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Home , Foodborne illness

Editorial overview .: ’ We are what we eat: Ensuring safe and healthy in the 21st centuy

Carl Keen Chair, Department of Nutrition, UC Davis Bennie Osburn Dean, School of Veterinary , UC Davis

lthough there is an abundance of food in A the industrialized world, hunger continues to occur here and around the globe. The current population of over 5.5 billion people will in- crease to 8 billion in the next quarter-century. In California alone, the population is expected to increase by 15 million people in the next 20 to 25 years. The growing need for food production in our state comes at the same time that prime farmland is being converted to housing and businesses (see p. 47). The implications of these dramatic increases in population and land re- quired for food production will require that food be produced by the global community. The major food suppliers of the future may well be a relatively few multinational companies that will dictate the sources, quality and quantity of that we eat in this new century. Previous issues of the California special series, “Future in Focus: 2000-2025,” have addressed the impact of demographic change (January-February 2000), environmental and natural resource problems (March-April 2000) and agricultural technology and sustainability (July-August 2000). This issue ad- dresses food security and the challenges we face to provide a high-quality food source that is safe and nutritious. Nutrition and health As we enter the 21st century, there is the expectation by many that changing one’s diet can markedly reduce the risk for a multitude of including diabetes, cardiovascular .- , macular degeneration, osteoporosis and senile dementia. In addition, many expect v) = that modest changes in diet will translate into if improvements in cognition, mood, physical Foodborne illnesses can have severe economic and political ramifications. All the cider mills in Apple performance and general well-being. While Hill, in the Sierra foothills around Camino, are par- the hypothesis that certain changes in the diet ticipating in a proactive quality assurance plan to will influence physical states is a reasonable prevent contamination of their fresh, unpasteurized one, the probability that all of these benefits apple juice and cider. At Kids, Inc. ranch, Peter and Christine Delfino enjoy the of their family’s can be achieved simultaneously by diet is farm. very low.

4 CALIFORNIA AGRICULTURE, VOLUME 54, NUMBER 5 Nutrient-disease interactions. Specific di- government etary recommendations are not cure-alls. While agencies. How- the investigation of dietary factors that can in- ever, the ultimate fluence one’s risk for the development of cer- reward will be tain diseases will be an exciting area of research the creation of a for decades to come, progress in this area is diet that may likely to be slow. First, for most diseases we still markedly en- have only a poor understanding of the actual hance the quality E biochemical mechanisms that contribute to their of life for all. ii occurrence and advancement. In the absence of -> 2 this information, well-focused investigations on Y nutrient-disease interactions are difficult to con- Theeconomic 4 struct. Further confounding the situation is and political im- Nutritionists and the lack of good biomarkers for most dis- plications of a safe food supply have been un- government agencies eases, or for that matter, nutritional status! As have recommended derestimated until recently. The most dramatic major dietary a consequence, dietary intervention studies recent example of a foodborne problem with changes. However, are often shaped by epidemiological observa- major negative repercussions has been bovine our understanding of tions that identify associative rather than spongiform encephalopathy (BSE), known as nutrient-disease interactions is still causative factors. “mad cow” disease, which afflicted cattle in the limited. Furthermore, while epidemiological studies (England, Scotland, Wales and can provide interesting clues regarding nutri- Ireland) in proportions starting in the tion and health, numerous questions remain. mid-1980s. This problem was followed by the For example, a wealth of epidemiological stud- appearance of a new variant of Creutzfeldt- ies suggest that diets rich in fruits and veg- Jakob disease (CJD),chiefly in British young etables are associated with a reduced risk for people who consumed contaminated beef, with certain cancers (see p. 26). However, the iden- the first human fatality reported in 1996. Both tity of the compounds present in these foods of these diseases are associated with an agent Although it has that are responsible for protective effects has re- thought to be derived from affected cattle, mained elusive. The identification of which causes a fatal nervous-system disorder. often been stated phytonutrients and the quantification of the There is no known treatment. that the United amounts needed in the diet to provide optimal Initially, more than 150,000 cattle were af- protection presents an important research chal- fected by eating contaminated animal-protein States has the lenge for the next decade (see p. 33). feed supplements. Then 80 people became in- safest food supply Genetics. A second major issue that will de- fected with the agent by eating the contami- lay progress is that an individual’s genetic nated beef. This large loss of cattle and the hu- in the world, the background can have a profound effect on their man fatalities have had severe adverse fact that one out susceptibility to a number of diseases and their economic and political ramifications in Britain, response to dietary manipulations. As a conse- and have resulted in significant changes in of four citizens quence, it is difficult at present to identify the what people eat. Economically, the losses from suffers from correct population in which a study should be cattle slaughtered, trade restrictions, bankrupt- conducted. Further, dietary recommendations cies and devaluation of land prices have cost foodborne illness may differ considerably depending on one’s ge- the United Kingdom over $5 billion. Consump- in a given year is netic constitution. These unknowns will also tion of beef has declined dramatically from provide significant challenges to public-health what it was 15 years ago, further affecting farm significant. officials involved with food delivery programs. livelihoods. Politically, the British Conservative Although numerous challenges must be Party lost the parliamentary elections in 1997, in addressed in the area of nutrition and health, large part because its members downplayed the we have made important strides in this field importance of this foodborne disease problem. during the last decade and are poised for Even though the number of from the rapid progress in many areas (see pages 12, new variant of CJD is low so far, projections in- 19,26 and 33). dicate an additional 136,000 deaths from the Armed with a better understanding of the disease could occur over the next 60 years. protectant nutrients in food, we will be able to Worldwide, there are 1.5 billion cases of turn attention to the development of new foods, foodborne illness each year; these illnesses rank and food products that increase the delivery of among the most common forms of disease in important nutrients. This will be a demanding the world. More than 3 million deaths are re- task that will take the concerted action of uni- corded per year. As many as 300,000 individu- versity scientists, partners and als have been affected in a single outbreak. A

