Cyclospora infections are increasing again this summer, with public health officials investigating outbreaks across several states. While the investigation is ongoing, early findings suggest lettuce and leafy greens may be involved in many reported cases. Investigators are still working to identify the exact source.
Cyclospora outbreaks are not new, but they can be frustrating because the parasite is particularly difficult to remove from fresh produce. Unlike many bacteria, Cyclospora is resistant to chlorine-based sanitizers, and washing alone cannot guarantee complete removal.
The good news is that there are practical steps you can take to reduce your risk while continuing to enjoy a healthy diet.
What Is Cyclospora?
Cyclospora cayetanensis is a microscopic parasite that causes an intestinal illness called cyclosporiasis. Symptoms often begin about a week after exposure and may include:
- Watery diarrhea
- Loss of appetite
- Nausea
- Stomach cramps
- Bloating
- Fatigue
- Weight loss
- Low-grade fever
Healthy adults often recover, but symptoms can last for weeks without treatment. Older adults, young children, pregnant individuals, and people with weakened immune systems may be at greater risk for complications.
Foods Commonly Associated with Cyclospora
Historically, outbreaks have been linked to a variety of fresh produce, particularly foods that are eaten raw.
Foods that have commonly been associated with Cyclospora outbreaks include:
- Lettuce and salad greens
- Bagged salad mixes
- Romaine lettuce
- Basil
- Cilantro
- Parsley
- Raspberries
- Blackberries
- Snow peas
- Sugar snap peas
A review published in the journal Foods found that approximately 65% of major produce-related Cyclospora outbreaks were associated with basil or raspberries. Cilantro and lettuce have also been responsible for numerous outbreaks worldwide.
Why Washing Is Not Always Enough
One of the biggest challenges with Cyclospora is that it can cling tightly to produce.
A 2021 study comparing different washing methods on raspberries found:
- Rinsing under running water removed only 11% to 69% of Cyclospora.
- Washing with vinegar improved removal somewhat but still left parasites behind.
- Using a salad spinner after washing was the most effective approach, but it still did not eliminate all of the parasite.
This does not mean you should stop washing produce. Washing remains an essential first step, but it is important to understand its limitations.
How to Reduce Your Risk
1. Choose Whole Produce Whenever Possible
Whenever possible:
- Buy whole heads of lettuce instead of bagged salads.
- Purchase whole fruits and vegetables rather than pre-cut versions.
Pre-cut and pre-packaged produce passes through additional handling steps, creating more opportunities for contamination.
2. Wash Every Fruit and Vegetable
Even if the label says “triple washed,” “ready to eat,” or “pre-washed,” rinse produce thoroughly under clean running water before eating.
Remember to:
- Wash produce before peeling it.
- Use a clean produce brush for firm fruits and vegetables such as melons, cucumbers, and potatoes.
- Cut away bruised or damaged areas.
Do not wash produce with:
- Soap
- Bleach
- Household disinfectants
These products are not safe for produce and are not recommended.
3. Remove Outer Leaves
For leafy vegetables, remove and discard the outer two to three leaves whenever possible. This may help eliminate the portions most likely to have surface contamination.
4. Prevent Cross-Contamination
After handling fresh produce:
- Wash cutting boards.
- Wash knives.
- Clean countertops.
- Use hot, soapy water.
Always wash your hands with soap and warm water for at least 20 seconds before and after preparing food.
5. Cook Produce When Possible
Cooking remains the most reliable way to destroy Cyclospora. The parasite cannot survive temperatures of approximately 158°F, or 70°C, and higher.
Produce that can easily be cooked includes:
- Spinach
- Kale
- Green beans
- Peas
- Zucchini
- Bell peppers
- Broccoli
Raw vegetables certainly have nutritional value, but lightly cooking vegetables during periods of increased Cyclospora activity may provide additional peace of mind.
Should You Avoid Lettuce Right Now?
If you live in an area experiencing a significant outbreak, particularly Michigan, Ohio, Kentucky, or West Virginia, where cases have been reported, some food safety experts recommend temporarily limiting raw lettuce and salad greens until investigators better identify the source.
Consumer Reports food safety experts also recommend:
- Avoiding pre-chopped fruits and vegetables.
- Avoiding pre-bagged salads.
- Buying whole produce and preparing it yourself.
Recommendations may evolve as investigators learn more, so continue following updates from your local health department and the CDC.
Let’s Redefine What a Salad Is
If you are avoiding leafy greens for a while, that does not mean salads have to disappear from your menu.
A great salad is simply a combination of a few key components:
- A hearty base
- A protein
- Vegetables
- Healthy fats
- Flavorful dressing or seasoning
- Crunch or texture
Leafy greens are only one possible foundation.
Try Grain-Based Salads
Whole grains make satisfying, fiber-rich salad bases:
- Quinoa salad
- Farro salad
- Brown rice salad
- Barley salad
- Wild rice salad
- Couscous salad
Example: Quinoa, roasted vegetables, chickpeas, feta, and lemon vinaigrette.
Bean Salads
Beans provide both protein and fiber.
Ideas include:
- Three-bean salad
- White bean and tomato salad
- Black bean and corn salad
- Mediterranean chickpea salad
- Lentil salad with roasted vegetables
Vegetable-Forward Salads
Use cooked or sturdy vegetables as your base:
- Roasted broccoli
- Roasted cauliflower
- Cucumber
- Tomatoes
- Bell peppers
- Carrots
- Roasted sweet potatoes
- Grilled zucchini
- Brussels sprouts
Protein Bowls
Build balanced meals using:
- Grilled chicken
- Salmon
- Tuna
- Shrimp
- Tofu
- Tempeh
- Hard-boiled eggs
Add whole grains and cooked vegetables for a complete meal.
Alternatives to Fresh Berries
Fresh berries have also been linked to previous Cyclospora outbreaks, particularly imported raspberries. While the current outbreak is being investigated, consider the following alternatives.
Frozen Berries
Frozen berries are often processed soon after harvest and are a convenient option for smoothies, oatmeal, yogurt, or baking. When using them in recipes that can be heated, cooking provides an additional layer of protection.
Cooked Berry Compote
Cooking berries to at least 158°F, or 70°C, destroys Cyclospora, making a warm berry compote a great alternative to eating fresh berries during an outbreak.
Ingredients
- 2 cups frozen mixed berries, blueberries, raspberries, or blackberries
- 1 to 2 teaspoons maple syrup or honey, optional
- 1 teaspoon lemon juice
- 1/2 teaspoon vanilla extract, optional
- Pinch of cinnamon, optional
Directions
- Combine all ingredients in a small saucepan.
- Bring to a gentle simmer over medium heat.
- Cook for 5 to 10 minutes, stirring occasionally, until the berries have softened and the mixture has thickened slightly.
- Allow the compote to cool slightly before serving.
Enjoy it over:
- Greek yogurt or cottage cheese
- Oatmeal or overnight oats
- Whole-grain pancakes or waffles
- Chia pudding
- Whole-grain toast with nut butter
- Ice cream
Tip: Make a larger batch and store it in the refrigerator for up to five days for an easy, antioxidant-rich topping throughout the week.
Other Fruits
Choose fruits that are naturally protected by a peel, such as:
- Bananas
- Oranges
- Mandarin oranges
- Mangoes
- Kiwi
- Pineapple
- Melons, washed before cutting
These options can provide similar vitamins and antioxidants while reducing reliance on fresh berries during periods of increased concern.
The Bottom Line
Cyclospora outbreaks remind us that food safety and healthy eating go hand in hand. While no method can completely eliminate the risk from contaminated produce, choosing whole fruits and vegetables, washing them carefully, removing outer leaves, preventing cross-contamination, and cooking produce whenever practical can meaningfully reduce your exposure.
If you are temporarily taking a break from leafy salads, think of it as an opportunity to expand your menu. Grain bowls, bean salads, roasted vegetable dishes, and protein-packed meals can offer the same nutrition, often with even more fiber, protein, and variety.
Healthy eating is not defined by a bed of lettuce. It is about building balanced meals that nourish your body while keeping food safety in mind.
