PODCAST: How You Get Food Poisoning & How to Avoid It

 ZACH MOORE: Welcome to On Health with Houston Methodist. I'm Zach Moore. I'm a photographer and editor here, and I'm also a longtime podcaster.

TODD ACKERMAN: I'm Todd Ackerman. I'm a former medical reporter, currently an editor at Houston Methodist.

ZACH: And Todd, have you ever had food poisoning?

TODD: Oh, yes, indeed.

ZACH: Okay.

[Laughter]

TODD: I've had a couple bouts that I think I was the sickest I've ever been.

ZACH: Oh, I totally agree. I've had it once as well. Many times in my life when I was younger, I thought I'd had food poisoning. I said, "Oh, this must be food poisoning. Oh, my stomach is upset. Oh, I better throw up and I'll feel better." No. That was not food poisoning. When I actually got food poisoning, probably the worst 48 hours of my life.

TODD: Yeah, I'd go along with you. Do we need to do some sort of who had it worse --

ZACH: No, we don't need to compare and contrast. No. It's the worst physical, like, sickness pain I've ever experienced.

TODD: Yeah. Nausea generally, I feel that way. I know migraines are really bad, but for me that stomach distress where you can't even stand up or sit up is about as bad as it gets.

ZACH: Yep. Were you, similarly to me where you had thought you had had it in the past and then when you actually got it for the first time, it blew your mind?

TODD: I don't remember as a kid thinking it was food poisoning, but I've had it twice as a -- At least, twice as an adult, you know, which it came on, there was no doubt in my mind what I had.

ZACH: Yeah.

TODD: And it lasted, like, 48 hours. And then even after that, took days after that until I was -- felt like I was normal.

ZACH: No, absolutely. It's not just, you know, six hours and it's over. Flush your system and it's over. It lingers around for a while. Now, we're gonna get into it in our conversation with our expert. But what caused your food poisoning when you got it?

TODD: Both times I indulged at a supermarket salad bar.

ZACH: Okay, I think you're asking for it then. The supermarket salad bar.

TODD: You know, the first I -- After the first time, I vowed I would never eat at one of those again. And 20 years later, I'd broken down and did it again. So, I only have myself to blame.

ZACH: I also believe it was salad that got me. Not at a supermarket but --

TODD: It would have been bad for this podcast if you said it was bad meat, or bad chicken, or something you got.

ZACH: Yeah.

TODD: But I guess we can't control these things.

ZACH: No, we can't. We cannot choose when we get food poisoning, but we can keep an eye out for what might cause it and how best to avoid it. And who did we talk to about that today?

TODD: We talk to Dr. Neeharika Kalakota, a Gastroenterologist at Houston Methodist.

[Sound effect plays to signal beginning of interview]

Hello Dr. Kalakota. Welcome back.

DR. NEEHARIKA KALAKOTA: Thank you so much for having me, Todd.

TODD: We're here this time to talk about food poisoning.

DR. KALAKOTA: Absolutely. Let's get into it.

TODD: So, maybe to start, what really is food poisoning?

DR. KALAKOTA: Sure. So, I think food poisoning as a term is kind of used to cover a range of symptoms. Typically, patients who come to see me that attribute their symptoms to food poisoning have things like upper abdominal pain, abdominal cramping, diarrhea, nausea or vomiting. And the kind of hallmark of that would be the sudden onset. So, you know, typically they can kinda trace it back to their food source. "Hey, I had a burger from such and such place, and immediately afterwards I started feeling sick or the next day I started feeling sick." So, that's typically the kind of patients or the story for food poisoning.

TODD: Can you describe kind of what happens when the poison, the bacteria, or virus, or toxin is kind of passing through you?

DR. KALAKOTA: Certainly. So, that is a little bit more nuanced depending on the bug that's actually infecting you. So, whether it's a virus, or a bacteria, or a parasite, there is various different mechanisms, and actually, different kind of parts as well. So, for example, a Staphylococcus aureus can -- produces like a toxin that you ingest that's usually already there in food. Those kind of symptoms can happen much more quickly than, like, a bacterial infection that takes some time for the bacteria to kind of reproduce in your body. But essentially, what typically causes the symptoms are the bug affecting the lining of your GI tract. So, in some cases you get diarrhea. That's kind of keeping the large intestine from absorbing the water as it typically should, whether that's toxin in the bacteria or even just the bacteria kind of adhering to the colon wall and keeping the cells from working the way they should.

TODD: And so, what kinds of dangers does food poisoning cause? I might guess fluid loss and dehydration are the big ones.

DR. KALAKOTA: Absolutely. So, those are definitely things to watch out for. In fact, they are things that would make me prompt the patient to go to the ER, especially if they're not able to tolerate water or hydrate themselves like you mentioned. That's definitely something that can go downhill quickly. And so, in those cases, better safe than sorry. I would recommend a professional evaluation.

TODD: Not tolerate water in the sense that if you try to drink it, you'll just throw it right back up?

DR. KALAKOTA: That, or even just feeling thirsty constantly, and every time you drink water having a lot of diarrhea, 'cause that's another thing that can happen if you're infected.

TODD: Okay. And so, but beyond that dehydration do the toxins cause any damage to organs?

DR. KALAKOTA: Typically, not lasting damage. Now, one entity that I do see that's not been very well described in literature, but there's definitely a few papers on it, is a condition called post-infectious irritable bowel syndrome. Tends to affect folks who have a history of irritable bowel syndrome. But the theory is that the bacteria/toxin/bug that affects you can change the makeup of the bacteria that live in your intestines normally. And when that happens, that can lead to symptoms such as diarrhea, abdominal bloating, those kinds of things that last longer than the bug is actually in your body.

TODD: And in extreme cases it can cause sepsis?

DR. KALAKOTA: It certainly can. Typically, as far as, you know, answering your question about how serious it is, I'm a little bit more worried with patients who have immunosuppression. So, patients who are undergoing chemotherapy or need to be on immunosuppressive medications for autoimmune diseases and things like that. In those cases, a typical bug that you or I would clear within a day would have more long-lasting effects and could affect them seriously where it leads to hospitalization.

TODD: So, I think I saw that food poisoning causes an estimated 48 million illnesses a year, 3,000 deaths, can't remember the hospitalizations. But those numbers seem pretty high to me. I didn't kno -- I didn't really think of this as that huge a problem. And I think a lot of people think of food poisoning as something more, like, in foreign countries, maybe cruise ships. But this is a pretty universal problem out there.

DR. KALAKOTA: Absolutely. So, I think we look at those numbers from the CDC's website and you're right, 48 million people get sick, about 128,000 get hospitalized, and about 3,000 will pass away from foodborne illnesses each year. I think it's a lot more common than we realize, but again, if it's affecting immunocompetent or patients with normal immune systems, usually they clear those infections within a day or so and don't often seek help from their physicians or, you know, going to the ER. So, in those cases, they kind of just clear it on their own and we don't always count those. So, it's definitely -- I think the burden of disease is large but not always leads to more hospitalizations or anything.

TODD: You mentioned the signs like vomiting, diarrhea. How do you tell if that's compared to a lot of GI conditions, stomach bug or something where you kind of have a lot of those kind of symptoms?

DR. KALAKOTA: Gotcha. A lot of people will kind of qualify a lot of symptoms as food poisoning, so it's a little bit hard to distinguish that from a GI bug. I think one of the things that may lead you to the fact that it's an infection could be that if you had any sick contacts, like, you know, your kid brings home an infection from day care or you got a sick family member at home that are touching things around the house and then it kinda goes through the whole family. Typically, with food poisoning, you can kind of pinpoint the symptoms starting after a certain meal. So, if you, like I said, have a burger from some place and the next morning you wake up you're having a bunch of diarrhea, and that kind of thing, I think that will point you in the direction of food poisoning.

TODD: It's a pretty quick onset?

DR. KALAKOTA: So, again, it depends. It depends on the bug as well. So, if it's a toxin mediated infection, typically, that's within about hours. So, you had potato salad at the picnic at lunchtime, usually by mid-afternoon you'd start having some symptoms. If it's a bacterial infection, usually it's a little bit longer, 12 to 24 hours.

TODD: What are the most common causes of food poisoning? I think I just know salmonella, E. coli. I think there's quite a few others, right?

DR. KALAKOTA: There are quite a few others. So -- And there is, in fact, quite a few especially viral ones that we don't even know about and we don't have tests for. But in addition to the ones that you mentioned, campylobacter is another one. One of the hallmarks of campylobacter infection is typically spread by meat and it typically can cause you to have, like, diarrhea with rectal bleeding as well. Yersinia is another one. The more famous Yersinia is the bug that caused the bubonic plague. But the one that causes food poisoning is obviously a lot less dangerous. And the other ones that are, like, more protozoa or parasitic are cyclospora and isospora. I don't know if you remember, but a couple years back there was a outbreak of isospora with strawberries.

TODD: Is there a deadliest type?

DR. KALAKOTA: That's a tough question. I think it -- Again, it depends on your state of health when you get the infection. Most of these bacterial infections or infections that we mentioned, for the average person, that is overall healthy when they get it, probably a couple of days of feeling pretty crummy and then they'll get over it and things will go back to normal. But again, if you already don't have an immune system that's working well, that's when things can get dangerous.

TODD: And the parasites you mentioned, that's not mostly a sort of third world, developing world thing? That's in the U.S. too?

DR. KALAKOTA: Yeah, certainly it can be. I think there are certain risk factors, again, right? So, travel outside the States is definitely a risk factor. Work with domesticated animals, especially farm animals, pigs, cows, that kind of thing. There are some zoonotic infections that you could be at risk for. But typically, if you were talking about a foodborne parasitic illness, yes, it's more common outside the States in developing nations.

TODD: So, what are the most common food sources of food poisoning?

DR. KALAKOTA: Meat is a big one, and there's a lot of work going on at the CDC of targeting foodborne illnesses at each step of the food processing, you know, from butchering to getting the meat out to grocery stores and things like that. There are certainly produce, really of any kind. There's risks for things like E. coli, which is very common, isospora again with fruits and vegetables. So, it -- Usually the fresh produce is at most risk and meat products. Those are the two big common ones.

TODD: Does it occur more often say eating out at restaurants, or at picnics, or barbeques where you've got food out for a long time or is it just as common someone preparing food in their home, maybe they got some bad meat there's -- we later learn there's an outbreak from?

DR. KALAKOTA: So, certainly, I think preparing your food at home should be a protective effect because you are able to control the hygiene, you know, cleaning the surfaces that you put the food on, washing the produce, and washing the meats itself, and making sure you cook it to the correct temperatures. I know chicken for example, you need to cook to 165 degrees Fahrenheit, again, according to the CDC to make it safe. When you eat outside or when you go to a picnic, yeah, you're absolutely right, leaving the food outside especially when things are meat-based, or cream-based, or things that can kind of curdle in the sun, those kinds of things can leave you at increased risk for foodborne illnesses.

TODD: Do some people get food poisoning more easily than others? Like, some people just seem to have like a cast-iron stomach and nothing bothers them, where as others, the slightest thing can upset their stomach?

DR. KALAKOTA: Absolutely, as far as strong stomach versus not strong stomach, the theories are mostly related to the gut microbiome, so certain people can have different populations of bacteria that could have a protective effect against these kind of outside bacteria that could cause infections in others.

TODD: So, it's probably not genetic. It's more environmental.

DR. KALAKOTA: Most likely. And again, the gut microbiome. There are genetic components as well. So, it's kind of hard to say, but a lot of it seems to be lifestyle and environmentally mediated.

TODD: You mentioned immunocompromised people as being vulnerable, but are there other groups, children, elderly, you especially have to worry about it with?

DR. KALAKOTA: Oh, absolutely. I think the two that you mentioned, so children and elderly folks, I think it has more to do with the proximity to others. So, often times children will be in children-heavy environments, right? Elementary schools, daycares, even play areas and things like that without the best hygiene. So, there are a lot of bugs on each surface, and they can get these frequent infections and things like that. Similarly for the very elderly, when they are in places like nursing homes and stuff like that, again, proximity to other people, high rates of infections. Especially if, you know, they are highly infectious, like fecal-oral spread. Norovirus is a big one, so you'll see that a lot in nursing homes, and daycares, and cruise ships is a big one.

TODD: Food poisoning, is it something that you can just kind of typically ride out? You're miserable for 24 hours or however long and then it gets better on its own? That's the usual –

DR. KALAKOTA: Most typically, yes.

TODD: So, is there anything you would recommend to self-treat in those situations or is it mostly just drink a lot -- as much water as you can?

DR. KALAKOTA: That's exactly right. So, a lot of water -- I know a lot of folks do things like electrolyte solutions which are great. So, the ones that contain magnesium, potassium, and sodium are usually the best ones. So, using these kinds of rehydration drinks that you've seen at the grocery store as well as sports drinks also have the required amount of electrolytes in them. So, I think those are all good options to kind of hydrate yourself. For symptoms that are kind of more upper GI tract with the nausea and the vomiting, stuff like that, the lining of your stomach gets pretty irritated when you throw up over and over again. So, something like those kind of chalky liquids you see at the grocery store, those work pretty well. There's also the antidiarrheal tablets can be useful, especially if, you know, you got sick and you gotta go on a big, long road trip the next day or something like that, certainly useful so you can avoid stopping a bunch.

TODD: So, I've been food poisoned a couple of times, and I remember that, like, first 24 hours being pretty miserable. But for me, it seemed like it -- for me to fully recover, it took quite a while. It was like a week before I felt like I was totally normal again.

DR. KALAKOTA: Yeah, so -- And I think that's attributed to the change in your gut microbiome, Todd. So, because you have that kind of rapid washing of fluid throughout your GI tract, it certainly can change the population of the bacteria there. And so, that can lead to things like you feeling bloated or you feeling a little bit nervous about eating and things like that. So, certainly, it can take a little bit longer to kind of feel back to normal.

TODD: Do probiotics help then?

DR. KALAKOTA: Certainly. Yeah. That's definitely something I ask patients to add in after an acute diarrheal illnesses, typically not in the first 24 to 48 hours, because sometimes that can make diarrhea worse. But I think the most available and most popular source would just be eating yogurt.

[Music to signal a brief interjection in the interview]

TODD: After the break, more with Dr. Kalakota. 

ANNOUNCER: From annual checkups to managing chronic conditions, your healthcare should be personalized to you. At Houston Methodist, our primary care doctors provide customized care for you and your family with more than 40 convenient locations across Greater Houston. We offer a variety of ways to get care, from in-person and virtual appointments to same-day visits when you're sick. Choose your doctor and schedule online at Houstonmethodist.org/stayhealthy Houston Methodist leading medicine. 

[Sound effect signals return to the interview]

TODD: So, how do you know you need medical help?

DR. KALAKOTA: Sure. I think it's very personalized. I usually have my patients contact me and that -- And I didn't tell them this in the clinic. When they feel like they can't manage their symptoms at home anymore, that's when you gotta either give your doctor a call, if it's really bad, you know, go to the ER. Really, the big thing that I can pinpoint to let them know that's "dangerous" is if they can't tolerate water. If they're throwing up the water or feel like they just can't catch up as far as hydration goes with diarrhea and things like that, seek professional help at that point.

TODD: And how about fever? Is that something that goes with it?

DR. KALAKOTA: Fevers can. It's less common with most gut-located or like foodborne illnesses. Typically, a fever is a more of a sign of a more systemic problem with the illness. So, I see that more in my immunocompromised patients.

TODD: So, if -- And if they do seek medical care, what kind of testing is done?

DR. KALAKOTA: Sure. So, it sort of depends on their symptoms. If it's usually only upper GI symptoms like you're basically only throwing up and you have a bellyache, like, typically there's not a whole lot of testing other than, you know, if it's flu season or, you know, during the Covid pandemic we used to test them because there were a lot of patients that showed up with just GI symptoms with Covid. But a lot of the treatment is focused on rehydrating someone because their GI system is not allowing them to absorb water. So, IV fluids tend to be the mainstay.

TODD: How about antibiotics? Are they giving much?

DR. KALAKOTA: Again, it depends. So, it's -- They are given frequently in the acute care setting, not always is that a good thing because as far as, like, you know, testing for diarrheal illnesses, there's a few panels that we can run on patients' stools that will look for those more common bacteria that we talked about earlier. And -- but outside of that, as I mentioned, there are infinity amount of viruses that we don't know about yet. So, it could be one of those as well. So, ruling out bacterial infections usually negates the need for antibiotics.

TODD: One thing I wanna say, couple times I've been food poisoned it was from salad bars at supermarkets.

DR. KALAKOTA: Yes.

TODD: Is that pretty common?

DR. KALAKOTA: Absolutely. So, it's those leafy greens that unfortunately it's tough to wash them, right? If you've ever tried to wash a head of lettuce, it's really hard to get in those like nooks and crannies. And so, that I think is the biggest piece of advice I would offer is making sure you adequately clean your produce and your meats before consuming them. So, for produce, when I looked it up on, like, the state department websites or the CDC, a lot of it just says hot running water to clean them. I've seen other sources that recommend soaking with, like, a 50/50 solution of, like -- or diluted vinegar and water, like distilled white vinegar. That's typically what I do with my berries and things like that. With the leafy greens, you wanna make sure that you soak them, get off all the visible dirt and things like that.

TODD: If you're eating out at a salad bar, you don't really have that option. Should you not eat out at those?

DR. KALAKOTA: I think that's a hard one to say. I think you should kind of look at the rest of the restaurant. If it looks pretty clean to you, the menus are clean and things like that, I think that's fine. It's hard to avoid foodborne illnesses 100% if you eat out in general, right? Because you don't have control over the cooking process, or the cleaning process, or anything like that. But, yes, unfortunately, I've had a number of patients that have been struck at food salad bars.

TODD: And these were salad bars at supermarkets. I vowed after the first time I would never do it again. But like 20 years later, I broke down and did it. [Laughter] I took us on a little bit of the digression there before the general question of any tips –

DR. KALAKOTA: Yeah, sure.

TODD: So, go ahead.

DR. KALAKOTA: Yeah, so, again, making sure to wash your produce. With meats you wanna make sure that you're cooking them to the adequate temperatures. Again, those are available online at the CDC website as well. But for example, chicken, 165 degrees Fahrenheit. That's where you want it to be before you consume it to make sure that the bacteria are dead, primarily salmonella is what we worry about with chicken.

TODD: And how about traveling?

DR. KALAKOTA: Traveling is tough. So, it depends on where you travel to. In developing nations, I think the -- You know, everybody kinda knows hey, you should drink bottled water and try to eat at the better restaurants and things like that. But I think if you are consuming street foods, or eating in someone else's home, typically, sticking to more vegetarian food and avoiding meat can help you avoid some of the more gnarly infections or ones that will take a little bit longer to cure. But the one thing I think people forget is having drinks with ice in them. Because the ice is not typically made with filtered water, and so, once it melts, you're exposed to all that bacteria as well.

TODD: And if you're traveling to some more risky places, do you suggest like bringing antibiotics or oral rehydration solution?

DR. KALAKOTA: I think that's sort of place to place dependent. I would suggest if you're going somewhere a little bit more remote, typically bringing, like, oral rehydration packs, or even those electrolyte solutions that we talked about before, definitely not a bad idea. Antibiotics typically are not recommended as prophylaxis. It's usually recommended as a treatment after you've identified the actual bug that's doing it. And the reason for that is sometimes even antibiotics can leave you at risk for other infections primarily clostridium difficile. So, preventative antibiotics can sometimes backfire in those cases. So, I would probably recommend oral rehydration possibly even those antidiarrheal pills, but I probably wouldn't recommend antibiotics.

TODD: Okay. And what do you suggest eating both, like, during a bout if you can eat and as you're recovering?

DR. KALAKOTA: Sure. So, I think during a bout, like you mentioned, keeping it real light. I even have some patients that just kind of go to a clear liquid diet until they can put in solid foods. So, things like sports drinks, water. Jello is pretty good. It's very light on your stomach but still will give you a little bit of sugar so you're not, you know, feeling so hypoglycemic. And then even popsicles are great because basically when they melt, they're clear liquid too. Once you feel a little bit stronger and you're kind of keeping liquids down reliably, I would graduate kind of to a bland diet. So, bananas, rice, dry toast, those kinds of things, things that are pretty easy to throw up even if you go back to it. So, keeping it light like that, and then kind of going very slow with yourself.

TODD: What specifically should you avoid those first days when you're starting to feel better?

DR. KALAKOTA: You know, I don't know that there's anything, like, that's an absolute no. But I would say if you're still intermittently having vomiting or diarrhea, avoiding real spicy foods would be good 'cause they're not pleasant to come out either end. And things like dairy and possibly coffee, 'cause coffee can worsen diarrhea especially when you're kind of in the midst of the symptoms. But again, all of those things, if you feel okay to take it you can try a little bit and then kind of see how you feel.

TODD: If I had something like a salad and raw food, like, isn't that a little rough to digest if you're –

DR. KALAKOTA: It can be. Yeah, definitely. Especially when you're stomach is still kind of recovering from an infection or your gut is still recovering from an infection. I'd probably hold off on raw salads and things. If you feel like you need to have a vegetable, make sure it's cooked, steamed, or roasted.

TODD: So, if you suspect you were poisoned by a certain food, should you report it to the -- some health authority?

DR. KALAKOTA: So, you don't necessarily need to take care of the reporting yourself. Typically, there's a list on the -- Well, we're in Texas. So, the Texas Department of Health that is -- That are reportable illnesses. What usually happens is if you are sick, you come see your doctor, you have a stool test and you have one of those infections, they are usually automatically reported, or the physician will take care of it for you. But not usually something that you need to report yourself.

TODD: What if you're pretty sure about it and you're kind of just self-treating at home and let it resolve and so, you're never going to the medical authorities.

DR. KALAKOTA: I don't know that there's really any place for you to report that to be honest with you unless you leave a bad Google review.

[Laughing]

TODD: Got it. Alright, anything I didn't ask that you would wanna add that people might wanna know about food poisoning?

DR. KALAKOTA: Oh, washing your hands is really great. I think everybody should do that a little bit more. There are a number of infections that are spread fecal-orally meaning somebody else's poop particles will -- came in contact with your food. So, washing your hands can eliminate some of that.

TODD: Yeah, very good. Kind of thought you would mention that before, so that's good you did…

DR. KALAKOTA: Yeah.

TODD: You did now. Alright. To summarize, is there something you would hope listeners would take away from this?

DR. KALAKOTA: Honestly, if you didn't listen to anything else we said, washing your hands and washing your food would help you the most.

TODD: Great. Okay, very good. This has been a very educational podcast for me.

DR. KALAKOTA: Great.

TODD: Great to have you here.

DR. KALAKOTA: Thank you so much for having me.

TODD: Thanks for your time.

[Sound effect plays to signal end of the interview]

ZACH: So, Todd, one of the most striking things to me about food poising were the numbers. How many people it affects.

TODD: Forty-eight million a year.

ZACH: That's a lot.

TODD: Yes. I would not have guessed anything anywhere near that.

ZACH: No.

TODD: And 128,000 hospitalizations which I guess is a sm -- comparatively is a small amount, but still, it's a lot.

ZACH: No, these are extreme cases, but that's a lot of cases. I mean, we were just, you know, talking about in our intro about how awful we felt. We didn't have to go to the hospital for our food poisoning incidents.

TODD: Yes. Although I -- Mine was enough that -- I was -- thought I was on the verge of it.

ZACH: Yeah.

TODD: Yeah, I mean, if I took anything away from it, was just kind of take any precautions you can. Be as careful as you can, just 'cause those were, you know, maybe the worst 48 hours of my life and I would rather not repeat that again.

ZACH: Yeah. She made a great point about, look, if you wanna do everything in your power to avoid potentially getting food poisoning, you know, don't go out to eat, right? I mean, like, well, that food is out of your control. You don't know where it's come from, know how it's been prepared, who's touched it. There are so many, you know, points along the way before it gets to you to consume. And if you prepare your own food at home and you're being smart about it, that's a good way to, you know, as best as you can guarantee not to get food poisoning.

TODD: Yeah. Particularly things like picnics, and barbecues, and things like salad bars at –

[Laughing]

ZACH: Salad bars at grocery stores. Yes, look out for those. And we probably sound like a broken record now, but Todd and I have both experienced food poisoning. It is awful. We don't wish it on anyone. And hopefully Dr. Kalakota's tips she shared with us can help us avoid it and recover from it if we happen to get it in the future. That's gonna do it for this episode of On Health with Houston Methodist. Be sure to share, like, and subscribe wherever you get your podcasts. We drop episodes Tuesday mornings. So, until next time, stay tuned and stay healthy.