December 2009 Issue
Protecting the U.S. Food Supply
By Sari Edelstein, PhD, RD
Today’s Dietitian
Vol. 11 No. 12 P. 34
Suggested CDR Learning Codes: 2030, 7100, 8040; Level 2
We live in perilous times. As we leap into the second decade of the 21st century, we find that protecting U.S. inhabitants from harm, including threats to the food supply, has become a daunting task. In fact, it’s so daunting that we may be on the verge of a crisis, needing to supply enough affordable food to feed U.S. citizens while protecting the population from pathogens and chemicals that invade the food supply.
This article addresses the four areas of paramount concern in America’s struggle to provide safe and adequate food and nutrition for all: food safety, biotechnology (genetically modified foods), food insecurity, and agroterrorism/bioterrorism.
Food Safety
Food safety involves the pursuit of uncontaminated, unadulterated, clean, wholesome food that is fit for consumption. We define “safe food” as that which will not cause illness upon ingestion or in the hours following ingestion. In short, safe food should not cause a food-borne illness, a disease that is carried or transmitted to people by food.1 Biological, chemical, and physical hazards can threaten food safety.
Biological hazards are the most common threat. Disease-causing pathogens in food can generate infection or intoxication in unwitting consumers. These illnesses can cause morbidity and mortality at alarming rates. Table 1 indicates illness rates from biological food-borne illness in the United States.
The most commonly recognized food-borne infections are those caused by the bacteria Campylobacter, Salmonella, and E. coli O157:H7 and by a group of viruses called calicivirus, also known as the Norwalk and Norwalklike viruses.2 Although most of the identifiable cases can be attributed to the Norwalklike group, the survey results in Table 2 indicate that most public health personnel identify the more familiar pathogens as likely causes.
Campylobacter is the most commonly identified bacterial cause of diarrheal illness in the world. This bacterium lives in the intestines of birds; most raw poultry meat contains Campylobacter. Recent U.S. outbreaks of Campylobacter have been linked to undercooking of chicken in a stir-fry.3
Salmonella is also a bacterium that is widespread in the intestines of birds, reptiles, and mammals. In people with weakened immune systems, it can invade the bloodstream and cause life-threatening infections. Recent U.S. outbreaks of Salmonella have been linked to peanut butter and peanut butter combination products.4
E. coli 0157:H7 is a bacterial pathogen found mostly in cattle and other animals. Human illness typically follows consumption of food or water that has been contaminated with microscopic amounts of cow feces. The illness causes bloody diarrhea and painful abdominal cramps. In 3% to 5% of cases, a complication called hemolytic uremic syndrome can occur and lead to kidney failure. Recent U.S. outbreaks of E. coli 0157:H7 have been linked to raw spinach consumption.5
Calicivirus is a very common cause of food-borne illness. Unlike many food-borne pathogens that have animal origins, the Norwalklike viruses spread from one infected person to another. Infected kitchen workers can contaminate food as they prepare it.
Some common diseases are occasionally food-borne even though they are usually transmitted via other routes. These include infections caused by Shigella, hepatitis A, and the parasites Giardia lamblia and Cryptosporidium. Some food-borne diseases are caused by the presence of a toxin produced by a microbe in the food. For example, Staphylococcus aureus and Clostridium botulinum grow and produce a powerful toxin in foods.
Other toxins and poisonous chemicals can cause food-borne illness. Chemical hazards in food are linked to paint, lubricants, cleaning agents, and pesticides. Physical hazards include broken glass, metal shavings, and plastic ties.
The Hazard Analysis and Critical Control Points (HACCP) system is almost universally applied in the food industry. The HACCP system recognizes that there are risks associated with growing, harvesting, processing, distributing, preparing, and/or using raw material or food product. Hazard usually means the contamination, growth, or survival of microorganisms related to food safety or spoilage. A hazard can also include dangerous chemical contaminants or foreign objects (eg, glass or metal fragments). A food safety hazard is any biological, chemical, or physical property that may cause a food to be unsafe for human consumption. Risk is the estimate of how likely it is that the hazard will occur.
The Food Safety and Inspection Service (FSIS) is the public health agency in the USDA responsible for ensuring that the nation’s commercial supply of meat, poultry, and egg products is safe, wholesome, and correctly labeled and packaged. It promulgates HACCP standards. Applied to food processing, storage, and preparation facilities, the HACCP principles (revised for 2009) are summarized below6:
• Principle 1: Conduct a hazard analysis. Identify potential hazards associated with a food and measures to control those hazards, which can be biological, such as a microbe; chemical, such as a toxin; or physical, such as ground glass or metal fragments. Plants determine the food safety hazards and identify the preventive measures they can apply to control them.
• Principle 2: Identify critical control points (CCPs). These are points in a food’s production—from its raw state through processing and shipping to consumption by the consumer—at which the potential hazard can be prevented, eliminated, or reduced to an acceptable level. Examples are cooking, cooling, packaging, and metal detection.
The effectiveness of control at a CCP depends on the correct identification of a hazard, the appropriateness of the CCP, the adequacy of control measures, the correctness of critical limits, the capability of the monitoring method to detect deviations from normality in time, the appropriateness of monitoring frequency, and the adequacy of process control adjustments.
• Principle 3: Establish critical limits for each CCP. A critical limit is the maximum or minimum value to which a physical, biological, or chemical hazard must be controlled at a CCP to prevent, eliminate, or reduce to an acceptable level. For a cooked food, for example, this might include setting the minimum cooking temperature and time required to ensure the elimination of any harmful microbes. Monitoring systems must be able to effectively determine whether a CCP is under control. Corrective action must be defined so it can be used when a CCP monitoring point indicates that the system is out of control.
• Principle 4: Establish CCP monitoring requirements. Monitoring activities are necessary to ensure that the process is under control at each CCP. The FSIS requires that each monitoring procedure and its frequency be listed in the HACCP plan. Such procedures may include determining how and by whom cooking time and temperature should be monitored.
• Principle 5: Establish corrective actions. These are actions to be taken when monitoring indicates a deviation from an established critical limit. The final rule requires a plant’s HACCP plan to identify the corrective actions to be taken if a critical limit is not met. Corrective actions are intended to ensure that no product injurious to health or otherwise adulterated as a result of the deviation enters commerce (eg, reprocessing or disposing of food if the minimum cooking temperature is not met).
• Principle 6: Establish record-keeping procedures. The HACCP regulation requires that all plants maintain certain documents, including a hazard analysis and written HACCP plan, and records documenting the monitoring of CCPs, critical limits, verification activities, and the handling of processing deviations (eg, testing time- and temperature-recording devices to verify that a cooking unit is working properly).
• Principle 7: Establish procedures for verifying the HACCP system is working as intended. Validation ensures that the plans do what they were designed to do (ie, they are successful in ensuring the production of safe product). Plants are required to validate their own HACCP plans. The FSIS will not approve HACCP plans in advance but will review them for conformance with the final rule.
Verification ensures that the HACCP plan is adequate (ie, working as intended). Verification procedures may include activities such as reviewing the HACCP plans, CCP records, critical limits, and microbial sampling and analysis. The FSIS requires that the HACCP plan include verification tasks to be performed by plant personnel, as well as by FSIS inspectors. Both the FSIS and industry will undertake microbial testing as one of several verification activities. This would include records of hazards and their control methods, the monitoring of safety requirements, and action taken to correct potential problems.
Although no system is perfect, the HACCP has an enviable record of preventing food-borne disease. However, other potential hazards are not under its purview. Much concern has been forthcoming about new food technologies, such as genetic modification. While the arguments and warnings about genetically modified (GM) foods are passionate, research fails to validate them. Since dietitians are sure to encounter questions on the issue, an overview will help them participate in the discussion.
Biotechnology and GM Foods
GM foods are created by a gene-splicing technique that enables scientists to insert genes into foods for the purpose of dealing with environmental stresses such as drought, insect infestation, or various diseases; helping crops survive treatment with weed-killing chemicals; or enhancing the production of vital nutrients.7 Traditional hybridization techniques, which produced many of today’s food crops, are time consuming and fraught with inefficiency. Unwanted traits have also been passed along to descendant generations and have to be painstakingly eliminated, if they can be eliminated at all. Selectively replacing a single gene can speedily add a desirable characteristic.
The genetic modification of food represents a potentially better way to feed the world’s population and eliminates the potentially dangerous side effects of pesticide and fertilizer residue. A GM food has pest resistance built in, so farmers can forgo using expensive pesticides. It may also benefit the overall environment, as pest-deterrent chemicals do not need to be released into the ground. Pest resistance makes food cheaper by preventing huge crop losses from insect invasion. Bt corn is an example of pest-resistant GM corn in common use.8
Genetic modification has allowed some crops to become tolerant to herbicides that are used to kill weeds but can also damage food crops. By being herbicide resistant, crops can be spared from the chemical, which will reduce the amount in use. The most well-known example is a strain of soybeans genetically modified to be unaffected by the herbicide product Roundup.
The FDA has evaluated and deemed more than 50 GM food products as safe as conventional foods, including canola and cottonseed oils, papayas, potatoes, soybeans, squash, sugar beets, sweet corn, and tomatoes. In the most recent reporting year, 81% of soybeans, 40% of corn, and 73% of cotton were produced from GM seed stock.7
Plant biologists are working to create plants with genetically engineered resistance to disease caused by viruses, fungi, and bacteria. In addition, some plants have been modified to resist cold temperatures, which is necessary to extend the growth period around winter. In the same vein, drought resistance is needed to grow crops in areas that formerly could not support plant growth.
Because malnutrition is a threat to life in many countries, adding nutrients to crops through genetic modification could save lives. An example of this is “golden” rice, which contains beta-carotene to prevent blindness.
Although biotechnology and GM food may bring the United States more environmentally sustainable products and some health advantages, critics cite downsides such as increased allergies, potential illness, and food safety/integrity issues. In these critics’ view, the United States is descending a slippery slope to a dependence on unnatural products, which will drive out “pure” products and whose long-term effects are unknown.
Governments worldwide are coping with these concerns while facing increasing demand for food. Some have banned GM foods on scant evidence or under political pressure (eg, to protect local agricultural concerns). However, genetic modification to improve food technology will likely prevail. Food insecurity—there are an estimated 1 billion undernourished people in the world, according to recent proclamations made on World Food Day 2009—will likely make it necessary. It is incumbent upon dietitians to remain up-to-date on this issue.
Food Insecurity
Food insecurity is not limited to Third World countries; the problem also affects many Americans. The two ways to categorize these individuals are “food insecure without hunger” and “food insecure with hunger.” In 2002, the USDA reported that 11.1% of U.S. households experienced food insecurity (7.6% without hunger, 3.5% with hunger).9 This represents an increase from previous years. Table 3 lists various government agencies and programs involved in improving this situation. These and other programs will likely become strained in the current recessionary economy, with limited resources making individual dietary choices even more important.
Agroterrorism/Bioterrorism
Agroterrorism/bioterrorism includes the purposeful adulteration or poisoning of food to cause illness or death. Although acts of aggression against the U.S. food supply are not new, the events of September 11, 2001, emphasized the potential for such acts to become a reality both from within the United States and from outside perpetrators. The United States established the Bioterrorism Act of 2002 to delineate potential agroterrorism targets and to examine our degree of preparedness.10 The act includes the following five titles:
• Title I — National Preparedness for Bioterrorism and Other Public Health Emergencies;
• Title II — Enhancing Controls on Dangerous Biological Agents and Toxins;
• Title III — Protecting Safety and Security of Food and Drug Supply;
• Title IV — Drinking Water Security and Safety; and
• Title V — Additional Provisions.
Information on each is available at www.fda.gov/Food/FoodDefense/Bioterrorism/ucm080817.htm.
