Buffet Bellyaches

Experts provide a plan to maximize your chances of eating safely at buffets.

From the WebMD Archives

When it comes to buffets, diners have their choice these days: mom-and-pop ethnic eateries, national chain buffets, and splashy Las Vegas casino spreads complete with seafood bars and sumptuous desserts.

With all-you-can-eat prices dipping as low as $7 or $8 in some cities, buffets tempt both the palate and the wallet. In 2005, Americans spent more than $1.5 billion at the nation's 5,630 cafeteria and buffet-style restaurants, according to Technomic, a restaurant research firm in Chicago.

But how safe are these serve-it-yourself restaurants?

As long as buffet operators take proper precautions, they're generally safe, experts say. Occasional outbreaks at buffets have made headlines. But though the CDC collects information on food-borne illnesses at restaurants, it doesn't track the type of establishment involved. So there's no hard evidence that compares the risk at buffets to other types of eateries.

Buffets do present a couple of special challenges.

First, foods rest in steam tables, ice baths, or salad bars. If improperly tended, these buffet stations can allow disease causing bacteria and viruses to flourish.

Second, customers can come into contact with food: the man who sneezes into his palm and then handles the serving tongs, the woman who grabs a few strawberries with her bare hand, the child who pokes a slobbery finger into the tuna salad.

"If food is not handled properly; if people cross-contaminate food; if you have little kids touching the salad prior to service; the likelihood of food-borne illness is much higher," says Timothy Ong, a San Francisco Public Health Department senior inspector who has checked hundreds of buffet restaurants in his 24-year career.

WebMD quizzed Ong and other restaurant inspectors and food scientists about ways to maximize your chances of eating safely at buffets. Does the Place Look and Smell Good?

Much of food safety happens in the kitchen -- out of your line of vision. But you can still get a sense of a restaurant's attention to hygiene.

"Look at the overall cleanliness of the establishment. While that's not a definitive clue, it's an indicator that things are being done properly," says Robert Gravani, MS, PhD, a Cornell University food science professor. Are buffet areas, floors, tabletops, and bathrooms clean? Do employees look neat? Do they wear gloves while handling food? Do they wipe away spills? Is the restaurant free of unpleasant odors?

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Also note how much attention employees pay to the food. "Look to see if the wait staff is coming around and maintaining the food, checking the temperature, stirring the food, replacing the food when the pans are nearly empty," says Carol Chase, senior public health sanitarian with the Tompkins County Health Department in upstate New York. Instead of pouring new food into old pans, employees should be switching out containers to prevent traces of old food from remaining on the buffet too long, she adds.

Look, too, for warning signs that food is being neglected. That dried-out pork or browned, wilted salad? Not good.

The Truth About Temperatures

When it comes to buffets, every expert mentioned this maxim: "Keep hot foods hot and cold foods cold."

Hot buffet foods should be kept at 140 degrees Fahrenheit, preferably at steam tables, which heat more evenly than Sterno burners. Cold foods should be kept at 40 degrees in refrigerated units or ice baths, according to experts.

"When we do inspections at buffets, we're strongly concerned with temperature control," Ong says. That's because proper temperatures help prevent harmful organisms from multiplying to disease-causing levels.

The dangers include salmonella, E. coli, listeria, and noroviruses, which have sparked outbreaks of gastrointestinal illness on cruise ships in recent years. Clostridium perfringens, nicknamed "the cafeteria germ," can also thrive in large portions left for long periods at lukewarm or room temperatures. For example, the bacteria can grow in cooked ground beef that may be used in tacos or casseroles.

When foods go "out of temperature," they enter what experts call a "danger zone" from 40 to 140 degrees. As temperatures move toward about 100 degrees -- roughly a normal reading for the human body -- bacteria multiply fastest, says Craig Hedberg, PhD, an epidemiologist who has investigated food-borne illnesses. He is an associate professor in the Environmental and Occupational Health Department at the University of Minnesota.

"The longer a food item is in the danger zone, the greater the risk of bacterial growth that could lead to disease," he says.

On unannounced inspections, Chase has caught buffet restaurants setting steam tables under 140 degrees. "As soon as we walk in, they turn them up quickly. But it doesn't make any difference because the food's not going to heat up in two minutes before we walk over to the buffet to take the temperature."

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Ong also sees operators turning down the heat, for example, to 125 degrees. "They're trying to keep the food palatable," he says. "They don't want the beef stew or chicken casserole to dry out."

Of course, no customer shows up with a food thermometer in her purse. So Ong offers this strategy: at steam tables, stir food and scoop from the bottom, where temperatures are hottest. "The casserole that's at the bottom of the dish, if you stir it up and turn it over a little bit, you could probably get it up to 155 degrees," he says. "When I go to a buffet, I just don't scoop my mashed potatoes from the top. I tend to stir it around a little bit."

