And three, two. Welcome back to another episode
of Your Mom on Drugs. We're so happy to have
you here today. I'm the son. My name's Josh.
And I'm the mom. I'm Jenny. We got episode 18
today, but before we go into episode 18, my mom
on drugs has a nice little housekeeping item
that she wants to bring up from the previous
episode on measles. Mom, what do you want to
tell us? What's the update? I just wanted, I
said something incorrectly in the measles podcast.
I think I may have said that pharmacists can't
vaccinate. children for measles, but that was
incorrect. In Texas, they can vaccinate children
for measles if they're 14 years of age and older
without a prescription. And if they're under
14, they need a prescription to be able to vaccinate.
And interestingly, for this vaccine, only pharmacists
can vaccinate the kiddos under 14, not the pharmacy
technicians. So I just wanted to clarify that
for everybody who listens to that podcast. Okay.
So if somebody is thinking of vaccinating their
child, If they're under 14, the pharmacist can
vaccinate. With a prescription. With a prescription.
But over 14, you can do it without a prescription.
Right. And I'm thinking, again, as we think about
that podcast very briefly, a lot of times we're
looking at kids under 14 that are going to get
that. So it may be that the parents decide to
get it done in the healthcare provider's office.
But there is the option with a prescription to
have a pharmacist do it. Okay, great. That's
good housekeeping. Thank you. Well, today we're
going to be talking about something a little
bit different today. We are talking about stomach
bugs today or more typical gastroenteritis. This
was inspired by a recent bout of gastroenteritis
that I had. And it was such a unique experience
because I hadn't had a stomach bug in a long
time. And I think if anybody's ever had a stomach
bug, you are just. It's my least favorite form
of illness in the world. I do not like how it
feels. I don't like feeling nauseous. I don't
like all the other stuff that happens inside
of it. So this is a bit of a disclaimer. We're
going to be talking about some gastrointestinal
stuff and fluids and things like that. So if
you're feeling a bit queasy or if this stuff
kind of grosses you out, this might be the episode
to skip. If this could happen to you and we want
to help you find ways to prevent it in the future,
other than just talking about what it is. So
hopefully my experience will educate you and
my mom on drugs will educate you on how I got
sick, why I got sick and how you can prevent
yourself from getting sick in the future, as
well as when you get sick, what are some steps
you can do? So does that sound good to you, mama?
That sounds great. Okay, mom, I got a stomach
bug. So what happened to me? Well, the first
thing is that you told me you thought you had
food poisoning. So again, we want to, we're going
to kind of help people differentiate between
having gastroenteritis and food poisoning, as
well as what to do, you know, at the end. And
one of the things, one of the reasons that it
happened at the time it did was that these stomach
bugs are very common from November to April of
every year because everybody starts moving inside
and they're very contagious. crowded more crowded
conditions like cruise ships or schools or nursing
homes you know then you can have um epidemics
or runs of this virus throughout a lot of people
so there are there so there are always recent
there are always norovirus cases which is a very
predominant virus that causes these stomach bugs
um and so it um happens typically like i said
in winter gatherings or cruise ships, schools,
restaurants. And in this most recent norovirus
outbreak, the states that had the highest cases
have been so far Wyoming, Nebraska, Colorado,
Oklahoma, West Virginia, and Texas has been moderate
with about 28 cases per 100 ,000 people. It's
known as the winter vomiting disease, and it
usually happens from November to April. because
of that confinement. And some people will also
call it the stomach flu, but it's really important
to recognize that the actual... flu which is
really influenza is a totally different virus
and it causes totally different symptoms there
are some there i will do a little bit of a disclaimer
there are some influenza viruses that can have
a little bit of effect on your stomach and may
make you feel nauseated and may vomit but that
is the exception really rather than the rule
when you have influenza it's made primarily a
respiratory illness, whereas the stomach flu
is a gastrointestinal illness. Yeah. I mean,
that's such a good point because in the winter
months, things like the flu, RSV, and coronavirus
are also going around and they're peaking. And
even I kind of thought like if it wasn't food
poisoning, it must have been the flu because
you hear about this thing called the stomach
flu. but i didn't know that that's actually just
like a colloquial term just like just like the
way that you hear um like i'm trying to think
of there's an animal name um oh my gosh why can't
i think of one at the moment but i mean the thing
that i'm thinking of it but it's actually oh
a jellyfish right a jellyfish is not actually
a fish um it's just a blob And, but it's not,
so it's a misnomer because it's not actually
a fish. It's actually in the family Cnidaria,
which is very similar to like coral and things
like that. So very similar to this. It's not
a flu, but it's just one of those names that
stuck. Yes. And so, and so. But this is a norovirus.
It's norovirus. And so this acute infectious
gastroenteritis is common in all age groups.
It doesn't, it doesn't. avoid anybody. And it
actually is the leading cause of death in developing
countries. And it's primarily because of the
dehydration associated with it. And then it can
be responsible for hospitalizations in up to
six to eight percent of kids, including the United
States. So it's not something necessarily to
sneeze at. You just have to, you know, watch
your family member to just watch for signs. And
we'll get to that in just a minute. Yeah, I,
you know, I can attest to the, you lose a lot
of fluid. And the bad thing about this is that
you don't really want to put anything inside
of you because you feel that urge of like, ooh,
don't do it because you're going to just eject
more of it. And so I'm sure you'll talk about
this later. But yeah, I mean, I can definitely
attest to the fact that I had some interesting
symptoms. Yes. So the primary causes for gastroenteritis
are viruses with norovirus and rotavirus being
the most common. And then there's a newer virus
called sapovirus that's been seen because of
vaccination against rotavirus. And we'll talk
about that later on. You can also get bacteria
that cause gastroenteritis, but primarily Staphylococcus,
Campylobacter and Escherichia coli or E. coli
as its nickname, Salmonella and Shigella. A lot
of times you get a bacterial gastroenteritis
when you're in areas that have poor hygiene and
sanitation. We don't see that as much in areas
in the United States because we've got just a
more fluent country. Although I know there are
areas in the United States that definitely have
poverty. But I think it's mainly due to the institutions
that manage our wastewater and also kind of like
we talked about in our pharmaceutical. manufacturing
episode there are good manufacturing processes
even within the food industry right so we're
not dumping a lot of waste into our water type
thing waste into our water and also we're doing
quality food inspections like if something has
spoiled or has been infected with a certain bacteria
It'll either be spotted at the manufacturing
plant or it'll get recalled. I remember there
were so many times where like there's certain
batch of spinach or I remember that we have an
ice cream place in Texas called Blue Bell. And
I remember one time there was a listeria outbreak
in a specific batch of like those kind of small
cups. but people didn't pay attention to the
entirety of the announcement and everyone who
had Bluebell just threw it away. Yes. But it
was literally just - And it was like a year or
so before Bluebell came back. It was a long time.
I know. So it's like those announcements can
really do some damage, but it's something to
be grateful for when you live in a society that
takes food safety. Seriously. And we're going
to get to more of that later in the episode,
but something I took for granted. Yeah. Fungus
can also cause a gastroenteritis as well as parasites.
And the parasite that you may have heard of the
most that causes a gastroenteritis is Giardia.
And it's going to be different than like a viral
gastroenteritis. When you have Giardia, it doesn't
go away in a day or two. You know, it's kind
of a, you've got to have some. anti -bacterial
treatment. I mean, I'm sorry, anti -parasitic
treatment for it in order to get rid of it and
stuff. So yeah, my, well, your daughter -in -law,
my sister -in -law got Giardia this past year
and it takes a long time. And I mean, we could
talk about the reasons, but I think that this
might be a good reason, time to bring it up.
