As a kid, one of my very favorite treats was licking the bowl (and spoons and spatulas and countertops) when my mom was finished making cookies, especially the chocolate chip variety. But as I’ve become more aware of the myriad of ways bacteria try to kill us or generally make our lives miserable, I have come to realize how fortunate I am that I never got sick from it. As awareness generally grew about the risks of eating raw cookie dough, the predominant thought was that real threat was Salmonella bacteria associated with raw eggs in the dough, but it turns out that isn’t the only risk.

The US CDC has made an active effort recently to continue raising awareness about the health risks associated with eating raw cookie dough (and other raw dough products), and their efforts seem to have caught many people’s attention this Holiday Season. This new wave of awareness may have started with a recent tweet (and really awkward Dr. Seuss-style rhyme) by US FDA Commissioner Scott Gottlieb. Finally, Twitter comes through with something productive. From there, the story gained traction on social media and with numerous local and national media outlets, both in the US and elsewhere.

Holidays seem tailor-made to put humans at additional risk, especially from food, ranging from undercooked ham or turkey to warm potato salad to even a Willy Wonka-sized chocolate spill blocking traffic. As has become Outbreak Thursday tradition, and holidays are all about tradition, we take a quick look at how to safely enjoy your holiday treats.

Food Safety Warnings

Following a national outbreak of Shiga toxin-producing E. coli (STEC) in the US (2015-16) that resulted from contaminated flour (63 cases across 24 states), the US CDC increased its efforts to warn against consumption of products containing raw flour. Interestingly, the outbreak began in the midst of the 2015 Holiday Season, with symptom onset in the earliest reported case on December 21. Despite a nationwide product recall, the outbreak continued through September 2016, due in part to flour’s long shelf life and the continued use of contaminated products. A similar outbreak in 2009 linked to prepackaged cookie dough is thought to be a result of contaminated flour as well—as this was the only ingredient not treated to kill potential pathogens—but this was not definitively confirmed. As a result of this outbreak, Nestlé (the manufacturer of the affected cookie dough) implemented rigorous testing protocols and transitioned to the use of heat-treated flour, although they emphasized that consumers should still avoid eating raw cookie dough or other products.

The US CDC and FDA both have websites dedicated to the dangers of eating/handling raw cookie dough (and other products containing raw flour, including homemade play dough), and they include safe food handling recommendations to reduce the risk of infection from contaminated flour (E. coli) and eggs (Salmonella). Most of these recommendations revolve around 2 primary topics: (1) ensure flour and eggs are cooked to the proper temperature to kill the bacteria that could make you sick, and (2) wash your hands, surfaces, and equipment properly to prevent cross-contamination with other food items or the inadvertent consumption of contaminated products. The guidance also notes that flour is a powder, so it spreads easily (eg, through the air).

The Nice List

If you simply must eat some raw cookie dough—trust me, I know the feeling—some people have found alternatives that could mitigate some of the risk.

As many of you know, chocolate chip cookie dough ice cream has been marketed widely for decades, so there must be safer options than traditional homemade dough. The CDC’s cookie dough website explicitly notes that some commercially available cookie dough (including that found in ice cream) is made with treated flour and pasteurized eggs and is, therefore, safe to eat raw. There are also a number of commercially available raw cookie dough products that use pasteurized ingredients and are marketed as safe to consume raw. As a note, many manufacturers of pre-packaged cookie dough still warn against eating the dough raw, even though they use pasteurized ingredients.

Some people make their own cookie dough using commercially available heat-treated flour and pasteurized eggs, which could reduce the potential for contamination. Like other foods at risk for bacterial contamination (eg, turkey, pork, eggs), heating flour to the appropriate temperature could reduce the risk of foodborne illness. The CDC recommends cooking ground beef and pork to 160°F/70°C to kill E. coli, but there does not appear to be an approved standard process or guidance for heat-treating flour for pasteurization purposes. Despite the lack of guidance, some people elect to pasteurize their own flour at home by heat-treating it in the oven (or microwave). Instructions for this process vary, and it might not be possible to guarantee that the entire batch of flour is heated to the appropriate temperature.

The US FDA does require warning labels with instructions for safe handling and cooking on all egg products that have not been pasteurized. As another example, the UK’s British Lion program, launched in 1998, aims to to reduce Salmonella in eggs, and approved products have even been deemed safe for consumption raw by vulnerable populations such as pregnant women, infants, and the elderly.  Besides cookie dough, many other recipes also call for raw eggs—including pasta carbonara, Caesar dressing, and eggnog, another holiday favorite—so pasteurized eggs could be used to lower the risk of foodborne illness for these dishes as well. So when you’re putting together your shopping list—and checking it twice—and dashing through the snow to the store, be sure to pay attention to whether your eggs have been pasteurized or not.

....And To All A Good Night!

While some blame the FDA and CDC for ruining cookie dough, they are certainly no Grinch. They just want to keep you safe and healthy, and following the experts’ recommendations is the best way to safely enjoy your favorite treats. And really, if warm, gooey cookies are the worst thing that happens this Holiday Season, you’re in pretty good shape. Unless you’re a gingerbread man, in which case, you’re in trouble.

From the Outbreak Observatory family to yours: Happy Holidays!

DISCLAIMER: Outbreak Observatory does not endorse any of the products, recipes, or procedures referenced in this post. These examples are simply included to illustrate potential ways to lower your risk of foodborne illness while enjoying the magic flavor of raw cookie dough. Following expert guidance, such as that published by the CDC and FDA, is the best way to stay safe and healthy.

Photo courtesy of Pixabay.

Outbreak Observatory aims to collect information on challenges and solutions associated with outbreak response and share it broadly to allow others to learn from these experiences in order to improve global outbreak response capabilities.