkets that are organic oriented, you're not out of the woods. You are safe to buy those, but you still need to wash them.

Nada Youssef: Okay. Do you wash your meats? Because there's controversy.

Dr. Lee: That's right. There's controversy for that. Usually, the meats, if you have a steak, and you're going to sear it on a grill, that ... You don't really need to wash. Because you're going to hit all the sides with high heat. The inside, whether you cook it all the way through or not, if it's a solid meat, the bacteria can only live on the surfaces. That being said, if you're buying ground meat, multiple surface areas, because it's all grounded and kneaded together, and therefore, for the ground meats, you must cook it all the way through. So no pink in the middle in that scenario. The controversy is, they do say, some people, recommend washing the ... Not the ground meat, but the solid steak. The meats.

But the chicken, they recommend not washing at all. And the reason why is poultry tend to have much, much higher concentration of salmonella naturally. So when you turn your water faucet on, inevitably, you have water splashing that splashes outward. Whether you are aware of it or not, almost like a mist-like fashion. And people have seen salmonella or E. coli ejected from the chicken from the power of the water pressure across the entire kitchen. So they feel, for poultry, it's not worth the risk. So they don't recommend you wash poultry at all. And you just boil them, bake them, or cook them however you do it. But make sure you hit at least 165 degree Fahrenheit cooking temperature, and make sure you cook it all the way through and no pink in the middle.

Nada Youssef: No pink in the middle.

Dr. Lee: Not for poultry.

Nada Youssef: What about people that eat steak, and they like it bloody or pretty rare, medium. How do you make sure it's okay?

Dr. Lee: Yeah, for steak, it's all about ... As long as it's prepped in a clean area, where they didn't just slap that steak on top of poultry that they just fixed up. As long as it's prepped properly. If you sear both sides, the middle should be completely uncontaminated because the bacteria lives on the surfaces. Now if the chef pierced their knife in the middle just to check something, and that thermometer or knife was contaminated, then you have a problem. But if it's a solid, intact, solid meat, that no one's compromised or shredded in any way, then searing on both sides, as long as it's seared on both sides, the middle can be whatever you ...

Nada Youssef: You can eat it how you like it.

Dr. Lee: Exactly. That's right.

Nada Youssef: Like medium rare.

Dr. Lee: But again, not ground meat. Ground meat, any hamburger meat, anything that's been ground, it must be cooked completely through.

Nada Youssef: So even like a hamburger patty, needs to be cooked through. I had no idea.

Dr. Lee: Absolutely. Because it's all about the surface area. So it's a solid steak, you can sear on both sides, the middle could be however you like. If it's a hamburger, which is meat, but that's grounded, you can imagine the surface area all the way through, including the middle. And therefore, hamburger meat or ground meat, any ground meat of any kind, can never be even medium or medium well. It should be cooked all the way through.

Nada Youssef: Okay. That's very, very good to know. Speaking of utensils, surfaces, the counter, all that, make sure that if you're using ... If you're handling something like chicken, raw chicken, make sure you clean all that up before you using that again for cutting vegetables or fruits?

Dr. Lee: Exactly. Exactly. You always want to go clean to dirty. So if you're preparing a meal, make sure you do your fruits and vegetables, or salads first. And then prepare the chicken dishes at the end, as a last ... I usually just have the thought of going clean to dirty, because it's just easier in the cleaning process. Now, you can go backwards, but you have to be very hypervigilant about making sure you wash the cutting board, the knife, the chopping dishes, or even the surface area, and particularly your hands and your nails.

Nada Youssef: Okay. Good to know. I want to talk about some of the power outages that happen here in some parts of the country, beginning of this week. And thinking about your fridge or your freezer and the food that was in there. Do we throw it all out? Are there exceptions? Are there a few hours here and there? What do we do if the light went out? Or the electricity went out?