So like mom just listed viruses, bacteria, and
fungus and parasites. And I think we all think
of those are all pretty small. So like they all
just be equivalent size, but just to give people
an idea of how different size these things are.
So thinking about viruses, bacteria, and even
your cells, like a white blood cell, if you use
a virus, which is 38 nanometers wide and nano
means a billionth of a meter. So it's a billionth
of a meter, 38 billions of a meter. Let's just
say that in reference point, we're going to make
you the height of you, the listener. as the size
of a virus. So you're the standard. Let's say
you're five foot seven or something. So compared
to a bacteria like E. coli, the height of you
would be five foot seven. The E. coli would be
the height of the Statue of Liberty. So just
think about that. If you're next to the Statue
of Liberty and you're a little virus and you're
looking at a bacteria, that bacteria is the size
of the Statue of Liberty. And then if you look
at your own white blood cells, so compared to
the virus, the white blood cells would be the
size of 120 -story mega skyscraper in a large
city. And then when you think about something
like a parasite that's composed of multiple cells,
things like a fungus or of something like Giardia.
That is like an actual organism, so it's massive.
So it's going to take a lot longer time for your
body to handle a larger organism, which is why
it's harder to clear from your system, especially
if you're not used to it, if you're in a sanitized
place that treats their wastewater. But also
the smallness of a virus. is really key for why
it can mutate quickly and also kind of evade
a lot of your body's defenses. Because if your
cell is so big, it can just kind of escape it
really easily. So really good to kind of keep
that mental image in your head of the size comparison
between a lot of these organisms. Just because
it's small to you doesn't mean it's small compared
to other things in your body. Just a quick little
size detour. I love that. Thank you. Back to
you, Dr. Schultz. Thank you. So a couple of other
things that can cause symptoms that are gastroenteritis
are toxic substances, alcohol, and medications.
So that's really not the focus of what we're
talking about here today, but just for completeness,
things that can upset our tummies. Yeah. I've
never thrown up with alcohol ever. Yeah. Wow.
I don't think I want to know. But that would
be good if that was the case. It's true. Yeah.
So let's turn our attentions back to the viruses
that cause gastroenteritis. And like I said,
the most prevalent one is norovirus. And it's
responsible for about 50 % of all the gastroenteritis
outbreaks. Usually per year, there's 19 to 21
million illnesses out of our population of what,
350 million people? Yeah. There's over 2 million
outpatient clinic visits for it, mostly in young
children. 465 ,000 emergency department visits,
mostly in young children. 109 hospitalizations,
and that's mostly going to probably be due to
dehydration. And then there's actually 900 deaths,
usually in older people. So norovirus can also,
there are other things that can cause traveler's
diarrhea, but norovirus can also cause traveler's
diarrhea. So you're going to think about the
cruise ships and maybe going into foreign countries
and getting ill. Can I tell a brief story? Absolutely.
So when we were discussing this episode before
we recorded, mom was telling me about norovirus
and I didn't know anything about it. So I started
looking into it and how it was discovered was
so interesting. I thought it was an interesting
story to tell. So norovirus was discovered in
1929 in a town called Norwalk, Ohio. And essentially
they discovered it because there was a large
outbreak of these type of symptoms. And this
is just when kind of the, you know, the pathogenic
bacterial, you know, cause of disease was gaining
more ground and becoming more popular. And so
actually it was called the Norwalk virus before
it was called the norovirus. But we changed it
to norovirus. And later, so essentially we have
this norovirus that is known from 1929. And then
in 1969, there was an outbreak in an elementary
school that affected 50 % of the kids. And so
50 % of the kids couldn't go to school, couldn't
function because of these symptoms. And researchers
were like, what is causing this? Like, is it
a virus? Is it a bacteria? And so these researchers
from Maryland basically... got samples and took
it to the local prison. And by samples, unfortunately,
I mean, they got fecal samples from the kids
and they pass it through this really, really
fine filter paper. Kind of like if you're making
coffee and you put coffee grounds in the filter
and you pour the water through, the liquid gets
through, but the coffee grounds stay on top.
Now it's even finer than that. It's actually
there to catch viruses because I think the researchers
suspected that this was a virus. If they filter
out all the things that are bigger than viruses,
what's left over on the filter paper is going
to be viruses. So they took the filter paper
after the excrement was passed through. And then
this would never fly now. This is back in the
late 60s. But they gave it to the prisoners and
they say, hey, we're going to give you this.
I don't know if they got their consent. The wording
that I read in the research paper was. We thought
it was fine because it wasn't going to cause
appreciable harm, which I thought was an interesting
judicious statement to make. I don't know what
they define as appreciable harm, but I've had
this illness, and I would say the harm is pretty
appreciable. But they essentially gave it to
the prisoners. I think there were three prisoners,
and out of the three prisoners, two of them got
these gastroenteritis symptoms. And they then
collected the excrement from those prisoners.
And then gave it to nine other prisoners. Same
filter method. And seven out of those nine prisoners
got symptoms, various degrees of symptoms that
we're going to talk about later. And then the
researchers concluded this is a virus. This is
the norovirus that is causing these symptoms.
I just thought that was such a wild story of
just like, what if we gave this to this population?
So thanks to these prisoners for essentially
biting the bullet. providing some evidence for
causality. I'm glad we have a little bit more
boundaries as far as how we do research nowadays.
Same. And, you know, mom's going to talk about
this a bit later, but one of the hard things
with viruses is that it's hard to grow them in
the lab because they're so small and you need
cells for viruses to infect so that you can grow
a lot of them and then study them under a microscope.
We call it an electron microscope. But these
cells or these viruses, norovirus, are famously
hard to culture. And so it's very hard to study
them in the lab. So unfortunately, you need them
kind of in real life to study them. So you actually
need patients to get sick. And I think in this
family, calciveridae, which includes the sapovirus
and the rotavirus, they're just famously hard
to grow in cell culture. which is unfortunately
why we need them in life patients. So I thought
that was a fun little story. Thank you for sharing
that. That is, I like history and you know, how
things came to be. So I think that's very interesting.
You know, science is a wild place. It is a wild
place. I'm going to, so, so the next, so rotavirus
is also a common. virus that causes gastrointestinal
illnesses in younger children. Usually worldwide,
it has infected all children by the time they're
three to five years of age. And neonates, which
is mean, a neonate is defined as a baby who is
one month or younger. They can get sick, but
usually their symptoms are asymptomatic because
they are protected by their mom's antibodies.
And or breast milk. Oh, wow. Really? So like
essentially from the placenta, the antibodies
that they've gotten there and if they're breastfeeding.
If their mama is breastfeeding, yes. Oh, that's
so interesting. But as they get older than three
months of age, then they will most likely develop
symptoms. It is the leading cause of diarrheal
death in children in developing countries due
to improper access to hydration therapy. The
symptoms for the disease of rotavirus peaks between
four and 23 months of age. It's really interesting.
This is a different kind of virus than norovirus.
You can get reinfected commonly, but if you get
reinfected, your symptoms get less. So I thought
that was very interesting. Do you think it's
just your body's better at mounting a just an
innate immune response or not an innate immune
response? And so if you are a caregiver for a
baby or a young child who has rotavirus, you
as the caregiver can also get sick. But so it's
something that should be in the differential
diagnosis for which means, you know, look, be
looking for this. If somebody's got these symptoms
and you can't exactly figure out what's going
on with them. And we'll come back to rotavirus
in a little bit because a vaccine has been developed
for rotavirus. And so because of that vaccine,
a virus called sapovirus has become more predominant
in younger kids as far as causing gastroenteritis.
So those are the viruses that we're going to
predominantly focus on. And then I want to switch
our focus to... Foodborne illness, because a
lot of times people will think when they get
a stomach bug, they think it's food poisoning.
