At 64 with type 2 diabetes, you may be living on smoked salmon, bagged salad and soft cheese because they need no cooking and they are what you can face, and you may have met food-safety advice addressed to people at higher risk and wondered whether it means you. Each of the three foods comes in a riskier form and a safer one for people with weakened immune systems. You can work out which form you bought, choose safer foods that need no heat, and tell which signs after eating mean phoning your doctor and which mean 911.
How a higher-risk food warning can apply to you before 65
A warning for people at higher risk of food poisoning can apply to you before 65 through your immune system rather than your age. The groups at higher risk include people 65 and older, children under 5, pregnant women and people with weakened immune systems, and that last group has no age limit. You may have a weakened immune system if you have diabetes, liver disease, kidney disease, alcoholism, HIV or an autoimmune disorder such as lupus, or if you are receiving chemotherapy or radiation therapy. Diabetes may weaken the immune system without having weakened yours, and your doctor is the one who can tell you which applies.
The immune systems of people with diabetes may not readily recognize the bacteria and viruses that cause food poisoning. Diabetes may also damage the cells that make stomach acid and the nerves that help the stomach and intestines move food along, and then the digestive tract may hold on to food for longer, giving harmful bacteria and viruses time to multiply. In most people, the immune system also begins to decline between 50 and 60.
Ask your doctor whether your diabetes counts as a weakened immune system where food is concerned, and which foods or other products to avoid because of any special health needs you have, in addition to the general advice. Until you have that answer, act on any symptoms as someone at higher risk would: people with diabetes are in one of FDA's higher-risk groups for foodborne illness.
Which form of each food you bought is the riskier one
The riskier smoked salmon is the kind kept refrigerated, the riskier soft cheese is one made from raw milk or any queso fresco-type cheese, and the riskier salad is unwashed. Riskier foods are those more often associated with food poisoning, and Listeria infection, one of the illnesses the safer choices help prevent, is rare. Bagged salad is not named in CDC's safer and riskier choices for people with weakened immune systems, so its row in the table below uses the entries for unwashed and washed vegetables.
| What you bought | Riskier form | Safer choice, no heat needed |
|---|---|---|
| Smoked salmon | Refrigerated smoked seafood, except in a cooked dish, usually labeled "nova-style," "lox," "kippered," "smoked" or "jerky" | Smoked fish in sealed, airtight packages or containers that do not need to be kept refrigerated before opening |
| Soft cheese | Soft cheese made from unpasteurized (raw) milk, such as brie, camembert and blue-veined cheese; any queso fresco-type cheese, made with pasteurized or raw milk, such as queso fresco, queso blanco and requesón; unheated cheese sliced at a deli | Instead: cottage cheese, cream cheese, string cheese, feta and mozzarella, when made with pasteurized milk |
| Bagged salad | Unwashed fresh vegetables, including lettuce and other leafy greens | Washed vegetables, though washed and then cooked are safest |
To tell which form of smoked salmon you have, check whether the pack has to be kept refrigerated before it is opened. If it does, it is the riskier form. According to FDA's list for people at greater risk, avoid smoked fish unless it is reheated until steaming hot, with no exception for the shelf-stable kind, so add that kind to the questions for your doctor. Until your doctor answers, canned fish and seafood is a safer choice that needs no heat.
For the soft cheese, check whether it was made with pasteurized milk, and whether it is a queso fresco-type cheese, which is on the riskier side either way. Brie or camembert eaten cold has no safer form: pasteurized soft cheese counts as a safer choice only when heated to 165°F or until steaming hot, and made from raw milk it is riskier. Ask your doctor about cold pasteurized brie, and until then choose one of the safer cheeses in the table, which need no heat.
Washed vegetables are on the safer side, and washed then cooked are safest. Under FDA's general advice on produce, written for everyone, bagged produce marked pre-washed and ready to eat can be used without washing it again.
