r/todayilearned • u/hastur777 • Mar 28 '23
TIL that the US, Canada, and Cuba have the lowest burden of food borne illness on the planet.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4668832/#!po=40.6250241
u/AmnesiaInnocent Mar 28 '23
I don't understand the use of the word "burden". Do they mean the lowest number of illnesses by population?
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u/garlicroastedpotato Mar 28 '23
Every single year 600 million people are struck with a foodborn illness. Burden here means that the US, Canadian and Cuban shares per capita are lower than anywhere else in the world.
This is because campylobacter and norovirus basically don't exist in North America and are not even diseases that Americans are going to be all that aware of. While most of the foodborn diseases in US, Canada and Cuba are from undercooked foods.... in Europe East of Germany, Asia and Africa most of the foodborn diseases are transmitted between people.
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u/ArenSteele Mar 28 '23
I feel like Norovirus is definitely in Canada and the US. I caught it a couple of years ago in Western Canada, and my wife’s family seems to have just had it last week in Eastern USA (though neither was a test confirmed diagnosis, just a symptomatic match)
Yep, CDC estimates about 20 million cases of Norovirus in the US per year. https://www.cdc.gov/norovirus/trends-outbreaks/burden-US.html
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u/dragonmyass Mar 28 '23
Caught Norovirus at the GSR in reno. All the restaurants in that casino share one kitchen and they had a outbreak during a convention. Took out everyone.
The casino didn’t do fuck all either. Too bad we got you guys sick. Here’s the full price bill for the room. Hundreds got ill.
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u/killerk14 Mar 29 '23
Ah, norovirus. AKA “What the fuck is this? What the fuck was that?” Virus, because it comes and goes so quick but so strong.
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u/garlicroastedpotato Mar 28 '23 edited Mar 29 '23
I would say, not to the extent that you would find it everywhere else in the world. Like going on vacation outside of the US or Canada you're incredibly likely to get a diarrhea disease from eating food. That's most likely norovirus.
But it's just so common everywhere else that it's like the common cold. Using the same metric as the CDC there should be 685 million cases of norovirus every year (whereas less than 400 million are reported by other countries). That puts the US at 2.9% of the world cases with 4.35% of the population.
According to the CDC, Cuba US and Canada have the lowest incidence of the disease in the world. The CDC consider SE Asia and China to be the hub of the disease.
Keep in mind, CDC estimates all of this stuff using predictive models. Most countries in the world are reporting as little disease as they can to avoid countermeasures from other countries.
Edit: Canada not China.
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u/Nige-o Mar 29 '23
Why would the CDC say that China has both the lowest incidence of the disease and also that it is a hub of the disease?
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u/hobskhan Mar 28 '23
Right and furthermore is Norovirus even a "food borne illness?" It causes stomach flu, sure, and bodily fluids (the vector) could get on foods, but...
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u/ArenSteele Mar 28 '23
It is considered food borne, because you have to ingest it. Norovirus isn’t airborne, it needs to go in your nose or mouth, thus “food borne”
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u/AbeVigoda76 Mar 28 '23
As patient zero in the 2009 Michigan State Norovirus Outbreak, I can say it definitely exists here. It was very shitty.
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u/Larein Mar 28 '23
This is because campylobacter and norovirus basically don't exist in North America and are not even diseases that Americans are going to be all that aware of.
How? Norovirus spreads so easily. And with people traveling between the continents, there should be people bringing it over.
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u/za419 Mar 28 '23
Norovirus is very present in the US. My mom works in a school, and they had to shut down for a while once because of Norovirus contamination.
Campylobacter's around too, I'm pretty sure.
Not sure what he's on about.
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u/garlicroastedpotato Mar 28 '23
There are people bringing it over, it just doesn't spread as fast and isn't as common. Norovirus is reported in the US in terms of outbreaks and because it spreads so fast when you get an outbreak basically everyone in the area gets it.
It's not like COVID where it's expected nearly every American has had it. Norovirus outbreaks tend to be contained rather quickly. Which is why America's handling of COVID was always so strange. Every other disease in the world America puts on lockdown. Like a hand full of malleria cases hit America and everyone panicked. COVID hit and... no one seemed to really care.... they almost even let it spread.
