DRHOOK- Big beef: E.coli danger is no bull

the handsome doctor John Hong of Charlottesville

The butcher, the baker, the candlestick maker. When I was growing up in Ohio, there was no butcher shop... or bakery... There was one supermarket with hitching posts in the parking lot for the Amish buggies. My mother would ask the supermarket butcher to thinly slice the beef for Korean BBQ. I never saw Sam, the butcher, in his own butcher shop like Alice did on The Brady Bunch.

Fast forward: Oprah got sued by Texas cattlemen for her 1996 program on mad cow disease. And now there's a growing concern about E. coli 0157:H7 contamination in meat. This year, I read about a nationwide recall on ground beef because of E. coli 0157:H7.

 Is there a reason to beef about beef? 

 Believe it or not, today I get most of my meat at a real butcher's shop, The Organic Butcher. Not only do I want the animals to have been treated well, but also I don't want unnecessary things in my meat, such as antibiotics, growth hormone, and potentially deadly bacteria. Enterohemorrhagic Escherichia coli (EHEC) serotype 0157:H7 is the bad type of E. coli to catch. It causes outbreaks that lead to a lot of diarrhea– about 75,000 Americans each year.

 EHEC produces a bad, bad thing called Shiga toxin. Not "sug-ah" as we say in the South, but Shiga, which doesn't cause plain old-fashioned diarrhea. It usually causes bloody diarrhea. Campylobacter, salmonella, and shigella are more common bacteria (usually found on poultry) that can cause bloody diarrhea, but not as often as EHEC. Ninety-one percent of folks with EHEC report blood at least once in their diarrhea. 

 Also, unlike the other bacterial diarrheas, EHEC tends to not cause a fever– so many folks are fooled into thinking they don't have an infection. 

 Abdominal pain, though, is very common because the Shiga toxin wreaks havoc on the colon, causing a lot of inflammation and breakdown of the mucosa– ergo, blood and diarrhea. A gentle push on the abdomen might feel like a Rocky Balboa slug: bam!

 Really bad consequences of EHEC are HUS (hemolytic uremic syndrome) and TTP (thrombotic thrombocytopenic purpura). The EHEC causes acute kidney failure, hemolytic anemia (meaning the red blood cells are sliced and diced worse than at an Iron Chef competition), and low platelets that can lead to severe bleeding. If fever and neurological symptoms are present, TTP is likely there as well, and that can cause permanent neurological damage. 

 HUS tends to occur in kids under the age of 10, although I've seen it in folks older than that. It usually occurs five to ten days after the diarrhea starts, and it can be deadly.

 Diarrhea usually starts a few days after eating EHEC. EHEC is best cultured from stool in the first six days of diarrhea. Newer lab tests to detect Shiga-1 and Shiga-2 toxins are done now to detect EHEC, but there are still false positives. Culture is the best way to confirm diagnosis of EHEC. 

 EHEC usually goes away after a week, and believe it or not, antibiotics are not recommended for treatment. In fact, antibiotics can increase Shiga toxin to cause more harm. HUS is more common in kids who took antibiotics. So hydration, hydration, hydration is the main therapy for EHEC. Diarrhea meds that slow down the GI system are bad for any type of bloody diarrhea because the toxins will just sit in the colon even longer.

 "Eat Fresh, Buy Local" bumper stickers are popping up all over the place. Smaller farms appear to be better at quality control and don't seem to be causing nationwide infectious outbreaks. I don't want the animals to be confined in a small space riddled with E. coli. 

Literally, such treatment is sickening.


 Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice. Email him with your questions.