Healthy Foods

Would Your Hospital Fail A Drug Test?

May | June 2008

The “Just Say No to Drugs” campaign has reached the supermarket and cafeteria. Food products labeled “No Antibiotics Added,” “No Hormones Added,” “rBGH Free,” and “Certified Organic” are produced without antibiotics or synthetic hormones, and consumers are choosing these options.

Sales of organic meat and seafood grew by nearly 70 percent in 2005. A recent Consumer Reports survey found that 89 percent of consumers said “natural” meat should come from animals whose diet was natural and free from drugs and chemicals.

Antibiotics treat disease in farm animals; most antibiotics are given to healthy animals to promote faster growth on less feed. They are also administered to prevent illness and to compensate for confined, stressful conditions on factory farms where the risk of infectious disease is heightened.
An estimated 70 percent of antibiotics used in the United States are given not to sick people, but to healthy livestock.

It matters because antibiotic use in livestock increases resistant bacteria that can be transferred to humans via the food supply.

According to the Centers for Disease Control and Prevention (CDC), “Antibiotic use in food animals is the dominant source of antibiotic resistance among foodborne pathogens” (disease-causing microorganisms). The most common foodborne infections are those caused by the pathogenic bacteria Campylobacter, Salmonella, and an E. coli variant.

There are an estimated 76 million cases of foodborne illnesses per year in the United States; 325,000 people will be hospitalized, and 5,000 will die.

What’s In My Water?

It gets worse. Feeding antibiotics to livestock leads to consumers ingesting the drugs, rendering human antibiotics less effective. Antibiotics enter not just food but water, as livestock drugs appear in animal wastes and can enter waterways and seep into aquifers.

A recent investigation by Associated Press found pharmaceuticals, including antibiotics, in the water supplies of at least 41 million Americans. Other research suggests 80 percent of U.S. waterways contain pharmaceuticals.

Tap water treatment plants may not remove all drug residues. The same is true for some bottled water manufacturers and even home water filtration systems.

The pharmaceutical concentrations are minute, but the concern over health consequences of repeated low-level exposure is real. Pharmaceuticals in water have been linked to sexual mutations in fish, and laboratory research reveals small amounts of medication can negatively affect human cells.

Last year, the U.S. Food and Drug Administration (FDA) found traces of antibiotics in 15 percent of tested fish imported from China, the third largest exporter of farmed fish to the United States. Antibiotics included fluoroquinolone, which the FDA forbids in seafood to prevent bacteria from developing drug resistance. Ciprofloxacin (Cipro), comes from the fluoroquinolone family. Companies in the Philippines and Mexico have also used drugs to help keep fish alive in overcrowded and diseased pools. The antibiotics used are often non-biodegradable and remain in the pools for long periods.

The Coming Crisis

The American Academy of Family Physicians, American Academy of Pediatrics, American Medical Association, American Nurses Association, and a host of governmental, public health and medical organizations warn of a crisis in treating infection.

Strains of superbugs such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycinresistant enterococcus (VRE), and extreme drugresistant tuberculosis (XDR-Tb) are becoming treatment resistant. Antibiotic resistance is making drugs like penicillin, erythromycin and tetracycline less effective. Overuse of antibiotics in medicine drives bacterial resistance. And, the overuse of antibiotics in food production is a significant contributor to the crisis.

About 2 million people in the United States acquire bacterial infections each year, resulting in 90,000 deaths. According to the CDC, about 70 percent of those infections are resistant to at least one drug.
Proposed legislation in the U.S. Congress would phase out the use of certain medically important human antibiotics in animal feed. The Preservation of Antibiotics for Medical Treatment Act (H.R. 962/S.549) seeks to maintain the effectiveness of seven specific classes of antibiotics: penicillins, tetracyclines, macrolides, lincosamides, streptogramins, aminoglycosides, and sulfonamides.

Got Hormones?

Increased exposure to drugs can also come through dairy products. Recombinant bovine growth hormone (rBGH) and recombinant bovine somatotropin (rBST) are synthetic hormones routinely given to dairy cows to increase milk production.

Cows treated with synthetic hormones can produce 10 to 20 percent more milk. However, the hormone injections carry an increased risk of 16 medical conditions including mastitis, an udder infection. And what are infections treated with? That’s right, antibiotics. So your milk may come with unrequested hormones and a side of antibiotic.

The threat doesn’t end there. An insulin-like growth factor, IGF-1, is found in higher quantities in milk from cows treated with rBGH. Elevated levels of IGF-1 can increase the risk of prostate and breast cancer in humans.

Australia, Canada, Japan, New Zealand and the entire European Union have banned rBGH, yet it’s in everyday use by U.S. milk producers.

