The importance of healthy eating and food safety

Food safety: why it’s important

Food safety is relevant for everyone but more so for transplant recipients. Recipients are at a higher risk of food poisoning due to immunosuppressants but can reduce the risk of getting foodborne illnesses with a few simple steps.

Ideally, only eat freshly-cooked food and well-washed fruit and vegetables. If there’s any doubt about hygienic preparation or storage, don’t risk it.

Leftovers can be eaten if they are refrigerated promptly and kept no longer than a day.

Refrain from eating raw shellfish. Shellfish can sometimes carry Vibrio vulnificans, a bacteria harmful to immunocompromised people.

Listeriamonocytogenes (Listeria) is a bacteria found in soil, water and some animals, including poultry and cattle. It can be present in some processed meats and foods made from unpasteurised or raw milk; for example yoghurt or pudding. Listeria loves to grow in the cold temperature of the refrigerator and can be killed by cooking and pasteurisation.

Note: Diligently check packaged foods for freshness and bin foods past their ‘Use by’/ expiry dates. 

Only keep leftovers in the refrigerator for a day and reheat them thoroughly to steaming to kill bacteria. When eating out, order hot meals. Choose menu items that are cooked to order and do not eat food that is served lukewarm.

As a general rule, avoid perishable foods that have been prepared in advance. Ready-to-eat foods from salad bars and sandwich bars may have been prepared and refrigerated some time before they’re on display; bacteria may have grown on them, so they’re best avoided.

If you plan to eat deli meats, re-cook the meats until steaming. Foods on open display in delicatessen counters like ham, prosciutto and salami are more likely to become contaminated than foods  packaged by the manufacturer. Packaged foods like packed salami or smoked salmon are safe.

Remember: Steaming makes it safe.

Good food hygiene

A few simple steps to reduce the risk of foodborne disease:

  • Thoroughly wash and dry hands before preparing food
  • Keep the refrigerator clean and operate it below 5°C
  • Wash knives, cutting boards and kitchen appliances, and dry thoroughly after handling raw food to prevent contamination of cooked and ready-to-eat foods
  • Thoroughly wash and dry raw fruit and vegetables before eating or juicing
  • Thaw ready-to-eat frozen food in the refrigerator or microwave – don’t thaw at room temperature
  • Thoroughly cook all raw meat, chicken and fish
  • Don’t leave foods to cool on the bench or stove top. Put them in the refrigerator after the steam has gone
  • If you are keeping food hot, keep it very hot (60°C +). Keep cold food cold (5°C or colder)
  • Heat food until it’s steaming hot
  • Keep stored foods covered
  • Store raw meat separately from cooked and ready-to-eat food in the refrigerator. Store it below other foods so that there’s no chance it will drip onto other foods

For information on good food hygiene visit the Food Safety Information Council.

Food safety - Wash

How to read labels

Nutrition information panel

Having an understanding of what’s in your food can make it easier to make better choices and look after your transplant. Being able to read a food label will help you choose better products within categories. In particular, pay attention to the energy, saturated fat, sugar and salt content of items you purchase.

When comparing two different products within a category – for example, two different types of yoghurt – always make comparisons using the per 100g column, as serving sizes may be different between the two products.

This link provides an excellent visual reference to understanding a food label.

The Health Star Rating system

A food can be rated from 0.5 to 5 stars. The Health Star Rating system is a front-of-pack label to help quickly and easily identify better choices within a food category. For example: comparing a 2-star cereal with a 5-star cereal. It shouldn’t be used to compare a 2-star flavoured drink with a 2-star cereal bar as the nutritional quality, although poor in both, is quite different from each other. The more stars a product has, the better the nutritional quality.

You can find more information at healthstarrating.gov.au.

Reading an ingredients list

Ingredients are listed from the highest to the lowest quantity. When buying a product that claims to contain a healthy ingredient, always look to see how high up the list that ingredient is.

