FOOD POISONING

Food borne illness, more commonly referred to as food poisoning, is the result of eating contaminated, spoiled, or
toxic food. The most common symptoms of food poisoning include nausea, vomiting, and diarrhea. Although it’s
quite uncomfortable, food poisoning isn’t unusual. According to the Centers for Disease Control and Prevention
(CDC), 1 in 6 Americans will contract some form of food poisoning every year.

SYMPTOMS

Food poisoning symptoms

If you have food poisoning, chances are it won’t go undetected. Symptoms can vary depending on the source of the
infection. The length of time it takes for symptoms to appear also depends on the source of the infection, but it can
range from as little as 1 hour to as long as 28 days. Common cases of food poisoning will typically include at least
three of the following symptoms:

 abdominal cramps

 Diarrhea

 Vomiting

 loss of appetite

 mild fever

 weakness

 Nausea

 headaches

Symptoms of potentially life-threatening food poisoning include:

 diarrhea persisting for more than three days

 a fever higher than 101.5°F

 difficulty seeing or speaking

 symptoms of severe dehydration, which may include dry mouth, passing little to no urine, and difficulty keeping
fluids down

 bloody urine

If you experience any of these symptoms, you should contact your doctor immediately.

CAUSES

Most food poisoning can be traced to one of the following three major causes:

 Bacteria
Bacteria is by far the most prevalent cause of food poisoning. When thinking of dangerous bacteria, names like E.
coli, Listeria, and Salmonella come to mind for good reason. Salmonella is by far the biggest culprit of serious food
poisoning cases in the United States. According to the CDC, an estimated 1,000,000 cases of food poisoning,
including nearly 20,000 hospitalizations, can be traced to salmonella infection annually. Campylobacter and C.
botulinum ( botulism) are two lesser-known and potentially lethal bacteria that can lurk in our food.

 Parasites

Food poisoning caused by parasites is not as common as food poisoning caused by bacteria, but parasites spread
through food are still very dangerous. Toxoplasma is the parasite seen most often in cases of food poisoning. It’s
typically found in cat litter boxes. Parasites can live in your digestive tract undetected for years. However, people
with weakened immune systems and pregnant women risk serious side effects if parasites take up residence in their
intestines.

 Viruses

Food poisoning can also be caused by a virus. The norovirus, also known as the Norwalk virus, causes over 19 million
cases of food poisoning each year. In rare cases, it can be fatal. Sapovirus, rotavirus, and astrovirus bring on similar
symptoms, but they’re less common. Hepatitis A virus is a serious condition that can be transmitted through food.

TREATMENT

How is food poisoning treated?

Food poisoning can usually be treated at home, and most cases will resolve within three to five days.If you have food
poisoning, it’s crucial to remain properly hydrated. Sports drinks high in electrolytes can be helpful with this. Fruit
juice and coconut water can restore carbohydrates and help with fatigue.

Avoid caffeine, which may irritate the digestive tract. Decaffeinated teas with soothing herbs like chamomile,
peppermint, and dandelion may calm an upset stomach. Read about more remedies for an upset
stomach.Over-the-counter medications like Imodium and Pepto-Bismol can help control diarrhea and suppress
nausea. However, you should check with your doctor before using these medications, as the body uses vomiting and
diarrhea to rid the system of the toxin. Also, using these medications could mask the severity of the illness and cause
you to delay seeking expert treatment.It’s also important for those with food poisoning to get plenty of rest.

In severe cases of food poisoning, individuals may require hydration with intravenous (IV) fluids at a hospital. In the
very worst cases of food poisoning, a longer hospitalization may be required while the individual recovers.

DIET

What’s good to eat when you have food poisoning?

It’s best to gradually hold off on solid foods until vomiting and diarrhea have passed and instead ease back to your
regular diet by eating simple-to-digest foods that are bland and low in fat, such as:

 saltine crackers, gelatin, bananas, rice, oatmeal, chicken broth, bland potatoes, boiled vegetables, toast, soda
without caffeine (ginger ale, root beer), diluted fruit juices, sport drinks

What’s bad to eat when you have food poisoning? To prevent your stomach from getting more upset, try to avoid
the following harder-to-digest foods, even if you think you feel better:

 dairy products, especially milk and cheeses, fatty foods, highly seasoned foods, food with high sugar content,
spicy foods

fried foods

You should also avoid:

 caffeine (soda, energy drinks, coffee), alcohol, nicotine

PREVENTION

How can food poisoning be prevented?

The best way to prevent food poisoning is to handle your food safely and to avoid any food that may be unsafe.

