Sterilization is an important factor to consider during the fermentation of foods. Failing to completely remove any microbes from equipment and storing vessels may result in the multiplication of harmful organisms within the ferment, potentially increasing the risks of food borne illnesses like botulism. However, botulism in vegetable ferments is only possible when not properly canned.  The production of off smells and discoloration may be indications that harmful bacteria may have been introduced to the food.
Alaska has witnessed a steady increase of cases of botulism since 1985. It has more cases of botulism than any other state in the United States of America. This is caused by the traditional Alaska Native practice of allowing animal products such as whole fish, fish heads, walrus, sea lion, and whale flippers, beaver tails, seal oil, and birds, to ferment for an extended period of time before being consumed. The risk is exacerbated when a plastic container is used for this purpose instead of the old-fashioned, traditional method, a grass-lined hole, as the Clostridium botulinum bacteria thrive in the anaerobic conditions created by the air-tight enclosure in plastic.
The World Health Organization has classified pickled foods as possibly carcinogenic, based on epidemiological studies. Other research found that fermented food contains a carcinogenic by-product, ethyl carbamate (urethane). "A 2009 review of the existing studies conducted across Asia concluded that regularly eating pickled vegetables roughly doubles a person's risk for esophageal squamous cell carcinoma."