Some retailers and suppliers have made changes. Kraft announced a line of cheese made with rBSTfree milk. Dean Foods offers a line of rBST-free products. Grocery chain Kroger sells only rBST-free products. Last year, Starbucks banned rBST in its nearly 6,800 company-operated cafes.

Healthy Food in Healthcare

In healthcare, the push for healthy food isn’t new. Some hospitals, such as Carroll Hospital Center in Westminster, Md., have had healthy food practices in place for years.

The hospital buys rBGH-free milk and is working to expand to yogurts and cottage cheese. They purchase their beef, produced without the routine use of antibiotics or growth hormones, from local Carroll County farmers and have done so for decades.

“We are committed to partnering with local vendors whenever possible,” said Marcea Cotter, Director of Food and Environmental Services, Carroll Hospital Center. “Because of this we are able to share our goals of improving the health of our customers. Our customers are their customers, so it provides the opportunity for a shared goal.”

Cotter noted that sourcing local vendors gives the hospital additional options in the event of disaster, so it is part of their emergency preparedness plans.

Patients, staff, and the community at large have a growing expectation they’ll find sustainable, healthy meals at their hospital. But what constitutes sustainable? What’s healthy?

Know the Lingo

Maria Simmons, RD, LDN, Manager of Patient Food Services at Chicago’s Swedish Covenant Hospital agrees there is a lot of confusion over terms.

“Consumers wonder, ‘What exactly is hormone-free milk, or genetically-altered meat?’ You can’t blame them. I’m an RD, and we weren’t taught this in school.”

Simmons said education is key. She researched the chemicals and pesticides that can reside in food. Chicago Chef Michael Altenberg, owner of Crust, the Midwest’s first certified organic restaurant and longtime collaborator with Swedish Covenant, introduced Simmons to organics and showed her how to apply that knowledge in an institutional setting.

In 2006, Swedish Covenant began sourcing meat from Tallgrass Beef, a 100 percent grass-fed beef program founded by journalist Bill Kurtis. Simmons incorporated the company’s beef products in her menus, including replacing conventional ground beef with grass-fed beef. Grass-fed beef contains less total and saturated fat than grain-fed beef, it doesn’t contain growth hormones or unnatural supplements, and the cattle roam freely in open pasture, which supports sustainable agriculture.

“High-quality, healthy food can enhance a patient’s recovery,” said Simmons. “Swedish Covenant Hospital promotes a healing environment, a patient-centered environment of care, so our administration has been on board since day one. It’s part of our mission to provide the health benefits of these organic and natural options.”

“The public is becoming educated on the potential hazards of drugs in their water and food,” said Simmons. “Reducing the chemicals in livestock, poultry and dairy is moving in the right direction. There’s some question about what level of toxin is detrimental to people; but please, it’s toxins we’re talking about. We should do as much as possible to reduce our exposure and that of our patients, staff and guests.”

Food Finding

Hospitals are discovering that when they are ready to switch, products aren’t always available from traditional suppliers. Food distributors may require some education on environmentally preferred purchasing, and some cajoling from food and nutrition professionals.

“We’re currently working with our primary vendor to offer more antibiotic-free meat and poultry,” said Sandra Rigney, Director, Nutrition Services, John Muir Health, Walnut Creek, Calif. “The process began with a letter writing campaign.”

John Muir’s Healthy Food Committee got the ball rolling after signing the Health Care Without Harm Healthy Food Pledge (http://www.noharm.org/us/food/pledge/). The San Francisco chapter of Physicians for Social Responsibility and a group of food and nutrition leaders from other hospitals in the area also joined the campaign.

“You need to be patient, but persistent,” said Rigney. “When requests come from a broader group of buyers, the purveyors begin to take notice!”

Rigney said group purchasing organizations can help in identifying suppliers of antibiotic free products as well. It’s important that all parties understand your hospital’s goals and purchasing criteria.

“Our Healthy Food Committee is comprised of dietitians, physicians, nurses, and representatives from administration, employee wellness and marketing,” said Rigney. “We set strategic goals and identify tactics. If it gets written down on paper, it gets done.”

One goal of the Healthy Food Committee is sustainable food procurement. They strive to purchase food produced in systems that eliminate use of toxic pesticides and hormones, support farm worker health, and use protective and restorative agriculture.

John Muir Health has purchased rBHG-free milk for more than 10 years. Some of their meat, pork and poultry come from local grass-fed animals and those produced without using non-therapeutic antibiotics.

Rigney said increased cost is always a challenging factor in moving forward with these initiatives. It’s critical to consider all the benefits of keeping people healthy versus the high cost of treating individuals with antibiotic resistant diseases.

“Food production is linked to healthcare. We’re helping people understand this concept through our words and actions.”