We are eating lunch and chatting about explosive diarrhea.
Brendan Brown is sharing how he once got cyclosporiasis — a severe intestinal illness now sickening thousands in a national outbreak — while on vacation. He was, alternately, flat on his back or dashing for the john. For a month.
“I didn’t eat much,” Brown says. “Nothing was appealing.”
The illness is caused by, ugh, fecal contamination of produce. Bagged iceberg lettuce has been blamed for the largest outbreak.
Brown’s perspective is especially welcome because of his day job: public health epidemiologist and professor of medicine at UC Riverside.
I suggest we talk over lunch.
Specifically, salads.
As we examine the menu Wednesday at a fast-casual restaurant in Riverside’s Canyon Crest Shopping Center, Brown says cheerfully: “The Caesar salad looks good. I haven’t had a Caesar in a while.”
He clarifies: “Not because of the parasite. I just don’t go out to eat.”
By contrast, I eat out daily. At lunchtime I often get a salad — spinach, arugula or romaine if I have a choice, not flavorless, nutritionally weak iceberg. But any lettuce is potentially suspect. It’s all grown in dirt and handled by strangers.
At the counter, Brown orders a Caesar salad and asks: “Is the lettuce bagged?”
“No, we put everything together in-house,” the employee replies.
I get the spinach and strawberry salad with chicken. We take our seats.
“There’s always a risk when we go out to eat, isn’t there?” muses Brown.
I observe: “Restaurants usually don’t want us in the kitchen watching.”
Cyclosporiasis — pronounced “sick-low-spore-eye-a-sis” — has sickened at least 6,700 people in 45 states, with another 11,000 cases suspected. My sense is that while it’s not fatal, at certain points you might wish it were.
Brown’s bout was eight years ago. His intestinal issues are behind him. So to speak. But his experience is newly relevant.
“I only became interested after the national outbreak happened because of my own experience,” he admits.
Brown and his wife were out of the country in 2018 on vacation. Their tour group was ferried to an island for one meal.
Back home in California, the couple’s cases of cyclosporiasis developed the way a Hemingway character went bankrupt: gradually and then suddenly.
The Browns began turning green around the gills. They didn’t know why they each seemed to have food poisoning at once.
“It was very confusing. If you get sick, you’re going to think it was what you ate today, not what you ate 1 1/2 weeks ago,” Brown says.
Tracing back the timeline, they realized that at that vacation meal, they were the only people to order a salad — and the only ones to become ill.
Brown figured his upset system would settle down soon. It didn’t. He was lethargic and unfocused. Food wouldn’t stay in his system. Mostly he drank Gatorade for the electrolytes. He lost 10 pounds off his 200-pound frame.
“After two weeks I had to go to urgent care,” Brown recalls. The medical staff didn’t suspect anything serious was going on. “Pepto-Bismol, that was the prescription,” Brown says.
The symptoms eased. Then they came back, strong as ever. Brown lost another 10 pounds.
He quit going to the gym. Pausing his workout routine to run to the restroom was annoying and also had the potential to infect others. His wife had all the same symptoms and lost a larger percentage of body weight.
This time they went to a hospital emergency room. They were hooked up to IVs for nutrition and tested for fecal contamination. Bingo. They were diagnosed with cyclosporiasis.
Prescribed an antibiotic, the couple soon recovered, with no long-term effects.
But the experience was stressful. “Twenty pounds is no joke,” Brown says. He and his wife were able to take time off from work, but not every wage earner would have that privilege, he points out.
That said, Californians have little to worry about.
“The outbreak isn’t an outbreak in California. We have 50 reported cases out of 11,000 nationwide,” Brown says. The difference, he theorizes, “could be where we get our lettuce, our produce.”
Signs in restrooms at restaurants and other food handling sites say “employees must wash hands.” Some must think those orders are advisory in nature.
We all know people like that. Years ago, when the newsroom was far larger, we would share intelligence about coworkers we observed walking out of a restroom stall directly to the exit. They would be quietly labeled “a non-handwasher.”
Management should have made them wear a scarlet letter. Which would be a P.
“Someone who has the parasite transmits it that way,” Brown says. “I wash my hands more often and more vigorously since COVID.”
“Vigorously” is the key, he says with a smile. He washes the tops of his hands, his palms and his fingernails.
That’s partly public health and partly because Brown and his wife live on a 2-acre grove in Riverside, with orange, avocado and peach trees, a bountiful garden and chickens. They grow a lot of their own produce, which they wash.
If they buy produce, they wash that too.
“I buy bagged lettuce that says ‘triple-washed.’ I wash it a fourth time,” Brown says with a twinkle. “It won’t hurt to wash it again.”
It also doesn’t hurt to ask at a restaurant where its lettuce comes from, is it from a bag and is it washed.
“The outbreak is not serious in Southern California, but it can be a good lesson for us,” Brown says. “Wash our hands and wash our produce.” Those simple steps can, he says, “prevent a lot of diarrheal diseases.”
I thank Brendan Brown for sharing his experience with cyclosporiasis publicly and for his good humor in doing so.
With that, I wash my hands of the subject.
brIEfly
To summarize a Page One story from Monday, a fellow likes south Riverside County, builds a house near Murrieta and commutes 35 miles to Escondido. Now he’s irritated that the 15 Freeway is packed with commuters like himself. He laments: “It’s just sad that the area is turning into an L.A.” His, uh, solution to keep the area rural? Add freeway lanes. Let me suggest two cheaper, quicker solutions: He could find work locally – or move to Escondido.
David Allen writes Friday, Sunday and Wednesday, sensibly. Email dallen@scng.com, phone 909-483-9339, and follow davidallencolumnist on Facebook or Instagram, @davidallen909 on X or @davidallen909.bsky.social on Bluesky.