I was enjoying a late afternoon lunch with my sister at a cheap ‘hole in the wall’ Japanese restaurant today. We sat at the small sushi bar, chatting away as we ordered and waited for the arrival of our food... Sorry, nothing really exciting happened. We didn’t have a moving lung fluke or tapeworm in our food. Neither did we immediately get sick, vomiting in a tiny bathroom or acquiring the spewing from the opposite end.
But then again… I only eat cooked things due to being slightly immunocompromised, and it’s a rare treat for my sister. (She only partakes in sashimi, raw fish, at “trusted” restaurants.)
Nonetheless, as I sat pointing out the different raw fish in the display case atop the bar, the idea of obtaining an extra passenger on the way out of the restaurant never fails to escape my mind. I guess I spend too much time reading about parasites to allow a prime pick-up spot get away mentally.
Then again, strangely enough, on the Food and Agriculture Organization of the United Nations (FAO) top ten list for food-borne parasites (you’ll recognize Toxoplasma gondii and Taenia solium if you’ve read my mental health post), only one is acquired from eating raw or undercooked fish, Opisthorchiidae, and it’s acquired from freshwater fish. Note that freshwater fish aren’t used as raw sashimi (you might see freshwater eel as a choice, but it IS cooked) due to the risk of parasites and other microorganisms [1]. For example, in Thailand, a popular dish involves raw, fermented fish that transmits this parasite which accumulates in the liver and causes bile duct cancer [2].
On the contrary, the typical culprits in infecting your sushi are Diphyllobothrium latum and Anisakidae, a tapeworm and roundworm respectively. If you’ve been following internet gossip or the news, one of the recent news stories describes a sushi-loving man discovering that his whole body was infected with Diphyllobothrium latum, which can be deadly if it reaches the brain [3]. (As in the case with most things.) Due to the translucent nature of raw fish, you can see any parasitic worms in your dinner by taking a close look (although your sushi chef should have done so already if he acquired the freshest fish and didn’t freeze it per FDA standards).
Other foods that pose a potential risk for parasites are undercooked or raw pork which can yield either an Trichinella spiralis (the worm responsible for trichinosis) or Taenia solium infection. Others are fresh produce since you don’t know about the quality of the water or whether any animals came into contact with said produce. This is why you always wash your fruits and vegetables, and certain produce that are hard to clean, such as broccoli or cauliflower, you should always cook.
One protozoan in particular, Cryptosporidium, I’d like to focus on for a moment. There was a particularly bad outbreak of Cryptosporidium in 1993 in Milwaukee, Wisconsin. Half the city contracted the parasite, and the main treatment is fluids to prevent dehydration during diarrheal episodes. (As always, it’s a main danger to immunocompromised patients as well as the very old and very young.) Known as the worst outbreak of the protozoan, the source of the disease was traced back to a contaminated water-treatment plant that serviced the southern portion of the city [4]. It just goes to show you, you always want to ensure the purity and cleanliness of your water.
To ensure you are never at the mercy of a food-borne parasite, always wash fruits, veggies, and even raw meats before cooking (you’ll wash off that layer of grime that also contains bacteria and viruses). Beware that even fermented or cured fishes and meats can still contain infectious parasites. Of course, just as abstinence isn’t the answer for “curing” the outbreak of sexually transmitted diseases, abstinence from your favorite foods (if unsafe) isn’t possible. If you like sashimi, ceviche, carpaccio, poke, or any other raw dish, don’t be afraid to ask the restaurant any questions about their sources and storage methods. (Be warned your home freezer isn’t enough to kill parasites so don’t try making sashimi at home unless you know how.) Also, you learn to know which restaurants are “trustworthy” and which may not be so much.
Remember, just as your food-borne friends love your gut, you too should love and trust your gut feeling.
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