Pleasures and pitfalls of eating / by Fritz K. Käferstein

G ood food is one of the greatest pleasures in life . Significant events in our lives are fre-quently celebrated with festive meals which reflect basic cultural values or religious convictions, or even national pride. But most pleasures also have pitfalls. The joys of eating can be overshadowed by contaminated food which may cause foodborne diseases that lead to nausea and abdominal pain, often followed by vomiting and diarrhoea . This causes embarrassment and inconvenience or severe discom- fort which can be disruptive. For the vulnerable groups - the pre- school child, the elderly or the ill - the outcome may be fatal. Other diseases acquired through food and beverages include typhoid and paratyphoid fevers , botu- lism , poliomyelitis, hepatitis A and various parasitic infections. While the risk of an individual catching a foodborne illness is statistically small, the total number of people affected and the harm caused makes food- borne disease a serious public health consideration. However , it is not worth worrying that every meal might cause disease . First of all , it is important to realise that chemicals are rarely implicated in food-associated ill- ness, contrary to the beliefs and fears of the majority of con- sumers, particularly in industria- lised countries. There is no evidence of harm to humans when food additives and agro- Cooking for the family in Colombia. Homemakers everywhere have a special responsibility for making sure that the food is well-cooked, well-stored and therefore safe. Photo WHO/P. Almasy Pleasures and pitfalls of eating by Fritz K. Kaferstein chemicals are used according to legal requirements. The illegal . use of chemicals in food masks poor quality and spoilage, and constitutes a deliberate adult- eration; it is also potentially harmful to health . However, food control authorities and the responsible food industry assure us that the illegal use of chemicals is the exception rather than the rule . Secondly, it is clear that we as consumers, in particular as travellers and homemakers, can protect ourselves from food- borne disease by observing certain rules . ''Be careful what you eat'' is common advice to travellers, but few people understand its impli- cations. Detailed advice on the general principles of food safety is crucial to the traveller. Caution in choosing and preparing food and beverages offers the best protection. It is unfortunate that contaminated food may appear extremely appetising. Appear- ance, therefore, is no guide to food safety. Eating safely when travelling means we cannot always eat when, where and what we want. The most important precaution is to consider any uncooked food (or unpasteurised milk), other than fruit and vegetables which can be peeled or shelled, as contaminated and thus potentially unsafe . It is important that hot dishes have been properly and recently cooked. If foods have been cooked in advance, they should be held at temperatures at or below 10 degrees C, or at 60 degrees C or above. Cooked foods kept at ambient temper- atures for more than four or five hours are a primary cause of foodborne disease . Unpasteurised milk should be boiled before drinking ; ice- cream is another common dan- ger . Unless drinking water is known to be pure, it should be boiled or chlorinated. Ice cubes should be avoided unless they are made from pure water. It should not be automatically assumed that non-carbonated drinks and water (even bottled) and fruit drinks are safe. Tea or coffee, however, which are usually made with boiling water can normally be drunk safely; the same is true of beer and wine. Slow-release disinfectant tablets in water, or filter attachments on domestic taps can be used if proved to be safe. Travellers A family meal in the Philippines. Cleaning the plates and utensils is part of the mealtime ritual in many Asian communities. Photo WHO/P. Almasy WORLD HEALTH 11 /88 The first of the TEN GOLDEN RULES FOR SAFE FOOD PREPARATION in the home (or restaurant) is to eat the food as soon as it has been cooked. Since many raw foods are contaminated with foodborne pathogens, it is important to make sure that food is thoroughly cooked, particu- larly poultry, meats and milk. Thorough cooking means that the temperature of all parts of the food reaches at least JOOC. In many societies the consumer can choose between foods which, for safety reasons, have been processed and those which have not. So the third of the ten golden rules is to choose foods processed for safety. For instance, choose pasteurised milk instead of raw milk, and irradiated fresh or frozen poultry instead of non-irradiated. It is not always possible to eat food immediately it has been cooked, especially when it has to be served on several occasions. If it needs to be kept for more than four or five hours, it must be stored either in hot (near or above 60°C) or cool (near or below l0°C) conditions. A common error, responsible for countless cases of foodborne illness, is putting too large a quantity of warm food in the refrigerator. Microbial proliferation, reaching disease-producing proportions, will occur in the centre of food which remains at a high temperature (above lOoC) for too long. Food for infants should preferably not be stored at all. The next rule is to make sure that food already cooked is reheated thoroughly (reaching JOoC throughout) prior to eating. In this way microbes which might have developed during the storage period will be killed, thus preventing infection or intoxication. Avoid contact between raw foods and cooked foods is another important measure to prevent foodborne disease. This contact could be direct (raw poultry meat coming into contact with cooked foods) or indirect (preparing an uncooked chicken and then using the same, unwashed cutting board and knife to dissect the cooked bird). In this way the cooked food is recontaminated, with all the potential risks for microbial growth and subsequent illness. Keep an kitchen surfaces meticulously clean; this is the seventh golden rule of food safety. Utensils, plates, cutlery and so on should be wiped with a clean cloth which should not, as a rule, be used for more than one day. The cloth should then be boiled for re-use. Separate cloths for cleaning the floor also need frequent washing. Wash hands before handling food is another vital prerequisite for food safety. This commandment applies in particular after using the toilet and after changing a baby's nappy. Hand infections are frequently pus-filled and the microbes responsible for the infection may cause foodborne illness. So it is important to prevent contact or to bandage injuries. Protect foods from insects, rodents and other animals is the next rule. Animals frequently carry pathogenic microorganisms which cause foodborne disease. The last of the ten golden rules of food safety, but by no means the least important, concerns the purity of the water supply used for drinking and food preparation. If any doubt exists, the water should be boiled or chlorinated. And, as for travellers, slow-release disinfectant tablets in water or filter attachments to domestic taps may be used, if proved to be safe and reliable. By following this advice, the risk of foodborne illness will be reduced significantly. In this way, good food will continue to be one of the greatest pleasures in life. WORLD HEALTH 11 /88 Sharing a meal and eating good food - one of the great pleasures offamily life. Photo WHOjP. Almasy should always re me mber the fo llowing popular dictum: cook it, peel it or leave it. During certain months of the year, some species of fish and she llfish may contain poisonous b iotox ins , eve n wh e n we ll- cooked . Local p ub lic he a lth authorities can advise on these dangerous species. If the re is any d oubt ab out food safety, consuming smalle r quanti- ties can p ose less risk, s ince the bod y 's normal gastric acid has a p rotective effect. It is better to miss a meal - and even to lose a little weight - than to risk illness. The homemaker , for obvious reasons , has several additional possibilities to ensure that the foo d he or she is p reparing does not cause illness. From epidem- iological investigations we now know the most common factors responsible for foodborne ill- ness: several are due to time- temperature abuse. As already mentioned , keeping cooked food at ambient temperature for four or five hours is one of the g r eates t ri sks o f food borne disease. WHO recommends ten "golden rules" for safe food (see box on the le ft). Travelling far from home, we are particularly vulnerable to food illness. The safe rules are: cook it, peel it or leave it. Photo WHO/M ]acot Health workers need to convince families about the benefits they will derive from choosing a sensible diet. Photo WHO JP. Almasy Breast-feeding is the natural way of ensuring good nutrition and immunity from infections in young babies. Photo WHOjZafar Growth monitoring: an entry point for the health of the whole community. Photo WHOjT. Kelly 8 WORLD HEALTH 11 /88