Based on current information, FDA advises that people not eat fresh spinach or fresh spinach containing-products that are consumed raw. Individuals who believe they may have experienced symptoms of illness after consuming pre-packaged spinach are urged to contact their health care provider.
At this time, Natural Selection Foods, LLC, of San Juan Bautista, California, is recalling all of its products that contain spinach in all the brands they pack with "Best if Used by Dates" of August 17, 2006 through October 1, 2006.
FDA continues to investigate whether other companies and brands are involved.
Natural Selection Foods, LLC brands include: Natural Selection Foods, Pride of San Juan, Earthbound Farm, Bellissima, Dole, Rave Spinach, Emeril, Sysco, O Organic, Fresh Point, River Ranch, Superior, Nature's Basket, Pro-Mark, Compliments, Trader Joe's, Ready Pac, Jansal Valley, Cheney Brothers, D'Arrigo Brothers, Green Harvest, Mann, Mills Family Farm, Premium Fresh, Snoboy, The Farmer's Market, Tanimura & Antle, President's Choice, Cross Valley, and Riverside Farms. These products include spinach and any salad with spinach in a blend, both retail and food service products. Products that do not contain spinach are not part of this recall.
E. coli O157:H7 causes diarrhea, often with bloody stools. Although most healthy adults can recover completely within a week, some people can develop a form of kidney failure called Hemolytic Uremic Syndrome (HUS). HUS is most likely to occur in young children and the elderly. The condition can lead to serious kidney damage and even death. To date, 94 cases of illness have been reported to the Centers for Disease Control and Prevention (CDC), including 14 cases of HUS and one death.
At this time, the investigation is ongoing and states that have reported illnesses to date include: California, Connecticut, Idaho, Indiana, Kentucky, Maine, Michigan, Minnesota, Nevada, New Mexico, New York, Ohio, Oregon, Pennsylvania, Tennessee, Utah, Virginia, Washington, Wisconsin, and Wyoming. The affected products were also distributed to Canada and Mexico.
FDA continues to work closely with the U.S. Centers for Disease Control and Prevention (CDC) and state and local agencies to determine the cause and scope of the problem. As part of our investigation, we will test packages of spinach from confirmed cases of E. coli infection.
FDA will provide daily updates on its investigation. Please check this site for updated information.
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Adapted from Eldridge B, and Hamilton KK, Editors, Management of Nutrition Impact Symptoms in Cancer and Educational Handouts Chicago, Il: American Dietetic Association; 2004.
Changes in Taste and Smell
Cancer and its treatments can cause changes in your senses of taste and smell. These changes can affect your appetite. If you are having these problems, try foods, marinades, spices, beverages, and ways of preparing your foods that are different from ones you usually eat. Also, keep your mouth clean by rinsing and brushing, which in turn may improve the taste of foods.
What to Do
If you have a bitter or metallic taste while eating:
- Try using plastic and glass flatware
- Use sugar-free lemon drops, gum, or mints.
- Try fresh or frozen fruits and vegetables instead of canned.
- Season foods with tart flavors such as lemon wedges, lemonade, citrus fruits, vinegar, and pickled foods. (If you have a sore mouth or throat, do not use this tip.)
- Try flavoring foods with new tastes or spices - with onion, garlic, chili powder, basil, oregano, rosemary, tarragon, barbecue sauce, mustard, catsup, or mint.
- Counter salty taste with added sweeteners; sweet taste with added lemon juice and salt; and bitter taste with added sweeteners.
- Rinse your mouth with baking soda mouthwash before eating to help improve the tastes of foods. (Mix ¾ teaspoon salt and 1 teaspoon baking soda in 1 quart water.)
- Keep you mouth clean and brush you teeth with a non-mint-flavored toothpaste to help relieve bad tastes.
- Serve foods cold or at room temperature. This can decrease the foods’ tastes and smells, making them easier to tolerate.
- Freeze and eat foods such as cantaloupe, grapes, oranges, and watermelon.
- Eat fresh vegetables, as they may be more appealing than canned or frozen ones.
- Try marinating meats to make them more tender.
- If red meats taste strange, try other protein-rich foods such as chicken, fish, eggs, or cheese.
- Blend fresh fruits into shakes, ice cream, or yogurt.
To improve smells:
- Cover beverages and drink through a straw.
- Choose foods that do not need to be cooked.
- Avoid eating in rooms that are stuffy or too warm.