Some foods are more likely to cause food poisoning because of the way they’re produced and prepared. Meat,
poultry, eggs, and shellfish may harbor infectious agents that are killed during cooking. If these foods are eaten in
their raw form, not cooked properly, or if hands and surfaces are not cleaned after contact, food poisoning can
occur.

Other foods that are likely to cause food poisoning include:

 sushi and other fish products that are served raw or undercooked

 deli meats and hot dogs that are not heated or cooked

 ground beef, which may contain meat from several animal

 unpasteurized milk, cheese, and juice

 raw, unwashed fruits and vegetables

Always wash your hands before cooking or eating food. Make sure that your food is properly sealed and stored.
Thoroughly cook meat and eggs. Anything that comes in contact with raw products should be sanitized before using
it to prepare other foods. Make sure to always wash fruits and vegetables before serving.

TRANSMISSION
How does food become contaminated?

Pathogens can be found on almost all of the food that humans eat. However, heat from cooking usually kills
pathogens on food before it reaches our plate. Foods eaten raw are common sources of food poisoning because
they don’t go through the cooking process.Occasionally, food will come in contact with the organisms in fecal matter.
This most commonly happens when a person preparing food doesn’t wash their hands before cooking.

Meat, eggs, and dairy products are frequently contaminated. Water may also be contaminated with organisms that
cause illness.

RISK FACTORS

Who is at risk for food poisoning?

Anyone can come down with food poisoning. Statistically speaking, nearly everyone will come down with food
poisoning at least once in their lives.There are some populations that are more at risk than others. Anyone with a
suppressed immune system or an auto-immune disease may have a greater risk of infection and a greater risk of
complications resulting from food poisoning.According to the Mayo Clinic, pregnant women are more at risk because
their bodies are coping with changes to their metabolism and circulatory system during pregnancy. Elderly
individuals also face a greater risk of contracting food poisoning because their immune systems may not respond
quickly to infectious organisms. Children are also considered an at-risk population because their immune systems
aren’t as developed as those of adults. Young children are more easily affected by dehydration from vomiting and
diarrhea.

How is food poisoning diagnosed?

Your doctor may be able to diagnose the type of food poisoning based on your symptoms. In severe cases, blood
tests, stool tests, and tests on food that you have eaten may be conducted to determine what is responsible for the
food poisoning. Your doctor may also use a urine test to evaluate whether an individual is dehydrated as a result of
food poisoning.
FOOD POISONING

Food poisoning is an illness caused by eating contaminated food. It's not usually serious and most people get better
within a few days without treatment.In most cases of food poisoning, the food is contaminated by bacteria, such as
salmonella or Escherichia coli (E. coli), or a virus, such as the norovirus.

SIGNS & SYMPTOMS

The symptoms of food poisoning usually begin within one to two days after eating contaminated food, although they
may start at any point between a few hours and several weeks later.

The main symptoms include:

 feeling sick (nausea)

 Vomiting

 diarrhoea, which may contain blood or mucus

 stomach cramps and abdominal (tummy) pain

 a lack of energy and weakness

 loss of appetite

 a high temperature (fever)

 aching muscles

 chills

In most cases, these symptoms will pass in a few days and you will make a full recovery.

What to do

Most people with food poisoning recover at home and don't need any specific treatment, although there are some
situations where you should see your GP for advice (see below).

 Until you feel better, you should rest and drink fluids to prevent dehydration. Try to drink plenty of water, even
if you can only sip it.

 Eat when you feel up to it, but try small, light meals at first and stick to bland foods – such as toast, crackers,
bananas and rice – until you begin to feel better.

 Oral rehydration solutions (ORS), which are available from pharmacies, are recommended for more vulnerable
people, such as the elderly and those with another health condition.

When to see your GP

You should contact your GP if:

 your symptoms are severe – for example, if you're unable to keep down any fluids because you are vomiting
repeatedly

 your symptoms don't start to improve after a few days

 you have symptoms of severe dehydration, such as confusion, a rapid heartbeat, sunken eyes and passing little
or no urine

 you're pregnant

 you're over 60

 your baby or young child has suspected food poisoning

 you have a long-term underlying condition, such as inflammatory bowel disease (IBD), heart valve disease,
diabetes or kidney disease

 you have a weak immune system – for example, because of medication, cancer treatment or HIV

In these situations, your GP may send off a stool sample for analysis and prescribe antibiotics, or they may refer you
to hospital so you can be looked after more closely.

How is food contaminated?

Food can become contaminated at any stage during production, processing or cooking. For example, it can be
contaminated by:

 not cooking food thoroughly (particularly meat)

 not correctly storing food that needs to be chilled at below 5C

 leaving cooked food for too long at warm temperatures

 not sufficiently reheating previously cooked food

 someone who is ill or who has dirty hands touching the food

 eating food that has passed its "use by" date

 the spread of bacteria between contaminated foods (cross-contamination)

CAUSES

Food can become contaminated at any stage during its production, processing or cooking.

For example, it can become contaminated by:

 not cooking food thoroughly (particularly meat)

 not correctly storing food that needs to be chilled at below 5C

 keeping cooked food unrefrigerated for a long period

 eating food that has been touched by someone who is ill or has been in contact with someone with diarrhoea
and vomiting

 cross-contamination (where harmful bacteria are spread between food, surfaces and equipment)

Cross-contamination can occur, for example, if you prepare raw chicken on a chopping board and don't wash the
board before preparing food that won't be cooked (such as salad), as the harmful bacteria can be spread from the
chopping board to the salad.It can also occur if raw meat is stored above ready-to-eat meals and juices from the
meat drip on to the food below.

Types of infection

Food contamination is usually caused by bacteria, but it can also sometimes be caused by viruses or parasites. Some
of the main sources of contamination are described below.

 Campylobacter

In the UK, campylobacter bacteria are the most common cause of food poisoning. The bacteria are usually found on
raw or undercooked meat (particularly poultry), unpasteurised milk and untreated water.

The incubation period (the time between eating contaminated food and the start of symptoms) for food poisoning
caused by campylobacter is usually between two and five days. The symptoms usually last less than a week.

 Salmonella

Salmonella bacteria are often found in raw or undercooked meat, raw eggs, milk, and other dairy products.

The incubation period is usually between 12 and 72 hours. The symptoms usually last around four to seven days.

Read more about salmonella infections.

 Listeria

Listeria bacteria may be found in a range of chilled, "ready-to-eat" foods, including pre-packed sandwiches, cooked
sliced meats and pâté, and soft cheeses (such as Brie or Camembert). All of these foods should be eaten by their
"use-by" dates. This is particularly important for pregnant women, because a listeria infection (known as listeriosis)
in pregnancy can cause pregnancy and birth complications, and can result in miscarriage.The incubation period can
vary considerably, from a few days to several weeks. The symptoms will usually pass within three days.
 Escherichia coli (E. coli)

Escherichia coli, often known as E. coli, are bacteria found in the digestive systems of many animals, including
humans. Most strains are harmless but some can cause serious illness.

Most cases of E. coli food poisoning occur after eating undercooked beef (particularly mince, burgers and meatballs)
or drinking unpasteurised milk.The incubation period for food poisoning caused by E. coli is typically one to eight
days. The symptoms usually last for a few days or weeks.

 Shigella

Shigella bacteria can contaminate any food that has been washed in contaminated water.

Symptoms typically develop within seven days of eating contaminated food and last for up to a week.

An infection caused by Shigella bacteria is known as bacillary dysentery or shigellosis. See the topic on dysentery for
more information about it.

 Viruses

The virus that most commonly causes diarrhoea and vomiting is the norovirus. It's easily spread from person to
person, through contaminated food or water. Raw shellfish, particularly oysters, can also be a source of infection.

The incubation period typically lasts 24-48 hours and the symptoms usually pass in a couple of days.

In young children, the rotavirus is a common cause of infection from contaminated food. The symptoms usually
develop within a week and pass in around five to seven days.

 Parasites

In the UK, food poisoning caused by parasites is rare. It's much more common in the developing world.

Parasitic infections that can be spread in contaminated food include:

giardiasis – an infection caused by a parasite called Giardia intestinalis

cryptosporidiosis – an infection caused by a parasite called Cryptosporidium

ameobiasis – a type of dysentery caused by a single-cell parasite (ameoba) called Entamoeba histolytica (this is very
rare in the UK)

The symptoms of food poisoning caused by a parasite usually develop within 10 days of eating contaminated food,
although sometimes it may be weeks before you feel unwell.

If left untreated, the symptoms can last a long time – sometimes several weeks or even a few months.

TREATMENT

Food poisoning can usually be treated at home without seeking medical advice. Most people will feel better within a
few days. It's important to avoid dehydration by drinking plenty of water, even if you can only sip it, as you need to
replace any fluids lost through vomiting and diarrhoea.
You should also:

 rest as much as possible

 eat when you feel up to it – sticking to small, light and non-fatty meals at first (bland foods such as toast,
crackers, rice and bananas are good choices)

 avoid alcohol, caffeine, fizzy drinks and spicy and fatty foods because they may make you feel worse

Contact your GP if your symptoms are severe or don't start to improve in a few days.

Preventing the spread of infection

If you have food poisoning, you shouldn't prepare food for other people and you should try to keep contact with
vulnerable people, such as the elderly or very young, to a minimum.

Stay off work or school until at least 48 hours after the last episode of diarrhoea.

If someone you live with has food poisoning, you should:

 make sure everyone in your household (including yourself) washes their hands with soap and warm water
regularly – particularly after going to the toilet and before and after preparing food

 clean surfaces, toilet seats, flush handles, basins and taps frequently

 make sure everyone has their own towels and flannels

 wash the laundry of the infected person on the hottest washing machine setting

Read more about preventing germs from spreading.

Oral rehydration solution (ORS)

Oral rehydration solutions (ORS) are recommended for people vulnerable to the effects of dehydration, such as the
elderly and those with a pre-existing health condition.

ORSs are available in sachets from pharmacies. You dissolve them in water to drink and they help replace salt,
glucose and other important minerals your body loses through dehydration.

If you have a kidney condition, some types of oral rehydration salts may not be suitable for you. Ask your pharmacist
or GP for further advice about this.

Further treatment

If your symptoms are severe or persistent, or you are more vulnerable to serious infection (for example, because you
are elderly or have an underlying health condition), you may need further treatment.Tests may be carried out on a
stool sample to find out what it causing your symptoms and antibiotics may be prescribed if the results show you
have a bacterial infection.Medication to stop you vomiting (anti-emetics) may also be prescribed if your vomiting is
particularly severe. In some cases, you may need to be admitted to hospital for a few days so you can be monitored
and given fluids directly into a vein (intravenously).

Reporting food poisoning

If you think your food poisoning has been caused by a restaurant or other food outlet, you can report it to your local
environmental health department. Environmental health officers may investigate and, if necessary, ensure that the
business involved improves its standards of hygiene to prevent it happening again.The Food Standards Agency (FSA)
provides further details about reporting poor hygiene standards in a food outlet.

PREVENTION

The best way to avoid getting food poisoning is to ensure you maintain high standards of personal and food hygiene
when storing, handling and preparing food.

The Food Standards Agency (FSA) recommends remembering the "four Cs":

cleaning

cooking

chilling

cross-contamination (avoiding it)

It's also recommended that you stick to a food's use-by date and the storage instructions on the packet.

These steps are important because things such as a food's appearance and smell aren't a reliable way of telling if it's
safe to eat.

Cleaning

You can prevent the spread of harmful bacteria and viruses by maintaining good personal hygiene standards and
keeping work surfaces and utensils clean.

Regularly wash your hands with soap and warm water, particularly:

 after going to the toilet or changing a baby's nappy, before preparing food, after handling raw food, after
touching bins or pets

You shouldn't handle food if you are ill with stomach problems, such as diarrhoea or vomiting or you have any
uncovered sores or cuts.

Cooking

It's important to cook food thoroughly, particularly meat and most types of seafood, to kill any harmful bacteria that
may be present.Make sure the food is cooked thoroughly and is steaming hot in the middle. To check that meat is
cooked, insert a knife into the thickest or deepest part. It is fully cooked if the juices are clear and there is no pink or
red meat. Some meat, such as steaks and joints of beef or lamb, can be served rare (not cooked in the middle), as
long as the outside has been cooked properly.When reheating food, make sure it is steaming hot all the way through.
Don't reheat food more than once.

Chilling

Certain foods need to be kept at the correct temperature to prevent harmful bacteria from growing and multiplying.
Always check the storage instructions on the label.

If food has to be refrigerated, make sure your fridge is set to 0-5C (32-41F).

If food that needs to be chilled is left at room temperature, bacteria can grow and multiply to dangerous levels.
Cooked leftovers should be cooled quickly, ideally within a couple of hours, and put in your fridge or freezer.

Cross-contamination

Cross-contamination is when bacteria are transferred from foods (usually raw foods) to other foods.

This can occur when one food touches or drips onto another food, or when bacteria on your hands, work surfaces,
equipment or utensils are spread to food.

To prevent cross-contamination:

always wash your hands after handling raw food

store raw and ready-to-eat foods separately

store raw meat in sealable containers at the bottom of your fridge so that it cannot drip onto other foods

use a different chopping board for raw food and ready-to-eat food, or wash it thoroughly in between preparing
different types of food

clean knives and other utensils thoroughly after using them with raw food

do not wash raw meat or poultry – any harmful bacteria will be killed by thorough cooking, and washing may splash
harmful bacteria around the kitchen

Food hygiene abroad

Always practise good food and water hygiene when you are abroad.

This is particularly important when visiting areas where standards of public hygiene are low, such as in some African
and Asian countries.Check the health advice of the countries you are travelling to by visiting the NHS Fit for Travel
website.