Person feeling unwell
Fried rice syndrome refers to food poisoning, when food has been left out. The connection with fried rice dishes arises from the way fried rice is prepared and stored. Image Credit: Shutterstock

When in doubt, throw it out: That’s the age-old food adage and it’s never been more relevant.

In the latest episode of what-can-make-you-seriously ill brought to you by TikTokers, leftover food can make you seriously ill, or even cause death, apparently.

Recently, a series of videos went viral online. The videos referred to a report of an American college student in his twenties, who died after eating room temperature spaghetti that had been left out for over two days, was contaminated with Bacillus Cereus, a toxin-producing bacteria that causes food poisoning. The case, which was explained on the global medical research platform - the National Library of Medicine, said that the man experienced several symptoms, including headache, abdominal pain and nausea. He passed away in his sleep, that night itself. It’s an old case, similar to the one that emerged in March 2021, when a man suffered the same symptoms after consuming leftover noodles left out for days. He survived, but with several amputations.

This syndrome has now been coined ‘Fried rice syndrome’, stirring much discussion online. What is it, and how can it be prevented?

Why is it called the Fried Rice syndrome?

Bowl of fried rice
When rice is left at room temperature, bacterial spores can multiply and produce harmful toxins. If these toxins are ingested, it can lead to symptoms of food poisoning. Image Credit: Shutterstock

What does fried rice have to do with it?

“It is a colloquial term referred to food poisoning, associated with a bacterium called Bacillus Cereus,” explains Cynthia Khalil, dietician and nutrition expert from Dubai-based Medcare clinic. “This kind of bacteria is often connected to foodborne illnesses. The connection with fried rice dishes arises from the way fried rice is prepared and stored,” she adds.

Elaborating more on the connection between this specific bacterium and fried rice, Khalil says, “Bacillus cereus is often associated with fried rice, owing to the preparation of the dish. In many cases, the rice is cooked, but left at room temperature for extended periods before it is fried. This practice is an ideal environment for the bacterium to thrive and produce toxins,” she says.

Bacillus cereus is often associated with fried rice, owing to the preparation of the dish. In many cases, the rice is cooked, but left at room temperature for extended periods before it is fried. This practice is an ideal environment for the bacterium to thrive and produce toxins...

- Cynthia Khalil, nutritionist, Medcare Clinic

This bacterium can be troublesome, because it has a weapon that other bacteria doesn’t have: It develops spores. These spores can withstand heating during the cooking process, explains Khalil. So, while heating leftovers can kill other bacteria, it might not impact the Bacillus Cereus. The spores are usually dormant, but if they’re left in the right temperature and conditions, they can grow. That’s what makes us unwell.“

Bacteria and temperature
Bacteria are present everywhere, and many of them thrive at temperatures between 40°F (4°C) and 140°F (60°C). This temperature range is often referred to as the ‘danger zone’. When food is left outside in this temperature range, any bacteria present on the food can multiply rapidly.

When rice is left at room temperature, these spores can multiply and produce harmful toxins. If these toxins are ingested, it can lead to symptoms of food poisoning,” she adds.

What kind of leftover food can cause illnesses?

Person sick
While the near-invisible bacteria can wreak havoc on your food, there are other factors to ruin your health, and your mood. There’s dust, insects and airborne bacteria too Image Credit: Shutterstock

The name is fried rice syndrome, but it extends to different kinds of food, too. That includes pizza too, sorry folks.

In light of the recent conversations online, healthcare professionals have rushed onto TikTok to soothe frazzled nerves and answer people’s questions. Many people appear to have rather skewed ideas of food hygiene, as conveyed by American sports dietician Kyndall Weir. Weir recalled a client who was eating the same pizza, over a week without storing it in the fridge. Needless to say, that’s a recipe for disaster.

Shazma Mithani, another doctor posted a video on TikTok saying, “Do not leave starchy food like rice, pasta, or potatoes out at room temperature,” she explained in the video. She explains that “starchy” food can be more prone to the bacteria exposure than other foods.

While the near-invisible bacteria can wreak havoc on your food, there are other factors to ruin your health, and well, your mood. There’s dust, insects and airborne bacteria too. When you leave food outside, you expose it to such contamination, explains Khalil. These contaminants can introduce additional bacteria and pathogens in the food.

Apart from pathogens, you need to remember that humid temperatures can affect your food as well. “It might not necessarily make you sick, but it can taste bad or have an unpleasant texture,” she says.

Khalil tells us in detail the different kinds of food that shouldn’t be left outside:

Person refrigerating food
Precut fruits and vegetables should be stored at low temperatures to prevent bacterial growth. When left unrefrigerated, these items can become contaminated and lead to illnesses. Image Credit: Shutterstock

Meat and poultry: Raw meat and poultry, including chicken, beef and seafood, are highly perishable and can be teeming with bacteria. If not stored at the right temperature (below 40°F or 4°C) in a refrigerator, these foods can quickly spoil and become sources of foodborne pathogens.