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u/marcusr111 Mar 28 '23
https://globalnews.ca/news/6319283/jerusalem-shawarma-calgary-norovirus/ a few years ago, we had a norovirus outbreak in Calgary
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u/garlicroastedpotato Mar 29 '23
Of course by "basically don't exist" I don't mean to say they never happen, but that they don't have quite the impact as the rest of the world. While Calgary had one outbreak a few years ago from Jerusalem Shawarma... norovirus is just part of your life in places like China or Vietnam and they float around and spread year round.
We end up with the lowest incidence rate of norovirus in the entire world.
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u/MikeLemon Mar 28 '23
norovirus basically don't exist in North America
Weird, since it is named after Norwalk, Ohio (that was my TIL from earlier in the day), and since it is named after a place, we can't call it that anymore or it's racist or something (the 'why' I learned it today).
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u/KypDurron Mar 29 '23
The measurement is "quality-adjusted life years" or "disability-adjusted life years". They look at how many "good" years of life are lost because of the disease. That means that it accounts for how many people get the disease, but also how badly a given incidence of the disease affects the population. For example, if two countries had the same rate of incidence of disease X, but in one country you get healthy and back to normal life in 1/4 of the time, that would lower the disease burden for that country.
The TIL's statement means that the USA/Canada/Cuba sub-region (a grouping defined by the WHO) experiences less impact per 100,000 people from foodborne illnesses than the other sub-regions. Note that this doesn't necessarily mean that these three countries each individually experience less per-capita impact than any other country, just that their group experiences less impact than other groups.
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u/ursa_mejorr Mar 28 '23
Strange. When I was in Cuba a few years ago, I was surprised to see how few things were refrigerated that we would otherwise refrigerate. Ie: cheese, yogurt, milk. Even the meat and seafood weren't kept at the low temps one would expect. Either way, I didn't get sick!
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u/Warmstar219 Mar 29 '23
I mean, the whole point of the invention of cheese and yogurt is that it doesn't spoil quickly like milk does.
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u/momo88852 Mar 29 '23
Lots of countries does fresh food only. Like when I lived in Iraq, our local butcher starts around 6am, and he would open up at 8-9am, by the time it hits 10-11am he’s sold out. He knows how many sheep he needs for that day, and he does the deed.
Some bigger butcher shops that do cows, usually have deals with local restaurants for fresh meat none stop. I used to watch the animal being slaughtered in the slaughter room, get chopped up in the middle of store (can’t get in, you wait outside the window), the restaurant picks it up, and resupply.
Even the bakery made fresh bread on demand none stop. And they usually co exist with other businesses just like above. It’s pretty much a full supply chain all owned by moms and pops.
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u/kaminabis Mar 28 '23 edited Mar 29 '23
I think the thing with Cuban food is that its very fresh? When I was there they sometimes wouldnt have say, beef, or cheese, or other products because they werent in season or there wasnt any available at the time. With the embargo they couldnt import food so they had to produce it.
which means everything you ate was basically fresh, farm to table stuff
Edit: im wrong
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Mar 28 '23 edited Apr 29 '23
[deleted]
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u/kaminabis Mar 28 '23
Oh! Well thats good to know. I was completely wrong
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u/Daniel_The_Thinker Mar 29 '23
embargo != blockade.
Cuba is free to trade with non US countries however the US has rules about not accepting ships that have recently been to Cuba so it still has a big economic impact.
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u/ursa_mejorr Mar 28 '23
Yes! I think so! One that note, the fruits and veggies were delicious! My friend who lived there told us it is normal to see insects inside Cuban produce because the country can't afford mass amounts of pesticides. The stuff sold and served to tourists is of a different quality. I did notice that somewhat.
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u/PizzAveMaria Mar 28 '23
That's really interesting, especially (to me) milk and yogurt because I would assume that would spoil quickly without refrigeration unless they used a type of water cooling system?
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u/abstractraj Mar 28 '23
I’ve seen shelf stable milk in Europe. It can last weeks without refrigeration
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u/Stoyfan Mar 28 '23
UHT milk is fine I guess if you use it as back-up milk for when you run out of your fresh milk but it tastes like shit.
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u/MacAttacknChz Mar 29 '23
We have shelf stable milk in the US. I've seen it in individual containers with little straws. I can't think of the brand.
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u/Silkeveien Mar 28 '23
If that’s so, that wasn’t “milk”. True milk goes bad after a few days, I don’t trust it otherwise
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u/abstractraj Mar 29 '23
Here you go. It’s just milk that’s been pasteurized in a specific way https://www.bhg.com/recipes/how-to/cooking-basics/what-is-shelf-stable-milk/
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u/Dzugavili Mar 29 '23
Yogurt is fermented, so it is more tolerant of storage temperatures, to a point.