Dr. Lee: For most people who have a completely immunocompetent patients with no comorbidities, then depending on your level of risk taking, you may or may not contemplate saving some. But for those people who have a lot at stake, they have lymphoma or they have cancer, they're on chemo, or they have a significant comorbidity that's suppresses their immune system, or they have a pregnant family member in their home, it's just probably safe just not to take those chances and just throw it out. The other trick I was taught, which is pretty cheap and easy and readily available for everyone is to get a little paper cup of water, fill it halfway with water, freeze it, and then put a little penny or dime, whatever you have, in the middle and then put the water on the other half. So now you've got a cup with a penny ...

Nada Youssef: Coin in the middle.

Dr. Lee: Yeah, coin that's in the middle. And you keep it in your freezer. So if you do have a power outage, and that coin level is all the way to the bottom, then you know that your refrigerator or freezer had completely thawed too long. And then all the meat should be thrown out. It's a simple trick that could be readily available.

Nada Youssef: Yeah, that's a good idea. I've never even heard of that.

Dr. Lee: Yeah, you could do a Dixie cup of water. If you do a Dixie cup, then just freeze the whole thing, put the penny on top. Put Saran Wrap, freeze it, leave it there. Whenever you go on vacation and you heard from the neighbors that they had some spotty electrical outages, if you come back and your penny is at the bottom of the cup, then you know you need to throw all the meat out.

Nada Youssef: Okay. Now I want to ask you something, it might sound like a simple question or a simple answer, but when I go to the store, and let's say I get some meats, that's it's fresh, or chicken. And then, I'm not gonna cook it that day, I put it in the freezer. I've heard before that once meat is thawed, you should not put it back ... Or fresh, you should not put it back in the freezer? Is that correct?

Dr. Lee: That's correct. That's correct. If you purchased chicken breasts and it's already frozen, from the store, then it's okay to just take it straight into the freezer. But once the meat has been thawed, that allows the bacteria, whatever ... Even the best handling of hands, no meat is sterile. So they'll have some acceptable numbers of contaminants, but as long as they're frozen very quickly, it's an insignificant amount that wouldn't harm anyone. So once you thaw it out, it can start reproducing, or getting much bigger than a safe level. And therefore, once it's been thawed, you probably should not refreeze.

Nada Youssef: Okay. Now, a lot of people marinate their chicken, I know I do, in the fridge, maybe. Are you supposed to just leave it for an hour or two? Is it okay to leave it in the fridge for a day while it's marinating?

Dr. Lee: Yes.

Nada Youssef: That is okay.

Dr. Lee: Yes. Marinades generally involve a lot of sodium. Back in the olden days, where they didn't have as much electricity like the beef jerkys and whatnot, they were able to offset the lack of refrigeration with the salt content. A lot of the marinades whether it's soy sauce or salt or some kind of ingredient that they use, oftentimes kill the bacteria, because of the high solute level.

Nada Youssef: That's good to know. Great. Can an expired food give me a foodborne illness? Not just chicken and meat, but anything that's expired.

Dr. Lee: Sure. That can vary from ... Depending on what the food item is. If it's cereal, it's less likely. It may be stale. But if it's a produce, then certainly.

Nada Youssef: Yeah, you definitely can see that. Yeah.

Dr. Lee: Sure. If it's a fruit or vegetable item, then I would definitely throw that out. If it's an expired box of sugar or cereal, then it may be a little bit soggier or stale, but less likely that you would get sick from it.

Nada Youssef: Yeah, and with the produce, with fruits and vegetables, you can see it. You can see what it looks like, if it's starting to brown, if it looks funky, you can throw it out.

Dr. Lee: But now you have those items where the fruit are in jars or glasses for snacks. So those are the ones you probably would need to be careful about.

Nada Youssef: Sure. And those probably have preservatives in them as well, correct, to keep them fresh?

Dr. Lee: Sure. Sure. Yes. And that's also a good point. If you buy organic, they will probably go bad on you quicker. They don't have as much preservatives or no preservatives, whatever the case may be. So in those cases, you really do need to be hypervigilant.

Nada Youssef: Even though I see the organic milk has way longer expiration date than the normal gallon from the store.

Dr. Lee: Sure. That has to do with the pasteurization. And their ability to ship the products to your local supermarket. Depending on how quickly they're able to mass ship, transport those to your store, you will see a longer expiration date. So it is pretty amazing what the transportations can do.

Nada Youssef: I know, and thinking about that, you never think about how everything, like a fresh produce, it's actually coming from a farm and coming on trucks that are refrigerated, and coming all the way to your store. And actually [crosstalk 00:23:59].

Dr. Lee: Sure. Just like when we buy things online. It used to take a week or two, but now two days or less.

Nada Youssef: Yes. [crosstalk 00:24:06] express shipping. All right. Well, we're gonna go to some live questions.

Dr. Lee: Okay. Great.

Nada Youssef: From Facebook here, so I have Greg. What are the most common foodborne illnesses?

Dr. Lee: Well, that's kind of tough to say, because most common is actually ... It depends if you are including all categories or if you're just looking at viruses, bacterias, or parasites. The most common overall category is usually viruses. Because those are so readily transmittable from person to person.

Nada Youssef: Like the norovirus?

Dr. Lee: The norovirus is very commonly known because of all the outbreaks they had, and the publicity that the cruise ships had. It's more common in people in close quarters, confined space. That got a lot of publicity. But rotovirus is also very common. And they have all the other viruses that are more kind of generic. They don't really have the publicity power because weren't on a cruise ship. But a lot of viruses, kind of like the common cold, we all know about the influenza A and B, but that's not the most common cause of flu. Those are the ones that's most deadliest, and that's why we vaccinate for influenza A and B. But most common flu isn't the influenza A and B, it's all those other viruses that doesn't have a specific name for.

Nada Youssef: Wow. That's very interesting. Great. Thank you. And then, we have Edward. Does your gut biome affect your resistance to food poisoning?

Dr. Lee: Your gut biome can increase your protective barrier. I wouldn't say that it's gonna be a completely protectant, but it definitely protect you to some point. But the most healthiest or strongest biomes probably wouldn't be able to withstand a large load of insult, whether it was C. diff, or E. Coli. Maybe a little bit. Most of us, actually, encounter or get in contact with pathogenic bacteria and viruses all the time, but we're completely unaware, and we're completely unaffected because our immune system and digestive track is strong and able to withstand that kind of insult to some degree.

Nada Youssef: Sure. So it all varies. And then, Diane, if someone has food poisoning, can you catch it from them if you eat from their fork or their cup?

Dr. Lee: The technical answer could be yes, but you really do need a lot of transference. So if it's a virus, you may need very little. But for bacteria, you do need a larger ... So unless there is a visible amount on that fork, bacteria transmission from just sharing a fork is probably low. What's very common is the viruses. The viruses, they don't need very much. You don't need very much inoculation of the virus to be transferrable. If you did get food poisoning, it's most likely that it was a viral food poisoning that you contracted, from a small contact like that.

Nada Youssef: Okay. And then, Edward has a few more questions. Which condiments need refrigerating?

Dr. Lee: Most condiments, like ketchup or mustard, generally do not need to be refrigerated.

Nada Youssef: I put mine in the fridge all the time.

Dr. Lee: I do too.

Nada Youssef: What about mayo? Mayo definitely, right?

Dr. Lee: Mayo definitely does, because a lot of them ... I know there's one line that's vegetarian or vegan, so there's no egg. But most of it does have some egg or dairy product in it. So they absolutely must be refrigerated. And that would be one that I would be an absolute stickler on the expiration date. I would toss it out.

Nada Youssef: Yeah, definitely. Definitely. But ketchup and mustard, you're saying does not have to be refrigerated?

Dr. Lee: Yeah. They can be left out unrefrigerated, although mine sits in my refrigerator.

Nada Youssef: So do mine. It's just easier that way. All right. And then, Edward also wants to know, can moldy food cause illness? For example, if one berry is moldy, do they all have to be tossed?

Dr. Lee: Well, personally, I would toss it. But we all know that a little bit of mold, as long as your immune system is intact and you're otherwise healthy, will not cause any significant harm. You don't have to be ... Although I am.

Nada Youssef: You don't have to be, but you are. That's okay.

Dr. Lee: You don't have to be. That's exactly right.

