Seven years ago, while reading Miami New Times for the first time, I spotted an advertisement seeking a restaurant critic. Aside from qualifications it asked, "Do you have the stomach for this job?"
Ambitious, hungry, and more than a little naïve, I thought I surely had both the background and the belly. During college I supported myself with numerous positions in restaurants, where I witnessed everything from drug transactions to fights between cooks with freshly sharpened kitchen knives. I sampled pigs' ears in Vietnamese restaurants and sea slugs in Chinese eateries. And I was too young at the time to suffer from a guilty conscience; leveling bad reviews did nothing to interfere with my appetite. For a brief time after I landed the job at New Times, I was virtually invincible.
Then I contracted my first case of food poisoning.
Anybody who's had food poisoning can almost always recall it in graphic detail: It can be as violent as a hurricane, albeit an internal one. As defined by the American Medical Association Encyclopedia of Medicine, food poisoning is "a term used for any illness of sudden onset, usually with stomach pain, vomiting, and diarrhea, suspected of being caused by food eaten within the previous 48 hours."
In this instance I'd gone to a multiplex after eating at a seafood restaurant. One minute I was sitting in a Jim Carrey movie, the next I was hanging on to a light pole in the parking lot, as were two of my fellow dining companions -- and it wasn't owing to Carrey's overacting. We concluded the cause of our upset was most likely a virus that dwells in sea animals.
The type of food poisoning will determine how fast you get sick. After eating tainted shrimp tempura at a South Beach sushi bar and spoiled eel at another SoBe sushi spot only a few weeks later, I became ill, both times within the hour. But my most recent bout of food poisoning, which I picked up via a tuna fish sandwich topped with hard-boiled eggs at a very popular country-style restaurant in South Miami only a few weeks ago, took a good six hours to show itself. That's not unusual. Mosby's Medical & Nursing Dictionary claims that salmonella is "characterized by an incubation period of 6 to 48 hours followed by sudden, colicky abdominal pain, fever, and bloody, watery diarrhea." Salmonella takes about as long to clear up as the flu.
"Most food poisoning is self-limited," says Dr. Neil Stollman, chief of gastroenterology at Miami VA Medical Center. "By the time you make an appointment, it's gone away. As a result I only see about six cases per year, and even then, we don't usually identify it. Usually we diagnose food poisoning empirically, based on a person's story."
Because more people eat out these days, food poisoning from restaurants is on the rise. But statistics are skewed because not everyone who gets food poisoning knows (it's often confused with the stomach flu) or reports it, while those who report it often don't get tested. The New York Times recently estimated that about 74 million people get food poisoning per year.
Salmonella, strains of which multiply rapidly in the intestines, is the most common bacteria to cause food poisoning. The riskiest foods for salmonella are poultry, followed by eggs. It's easy to get because it doesn't make the food smell or taste any different. Chicken can breed salmonella and you won't know it. People often don't cook it correctly. They'll throw it on the grill when it's still frozen, which means it will cook unevenly and possibly contain salmonella. Don't ever eat the flesh of a bird like turkey or chicken if it's still pink -- that's a sure sign it isn't cooked.
Food-borne botulism is a more severe toxin. Although the American Medical Association Encyclopedia of Medicine reports "botulism is more common in the U.S. than anywhere in the world," it's rare -- only about twenty cases are reported each year. But beware: Approximately two-thirds of botulism cases are fatal. Botulism bacteria produces spores that are resistant to boiling, salting, smoking, and pickling and can only multiply in airless environments. Therefore canned or bottled foods, particularly those preserved or pickled improperly, are suspect. Bulging cans almost certainly contain botulism and should be discarded immediately; it's not a good idea to eat from dented cans either. Cured pork or ham and smoked or raw fish can also contain botulism, which is usually detectable (but not always) by an "off" smell.
Generally E.coli bacteria is found in meats. It's relatively uncommon but tends to occur in epidemics; a lot of people can catch it from one batch of beef. You can kill E.coli with high temperatures, and should cook or order meat medium-well. The tradeoff is that you frequently get hamburgers like hockey pucks. I'd rather take my chances.
The main problem with sushi is parasites, though raw fish can also contain botulism bacteria. Shellfish are susceptible to rotovirus, which comes from human-feces-contaminated water, and causes intestinal discomfort. More dangerous is the protozoa known as "red tide," which clams and mussels ingest from the warm waters where the protozoa multiply. The toxin responsible is called saxitoxin and can cause neurological symptoms, including paralysis of the extremities and/or respiratory system. Saxitoxin can't be killed by cooking, so the best way to avoid it is to shun clams and mussels that come from warm or tropical waters.
When you cook at home, you can and should take precautions to make sure your food is safe. It's not as easy to exert control when you dine out as often as I do. In my case I chalk food poisoning up to a job hazard, and I often joke that the symptoms are a food critic's best fad diet. Sure, eat in establishments that come recommended. Don't deliberately court contamination by eating raw oysters in, say, summertime. But in reality you just can't predict when and where food poisoning will occur. Of the cases I mentioned, all happened at well-respected restaurants, one of which I continue to dine at regularly.
If you do get sick after eating and if you're in ill health or immuno-compromised, it's best to bring yourself to an emergency room where proper diagnoses can be made. But unless your case is ultraserious or could indicate a widespread outbreak where a source needs to be traced, technicians won't test you for food poisoning. Rather they'll treat the symptoms, the most dangerous of which is dehydration, by giving you intravenous fluids before sending you home.
Really you've got little choice but to wait it out. "Don't take antidiarrheals unless you're very old or very young and in danger of dehydrating to the point of death," recommends Dr. Stollman. "Diarrhea is the body's attempt to get rid of [the toxin]. In normal, healthy people, antidiarrheals will only prolong the syndrome."
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