Dairy products: Milk, cheese, yogurt, and other dairy items can get spoiled, if not refrigerated. Contaminated dairy products are a common source of foodborne illnesses, particularly due to the presence of pathogens like Listeria Monocytogenes that causes Listeriosis, with symptoms including fever, muscle aches, fatigue, headache, stiff neck, confusion, loss of balance and seizures.

Milk
Milk, curd and other dairy items should be refrigerated. Image Credit: Pexels.com

Eggs: Eggs should be stored in the refrigerator to prevent the growth of Salmonella bacteria. When eggs are left out at room temperature, the risk of contamination and foodborne illness increases. Salmonellosis is an infection that causes diarrhea, fever and stomach cramps, and spread through feces that contaminate food and water, as per the Mayo Clinic website.

Cooked rice and pasta: Cooked grains like rice and pasta can become a breeding ground for Bacillus Cereus when left at room temperature for an extended period. This can lead to the Fried Rice Syndrome.

Pasta
Pasta can become a breeding ground for bacteria. Image Credit: Pexels.com

Prepared salads: Items like potato salad, coleslaw, and other salads that contain mayonnaise can get spoiled quickly if left at room temperature. Mayonnaise is an ideal medium for bacterial growth.

Cut fruits and vegetables: Precut fruits and vegetables should be stored at low temperatures to prevent bacterial growth. When left unrefrigerated, these items can become contaminated and lead to illnesses.

Salads
Items like potato salad, coleslaw, and other salads that contain mayonnaise can get spoiled quickly if left at room temperature. Mayonnaise is an ideal medium for bacterial growth. Image Credit: Pexels.com

Leftover cooked foods: Any cooked food, such as casseroles, soups, and stews, can pose a risk if not stored properly. Bacteria can multiply rapidly in leftover dishes if they are not refrigerated promptly.

Canned foods: While canned foods have a longer shelf life, they can also become unsafe, if the cans are damaged, dented, or corroded. This can lead to the growth of harmful bacteria, including the risk of botulism in certain cases. This toxin is made by Clostridium Botulinum and sometimes Clostridium Butyricum, and Clostridium Baratii bacteria.

The toxin attacks the body's nerves and causes difficulty in breathing, muscle paralysis, and even death. The botulinum toxin has been found in a variety of foods, including low-acid preserved vegetables, such as green beans, spinach, mushrooms, and beets; fish, including canned tuna, fermented, salted and smoked fish; and meat products, as per the World Health Foundation.

Shellfish: Oysters, clams, mussels, and other shellfish are highly perishable and need to be kept cool. Eating spoiled shellfish can lead to gastrointestinal illnesses.

Can leftover food really be fatal?

There is no need for panic, as Chaitra Joshi, a nutritionist and food safety expert  explains. However, she warns that you still need to be careful. “You just need to take basic precautions and use common sense, when it comes to storage and food hygiene at home,” she says.

Referring to the illnesses, she says, “Usually, such cases result in severe abdominal pain and nausea. The symptoms, including nausea, diarrhea normally last for 24 hours and then subside. If it lasts for more than a day, do check in with a doctor. There is a small percentage of severe cases that can actually lead to amputations or death, but let’s not take the risk,” she says. However, those with a weakened immune system are at more risk, especially those with injuries or trauma

Joshi adds that such illnesses are comparatively rare.

How can we prevent such illnesses?

Joshi advises the two-hour-four-hour rule. If you have left something out of the fridge for two hours, you can put it back. If it has been out for more than four hours, it can be a risk.

Joshi and Khalil break down how we can follow food safety practices at home:

Refrigeration

Make sure that perishable items, such as meat, poultry, dairy products, and cooked dishes, are promptly stored in a refrigerator set at or below 40°F (4°C). The cold temperature slows down the growth of harmful bacteria.

How to refrigerate
You need to ensure the freshness of safety of perishable foods like meat, seafood, dairy products, eggs, leftovers, salads. The safe storage items vary for each product. For instance, raw meat should be consumed within 1 to 2 days. Dairy products last 5 to 7 days. Eggs can remain fresh for 3 to 5 weeks. Deli meats, cooked rice, pasta, tofu, and meat substitutes all have their recommended safe storage periods

Immediate cooling

When cooking rice, pasta, or any food item that needs to be cooled, cool it immediately. Divide large portions into smaller containers and refrigerate or freeze them. Avoid leaving cooked food out at room temperature for extended periods.

Safe food handling:

It sounds basic, but it’s essential: Wash your hands thoroughly before cooking or handling food. Use clean utensils and cutting boards to avoid cross-contamination.

Canned goods:

Check your canned goods for signs of damage, such as dents or rust before use. Be aware of expiration dates and follow proper storage recommendations.