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The Summer Everyone Became Afraid of Salad
The intestinal illness cyclosporiasis is summer’s least charming public health mystery
This summer, the scariest thing at the picnic may be the salad.
AARP (Getty Images,4)
By early evening on the Fourth of July, my family’s cottage in northern Michigan had achieved peak summer. The lake was sparkling, the grill was working hard, and children were running around barefoot with the confidence of people who believe their knees are permanent.
Then someone brought out the vegetable tray.
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The mood didn’t change dramatically. Nobody screamed or knocked over a lawn chair. But you could feel the adults reassessing. The tray made its way from person to person, a festive ring of carrots, celery, cherry tomatoes and broccoli, suddenly carrying the emotional weight of a police lineup.
People smiled politely and passed it along. One cousin hovered over the ranch dip and thought better of it. A lifelong salad person reached for a chip instead. Even the vegetarians, usually reliable allies of anything crunchy and raw, eyed the cauliflower the way you’d study gas station sushi.
My Uncle Jeff snorted and waved the tray away: “See. This is why I never touch vegetables.”
That line got a laugh, partly because it was funny and partly because it gave everyone permission to acknowledge what we were all thinking. Nobody wanted to be the person who ruined a perfectly good holiday party by saying “explosive diarrhea” out loud. Michigan is in the middle of a fast-growing outbreak of cyclosporiasis, an intestinal illness caused by the parasite Cyclospora cayetanensis.
The illness can cause weeks of diarrhea and has been linked to lettuce or salad greens. Because those foods are typically eaten raw, the parasite survives, and the U.S. Food and Drug Administration warns that washing produce doesn’t always remove it completely. Reported cases more than tripled in less than a week earlier this month, according to the Michigan Department of Health and Human Services. As of the latest MDHHS update, state health officials hadn’t identified a specific produce type, grower or supplier as the source.
This is not the sort of information that improves a cottage buffet.
Cyclosporiasis isn’t usually life-threatening, but it’s also not the kind of “stomach thing” you want to casually ride out between lake swims. The U.S. Centers for Disease Control and Prevention says symptoms can include watery diarrhea, loss of appetite, weight loss, cramping, bloating, gas, nausea and fatigue. Without treatment, symptoms can last from a few days to a month or longer, and they can seem to go away and then return.
For older adults, that matters. Diarrhea isn’t just an indignity with comic timing. It can lead to dehydration, which can become serious more quickly in older people, especially those with underlying health conditions or weakened immune systems. Which is how my summer in northern Michigan became less about sunsets and more about the epidemiology of the crudité table.
At gatherings around the lake, conversations have developed a familiar rhythm. First, everyone asks the normal questions: How long are you up here? How’s the water? Did you see the fireworks? Then somebody lowers their voice and asks, “So … are you still eating salad?”
That’s when the real meeting begins. Everyone in our Michigan beachfront community talks about lettuce the way people talk about a strange noise coming from the basement. Raspberries are treated with suspicion. Cilantro has lost whatever trust it once had (if any!). Someone mentions a friend of a friend who “went down” or is experiencing “digestive turbulence,” and everyone nods gravely, because we understand the euphemisms. (I have a personal fondness for “a touch of the collywobbles,” which sounds like something a Victorian doctor would murmur before recommending laudanum.) Those poor souls didn’t fall off a dock or get injured playing pickleball. They’d been claimed by the summer’s least charming public health mystery.
Nobody wants to panic. We’re all grownups. Many of us have colonoscopy prep experience and therefore consider ourselves veterans of gastrointestinal adversity. But uncertainty has a way of turning reasonable adults into amateur outbreak investigators.
That reaction is understandable, says Ellen Peters, a University of Oregon professor who studies risk perception. When a health story involves uncertainty, rising case counts and vivid symptoms, it feeds emotional reactions to the disease, she says. “Those feelings sound an alarm that can be louder than the actual risk may warrant.”
In other words, the phrase “explosive diarrhea” lands in the brain like a fire alarm.
Peters says people can make better decisions by remembering that while the risk is always possible, it isn’t necessarily likely. Instead of focusing only on the risk of getting sick, also consider the risk of not getting sick. Then turn your attention to tactics that actually help.
“Know what actions work to avoid the parasite and what best steps to take if you experience symptoms,” she says. In psychology, this builds what experts call response efficacy, knowing which actions work; and self-efficacy, believing you can do them. Alarm on its own will only make you anxious, but alarm plus useful action can help you survive a very real health risk.
Baruch Fischhoff, a Howard Heinz University Professor at Carnegie Mellon University and an expert in risk analysis, told me he hadn’t heard of this outbreak before I asked him about it, despite being a native Detroiter with family still in the area.
That, somehow, was comforting. If one of the country’s leading risk experts hadn’t been obsessively monitoring Michigan produce alerts, perhaps the rest of us could stop giving raspberries the kind of side-eye usually reserved for hotel hot tubs.
Still, Fischhoff’s advice isn’t to ignore the risk. For now, he says, wash the food. If raspberries seem especially hard to clean, passing on fresh ones may be reasonable for the time being. In the longer run, he continues, this is the kind of thing people should ask their elected officials about, especially if food inspection systems don’t have the resources they need.
“Individuals shouldn’t have to conduct their own risk analyses based on fragmentary evidence,” Fischhoff says.
That may be the sanest sentence anyone has said about this outbreak. Most of us don’t want to become part-time parasite detectives. We just want to know whether the thing next to the ranch dip is safe.
The reasonable advice, of course, is not “never eat vegetables,” despite my uncle’s lifelong commitment to that theory. Health officials recommend washing produce thoroughly under clean running water; cooking or using frozen alternatives when possible; and taking extra care with foods that can be harder to clean. The trick is figuring out how to take the risk seriously without treating every broccoli floret like it should be handled by a hazmat team.
A few nights later, at another gathering near the lake, another vegetable tray appeared.
This time, I didn’t flinch. I didn’t make a joke or launch into a lecture about parasite life cycles, which I now know enough about to become dangerously boring at parties. I reached for a baby carrot, because you can’t live in fear.
Then I washed that single carrot as if my night, or the next few nights, depended on it — thoroughly. I’m not going to live in fear, but I also don’t want to spend the rest of my summer on the toilet.
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