Is It Time to Eat Lettuce Again?
My friend Dr. Zachary Rubin is eating lettuce again, but I am waiting a bit.
I have known Zachary from social media for a few years, and we have become friends. It turns out his father and I went to medical school together.
Dr. Rubin and I fight the same battles on social media against misinformation. On a side note, he is one of the kindest people you can know.
So if he and his wife come to the central coast of California, I look forward to taking them to dinner. Which means, for the moment, we are going somewhere that serves locally grown lettuce. I really don’t want dinner to end with me prescribing antibiotics. Ever been to a dinner where you hear your guests stomach rumbling? Yes, I’ve had that happen to me.
Dr. Ruben wrote an excellent piece explaining why he returned to salad. Like myself, he spent much of summer avoiding lettuce and explosive diarrhea. His central point is correct: The lettuce sitting in a restaurant in September is not necessarily the lettuce we were eating in June. The iceberg lettuce implicated in this summer’s outbreak has been recalled and should no longer be in stores or restaurants. Any leftover has long since wilted.
I worry less about the date than about the water
September 1 is not my lettuce liberation day. I prefer lettuce when it is less dependent on irrigation.
Lettuce is grown not far from where I live in California. If you drive from Phoenix to California, you will see miles of lettuce farms.
And irrigation is my main concern. For example, the 2018 romaine lettuce outbreak came from E. coli O157:H7. That contaminant was traced to canal irrigation (well, one portion of the canal ).
I love the canals of Arizona, some of which have their origins, a thousand years ago from the Ho Ho Kam. The supply from the Colorado River was guaranteed because of the political power of Arizona’s congressional staff, Senator Hayden and Congressman Rhodes. This provided Arizona with plenty of water for its farmers. Thus, you will see canals going through Arizona. Not quite Venice, no masks (maybe Zorro).
Hence my admittedly peculiar lettuce rule
I wait to get lettuce from the store, or a taco with lettuce, when the canals provide less water for the lettuce.
And yes, I did eat a Caesar salad recently.
Before my friend accuses me of violating my own embargo, the lettuce was locally grown. One loves a restaurant that sources from small local farms.
So I ate it. Besides, it was a Caesar salad. There are limits to the sacrifices science should demand. And of course, the dressing was made in house, with a coddled egg, with anchovies, and with California olive oil. Okay, my keyboard is now irrigated with saliva. A true Caesar salad - by the way, the best one I ever had was at Marx Brothers in Anchorage, Alaska - which sadly closed because the owner decided to retire.
But I am not yet back to casually ordering lettuce everywhere.
Summer is not the whole story
Cyclospora has a strong seasonal pattern, traditionally occurring during the warmer months. But leafy greens have repeatedly demonstrated an annoying refusal to obey simple seasonal rules.
E. coli O157 outbreaks tend to peak during summer, during peak irrigation. Yet when investigators have looked specifically at outbreaks involving leafy vegetables, many begin in the fall. Because the summer harvested lettuce, is available in the fall.
Labor day may be the last day you wear white, but it is not the first day I get salad from Ralph’s Grocery.
So who is right?
Probably both of us. My friend is making a perfectly reasonable evidence-based decision. The implicated product has left the market. The agricultural supply chain is changing. There is no justification for treating every head of lettuce in America with that degree of suspicion.
Where we differ is simply how much residual uncertainty we are willing to tolerate. Medicine works like this all the time. Two physicians can look at exactly the same evidence, agree about the facts, and come to different diagnoses.
And since his father and I survived medical school together, I feel a certain obligation to keep the next generation healthy.
So when clan Rubin comes to the Central Coast of California for dinner, I’ll happily buy. I’ll even let him order the salad. Of course, the restaurant will have lettuce from a local supplier, it is the least I could do.
Now if he comes when the rains have returned, alas, lettuce entertain you.
The last thing I need to explain to my medical school classmate is that I sent his son and wife home with antibiotics instead of leftovers.
By the way - please subscribe to my friend, Dr. Rubin.