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New Study Reveals Danger of Sack Lunches

It is back to school time. While you are out shopping for school clothes and supplies, I want to encourage you to consider adding EndoMune to your shopping list.

Over the years I have written a number of newsletters that discuss the benefit of probiotics for children. Topics have included: lessening the risk of infectious diarrhea, preventing cold and flu symptoms and avoiding antibiotic related diarrhea.

This month I want to discuss a new reason for giving your child a daily probiotic: foodborne illnesses.

An interesting study(1) was published this month in the respected medical journal, Pediatrics. The study discussed the risk of foodborne illnesses in sack lunches prepared at home for preschool children going to day care centers. The researchers wanted to determine the temperature of the perishable foods during the morning hours prior to lunchtime.

What Causes Foodborne Illnesses?

Before diving into the findings of the article, I would like to make some general comments about how contaminated foods cause intestinal infections that lead to symptoms of nausea, vomiting, diarrhea, fever and abdominal pain.

Most foodborne infections are undiagnosed and unreported, although the Centers for Disease Control and Prevention estimates that every year about 76 million people in the United States become ill from contaminated foods. Of these people, about 5,000 die(2).

Almost half of the reported foodborne illnesses occur in children, with the majority occurring in children under age 15 years. Frightening, right?

Children are at high risk for foodborne illness for several reasons: immature immune system, reduced stomach acid to kill harmful bacteria, and low body weight – which means a lower dose of pathogen is required to cause injury(3).

There are three important factors when considering food safety: (1) type of food, (2) stored temperature, and (3) time exposed to unsafe temperature.

Bacteria that cause foodborne illnesses like Salmonella and E. coli grow rapidly in certain types of foods. Meat, poultry, fish, dairy products and cut fruits and vegetables are most likely to carry these bacteria.

If the bacteria are present when the food is prepared, then refrigerating the food to below 40°F prevents the bacteria from multiplying and causing an infection. Additionally, cooking foods to a temperature greater 165°F will kill any bacteria in food.  Once cooked, the hot foods need to stay at a safe temperature of greater than 140° F prior to serving or refrigerated to less than 40°F for storing.

When perishable foods like chicken salad or bologna sandwiches are left in the “danger” temperature zone of 40°F to 140°F for greater than two hours, the harmful bacteria rapidly multiply. When this happens, the foods must be discarded due to risk of contamination by bacteria and toxins, which can cause mild to life threatening intestinal infections.

Pediatrics Study: Sack Lunches at Risk of Bacteria Proliferation

This brings us back to the study. The objective was to measure the temperature of the foods in preschool-aged children’s sack lunches. Using non-contact temperature guns, the researchers tested 705 lunches that contained a total of 1,361 perishable foods. The temperature was measured 90 minutes before lunchtime.

The results were astounding: Only 22 or 1.6% of the 1361 perishable food items were in a safe temperature zone.  Overall, 97.4% of meats, 99% of dairy, and 98.5% of vegetables were in the danger zone.

The researchers found that the use of thermally insulated bags with ice packs only marginally improved the number of perishable foods in the safe temperature zone.

So what is a parent to do?

Here are some recommendations:

  • Wash hands and use clean cutting boards and knives.
  • Use safe foods like peanut butter (if allowed), raw, cooked or dry fruit and raw vegetables.
  • Consider making a meat sandwich of turkey or roast beef the night before and putting in the freezer using bags designed for freezing. It will take 3 to 3.5 hours for the sandwich to thaw.
  • Soups, stews and chili make a hearty lunch. To use them in a packed lunch, heat to boiling and put in a sterilized thermos bottle.

Finally, I recommend giving your child a high quality probiotic like EndoMune Junior.

Studies have shown that probiotics are able to defend the human intestinal tract against harmful bacteria. The probiotic bacteria stimulate the immune response, prevent pathogens from adhering to the intestinal lining cells and produce antibacterial proteins(4).

There has been increasing evidence in the last 10 years for the benefit of probiotics in preventing and treating acute diarrhea in children. A number of studies have found that giving probiotics versus a placebo to children in day care facility can statistically lessen the risk of having an episode of diarrhea(6,7).

Take Home Message

Given the results of the study on food temperature in school lunch bags, I would think it would be a good idea to give EndoMune Jr to lessen the risk of experiencing a bout of foodborne gastroenteritis.

Eat healthy, exercise and live well!
Dr. Hoberman


(1) Temperature of Foods Sent by Parents of Preschool-aged Children. Almansour FD, Sweitzer SJ, Magness AA.
(2) Food-related illness and death in the United States.Mead, P., L. Slutsker, V Ddietz et al.Emerg Infect Dis, Sept-Oct 1999, 56(No. 53).
(3) Children and microbial foodborne illness.Buzbym H>C. Food Revuewm 2001l 24(2):32-7.
(4) Use of probiotics in children with acute diarrhea. Szajewska H, Mrukowicz JZ. Paediatr Drugs. 2005;7(2):111-22
(5) Probiotics for treatment of acute diarrhoea in children: randomised clinical trial of five different preparations. Canani RB, Cirillo P, Terrin G, Cesarano L, Spagnuolo MI, De Vincenzo A, Albano F, Passariello A, De Marco G, Manguso F, Guarino A. BMJ. 2007 Aug 18;335(7615):340
(6) Efficacy of probiotics in prevention of acute diarrhoea: a meta-analysis of masked, randomised, placebo-controlled trials. Sazawal S, Hiremath G, Dhingra U, Malik P, Deb S, Black RE. Lancet Infect Dis. 2006 Jun;6(6):374-82
(7) Probiotics for children with diarrhea: an update. Guandalini S.J Clin Gastroenterol. 2008 Jul;42 Suppl 2:S53-7

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