And that's not always the case. I definitely
thought that. And I think it's usually because
it's usually after you eat a meal and you're
usually throwing up. the thing that you just
ate. So I think there's a kind of that logical
conclusion of like, Oh, it must've been something
I ate, but you're saying that that's not, not
necessarily not the case. Usually not the case.
You can usually food. You have foodborne illness
when you've got food that's contaminated with
a virus or bacteria. And the, the reason that
foods get contaminated with viruses or bacteria
are that they are either not cooked properly.
They have been contaminated with germs and then
they're spread to hands or surfaces. or other
foods, or they're not refrigerated properly after
cooking. I think about Thanksgiving, you know,
things sit out, you know, for hours, you've just
got to be, you've got to be sensitive to that,
you know, that potato salad, or maybe it's a
picnic or whatever, you, you know, after a while,
you're like, I'm gonna, sorry, I've got to toss
this, you know, and stuff. So, and the most common
that cause foodborne illness are salmonella,
I'm sorry, norovirus, salmonella, and campylobacter.
And because of the relative environmental stability,
norovirus is usually implicated in about 50 %
of all foodborne outbreaks. I also read in that
paper that you need like 100 or less viral particles
to cause a, like to start the illness transaction.
And that is just a relatively small number. Yes.
Because I think we also remember viruses need
cells in order to replicate themselves. So in
order for them to basically be pathogenic, they
need to get inside of you. And they can do that
via the food. So there just needs to be a viral
particle or at least 100 of them. But things
like the salmonella or campylobacter, these are
bacteria. And they can replicate on their own.
So like mom said, if you have these. somewhat
warm as a relative term because warm for a bacteria
can mean above 40 degrees and below 140 degrees.
And in that range, that's like prime, wonderful
warmth for bacteria and they can replicate and
divide. And obviously the more of them there
are. the higher the risk is for them causing
a disease inside of you. So that's why we're
going to talk about proper food cooking and storage
later on in the episode. But that range, like
mom said, if you leave that out for hours, you're
just increasing the risk of that potentially
causing a foodborne illness. Right. There have
been about 48 million cases of foodborne illness
per year. So that's definitely more than norovirus.
But the reason... possibly for that is that,
well, there could be, this is just speculation
on my part. It just depends on whether or not
you report it or not. And there may be more people
that are reporting foodborne illness than a lot,
I mean. Joshua obviously did not go and report
his stomach bug to anybody but me, you know,
and stuff, or maybe his friends. Now the whole
world. But not the CDC. And then there are 128
,000 people that are hospitalized per year from
foodborne illness, and there are 3 ,000 deaths
per year from foodborne illness. So this effect
of your gastrointestinal tract, and again, the
biggest... deal with it is dehydration. We're
going to get to it. And dehydration is no bueno.
I mean, it can cause a lot of illness. So foods
that are most likely to be contaminated or more
likely to be contaminated are going to be raw
or undercooked poultry, meat, seafood, or eggs.
Raw or undercooked sprouts, which I was like,
oh, that kind of makes sense. You know, unwashed
fruits and vegetables, cut melon. unpasteurized
milk juice cider or soft cheese it's that word
is unpasteurized you know yeah and then raw dough
or raw dough or raw batter made with uncooked
flour and josh and i have eaten a boatload of
cookie dough so we're very fortunate that i don't
think we've gotten sick from it but you just
never know so it's hard to tell yeah People who
are at increased risk for foodborne illness are
going to be those that are over 65 years of age
or kiddos less than five years of age, people
with weakened immune systems, as well as pregnant
women. Because pregnant women, when you're pregnant,
your immune system kind of dampens down so that
it does not attack the baby growing inside of
you, so that pregnant women will get a lot more
illnesses because of that. Yeah, there's a great
YouTube channel. It's a very bizarre name called
Kirkestat. And they're a wonderful science YouTube
channel. And there's actually a great episode
on pregnancy and the wonders of pregnancy and
how your body doesn't attack your own child.
Because most of the time your body sees a foreign
threat and it's going to have an immune response
to the fact. I think a lot of times in our episodes,
pregnant women are always like a risk group.
And I think there's a reason why that is, is
because your body is going to great lengths to
protect the new life that is being formed inside
of you. So let's talk about why on earth do these
viruses cause you to be ill? Yeah, what was happening
to me when I was just in the bathroom for hours,
cold sweat. Flu is draining out of me. It was,
it is, if anyone's gone through this, it is such
an uncomfortable, uncomfortable state. What is
going on? Yeah. It's not fun for a parent either
when their little kids are sick either. So absolutely.
Cause you might get sick too. Yeah. Well, no,
it's just like, you're like, I can't fix this,
you know? So yeah. So the viruses, along with
cytotoxins associated with the viruses, they
have effects on the enterocytes of the intestines.
And the enterocytes in your intestines are your
absorptive cells in your intestine. And so they
actually use these enterocyte cells to... reproduce,
replicate the viruses do. So that's going to
cause them to affect. So these cells, they produce
these brush border enzymes, which allows you
to digest food. And then it's going to cause
you to not absorb food and the nutrients in it.
And it causes osmotic diarrhea. So it's like
it's concentrated like salt solution. And it
just causes you to, you know, poop more and stuff.
And then it can also damage. uh cells and it
can also cause breakdown of the enterocytes so
so it just increases the amount of fluid that
goes through your intestine and when you lose
a lot of fluid then you lose electrolytes as
well too like sodium and potassium and we'll
get to that a little bit too The other thing
is that norovirus specifically affects the vomiting
center. So we have a vomiting center inside of
our brain. And so that's what causes us to vomit.
And the reason that that happens in acute gastroenteritis
is because the virus triggers a signaling cascade.
And the first thing it targets is serotonin release.
And serotonin is released from... intrachromaffin
cells that are in your intestine. And I can't
remember exactly what the intrachromaffin cells
do, but one of the things that they do is that
they release serotonin. So when serotonin is
released, then that goes to the nervous system
and different nerves that transmit signals to
the brain. And then these structures in the brain
activate the vomiting center. And so that produces
the really violent vomiting that you go through.
And so serotonin is famous for - Are you talking
about the enterochromaffin cells? Yes, enterochromaffin.
Yeah. And then they stimulate the vagus nerve?
Yes. Yeah. Yeah. And then there's certain regions
of the brain, like the nucleus tractus solitarii
and the area prostrema in the brain, right? Right.
Is that what you were referring to? Yes. Okay.
Yes. Yeah. Okay, Mr. Biology. Well, I'm just
reading what you put down. But yes, I mean, it's
so interesting to see that we have a region in
our brain that is connected to our gut. And I
think if anyone's ever heard of the gut -brain
connection, it is this vagus nerve that is primarily
associated with this neurotransmitter. And I
think a lot of times people think serotonin and
it has to do with like mood disorders because
we did a whole episode on SSRIs and those reuptake
inhibitors. But serotonin. is just a neurotransmitter.
And what a neurotransmitter is, is just a transmission
of signal from neuron to neuron. And neuron is
just a nerve cell that basically says, I've got
a message. I need to send it down the line to
the end of the terminus, very much like a train
going from one place to another. And so serotonin
just happens to be the molecule that's used in
the gut to signal to the brain to say, hey, something's
going on here. We need you to do something about
it. So mom, when this signal gets sent via the
vagus nerve to these areas of the brain, the
vomit center of the brain. it triggers this vomiting
reflex and what happens after that? Well, so
it also, so, I mean, so you obviously are vomiting.
It also causes delayed gastric emptying. So your,
your gut is slowed down. So obviously that makes
everything worse. You know, then you're going
to feel more nausea and vomiting because it's
all, it's just, yeah, it's going the wrong way,
you know, and stuff. So yeah, absolutely. And
like we talked about, the key viruses that cause
this are norovirus and rotavirus. And they've
got different ways that they may interact in
the gut that causes you to be sick. It causes
primarily malabsorption of nutrients when you
get sick. And so that contributes to some of
the complications or the consequences of having
a gastrointestinal illness. Some people might
think that it's not contagious, but that is so
wrong. Infectious gastroenteritis is very contagious
and it's transmitted by what we call the fecal
oral route. So that means that from your bottom,
when you've wiped yourself going to the bathroom,
and then if you don't wash your hands and you
touch the flusher on the... toilet or the spigot
you know or the wall or the light switch or whatever
and you then have contaminated that area and
somebody comes behind you and uses it then that
makes them susceptible to getting that virus
as well a lot of times or You can get also, like
I talked, bathroom services, but diaper changing
stations for kiddos as well, too. Or if you shake
hands with somebody who didn't wash their hands,
you know, so that's a big deal. And again, it's
only traces that will cause the disease like
Josh has already spoken about. And so then it's
going to spread. And so it has an incubation
period of about 24 hours before you start seeing
symptoms. 12 to 72 hours, but the illness can
last from 12 to 60 hours, just depending on the
person. And the virus is shed through both your
feces and occasionally through the vomitus. And
the peak viral load in your stool or in your
feces or in your bowel movement is at 24 to 48
hours. Can we go back? I think people might not
know what an incubation period is. Because I
think a lot of times people think, well, I'm
only sick when I get sick. But an incubation
period is something that's a bit different, right?
Right. It's from the point that you got... got
exposed to the virus or bacteria until you start
developing symptoms. So it just, it may not be
in 30 minutes, you know, it may be a whole day,
you know, before you get sick, or it could be
two days, you know, and stuff. So, and then you
will then, but you're contagious, even if you're
not having symptoms yet. Okay. So gotcha. So
that's, that might be one of the reasons why
people think it must be food poisoning because
I just got sick, but really it might've been
something that you touched one or two days before
and the virus was incubating inside of you. It
was growing inside of you. Yes. Incubating inside
of you. Yes. Okay. Yes. And different viruses
have different incubation periods, right? I think
there are certain respiratory viruses that are
a bit longer. They could be in the terms of like
days, like seven to. Yeah, nine days or something
like that. Yes. Okay. Yes. People with norovirus
can shed billions of virus particles in their
stool and even in their vomit. And so it can
last and hang on to objects and surfaces for
days or even weeks. And that's why it can, that's
why when you hear about these outbreaks on cruise
ships, they're just frantically trying to clean
everything so that it can not. be passed on to
other people. Stop the spread. Yeah. Yeah. Foodborne
illness. Interestingly, because remember it's,
it's, it's caused by similar viruses and bacteria
that cause a regular gastroenteritis. It can
also be contagious because of the fact that you're
expelling these same types of organisms. And
I thought it was, you know, again, it's transmitted
by that fecal oral route. I thought this was
really interesting. If Josh ate bad lettuce.
And then ends up with a gastroenteritis, forgets
to wash his hands. And he then gets a foodborne
illness. But if I get it, it's considered gastroenteritis
and not foodborne illness because I didn't eat
the food. I just got the virus. Interesting.
Yeah. Okay. So I thought that was really interesting.
So the source might be the food, but then the
passing just becomes. It becomes a regular just
gastroenteritis. Sounds like a chicken or egg.
Yeah. Where did it come from? Yeah. Foodborne
illnesses may not be contagious if they're due
to toxins or chemicals. And I think one of the
ones that may be more notable is botulism. Again,
remember that is due to, I think about, you think
about your grandma's canned goods. And if it
didn't seal correctly, the botulinum toxin, which
is, oh my gosh. Clostridia. Clostridia and botulinum.
Yes. It will start growing. And then if you eat
it, then you'll get sick. But that is not a transferable
bacteria. This is also so interesting because
this is literally a dose makes the poison lesson
because the primary ingredient in Botox treatment.
is botulinum toxin. So when you get a Botox injection,
you're getting a low dose of botulinum toxin,
which basically acts as kind of like a, basically
it increases water's ability to rush into certain
bits of your tissue to kind of give you a more
like puffed out experience, which people associate
with youth. But too much of it. uh you can you
can basically go through severe paralysis paralysis
is the big deal yeah so this is literally like
where dose makes the poison um you can have too
little or too much or just the right amount of
something and that's why things aren't usually
quote unquote bad it just really does depend
on the amount um and that's why it's really good
to study what amounts are are tolerable and where
your risk profile is low or high there you go
there you go OK, here we go. Clinical manifestations
are what on earth happens when we get a gastroenteritis.
OK, let's talk about, first of all, viral gastroenteritis.
I mentioned that the incubation period or the
time that you could. Already have the virus,
but you're not showing symptoms yet is 24 hours
with a range of 12 to 72 hours. And then you
have a sudden onset of symptoms like loss of
appetite, nausea. Vomiting can be more prevalent
in children than adults, but we also as adults
can vomit as well. I can assess to that. Diarrhea
is also more prevalent in adults than kiddos,
but they can also have loose watery stools as
well. Abdominal pain. And sometimes you can also
have other systemic symptoms like headache, fever,
chill. or myalgias. Myalgias are like just body
aches. The symptoms usually last from anywhere
from 12 to 60 hours. And then it's usually self
-limiting. With foodborne illness, the symptoms
are going to typically show up more rapidly,
usually two to six hours after you've eaten contaminated
food or liquid. Although it can take longer in
some cases. So there's no like hard and fast
rule on that. Symptoms are very similar with
diarrhea, fever, headache, stomach pain, nausea,
and vomiting. And the symptoms typically resolve
more quickly with food poisoning than they do
with gastroenteritis, usually within 12 to 48
hours. So you can see that it can be difficult
to determine whether or not you've got food poisoning
or a viral gastroenteritis. But one, I think,
way to maybe differentiate as well is If you
hear that there is some sort of a bug going around,
when my kids were in school, some parent would
say, oh, they're out because they're throwing
up. And I'm like, oh, no, here it comes because
it can pass very easily, especially in a closed
environment like a school. So if you hear about
something going around, it may be more likely
a gastroenteritis than food poisoning. And to
your point earlier, it can be really hard to
determine, right? a foodborne illness could be
the genesis of a case of gastroenteritis right
so one person eats a bad you know bad enchilada
and then passes it to their family and then that
family goes out and spreads it so it really does
seem like this kind of almost like tangled web
Of like, where does one stop and where does one
begin? Because basically you describing these
symptoms to me, both of those sound exactly what
I went through. And actually looking at this
list, it does seem more like the foodborne illness,
even the timeline. I was like, it seemed to happen
very quick after I ate a meal, but it's hard
to determine causality, right? It is. And it
also, they tended to stop, you know, within a
really short. Period of time, because I think
the next day I was just I was just kind of feeling
tired, but I didn't feel the same way. I don't
think you wanted to eat anything, though. So,
yeah, that is correct. Yeah. So maybe that's
a sign that I had more gastroenteritis than than
these foodborne illness. And it is really hard
to tell. And again, remembering that norovirus
is very common between November and April. It's
just because of closed systems, because we all
go inside because the weather is just different.
So in the fact that other people I. heard that
people were having you know similar stomach illnesses
as well right i just associated that with the
flu because the flu was going around right but
that's not the same right not the same yeah so
yeah so so any and you're like thinking well
we couldn't have all eaten the same bad food
you know because we all obviously didn't go eat
at the same place exactly yeah so yeah so that
that so you have to kind of piece some things
together and stuff so um so Potential complications
associated with a gastroenteritis. First of all,
let's start with viral gastroenteritis. Well,
both viral gastroenteritis and foodborne illness.
If you start vomiting blood or you see blood
in your stool, then you need to see a health
care provider because that's not necessarily
normal. And then if you have prolonged vomiting
for greater than 48 hours. Or if you cannot keep
fluids down for 24 hours, then you need help.
Because, again, you are fluid deprived and you
also are electrolyte deprived. And it makes you
feel really sick. And the reason that you feel
really sick is because you are dehydrated. It's
really interesting. Symptoms associated with
dehydration are thirst. But like Josh said, the
last thing you want to do is drink anything when
you're throwing up. And that's why a lot of places
will put. IVs in you, right? Like it's like you,
because you can't keep something down. You got
to put something inside of you. You got to get
those electrolytes back in you. Yeah. Cause what's
the primary fluid in your body, mom? Water. Yeah.
And what is it? What does it help circulate around
you? Well, you got blood. Blood. Yeah. The whole
thing that carries oxygen and glucose to the
rest of your body. Yeah. So if you're not, if
you don't have enough fluid to. pump that around,
of course you're going to feel awful. You're
going to feel terrible. I was just giving you
a few questions. In addition to the whole GI,
the gastrointestinal feelings, then you've got
other systemic things that cause you to feel
really bad because you're dehydrated. Absolutely.
Other ways to know that you're dehydrated are
if you're not. peeing as much or if your urine
is a really dark color. You may notice, and this
is a little fun fact, in the morning when you
pee for the first time after you get up, your
urine is darker. But as you go on through the
day and you've hydrated yourself with beverages,
your urine color will get lighter. That makes
sense because, I mean, at night you're sleeping
for seven or eight hours. That makes a lot of
sense that you're more dehydrated when you wake
up. If you stop having bowel movements, you know,
then that can be a sign of being dehydrated.
If you feel weak, dizzy, lightheaded, if you
have sunken eyes. For kiddos, if they cry without
tears or if they have no wet diaper for six hours,
it's very concerning. Or babies have this little
sunken area in the top. They've got this little
soft spot in the top of their head. It's called
their fontanelle. That can sink in when they
are dehydrated and that's not good. You would
need to maybe possibly talk to your pediatrician
about that. You can feel if babies are really
sleepy or drowsy or unresponsive, then that's
not good as well, too. And you can get a dehydration
headache. Your lips and tongue can be dry. And
as I talked about, you can. be depleted of certain
electrolytes. The ones that are most common are
potassium and sodium. If you have low sodium,
you can get muscle cramping and weakness. It
also contributes to nausea and vomiting. It also
can cause lethargy or feeling really tired or
headaches. So when you have low sodium, you can
feel sick. And with low potassium, you can be
constipated. Or the thing with low potassium
is it can cause heart palpitations and potentially
heart arrhythmias if it gets low enough. And
so you can have muscle weakness and spasms. So
again, nothing to sneeze at when you have low
electrolytes, lower electrolytes. Yeah, this
might be a good time to remind people why electrolytes
are important. Your cells in your body. are always
trying to return to this thing called homeostasis,
which is like just a fancy word for balance.
And by balance, it just means we have the proper
amount of sugar inside of a cell and outside
of a cell. We have a proper amount of water inside
the cell and outside of the cell. And in order
to transport or move those things back and forth,
they do them on these things called chemical
gradients, which basically means you have a concentration
of one on one side and one on the other. And
primarily how that's done are these things called
sodium potassium pumps, where you move sodium
inside the cell, potassium outside the cell.
And this constant shifting of these sodium potassium,
which we call electrolytes, gives the energy
to move a lot of these substances in and out
of the cell, making your body feeling like it's
at balance. So if you are constantly purging
your body of fluid that has a lot of these electrolytes
in it, your body doesn't have them to be able
to move these things in and out. Which can obviously
cause a lot of problems. So I think a lot of
times people hear electrolyte and like, oh, I
need to have more of these. It's like, it really
depends. And the reason you need them is so that
your body can function properly so that it can
do the jobs that it needs to do. So just want
to give, just give a brief explanation of what
electrolytes are. That's a great point. And then
the last thing that you, well, not. One of the
last things is that there's something called
vasovagal syncope, which means that you can pass
out when you are dehydrated. That happened to
me. Yeah, that's wild. There's a term for it?
There is. It's called vasovagal syncope. So syncope
means passing out because what happens is that
similar, that same vagus nerve that Josh talked
about, that's that connection between those.
enterocytes and enterochromaffin cells in the
gut and your head, they carry signals from the
brain to the rest of the body. And they also
control functions like heart rate and blood pressure.
So they can get overstimulated due to triggers
like stress or dehydration. And so if they get
stimulated, it then will cause the heart rate
to slow and the blood vessels will open up or
become wider. And that's going to cause you to
get lightheaded or even pass out. Um, so, um,
you, if you feel like that and you're still throwing
up, it would be a good idea to at least be sitting
on the floor, you know, to do that. Passing out
makes sure I did that. Yeah. Yeah. So, yeah,
because if you pass out from a standing position,
then you can really get yourself hurt because
we're, even though you don't think we're that
heavy, we're that heavy. You could hit the head
of the toilet. I mean, then you end up with a
lot of other things and stuff. So going on. Yeah.
It was wild of just like all of a sudden just
wake up and be like. how did I get on the floor?
And luckily I was sitting down. Yeah. But it
was, it was such a, if anyone's ever passed out
before, it's such a wild experience because it's
like falling asleep. Like you don't really know
that you've done it until you regain consciousness
again. Yeah. Yeah. Other complications that can
be associated specifically with foodborne illnesses
are miscarriages and stillbirth. If you get a
listeria. Um, that because listeria causes neurologic
damage, damage and death to the growing fetus.
Um, you can get kidney damage. Now these aren't,
these are not common. I'm just giving you things
that have happened, but they're not, that's not
the norm. These are extreme cases of foodborne
illnesses. Uh, kidney, you could have kidney
damage with. Escherichia coli, which is E. coli,
because it can cause kidney failure. And then
interestingly, you can get arthritis with salmonella
and campylobacter, so it could cause chronic
arthritis and joint damage. But again, these
are the exceptions, not the rules, but we're
just doing a complete conversation about things
that can happen. I imagine these are just extreme
immune responses to a large bout of these pathogens.
Right. Really interesting. So as we've described
this illness, which nobody really ever wants,
what on earth can we do to treat it? And what
can we do in the aftermath? Yeah, in the moment
when I was doing, I'm like, I don't really know
what to do. Like I'm just sitting here vomiting
and I want to know what is the best way to treat
myself to give myself the best possible outcome
so that I don't have either a permanent damage
or that I can make the symptoms last less. So
I think. What are some of the things that I can
do in this moment? Well, there's not a lot of
things to do to necessarily make it last for
a shorter time period, but we can rest. And when
we can... ingest oral fluids it's small sips
of fluids or ice chips maybe and um and then
oral rehydration formulas like pedialyte adults
can even drink pedialyte as well too i remember
when my kids were little and they would get a
stomach bug my pediatrician's office would say
if they haven't vomited in an hour then you can
try um a a small drink with them because they
were thirsty when they were little kids and they
didn't understand they shouldn't drink and guzzle
it and stuff. But normally they were, they were
definitely vomiting within an hour and stuff.
So it took a several times, you know, it took
a while before you could give them something.
So it might be good just to have a bottle of
that. Just like when you do happen to have a
stomach virus, then to have that just lying around
to replace electrolytes as well. Okay. Because
it's got some electrolytes in it. Okay. The other
thing that can be done is there, you know, you
can contact your health care provider and see
if they would give you an anti -emetic, which
means an anti -throwing up drug. The one that's
most commonly prescribed is on Dancitron or Zofran.
It could help just control some nausea and vomiting
symptoms because it's, it's, it's, this is going
to be like after it's been going on for a while.
You're not going to want to take it initially
because, you know, and the, the, the virus, exudes
a toxin and you've got to get that out of your
body and stuff. So is this something like Zofran
or what was the other or Dancitron? They're the
same thing. Oh, they're the same thing. Okay.
And these are anti emetics. So they stop you
from vomiting. Right. Okay. So are these things
that you could, these are prescription based.
They are. Could you go to a doctor to just get
them prescribed just in case, or do you need
to show symptoms? Because it seems like if these
diseases last for a short amount of time, it
seems like it would be a good thing just to have
on hand, you know what I mean, when it does happen.
Because probably by the time you're seeing a
physician. Most of the symptoms are gone. That
would be something you could talk with your physician.
I don't know about, I don't know what their philosophy
is on that. So I know that it used to be that
there was a medication that you could give your
babies or your kiddos a suppository. But that
suppository then was, then the medication was
shown to cause some adverse effects that were
not desirable. for the pediatrician stopped prescribing
them. And usually you're usually, you know, you
think after you vomited a few times, you may
not be vomiting anymore, but you feel really
nauseated. And so then the drug can help at least,
you know, let you get some rest. If it can like
dampen down those types of. Yeah. I think, I
think sometimes just getting a break so that
you don't vomit as frequently. Yeah. Might be
good. Okay. Yeah. Cause after a while, there's
just not a whole lot left. So maybe you have
people talk to their primary care. Like if you're.
worried about having one of these episodes in
the future. And if you're about to see your doctor,
it might be good to bring up like, Hey, could
I get, they say no, but you know, that's, that's,
you know, it's again, it's a conversation to
have. Yeah. It'd be interesting. Yeah. If you're
a doctor out there listening, maybe write in,
let us know if you would prescribe something
like that. Yeah. There's a debate about whether
or not to give anti -diarrheal medication. The
ones that are available, diphenoxalate, atropine,
which is the brain name used to be limodal, and
then loperamide was imodium. They're not recommended
for patients over 65 years of age. And you can
use them in younger patients, but not in kids
under two. And they're really not preferable
for kids. Under six years of age as well, too,
because if you can maintain a hydration status,
then it may not be necessary to give an antidiarrheal
because they do have some adverse effects associated
with them. And so, you know, like you're going
to transfer one set of symptoms to another. And
so it's just kind of debatable as to whether
or not you would take them. That's good to know.
The thing after you've been ill, you want to
eat bland, easy to digest foods for maybe several
days after the symptoms subside. So the first
thing is really, you know, think about that chicken
soup, but it's really chicken broth. So and the
reason that you do chicken broth is because it
has sodium in it. So you could probably tolerate
the Campbell's chicken noodle soup. The noodles
are pretty bland in and of themselves, but it
has sodium in it and it just helps you feel better.
Or some saltine crackers, something really bland.
My mom used to give me toast and hot tea. So
I hate hot drinks. Probably because of that.
I'm like, why hot tea? Anyway, so if you do have
severe dehydration or you just can't stop throwing
up, you may need... to be seen in an outpatient
clinic or an emergency department. And if you
are significantly dehydrated, it may be necessary
to hospitalize you just to get those fluids and
electrolytes back in you, especially in people
that have renal failure or severe abdominal pain,
or if you're pregnant as well, too, and you get
one of these nasty bugs. So is there anything
we can do to prevent this from happening? So
not every viral gastroenteritis case is preventable,
but there can be some things that we can do to
maybe minimize or reduce the opportunity for
those viruses to catch us. First of all, this
is so important. Keep your distance from someone
who's sick or has been sick for at least... two
days after their symptoms subside because the
virus is still being shed in their poop. And
so that means that they are still contagious.
And it's, you know, it's hard. You feel better.
And so you want to go out and do stuff and all.
But it's it's a matter of just for other people's
sake, stay home. And for your sake, stay away
from people who have been sick for at least two
days. Even if they're living in the same house
as you, maybe just kind of keep distance. Don't
use the same bathroom. Yeah. You know, so I guess
if you and if you are sharing the same bathroom,
then it might be good to move to some of the
next steps that we're going to be talking about,
which is talking about good hygiene. Right. So
you want to wash your hands well. That's one
of the most effective ways to keep from getting
infections from other people. Again, we learned
this during the pandemic. You wash your hands
with good soapy water for 20 seconds. So you
sing the happy birthday song twice. Do you mind
if I give a brief reminder of why soap is effective?
No, go ahead. Most of the time when we think
of things like viruses, bacteria, these are things
that have an envelope or a barrier that protects
the inside of the cell or the virus, which usually
in the virus's case contains their genetic material,
whether it's a DNA or RNA virus. The norovirus
is an RNA virus. And things like bacteria have
a lot of other stuff inside of them. You know,
things like their genetic material, but also
enzymes for them to replicate themselves. Now,
their barrier, just like the human cells, is
composed usually of a fatty, we call it a phospholipid
bilayer. That's specifically in human cells.
But most of the time in other cells as well,
it's usually composed of things that are fatty.
So a soap, which we call a detergent, also has
a fatty layer to it and if you've learned from
anything of trying to mix oil with water you
kind of know this that oil and water don't mix
because water is usually uh basically it just
depends on um essentially it has to just kind
of do with electrical attraction and so essentially
oil is usually attracted to other similar fatty
-like substances. Water's attracted to more kind
of water -like substances, and so they don't
mix. But fat loves to mix with other fats. And
so when you mix soap with some of these layers,
it actually like rips. the membranes apart. It
actually tears these viral particles and these
bacterial particles apart, exposing their insides
so that they're no longer organized, quote unquote,
and they can't do the things that they want to
do, which is replicate a lot inside of your body
using your food sources. So that is the reason
we use soap. And it's also the reason why we
use detergent and laundry, because most of the
substances that get in your clothes are usually
fat. soluble and we want to get them out of your
fibers as well. So just a fun little reason of
why we use soap and why it's such an amazing
molecule so that it can keep us clean and keep
our clothes nice and fresh. So continue on with
good hand washing, which is very important. Yes.
So also you want to clean surfaces. In schools,
daycares, nursing homes, hospitals, where people
that use the same facilities every day, you want
to clean with disinfectants to help remove the
germs that can linger on common surfaces. And
I know I've got this later on, but let us say
this now. Norovirus, it needs to be cleaned with
a soap, not... hand sanitizers. For some reason,
the alcohol that's in the hand sanitizer does
not kill the norovirus. It has to be soap. However
the virus is built, it doesn't respond as well
to soap as it does to cleaning and bleach. Yeah,
it just doesn't attach to the proteins on the
outside of the viral envelope. But soap and bleach
do. Yes. They're also from the EPA. There are
also certain cleaners that specifically have
the label norovirus on them. So if you can go
to the EPA's website or if you're shopping at
your local convenience store or grocery store
that has cleaners, if it specifically says norovirus
on there, then that means that it's been approved
by the EPA to disinfect against norovirus, which
as Dr. Seltzer said. uh caused about 50 of the
gastroenteritis cases uh in in the united states
yeah and epa is your environmental protection
agency yes um So we've talked about kind of surfaces
in our hands. What about safe food handling?
Food can become contaminated at any stage of
production from harvesting and storage to cooking
and preparation. So we want to wash our hands
before and after handling food. And we want to
wash, refrigerate, freeze, cook, and serve food
according to food safety guidelines. Yeah. And
I'd like to talk about those guidelines real
quick. So there's a lot of steps along the way.
So, and we're going to basically, we're not going
to start at the factory production because that's
out of our control. We're going to work on things
that are within our control. So when you are
handling things like fruits and vegetables, just
because there can be things on the outside of
the fruits and vegetables that just didn't get
cleaned. as properly as they should. So what
is a good thing to do is just to wash with soap
and water before you prepare and handle them,
especially if you're going to eat them raw and
you're not going to cook them. Now, let's say
you're going to move on to cooking. Let's say
you're cooking. Let's say you're going to move
on to cooking meats, things like fish, poultry,
ground meat. There are actually specific temperatures
associated with the internal temperature of what
needs to be reached for the inside for it to
be safe. Because remember earlier we said that
bacteria especially, they love to live in that
range of 40 degrees Fahrenheit to 140 degrees
Fahrenheit. So most things need to be cooked
above 140 degrees Fahrenheit. In order to be
deemed safe because you've essentially provided
a heat that kills the bacteria. And different
forms of protein have different amounts. Poultry
is 165 degrees. Ground meat is 160. Whole cuts
of meat like a tenderloin or a ribeye needs to
reach about 145. And fish is about 145. Did you
by chance see what the temperature... temperature
is for eggs oh that's a good question um i didn't
see that i imagine because i've known people
to get sick from eating like what is it called
when you put an egg on a sandwich that's some
name or what is it dirty or something anyway
but you know oh you're trying to be like over
easy or like no they'll add it to like hamburgers
and stuff like that so yeah i mean and you've
got to make sure that not a raw egg yeah well
no but even if you cook if you you think about
sunny side up eggs are not cooked all the way
through yeah the yolk's not cooked yeah that's
a good question yeah we will We will put an addendum
to this, or maybe I make a comment on one of
our Instagram posts about that. But if somebody,
this could be research, homework that you could
do at home, your mom at drugs, look up the internal
cook temperature of an egg. I've never even thought
about putting a thermometer in an egg. I know,
I haven't either, but I'm like thinking, yeah,
because I cook. my husband's eggs all the way
through. Right. And so maybe people look that
up if there's any risk for sunny side up eggs,
because maybe there's not, I don't know off the
top of my head, but this is all the proteins.
So after you're done cooking, let's say you have
some leftovers and you're going to store them
in your refrigerator. Okay. So there are best
practices, essentially, if anything that has
been cooked. You essentially want to cool immediately.
There's kind of this myth out there that you
need to let it sit on the counter until it goes
in the refrigerator, which to me doesn't make
sense because the refrigerator is going to cool
it anyway. But the more time that that food sits
at quote unquote room temperature, in between
40 to 140 degrees, you're giving any bacteria
or virus a chance to grow and replicate itself.
Viruses can't replicate, but bacteria can. And
so you really want to get it inside of the fridge.
preferably less than 40 degrees as possible.
It's not going to kill the bacteria, but it's
going to basically stop its growth because bacteria
needs energy to grow. And even better if you
can freeze it, because if you can freeze it,
you can essentially store food almost indefinitely
because you've essentially stopped that bacterial
and fungal growth. Good rule of thumb is that
if you cooked anything, especially, you know,
produce or vegetables or meats, leave it for
three to four days. And after that fourth day,
No matter what temperature you've kept it at,
it's just a good idea to pitch it. Just because
you essentially are increasing that risk of some
type of bacteria or fungus to have grown inside
of there. And that can basically cause one of
these foodborne illnesses. Another thing too
is like if you're, this is a great one that I
think people should be aware of. There are these
things that we see in grocery stores all the
time called expiration dates or best by dates
or use by dates. These are all related to, this
is a common myth that's out there. I've even
told my mom this many times. This is all about
food quality, not food safety. So if you see
a best by date, that is the date in which the
manufacturer or grocery store can sell to guarantee
that that food maintains its food quality. Because
very much like a drug or pharmaceuticals expiration
date. They have things called half -lives, meaning
that the molecules in there will just lose their
quality and you'll lose things like taste, texture,
and especially things like cereals. You'll get
staleness. You won't get the freshness. But it
has nothing to do with food quality because bacteria
and fungus will infect those things at different
rates. So you could get a bacteria, enter it
on day one or on day 20. But once you open that
container, and it's usually things like dairy.
or eggs or hummus or like any type of dip that
essentially has like a biological organism, like
a chickpea or an egg or cottage cheese. Yeah.
Yeah. Once you've opened that, you have basically
said, hello world, I'm going to expose you to
all the microbes that are flying around. And
you've then increased the risk of that thing
becoming contaminated. So that once you open
that like plastic thing that holds the cottage
cheese or the plastic tab that's associated with
your milk. you've started a three to four day
period in which that could be affected. Now it's
your life. You can expose yourself to as much
risk as you want. But a general rule of thumb
is like any of those like biologics will essentially
be contaminated. But if you have a can of peas
that says best by June 29th of 2026 and you don't
open it, it's fine. You can keep that thing.
for months after that in terms of food quality.
It is really when you open it, that's when the
risk starts. So I really want people to kind
of get used to this idea just because you see
an expiration date or a due by date, especially
if it's not something like milk or cheese. it's
just like a cereal. It'll just become stale.
It's not going to harm you, but it's not going
to taste very good. So you can throw it out for
taste reasons, like a bowl of cornflakes or something
like that. But for things like milk and other
biologics, that's when you introduce foodborne
illness risks. So just kind of want to put that
out there as a delineation or a differentiation
between things of like food safety versus food
quality, which usually we only deal with food
quality when we have expiration dates or due
by dates. Food expiration, usually it's either
a smell test or just kind of the three to four
day rule. So that's my soliloquy on food safety
and food quality and how to mitigate the risk
against foodborne illness. Okay. So one other
thing we want to say about as far as safe practices
would be when you travel. It's especially easy
to get food poisoning if you travel abroad because,
and this is primarily called traveler's diarrhea
because it's different. different areas of our
world have different dietary plans, experiences
that our bodies might not be used to. So you
want to just be careful when you travel. It's
best to stick with cooked, peeled, or packaged
foods and to use bottled water. And interestingly,
as Josh talked about fruits, when you have a
fruit that gets... peeled rather than when you
just can just cut it up, they are going to be
safer like bananas or oranges where you peel
off the outside. So those are going to be safer
to eat in other countries or even here, you know,
than things like an apple. That makes a lot of
sense. I was actually in Norway in 2025 in the
summer and I bought some fruit from a grocery
store. Delicious. Didn't wash it before I ate
it because I was a fool and I didn't do this
podcast yet. And I got sick and I got a very
mild form of traveler's diarrhea. And my travel
companion who was with me at the time was not
content with sharing a room with me. So it's
one of those things where, yes, even in another
place, even in a place like Norway, you're used
to bacteria and cultures in the United States
and even a completely different water source.
Can be treated differently. Going to Mexico because
we're in Texas. So we live very close to Mexico.
Bottle water is just the way to go because we
can't tolerate the water down there. That's correct.
And even in other places. Even in other places
in the United States, like if you're backpacking
or camping and you get water from a river, which
I frequently did, there are ways to treat that
as you camp, but you can definitely pick up a
pathogen there. You know, there's just a lot
of critters out there and they're always trying
to live off of you. They're trying to live. We're
trying to live. We're all trying to live. There
you go. So interestingly, you might say, well,
is there a norovirus vaccine? Interestingly,
so I was like thinking. Never heard of one, but
as I was investigating for this talk, sure enough,
they're not commercially available yet, but there
are trials in progress to try to find an effective
vaccine for norovirus. Remember, norovirus is
kind of like the flu virus in that it changes
all the time. So that makes it harder to create
a... vaccine for that particular virus, but we've
figured out how to do that with the flu and that
they modify it every year. So our flu vaccines
every year are not the same. And so I think that
they're looking at this from the norovirus vaccine
and at least investigating, is there a way that
we can create a vaccine that would be effective?
So, you know, stay tuned. More to say about that
particular topic. Okay, we covered that already.
Okay, so we always like to talk about common
myths and untruths associated with whatever topic
that we're discussing in our Your Mom on Drugs
podcast. So here is our common myths and untruths
associated with gastroenteritis and food poisoning
or foodborne illness. Number one. We've talked
about this. The stomach flu is the same thing
as influenza. This is definitely false. The influenza
virus targets the respiratory tract primarily,
not the gastrointestinal tract. And so although
we call gastroenteritis the stomach flu, it's
not a true flu. Second one, it's just a virus.
Well, if you have it. It feels like more than
a virus to you. So and also to remember, it's
got some consequences. I mean, dehydration is
very real. And so you want to make sure that
that. You keep a handle on either yourself or
your kiddo if you get a gastroenteritis because
it's not benign. I mean, it does make you feel
pretty sick for several days. So again, remember,
dehydration can cause a lot of adverse consequences
to it. So we want to stay on top of our cells
or our kiddos if they get a gastroenteritis.
Here's number three. Most gastroenteritis is
probably food poisoning. False. The majority
of vomiting and diarrhea in children is viral
gastroenteritis. Bacterial infections are more
likely if the child has been to an area with
an endemic infection. That means an infection
that's common to that particular area. And if
you've got a history of consuming foods that
are likely to have been contaminated, that's
also important to know, you know, when you get
symptoms, was it due to the food or was it due
to just a virus that was just a random virus?
A sudden onset of vomiting does not imply food
poisoning. Norovirus, for example, is typically
causes sudden and severe symptoms. So you can't
always say that gastroenteritis is probably food
poisoning. Number four. Pregnant women are in
danger if they contract norovirus. False. Research
has shown that there is no unique harm of a norovirus
during pregnancy. If you do get vomiting and
diarrhea, that leads to dehydration and electrolyte
imbalances in pregnancy. You just want to talk
with your healthcare provider to make sure that
you get adequate fluid replacement. They should
stay well hydrated and rest up. And then if you
get a high fever or you start having contractions
or you can't keep fluids down, then you've got
to go to the emergency room immediately. There
are medicines that will kill norovirus. That,
unfortunately, is false. There's no effective
antivirus medication for norovirus. Although
it's an unpleasant virus. Typically, the good
news is that the symptoms disappear within one
to three days. Again, like we keep reiterating,
the biggest danger is dehydration. So you want
to make sure that you drink as much fluid as
possible and rest as much as possible when you
have one of these viruses. Number six. I should
have numbered these instead of letter these.
It was just a 24 -hour flu bug or the stomach
flu. I've never had a foodborne illness. False.
Food -borne illness is frequently mistaken for
the stomach flu. Many symptoms are similar. And
depending on the bacteria or the virus that cause
the illness, the symptoms could be very similar.
So you want to look at your circumstances that
are surrounding your illness and maybe talk to
your health care provider to figure out maybe
or discern exactly what the root cause is for
your particular illness. But you can't always
rule out a stomach, a food -borne illness. The
next one. I just ate at a restaurant 45 minutes
ago and I'm already sick. I know that restaurant
gave me a foodborne illness. Most likely false.
People think that often that when they get sick,
it's due to the most recent food they ate. Remember,
it's rarely caused by the food that you just
ate. It usually takes several hours. If you've
got a foodborne illness, remember we talked about
two to six. And if it's a norovirus gastroenteritis,
it's going to take maybe 12 to 48 to 60 hours
to start showing symptoms. So some bacteria,
if you think it's a bacteria that caused it,
it usually takes about six to 48 hours before
you start seeing symptoms. And sometimes bacteria
can take, like Joshua alluded to earlier, it
can take up to two weeks before you start seeing
symptoms. Sometimes it's very difficult to tell
you which food made you sick. And so because
stomach flu symptoms are similar to food -borne
illness symptoms, remember, it can take one to
four days from exposure to the start of stomach
flu symptoms. And remember, food -borne illness
may be a little bit quicker. Here's the next
one. You can tell a food will make you sick by
its smell, look and taste. False. Now, my son,
Josh, always wants to tell me it's all about
and you just smell your food or look at your
food and you can tell whether or not it's bad
or not. Well, that's not always the case. You
can't rely on your senses to tell when a food
is no longer safe to eat because E. coli, Escherichia
coli and salmonella. don't affect the way the
food looks, tastes, or smells. Okay, so I'm not
always right. So you want to make sure that for
sure if a food smells or looks bad, don't eat
it. But again, if you haven't been following
those food safety practices that Joshua talked
about, the rule of thumb is you want to make
sure something gets into the food within two
hours of cooking it and shorter if possible,
then I would just toss it instead of taking the
risk of getting sick. Yeah. That's well said.
Um, yeah. Cause I, as mom alluded to earlier,
we, in our family, we love eating cookie dough
and it probably does benefit that we make it,
then we eat it and then we bake it. So hopefully
there's a short amount of time. So the salmonella
and like mom said, it always smells delicious,
but there's, I think because there's eggs in
there and there could be some of the salmonella
inside of the eggs. So, okay. Yeah. And then
the last one, we've kind of alluded to this already.
Alcohol -based sanitizers do not help prevent
norovirus. Despite the fact that alcohol -based
sanitizers help control pathogen transmission,
and they do things with other things like the
COVID virus and flu, but for norovirus, they
don't. They are ineffective because you've got
to have antibacterial soap and water or bleach
to treat that particular virus like we've alluded
to earlier. So to wrap up our talk today about
gastroenteritis, foodborne illness, and the aftermath,
we first of all want to say that infectious,
primarily viral gastroenteritis, is common in
all age groups, and it's usually self -limiting.
And foodborne illness can sometimes be confused
with viral gastroenteritis or infectious gastroenteritis,
and it's easy to see why because the symptoms
are very similar. Both infectious gastroenteritis
and foodborne illness are contagious. So don't
just think that viral gastroenteritis alone is
contagious, but foodborne illness is not because
foodborne illness can be caused by those same
viruses and bacteria that are causing viral and
infectious gastroenteritis. We've talked about
the common symptoms, including nausea, vomiting,
and diarrhea, and dehydration is one of the most
notable complications associated with the illness.
And so we want to make sure that when we treat
this illness, It includes rest, but also we want
to get oral replenishment or fluid replenishment
in whatever way we need to be able to get fluids
as well as electrolytes to help combat the consequences
of this illness. And preventive measures include
avoiding those who are ill, good hand washing,
good cleansing, and safe food handling. Yeah,
I think those four of just like, yeah, avoid
people who are sick, good hand washing and food
washing. safe food storage and preparation and
then cleaning and then safe traveling. You know,
those are probably the best ways that you can
mitigate your risk against some of these pathogens.
And then when it does happen, you know, rest
and hydrate. And if you can get things like Pedialyte
and then maybe ask your physician about some
of those anti -emetics, yeah, then that would
be a really good strategy going forward. I really
hope this never happens to me or anyone else
ever again, but it probably will. But hopefully
thanks to this episode, y 'all will be nice and
prepared and educated on all the. all the things
inside of your body that happens when you get
a gastroenteritis or a foodborne illness. So
we so appreciate you joining us today on another
episode of your mom on drugs. Anything you want
to close out with mama? I'm sorry that this was
maybe a less than pleasant topic, but you know,
one that, you know, probably it's good for us
to know about. So when they say knowledge is
power, right? And so until next time, which is
going to be episode 19, I don't think we know
what we're doing yet, but hopefully it'll be
good. And So we'll see you next month. And my
name's Josh. And I'm Jenny. And we'll see you
next time on another episode of Your Mom on Drugs.
Bye. Bye.