Lettuce, Other Leafy Greens, and Food Safety

"Vegetables are an important part of a healthy, balanced diet. Leafy vegetables (called leafy greens on this page) such as lettuce, spinach, cabbage, kale, and bok choy, provide nutrients that help protect you from heart disease, stroke, and some cancers.

But leafy greens, like other vegetables and fruits, are sometimes contaminated with harmful germs. Washing does not remove all germs because they can stick to the surfaces of leaves and even get inside them. If you eat contaminated raw (uncooked) leafy greens, such as in a salad, you might get sick. To prevent contamination, leafy greens should be grown and handled safely at all steps in the journey from farm to fork.

• CDC estimates that germs on produce that is eaten raw cause a large percentage of U.S. foodborne illnesses (also called food poisoning).
• Leafy greens and other vegetable row crops are a major source of E. coli O157 infections.
• Other harmful germs found on leafy greens include norovirus, Salmonella, Listeria, and Cyclospora.

Although anyone can get food poisoning, these groups are more likely to get sick and to have a more serious illness:

• Adults aged 65 and older
• Children younger than 5 years
• People who have health problems or take medicines that lower the body’s ability to fight germs and sickness (a weakened immune system)
• Pregnant women

Leafy Greens Q&As

Read these Q&As to learn more about how leafy greens get contaminated and how to lower your chance of getting sick from eating leafy greens.

How common are foodborne disease outbreaks linked to leafy greens?

During 2014 to 2018, 51 foodborne disease outbreaks linked to leafy greens (mainly lettuce) were reported to CDC. Five were multistate outbreaks that led CDC to issue warnings to the public. Among those, two outbreaks were linked to packaged salads and two were linked to romaine lettuce. The specific type of leafy greens could not be determined for the other outbreak.

The 1,406 illnesses caused by those 51 outbreaks represent only a small proportion of all illnesses caused by contaminated leafy greens in those years. That’s because most foodborne illnesses are not part of a recognized outbreak. Some outbreaks never lead to consumer warnings because the food is no longer in stores, restaurants, or homes by the time it is identified as the source. Usually the source is not identified, and people might not even suspect that their illness was caused by contaminated food. Also, most outbreaks affect people in only one state, so local or state health departments lead work to identify, investigate, and communicate about those outbreaks.

Most recently, in 2019 and 2020, CDC investigated and issued public warnings on three multistate outbreaks linked to leafy greens..."
Leafy Greens 

Fruit and Vegetable Safety

"Eating a diet with plenty of fruits and vegetables gives important health benefits. But it’s important to select and prepare them safely.

Fruits and vegetables add nutrients to your diet that help protect you from heart disease, stroke, and some cancers. In addition, choosing vegetables, fruits, nuts, and other produce over high-calorie foods can help you manage your weight.

But sometimes raw fruits and vegetables contain harmful germs that can make you and your family sick, such as Salmonella , E. coli, and Listeria, CDC estimates that germs on fresh produce cause a large percentage of U.S. foodborne illnesses.

The safest produce is cooked; the next safest is washed. Enjoy uncooked fruits and vegetables while taking steps to avoid foodborne illness, also known as food poisoning.

At the store or market:

• Choose produce that isn’t bruised or damaged.
• Keep pre-cut fruits and vegetables cold by choosing produce that is refrigerated or kept on ice.
• Separate fruits and vegetables from raw meat, poultry, and seafood in your shopping cart and in your grocery bags.

At home:

• Wash your hands, kitchen utensils, and food preparation surfaces, including chopping boards and countertops, before and after preparing fruits and vegetables.
• Clean fruits and vegetablesexternal icon before eating, cutting, or cooking, unless the package says the contents have been washed.
  • Wash or scrub fruits and vegetables under running water—even if you do not plan to eat the peel. Germs on the peeling or skin can get inside fruits and vegetables when you cut them.
  • Cut away any damaged or bruised areas before preparing or eating.
  • Dry fruit or vegetables with a clean paper towel.
• Keep fruits and vegetables separate from raw foods that come from animals, such as meat, poultry, and seafood.
• Refrigerate fruits and vegetables within 2 hours after you cut, peel, or cook them (or 1 hour if the outside temperature is 90°or warmer). Chill them at 40°F or colder in a clean container..."
  Fruits and vegetables

Fruit and Vegetable Safety

"Eating a diet with plenty of fruits and vegetables provides important health benefits, but it’s important that you select and prepare them safely.

Fruits and vegetables add nutrients to your diet that help protect you from heart disease, stroke, and some cancers. In addition, choosing vegetables, fruits, nuts, and other produce over high-calorie foods can help you manage your weight.

But sometimes raw fruits and vegetables contain harmful germs, such as Salmonella, E. coli, and Listeria, that can make you and your family sick. In the United States, nearly half of foodborne illnesses are caused by germs on fresh produce.

The safest produce is cooked; the next safest is washed. Enjoy uncooked fruits and vegetables while taking steps to avoid foodborne illness, also known as food poisoning..."
Fruits and vegetables

Put Your Best Fork Forward!

"Eat more fruits and vegetables.

March is National Nutrition Month and this year's theme is "Put Your Best Fork Forward!" Part of leading a healthy life means eating a healthy diet and being physically active.

A recent CDC study highlights when, where, and how U.S. adults and children are eating a healthy diet. Those who are not getting enough fruits and veggies can take small steps towards meeting recommended amounts, including adding more fruit to your usual breakfast routine or adding vegetables to your meals..."
Nutrition

Adults Meeting Fruit and Vegetable Intake Recommendations — United States, 2013

"Eating more fruits and vegetables adds nutrients to diets, reduces the risk for heart disease, stroke, and some cancers, and helps manage body weight when consumed in place of more energy-dense foods (1). Adults who engage in <30 1.5="" 2="" activity="" and="" class="Apple-converted-space" consume="" cup="" cups="" daily="" equivalents="" fruit="" minutes="" moderate="" of="" physical="" should="" span="" vegetables=""> 
daily.* However, during 2007–2010, half of the total U.S. population consumed <1 76="" 87="" and="" cup="" cups="" daily="" did="" fruit="" intake="" meet="" not="" of="" recommendations="" span="" vegetable="" vegetables="">2). Although national estimates indicate low fruit and vegetable consumption, substantial variation by state has been observed (3). Fruit and vegetable intake information from the Behavioral Risk Factor Surveillance System (BRFSS) is the sole source of dietary surveillance information for most states, but frequency of intake captured by BRFSS is not directly comparable to federal intake recommendations, which are expressed in cup equivalents. CDC analyzed median daily frequency of fruit and vegetable intake based on 2013 BRFSS data for the 50 states and the District of Columbia (DC) and applied newly developed prediction equations to BRFSS to calculate the percentage of each state's population meeting fruit and vegetable intake recommendations. Overall, 13.1% of respondents met fruit intake recommendations, ranging from 7.5% in Tennessee to 17.7% in California, and 8.9% met vegetable recommendations, ranging from 5.5% in Mississippi to 13.0% in California. Substantial new efforts are needed to build consumer demand for fruits and vegetables through competitive pricing, placement, and promotion in child care, schools, grocery stores, communities, and worksites..."Fruits and Vegetables 

Fruit and Vegetable Consumption Among High School Students — United States, 2010

"A diet high in fruits and vegetables is associated with a decreased risk for many chronic diseases and some cancers (1), and can aid in weight management (2). Current daily fruit and vegetable recommendations for adolescents who participate in <30 minutes of physical activity daily are 1.5 cups of fruit and 2.5 cups of vegetables for females and 2 cups of fruit and 3 cups of vegetables for males (1) (1 cup is approximately equal to one medium apple, eight strawberries, 12 baby carrots, or one large tomato).* However, recently published data from the National Health and Nutrition Examination Survey 2003--2004 revealed that consumption was considerably below these levels (3). To assess fruit and vegetable consumption among high school students, CDC analyzed data from the 2010 National Youth Physical Activity and Nutrition Study (NYPANS). This report describes the results of that analysis, which indicated that, in 2010, the median number of times per day that high school students consumed fruits and vegetables was 1.2 for both. For vegetables, the median number of times per day was lower for non-Hispanic black students (1.0) and Hispanic students (1.1) than non-Hispanic white students (1.4). Overall, 28.5% of high school students consumed fruit <1 time daily, and 33.2% of high school students consumed vegetables <1 time daily..."

Seven Steps for Cleaning Fruits and Vegetables


Video from the U.S. Food and Drug Administration on cleaning fruits and vegetable.

The U.S. Produce Industry and Labor: Facing the Future in a Global Economy
"Fruit and vegetable production is a labor-intensive process, and over half of the hired workers employed by growers are believed to be unauthorized immigrants. Reforms to immigration laws, if they reduce the labor supply, may increase the cost of farm labor. The authors of this report assess how particular fruit and vegetable commodities might adjust if labor rates increased. Analysis of case studies suggests a range of possible adjustment scenarios, including increased mechanization for some crops, reduced U.S. output for a few crops, and increased use of labor aids to improve labor productivity for others."

State-Specific Trends in Fruit and Vegetable Consumption Among Adults --- United States, 2000--2009
"A diet high in fruits and vegetables can reduce the risk for many leading causes of death (1--3) and can play an important role in weight management (4). Healthy People 2010 objectives for fruits and vegetables include targets of increasing to 75% the proportion of persons aged ≥2 years who consume two or more servings of fruit daily and to 50% those who consume three or more servings of vegetables daily.* To assess states' progress over the past decade in meeting these targets among adults and to provide an update of the 2005 subgroup estimates (5), CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS). This report describes the results of that analysis, which indicated that, in 2009, an estimated 32.5% of adults consumed fruit two or more times per day and 26.3% consumed vegetables three or more times per day, far short of the national targets. Overall, the proportion of adults who met the fruit target declined slightly, but significantly, from 34.4% in 2000 to 32.5% in 2009; no significant change was observed in meeting the vegetable target. No state met either target, and substantial variability occurred among states. Only one state had statistically significant increases in the percentages of adults meeting each target. These findings underscore the need for interventions at national, state, and community levels, across multiple settings (e.g., worksites, community venues, and restaurants) to improve fruit and vegetable access, availability, and affordability, as a means of increasing individual consumption..."

State Indicator Report on Fruits and Vegetables, 2009
"The State Indicator Report on Fruits and Vegetables, 2009 provides for the first time information on fruit and vegetable (F&V) consumption and policy and environmental support within each state.† Fruits and vegetables, as part of a healthy diet, are important for optimal child growth, weight management, and chronic disease prevention.1,2 Supporting increased F&V access, availability, and reduced price are key strategies towards the Centers for Disease Control and Prevention’s (CDC) goal of improved F&V consumption and thus improved nutrition among all Americans..."

Majority of Americans not Meeting Recommendations for Fruit and Vegetable Consumption
"No U.S. state is meeting national objectives for consumption of fruits and vegetables, according to the first report to provide state–by–state data about fruit and vegetable consumption and policies that may help Americans eat more fruits and vegetables.

“State Indicator Report on Fruits and Vegetables, 2009”was released today by the Centers for Disease Control and Prevention.

The Healthy People 2010 objectives aim for at least 75 percent of Americans to eat the recommended two or more daily servings of fruit, and for at least 50 percent of Americans to eat the recommended three or more servings of vegetables daily. However, CDC surveys indicate that only 33 percent of adults meet the recommendation for fruit consumption and 27 percent get the recommended servings of vegetables. The statistics are even worse for high school students – 32 percent report eating at least two servings of fruit daily and 13 percent say they eat at least three servings of vegetables each day..."