In addition to the USDA’s policy making, the FDA is working to prevent acts of bioterrorism through the following:
• working with industry to reduce threats and contain outbreaks of food-borne illness;
• increasing risk-based surveillance of domestic and imported food;
• developing the PrepNet food safety network;
• implementing the Bioterrorism Act;
• increasing the ability to quickly identify outbreaks of food-borne illness; and
• increasing participation in the first Internet-based food safety system.
Summary
Whether the threats to the American food supply are described in terms of food safety, biotechnology, food insecurity, or agroterrorism/bioterrorism, the task before us requires the careful assessment and implementation of programs and processes to ensure our food remains safe and adequate. This article serves as an invitation to nutrition professionals to become educated on these issues and to be part of the team that assists the United States in problem solving that not only continues to feed the U.S. and world population but feeds it better.
— Sari Edelstein, PhD, RD, is an associate professor of nutrition in the nutrition department at Simmons College.
This article has been modified with permission from Edelstein S. Is America at risk? In: Edelstein S, Gerald B, Crutchley Bushel T, Gunderson C. Food and Nutrition at Risk in America: Food Insecurity, Biotechnology, Food Safety, and Bioterrorism. Boston: Jones and Bartlett Publishers; 2009.
References
1. Food and Drug Administration Center for Food Safety and Applied Nutrition. Bad Bug Book: Foodborne Pathogenic Microorganisms and Natural Toxins Handbook. McLean, Va.: International Medical Publishing; 2004.
2. Centers for Disease Control and Prevention. Foodborne illness. October 25, 2005. Available at: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/foodborneinfections_g.htm. Accessed March 12, 2009.
3. Evans MR, Lane W, Frost JA, Nylen G. A campylobacter outbreak associated with stir-fried food. Epidemiol Infect. 1998;121(2):275-279.
4. DeNoon DJ. Peanut products still sicken Americans. March 11, 2009. Available at: http://www.webmd.com/food-recipes/food-poisoning/news/20090311/peanuts-still-sicken-americans. Accessed March 12, 2009.
5. Centers for Disease Control and Prevention. Multi-state outbreak of E. coli O157:H7 infections from spinach. September-October 2006. Available at: http://www.cdc.gov/foodborne/ecolispinach. Accessed March 12, 2009.
6. Food and Drug Administration Center for Food Safety and Applied Nutrition. Hazard analysis & critical control points. Available at: http://www.cfsan.fda.gov/~lrd/haccp.html. Accessed March 16, 2009.
7. Bren L. Genetic engineering: The future of foods? FDA Consumer Magazine. November 1, 2003. Available at: http://findarticles.com/p/articles/mi_m1370/is_6_37/ai_111269298/?tag=content;col1. Accessed November 11, 2009.
8. Whitman DB. Genetically modified foods: Harmful or helpful? ProQuest. April 2000. Available at: http://www.csa.com/discoveryguides/gmfood/overview.php. Accessed March 12, 2009.
9. Nord M, Andrews M, Carlson S. Household Food Security in the United States, 2002. Available at: http://www.ers.usda.gov/Publications/FANRR35. Accessed October 12, 2007.
10. U.S. Food and Drug Administration. FDA rules implementing the Bioterrorism Act of 2002 — Overview of registration and prior notice interim final rules. Available at: http://www.fda.gov/Food/FoodDefense/Bioterrorism/ucm080817.htm. Accessed October 12, 2007.
Learning Objectives
After completing this continuing education exercise, the student should be able to:
1. Identify the concern for food safety and the presence of food-borne illness in the United States, as well as some viable solutions for illness prevention and control.
2. Articulate an understanding of the term “biotechnology” as it relates to genetically modified foods and its advantages and disadvantages for use in the U.S. food supply.
3. Discuss food insecurity as a growing concern in the United States and the programs that are in place to alleviate the problem.
4. Recognize the threat of agroterrorism/bioterrorism as it exists in the United States and potential methods for surveillance, prevention, and control.
Table 1: Average Annual Hospitalizations and Deaths for Gastrointestinal Illness by Diagnostic Category, National Hospital Discharge Survey, 1992–1996 |
||||
|
1st diagnosis |
All diagnoses |
||
|
||||
Cause of enteritis |
Hospitalizations |
Deaths |
Hospitalizations |
Deaths |
Bacterial |
27,987 |
148* |
54,953 |
1,139 |
Viral |
82,149 |
0* |
132,332 |
194* |
Parasitic |
2,806 |
82* |
5,799 |
127* |
Unknown etiology |
186,537 |
868* |
423,293 |
5,148 |
Total |
299,479 |
1,898 |
616,377 |
6,608 |
*Estimate unreliable due to small sample size. |
||||
— Source: Mead PS, Slutsker L, Dietz V, et al. Food-related illness and death in the United States. Emerging Infectious Diseases Newsletter. 1999;5(5). Available at: http://www.cdc.gov/ncidod/eid/vol5no5/mead.htm. Accessed October 12, 2007. |
||||
Table 2: Percentage of Respondents Identifying Each Pathogen as Among the Top Three Causes of Food-Borne Illness, and Estimated Percentage of Food-Borne Illnesses in the United States Actually Caused by Those Pathogens |
||
Pathogen |
Percentage of respondents listing it among top three causes |
Estimated percentage of food-borne illness in U.S. caused by pathogen |
Salmonella |
90 |
9.7 |
Escherichia coli |
56 |
1.3 |
Staphylococcus |
36 |
1.3 |
Shigella |
32 |
0.6 |
Campylobacter |
18 |
14.2 |
Listeria |
16 |
< 0.1 |
Hepatitis A virus |
8 |
< 0.1 |
Clostridium perfringens |
8 |
1.8 |
Norwalklike virus |
5 |
66.7 |
Viruses* |
4 |
67.2 |
Giardia lamblia |
3 |
1.4 |
Streptococcus |
2 |
0.4 |
*Respondents who wrote in "viruses" only; does not include those who specified Norwalklike virus.
|
||
Table 3. Government Agencies and Programs to Improve Food Insecurity
Women, Infants and Children School Meals Food Distribution Other Programs |
Examination
1. A correct definition of safe food is:
a. that which is obtained from a trusted source.
b. that which has been approved by the FDA.
c. that which will not cause illness upon ingestion or in the hours following ingestion.
d. that which has never been handled by human hands.
e. None of the above
2. A correct definition of food-borne illness is:
a. an allergic reaction to a particular food.
b. lifestyle- or diet-related conditions such as heart disease.
c. hypersensitivity to chemicals in foods.
d. a disease or condition that is carried or transmitted to people by food.
e. an obsession with eating only a few, narrowly defined “healthy foods.”
3. _______ is/are the cause of most common food-borne illnesses in the United States.
a. Parasites
b. Bacteria and viruses
c. Chemical contamination
d. Allergic reactions
4. Norwalklike virus is:
a. one of the most common causes of food-borne illness.
b. transmittable from infected human to noninfected human.
c. a group of viruses called calicivirus.
d. All of the above
5. Diseases cannot be food-borne.
a. True
b. False
6. A critical control point (CCP) in reference to food safety is:
a. a point in a food process when a food safety hazard can be prevented, eliminated, or reduced to an acceptable level.
b. the stage in policy making where legislators decide action must commence.
c. the identification of the origin of the food-borne illness in a patient seeking medical treatment.
d. the final step before the human consumption of food.
e. a facility where recalled contaminated food is collected for destruction.
7. Which of the following is not one of the seven Hazard Analysis and Critical Control Points (HACCP) principles?
a. Conduct a hazard analysis.
b. Identify critical control points.
c. Assemble an HACCP team.
d. Establish corrective actions.
8. There are genetically modified food products that the FDA has evaluated and found safe.
a. True
b. False
9. The public health agency in the USDA responsible for ensuring safe foods is the:
a. Center for Nutrition Policy and Promotion.
b. Agricultural Research Service.
c. Risk Management Agency.
d. Food Safety and Inspection Service.
e. Office of the Inspector General.
10. Approximately ____ Americans experience some degree of food insecurity.
a. 50%
b. 5%
c. 1%
d. 10%
e. one in six