CALIFORNIA AGRICULTURE, SEPTEMBER-OCTOBER 2000 5 variety of disease- percentage (36%) of the outbreaks were associ- causing organisms ated with fresh fruits and vegetables. These are are involved. In foods that may not be suitable for and the last 25 years, at therefore pose a greater risk of harboring micro- least 30 newly rec- bial causes of disease. ognized infectious NaturaVorganic foods and supplements. agents have been Interest in natural organic foods and supple- associated with ments continues to increase (see pages 26,33). food- and water- Herbal products sometimes may include poi- a E borne illnesses sonous plant extracts that have powerful S (see pages 62,69 affecting organs such as the , kidneys and 2 and 78). In the heart, causing serious health problems. Organic Food preparation and United States, the foods, like all uncooked produce, may contain handling can have an Centers for Disease Control and Prevention re- contaminants that cause foodborne illnesses. impact on safety. At the Northern Califor- ports 76 million cases, 325,000 hospitalizations Oversight of natural and organic products will nia Food Service and and 5,000 deaths per year. Although it has often help assure safer products for consumers. Baking School in been stated that the United Stateshas the safest Emerging . The ability of mi- Butte work- food supply in the world, the fact that one out crobes to exchange genetic information - in- ers are trained in the art of sDecialtv bread of four citizens suffers from foodborne illness in cluding disease-causing traits and re- baking. a given year is significant. sistance - is now well known. The exchange of Globalization of the food supply. For a va- disease-causing genetic material helps innocu- riety of reasons, including loss of agricultural ous microbes become virulent. Nonpathogens lands, increased labor and production costs, and can become pathogens or develop antibiotic re- year-round consumer demand for fresh fruits sistance through gene transfer. These new and vegetables, agricultural products are being agents affect not only the digestive system but brought into the United States and Europe on a other organs as well. Serious, chronic health larger scale each year (see p. 54). These products problems may follow certain food- and water- are raised in environments where microbial borne illnesses, including arthritis, kidney fail- agents new to the United States may be intro- ure and degenerative neurological disease. In duced with imported food. This represents an- addition to the challenges of identifying new other way for foreign to become pathogens, antibiotic-resistancefactors ex- established in this country. Also, standards for changed between microbes make it more diffi- chemical use in production in many countries are cult to treat many bacterial in people different than those practiced in the United and animals. States. These potential contaminants are signifi- Genetically modified food products. An- cant risk factors for consumers. other issue of major concern is the genetically More complex processing, transport, stor- modified crops and animals that are being de- age and preparation. Central processing op- veloped. Many benefits are associated with the erations create efficiencies but can amplify modifications; however, the long-term health foodborne disease, affecting large quantities of impacts on people and animals are not yet product. Widespread distribution systems can known. Many GMO foods have not received move products - and food- and waterborne thorough testing to determine whether they pathogens - more quickly than ever. The in- cause or create nutritional or metabolic crease in consumption of foods prepared out- imbalances. Consumer acceptance will depend side the home are of concern as proper han- on assurances of safe products. dling, appropriate storage temperatures and Food safety infrastructure. Probably the final preparation add "critical control points" biggest challenge is the increasing difficulty that and potential risks in the food chain. existing regulatory infrastructures have in han- Recommended dietary changes. Major dling food safety issues; there are more than a changes in eating habits, being encouraged by dozen U.S. agencies that claim a role in food nutritionists and government agencies to reduce safety. Unprepared for rapid changes in food the risks of cancer and heart disease, have re- production systems and new issues in sulted in an increase of foodborne disease. For foodborne disease, officials have been slow to example, the eating of uncooked fresh fruits and communicate with each other and respond to vegetables has resulted in greatly increased change. Current agencies are burdened with bu- foodborne illnesses. Over the past 10 years, reaucracy, making it more difficult to establish California Department of Health Services criteria or monitor the increasingly complex records indicate that an increasingly greater food chain. Since there is no single agency to set

