I had a good talk the R.J. Wilson of Healthway a few weeks ago – love the illustration.

Most of us live in relatively ignorant bliss when it comes to our food. We know that we shouldn’t eat from the salad bar of a seedy motel, for instance, and that we’re better off avoiding fast-food sushi.

Ultimately, however, we don’t really know what happens to our food before it’s presented to us.

Studies show that 76 million people are affected by food illness every year. Those illnesses can be caused by bacteria, viruses, molds, and even parasites—and in some cases, the symptoms are life-threatening.

Food poisoning attorney Bill Marler has seen just about everything. He has represented clients in some of the biggest food safety cases on record, and over time, his professional life has shaped his food preferences.

I have a different relationship with food because of my profession.

In early 2016, Marler compiled a list of six foods that he never eats (although, as we’ll explain shortly, he’s taken occasional liberties with one of those foods). The article quickly went viral, which didn’t surprise the attorney.

“I get asked a lot about what foods I stay away from,” Marler explains to HealthyWay. “It was one of those kind of things where I finally decided to just put them [together], and I came up with six.”

But while Marler thought that the piece would do well, he might not have anticipated its reach.

“My daughter called me and said, ‘Dad, you’re trending [online],’” he recalls. “It was the first time she actually thought I was interesting!”

We spoke with Marler to review the original list—and to find out whether he’s really serious about some of these.

1. The first item isn’t exactly a hard one to pass up…

What’s healthier than raw sprouts? They’re a great addition to any sandwich, right?

Not quite. In the past 20 years, over 30 reported illness outbreaks resulted from sprout consumption, including numerous cases of salmonella and E. coli.

In 2014, 19 people were hospitalized with salmonella poisoning from eating sprouts. Marler warns that there have been too many outbreaks to not pay attention to the risks.

The U.S. government’s consumer food safety website, Foodsafety.gov, includes this warning: “Children, the elderly, pregnant women, and persons with weakened immune systems should avoid eating raw sprouts of any kind (including alfalfa, clover, radish, and mung bean sprouts).”

Of course, the site also notes that cooking the sprouts kills the harmful bacteria, so if you prefer your bean sprouts cooked, you’ve got nothing to worry about.

Plus, sprouts are…well, kind of gross, so we don’t really mind avoiding them. Unfortunately, the list gets harder from here.

2. Marler admits to cheating on this one.

This one isn’t so much about the food as the way it’s prepared.

Pre-cut fruit seems like a great idea, in theory; you get delightfully sliced pieces of perfectly ripened fruit filled with vitamins, minerals, and antioxidants.

However, in his original article, Marler wrote that he avoids pre-cut fruit “like the plague.”

As Marler wrote, the extra handling and processing increases the chances that the fruit will be contaminated. According to the Australian Institute of Food Safety, pre-cut fruit is one of the most common foods associated with foodborne illnesses.

Still, Marler admits that he doesn’t exactly avoid cut fruits “like the plague.” He was using a bit of hyperbole to get his point across.

“If I’m traveling or looking for a quick lunch, sometimes it’s just too convenient,” he says.

He does recommend eating whole fruits instead; that should help people avoid listeria, a bacteria that can cause gastrointestinal and nervous system issues.

3. Ready for a healthy breakfast? Well…sorry in advance.

This one might be hard for some people to stomach; we can’t imagine asking for our eggs over-hard.

Even though much has changed in the way of the handling and processing of eggs nowadays, it wasn’t long ago that people were getting sick from raw eggs. In the early ’80s and ’90s, salmonella was an epidemic, but in 2010, the CDC reported around 2,000 cases of salmonella contamination involving eggs.

Salmonella can live both inside and outside the shells of eggs. Symptoms of salmonella poisoning can last for over a week and include cramps, diarrhea, and fever. Infectious disease experts recommend keeping eggs refrigerated until they’re ready to be prepared.

Marler admits that eggs are getting safer. “[Salmonella in eggs] is less of a problem than it was, say, 10 years ago,” he says. “But it’s still a risk that is, in my view, not worth taking.”

Not to disagree with our expert, but we’ll note that the risk is quite limited. Per Forbes, about one in 20,000 eggs is infected with salmonella. That’s a pretty small number, all things considered. Cooking your eggs (properly) limits the growth of bacteria and reduces the chance of salmonella poisoning.

Still, a representative of Foodsafety.gov tells HealthyWay that eggs still pose a pretty significant risk, particularly to immunocompromised people, and consumers need to understand that risk before partaking.

4. This food trend might seem healthy, but that’s not the case.

Pasteurization removes some of the nutrients in juice and milk and that doesn’t bode well with the super-health-conscious crowd. As a result, raw milk and juices have become more popular over the past few years, despite warnings from the FDA.

Marler argues that there’s no benefit compelling enough to minimize the risks involved with these drinks. Since pasteurization is an important safety procedure that eliminates harmful parasites, bacteria, and viruses from beverages, it would be irresponsible to risk possible infection for a couple of extra nutrients.

Of course, his opinion is informed by his case work. In 1996, Marler fought for several children against the popular beverage company Odwalla. One client developed a serious affliction called hemolytic uremic syndrome (HUS) from drinking unpasteurized apple juice. HUS is caused by E. coli and is linked to anemia and kidney failure.

Ultimately, Odwalla was held responsible and had to pay a $1.5 million fine and another $12 million to the victims.

5. We’ve got bad news for meat eaters.

Although something of a delicacy, rare steak (and other kinds of beef) carry with them a host of potential foodborne pathogens, including listeria, salmonella, and E. coli. Marler recommends steering clear of meat that is cooked rare.

He suggests that steak should only be consumed if it’s medium-well or well, which should kill the harmful bacteria.

It may not be the most delicious way to eat a steak, but Marler says the risks outweigh the rewards. The FDA cautions that red meat needs to be cooked to 145 degrees Fahrenheit (160 degrees for ground meats) in order to be safe.

Ground meat products (like hamburgers and meatloaf) need to be cooked even more thoroughly since bacteria that sits on the surface of the meat is often ground inside of it.

Still, we had to ask: Does he really order all of his steaks well done? Yes, although he recalled one meal in which a restaurant confused his order with his colleague’s.

“They switched the order, and I quickly looked at his steak and my steak and realized it,” Marler recalls. “We had to switch them back.”

6. But Marler received the most complaints for this final item.

Most people know that oysters are not the cleanest food available, but often people don’t realize why. Oysters filter feed, which means they eat (and hold on to) everything that’s in the water—and we mean everything.

When you eat raw oysters, you ingest their bacteria (somewhat obviously). Marler says that he has seen many more issues with the consumption of raw oysters over the last five years as compared to 20 years ago, and he believes that warmer water temperatures are to blame.

Why? Well, higher water temperatures mean more microbial growth, which means more cases of foodborne illness. In order for an oyster to be safe from bacteria and viruses, it must be cooked thoroughly. That reduces the risk of an illness, but doesn’t eliminate it altogether.

“We’re starting to see more cases [involving oysters],” Marler says, noting that, despite the pushback from his friends on the East Coast, he wouldn’t take the mollusks off of his list.

So, would Marler make any changes to this list?

Nope. He says that while he’s seen contamination with specific brands, he doesn’t think he’d make any additions.

“There’ve been lots of outbreaks linked to, for example, soy nut butter,” Marler says. “But [the list] includes things that, historically, in my experience, have been much more risky. They’re involve products that don’t have a ‘kill’ step—they’re not cooked.”

He also says that while he’s fairly strict about his own diet, he doesn’t ask his friends to order differently at restaurants.

“Most people know what I do, and they either don’t care or they change their order,” Marler says with a laugh. “I have a different relationship with food because of my profession.”

Perhaps I need to add in flour in cookie dough?

More than 45 million turkeys are eaten on Thanksgiving Day, with a never-ending list of side dishes and desserts. The Thanksgiving meal is by far the largest and most stressful meal many consumers prepare all year, leaving room for mistakes that can make guests sick. But never fear, the U.S. Department of Agriculture (USDA) Food Safety and Inspection Service (FSIS) is available with tips and resources to make this Thanksgiving safe and stress-free.

“Turkey and other meat and poultry may contain Salmonella and Campylobacter that can lead to serious foodborne illness,” said acting FSIS Administrator Paul Kiecker. “By properly handling and cooking your turkey, you can avoid these harmful pathogens and ensure your family has a safe and healthy Thanksgiving feast.”

Begin by following these five steps:

Wash your hands, but not your turkey

Washing your hands before cooking is the simplest way to stop the spread of bacteria, while washing your turkey is the easiest way to spread bacteria all over your kitchen. According to the 2016 Food and Drug Administration Food Safety Survey, 68 percent of consumers wash poultry in the kitchen sink, which is not recommended by the USDA. Research shows that washing meat or poultry can splash bacteria around your kitchen by up to 3 feet, contaminating countertops, towels and other food. Washing doesn’t remove bacteria from the bird. Only cooking the turkey to the correct internal temperature will ensure all bacteria are killed.

The exception to this rule is brining. When rinsing brine off of a turkey, be sure to remove all other food or objects from the sink, layer the area with paper towels and use a slow stream of water to avoid splashing.

To stuff or not to stuff

For optimal food safety, do not stuff the turkey. Even if the turkey is cooked to the correct internal temperature, the stuffing inside may not have reached a temperature high enough to kill the bacteria. It is best to cook the stuffing in a separate dish.

Take the temperature of the bird

Although there are various ways to cook a turkey, the only way to avoid foodborne illness is to make sure it is cooked to the correct internal temperature as measured by a food thermometer. Take the bird’s temperature in three areas — the thickest part of the breast, the innermost part of the wing and the innermost part of the thigh — make sure all three locations reach 165ºF. If one of those locations does not register at 165ºF, then continue cooking until all three locations reach the correct internal temperature.

Follow the two-hour rule

Perishable foods should not be left on the table or countertops for longer than two hours. After two hours, food falls into the Danger Zone, temperatures between 40-140ºF, where bacteria can rapidly multiply. If that food is then eaten, your guests could get sick. Cut turkey into smaller slices and refrigerate along with other perishable items, such as potatoes, gravy and vegetables. Leftovers should stay safe in the refrigerator for four days.

When in doubt call the USDA Meat and Poultry Hotline

If you have questions about your Thanksgiving dinner, call the USDA Meat and Poultry Hotline at 1-888-MPHotline (1-888-674-6854) to talk to a food safety expert. You can also chat live at AskKaren.gov, available from 10 a.m. to 6 p.m. ET, Monday through Friday, in English and Spanish.

If you need help on Thanksgiving Day, the Meat and Poultry Hotline is available from 8 a.m. to 2 p.m. ET.

  1. Safely Thaw Your Turkey

Thaw turkeys in the refrigerator, in a sink of cold water that is changed every 30 minutes, or in the microwave. Never thaw your turkey by leaving it out on the counter. A frozen turkey is safe indefinitely, but a thawing turkey must defrost at a safe temperature. When the turkey is left out at room temperature for more than two hours, its temperature becomes unsafe as it moves into the danger zone between 40°F and 140°F, where bacteria can grow rapidly.

  1. Safely Handle Your Turkey

Raw poultry can contaminate anything it touches with harmful bacteria. Follow the four steps to food safety – cook, clean, chill, and separate – to prevent the spread of bacteria to your food and family.

  1. Safely Stuff Your Turkey

Cooking stuffing in a casserole dish makes it easy to make sure it is thoroughly cooked. If you put stuffing in the turkey, do so just before cooking. Use a food thermometer to make sure the stuffing’s center reaches 165°F. Bacteria can survive in stuffing that has not reached 165°F and may then cause food poisoning. Wait for 20 minutes after removing the bird from the oven before removing the stuffing from the turkey’s cavity; this allows it to cook a little more. Learn more about how to prepare stuffing safely.

