All About E. Coli

What it is, what are E. Coli symptoms, and what you can do to protect yourself and the people you love

Four minute read

Just hearing the word E. coli can evoke an uneasy feeling. It’s one of the back-of-your mind discomforts that jumps to the forefront of your attention when stories of yet another outbreak hit the news.

In 2018 alone, there have been three nationwide, multi-state E. coli eruptions, with the most recent being the pre-Thanksgiving outbreak that swept through California, New Jersey, Michigan and New York. Though epidemiologists were able to narrow the source of the latest occurrence to romaine lettuce, it wasn’t before the fresh produce sickened 43 people and sent sixteen to the hospital.

It seems like Escherichia Coli, or E. coli, is in everything we eat. Just look at the news: in 2018 alone, outbreaks have been traced not just to romaine lettuce but also ground beef. In 2017, leafy greens and soy nut butter were the culprits. In 2016, flour—ordinary bread flour—made an appearance on the E. coli source list. It’s enough to make anyone swear off food.

What exactly is E. coli?

As with most things that make us nervous, the more we know about E. coli—what it is, where it’s found, and what it does—the better prepared we are to prevent it.

It may surprise you to know that E. coli is a common bacterium found in the large intestines of most humans and animals, living in harmony with the other bacteria that inhabit your gut and support your digestion.

“This mixture of microbes in your large intestine is called the microbiome,” explains Dr. Adam Solomon, Chief Medical Officer, MemorialCare Medical Foundation. “Scientists are just now learning how important the composition of your microbiome can be to your health and even your mood.”

The thing is, Escherichia coli (E. coli for short) has a variety of strains or sub-types, six of which are known to cause diarrhea. Of these, Shiga toxin-producing E. coli (STEC) is most commonly associated with the wide-spread outbreaks we keep hearing about.

How does the bacteria spread?

So how does STEC get into your intestine and cause trouble? It happens when a tiny particle—usually microscopic—of fecal matter from a contaminated animal or person finds its way into your mouth and travels through your GI tract to your intestine. Unless you work on a cattle farm, the most common way this happens is through consuming tainted food. Perhaps the meat got contaminated while being prepared or some of the manure used in fertilizing the vegetables wasn’t washed off. That’s what makes it so insidious. We all must eat, right? Here are just a few of the foods that have been sources of E. coli contamination:

  • Raw or undercooked meat products such as ground beef, ground bison, hamburgers, dried cured salami, sausages venison and poultry
  • Alfalfa sprouts, radishes and clover sprouts
  • Unpasteurized dairy like raw milk, yogurt, unpasteurized cheese, ice cream and raw goat's milk
  • Fruit and vegetables, including lettuce, coleslaw, cucumbers, spinach, romaine, salad, radishes, broccoli and cantaloupe
  • Drinking water, unpasteurized apple juice and orange juice
  • Unrefrigerated sandwiches, mayonnaise, unpasteurized apple cider, raw cookie dough, in-shell hazelnuts and shelled walnuts

That sure seems like a lot of ways to contract E. coli. It’s no wonder people get nervous every time they hear about a new outbreak.

Are my family and I at risk?

What are the chances that you or a loved one will be impacted by E. coli? According to the Center for Disease Control and Prevention (CDC), there are approximately 95,000 cases of E. coli-related food poisoning in the US each year, with symptoms ranging from mild to extremely severe. That’s roughly a .30% chance of contracting the condition. That’s comforting—unless it’s you or your family who gets it.

Anyone can contract a diarrheagenic E. Coli infection, but children and the elderly are most susceptible.

“Also,” Dr. Solomon notes, “People who regularly take acid suppressing medications may be at an even higher risk because stomach acid is one of our main defenses against unwanted intestinal infections.”

So how do I prevent it?

The CDC website shares specific guidelines for ensuring you and those you care about are as protected as possible from the next outbreak. These include:

  • Practice proper hygiene, especially good handwashing
  • Wash your hands thoroughly after using the bathroom and changing diapers
  • Wash your hands thoroughly before and after preparing or eating food
  • Wash your hands thoroughly after contact with animals or their environments (at farms, petting zoos, fairs, even your own backyard)
  • Wash your hands thoroughly before preparing and feeding bottles or foods to an infant or toddler, before touching an infant or toddler’s mouth, and before touching pacifiers or other things that go into an infant or toddler’s mouth
  • Keep all objects that enter infants’ and toddlers’ mouths (such as pacifiers and teethers) clean
  • If soap and water aren’t available, use an alcohol-based hand sanitizer with at least 60% alcohol (check the product label to be sure). These alcohol-based products can quickly reduce the number of germs on hands in some situations, but they are not a substitute for washing with soap
  • Follow the four steps to food safety when preparing food: clean, separate, cook, and chill
  • Wash fruits and vegetables well under running water, unless the package says the contents have already been washed
  • Cook meats thoroughly:
    • To kill harmful germs, cook beef steaks and roasts to an internal temperature of at least 145°F (62.6˚C) and allow to rest for 3 minutes after you remove meat from the grill or stove
  • Cook ground beef and pork to a minimum internal temperature of 160°F (70˚C)
    • Always use a food thermometer to check that the meat has reached a safe internal temperature because you can’t tell whether meat is safely cooked by looking at its color
  • Don’t cause cross-contamination in food preparation areas. Thoroughly wash hands, counters, cutting boards and utensils after they touch raw meat
  • Avoid raw milk, unpasteurized dairy products, and unpasteurized juices such as fresh apple cider
  • Don’t swallow water when swimming and when playing in lakes, ponds, streams, swimming pools, and backyard kiddie pools

Despite all the precautions, the safest among us may still contract E. coli. So how do you know if the nausea you’re feeling 24-hours after eating that burger at a roadside stand is E. coli or just regret?

Am I infected with E. coli bacteria? What do I do?

The first thing is the timeframe. Unlike food poisoning caused by salmonella (another oh-so-fun bacteria we will examine another time) which shows up between six and 72 hours, E. coli infections and symptoms usually begin about five days to a week after consuming the tainted food, although sometimes it can be sooner.

Here are the major E. coli symptoms to watch for:

  • Nausea
  • Vomiting
  • Severe fatigue
  • Abdominal cramping and pain
  • Diarrhea, either watery or bloody

How do you know when to see your doctor? If your diarrhea lasts for more than three days or is accompanied by a high fever, see your doctor. If you have bloody diarrhea, seizures or confusion, don’t wait—go right away. Your doctor will do a culture to confirm if you have E. coli in your system. If you do, the treatment is simple: plenty of rest, plenty of fluids, and limited low-fiber foods.

While a small number of cases can lead to much more severe symptoms including hemolytic uremic syndrome (a condition where damaged red blood cells clog the filtering system in the kidneys) and may require hospitalization, it’s important to point out that for most people, E. coli infection generally does not result in long-term damage.

We can lessen the risk

Now that FDA food safety investigators have located the source of the most recent outbreak, we can go back to enjoying romaine lettuce again—provided it didn’t originate in California’s Monetary County. One more thing to keep in mind to sooth your unease about E. coli: while it’s impossible to completely eliminate every potential food risk, we can take an active role in lessening the risk by taking a few extra minutes to follow the food prep guidelines the CDC recommends. Now that is newsworthy!