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Sore or Irritated Mouth or Throat
Some people with cancer may have a sore mouth, mouth sores, or a sore throat which is usually caused by certain chemotherapy agents and radiation therapy to the head and neck area. If you have these problems, eating soft, bland foods and lukewarm or cool foods can be soothing. On the other hand, foods that are coarse, dry, or scratchy should be avoided. In addition, you may find that tart, salty, or acidic fruits and juices, alcohol, and spicy foods may be irritating and should be avoided. Rinsing your mouth regularly with a salt solution (one teaspoon of baking soda, ¾ teaspoon salt, and one quart water) helps prevent infections and improves healing of a sore mouth and throat.
What to Do for a Sore or Irritated Throat
- Avoid tart, acidic, or salty foods and drinks such as citrus fruit juices (grapefruit, orange, lemon, and lime), pickled and vinegary foods, tomato-based foods, and some canned broths.
- Avoid rough-textured foods, such as dry toast, granola, and raw fruits and vegetables.
- Choose lukewarm or cold foods that are soothing. Very hot can cause discomfort. Try freezing fruits and suck on frozen fruit pops, fruit ices, or ice chips.
- Stay away from alcohol, caffeine, and tobacco.
- Avoid irritating spices such as chili powder, cloves, curry, hot sauces, nutmeg, and pepper.
- Season foods with herbs such as basil, oregano, and thyme.
- Eat soft, creamy foods such as cream soups, cheeses, mashed potatoes, yogurt, eggs, custards, puddings, cooked cereals, ice cream, casseroles, gravies, syrups, milkshakes, and commercial liquid food supplements.
- Blend and moisten foods that are dry or solid. Use in soups or with sauces, gravies, and casseroles.
- Avoid commercial mouthwashes that contain alcohol (which will cause burning).
- Puree or liquefy foods in a blender to make them easier to swallow.
What to Eat When Your Throat Is Sore
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Recommended |
Foods that May Cause Distress |
High Protein |
Soft, bland meats and casseroles such as chicken rice casseroles, macaroni and cheese, tuna noodle casserole; creamed soups; pasteurized eggnog, milk, milkshakes |
Spicy entrees such as spaghetti, tacos, chili; whole meats if not well tolerated |
Breads, Cereals, Rice, and Pasta |
Bread if tolerated, cooked cereals, cold cereals with milk |
Crackers, hard crust breads, salted rolls |
Fruits and Vegetables |
Soft, nonacidic fruit and vegetables if tolerated |
Citrus fruit and raw vegetables |
Beverages, Desserts, and Miscellaneous |
Non-acidic juices such as apple juice and nectars; decaffeinated coffee, tea, and soft drinks; non-chocolate pudding, cake, cookies (as tolerated), pie; gelatin; ice cream, sherbet |
Citrus juices, tomato juice, caffeinated beverages, alcohol, chocolate desserts, pickles, vinegar, spices, potato chips, pretzels, popcorn, snack chips |
What to Do for Mouth Sores
- Eat soft, bland foods such as creamed soup, cooked cereal, macaroni and cheese, yogurt, and pudding.
- Puree or liquefy foods in a blender to make them easier to swallow.
- Serve foods cold or lukewarm, rather than hot, to reduce mouth irritation.
- Tilt your head back and forth to help foods and liquids flow to the back of the throat for swallowing.
- Drink through a straw to bypass mouth sores.
- Avoid irritating spices, seasonings, and condiments such as pepper, chili powder, cloves, nutmeg, salsa, pepper sauces, and horseradish.
- Avoid rough, dry, or coarse foods, which can scratch an irritated mouth or throat.
- Eat high-protein, high-calorie foods to speed healing.
- Avoid alcohol, carbonated beverages, and tobacco.
- Rinse your mouth often with a baking soda and salt mouthwash (made with 1 quart water, 1 teaspoon baking soda, and ¾ teaspoon salt) to help keep your mouth clean and make you more comfortable.