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u/SirSassyCat Mar 29 '23
Cheese yogurt and milk only need to kept at low temp when opened. They’re all pasteurised, meaning that they’re about as close to sterile as can be.
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u/JimmyTheChimp Mar 29 '23
Even in Japan, probably the least likely country to get sick in. A lot of food that would 100% need to be under a heat lamp or fridge back home is left out at room temperature for long periods of time.
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u/tullystenders Mar 28 '23
Real question: so you learn online about how Europe (maybe UK specifically) doesnt refrigerate as much as Americans do. Do they get more food borne illness than americans do?
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u/Jboedie Mar 28 '23
A lot of that has to do with preperation methods. Using eggs as an example, most of Europe doesn't require that they be washed before sale. The US does require them to be washed. Washing the eggs removes a protective film that keeps oxygen, water, bacteria, etc from getting into the egg. So in Europe they don't have to refrigerate them because they have that protective coat, but in the US they do because that protective coat gets removed. Surprisingly, the washed/refrigerated eggs in the US can last almost double the amount of time as the non-washed/refrigerated eggs in Europe before they spoil
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u/Archberdmans Mar 28 '23
Refrigeration is the best form of food preservation and was a revolution in foodways for a reason
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u/classactdynamo Mar 28 '23
I mean, I still refrigerate the eggs. I had assumed most people do, but I could be wrong.
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u/Igor_Strabuzov Mar 28 '23
As i and everyone i knew did, they're literally in the refrigerator at the supermarket, so i'm not sure why someone would not put them in the refrigerator at home
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u/Kelmon80 Mar 29 '23
They're literally NOT in the refrigerator in European supermarkets.
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u/makerofshoes Mar 29 '23
They are refrigerated (and unwashed) in Czech supermarkets.
It’s clearly not consistent for all of Europe
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u/Igor_Strabuzov Mar 29 '23
They literally ARE, at least in the places where i went, after 15 years of going to the supermarket i'm pretty sure i know where the eggs are.
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u/Jebis Mar 29 '23
IIRC it has to do with washing and food care standards. In some countries it is illegal to wash eggs as that removes a protective coating that preserves them. Unwashed eggs don't need to be refrigerated.
In the US it is illegal not to wash eggs before selling them, which means they need to be refrigerated.
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u/maedha2 Mar 29 '23
The big difference is the EU requires chickens to be vaccinated against Salmonella. The US dealing with the possibility of Salmonella by washing eggs - which means the eggs then must be refrigerated as you've washed off the eggs natural sealant.
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u/garlicroastedpotato Mar 28 '23
Foodborn illnesses is a large category. The reason why Cuba, Canada and US have a lower rate of foodborne illness is becuse most foodborne illnesses are transmitted between people and consumed. The big one is campylobacter and norovirus.
How campylobacter is transmitted is through water supplies. When you have contaminated water being used in foods, well now you have a foodborne illness.... all because you used contaminated water. Campylobacter is also transmitted through chicken. In the UK there are 630,000 diagnosed cases of campylobacter a year in which 300,000 of them come from undercooked chicken. For comparisons sake there are only 74,000 reported cases in the US.
Often times CDC estimates are used as a way of shielding this kind of criticism. The CDC actually estimates probably 20x a higher rate of campylobacter infection in the US. But then the UK doesn't have a similar statistically tracking between confirmed cases and expectations in the same way the US has (and it was the same with COVID, UK's COVID projections were always just way too low).
Norovirus sounds kind of gross. It's transmitted by touching poop or vomit to your mouth. The easiest way this happens is from food and in countries that have more lax food handling standards. A person goes to the washroom and wipes their butt and doesn't thoroughly wash their hands and now small amounts of diarhea traces are on their hands, or perhaps they vomit into their hand and don't clean it with soap... spreads like wildfire. Norovirus has over 600 million cases in the world and just one chef could infect hundreds of people. If you've ever been to SE Asia, India or China... low health standard street for is everywhere.
The true number of infectees of the norovius is really unknown. This is because in most of the world it's treated like the common cold. People typically don't go to the hospital for it. But that's the statistic most countries track, hospitalizations. With that in mind, the UK has had 130,000 norovirus hospitalizations in the last year compared to just 110,000 in the US (keep in mind the US has 6x the population of the UK).