If bowls of cold food are held in ice, they shouldn't rest on top, but be set deep, Chase adds. "You want the ice to surround the bowl and come up to the sides of the bowl. If you have an entire bowl of tuna fish, you wouldn't want the ice just on the bottom because then it would only keep the bottom of the product cold."

Ong says food temperatures are less of a concern during busy times, for instance, from the 10 a.m. to 2 p.m. rush period, when food turns over rapidly. While people can still eat safely during slower periods, such as 2 p.m. to 5 p.m., they should watch how carefully the restaurant is replenishing and maintaining the food. Says Ong, "I think it's very dangerous for people to eat later in the day at a buffet if temperature control and food handling is not paramount in the establishment."

The Public Nuisance

Short of hiring Miss Manners to scold the etiquette-challenged, what can restaurants do about customers who touch food or cough and sneeze on it?

For starters, buffets should have sneeze guards to shield food, experts say. Occasionally, someone can pass strep throatstrep throat by sneezing onto food, Hedberg says.

But, he adds, "I worry more about what's on people's hands." Noroviruses, which can cause nausea, vomiting, and diarrheadiarrhea, can be passed when customers touch food, he says. So can E. coli and other bacteria.

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Make sure that the buffets you patronize supply serving spoons and long-handled tongs to discourage customers from touching food.

And still, it happens. Chase once saw a customer try to shake Parmesan cheese out of a container, only to find it had hardened. So the woman simply stirred the cheese up with her finger. "Luckily, that's a dry food and it's not all that potentially hazardous. But we had [the restaurant] change it," Chase says.

If you see patrons touching food, sneezing on it, or otherwise mishandling it, ask employees to replace it, Chase says. "As customers, we need to be more forthcoming with our requests."

Hedberg advises all customers to wash their hands before eating at a buffet to cut down on the spread of germs. And if you spot restaurant employees in the restroom, check whether they're washing their hands thoroughly.

Watch What You Eat

Every year, about 76 million cases of food-borne disease occur in the U.S., according to the CDC. While the vast majority of people have a day or two of vomiting, cramps, or diarrhea, food-borne illnesses cause roughly 325,000 hospitalizations and 5,000 deaths annually.

Some groups -- the elderly, young children, and the immune-compromised -- tend to become sicker, according the CDC. For them, it's especially crucial to choose restaurants with care and avoid riskier foods.

You might want to pass up foods the CDC lists as more likely to cause illness, including raw and undercooked meat, poultry, or shellfish; raw or runny eggs (which can be in Hollandaise sauce or restaurant-made Caesar dressing); alfalfa sprouts; and unpasteurized juices.

Some experts told WebMD they specifically avoid raw oysters, which can be contaminated with seawater pathogens.

In general, foods with high acidity -- vinaigrette dressings, even salads with mayonnaise -- are usually more resistant to bacterial growth than low-acid foods, as long as they aren't prepared improperly or kept at wrong temperatures, Gravani says.

Check It Out Online

Hedberg doesn't believe you need to check out a buffet's restaurant inspection report before going. "I think we have to have a little bit of confidence in the system," he says.

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But if there's any question about safety, call your local health department or search online for inspection results.

For example, the Los Angeles County Department of Public Health site reveals an all-you-can-eat buffet restaurant that closed six days because of vermin infestation. The New York City Department of Health and Mental Hygiene's site lists one Manhattan buffet's past and current violations: hot and cold foods not held at proper temperatures, inadequate personal cleanliness, evidence of roaches, improper bare hand contact with food, improperly installed or maintained plumbing, and "Food Protection Certificate not held by supervisor of food operations."

Reports aren't foolproof. Overburdened inspectors often check a restaurant only once or twice a year, so results are more of a snapshot. But reports can still allow you to be an informed consumer.

Or take Ong's suggestion. When people ask him for buffet recommendations, he steers them toward what he calls "exhibition kitchens" -- where chefs prepare food right in front of customers. Instead of a typical cafeteria setup, diners often can pick their own fresh ingredients and the chef will cook the dish for them right on the spot.

"When there's an exhibition kitchen -- and they have those at buffets -- it's a very good indicator that the place is kept up well because nobody wants to have an exhibition kitchen that discourages customers from partaking," he says. "You have a little more control."

WebMD Feature Reviewed by Louise Chang, MD

Sources

Published Oct. 27, 2006

SOURCES: Carol Chase, senior public health sanitarian, Tompkins County Health Department, New York. Timothy Ong, senior inspector, San Francisco Public Health Department. Sheldon Lew, senior health inspector, San Francisco Public Health Department. Robert Gravani, MS, PhD, professor of food science, Cornell University. Craig Hedberg, PhD, associate professor, Environmental and Occupational Health, University of Minnesota. Jianghong Meng, PhD, professor of nutrition and food science, University of Maryland. CDC: "Foodborne Illness", 2005. Los Angeles County Department of Public Health. New York City Department of Health and Mental Hygiene. Technomic: "Technomic Top 100 Company U.S. Sales Trends," Chicago.
© 2006 WebMD, Inc. All rights reserved.

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