What to Eat When Your Mouth Is Sore
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Recommended |
Foods that May Cause Distress |
High Protein |
Ground, chopped, or blenderized meats, poultry, or fish; casseroles; egg, cheese, and bean dishes; milkshakes, yogurt, and commercial liquid nutritional supplements |
Whole meats, poultry, fish, dry meats |
Breads, Cereals, Rice, and Pasta |
Moistened breads, cooked cereals, cold cereal soaked in milk, pasta and rice in sauce |
Dry toast, hard rolls, dry crackers, English muffins, bagels |
Fruits and Vegetables |
Cooked or blenderized fruits; fruits and vegetables |
Fresh fruits and vegetables (unless very ripe, soft, and juicy, such as applesauce, bananas, and watermelon); citrus fruit, pineapple, and other acidic fruit; pickled fruit; raw and pickled vegetables |
Beverages, Desserts, and Miscellaneous |
Fruit nectars, flavored gelatin, ice cream, sherbet, pudding; butter, margarine, and vegetable oils |
Carbonated beverages; cookies and cakes unless soaked in milk; crunchy snacks such as pretzels and chips; vinegar; condiments such as pepper, pepper sauces, chili powder, cloves, nutmeg, salsa |
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Food Handling Tips
Some kinds of cancer therapies cause low white blood cell counts. If you have a low white cell count, you must handle and prepare food carefully to reduce your exposure to bacteria. Wash your hands before and after preparing food and before eating. In addition, keep hot foods above 140 o F and cold foods below 40 o F.
What to Do
- Wash hands thoroughly with warm soapy water before and after preparing food and before eating.
- Use different cutting boards for meats and vegetables. Sanitize cutting boards well after each use. To do this, wash the board with warm soapy water and rinse well. Wash the board again with a solution of one tablespoon bleach in four cups warm water. Let the solution stay on the board for at least two minutes and then rinse with hot clean water.
- Keep hot foods hot (above 140 o F) and cold foods cold (below 40 o F).
- Thaw foods in the refrigerator or microwave oven and cook them immediately. Never thaw foods at room temperature.
- Refrigerate all leftovers within two hours of cooking them and eat them within 24 hours.
- Eat only well cooked foods. Avoid raw and undercooked foods.
- Substitute frozen pasteurized eggs or powdered egg whites for raw eggs in recipes such as eggnog, Caesar salad dressing, and meringues.
- Drink bottled water and commercially bottled soft drinks.
What to Eat When Your White Blood Cell Count Is Low |
|
Recommended |
Foods that May Cause Distress |
High Protein |
Well-cooked bacon, beef, chicken, fish, ham, hot dogs, lamb, pork, sausage, veal; canned fish; well-cooked pasteurized eggs or egg custard; cream, cottage, or processed cheeses; pasteurized yogurt; cooked homemade, canned, dehydrated, frozen soups |
Meat or fish salads with raw vegetables; raw fish and shellfish, such as sushi and oysters; raw or rare meats, such as steak tartare; raw or soft cooked eggs (includes "over easy," poached, soft boiled, and "sunny side up" eggs, as well as Caesar salad, home-made eggnog made with raw eggs, and raw cookie dough); Fresh blue or Roquefort cheeses and salad dressings; Brie, Camembert, and other unpasteurized cheeses; cold, uncooked soups |
Breads, Cereals, Rice, and Pasta |
All breads, bagels, muffins, rolls, and cereals without dried fruits, nuts or seeds; crackers, French toast, noodles, pancakes, pasta, potatoes, and rice |
Macaroni or pasta salad or potato salad made with raw vegetables; breads or cereals with dried fruits, nuts, or seeds |
Fruits and Vegetables |
Peeled thick-skinned, unblemished fruit (banana, citrus fruit, melon), peeled apples, canned fruits, cooked dried fruits; well-cooked fresh, frozen, or canned vegetables |
All other fresh or dried fruits; raw vegetables |
Beverages, Desserts, and Miscellaneous |
Processed fruit juice, pasteurized milk, instant breakfast, homemade milkshakes, nondairy creamer, soda, coffee, tea, commercial liquid nutritional supplements
Fruit pies; cakes and cookies without nuts; flavored gelatin; commercial ice cream, sherbet, popsicles pretzels; chips
Butter, margarine, cooked gravies, mayonnaise, salad dressing, vegetable oils; plain peanut butter
Salt, pepper, herbs, spices, or honey (may be added to foods only during the cooking process)
Sugar, jam, jelly, preserves, syrup, molasses, mustard, catsup; candy, chocolate; pickles, relish, olives |
Fresh-squeezed fruit juice, unpasteurized fruit juice, unpasteurized beer and wine
Noncommercial ice cream, sherbet, or popsicles; popcorn
Raw or roasted nuts; salt, pepper, herbs, spices, or honey added after cooking |
Adapted from Walker MS, Masino K, Editors, Oncology Nutrition Dietetic Practice Group. Oncology Nutrition; Patient Education Materials. Chicago, Ill: American Dietetic Association; 1998
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