Food Poisoning: What You Need To Know About Botulism

Disclaimer.  I am not a licensed health practitioner.  This is just another post on knowledge and understanding you might wish to acquire in advance of a disaster in case no higher care is available.  As long as our society is functioning, you should leave anything more substantial than applying a Band-Aid to the professionals.  No medication, including those available over the counter, should be taken without consulting a physician.  Information shared here is for educational and entertainment purposes only.  It is not medical advice nor a substitute for licensed medical care. 

So what do you need to know?  What symptoms does botulism cause?  Abdominal cramps?  Fever?  Vomiting?  You don't know?  Read on!

Botulism stands alone in the field of pathogens linked to food poisoning.  There is no diarrhea or abdominal cramps.  No fever.  Vomiting and nausea may occur with two less common forms of the disease, and only after the onset of other symptoms.  There's really nothing in the symptoms for most people to associate with food.  And it is the most deadly form of food poisoning.  You don't want to be dealing with it without a functioning hospital.

Armageddon Medicine was the only off-grid medicine book to address this topic at all.  Most of the information in this post comes from the Centers for Disease Control.

There are three types of botulism:

• Wound botulism accounts for about 29% of all botulism cases.   It is contracted primarily by drug abusers injecting heroin.  The injection site itself does not often look infected.  As it is a disease that affects people who aren't likely to survive long in a collapsed society due to their addiction, it won't be discussed any further.
• Infant botulism comprises the majority of botulism cases in the United States.  As all parents are warned, honey is never to be given to an infant under twelve months of age.  Honey has been shown to contain the Clostridium botulinum spores that cause botulism.  The spores reproduce in the infant's intestines and release the toxin that causes botulism.  However, honey is implicated in only about 20% of cases in infants.  Many of the remaining 80% of cases are believed to originate from dust in the soil and air.  It's been observed that many infants with botulism live near construction sites.
• Food-borne botulism arises from eating contaminated foods.  

All forms of botulism have the same symptoms.  As mentioned above, there are no gastrointestinal complaints.  The toxin that causes botulism affects the central nervous system.  The incubation period ranges from 6 hours to 10 days, with 18-36 hours being average.  In infants, the first sign of botulism is constipation, followed by lethargy, weakness, difficulty feeding, and an altered cry, progressing to paralysis, where the baby becomes very floppy.  (Botulism was first described as "floppy baby syndrome.")  With intensive hospital care, the survival rate is almost 100%. 

In older individuals, weakness and paralysis start from the top of the head and work their way down. Signs and symptoms start with the droopy eyelids, blurred or double vision, difficulty chewing and swallowing, and a dry mouth.  Facial paralysis sets in, followed by postural hypotension (inability to stand without the risk of passing out).  This near-paralysis descends down the spinal column affecting the neck, followed by the shoulders, upper arms, and forearms, and fingers.  It progresses to the chest muscles, and then it hits the thighs, lower legs, and feet.  Respiratory paralysis may set in anywhere along the way and the patient will need mechanical support to survive.  Recovery may take months.  Only a few cranial nerves may be affected, or it may be the whole body.  Progression may take hours or days and appears to be dose-dependent.  Paralysis occurs due to the toxin binding to the nerve endings.  It is irreversible, but the nerve endings do eventually regenerate.  The paralysis eventually resolves but outpatient therapy may be required for months.

Interestingly, the sensory system is completely intact and patients are entirely cognizant.  Assuming they are still able to breathe (via intubation), they can respond to questions, even if only by moving fingers or toes.  That is, of course, assuming the paralysis has not extended that far.  Death in botulism patients is due to pharyngeal muscle paralysis and insufficient respiratory intake due to paralysis of the diaphragm and other muscles used in respiration.

The symptoms of botulism are very similar to those for myasthenia gravis.  Myasthenia gravis is most common in women under forty and men over sixty.  It may appear in infants whose mothers have the condition.  Myasthenia gravis is uncommon in children.  Botulism also looks similar to Guillain-Barre.  Both myasthenia gravis and Guillain-Barre are autoimmune diseases with rapid onset as well.  However, neither occurs in an outbreak.  If there are two or more cases, the diagnosis is botulism.

Most of the twenty to thirty cases of food-borne botulism that occur in the United States each year arise from home-canned foods, especially vegetables and fish.  Some occur due to a relatively unknown source--baked potatoes wrapped in foil.  Statistics from the CDC for 1950-1996 showed that 65% of botulism cases came from home-canned foods, while 7% were from commercially canned products.  The remaining were undetermined.  Of the foods that were implicated, 40% were vegetables, 13% fish, 7% marine mammals, 2% fruits and pork, 1% each of condiments, dairy, beef, and poultry; 4% other, and 30% unknown.  While "unknown" seems high, keep in mind that botulism can take several days to manifest.  By that time, the food to blame is already long gone to the dump.  While there can be "outbreaks" of botulism because two or more people ate the same food, botulism is not transmitted from person to person contact. 

We've reviewed the symptoms and the sources, and undoubtedly, because Clostridium botulinum is the culprit implicated here, some are wondering why antibiotics aren't being used.  And the reason is, antibiotics, also known as antibacterials, are effective only against bacteria.  Botulism is an illness that arises because the botulinin toxin produced by the bacteria have attached to the nerve endings.  The bacteria simply made the toxin.  Botulism antitoxin is only available from the CDC.

So let's now take a look at exactly how botulism happens.  The Clostridium botulinum bacteria are found everywhere in the soil at low levels.  But they don't reproduce really well there.  They just kind of chill or hang out, not really doing much with their lives.  Maybe a few grow near some beans or carrots or beets and hang onto those veggies when they're harvested and taken inside.  The veggies get washed and still a few bacteria might hang on and get eaten.  They do nothing.  No one gets sick.  Their little bacterial lives have been a waste.

The beans are slated for canning.  They get washed pretty well. No one can see any dirt.  They get carefully processed according to directions.  The temperature reaches 250 degrees Fahrenheit and stays there for at least 3 minutes. The Clostridium botulinum bacteria are killed off.  Their lives were also wasted.  The heat under the canner is turned off, and life in that house proceeds as usual.

Next up for the canner are the beets.  But something goes wrong.  Nobody really remembers what.  Maybe the gauge on the canner isn't working or the gasket is cracked.  For some reason, temperature and pressure aren't reached.  Or maybe Grandma forgets when the gauge started rocking and thinks it's been 90 minutes when it has only been 30 or 60 and the requisite temperature to kill the bacteria isn't reached.  Maybe society's been a wreck for a while and people are getting more desperate to preserve food.  Mom decides to make jam from some berries that are just a bit too gone and should really be given to the chickens or thrown away.  Whatever the cause, the proper temperature isn't reached.  Those Clostridium botulinum bacteria have been awakened.  They are really excited.  Really super happy.  And they indulge in wild, non-stop orgies and reproduce faster than mice and rabbits ever dreamed.  But, you know, they're subtle about it.  They don't want anyone to know, so they don't change the color of the food, and they don't make a stink.  Because if they do, then people won't get sick.  They multiply for weeks or months or longer.  And still, no one can tell.

Properly home-canned and commercially canned foods are safe to eat straight from the can.  Improperly canned stuff may kill you.  However, it's hard to tell if food containing botulism was improperly canned.  It doesn't smell or have an off appearance.  And you can't taste a difference, either.  To be safe (and this comes from the CDC), all home-canned low-acid foods should be boiled for 10 minutes plus an additional minute for every 1,000 feet above sea level to deactivate the toxin. 

In the US today, life is still pretty normal.  Anyone suspected of botulism poisoning is given antitoxin and may do some time with a ventilator.  Weeks or months wouldn't be unusual.  Post-collapse, there will not be any antitoxin.  Ventilation will have to be done round-the-clock with a bag-valve mask.  Most families won't be able to do it.

There are very limited accounts of using activated charcoal, even several hours after the suspect food was ingested.  The studies suggest that for whatever reason, the botulinum toxin remains in the stomach for a while, where the activated charcoal can bind to it.  As the progression and outcome of the disease appears to be dose-dependent, a case of botulism is not always fatal.  Getting the patient to swallow copious amounts of activated charcoal before those muscles become affected may be critical to a positive outcome. 

Links to related posts:
Activated Charcoal
Food Poisoning Overview   


For further reading: 
Armageddon Medicine, pp 340-342, 483
https://www.cdc.gov/botulism/pdf/bot-manual.pdf   (free download manual)
https://www.sciencedirect.com/science/article/abs/pii/S0196064495702148  mice treated with AC more likely to survive
https://academic.oup.com/cid/article/41/8/1167/379325 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4774742/  cows
http://www.veterinaryworld.org/Vol.8/November-2015/6.pdf  cows
https://calpoison.org/news/botulism  (use of activated charcoal)
https://www.msdmanuals.com/home/infections/bacterial-infections-anaerobic-bacteria/botulism (use of activated charcoal)
https://www.who.int/csr/delibepidemics/clostridiumbotulism.pdf
https://www.ncbi.nlm.nih.gov/pubmed/9652437
https://www.fda.gov/food/consumers/what-you-need-know-about-foodborne-illnesses
https://www.fsis.usda.gov/wps/wcm/connect/a70a5447-9490-4855-af0d-e617ea6b5e46/Clostridium_botulinum.pdf?MOD=AJPERES

 26 february 2020