April 18, 2025, 4:00 am | Read time: 4 minutes
In 2008, a tragic case occurred when a student from Belgium died from the so-called “fried rice syndrome.” The 20-year-old had eaten five-day-old, unrefrigerated pasta. But why is the syndrome named after rice, and what was in the deadly pasta? FITBOOK nutrition expert Sophie Brünke explains the background and how you can protect yourself.
The young student was not an isolated case. The World Health Organization estimates that 420,000 people worldwide die each year directly or indirectly from foodborne illnesses.1 But what makes food so dangerous to our health? Should we avoid pasta and rice? Here you will find everything you need to know about fried rice syndrome.
Overview
What is Fried Rice Syndrome?
Since 1965, numerous food poisonings or illnesses have occurred in Europe from consuming milk, ice cream, fish, cooked meat, and poultry as well as soups with meat and vegetables. The term “fried rice syndrome” originates from the first reported case of a contaminated rice dish in a Chinese restaurant.2
In the case of the young student from Belgium, the investigation of the pasta showed it was contaminated with emetic strains of Bacillus cereus and high amounts of cereulide, a toxin produced by these bacteria. Symptoms such as headaches appeared within ten hours, followed by nausea and diarrhea. The “Journal of Clinical Microbiology,” which documented the case, lists liver failure and possibly colon necrosis as the cause of death.3
The Culprit: Bacillus cereus Forms Heat-Resistant Spores
Bacillus cereus is a spore-forming bacterium found worldwide. Due to contamination with spore-containing soil particles or dust, the bacterium easily finds its way onto food. Typically, the initial contamination dose in food is low and poses no health risk. However, complete contamination is difficult to avoid because the spores of the bacterium are true survivors–whether it’s cold, heat, or dryness. These spores germinate when food is not stored correctly–even in your own kitchen!4
The bacterium can cause two different foodborne illnesses: emetic illness and diarrheal illness.
Emetic Illness
The term emetic means “causing vomiting.” After consuming contaminated food, nausea and vomiting occur within 30 minutes to six hours. The cause is the previously mentioned toxin cereulide. Normally, the symptoms subside within a few days. In severe and rare cases, however, damage to the liver and brain can occur. A cereulide poisoning is often associated with starchy, cooked foods like rice or pasta. However, only a few strains of Bacillus cereus are capable of producing this toxin. Only a small portion of B. cereus strains have the ability to produce cereulide.
Also interesting: Allergic to meat after a tick bite! What’s behind the Alpha-Gal Syndrome
Diarrheal Illness
In this case, diarrhea and abdominal cramps occur within six to 24 hours. The cause is so-called endotoxins–simply put: toxins. They are found in the bacteria hiding in the contaminated food or are produced in the small intestine, where the spores of Bacillus cereus germinate.
Causes and Symptoms of Food Poisoning
Botulism–This Bacterium Produces One of the Deadliest Toxins in the World
Which Foods Are Particularly Sensitive?
Although most strains of Bacillus cereus prefer to grow in starchy foods, they are often also found in protein-rich foods like raw and processed meat. Alarmingly, bacterial spoilage occurs more frequently, quickly, and devastatingly in most protein-rich foods.
How to Protect Yourself from the Illness
First of all, it should be clarified that not every contact with Bacillus cereus leads to death; most affected individuals experience a gastrointestinal infection. Nevertheless, you can follow a few simple rules:
- For one, do not underestimate food hygiene: Wash your hands and the food before preparing meals. Pay attention to clean kitchen utensils such as cutting boards and knives.
- Foods that need to be refrigerated should only break the cold chain for as short a time as possible. Put them in the refrigerator immediately after shopping or after a meal. This time window should not exceed two hours.
- Foods that have been out of the refrigerator for more than four hours can still be consumed. If there are leftovers, they should be discarded for health reasons.