Food Safety for People with Diabetes

By Sondra Forsyth

Food safety is important for everyone—but it’s especially important for people with diabetes. That’s why the U.S. Department of Agriculture’s Food Safety

and Inspection Service and the U.S. Department of Health and Human Services’ Food and Drug Administration offer this information to provide practical guidance on how to reduce your risk of foodborne illness. In addition to this guide, you’d be wise to check with your physician or health care provider to identify foods and other products that you should avoid. You have a special need for this important information . . . so read on!

Foodborne Illness in the United States

When certain disease-causing bacteria, viruses or parasites contaminate

food, they can cause foodborne illness. Another word for such a bacteria,

virus, or parasite is “pathogen.” Foodborne illness, often called food poisoning,

is an illness that comes from a food you eat.

• The food supply in the United States is among the safest in the world—but it can still be a source of infection for all persons.
• According to the Centers for Disease Control and Prevention, 48 million persons get sick, 128,000 are hospitalized, and 3,000 die from foodborne infection and illness in the United States each year. Many of these people are children, older adults, or have weakened immune systems and may not

be able to fight infection normally. Since foodborne illness can be serious—or even fatal—it is important foryou to know and practice safe food-handling behaviors to help reduce yourrisk of getting sick from contaminated food.

Food Safety: It’s Especially Important for Diabetics

As a person with diabetes, you are not alone—there are many people in the United States with this chronic disease. Diabetes can affect various organs and systems of your body, causing them not to function properly, and making you more susceptible to infection. For example:

• Your immune system, when functioning properly, readily fights off harmful bacteria and other pathogens that cause infection. With diabetes, your immune system may not readily recognize harmful bacteria or other pathogens. This delay in the body’s natural response to foreign invasion places a person with diabetes at increased risk for infection.
• Your gastrointestinal tract, when functioning properly, allows the foods and beverages you consume to be digested normally. Diabetes may damage the cellsthat create stomach acid and the nerves that helpyour stomach and intestinal tract move the food throughout the intestinal tract. Because of this damage, your stomach may hold on to the food and beverages you consume for a longer period of time, allowing harmful bacteria and other pathogens to grow.
• Additionally, your kidneys, which work to cleanse the body, may not be functioning properly and may hold on to harmful bacteria, toxins, and otherpathogens.

• A consequence of having diabetes is that it may leave you more susceptible to developing infections—like those that can be brought on by disease-causing bacteria and other pathogens that cause foodborne illness. Should you contract a foodborne illness, you are more likely to have a lengthier illness, undergo hospitalization, or even die.
• To avoid contracting a foodborne illness, you must be vigilant when handling, preparing, and consuming foods. Make safe food handling a lifelong commitment to minimizeyour risk of foodborne illness. Be aware that as you age, your immunity to infection naturally is weakened.

Major Pathogens That Cause Foodborne Illness Campylobacter

Associated Foods

• Untreated or contaminated water
• Unpasteurized (“raw”) milk
• Raw or undercooked meat, poultry, or shellfish

Symptoms and Potential Impact

• Fever, headache, and muscle pain followed by diarrhea (sometimes bloody), abdominal pain, and nausea. Symptoms appear 2 to 5 days after eating and may last 2 to 10 days. May spread to the bloodstream and cause a life-threatening infection.

Cryptosporidium Associated Foods/Sources

• Swallowing contaminated water, including that from recreational sources, (e.g., a swimming pool or lake)
• Eating uncooked or contaminated food
• Placing a contaminated object inthe mouth
• Soil, food, water, and contaminated surfaces

Symptoms and Potential Impact

• Watery diarrhea, dehydration, weight loss, stomach cramps or pain, fever, nausea, and vomiting; respiratory symptoms may also bepresent.
• Symptoms begin 7 to 10 days after becoming infected, and may last 2 to 14 days. In those with a weakened immune system, includingpeople with diabetes, symptoms may subside and return over weeks to months.

Clostridium Perfringens Associated Foods/Sources

• Many outbreaks result from food left for long periods in steam tables or at room temperature and time and/or temperature abused foods.
• Meats, meat products, poultry, poultry products, and gravy

Symptoms and Potential Impact

• Onset of watery diarrhea and abdominal cramps within about 16 hours. The illness usually begins suddenly and lasts for 12 to 24

hours. In the elderly, symptoms may last 1 to 2 weeks.

• Complications and/or death occur only very rarely.

Listeria Monocytogenes Can Grow Slowly at Refrigerator Temperatures

Associated Foods

• Improperly reheated hot dogs, luncheon meats, cold cuts, fermented or dry sausage, and other deli-style meat and poultry
• Unpasteurized (raw) milk and soft cheeses made with unpasteurized (raw) milk
• Smoked seafood and salads made in the store such as ham salad, chicken salad, or seafood salads
• Raw vegetables

Symptoms and Potential Impact

• Fever, chills, headache, backache, sometimes upset stomach, abdominal pain, and diarrhea. May take up to 2 months to become ill.
• Gastrointestinal symptoms may appear within a few hours to 2 to 3 days, and disease may appear 2 to 6 weeks after ingestion. The duration is variable.
• Those at-risk (including people with diabetes and others with weakened immune systems)may later develop more serious illness; deathcan result from this bacteria.
• Can cause problems with pregnancy, including miscarriage, fetal death, or severeillness or death in newborns.

Escherichia coli O157:H7, One of several strains of

1. colithat can cause human illness

Associated Foods

• Undercooked beef, especially hamburger
• Unpasteurized milk and juices, like “fresh” apple cider
• Contaminated raw fruits and vegetables, and water
• Person-to-person contact

 Symptoms and Potential Impact

• Severe diarrhea that is often bloody, abdominal cramps, and vomiting.Usually little or no fever.
• Can begin 1 to 9 days after contaminated food is eaten and lasts about 2 to 9 days.
• Some, especially the very young, may develop hemolytic-uremic syndrome (HUS),which can cause acute kidney failure, and can lead to permanent kidney damage or even death.

Noroviruses (and other caliciviruses)

Associated Foods

• Shellfish and fecally-contaminated foods or water
• Ready-to-eat foods touched by infected food workers; for example, salads, sandwiches, ice, cookies, fruit

Symptoms and Potential Impact

• Nausea, vomiting, and stomach pain usually start between 24 and 48 hours, but cases can occur within 12 hours of exposure. Symptoms usually last 12 to 60 hours.
• Diarrhea is more prevalent in adults and vomiting is more prevalent in children.

Salmonella (over 2,300 types)

Associated Foods

• Raw or undercooked eggs, poultry, and meat
• Unpasteurized (raw) milk or juice
• Cheese and seafood
• Fresh fruits and vegetables

Symptoms and Potential Impact

• Stomach pain, diarrhea (can be bloody),nausea, chills, fever, and/or headache usually appear 6 to 72 hours after eating; may last 4to 7 days.
• In people with a weakened immune system, such as people with diabetes, the infection may be more severe and lead to serious complications including death.

Toxoplasma gondii

Associated Foods/Sources

• Accidental contact of cat feces through touching hands to mouth after gardening, handling cats, cleaning cat’s litter box, or touching anything that has comein contact with cat feces.
• Raw or undercooked meat.

Symptoms and Potential Impact

• Flu-like illness that usually appears10 to 13 days after eating, may last months.

Those with a weakened immune system, including people with diabetes, may develop more serious illness.

• Can cause problems with pregnancy, including miscarriage and birth defects.

Vibrio vulnificus

Associated Foods

• Undercooked or raw seafood

 Symptoms and Potential Impact

• Diarrhea, stomach pain, and vomiting may appear within 4 hours to several days and last2 to 8 days. May result in a blood infection. May result in death for those with a weakened immune system, including people with diabetes, cancer or liver disease.

Eating at Home: Making Wise Food Choices

Some foods are more risky for you than others. In general, the foods that are most likely to contain harmful bacteria or viruses fall into two categories:

• Uncooked fresh fruits and vegetables
• Some animal products, such as unpasteurized (raw) milk; soft cheeses made with raw milk; and raw or undercooked eggs, raw meat, raw poultry, raw fish, raw shellfish and their juices; luncheon meats and deli-type salads (without added preservatives) prepared onsite in a deli-type establishment.

Interestingly, the risk these foods may actually pose depends on the origin or source of the food and how the food is processed, stored, and prepared

If You Have Questions about Wise Food Choices:

Be sure to consult with your doctor or health care provider. He or she can answer any specific questions or help you in your choices. If you are not sure about the safety of a food in your refrigerator, don’t take the risk. When in doubt, throw it out! Wise choices in your food selections are important.

KEEP YOUR FAMILY SAFER FROM FOOD POISONING

SEPARATE, CHILLºF CLEAN

WASH HANDS AND SURFACES OFTEN

SEPARATE RAW MEATS

FROM OTHER FOODS

COOK TO THE RIGHT

TEMPERATURE

REFRIGERATE FOOD PROMPTLY

As a person with diabetes, it is especially important that you—or those preparing

Four Basic Steps to Food Safety

1. Clean:

Wash hands and surfaces often. Bacteria can spread throughout the kitchen and get onto cutting boards, utensils, counter tops, and food.

To ensure that your hands and surfaces are clean, be sure to:

• Wash hands in warm soapy water for at least 20 seconds before and after handling food and after using the bathroom, changing diapers, or handling pets.

• Wash cutting boards, dishes, utensils, and counter tops with hot soapy water between the preparation of raw meat, poultry, and seafood products and preparation of any other food that will not be cooked. As an added precaution, sanitize cut-ting boards and countertops by rinsing them in a solution made of one tablespoon of unscented liquid chlorine bleach per gallon of water, or, as an alternative, you may run the plastic board through the wash cycle in your automatic dishwasher.

• Use paper towels to clean up kitchen surfaces. If using cloth towels, you should wash them often in the hot cycle of the washing machine.
• Wash produce. Rinse fruits and vegetables, and rub firm-skin fruits and vegetables under running tap water, including those with skins and rinds that are not eaten.

• With canned goods: remember to clean lids before opening.

Thank you to Lydia Medeiros, Ph.D., R.D., Patricia A. Kendall, Ph.D., R.D., and Val Hillers, Ph.D., R.D., for their assistance and groundbreaking research and outreach to the at-risk community.

To read and download the complete FDA brochure, visit

http://www.fda.gov/downloads/Food/FoodborneIllnessContaminants/UCM312796.pdf