When should you not eat romaine lettuce?: A Comprehensive Guide

October 9, 2025 •

4 min read

According to the Centers for Disease Control and Prevention (CDC), millions of servings of leafy greens are consumed safely every day, but romaine lettuce has been at the center of several high-profile foodborne illness outbreaks over the years. These incidents raise a critical question for consumers: When should you not eat romaine lettuce to avoid potential risks?

Quick Summary

Romaine lettuce should be avoided during a recall, if it shows signs of spoilage, or if you belong to a high-risk group for foodborne illness. Proper handling and informed purchasing are essential to mitigate risks associated with raw leafy greens and ensure food safety.

Key Points

Heed Public Health Warnings: Never eat romaine lettuce during a recall or outbreak warning issued by health agencies like the CDC or FDA.
Avoid If High-Risk: Children, the elderly, pregnant women, and the immunocompromised should exercise extreme caution or avoid raw romaine during outbreak warnings.
Check for Spoilage: Discard any romaine that appears slimy, wilted, has a foul odor, or shows excessive browning, as these are signs of bacterial growth.
Opt for Whole Heads Over Bagged: Bagged, pre-cut romaine poses a higher risk of cross-contamination during processing, so choosing whole heads can be safer.
Verify Growing Region: Use labeling information to ensure your lettuce is not from a region implicated in an ongoing E. coli outbreak, as health advisories are sometimes regional.
Prioritize Safe Handling: Always wash your hands and sanitize kitchen surfaces when preparing romaine to prevent cross-contamination, and store it refrigerated.
Consider Cooking: For high-risk individuals, cooking romaine until fully wilted is an effective way to kill potential bacteria and ensure safety.

Understanding Romaine Lettuce Food Safety

Romaine lettuce has faced scrutiny due to its susceptibility to contamination, particularly with E. coli. The primary concern stems from how and where it is grown and processed. The vast majority of romaine in North America comes from large agricultural areas with adjacent cattle farms. E. coli O157:H7, a particularly virulent strain, lives in the intestines of healthy cattle and can contaminate crops via water runoff from fields contaminated with animal feces. Because romaine is often consumed raw, there is no cooking step to kill harmful bacteria, making safe handling and proper sourcing critical. While food producers have implemented additional safety measures, and regulations have been strengthened, vigilance remains essential.

Recalls and Outbreaks

The most obvious and immediate reason to avoid romaine lettuce is during a public health advisory or recall. Federal health agencies, such as the Food and Drug Administration (FDA) and the CDC, issue these warnings when an outbreak of foodborne illness is linked to a specific product or growing region. These advisories can change quickly, so it is important to stay informed by checking reputable news sources and health agency websites. In some cases, warnings are broad, advising against all romaine from a particular region, especially if the source of contamination is not fully identified. The complexity of the food supply chain and processing can make pinpointing the exact source challenging. For example, a single contaminated head of lettuce can cross-contaminate entire batches during processing, increasing the risk, especially with bagged and pre-cut greens.

Special Consideration for High-Risk Individuals

While a healthy adult may recover from a mild foodborne illness, certain populations face a much higher risk of severe complications, such as hemolytic uremic syndrome (HUS), a type of kidney failure. These groups should exercise extreme caution and may consider forgoing raw romaine altogether, especially during periods of increased public health warnings.

High-risk populations include:

Children under 5 years of age
Adults over 65 years of age
Pregnant women
Individuals with compromised immune systems (e.g., due to cancer treatment, diabetes, or autoimmune disorders)

Signs of Spoilage and Improper Handling

Even outside of a major recall, there are clear signs that romaine lettuce should not be eaten. Spoilage indicates microbial growth that could be harmful. Always inspect your lettuce for freshness. You should not eat romaine lettuce if it:

Is wilted and slimy: This is a clear indicator of decomposition and bacterial growth.
Has an unpleasant odor: A foul smell suggests the lettuce has gone bad and may contain harmful bacteria.
Shows significant discoloration: While some pink or red edges are safe, widespread browning or dark spots indicate oxidation and potential spoilage.
Has been left unrefrigerated: Bacteria multiply rapidly at room temperature. Romaine should be stored in a refrigerator below 41°F.

