Locavorism vs. Salmonella: A Physician’s Perspective

Food Safety, Nutrition

Whenever the media reports an outbreak of Avian flu or Ebola, I invariably receive a flurry of panicked calls from patients wondering whether their cough or chill heralds San Francisco’s first case of that disease. While I can never be certain, geography alone allows me to offer a hefty dose of reassurance. Recent reports of salmonella-tainted peanut butter have generated a similar barrage of patient calls from anyone experiencing a stomach grumble.  Hopefully most of these calls represent nothing more than dyspepsia or a passing virus, however I feel less confident offering blanket reassurances.  After all, the victims of this latest outbreak have popped up in almost every state and the culprit, salmonella-infected peanut butter, has infiltrated a dizzying array of foodstuffs from chicken satay to energy bars to Valentine’s Day candy. Recently, we have witnessed a rash of tainted food scares but the range of this particular recall makes it undeniable that centralized food production poses a major threat to our health.

Given this obvious connection between food production and health, it is surprising how few in the health field are interested in food, much less the system that produces that food.  Recently, thanks to the strength of the sustainable agriculture movement, there have been some promising signs that this is changing: Health Care Without Harm, a multinational not-for-profit, has spearheaded a healthy food in hospitals program and so far 168 hospitals across the country have pledged to buy regional foods whenever possible. And for the first time, in 2007, health care professionals began to take an interest in the content of our Farm Bill. But even so, a large fissure remains between the system that is supposed to feed us, and that which is supposed to keep us healthy.

This fissure is seen at every level: Historically the department of Agriculture and the Department of Health and Human Welfare have had little to do with each other. Similarly, the American Medical Association has hardly concerned itself with issues of agriculture and food production. While most state and city health departments do have programs to help low income families gain access to food, disinterest or red tape has hobbled most efforts to require that these foods be from a local source. And when I discuss sustainable agriculture with medical colleagues, especially those that work with under-served patients, I am often told that this is an elite issue or simply an environmental concern with negligible heath implications. I wonder if this latest round of Salmonella poisonings might finally prompt us all to reassess; after all, physicians across the country are seeing the damage that can be wrought by one peanut processing plant in Georgia and our business-as-usual food chain.

My neighborhood market sells locally roasted peanuts and provides a mill so that customers can grind their own peanut butter. Suddenly this seems less like a frivolous foodie activity and more like a prudent public health measure. Would it not be similarly advisable to use this fresh-ground peanut butter to prepare my own Thai style chicken satay rather than selecting a prepackaged brand from the freezer case? And maybe an in-season apple would be a better snack choice than that Clif Bar. In fact, I can safely say that anyone making food choices based on the principles of “fresh and local” would have nicely side-stepped all the recent major outbreaks of salmonella, listeria, botulism and E coli.

Of course, there are many reasons beyond the threat of food-borne illness why health officials should join the effort to build a sustainable agricultural system. A large body of research now identifies regionally produced foods as being more nutrient rich, less chemical-laden and more affordable. Furthermore, there is ample evidence that populations around the world who still eat their local foods are relatively free of most modern chronic diseases.

Who knows. Perhaps this latest outbreak of salmonella, along with a will for change, is finally the catalyst we need. We will become a much healthier nation if our community health programs and community food systems team up, if our family doctors and family farmers link arms and, most importantly, if the two Toms, our Secretary of Health and our Secretary of Agriculture, take each other out for lunch and discuss ways to collaborate—hold the chicken satay, please.

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  1. yann
    Tuesday, January 27th, 2009
    I wish my health professional would take into consideration other aspects of wellness. Thanks for the thoughtful post!
  2. John
    Wednesday, January 28th, 2009
    In the last year, we've moved our household over to as many local food sources as we can find. We now purchase local meats, we're subscribed to a CSA for veggies, and use a local buying club for odds and ends wherever we can. We did this after reading things like The Omnivore's Dilemma and seeing things like King Corn, but I'm happy to say that I fear no tomato or peanut butter that comes out of our kitchen.

    As for the elitism argument, there is a green living magazine I came across this Christmas in Kansas City that published an article showing people how they can switch to all-organic groceries and use - wait for it - food stamps to buy every last crumb of it. Can't remember the name of the mag, but there aren't two that fit that description (green living +Kansas City) so it should be pretty easy to find if they're online.
  3. Wednesday, January 28th, 2009
    We, too, buy peanut butter (and almond butter) freshly milled at our local health food store. But I've been wondering at the trade-off between possible salmonella contamination in commercial peanut butter vs. the possibility of aflatoxin in the peanuts stored in the mill. My sense is that this is fairly unlikely, given how little time the peanuts spend in the mill, although one doesn't know how long they've been stored elsewhere. Any comment?
  4. Friday, January 30th, 2009
    I am amazed when I talk to those friends and family who are in or have gone through medical school how little they learn about nutrition and diet. I have brought up many discussions with these folks hoping to get an expert opinion on such things as whole fats and microbes (inspired from Nourishing Traditions) only to find they know very little about digestion and dietary health. In fact they tell me that one of the first things they learned in med school is that many of what they will learn about nutrition and diet is wrong or incomplete.

    Much of the work on health care reform will need to address the fact that many doctors may not know how to provide the best information about the cheapest form of preventative care; a diet of whole and active foods. If only all doctors spent more time in the jungle!
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