Be aware of the many ways sugar can be listed. It may be listed as sugar, glucose, sucrose, fructose, malt extract, rice malt syrup, honey and corn syrup, just to name a few.

reading ingredients

Be aware of nutrition claims: Some products will place nutrition claims on their labels. For example, ‘salt reduced’ does not mean the product is low in salt; it simply means that it has less salt than the original version. Products labelled as ‘lite’ may not be low or reduced in fat, but light in flavour. Foods with ‘no added sugar’ may be high in naturally occurring sugar.

For nutrient claims to be made such as ‘low in fat’ or ‘good source of calcium’, products must meet certain requirements set out by Food Standards Australia and New Zealand (FSANZ). Check these claims by referring to the Nutrition Information Panel while choosing healthy foods. For example, products carrying ‘low fat’ claims may not be low in total energy (kilojoules).

Making safer food choices

Examples of high-risk foods and safer alternatives:

tandoori
 
 Safe
Unsafe
Meats and poultry Home-cooked lean meat such as beef, lamb chicken, turkey. Packaged meats like packed salami or salmon.

Best cooking methods include grilling, BBQ, stewing, casseroles and stir-frying with a small amount of oil to steaming hot.

Meat or poultry must be cooked to a safe temperature (77oC for well-done meats, 74oC for poultry and 75oC for reheating).

Raw or undercooked meat and poultry; unpackaged, sliced, ready-to-eat meat from  delicatessen counters or sandwich bars; cooked cold chicken.

 

Tip: Cook minced meat, sausages and poultry right through to the centre till it’s no longer pink and juices run clear. Cook deli meats till steaming.

 

Pâté Canned or on-the-shelf spreads. Unpasteurised, refrigerated pâté or meat spreads.
Fruit and vegetables Washed fresh vegetables, fruits and salads, cooked vegetables and sprouts. Unwashed vegetables, pre-prepared or pre-packaged salads from salad bars, smorgasbords and raw sprouts.
Fish and seafood Cooked fish and seafood that is steaming; canned fish and seafood.

 

Tip: Cook fish until 63oC and it is opaque, firm and flakes easily with a fork.

 

Raw or undercooked fish and shellfish like oysters, sashimi or sushi; smoked ready-to-eat fish like smoked salmon; ready-to-eat peeled prawns (cooked); foods like prawn cocktails, sandwich fillings and prawn salads; partially cooked crabs, or rice paper rolls with uncooked meat or fish.
Cheese Hard and processed cheeses, cream cheese, mozzarella, soft cheeses made from pasteurised milk (check label). Soft, semi-soft and surface-ripened cheeses (pre-packaged and delicatessen) from unpasteurised milk, like brie, camembert, ricotta, feta and blue. Unpasteurised dairy products like  goat milk (check label).
Eggs Cook eggs until yolk and white are firm. Use pasteurised eggs or egg substitutes in cooking foods with raw eggs.

Pasteurised egg products that include commercially produced dressings and sauces are safe.

Home-cooked food that can contain eggs, like mayonnaise, tiramisu, Caesar salad dressing and aioli.

When eating out, ask if pasteurised eggs were used for items that may contain raw eggs.

food safety pate
sushi
raw eggs

Acknowledgements

Transplant Australia gratefully acknowledges the valuable contribution of the following experts in reviewing this material:

Arian Chong

Senior Renal Dietitian
Royal Prince Alfred Hospital

Carissa Maroney

Dietitian
Cardiothoracic Medicine, Surgery & Intensive Care, Heart & Lung Transplant, Cardiology
St Vincent’s Hospital

Helen Vidot

Specialist Dietitian
Liver Disease & Transplantation
Royal Prince Alfred Hospital

Katie Marks

Dietitian
Nutrition & Dietetics
The Children’s Hospital at Westmead

Sheridan Collins

Dietitian
Nutrition & Dietetics
The Children’s Hospital at Westmead