Some other chilled foods eaten without heating are riskier too, among them premade deli salads such as coleslaw, potato, tuna, chicken or egg salad, unheated deli meat, cold cuts and hot dogs, refrigerated pâté or meat spreads, and raw sprouts.
What is safer to eat when you are not going to cook
Plenty of safer food needs no cooking. Beyond the forms in the table, these safer choices for people with weakened immune systems need no heat:
- hard cheeses made with pasteurized milk, such as Asiago, Cheddar, Parmesan, Swiss, Gruyere or Emmental
- pasteurized milk, and dairy products made from pasteurized milk
- canned fish and seafood
- washed fruits, and melon that has just been cut or has been kept cut in the refrigerator for 7 or fewer days
- pâté or meat spreads in sealed, airtight containers that do not need to be kept refrigerated before opening
- deli salads you mix at home, in place of premade ones
When you buy salad or other produce pre-cut, bagged or packaged, choose only packs that are refrigerated or surrounded by ice, and refrigerate them once you are home. A bag not marked pre-washed needs washing under running water, with no soap, detergent or produce wash, and washing can reduce bacteria that may be present but will not eliminate it.
If you are living on these few foods because your appetite has gone, write down how much you manage in a day (see No appetite at all? Start by writing down one day of eating).
Which signs of food poisoning you should not wait out
With diabetes, you should not wait out any of the signs of food poisoning. Diarrhea, stomach pain or cramps, nausea, vomiting and fever are the most common, and in a higher-risk group, contact your doctor right away if you suspect food poisoning, rather than waiting until a symptom is severe, which is the general advice for everyone. People in the higher-risk groups are more likely than others to have a longer illness, to be hospitalized, or even to die from it.
The illness may not arrive the same night. Symptoms of food poisoning usually appear 12 to 72 hours after eating, but may occur anywhere between 30 minutes and 4 weeks later. Common sources of Listeria include soft cheeses and smoked fish, and its intestinal illness, typically diarrhea and vomiting, usually starts within 24 hours and lasts 1 to 3 days, while its invasive illness, once the bacteria spread beyond the gut, usually starts within 2 weeks of eating the food. In people who are not pregnant, the symptoms of invasive illness typically include fever, flu-like symptoms such as muscle aches and fatigue, headache, stiff neck, confusion, loss of balance and seizures.
When you contact your doctor, say what you ate and when you ate it. If you ate food that may have carried Listeria and you do not feel sick, most experts believe you do not need tests or treatment. If you have diarrhea or vomiting, drink plenty of fluids to prevent dehydration.
Where to turn depends on the sign:
| Sign | What to do |
|---|---|
| A seizure that lasts more than 1 minute, or one you do not quickly wake from | Someone with you calls 911 |
| Any other seizure, sudden confusion, an unusual or bad headache, particularly one that started suddenly, or a high fever with headache and stiff neck | Go to an emergency department or call 911 |
| Throwing up or loose stools that do not stop, a high fever that does not get better with medicine, or dizziness or weakness that does not go away | Go to an emergency department or call 911 |
| Bloody diarrhea, diarrhea that lasts more than 3 days, a fever over 102°F, vomiting so often that you cannot keep liquids down, or signs of dehydration, which include not urinating much, a dry mouth and throat, or dizziness when you stand up | Phone your doctor right away and ask to be seen |
| Any other sign you suspect is food poisoning, such as fever with muscle aches, or loss of balance, in the two weeks after a riskier food | Contact your doctor right away |
Vomiting, loose stools and fever start in the doctor rows and move to the emergency department once they do not stop, or, for a high fever, once medicine does not bring it down.
If you have weight care through NicoCares and your eating has narrowed to a few chilled foods, tell your care team so in a Spruce message, since Spruce is where that team answers. A sign in the table needs the doctor, emergency department or 911 its row names, reached by phone or in person, because the site promises no answer time for Spruce messages.