Nada Youssef: That's the thing with me, as well, if I see a box of fruit, or anything like that, and I see any mold in there ...

Dr. Lee: I throw the whole thing out.

Nada Youssef: I throw the whole thing out. Because I've heard that mold, you don't really see it. And if it's there, it probably could be spread in other places.

Dr. Lee: Be a lot more. Absolutely. Yes.

Nada Youssef: Yeah. All right. Cool. So Valia wants to know, can probiotics and/or digestive enzymes help you in digestion?

Dr. Lee: The probiotics are basically bacteria, they're live bacteria that help in digesting some of the food or enzymes. So it can help you in digestion, but most of us have a really good biome on our own, so most of us don't need that extra help. But if you feel that you need that extra help. Then those probiotics can offer some assistance. But most of us don't really need it.

Nada Youssef: Okay. Best source of probiotics?

Dr. Lee: Is all natural. Best source of probiotics would be onions, garlic, cabbages, sauerkraut, they're just reach in natural probiotics.

Nada Youssef: I was thinking about yogurt. Is yogurt not?

Dr. Lee: I'm sorry, that's a great point. Yogurt has lactobacilli, so it's a natural probiotic, and that's safe because it's FDA regulated. It's refrigerated. It's got an expiration date. So those are all very good as well.

Nada Youssef: Okay. Great. And then, Samia, how do I treat foodborne illness symptoms?

Dr. Lee: If you are unfortunate enough to have contracted a foodborne illness, the best thing to do is ... As long as you don't have significant comorbidities like you had a liver transplant or a heart transplant, as long as you're just otherwise normally health and not on immune suppressing medication, you just can do conservative measures. You want to be on a bland diet, what we call BRAT diet. Bread, rice, applesauce, toast, bananas. Chicken broth, soup, veggie broth, whatever you prefer. But just a bland diet. A lot of fluid. You want to do a lot of fluid. A lot of people grossly underestimate the amount of fluid that they lose from a gastroenteritis or a foodborne illness. They're vomiting up a lot of the fluid, they're losing a lot of fluid from below, and they may or may not have some insensible losses from the fever.

Nada Youssef: Now, if you're ... Just like you said earlier, if you're having a fever and you can't move, and you're sweating, is that when, maybe, even see a physician at that point?

Dr. Lee: It all kind of depends on your safety comfort level. I strongly believe that nobody knows your body better than yourself. So if your gut tells you something is seriously wrong, then don't mess around. Go to the emergency room, and get yourself checked out. If you do have a fever, and you're vomiting, and you're having the worst bout of gastroenteritis of your life, but otherwise, you're not having chest pains, you're not short of breath, you think you're ... As long as you're able to keep food or liquids down, then it's safe. Because you can try to hydrate at home. Because at the end of the day, if it's a simple gastroenteritis, there is no magic wand in the emergency room. It just has to kind of play its course. You gotta release the toxins, whether it's through diarrhea or vomiting phase.

It just has to kind of be eliminated from your body. What's important is that you're able to maintain adequate blood flow, circulation, throughout this illness. So make sure that you can hydrate, hydrate, hydrate. If your nausea is so severe that you're unable to keep any fluids down, then that's the time, whether you want to or not, you really do need to seek medical help. Because then they can put an IV in your arm and give you all the fluids and electrolytes that you desperately need. Again, just water alone isn't sufficient in this kind of scenario. Your potassium, sodium, those levels are critically important for a good circulatory system and good ... Maintaining your neurologic system as well.

Nada Youssef: Great. Thank you. All right, just a few more questions for you. I have Kendall, is the last thing you ate always the cause of the illness? And I guess I'll add to that, it's really the timing of food poisoning. Is it immediate or does it take awhile?

Dr. Lee: It depends on what the culprit is. If it's, for example, the common food poison, like Bacillus cereus, it tends to be a lot quicker, so within 2 to 4 hours. But there are some foodborne illnesses that are latent, meaning they have to reproduce in your system, then they have to produce, reproduce, and get into a large load. So that may not present until 12, 16 hours later. It's not necessarily always the last thing you ate. It all depends on the culprit, whether it's virus or bacteria. But even bacterias, depending on the bacteria, will vary, the onset of presentation. Whether 1 to 2 hours vs. 12 to 16 hours.

Nada Youssef: 12 to 16 hours, that would be hard to tell after ...

Dr. Lee: Well, there's another virus, the hepatitis A virus, that's a foodborne illness, that can take a couple of days to present.

Nada Youssef: A couple of days!

Dr. Lee: Yeah. And you will get very ill. You can even turn yellow and jaundiced. We had an outbreak of hepatitis A several years ago, and it was linked to strawberries and raspberries that were poorly washed that was shipped. But when the CDC discovered it, they did make sure that, it's the one from X, certain farm, and the production number. And it was located in the southwest of the region.

Nada Youssef: And the thing with strawberries, the seeds are on the outside, it's very exposed.

Dr. Lee: That's exactly right. So the hard things are ... Alfalfa sprouts, used to be very common in sub shops, but now most sub shops have just decided not to deal with the risk at all. And alfalfa sprouts are very difficult to wash, because if you wash it adequately, you destroy them. I find raspberries the same way. Because I was mine very vigorously, and then when you try to present it to your guests, it's all falling apart. Strawberries are a little bit sturdier. You can wash that a little bit harder. But things like blueberries, they're hard to wash as well. They have tricks. You can buy those special sprays for fruits and veggie washes. Or you can make them yourself. You just put them in a colander, soak them in, whether it's baking soda or salt. Once you put them on there, you wash it until you can't see the baking soda or salt anymore. Then you know you did your job.

Nada Youssef: Oh, very cool.

Dr. Lee: Another person uses vinegar. If you can still smell or taste the vinegar, then you didn't wash enough. So there are little easy ways to wash them yourself at home without buying those fancy kits.

Nada Youssef: Great. And organic doesn't mean not contaminated.

Dr. Lee: Definitely.

Nada Youssef: That's important to know. And Amanda, is foodborne illness caused by food that's spoiled or bad?

Dr. Lee: Not necessarily. You could have a non spoiled chicken, raw chicken ...

Nada Youssef: It's the way it's cooked.

Dr. Lee: It's the way it was cooked. Absolutely. And that can cause foodborne illnesses. So it's not necessarily rotten or spoiled food. It could be perfectly good food, it was just improperly handled.

Nada Youssef: And there was, just like we were talking about, the Goldfish crackers, there's contaminated flour, these things are ... You don't know what's going on with them.

Dr. Lee: Right. Whether it's the flour or the cheese powder, because with dairy products you just have to be very careful how it was handled, processed, stored, refrigerated, and transported to your local stores.

Nada Youssef: Right. Right. All right. One more question for you. Is there ... Sorry, Diane, she asks if there is mold on cheese, is it safe to use it if you cut it off? It reminds me of the question earlier.

Dr. Lee: Yeah. Well, you know, bleu cheese is basically mold.

Nada Youssef: Mold. It's so good, too.

Dr. Lee: Oh, yeah.

Nada Youssef: So how do we get away with that? How do we get away with mold on bleu cheese, and say it's okay, or like Gorgonzola cheese, vs. what's Diane's asking?

Dr. Lee: Sure. That goes all towards processing. If it was pasteurized the right way, and it was molded the correct way, certain kinds of molds are okay. But if you get Parmesan cheese, and you see green mold on it, then it's time to chuck the whole thing.

Nada Youssef: Yeah, do that please. All right. Thank you so much for joining us today. It's been a pleasure.

Dr. Lee: Sure. Thank you for having me.

Nada Youssef: Thank you. And for more information on Cleveland Clinics Digestive Disease and Surgery Institute, visit ClevelandClinic.org/digestive. And to schedule an appointment, please call 216-444-7000. And to stay up to date on health news and information from Cleveland Clinic, make sure you're following us on Facebook, Twitter, Instagram, and SnapChat, user name ClevelandClinic, one word. We'll see you again next time. Thank you. This concludes this Cleveland Clinic Health Essentials podcast. Thank you for listening. Join us again soon.