A Rarely-Considered Angle on Food-Borne Illness

As a food critic who's eaten in tens of thousands of eateries in dozens of countries, I've felt pretty expert about foodborne illness, both experientially and scientifically. But four months with a seemingly unpurgeable Campylobacter infection—so severe that I lost 35 pounds and filled my kidneys with tiny stones from dehydration—proved educational.

Scientists know a lot, and eaters know a lot, but it takes an ordeal like that to bridge the two. I've pieced it all together, and it's useful knowledge for all chowhounds.

There's a widespread notion that greasy little ethnic joints can make you sick because they're careless and sloppy. And while you can get sick anywhere, odds do seem empirically worse in certain venues. It feels xenophobic to ascribe sloppy carelessness to certain groups. Also, it's wrong. Any human grouping cooking dangerously wouldn't last long. Humans are super good at reproducing, defecating, eating, and cooking. Those things are bedrock for us. Every group cooks healthy for their group (or at least did until modernity shifted diet).

So are the perceived perils entirely xenophobic? No. There's a reasonable explanation: the third world doesn't sweat cross contamination. Not because its standards are lower, but because it's usually unecessary...for two reasons. We'll get to those reasons in a moment.

This is a terrible time to be writing this, with a big chunk of America increasingly vocal about third world immigrants as filthy spreaders of pestilence. I'm doing the opposite. I'm explaining what's actually happening, which is perfectly innocent.

Cross contamination, for the few who don't know, is when hands, implements, or surfaces touch raw meat and then come into contact with cooked meat, contaminating the cooked meat. Absurdly extreme diligence is required to prevent this. I'm hyper-aware of the issue, and even I find it difficult to be 100% conscientious in my food handling.

Cross contamination is a fairly recent peril in the First World which, in the 20th century, industrialized its meat handling (densely packed farms and slaughterhouses, multiple processings, etc.). At some point, it became so laborious—i.e. expensive—to keep meat safe through that production line that we gave up trying. As a result, our meat must be handed like medical waste.

Yes. We are the sloppy, careless, dirty ones. And the Third World is unprepared for our slovenliness. In less developed parts of the world, much of the meat is butchered from known animals within a few miles of home, and reasonable butchering/cooking/storing practices keep things safe for people with healthy digestive systems. And people do have healthy digestive systems. Kids play in streets with dodgy sanitation, stoking the super fortified guts and immune systems we all enjoyed before First Worlders began raising kids in sterile bubbles, leaving them asthmatic, colicky, and eternally sensitive.

The Third World has no concept of meat as medical waste, so immigrants may not treat meat like medical waste. They cope in their home cooking because their guts and immune systems are hardy. And when they take jobs as cooks, they learn the strange practices of avoiding cross contamination. We enjoy their food without problems, as their cohorts, licensers, and inspectors ensure they're up to speed (though restaurants in more insular Indian communities may be more prone to old-fashioned cooking methods for the old-fashioned Indian guts of their clientele).

In Portugal, off-the-boat Indians cook largely Indian-style with no sub-community of native-friendly Indian restaurateurs to spread word about the colicky, sensitive stomachs of locals, or about the medical waste nature of industrialized meat. And their largely Indian clientele experience no problems, so they work with no sense of peril.

The good news is that even in worst case scenarios, most of us can endure food-borne illness without medical treatment. 24 hour turnaround is normal. But not me. For various reasons, I'm unusually susceptible, which has forced me to puzzle this all out.

Even for me, there's a solution. A brief (seconds, not minutes) reheating to a modest 165F/74C (internal) kills relevant cooties.

Disclaimer: This reheating advice covers typical cross-contamination scenarios from conscientious kitchens. Truly hazardous pathogens arising from severe neglect require prolonged boiling or sustained high heat, but such outbreaks would make news and you're generally no more vulnerable than anyone else.

A risk scenario between the two extremes occurs when cross-contaminated food sits at room temperature long enough for bacteria to multiply significantly. While brief reheating will still kill the organisms, their abundant microscopic remnants may still pose risks. Such cases, fortunately, are less common. Reasonably diligent chefs from everywhere know to take pains to refrigerate.

Two notes:

1. Use a thermometer to ensure that interiors hit that temperature (position meats at the bottom of the rewarming pan, close to heat source).

2. Be careful of your own cross contamination. Until heated, handle everything like raw meat.

Since I can't possibly train every immigrant in the knotty practice of avoiding cross-contamination (to them it seems like hysterical paranoia—which, in a way, it is), when I want Indian food, I take it home and briefly reheat. No problem. And any thriving business with non-Indian customers is safe, too. Again, kitchens that sicken customers don't last.

I eat tons of Indian food (my Bengali food is cooked by an Ayurvedic practitioner who is extra-healthy in ways even I can't fathom), and I haven't had a recurrence in quite some time. That said, I haven't figured out how I can safely travel to the Third World. My wanderings may be done.


More general advice on gastric issues