Is it true cooked food cannot be left in room temperature for longer than 4 hours?

The food safety guidelines are based on scientific & mathematical calculations along the lines of:

Given an initial bacteria count of X they will under the given conditions mulitply to a number of Y amd have produced Z [unit] of toxins.

Now what to do with these values?

We use them like seat belts or helmets. Not wearing a seat belt will not automatically kill you, only if you are involved in an accident you are much more likely to suffer severe injury or death without it. Still, nobody could responsibly recommend ignoring a seatbelt, knowing that accidents do happen. But with food safety, many are willing to skip their seat belt, so to speak.

One very common misconception is that contaminated food can be detected by smell, looks or taste. Yes, some kind of spoilage is obvious, but many, especially the more dangerous ones, are not "visible". One very prominent example is Salmonella. Note that many toxins are not destroyed by cooking, more details in our canonical post.

I can guarantee that people in your country have issues with cases of foodborne illnesses - all countries do. You need to keep in mind that

• Foodborne illnesses need not become apparent immediately or shortly after a meal. The symptoms of Salmonellae, for example, might start as late as 72 hours after infection. It is likely that the connection between a sudden bout of sickness and a meal eaten three days prior is simply overlooked.

• In healthy adults infections may pass unnoticed or cause only mild sympotms like indigestion. The human body can handle a certain amount of bacteria or toxins, the individual levels of tolerance vary, though. So children, elderly people or those with a compromised imune system are more likely to suffer and have a higher chance of severe complications or death. The given safety guidelines are calculated to protect these groups as well. Also note that often the side-effects are as dangerous as the pathogens themselves, diarrhea being a classic example.

• There is no way of determining the amount of bacteria present in a specific dish, piece of meat or other food prone to spoiling - unless you get a lab involved. The values used to calculate safe thesholds contain a certain safety margin. Your dish could contain fewer bacteria to start with or if any were present, they might not have multiplied that much. (But they might as well have, we can't safely know.) The two/four hours rule simply means that the food will remain in the safe range, not that it will be spoiled afterwards.

So what now?

It is entirely up to you to whether you choose to drive with or without seatbelt or helmet. Make an informed devision and consider the welfare of those weaker than you. What you as a healthy adult can stomach (pun intended), might be fatal to a young child or weak elderly person.

Only a few days ago the WHO published a news release on foodborne diseases:

• First ever estimates of the global burden of foodborne diseases show almost 1 in 10 people fall ill every year from eating contaminated food and 420 000 die as a result
• Children under 5 years of age are at particularly high risk, with 125 000 children dying from foodborne diseases every year
• WHO African and South-East Asia Regions have the highest burden of foodborne diseases

(Source)

Yes, that's generally thought to be true — as determined through the science of modern food safety. You can read about specific guidelines on the Food-Safety tag wiki. Those practices were developed as broad recommendations, usually erring on the side of caution.

That being said, you might be able to get away with it sometimes, without dying of food poisoning, but it could be risky. Much depends on the food itself — bread left at room temperature may last for days, but you could have problems with meat or dairy products after just a couple of hours.

Bacteria and other harmful pathogens can exist everywhere. At room temperature, those organisms can multiply very rapidly, producing toxins that can make you sick. You can NOT rely on smell to detect them — food can be highly infected, but smell and taste just fine. That's why, for safety, it's important to refrigerate or freeze cooked food to slow down the growth of any pathogens.

It's best to do this as soon as possible after the food cools down to room temperature. You also want to avoid putting hot food directly into the refrigerator because it may heat up the 'fridge, affecting other food inside, and actually delay your food cooling down to a safe temperature.

Food poisoning isn't something that only breaks out when we grow old, though elderly people, young children, and those with weak immune systems can be more susceptible.

As leaving cooked food at room temperature was "normal" in your country, I wonder if there wasn't also a prevalence of food poisoning that was also just considered "normal'. How often did people have upset stomachs or diarrhea, and just accept it as part of everyday life?