In recognition of food safety month, Food Safety News is profiling people whose lives have been altered or ended by a foodborne illness. In this series, we hope to illustrate the devastating effects that food poisoning can have on victims and their families, and the importance of making our food system as safe as possible. 

The Armstrong family’s daily routine looks dramatically different than it did five years ago, when both daughters were healthy. Now the youngest, Ashley, takes five medications a day, requires weekly blood tests, and will likely require multiple kidney transfers throughout her life. Why? Because one day in August, 2006, the family ate fresh spinach.

Unfortunately the meal, intended as a nutritious option for two growing girls – Isabella, age 4 and Ashley, age 2  –  instead gave the Indiana children serious E. coli infections that would sicken both and threaten Ashley’s life.

A few days after eating the spinach salad, made with Dole brand baby spinach, Isabella started experiencing diarrhea. Instead of getting better after a few days, her symptoms worsened. Four days after her illness began, her mother Elizabeth took her to the doctor, who said Isabella probably had a virus, and sent her home with instructions to stay hydrated.

The following day, just as Isabella’s health was finally beginning to improve, Ashley developed diarrhea. Thinking that Ashley had caught the same “bug” as Isabella, Elizabeth and her husband Michael assumed she would also recover in a few days’ time if they gave her plenty of liquids.

But by late afternoon, Ashley had become lethargic and was refusing all food – a marked change for a girl who usually loved to eat.

The next morning, Ashley slept far longer than usual. When she awoke, she was barely moving. Her parents had to change her diapers almost a dozen times before noon as her diarrhea worsened. When streaks of blood began to appear in Ashley’s stool, Elizabeth immediately took her into the doctor’s office, where a sample of Ashley’s blood was taken.

Hours later, Elizabeth received a gut-wrenching phone call. The blood test had shown Ashley to be severely dehydrated. She needed to be taken to the hospital immediately.

Once there, doctors inserted a urinary catheter, a traumatizing experience for the 2-year-old. As the day progressed, Ashley was unable to produce any urine, and began to vomit a substance that turned progressively darker and greener, eventually becoming almost black, a sign that blood is present.

And Ashley’s condition continued to worsen. Her body began to appear puffy, a condition that prompted doctors to take more tests. She had begun to cry inconsolably, and refused to be touched or held. She started exhibiting behavior her parents had never seen before, thrashing around her crib “like a caged animal,” screaming and clawing at her IV lines.

Finally, lab results showed that Ashley’s kidneys were failing.  Ashley had developed hemolytic uremic syndrome (HUS), a condition that arises when toxins produced by E. coli bacteria get into the bloodstream and damage the tissues of small vessels. The resulting decreased blood flow compromises the kidney’s ability to filter waste from the body.

If Ashley did not receive dialysis, a method of blood filtration, she would die.

She had also suffered damage to her pancreas, which explained her vomiting.

It later turned out that swelling to Ashley’s brain had caused her violent and uncharacteristic behavior.

Ashley was transferred to the pediatric intensive care unit at Riley Children’s Hospital in Indianapolis for specialized treatment. A catheter for dialysis was inserted, along with a central venous line into Ashley’s chest. Ashley was put into an isolation room, and continuous dialysis was begun.

Elizabeth recalls the anxiety and worry of seeing her daughter so sick.

“If you’ve never had a seriously ill child, it’s hard to understand the strain that living in a hospital puts on you. You were, of course, worried sick about whether your child would make it through at all, let alone be normal again.”

At this point, Ashley’s small body had become horribly swollen. She was unable to keep fluids or water down, and her dialysis catheter filled up with bloody drainage.

“In the first few days and weeks we watched Ashley go from being swollen from excess fluid, to dehydration when too much was removed,” recounts Elizabeth.  “She looked like a skeleton…Our lives were consumed by fear and uncertainty.”

Finally, days later, Ashley’s condition began to improve, and she was able to produce a small amount of urine. A month after she had entered the hospital, she was transferred out of the intensive care unit, and two weeks later her IV was removed.

Doctors trained Michael and Elizabeth in how to administer dialysis themselves, so that Ashley could be transferred home, a move she made after six weeks of hospitalization.

Administering dialysis at home put intense stress on Ashley’s parents, who worried that if they removed too much fluid, or too little, they would either dehydrate her or cause her blood pressure to spike. One day during a treatment, her blood pressure reached 170, and she was rushed to the hospital.

After 4 months of dialysis, Ashley’s treatment was finally finished. But her struggle with the repercussions of her E. coli illness was just beginning. Her doctors say it will be difficult for her to achieve normal growth, and she will likely require two to three kidney transplants over the course of her life, before which she will require extended periods on dialysis.

