170 | Sequelae: The Mysterious Long-term Outcomes of Foodborne Illness | Toxic Bean Sprouts |
Plus, he did what to the donuts?
This is The Rotten Apple, an inside view on food fraud and food safety for professionals, policy-makers and purveyors. Subscribe for insights, latest news and emerging trends straight to your inbox each Monday.
Sequelae: The Mysterious Long-term Outcomes of Foodborne Illness;
What’s next for The Rotten Apple;
Food Safety News and Resources;
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Food fraud news, emerging issues and recent incidents.
Just when you think you’ve seen everything in food fraud, something new appears. Last week I discovered that a plant growth promoter that is potentially harmful to consumers and not allowed in human food production is being used to soak mung bean sprouts for better-looking, faster-growing products. Its use is allegedly widespread in the Vietnamese sprout industry.
Welcome to 2025 with The Rotten Apple, thank you for joining me.
This week’s issue is designed to help ease you into the new year - and help me catch up on three weeks’ worth of food fraud and food safety notifications.
You’ll discover what’s next for this publication (mostly just more of what you love already), and hear some podcast stats. The big story this week is about the often horrific sequelae (subsequent illnesses) that can follow a foodborne illness. Turns out they’re not as rare as I thought, but are every bit as scary. As if we needed another reason to care about food safety!
There’s lots of food fraud news this week, including details of the bean sprouts nastiness, plus tales of Christmas cake poisonings, cocktail dramas and donut disgustingness in our food safety news.
Enjoy your week,
Karen
P.S. Huge thank yous to everyone who upgraded their subscriptions over the break, including 👏👏 Haeyeon who purchased a group subscription (35% discount!), Joop and Deepa 👏👏. Your support means the world to me. Happy New Year!
What’s next for The Rotten Apple?
Three and a half years ago I decided to create the thing I wished existed in the world:
A food safety newsletter that inspires, educates and doesn’t exist just to sell advertising space for lab equipment suppliers and heat exchanger companies… A newsletter that was neither too academic nor too dumbed down…. A place to discover new knowledge and keep up to date with the world of food safety and food fraud without the boring stuff.
As we jump into 2025, here is a look at The Rotten Apple by the numbers, across our key mission areas: grow, connect, learn.
🍏 Grow. Our total readership grew by almost 50% in 2024, to 3,684 subscribers (free and paid). Paid subscriber numbers increased by 46%.
🍏 Connect. Dozens of readers attended 8 monthly meetups in 2024, making new connections with other professionals around the globe. I also met some of you in person at the IAFP convention in Long Beach.
🍏 Learn. In 2024, my assistant Jane and I scanned, read, wrote and shared hundreds of thousands of words for you…
26,040 headlines scanned;
5,550 online stories read;
500 short, sharp news items created;
493 peer-reviewed articles cited;
150 high-quality free webinars sourced;
113 impactful infographics shared;
109 takeaways,
… for a total of 216,038 views from 101 countries.
This year I aim to help even more food professionals grow, connect and learn.
I’m also hoping to earn a meaningful wage from this publication, which currently pays me about the same hourly rate as I would earn making sandwiches at my local cafe.
That could mean a change to my policy on sponsorship, with free readers (only) being affected. I’ll also be increasing prices for paid subscriptions for the first time. Current paying subscribers will continue to enjoy renewals at the current price in perpetuity, so if you’ve been on the fence about supporting my work, upgrade now to beat the price rise.
In 2025 there will be changes to live events. In 2023 you told me that you wanted monthly meetups, but attendance was poor in the second half of the year so they’ve been discontinued. In their place: more live training. Topic suggestions and presenters are needed. We’ll continue with the occasional food safety competition, as they were lots of fun in 2024.
Meanwhile, I’ll continue to bring you only the best, most interesting, carefully crafted, hand-curated selection of food safety and food fraud insights from around the world each week, for less than the cost of a weekly sandwich🥪.