  1. Safely Cook Your Turkey

Set the oven temperature to at least 325°F. Place the completely thawed turkey with the breast side up in a roasting pan that is 2 to 2-1/2 inches deep. Cooking times will vary depending on the weight of the turkey. To make sure the turkey has reached a safe internal temperature of 165°F, check by inserting a food thermometer into the center of the stuffing and the thickest portions of the breast, thigh, and wing joint. Let the turkey stand 20 minutes before removing all stuffing from the cavity and carving the meat. Learn more about safe minimum cooking temperatures and how to use a food thermometer for turkey and other foods.

  1. Take Care with Leftovers

Clostridium perfringens are bacteria that grows in cooked foods left at room temperature. It is the second most common bacterial cause of food poisoning. The major symptoms are vomiting and abdominal cramps within 6 to 24 hours after eating.

  • Clostridium perfringens outbreaks occur most often in November and December.2
  • Many of these outbreaks have been linked to foods commonly served during the holidays, such as turkey and roast beef.

Refrigerate leftovers at 40°F or colder as soon as possible and within two hours of preparation to prevent food poisoning.

Use a food thermometer to check for a safe internal temperature.

 Thanks to CDC

According to local press reports, Westchester County has treated 250 people who may have been exposed to hepatitis A at Sleepy Hollow Country Club, officials said today.

Those people received preventive treatment after a club employee was infected by one of the five people who were exposed to hepatitis A at bartaco in Port Chester, said Caren Halbfinger, a spokeswoman for the Westchester Department of Health.

The department is offering free treatment at its clinic at 134 Court St. in White Plains for anyone who ate or drank at the club between Oct. 30 and Nov. 4.

The Health Department will offer hepatitis A vaccine to most people. Infants under 1 year old and people with immune-compromising conditions will be given immune globulin.

The county clinic is providing treatment from 9 a.m. to 4 p.m. today and Tuesday, 9 to 11 a.m. on Wednesday and Thursday, and 9 a.m. to 3 p.m. on Friday. Officials said treatment is most effective within two weeks of exposure.

Phelps Hospital in Sleepy Hollow is offering treatment for anyone who attended its gala at the country club on Nov. 3. Treatment is available at the hospital at 755 N. Broadway from 10 a.m. to 5 p.m. Monday through Friday this week.

Anyone who ate or drank at the club between Oct. 21 and Oct. 29 may also have been exposed, but the treatment is only effective within two weeks of exposure, officials said. Anyone who is too late for treatment is still urged to contact their health care provider immediately, though, so that anyone they may have exposed can receive treatment.

Health officials said they did not expect this outbreak to affect as many as people as bartaco’s outbreak, which included treatment of more than 3,000 people who were potentially exposed to hepatitis A.

CNBC reports that two more carriers, Delta Air Lines and Virgin Australia, have suspended service from an onboard catering facility in Los Angeles International Airport after it detected listeria there in a recent inspection.

Earlier this month American Airlines said it had halted deliveries from the Gate Gourmet facility after the bacteria was detected there.

Listeria, which can cause fever and diarrhea and can be fatal in some cases, was detected during a safety audit at the Los Angeles kitchen, Gate Gourmet said. The company said the traces of the bacteria were found in areas such as floor drains that do not come into contact with passenger food.

The Los Angeles airport facility is still open and operating, said Catherine Nugent, a Gate Gourmet spokeswoman.

“We can’t comment on behalf of our customers, but we remain committed to delivering a safe and efficient service,” she said.

Delta spokeswoman Catherine Sirna said the kitchen is in compliance with local and federal regulations but that the airline decided to suspend deliveries from the facility “out of an abundance of caution for the health and safety of our customers.”

Onboard meals will remain the same, she added.

A spokesperson for Virgin Australia said, “Over the coming days there will be limited catering available on flights from Los Angeles.”

As an alternative it will offer vouchers to passengers to purchase food before the flight.

The New Jersey Department of Health (DOH) on Friday issued cease-and-desist orders to Udder Milk, a home delivery company that has illegally sold unpasteurized milk in New Jersey. State and federal officials are investigating to determine from which farms Udder Milk acquired its raw milk, after a North Jersey woman became ill with a rare bacterial infection.

“It is illegal in New Jersey to sell or distribute raw milk or products made from raw milk, such as yogurt, soft cheese and ice cream,” State Epidemiologist Dr. Tina Tan said. “People should know that, in general, unpasteurized milk may contain dangerous bacteria and those who have become ill after consuming raw milk products should immediately consult a medical professional. Pasteurized milk and dairy products bought commercially are considered safe for consumption, because they are heated to a high temperature that kills harmful bacteria.”

The United States Department of Agriculture (USDA), the Centers for Disease Control and Prevention (CDC) and the Department’s Public Health and Food Protection Program, with the cooperation of the New Jersey Department of Agriculture, are investigating to determine the suppliers.

DOH was notified on Oct. 23 that a North Jersey woman tested positive for Brucella RB51 infection, and she has since recovered. It marked the second case associated with raw milk consumption confirmed in the United States this year. The Texas Department of State Health Services, with assistance from CDC, is investigating Brucella abortus RB51 exposures and illnesses connected to a dairy company in Paradise, Texas that also sells raw milk products.

Brucella bacteria are primarily passed among infected animals. While rare, people can become infected by eating or drinking contaminated raw milk products. A Brucellosis infection can cause a range of symptoms including fever, sweats, chills, weight loss, headache, fatigue and muscle and joint pain. Symptoms may appear up to six months after exposure. In severe cases, infections of the central nervous system or lining of the heart may occur. People who may have consumed contaminated milk should see a doctor right away. Brucella RB51 cannot be diagnosed through tests commonly used to diagnose the disease, and this strain is resistant to one of the antibiotics commonly used to treat brucellosis in people.

From 1993 through 2012, 127 outbreaks linked to raw milk were reported to CDC, resulting in 1,909 illnesses and 144 hospitalizations. Between 2012 and 2016, only three New Jersey cases were reported.

Homelessness in the greater Seattle/King County region seems to be rising as fast as High-Tech jobs and housing prices.  There are estimated to be 3,000 people in Seattle each night who are unsheltered and about 10,000 homeless people living on either the streets or in shelters. And, as the nights grow wetter and colder, the lives of our fellow citizens grow even more precarious.  Clearly, homelessness is a complex issue that combines various elements of poverty, substance abuse and mental health, however, now, enters yet another concern – public health – specifically, the growing risk of hepatitis A amongst the homeless, and the risk that it will spread.

It is what is happening in other regions and the risk that it could happen here is real.

In the Detroit, Michigan area there have been 486 cases of hepatitis A, including 19 fatalities, identified as related to an outbreak in Southeast Michigan, according to the Michigan Department of Health and Human Services. In October, health officials said they were investigating cases at Firewater Bar and Grill and a Little Caesars Pizza location in Detroit and a restaurant worker in Ann Arbor. Cases were also linked to Whole Foods in Detroit and Social Kitchen in Birmingham and recently at Champs Rotisserie and Spirits in Wayne County.

In San Diego, California, the county Health and Human Services Agency published new weekly totals, which add one to the number of deaths recorded since the health crisis started in November 2016. The running tally of confirmed cases also continues to increase, reaching 536 from a previous total of 516 – including 20 deaths. On September 15th, the county notified the public that a worker at World Famous restaurant in Pacific Beach had tested positive.

And, thanks to the Huffington Post, you can see the problem in the whole country:

Hepatitis A is preventable with a vaccine and/or good sanitation and/or handwashing. Hepatitis A is a communicable — or contagious — disease that often spreads from person to person. Person-to-person transmission occurs via the “fecal-oral route,” while all other exposure is generally attributable to contaminated food or water.