While Ashley was hospitalized, investigations revealed that she and Isabella had been victims of an outbreak of E. coli O157:H7 linked to Dole bagged baby spinach. The epidemic ultimately sickened 205 people across the country, claiming four lives and resulting in 104 hospitalizations. Thirty other victims suffered HUS infections like Ashley’s.

In the short term, as the wait to see what Ashley’s long-term health will bring, the Armstrong family is taking their life together one day at a time.

“Unfortunately, giving multiple medications and shots, and worrying about the results of Ashley’s blood test are just a part of life now,” says Elizabeth.

Household meals are structured around Ashley’s severely limited diet, which ironically cannot include most fresh fruits and vegetables. The family faces medical expenses that will rise exponentially if Ashley requires a transplant.

“We were eating very healthy foods. We were eating fresh spinach. That’s what they tell you to eat all the time. That’s one of the healthiest greens that you can eat for your family, so that’s what we were doing,” said Elizabeth in an interview with CNN in 2010.

“It’s really hard to think of how her life is going to be limited. She might not get to be able to have all of these fun family experiences, nor Isabella, because of this. Everything has changed and we still don’t know how to deal with all of it.”


  • Laura Slitt

    E-Coli and ALL OTHER food contaminants do NOT originate in plant foods, like the media would tell us. E-COLI, Salmonella, Listeria, ALL ORIGINATE from animal waste, animal feces, probably from either factory farm run off or the fertilizer used to grow produce.
    STOP BLAMING the spinach, tomatoe, or other vegetable…these items do NOT produce animal based bacterias’
    If our food system contained what we are suppose to eat, ONLY plant based foods, and animal manure getting more dangerous from the resistant bugs that are being created from the gross overuse of powerful antibiotics, we’d NEVER see illness or death from E-Coli.
    The FDA protects agribusiness always, NOT our public health.
    People should LEARN just how dangerous these government agencies have become. Read Michele Simons book, “Appetite For Profit.”
    My blood boils when spinach or other veggies are blamed for bacteria strains ONLY sourced from animals.

  • Sonya Reiser

    I wish I could agree with your comment that we are supposed to eat ONLY plant based foods. Unfortunately, MY blood boils when I hear people blaming all illness on an omnivorous diet.
    I read Diet For A New America at the impressionable age of 20. I fell in complete compliance with the radicalism of the vegan community. I identified myself as a Vegan as if I came from another planet rather than just a human being making a choice to follow a vegan diet. How preposterous! The folly of youth. A choice I live to regret.
    I convinced myself I felt great. I didn’t eat any produce from giant manufacturers such as Dole. I supported my local, organic farmers. I ate soy protein, lettuce, micro greens, cruciferous cabbage family produce, nuts, and fruits. I tried so hard to carry on this way with my husband and all of our friends. I never thought to blame SIX years of a vegan diet for my increasing health issues. I was killing myself.
    I now suffer severe thyroid dysfunction. I have made myself allergic to whole grains, I have irritated my bowels and thrown my hormonal balance so far off. My adrenals are shot. I am lucky to wake up with a body temperature over 95.5. My metabolism is slow and I have suffered so many years of inflammatory issues I have pain in every joint and spurring in my spine. Soy and other plant based foods make my body attack me.
    There is no universal diet. My husband thrived while following a vegan diet but he has a totally different ethnic background than i do. My body has different needs.
    I wish “vegans” would stop identifying themselves as Vegan, as if it were a race. I wish that they could open their eyes and realize that their global vegan dream wont bring a utopian age of health and wellness for all. If you fed me a vegan diet for one week you would witness my systemic swelling and bleeding orally and rectally while crippling pain takes over. Perhaps you would feel bad for hurting me. your intentions would have been good but I would suffer. Taking away clean, fresh dairy and lean, well raised meats from me would be unethical.
    I believe it IS ethical to raise animals for food. However as Temple Grandin explains, we owe these animals a decent life and a calm, painless death. Nature is cruel but we don’t have to be. I hear you are saying that the unethical practices that allow animal waste and run off to be contaminated by sick animals and bad feed is an outrage – and I agree. However your opinion that all people are “supposed” to rely on a plant based ONLY diet is inaccurate and dangerous. Those who refer to themselves as Vegans on a global mission are biased and prejudiced against people that live a higher quality of life on an omnivorous diet. It is dietary evangelism based on a nutritional plan. My blood is boiling just thinking about the narrow vision those who choose this lifestyle opined. All the Thanksgiving family strife and arguments that happen because someone thinks their whole family is dying from meat and dairy. Fighting over food one chooses to put in their body is akin to arguing fantically over which brand of tampon to insert. It is a personal thing.
    Meat eaters and vegetarians need to respect one another and understand that what may make you feel healthy and at peace is not the same for everyone. Vegetarians need to understand that animal husbandry can be healthy and gentle if we insist upon it. I want you to have the same concern for my access to healthy meat based foods as I have for your access to clean and safe produce.
    The last thing left on my soapbox directed towards you Laura and all global vegan diet advocates is in regards to soy. Soy has very unhealthy potential and is not always good for you. It can have an impact on the endocrine system and can cause cystic ovarian conditions. Many soyfoods that use non genetically modified soy are extremely processed and condense a huge amount of soy into a small amount of food. I have close friends who were raised as lifelong Vegans who now have to cut way back on their soy because of thyroid and other hormonal imbalances.
    Alright Laura, my seething blood is now down to a slow simmer. I know this comes of strong but I am speaking from the heart and from a life on both sides of the vegan fence. I wish you and people following all types of diets happiness, freedom and an abundant access to safe and healthy foods to suit their individual needs as unique human beings.

  • Ashlee

    Thank you Sonja.
    As one of the victims of the spinach outbreak in 2006 myself, it infuriates me to no end when I hear people essentially “blame the victim”. I have educated myself about the food industry, and understand pretty well how this stuff gets to our dinner tables. There are certain foods that I would not touch with a ten foot pole. Ground beef and sprouts top the list, spinach makes it on there for the sheer fact that it landed me in the ICU for 2 weeks+.
    You don’t want to blame the spinach and the produce industry for their blatant negligence. But instead, who do you want to blame? You would rather the government force regulation on the beef industry and just hope that the trickle down effect keeps your salad safe? I’ve got news for you. They are growing your salad in a literal pile of shit. Not thinking that the spinach grower is responsible for that is ignorant.
    At some point people have to wake up. These outbreaks are not stopping or lessening in severity. Making everyone vegan doesn’t solve where this countries food safety is headed. Americans will never stop eating hamburgers. That’s the end, there is no more.
    Like Sonja said, we have to make food safety that works for everyone. And that isn’t just about killing the bugs, it is about education. Our food system is international, but our food safety is mostly localized. Leaving the burden in these outbreaks to local government agencies to back peddle and find the vector while more people fall ill.
    It doesn’t matter that I’m now afraid of certain foods, there will be a new strain and a new outbreak around every corner. Becoming a vegan won’t change that. In fact, it would lead to death by starvation as the world wouldn’t be able to sustain the population on vegetables alone.

  • Nick

    Ashlee, It’s my understanding that if one devotes a given amount of land to raising vegetables and the same amount to raising cattle (for example), the one with veggies will make more food. I’ll have to check that out again.
    Sonya, I’m vegetarian and have found that the only problem at Thanksgiving is when I’m singled out and attacked or made fun of for not eating the turkey (something that has eased off with the years, but there are some parts of the family that have been avoided for those years.) A couple of times the grandparents have tried to sneak dead animal to the children.
    I’m so sorry about your health problems. It sounds like you had too much of some things, and that you were allergic to some of them. That’s terrible. It’s not the same thing as veganism being bad, though. I’m guessing you’ve been tested for Crohn’s disease, colitis and similar ailments? My digestive issues are more with meat…makes me feel awful…always did, especially beef. I don’t miss it. My allergies tend to surface with too much wheat…not sure if it’s the wheat itself, but my brother’s allergic, so maybe it is…
    I guess you’re from a different sort of area than I am. Our vegan community is very inclusive…I’ve only felt snubbed once for being a vegetarian and not a vegan (and I think she just didn’t like me, anyway 🙂 .) But they’re a minority here, thus the inclusiveness probably.
    Of course, it isn’t okay to attack a person for their beliefs–whatever side you fall on. (I don’t think Laura was attacking, but defending…not sure if that’s what you were feeling on that.) Even when my family has attacked, I’ve respectfully disagreed and left it at that…unless they kept on. Then, I quoted a statistic or two or mentioned some article or documentary I’d seen about the meat industry and they got grossed out and left me alone. Otherwise, I don’t bring it up. Live and let live…just don’t try to take out a cow in front of me 🙂 .

  • husna aijaz

    I am truly sorry to hear the devastation this family has undergone. Only a parent whose child has undergone a food borne illness/tragedy can relate to another suffering in the same manner.
    As a trained food scientist, I can tell you that plants can get contaminated by animal manure in the fields. It can even happen at the food plant,if an employee does not follow safe handwashing guidelines (most do not). The result: huge loss for the reputation of the company and devastating health effects on its customer. Secondly, the food industry packs the veggies in MAP packages. Even though aerobic pathogens cannot grow in them, they are likely to be exposed to anaerobic bacteria.
    My advise: Please remember to wash your bagged veggie every time you open it, even if it is triple washed. Do not use the bagged produce after the sell by date.