In short: 🍏 We’ve worked hard to bring you the best not-boring food safety and food fraud information from around the globe for 3.5 years 🍏 In 2025 there will be more live training - get in touch if you want to deliver some - and more competitions 🍏 I may open the publication to sponsorship (free readers only) 🍏 There will be a price rise (current paying subscribers will not be affected) 🍏 I’ll keep striving to bring you the best food safety and food fraud content from around the globe every week 🍏
Sequelae: The Mysterious Long-term Outcomes of Foodborne Illness
We all know that foodborne illnesses can cause gastrointestinal symptoms like vomiting, diarrhoea and abdominal pain.
You’re also probably aware that some foodborne pathogens cause more serious and irreversible outcomes such as miscarriage (Listeria monocytogenes), kidney failure (Shiga-toxin producing E. coli)) and death from respiratory paralysis (Clostridium botulinum).
But what we don’t often hear about in food safety circles is the long-term after-effects - sequelae - of foodborne illnesses, caused by some pathogens and toxins.
These sequelae range from arthritis (Salmonella spp. and Shigella spp.) to the severe neurological disorder Guillain-Barre syndrome (Campylobacter). There are even links between foodborne illness and long-term conditions such as autoimmune thyroid disease (Yersinia enterocolitica) and Alzheimers disease (Helicobacter pylori).
Sequelae of foodborne illnesses are estimated to develop in 12 to 18 million* individuals each year.
Compare that number to the incidence of norovirus, the USA’s most prevalent foodborne illness, and you can see that sequelae have a significant public health footprint. Norovirus is estimated to cause 135 million illnesses per year globally, according to the World Health Organisation.
For every ten people who contract norovirus, with its typically quick recovery time, one person will discover they have an ongoing chronic after-effect from a previous bout of foodborne illness.
Which are the worst foodborne pathogens for sequelae?
Ford et al (2014) compared data from sequelae following infections with Campylobacter spp., Shiga-toxin producing E. coli (STEC), nontyphoidal Salmonella spp., Shigella spp., and Y. enterocolitica and estimated that eighty percent of sequelae cases were the result of Campylobacter infections.
Campylobacter is responsible for Guillain-Barré syndrome, a neurological disorder that can be life-threatening and is the most common cause of paralysis globally. It causes rapid-onset muscle weakness and can lead to problems with breathing, abnormal heart rate and blood pressure. Two-thirds of people recover, with recovery taking from weeks to years.
STEC causes haemolytic uraemic syndrome after toxins from the bacteria enter the bloodstream and damage blood vessels. It is a life-threatening condition that can cause damage to kidneys and other organs. Shigella, Salmonella and pneumonia infections can also cause haemolytic uraemic syndrome.
Campylobacter, nontyphoidal Salmonella and Shigella cause irritable bowel syndrome, a gastrointestinal disorder that causes abdominal pain and bowel dysfunction and can persist for years.
Campylobacter, nontyphoidal Salmonella, Shigella and Y. enterocolitica cause reactive arthritis, a condition characterised by inflammation, pain and swelling in the joints and tendons, rashes and eye pain. Eighty percent of people make a full recovery within 12 months.
Liver flukes, a group of terrestrial parasites that can cause infections from contaminated food and water, play significant roles in the development of bile duct cancers in humans.
The seafood parasite Anisakis has been linked to colon cancer.
Who is most at risk?
Chronic illnesses that follow a foodborne illness event, but are distinct from the initial illness are not tracked and reported like the most common foodborne illnesses. They are rarely linked epidemiologically to a particular outbreak because they often occur weeks or months after the initial infection.
After suffering from a foodborne illness, the likelihood of a patient developing a sequela or sequelae varies, depending on the virulence of the organism and the dose received, as well as the age, immune status and genetic characteristics of the patient.
Case study: paralysed from the neck down
When a 24-year-old Irish man ended up in the intensive care unit with rapidly progressing paralysis in August 2024, doctors were initially baffled. His first symptom was tingling in his leg. Within 24 hours he had lost all feeling from the neck down, lost his ability to communicate, and required assistance to breathe.
His parents described the horror of taking him to the hospital, saying that when he left home could walk to the car but by the time he got to the hospital he could not only not walk but couldn’t even open the car door.
He was diagnosed with Guillain-Barré Syndrome (GBS), likely caused by a bout of food poisoning from Campylobacter two weeks earlier.
Two weeks after being admitted to hospital he remained in the intensive care unit, still paralysed and with a long road to recovery ahead. I tried but was unable to find a more recent update on his status.
Campylobacter jejuni infection-related GBS is thought to be more severe than GBS from other causes. For example, among British patients who contracted GBS following a Campylobacter infection, 23% could not walk unassisted 12 months after the onset of symptoms, compared to 9% of other GBS patients.
Among Dutch patients in another study, 58% who contracted GBS following a Campylobacter infection could not walk unassisted 6 months after the onset of symptoms, compared to 12% of patients with no evidence of a preceding Campylobacter infection.
What can be done to prevent these serious chronic diseases?
With up to 3% of foodborne illness cases leading to serious chronic disease, it goes without saying that reducing the number of cases of foodborne illness should be a top public health priority.
Food safety interventions aimed at reducing campylobacteriosis rates in New Zealand, which included poultry industry interventions, testing performance targets at primary processing plants and the promotion of freezing all fresh poultry meat, successfully reduced notifications for the disease by 54% between 2006 and 2008. GBS hospitalisations declined by 13% during the period.
Programs to reduce pathogenic E. coli in fresh produce are underway in the United States.
Everyone in the food supply chain has a part to play to keep pathogens out of food, not just to stop acute foodborne illnesses, but to protect consumers from the devastating effects of preventable, debilitating and deadly diseases like GBS, haemolytic uremic syndrome, bowel disorders and cancer.
In short: 🍏 A small but significant proportion of foodborne infections results in a secondary illness that is distinct from the initial illness 🍏 These secondary illnesses (sequelae) can lead to severe, long-term negative impacts on health and quality of life 🍏 They can lead to neurological disorders including paralysis, permanent kidney damage, chronic bowel dysfunction, painful arthritis and cancer 🍏 Preventing foodborne illness prevents these serious sequelae 🍏 Everyone in the food supply chain has a role in prevention 🍏
Sources:
Ford, L., Kirk, M., Glass, K. and Hall, G. (2014). Sequelae of Foodborne Illness Caused by 5 Pathogens, Australia, Circa 2010. Emerging Infectious Diseases, 20(11), pp.1865–1871. doi: https://doi.org/10.3201/eid2011.131316.
Galvin, T. (2024). ‘Nothing’s working except his mind’ – Man left paralysed from neck down after eating bad chicken. [online] SundayWorld.com. Available at: https://www.sundayworld.com/lifestyle/real-life/nothings-working-except-his-mind-man-left-paralysed-from-neck-down-after-eating-bad-chicken/a1930677627.html
Nachamkin, I., Allos, B.M. and Ho, T. (1998). Campylobacter Species and Guillain-Barré Syndrome. Clinical Microbiology Reviews, 11(3), pp.555–567. doi:https://doi.org/10.1128/cmr.11.3.555.
*This figure is derived from the estimated 2% to 3% of cases that develop a chronic long-term condition and the 600 million cases of foodborne illness estimated to occur globally.
Food Safety News and Resources
My food safety news and resources posts are expertly hand-curated food safety news from around the globe. This week: new evidence for the survival of Avian influenza in cold milk, two food tampering incidents (he did what to the donuts?!) and much more.
Click the preview below to read.
The Rotten Apple on Spotify
Did you know I publish an audio version of this newsletter each week on Spotify, as well as Apple Podcasts and various other podcasting platforms?
In 2024, Spotify listeners tuned into The Rotten Apple Podcast from 19 countries. My youngest listeners were from Algeria and the oldest from the United Kingdom. The most popular episode on Spotify was Issue 123, which was streamed 182% more than the average episode.
Below for paying subscribers: Food fraud news, research and incident reports
📌 Food Fraud News 📌
In this week’s food fraud news:
📌 Rat juice guilty plea (yuck!), massive organised crime network in clam supply chain, rice misrepresentation, ‘saliva oil’ in restaurant dishes;
📌 Predicting unknown adulterants in dairy foods;
📌 Methods for olive oil, essential oils and meat;
📌 Unauthorised chemical treatment of bean sprouts an open secret in industry.
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