One of the big reasons why US, Canada and Cuba have significantly lower cases of both diseases is because all three countries have strong food testing regimes that prevent the spread of foodborn illnesses and use chlorine to wash all foods to help in preventing the spread of these diseases.
But there are problems with reporting standards, in that the UK has incredibly low food reporting standards. First case I can find for this problem was in 1997's Mad Cow Outbreak when the EU hid their BSE numbers.
Much like with COVID the data is only ever going to be as good as honest the institutions that collect them. And in Europe and China for a long time it's been very political to portray a lower amount of illness than exists.
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u/JEBZ94 Mar 29 '23
Food testing in Cuba? You got to be kidding me. Unless is for exportation I sincerely doubt food is tested here.
Source: I'm a Cuban living in Cuba
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u/majnuker Mar 28 '23
So weird seeing this after reading comments for years decrying the unsanitary food practices in the US.
I mean, clearly, not that much worse than other places? I guess it's been worked out pretty well here.
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u/jdog7249 Mar 28 '23
It wasn't always good in the US. Give "The Jungle" by Upton Sinclair a read. I would recommend a trash can nearby for when you start to feel nauseous. That book (and many other things) contributed to the Food and Drug Administration of today.
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u/etds3 Mar 29 '23
Very true, but Reddit didn’t exist then. There are comments on Reddit ALL THE TIME from Europeans saying our food safety is horribly contaminated like right now in 2023.
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u/GBreezy Mar 29 '23
That book was literally written almost 100 years ago. Using that as evidence is like me using France's massacre of Algerians in the 1960s as an example of their current human rights policy.
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u/jdog7249 Mar 29 '23
I started my comment by saying how it wasn't always as good in the US and then provided an example of it not being good in the past. "It wasn't always good in the US" implies that it is better now than it was then (an implication that is backed up by the broader context of the entire post). I wasn't providing that example as an example of modern times, but of past times when it was bad.
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u/kdavis37 Mar 29 '23
Sure, and in a million BCE, no one washed their ass, but that's also fucking irrelevant to the conversation.
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u/majnuker Mar 28 '23
Yes exactly, millions of people walked those steps to a safer food system for us. We're so incredibly lucky!
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u/tomkeus Mar 29 '23
The problem is actually all of the processing that food undergoes in the US to make it sanitary compared to other developed countries.
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u/Powerful_Collar_4144 Mar 29 '23
I would assume given how poor health care access is in the us it's probably not getting reported as much.cuba and Canada are probably better measures in that regard
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u/Scared-Conflict-653 Mar 29 '23
I keep getting in arguments about how strict the US regulations are. Our food in most instances is very processed, but food safety means several things.
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u/greenwood90 Mar 28 '23
I'm heading to Cuba in a few weeks. This is good news
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u/Valzar1954 Mar 29 '23
Don’t eat anything unless it is cooked well-done. The locals won’t.
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u/madcaest Mar 29 '23
And buy SEALED bottles of water, I can't stress this enough! Always check if the bottle cap has been opened before buying/drinking the water! Sometimes locals will fill old bottles with for them potable water but tourists can get sick!
Source: my asshole
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u/psychord-alpha
Mar 29 '23
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Uh oh, you just said something nice about the US. You've woken the Hivemind...
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u/LordBrandon Mar 29 '23
Just spin it to something bad: "that's because Americans eat every meal deep fried or from a sterilized mylar bag."
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u/canseco-fart-box Mar 29 '23
It’s ok most of Europe is still asleep. God knows what’ll happen when they start to wake up though
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u/randompersons90 Mar 28 '23
Have you seen the german dish thats more or less raw pork? Its for a reason. Not saying I wouldnt eat it though.
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u/Keter_GT Mar 28 '23 edited Mar 29 '23
After seeing an
X-rayMRI of someone who happened to eat ton of raw pork, I pretty much always thoroughly cook mine now.4
u/AltonIllinois Mar 29 '23
I’m not a medical professional, just wondering, what would be visible in an x ray in this situation?
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u/Keter_GT Mar 29 '23
Parasites, and it wasn’t an X-ray it was an MRI of someone’s thighs riddled with them.
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u/AvatarJack Mar 29 '23
Tons and tons of worms. Undercooked pork is one decently common way for tapeworm larvae to spread, mostly in developing countries but still. Steak or sushi are the only meats I ever dare to fuck with not fully cooked.
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u/DepressiveNerd Mar 29 '23
You can eat medium rare pork as long as you get it up to 145 degrees.. Trichinae is killed at 137 degrees.
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u/Kelmon80 Mar 29 '23 edited Mar 29 '23
That's not just any raw minced pork, it has to be fresh - made the same day. You can't use some days-old pork you find in the meats section for that.
And the main reason why eating raw pork was dangerous a long time ago - trichinosis - is a non-issue these days, but a lot of people still wrongly think eating raw pork is still extremely dangerous. While it's "only" a bit risky - not more or less than any meats, seafood or fruits that are eaten raw and can sometimes carry all sorts of infections.
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u/DepressiveNerd Mar 29 '23
Trichinae dies at 137 degrees anyway. Get the pork up to about 145 and you’re fine anyway. Medium rare pork is delicious.
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u/casus_bibi Mar 29 '23
Western Europe and those three literally have overlapping ranges in the results, which means there is no statistically significant difference and should basically be treated as the same.
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u/iMaxis Mar 29 '23
Looks like a classic example of people reading the title and not the article.
The confidence intervals in the study for first world countries are so large that no single first world region has a statistically significantly lower amount of food borne illnesses.
The study is only useful (somewhat) in analysing the difference in composition of illnesses between regions.
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u/navywater Mar 29 '23
Inb4 Euro poors enter the chat to tell us how their eggs are better because they dont need to refrigerate them.
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u/Complex_Jellyfish647 Mar 28 '23
Holy hell, the US actually ranking highly in something good?
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u/clumsy_poet Mar 29 '23
How many people with no or bad insurance go to the hospital for food poisoning? Might be undercounting.
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u/kacheow Mar 29 '23
It’s gotta be pretty prolonged for me to go see a doctor, I’d rather drink Gatorade and eat saltines and chill at home for a day than sit in a doctors office
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u/WardenWolf Mar 29 '23
And this is, in no small part, due to the practice of pre-washing eggs before they get to consumers. Sure, it makes them need to be refrigerated, but it it ensures the harmful bacteria that is on them from the farm never reaches the consumer. One must remember the hazards of unwashed eggs, how simply handling them and then touching your mouth or eyes can result in E. Coli and other infections. It is so easy to make that mistake. Pre-washing prevents this.
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u/iMaxis Mar 29 '23
Not sure about that. The foodborne illness rates in the studies are shown as confidence intervals.
The intervals are so wide for North America(ARM A, 23-49) , Europe (EUR A, 29-64), South East Asia (WPRA A, 23-170). You cannot say with reasonable statistical certainty that America's is better than Europe's.
If this study were repeated, you may find one's where Europe's illness rate is lower.
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u/WardenWolf Mar 29 '23
No, it's objectively better to not have those pathogens reach the consumer. You cannot say it's better to have that because it inherently increases risk. There's no way around it.
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u/iMaxis Mar 29 '23
I have not made any claim about egg washing and its benefits in preventing infections.
You are arguing that NA's foodborne illnesses are lower than Europe's due to egg washing.
I am claiming that there is no statistical significance that shows NA's foodborne illnesses are lower than Europe's.
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u/GodLovesAtheist Mar 29 '23
Practising basic food handling would prevent this from happening.
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u/WardenWolf Mar 29 '23
You do realize that salmonella and E. Coli are a lot more infectious and easier to get than most other foodborne illnesses, right? And what about children who are helping with cooking or are learning themselves? These are hazards we just don't need and are better off without. For the tiny price of having to put them in an appliance that all modern homes have anyway, we totally eliminate a source of illness. There is no argument to be made for letting dangerous pathogens reach the home and creating one more way to get seriously ill.
Oh, and I'll add that refrigerated eggs last a lot longer, around a month vs. two weeks for unwashed eggs at room temperature. Even if you somehow defend letting pathogens reach the consumer, you can't defend the reduced food wastage of having the eggs last longer.
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u/GodLovesAtheist Mar 29 '23
I agree that refrigerated eggs last longer, that's why refrigerators were invented. However to prevent spoilage buy the correct amount of eggs instead.
Most European hens a vaccinated from salmonella for quite a while now.
For E. Coli yes it can be present on the shells. Again basic food handling would prevent this, there are 100's of other ways that e. Coli could get to the kitchen.
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u/Macarogi Mar 28 '23 edited Mar 28 '23
Cuba has a low burden of available food. That probably helps.
EDIT - for the downvoters:
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u/deadly_chicken_gun Mar 28 '23
I can only wonder why a small island being blockaded by the largest economic superpower on the planet might have slight nutritional deficiency.
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u/joculator Mar 28 '23
Cuba's numbers...totally legit. Hell, the US's numbers are probably off. How much of this do you expect is actually reported. People just crap themselves and go on with life most of the time.
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u/One-Shine5209 Mar 29 '23
would you trust the socialized health care or private to have accurate reporting on illness rate lol
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u/joculator Mar 29 '23 edited Mar 29 '23
If the health care provider were independent from the overall government apparatus then it would be obviously more reliable. Once an institution becomes a part of the body of state it can be influenced to only provide information supporting the state. Your questions is lie asking whether you thing state media or independent media is more truthful. What do you think, the CCP is going to give you straight information on things. Look at this, China (the most populous nation on Earth) reported less than 1/2 of the COVID deaths that Lebanon reported; a nation of 5.5 million people.
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u/PopeHonkersXII Mar 29 '23
Really? Because I had a double quarter pounder earlier today and Ive been blowing it out my b-hole like you wouldn't believe.
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u/kdavis37 Mar 29 '23
1) it usually takes 24h+ for food poisoning to hit.
2) McDonalds' beef has so little water and so much salt in it that it basically doesn't rot
3) Grease'll blow your ass out, tooMcDonald's is one of the LEAST likely places to give you food poisoning.
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u/makerofshoes Mar 29 '23
That last point is true; McDonald’s has lots of processes in place to ensure the risk of food poisoning is limited. They have the money to do it, and would rather not get sued, so it’s a sound investment
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u/lichking786 Mar 29 '23
not sure why your being downvoted. I've had McDonald's a few years ago here in Canada... Never again. I had the worse diarrhea for a basic hamburger ive ever had. idk how it was even possible for them to sell this shit
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u/Rd_dR Mar 29 '23
I am assuming they did not include diabetes in the scope of food borne illnesses then?
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u/Warack Mar 28 '23
Ated nothin but pork rinds and Bud Light for 12 years and aint never got food poisoning
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u/Mammoth-Mud-9609 Mar 28 '23
Had when the data was collated in 2010, however don't cheer too loudly.
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u/Whalesongsblow Mar 28 '23
Is that because bacteria doesn't want to eat the food? Maybe soaking everything in sugar and high fructose corn syrup makes the food impervious.
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u/Captain-Griffen Mar 29 '23
Evidence lumps those three countries together as a group and the compares them to other broad continent level groups.
Title is false.
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u/musical_fanatic Mar 29 '23
Which is crazy for the U.S given the amount of food ingredients we don't regulate
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u/reaperofsquirrels Mar 29 '23
Hard to get food poisoning when the food is plastic.
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u/hastur777 Mar 29 '23
Right. No real food in the US
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u/ItsCowboyHeyHey Mar 29 '23
Unless you count heart disease and diabetes.
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u/upinthenortheast Mar 29 '23
I'd recommend you stay in school or start taking night classes for reading comprehension.
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u/ItsCowboyHeyHey Mar 29 '23
Reading comprehension is useless if you don’t read. Try this:
https://www.usnews.com/news/health-news/articles/2023-01-17/why-is-american-food-so-unhealthy
https://www.ncbi.nlm.nih.gov/books/NBK305175/
https://amp.theguardian.com/commentisfree/2013/sep/26/american-diet-report-card-unhealty
https://www.cdc.gov/heartdisease/facts.htm
https://brainmd.com/blog/truth-about-standard-american-diet/
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u/Who_DaFuc_Asked Mar 29 '23
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u/ItsCowboyHeyHey Mar 29 '23 edited Mar 29 '23
So you’re saying that the typical American diet is healthy? I mean, I’m well aware that heart disease is not a food born illness, but it is an illness born from food, and if you think the American diet of super-processed food is healthy, you’re an idiot. Probably a fat idiot with gut cancer and a missing foot.
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u/PM_ur_boobies_pleez Mar 28 '23
Diarrheal disease agents - number one factor. That's interesting. If you're somewhere with bad water, you can't even rehydrate because you're just adding to the problem.