Stop eating salad? Lettuce may be to blame for ‘explosive diarrhea’ parasite outbreak

Michigan, the state with the highest number of cases of cyclosporiasis — caused by what The Post first nicknamed the “explosive diarrhea” parasite — has a primary suspect for the source of the outbreak: lettuce.

They haven’t, however, found the specific lettuce or salad green to blame, nor a grower or supplier at fault.

While cases skyrocket in Michigan to 2,640 — up 69% from Friday — they’re are also rising across the country. New York City is another hotspot for the infection, with 374 cases between May 1 and July 10, an official told The Post. The city is still hunting for a source for the outbreak here.

So if we know people generally get cyclospora from produce and some officials think lettuce is what’s to blame this time around — should we, at least for now, stop eating salad… for our health?

What foods should you avoid? Is washing enough?

Previously, there was only broad guidance from the CDC on washing and cooking produce whenever possible. Previous outbreaks pointed to bagged salad mixes, herbs like cilantro and basil, and berries like raspberries.

Cooking is the best, most effective way to kill any undesirables, experts agree.

If food must be consumed fresh — like a beloved salad — washing whole produce well is the next best thing. But it’s not perfect.

“The parasite can be difficult to remove from leafy produce because it may become trapped in folds, crevices, or areas that water does not reach easily,” Melissa Vaccaro, a senior food safety program specialist at National Environmental Health Association (NEHA), explained.

Cyclosporiasis symptoms include severe cramping, nausea, vomiting, fatigue — and what’s been described as watery, explosive diarrhea. While some who are infected never exhibit symptoms, others need to be hospitalized.

Dr. Manish N. Trivedi, director of infectious diseases at AtlantiCare, said that if you’re not washing your greens yourself, it might be a good idea not to order it at a restaurant or else buy it prepared — especially if you’re immunocompromised.

“I’m not saying that they’re not taking all the precautions they necessarily need to, but individuals need to really weigh up their risks and benefits … each individual is different,” Trivedi said.

If you’re on medications that suppress your immune system, you’re likely to react “dramatically different” than someone with a healthier-functioning immune system.

“You know these symptoms of diarrhea … they can they can be traumatic for some individuals, and they can last even longer for for individuals who are immunocompromised.”

So… can we still eat salad?

It’s true that cyclospora has historically been traced to imported foods. Those foods are shipped around the country — but some products may be contaminated while others might not be, explains Jill Roberts, an epidemiologist and professor in the University of South Florida College of Public Health.

Skipping all raw food, then, would be a “draconian” measure, insists Dr. Aaron E. Glatt, chief of Infectious Diseases and Hospital Epidemiologist at Mount Sinai South Nassau.

“Consumers shouldn’t lose confidence in eating fresh fruits and vegetables,” Vaccaro agreed. “Produce is an important part of a healthy diet”

The goal is to identify the contaminated product, remove it from commerce if necessary, and prevent additional illnesses — not discourage people from eating produce.

Michigan’s guidance is reasonable “for people living in the affected areas,” she added. “That does not mean everyone across the country needs to stop eating lettuce.”

And it’s always good practice, whether there’s a parasite outbreak or not, to wash all herbs and berries under water, and refrigerate them appropriately, said Dr. Perry N. Halkitis, Dean of the Rutgers School of Public Health.

Just “don’t panic,” he said.

The silver lining

Officials are hard at work interviewing people about what they ate to try and trace back to a particular store, restaurant or product. Then, labs get involved to identify this parasite.

“An increase in reported cases doesn’t necessarily mean we’re seeing more contamination,” Vaccaro said. “It also reflects improvements in laboratory testing and public health surveillance that help us detect illnesses and connect cases that might have gone unrecognized in the past.”