Hepatitis A is relatively stable and can survive for several hours on fingertips and hands. It can live up to two months on dry surfaces. The virus can be inactivated by heating to 185 degrees F (85°C) or higher for one minute, or disinfecting surfaces with a 1:100 dilution of sodium hypochlorite (household bleach) in tap water. Freezing does not kill the virus.

The vaccine is recommended by public health officials for the following people:

  • Travelers to areas with increased rates of hepatitis A;
  • Men who have sex with men;
  • Injecting and non-injecting drug users;
  • Persons with clotting factor disorders;
  • Persons with chronic liver disease;
  • Persons with occupational risk of infection;
  • Children living in regions of the U.S. with increased rates of hepatitis A; and
  • Household members and other close personal contacts.

So, what can we do to prevent the tragedies that have hit California and Michigan hard and appear to be spreading to other areas of the country?

  • Encourage and offer hepatitis A vaccines to the homeless and other at-risk members of the public;
  • Provide sanitary bathroom and handwashing facilities to the homeless; and
  • Provide assistance to our neighbors to deal with the underlying issues of poverty, substance abuse and mental health.

Pride & Joy Dairy, a Toppenish, Washington, raw milk dairy has surrendered its processors license, though it could regain the license by satisfying the state Department of Agriculture (WSDA) that it has found and cleaned up the source of Salmonella.

WSDA suspended the dairy’s license on October 6 after state health officials linked raw milk from Pride & Joy to two people hospitalized in January with Salmonella poisoning.

If Pride & Joy had not surrendered its license, the dairy faced having the license revoked by WSDA.

The dairy agreed that it must submit a plan for WSDA’s approval for investigating the cause of pathogens in its bottled milk and for correcting problems.

WSDA reported finding Salmonella in raw milk samples collected from the dairy in September. WSDA issued a public health alert after the dairy declined to voluntarily recall its milk.

As I said before – “For Goodness Sake – Vaccinate”

Management of Champs Rotisserie and Spirits at 20515 Mack Ave. alerted the Wayne County Department of Health, Veterans and Community Wellness to the issue.

Hepatitis A is spread through contaminated food or water, or close personal contact with an infected person.

The ill employee is not working and is receiving medical care, the health department said in a news release.

Health officials say those who ate food from the restaurant on or after Oct. 20 should get a vaccine by Nov. 13 if they have not already been vaccinated. People who consumed food from the restaurant Oct. 10-30 should watch for symptoms of hepatitis A, which can include abdominal pain, nausea, vomiting, diarrhea, dark urine, clay colored stool, fever, chills and jaundice. Symptoms occur 15-50 days after exposure and can last for several weeks to months.

Since Aug. 1, 2016, there have been 486 cases of hepatitis A, including 19 fatalities,  identified as related to an outbreak in Southeast Michigan, according to the Michigan Department of Health and Human Services.

In October, health officials said they were investigating cases at Firewater Bar and Grill and a Little Caesars Pizza location in Detroit and a restaurant worker in Ann Arbor. Cases last year were linked to Whole Foods in Detroit and Social Kitchen in Birmingham, and a pizza restaurant in Alabama.

In San Diego California, the county Health and Human Services Agency published new weekly totals, which add one to the number of deaths recorded since the health crisis started in November 2016. The running tally of confirmed cases also continues to increase, reaching 536 from a previous total of 516 – including 20 deaths. On September 15th the county notified the public that a worker at World Famous restaurant in Pacific Beach had tested positive.

And, thanks to the Huffington Post, you can see the problem in the whole country:

According to the FDA, the CDC reports a total of 251 people were infected with the outbreak strains of Salmonella Thompson (144), Kiambu (54), Anatum (20), Agona (12), Gaminara (7), Urbana (7), Newport & Infantis (4), and Senftenberg (3), from 25 states.

Seventy-nine ill people were hospitalized. Two deaths were reported, one from New York City and one in California.

Outbreak Investigations Linked to Papayas: