The Real Truths About E. coli

All About E. coli

What it is, what E. coli symptoms look like, and how to protect yourself and the people you love

Just hearing the words E. coli can make people uneasy. It’s one of those health concerns that often sits in the back of our minds until another outbreak makes headlines.

In 2018 alone, there were three nationwide, multi-state E. coli outbreaks. The most recent, just before Thanksgiving, affected people in California, New Jersey, Michigan, and New York. Although investigators eventually traced the source to romaine lettuce, 43 people became ill and 16 required hospitalization before the outbreak was contained.

Over the years, E. coli outbreaks have been linked to a surprising variety of foods—from leafy greens and ground beef to soy nut butter and even flour. While it may feel like E. coli can be found everywhere, understanding how it spreads can help you take practical steps to reduce your risk.

What Exactly Is E. coli?

The more we know about E. coli—what it is, where it’s found, and how it affects the body—the better prepared we are to prevent infection.

It may surprise you to learn that E. coli is actually a common bacterium that naturally lives in the large intestines of humans and animals. Most strains exist peacefully alongside other bacteria in your digestive system and even help support healthy digestion.

“This mixture of microbes in your large intestine is called the microbiome. Scientists are just now learning how important the composition of your microbiome can be to your health and even your mood.”

- Dr. Adam Solomon, Chief Medical Officer, MemorialCare Medical Foundation

Not All E. coli Strains Are Harmful

Escherichia coli, commonly called E. coli, includes many different strains. While most are harmless, six types are known to cause diarrhea.

One of the most concerning is Shiga toxin-producing E. coli (STEC), the strain most often associated with widespread foodborne outbreaks.

How Does E. coli Spread?

STEC infections occur when tiny, often microscopic particles of contaminated fecal matter enter the body through the mouth and travel through the digestive system.

For most people, this happens through contaminated food. Meat can become contaminated during processing, or produce can be exposed through fertilizer or irrigation sources. Because food is a daily necessity, E. coli can feel especially difficult to avoid.

Common Sources of E. coli Contamination

Foods that have been linked to E. coli outbreaks include:

• Raw or undercooked meats, including:
  • Ground beef
  • Ground bison
  • Hamburgers
  • Dried cured salami
  • Sausages
  • Venison
  • Poultry
• Sprouts such as:
  • Alfalfa sprouts
  • Clover sprouts
  • Radish sprouts
• Unpasteurized dairy products, including:
  • Raw milk
  • Yogurt
  • Cheese
  • Ice cream
  • Raw goat's milk
• Fresh fruits and vegetables, including:
  • Lettuce
  • Romaine
  • Spinach
  • Cucumbers
  • Coleslaw
  • Radishes
  • Broccoli
  • Cantaloupe
• Beverages such as:
  • Untreated drinking water
  • Unpasteurized apple juice
  • Unpasteurized orange juice
• Other foods, including:
  • Unrefrigerated sandwiches
  • Mayonnaise
  • Unpasteurized apple cider
  • Raw cookie dough
  • In-shell hazelnuts
  • Shelled walnuts

With so many possible sources, it's understandable why new outbreaks often receive significant public attention.

Are My Family and I at Risk?

According to the Centers for Disease Control and Prevention (CDC), approximately 95,000 cases of E. coli-related food poisoning occur in the United States each year. Symptoms can range from mild discomfort to severe illness.

Anyone can become infected, but certain groups face a higher risk.

Who Is Most Vulnerable?

Children and older adults are particularly susceptible to E. coli infections.

“Also, 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.”

- Dr. Solomon

How Can I Prevent E. coli Infection?

The CDC recommends several steps to help protect yourself and your family from E. coli and other foodborne illnesses.

Practice Good Hand Hygiene

Wash your hands thoroughly:

• After using the bathroom
• After changing diapers
• Before preparing food
• Before eating
• After handling animals or visiting farms, petting zoos, or fairs
• Before feeding infants or toddlers
• Before touching pacifiers, bottles, or items that go into a child's mouth

Keep pacifiers, teethers, and other infant items clean.

If soap and water are unavailable, use an alcohol-based hand sanitizer containing at least 60% alcohol. However, hand sanitizer should not replace proper handwashing whenever possible.

Follow Food Safety Best Practices

Remember the four food safety steps:

• Clean
• Separate
• Cook
• Chill

Additional food safety tips include:

• Wash fruits and vegetables under running water unless packaging indicates they are pre-washed.
• Avoid cross-contamination by cleaning hands, counters, cutting boards, and utensils after contact with raw meat.
• Avoid raw milk, unpasteurized dairy, and unpasteurized juices.

Cook Foods Thoroughly

To reduce the risk of harmful bacteria:

• Cook beef steaks and roasts to an internal temperature of 145°F (62.6°C) and allow them to rest for three minutes.
• Cook ground beef and pork to a minimum internal temperature of 160°F (70°C).
• Always use a food thermometer rather than relying on appearance or color.

Be Careful Around Water

Avoid swallowing water while swimming or playing in:

• Lakes
• Ponds
• Streams
• Swimming pools
• Kiddie pools

What Are the Symptoms of E. coli?

Even with careful precautions, E. coli infections can still occur. Knowing the symptoms can help you recognize when it may be time to seek medical care.

When Do Symptoms Begin?

Unlike salmonella food poisoning, which may appear within six to 72 hours, E. coli symptoms typically develop five days to one week after consuming contaminated food, although symptoms can sometimes appear sooner.

Common E. coli Symptoms

Watch for:

• Nausea
• Vomiting
• Severe fatigue
• Abdominal cramping and pain
• Diarrhea (watery or bloody)

When Should You See a Doctor?

Contact your healthcare provider if:

• Diarrhea lasts more than three days
• You develop a high fever
• Symptoms become severe

Seek immediate medical attention if you experience:

• Bloody diarrhea
• Seizures
• Confusion

Your doctor can perform a stool culture to determine whether E. coli is the cause of your illness. For most people, treatment involves:

• Plenty of rest
• Adequate hydration
• A temporary low-fiber diet

Can E. coli Cause Serious Complications?

Although most people recover without lasting effects, some infections can lead to serious complications, including hemolytic uremic syndrome (HUS). This condition occurs when damaged red blood cells clog the kidneys' filtering system and may require hospitalization.

Fortunately, long-term complications are uncommon for most people.

We Can All Help Lower the Risk

While it's impossible to eliminate every potential food safety risk, there are practical steps we can take to protect ourselves and our families.

By following CDC food safety recommendations, practicing good hand hygiene, and handling food properly, we can significantly reduce the likelihood of infection.

The good news is that awareness, prevention, and informed food preparation go a long way. A few extra minutes spent washing produce, checking cooking temperatures, and maintaining clean preparation areas can make a meaningful difference—giving you greater confidence every time you sit down to eat.