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Safety Issues in the Human Food Chain, Richard (Dick) H. Dougherty,
-------------------------------------  Ph.D., Food Processing
Specialist, Department of Food Science & Human Nutrition, Washington
State University, Pullman, WA

The Center for Disease Control estimates that there are 76 million
cases of food-borne illnesses per year.  Some pathogens that can and
do show up in our food chain include E. coli, Listeria monocytogenes,
salmonellae, toxoplasma, giardia, cryptosporidia and campylobacter.
The first three account for about 74% of the recorded deaths (about
1500).  In recent years outbreaks have occurred in meat products, raw
juices, produce, dairy products, cereals, and seafoods.  The reasons
for the increase in reported outbreaks include:

  * Our ability to detect pathogens (disease-causing organisms) at low
    levels has improved significantly.

  * Information generation and dissemination is better, faster and
    wider through phone, fax, radio, television, and the internet.

  * Testing and monitoring techniques have been improved
    significantly.

  * The reporting of problems by both the manufacturers and the
    governmental agencies is more complete.

  * The microorganisms themselves are changing.

  * The food chain systems, especially distribution, are changing.
    What was once available only in season from the adjacent truck
    farm is now available from somewhere in the world year round.

The sources of pathogens in the food chain can be anywhere from the
raw materials to the ingredients to the people/workers and the
equipment/transportation.  Some of the worst problem areas include
sponges, cutting boards, pipes and areas of that nature.  But the
worst area is spices because they are never cleaned and cannot be
washed down with water.  The only method for cleaning is irradiation.

There are two methods for making food safe.  The first is to keep the
bugs out by washing or cleaning the product.  The second is to kill
the bugs before consumption by either cooking the product well or
irradiating it heavily.

From the consumer standpoint, Dr. Dougherty suggested the following
cautions:  First, understand what the true risks are.  Then, know what
the options are.  After that, know your foods and your food sources.
And finally, control what you can.

The people who are at highest risk with any food borne pathogen are of
course children, elderly and anyone with a severely depressed immune
system.  The foods which present the highest risk to people are
uncooked meat, poultry, seafood and eggs as well as raw milk.  Sprouts
present a moderate risk as a food.  However, there are no controls on
them and no one knows what to do.

Because most pathogens are on the outside of food products, the best
protection is to clean and wash everything.  In the case of meats,
such as steak and hamburger that require cooking, different rules
apply.  Steak, because it is heated well on the outside, is generally
safe.  Hamburger, because the outside of each strand of meat is mixed
throughout, is not safe unless it is heated all the way through or
cooked well.

Dr. Dougherty ranked the risks as follows:

  1. Highest risk:  uncooked meat, poultry, seafood or eggs, and raw
     milk.
  2. Moderate risk:  sprouts and raw milk cheeses.
  3. Low risk:  fresh produce, cooked meats, and filled pastries.
  4. Lowest risk:  canned foods, pasteurized food (milk, juices),
     breads, and pastries.

Public policies or attitudes will determine what trade-offs we make.
Because we will never be able to attain 100% safety, we must determine
1) how safe is safe?, 2) how much risk are we willing to accept for
the desired level of safety?, and 3) how many dollars are we willing
to spend?  Consumers are the link between these questions.  They help
decide by the choices they make.

In response to questions Dr. Dougherty indicated:

  * Based on the FDA cleaning standards, he does not see crop
    contamination as a problem.

  * He is not sure about oranges but any pathogens would probably be
    on the outside only.

  * The FDA website is <http://www.fda.gov>.

  * Organic foods are a quality issue, not a safety issue.

  * Imported foods must meet the U.S. standards the same as domestic
    products.

  * He personally does not wash all fruits and vegetables.  It depends
    on the situation you are in.


The Role of the Small Bowel Biopsy in Celiac Disease, Cynthia S.
----------------------------------------------------  Rudert, M.D.,
Board Certified Gastroenterologist, former Assistant Professor of
Medicine Division of Digestive Diseases at Emory University, private
practice specializing in Celiac Disease, Atlanta, GA.

The usual diagnostic procedure for Celiac Disease (CD) is a good case
history, serology and then a small bowel biopsy.  Dr. Rudert obtains
at least 12-15 samples in each biopsy and sometimes uses a pediatric
colonoscope to get deeper.  Some patients, however, have bowel x-rays
after serology to rule out other diseases such as Crohn's disease.
Dr. Rudert has found that one of four of her Crohn's patients
actually has CD.  She has also found that CD mimics ulcerative
colitis.

Blood testing has been found to absolutely correlate with TOTAL
villous atrophy.  The tissue transglutaminase test is now being done
with the anti-endomysial blood test by some labs.  However, the
endomysial antibody tests have a poor correlation with PARTIAL villous
atrophy, which leads to the conclusion that one should not completely
trust serology.  The results should be taken with a grain of salt.

There was a workshop of interested CD professionals that convened in
Marina del Ray, CA in Feb, 1999 to examine blood testing standards in
the U.S.  The participants included Joe Murray (Mayo Clinic), Chris
Maldorf (Netherlands), and Don Kasarda (USDA).  It was determined that
there are many labs involved but no standards and no 100% match
between labs.  A celiac standards group was established to examine the
situation yearly and establish national laboratory standards for CD
blood testing.

There are two rules for small bowel biopsy.  If doing an endoscopy-for
ANY reason-do a CD biopsy.  When doing a biopsy, get multiple
samples--more is better.  An endoscopy can look normal in most cases
but a biopsy is always required because the diagnosis of CD is
microscopic, not visual.


Celiac Disease and Psychiatry, Dr. Newport [ed. note: Dr. Newport
-----------------------------  was an addition to the printed program
and his credentials, unfortunately, were not obtained.]

There are many psychosomatic diseases and many diseases with
psychiatric implications.  There is little research on Celiac Disease
(CD) and it's psychiatric manifestations, so we must learn from other
illnesses and apply it to our expectations in the unfolding of CD.

CD in a child may look like Attention Deficit Disorder (ADD) and we
can deal with this by educating health professionals.  There may be
more than one problem.  If you treat ADD only and don't get good
results, then look for something else.

Earlier dementia in Alzheimer's Disease may be caused by CD.

The relationship between a known medical problem and psychiatric
symptoms can be the result of one of three conditions:

  1. It can be the result of the stress of the medical condition.  For
     example, the diagnosis of the medical condition can induce
     depression and/or anxiety.  Or the illness changes the patient's
     lifestyle inducing stress and resultant problems.

  2. The biological illness itself may be the direct cause.  For
     example, cancer can spread and attack other parts of the body.
     Or a malabsorption condition can affect memory or other
     activities.

  3. The treatment regimen can cause a problem.  The medicines used to
     treat cancer, for example, can have disruptive side effects.  Or
     a diet can manage an illness but unbalance other aspects of the
     patient's well being.

The issue is when to diagnose psychiatric problems, e.g., if a patient
is diagnosed with cancer, don't they have a right to be depressed?
Both cancer and depression can cause loss of weight, sleep problems
and/or pain.

The first step is to maximize the medical treatment including patient
education and involvement with support groups.

The next step is to treat the psychiatric symptoms with the current,
vastly improved, depression/anxiety medications.  One must be careful
with any drug interactions; cautious with the dosage level-start low
and increase slowly- and patient awaiting results.  If these two steps
produce no response, one must look deeper for the cause.

His take home message was:  CD could produce extreme despondence,
especially when dealing with restaurants.

Dr. Newport knew of no studies of schizophrenia and CD since the
1970's and that data showed no connection.