6 CALIFORNIA AGRICULTURE, VOLUME 54, NUMBER 5 priorities for much-needed research, such pro- diagnostic testing. Setting up an efficient sys- grams are severely underfunded. These issues tem for reporting and responding to foodborne are further complicated by the rapid changes in outbreaks would be another priority. Finally, to agriculture, globalization issues (including assure the quality of foods and consumer health trade restrictions and liberalization of regula- -as well as animal and environmental health tions), and the control of foods by multinational such an agency would guide credible research corporations from farm to table. and testing programs. There is a way to bring us to an effective so- We should begin with a major food-safety fo- lution to this growing problem. It is time for a rum to lay these issues out on the table in a new new, comprehensive California agency that in- way. Such a forum would recommend to our cludes all the broad aspects of the food chain. policy-makers a new structure addressing all The regulation umbrella must encompass both aspects of food production safety, integrated animal- and plant-based foods. Such an organi- monitoring of food products and , zation would have the clout to oversee critical and assurance of the public health "from farm issues such as the safety of genetically modified to fork." This bold move would establish food products. This agency needs to be empow- California again as a leader in setting world ered to carry out coordinated surveillance and standards for food safety.

H Supplements may contain high doses pounds need to be regulated." Products such as Although they may protect against some forms Gingko biloba pills, grape-seed extract and flax- of cancer when consumed in the diet, plant fla- seed may contain high levels of flavonoids. vonoids may actually have the capacity to be- come carcinogenic at higher levels, scientists at UC hosts food security symposium the UC Berkeley School of Public Health report The Community Food Security Symposium -

in a new study. Uc's first conference to explore the relationships ~ -m In the August Free Radical Biology and Medi- among agriculture, hunger and community- ._(D cine, UC Berkeley toxicologist Martyn Smith based food systems - took place Oct. 10 and 11 : and graduate student Christine F. Skibola de- at UC Berkeley. "I'm particularly pleased that s scribe the many biological activities of fla- many of the Division's programs are working vonoids, showing that high levels of plant fla- closely with the community to develop innova- UC is working to vonoids can bind with and damage chromo- tive approaches to these critical issues," says link area farnks with school lunch somes and DNA in cultures. The effects fol- UC Vice President Reg Gomes. programs. low a gradient, with protective effects at low The purpose of the symposium was to share levels and mutagenic effects at high levels. information among the University, government The authors point out that no one could agencies and community groups, in order to de- swallow in food anywhere near the amounts of velop community-based solutions, with agricul- flavonoids provided in some dietary supple- ture as a critical link. The UC Food Security ments. In fact, Asians and vegetarians have less Workgroup, which organized the symposium, cancer than other people, in part because of includes UC Cooperative Extension, UC Sus- their high consumption of flavonoids in soy, tainable Agriculture Research and Education green tea and vegetables (see pages 26/33). Program (SAREP) and USDA. Studies in the United States, Europe and Symposium participants discussed programs Asia, for instance, show that people get 5 to 68 linking small farmers with school lunch pro- milligrams of the flavonoid quercetin in their grams; community gardening projects; farmers' diets per day. But a popular health food supple- markets and food stamps; and hunger in low- ment recommends taking 1,000 milligrams in income communities (see pages 8,10,40,47). one swallow - 10 to 20 times more than even a "UC can help consumers understand the high dietary intake of quercetin. benefits of nutritious, locally produced food, "That's when we get worried," says Skibola. which in turn helps create markets for small "There is no rhyme or reason for the dosages farmers," says Gail Feenstra, UC SAREP food recommended on these bottles. These com- systems analyst.

CALIFORNIA AGRICULTURE, SEPTEMBER-OCTOBER 2000 7