Comparing Romaine Safety: Whole Heads vs. Bagged

When it comes to potential contamination, not all romaine is created equal. Whole heads and bagged lettuce present different levels of risk due to how they are processed and handled.


Feature	Whole Head Romaine	Bagged/Pre-Cut Romaine	Primary Difference
Handling	Minimal handling before purchase. Inner leaves are less exposed to external contamination.	Processed, chopped, and bagged in a central facility, increasing touchpoints.	Less processing reduces opportunities for cross-contamination.
Washing	Requires thorough washing by the consumer. Can remove surface dirt but not internalized bacteria.	Often labeled as "ready-to-eat" or "triple-washed." Rewashing isn't necessary and can introduce new bacteria.	Whole heads allow for more thorough washing of individual leaves.
Contamination Risk	Lower risk for inner leaves compared to bagged. Contamination more likely on outer leaves or from irrigation water.	Higher risk of cross-contamination if one head of lettuce is compromised during processing. Releases plant juices that feed bacteria.	Centralized processing can spread bacteria across a large batch of product.
Traceability	Can be difficult to trace back to a specific farm if sold unpackaged at a market.	Generally has better traceability via packaging labels and codes.	Packaging helps identify the source, aiding recalls.

Cooking Romaine Lettuce

For those who are highly concerned about raw romaine, cooking offers a viable solution. Heat kills E. coli and other bacteria. While it may seem unusual, romaine can be added to stir-fries or braised to reduce risk. Cooking until fully wilted ensures it has been heated enough to be safe.

Conclusion

Romaine lettuce can be a healthy part of a balanced diet, but its history of contamination means consumers must remain cautious. Always heed public health advisories, be selective when purchasing, and handle it properly at home. High-risk individuals should be especially prudent. By staying informed and following best practices, you can enjoy romaine while minimizing the risks associated with it.

How to reduce your risk:

Stay informed: Regularly check FDA and CDC websites for any food safety alerts regarding romaine lettuce.
Check the label: When buying bagged romaine, look for a growing region label. Avoid products from regions identified in an outbreak.
Choose whole heads: Whole heads of romaine generally have fewer handling touchpoints, and the inner leaves are less likely to be contaminated.
Wash properly: For whole heads, remove outer leaves, wash hands and surfaces thoroughly, and rinse individual leaves under running water before use. Do not rewash pre-washed, bagged varieties.
Store correctly: Refrigerate lettuce promptly and keep it separate from raw meats to prevent cross-contamination.
Consider cooking: If you have a compromised immune system or are especially concerned, consider cooking romaine to kill any potential bacteria.

Frequently Asked Questions

Yes, unless there is a specific recall or public health advisory from the CDC or FDA. The Centers for Disease Control and Prevention states that romaine is safe to eat as long as it has not been recalled.

The main risk is contamination with harmful bacteria, most notably E. coli O157:H7, which can cause severe foodborne illness. This bacteria can come from contaminated irrigation water, especially in areas near cattle farms.

Washing lettuce can remove surface-level dirt and some bacteria, but it is not a guarantee against E. coli contamination, which can sometimes be internalized within the leaves of the plant. Washing is not a substitute for heeding a recall warning.

Children under 5, adults over 65, pregnant women, and individuals with weakened immune systems are at a higher risk of developing serious complications from foodborne illnesses.

Yes, bagged lettuce generally carries a higher risk because the chopping process creates more surfaces for bacteria to adhere to and releases plant juices that can promote bacterial growth. If one head is contaminated, it can spread to the entire batch during processing.

Yes, cooking romaine lettuce can effectively kill E. coli and other bacteria. Braising or adding it to a stir-fry and cooking until it is fully wilted will typically heat it enough to be safe.

You can find up-to-date information on food safety recalls and advisories on the websites for the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC).