Dr. Stephen Chang, a gastroenterologist at Northwestern Memorial Hospital, shares how his insights on how to stay safe amid the cyclospora outbreak.Northwestern MedicineDr. Stephen Chang is a gastroenterologist at Northwestern Memorial Hospital in Illinois.Amid the cyclospora outbreak, he and his family haven't changed their eating habits.He advises practicing good food hygiene and being vigilant rather than forgoing all fruits and vegetables.This as-told-to essay is based on a conversation with Dr. Stephen Chang, a gastroenterologist and the interim endoscopy director at Northwestern Memorial Hospital and an assistant professor of medicine at Northwestern University's Feinberg School of Medicine. The following has been edited for length and clarity.Since the cyclospora outbreak, my family hasn't changed what we're consuming or our eating practices. I have older children, and I don't want them to use this as an excuse to stop eating fruits and vegetables. The teaching point in our house right now is reminding them about how to prepare them safely.It's important for everybody to remember that we actually have had outbreaks of cyclospora in the past. This is bigger than what we've seen before, but the numbers are still relatively low overall. (As of late last week, just over 300 confirmed cases were reported here in Illinois, and the state's population is over 12 million people.) It's much more likely for us to come across other causes of acute diarrhea, like norovirus, E. Coli, and Salmonella, than cyclospora.If you start having persistent symptoms — especially diarrhea lasting longer than a few days to up to a week — seek medical care and see if testing is appropriate.Here's the advice I'm giving my friends and family about being vigilant about avoiding suspected sources of this outbreak, without completely changing our eating habits:1. Wash your veggies thoroughlyI'm a salad person. Even before this cyclospora outbreak, I would usually still thoroughly wash my bagged salad, even if the packaging said it was pre-washed or triple-washed.I've always tried to be pretty good about food handling, and this situation has reminded me to wash my food a bit longer than I usually do.It's a good reminder of things we should always be doing for food safety: washing our hands both before and after working with food, very thoroughly washing our produce — not just splashing them in the water for a cursory couple of seconds — and discarding the outer leaves of a head of lettuce after you've washed it and making sure you're washing the inside of it.Be sure to wash your vegetables before you cut them, to prevent the knife from spreading contamination.You can also consider leaning more toward well-cooked vegetables during the outbreak if you can, for a better chance of not getting sick. We know that cyclospora is killed when heated to at least 158 degrees Fahrenheit.2. Be careful with lettuce for now — including when dining outNow that we have narrower guidance in terms of one potential source — iceberg lettuce, specifically from Taylor Farms — it might be worth giving some pause about purchasing iceberg lettuce, or at least knowing where it's sourced from. (Editor's note: The Food and Drug Administration has advised consumers not to eat recalled Taylor Farms' lettuce products.)I'm not a regular iceberg lettuce consumer, but I'm watching the news closely to make sure I'm not purchasing from somewhere that might be a suspected source.Being careful when eating out may be the bigger issue, because when you're preparing food at home, you're the one who cleans the products to eat yourself.If you're really set on consuming lettuce at a restaurant but you don't know where it's from, maybe ask the restaurant if they know where they get it from. Or, take a pass on that for now, and lean more toward the well-cooked vegetable options until we know this is over.3. Clean your fruit carefully, tooBerries are tricky. Some past outbreaks have been tied to them, but we don't know that about the current outbreak yet. They're smaller, not easy to clean with a brush, and many contain fine hairs that experts think cyclospora has an easier time sticking to. Be more vigilant about how you wash them, or maybe avoid them altogether.Generally, even for fruits with a rind, you should still have to wash the exterior part very thoroughly — like with a clean produce brush — before you cut it. Otherwise, the knife could theoretically carry the organisms into the interior part that you're planning on eating.4. Higher-risk individuals should be more carefulThe higher-risk groups — those more likely to be hospitalized if they get sick — that need to be much more vigilant include people who are immunocompromised, the elderly, and young children or infants.If you're in one of those higher-risk groups, reduce your raw vegetable and fruit intake and consume vegetables that are cooked at safe temperatures until the outbreak appears to be over, to give you the best
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