Safe Eating While Traveling Abroad

[Schielke]

When traveling, what can you do to avoid becoming sick from food prepared in places with questionable sanitation?

I have yet to really deal with this yet, since I havent really traveled too much. I would love to learn from all of your experience.

Ben

[Jason Perlow]

Dont drink the local water. Only drink bottled.

[Stone]

It depends where you're travelling and how susceptible you are.

Bottled water is always the best start. Outside large cities in India, Nepal, Thailand, etc., I'd be very careful with any fresh vegetables or fruits, unless they have a thick peel and you peeled them yourself. By careful, I mean that if someone tells you you can eat a salad at Chez Joe's in extapur, you better trust that someone before you put the fresh veggies in your mouth. But if you're in Delhi, Kathmandu, etc., and are eating at a restrauant that caters to travellers, it's probably safe.

Also -- if you're in an area where you're worried about the safety of the food, always feel free to look in the kitchen. Dysentary, giardia, etc., can ruin a vacation, it's o.k. to be a little rude, as long as you're nice about it. (Although when I got giardia in Pakistan, as painful as it was, shedding 20 pounds in week made me slim and trim. (almost).)

[Fat Guy]

The CDC has this to say:

http://www.cdc.gov/travel/foodwatr.htm

It's also worth remembering that many cases of stomach upset among vacationers (several doctors have told me upwards of 90%, but whatever the real number I'm sure it's big) are due to overingulgence, change in diet, change in schedule, and various other causes that have nothing to do with defects in the food consumed. So if you're trying to have a happy vacation from a gastrointestinal perspective you should not only observe basic sanitation protocols but also practice some degree of moderation at least until you've acclimated to the rhythm of a given place.

[anil]

Let me take a shot at this:

1. Drink bottled water (insure it is brought to you sealed properly)

2. If not possible, drink hot tea with your meals.

3. I never have my alcohol on the rocks (never know about the ice)

4. Avoid rare meats - Medium should be the norm.

As an extra precaution have at least a quinine tablet once every two days.

Carry your own vitamens; skip a meal to sync the timezones if possible.

Finally from my archives -

http://www.iamat.org

http://www.masta.org/home.html

http://www.istm.org/

http://www.tripprep.com/

http://www.drwisetravel.com/

and finally http://www.vh.org/Providers/Textbooks/Trav...ravelMedHP.html

[shugga]

Before my trip to China, my doctor told me to avoid eating at the little stands on the streets.

Of course I only drink bottled water, even at home!

We followed his advice and were fine. I always carry some pepto bismol with me, too.

[mb7o]

depends on where you're going.

one thing to consider is a hepetitis A shot if you haven't already had it. i just assume everyone in [insert 3rd world country here] got hep a as a child, though i could be wrong.

eat where many other people are eating. food will be fresher and probably has a better rep.

food stands, well many people claim to have gotten sick from 'good' restaurants while never having a problem with food stands.

carry azithromicin or other antibiotic in case of serious diherria if you will be in a place with poor medical care. otherwise you can always buy it, this is something you ususally don't want to take immediately anyway.

some people claim they'll be ok so long as they eat like the locals, once they're past some initial sickness. but a top (often #1 or #2) cause of death in many countries is dyssentry. maybe not the best idea.

[Ellen Shapiro]

Further to what the Fat Guy was saying, often times it's the different bacteria in the food and water that upsets your system--it's not that it's bad, it's just different--and your body isn't accustomed to it so it goes into defense mode.

Cipro is another good antibiotic to have along. I carry it with me for stomach ailments on every trip to Nepal. Thus far--never had to use it--but I have a cast iron gut.

[Ellen Shapiro]

I revert to my old vegetarian status when I travel to developing countries. There are too many problems that can develop out of eating improperly kept meat and fish and I figure it's not worth the risk. After all, how often do you get to travel to these places--I'd hate to waste the whole trip sick in bed (or elsewhere).

[Tonyfinch]

This thread shows how myth and misinformation still surround the problem of stomach upsets abroad.

First of all the overwhelming majority of problems are NOT caused by food but are related to water. The advice to drink bottled water only is generally sound.

Ice in alcoholic drinks will generally cause no problem as any bacteria in the ice will be killed by the alcohol

Eating from small food stands is no more likely to cause problems than eating in restaurants. This is because the food at stands tends to be cooked on the spot and there is a fast turnover. More food is stored and kept in larger restaurants and may cause problems if done so improperly.

Avoiding meat and fish, unless one actually wants to, is pointless. Fruit vegetables, water and dairy products are far more likely to cause problems. Meat and fish are more likely to be properly cooked through and one can generally tell when they're not. Even if it is not stored in the most hygienic of conditions, food is unlikely to cause problems if thoroughly cooked as the cooking process kills the bacteria.

[Beachfan]

Here's my version. I'm pretty conservative and prefer to be envious of others, but healthy.

1) Know the country. For example, Argentina and Chile have relatively high levels of sanitation and I ate salads with impunity. Also, ice in Thailand is generally safe because it comes from purified water almost everywhere.

2) Water should be in bottles and sealed. This includes the water you use on your toothbrush. Better to rinse the toothbrush in beer if you aren't sure.

3) Assuming you are in a place with questionable sanitation. Food stand or restaurant, you want the food hot. HOT. If it's not hot, don't eat it. ON the other hand, barbequed squid in Thailand was fabulous, and though I had questions initially, once you saw how hot the coals were, you knew there wasn't a problem.

4) Hot refers to temperature, not spices. According to a recent article (WSJ maybe), 90 percent of the restuarant salsa served in Juarez had unsafe levels of e coli. It might be too spicy for you to live in, but it isn't for e-coli.

5) In a place with questionable sanitation, we take two pepto bismol tablets daily, and sometimes before a meal. There have been studies showing this works.

6) Salads and peeled fruit are the enemy. It can be very sad to see others enjoying themselves so enthusiastically with the phenomenal tropical fruit at breakfast while you are peeling your market bananna. But, after water and salsa, that's your biggest risk.

On the other hand, I have friends who go to Mexico often and eat most everything. They have only "a little" problem once in a while. Whether I'm more susceptible, or less tolerant, I take a more restricitive approach.

[Fat Guy]

This thread shows how myth and misinformation still surround the problem of stomach upsets abroad.

Undoubtedly true, Tony. You sound like you know your stuff. Where can one go to get authoritative information of this sort? Is there a repository of online information or a book that you can steer us towards?

[Tonyfinch]

I got my info. from speaking to a doctor friend. I'll ask him and report back.

[bourdain]

Stick to bottled water--and the local alcoholic beverages whenever possible. The "ice issue" is tricky. A lot of Asian countries put non-purified ice in their beer for instance--and at some point, given the choice between spinning the wheel and drinking hot beer again, you will probably want to spin the wheel. Didn't bother me.

Pack plenty of lomotil. (Get a scrip when you get your shots)

As small amounts of e-coli and other bacteria are inevitable--usually in the most delicious and interesting stuff--you might consider beginning NOW to eat some of the nastier street food in your home area.I suggest deli salad bars, old hollandaise, street kekabs, dirty water hot dogs) Your system does get used to it somewhat--and it won't hit you so hard when you find yourself at the salad bar in Battambang or Laotian hill country.

My best advice is to eat without fear. Don't miss out. Do NOT insult your hosts, or local merchants by demanding to examine their kitchens--that's just no way to travel. You may as well eat all your meals at the Hilton. Take a chance--take lots of chances. Food should be an adventure. Those occasional lonely moments praying for relief on a dirty bathroom floor make the good ones all the more magical. After a while on the road your system does adapt. Amoebas? You're on your own. Hope for the best--and eat.

I recommend AGAINST anti-malarial drugs. They don't work, no expats seem to take them--and they mess you up in ways that even bad acid can't.

Have fun. Eat everything that looks good and smells good (avoiding only unbottled water). And get a full GI screen when you return.

[Jinmyo]

As small amounts of e-coli and other bacteria are inevitable--usually in the most delicious and interesting stuff--you might consider beginning NOW to eat some of the nastier street food in your home area.I suggest deli salad bars, old hollandaise, street kekabs, dirty water hot dogs).

The patented Bourdain Immune System Megabooster diet. As seen on TV. Order now.

Good advice though. Especially about a full screen on return. Someone who works for me goes to China three or four times a year (and brings back flower mushrooms for the kitchen). She had the biggest worm you've ever seen. (Well, perhaps not Tony). And another time tiny flora lining her gut. She used to wait until she felt ill until going to the tropical specialist. Now it's the day following return. Another friend still can't shake a skin fungus that followed him back from Egypt four years ago.

[Jaymes]

Sanitation in underdeveloped countries...

After traveling to many third world countries, and living in two of them, this is what works for me.

When I first arrive into the country, I go immediately to one of the big, fancy, tourist hotels to eat. I know that their income is dependent upon not getting foreigners sick. I eat there at least two or three times the first day or two, chatting up the staff, especially the portly ones. THEN, I begin to pick their brains about other good places to visit, eat, sightsee, etc.

This technique has never failed me, and I've been invited into homes, gone to family parties and celebrations, and even one wedding, with my new friends from the hotel.

If I'm in a big city, I do much the same thing by immediately taking the "City Tour." I see a lot of things really fast, in an hour or two, and have a guide to chat up.

Other than these two tips for making new friends of the locals, I follow the usual advice... commerically bottled drinks, water, etc. (Also want to add that when I was in China, I was talking with a Chinese about the water and said that because I was foreign, it might make me sick. To which he said, "It's not just because you're a foreigner. It makes us all sick. That's why we drink so much tea. We boil it first. I'll be happy when we get good water like you have in the States.)

Try to eat in places that are obviously clean, reputable, have a good name. Avoid food stalls.

Unless I am in very well-known, even famous, restaurant, I don't eat anything uncooked that has a large surface area to wash...like lettuce.

I don't drink anything that has irregularly-shaped ice cubes that look as though they've been chipped off of a large block sitting out back in the alleyway covered with flies.

Even in the largest and fanciest of restaurants, I never eat any kind of ground meat.... absolutely no hamburgers by the pool no matter how luxurious the hotel nor how good the hamburgers look or smell.

If I'm in a seaport, I eat lots of fish... it seems to me that the fish is invariably fresh, just off the boats.

Basically, I just try to use common sense...but I sure will not give up the experience of trying new things. Even though I have munched on extremely exotic items (Creamed Chicken Testicles in Hong Kong comes to mind), I have never gotten sick.

Giardia... By contrast, my youngest boy contracted Giardia while we were living in Panama City, Florida....so there you go. You never know.

[Margaret Pilgrim]

I'm going to throw a tire-iron into the cogs by proposing an exacerbation to the usual hazards of travel or even eating away from home or, worse, even staying home! I want to phrase this in the form of a question, actually, because I have no proof or scientific information to support my premise.

My husband began taking one of the well publicized prescription 1-a-day acid preventative capsules several years ago. Since then, perhaps 2 years, he has had 3 episodes of severe stomach flu/food poisoning/digestive chaos, lasting from a week to 10 days each in spite of medical intervention. I recently read that one of the major reasons for stomach acids was to kill dangerous bacteria. Is it at all possible that the use of the acid suppressors increased my husband's susceptability to whatever bacteria caused his upsets? Has anyone else experienced this joint phenonenon? Inquiring minds want to know.

[mb7o]

Ice is often manufactured safely, but transport is scary.

At least in this picture they're not using their feet to move the ice or dragging it along the ground. The brown stuff you see is the insulating straw.

And no, ice never made me sick. Well, probably at a japanese restaurant for tourists in mexico years ago. At least that's my theory.

[bourdain]

I see above, again, the advice to "avoid food stalls". To do so--especially for a travlling gulleteer--would be a terrible, terrible lapse. Some of the best eating experiences are in fact at food stalls in developing countries--and if you inquire of local foodies (above and beyond the waiter at the Hilton--who naturally assumes the worst of you because..well..you're staying at the Hiton, aren't you?) they will almost invariably send you to a particular stall/wet market/hawker stand. In Singapore, for instance, food stalls and hawker stands are a religion--with everybody having a favorite. There's even a guide published--a sort of hawker Zagat (only meaningful) with hundreds of fantastic places. The food handling at Singapore stalls is--by the way--close to impeccable--rigorously enforced and supplies are rotated regularly. In Vietnam, the little pho stands, noodle knockers, banh mi joints, coms are one of the principle attractions, the markets loaded with folks serving up unspeakably fresh and tasty stuff. Just use your head! Pate--sitting at room temperature might not be a good choice. But to miss out on fresh tacos of pig's head, or menudo, posole, those little zucchini flower quesadillas would be herecy--you might just as well stay at home. Thailand--Mamster tells me (haven't been there yet) is another example of missing half the experience if you avoid stalls. A rule of thumb might be: If the plac is packed with happy-looking locals--an the turnover of food looks quick; if the food looks fresh and smells fresh--then for God's sake EAT IT! Raw shellfish? Okay, the odds might not be attractive--you might well want to take a pass--but that's true anywhere to one extent or another. Some of the best, freshest and most memorable meals of my life have been within sniffing distance of pig styes (literally), flies and animal dung --which is also where many generations of our forefathers and ancestors probably enjoyed their meals, celebrated a good crop, rutted happily in their fetid bedding.

How clean you think all those beloved French bisto kitchens were in Paris of the 30's and 40's--or even now?

" A little honest dirt is rarely an impediment to a good meal." --Idwal Jones

[Stone]

The desserts from street vendors in Northern Thailand (usually sweetened coconut milk confections) was some of the best food I had in Asia.

[Jinmyo]

I agree about street vendors. I still remember a roasted turnip had from a vendor in a Beijing alley.

[bigbear]

Thailand--Mamster tells me (haven't been there yet) is another example of missing half the experience if you avoid stalls.

The only time I got the "Bangkok belly" was in a supposedly upscale restaurant. You really do miss a lot by avoiding the stalls or "Howard Johnsons," as we called them.

[Jaymes]

and if you inquire of local foodies (above and beyond the waiter at the Hilton--who naturally assumes the worst of you because..well..you're staying at the Hiton, aren't you?

No.

I don't "stay" at the Hilton (although frankly, I don't understand why it'd be such a crime if I did). In fact, I usually stay at some small dive that I can afford, one of which was nothing but a hammock in a hut, and the most-recent of which was $35 a night right off the plaza in Playa... The sorts of places where I must, indeed, "brush my teeth with bottled water" after checking to be sure the seal is intact.

What I said I did, and what I do, is go EAT at the "Hilton" a few times the first two days. It beats starving and I know I probably won't get sick before I learn my way around. I have frequently arrived in foreign countries where I know absolutely no one, and have no access to those "local foodies" with whom you so helpfully suggest I get in touch.

So after I get to know the waiters, I then go with my new friends into all sorts of small restaurants, alleyways, markets, etc., and follow their advice as to what is safe to eat and what is not. They usually speak English (I am not fluent in, for example, Chinese) and are an invaluable resource... friendly, knowledgeable and helpful. Also because I am a woman, frequently traveling alone, there is a safety issue here and I believe these people are likely trustworthy.

And I'm often invited into their homes (twice even being an honored guest at weddings, one of which included, for the marriage banquet, throwing just-killed monkeys and iguanas onto the open campfire along with the fish). Which I don't think they'd do if they actually "assumed the worst" of me.

I don't consider Singapore to be included in the same class, sanitation wise, as the countries we are discussing. When I lived in Hong Kong for example, I ate street food probably daily; in Manila, I did not. Hong Kong at that time was a British Crown Colony, and I did not interpret this question as pertaining to places like that.

I am sure that, as always, you're undoubtedly brilliantly correct as far as what works for you. And you can look down your nose at me all you want, but I have made it to the ripe age of nearly 60, and have both traveled and lived all over the world (including places that use human excrement as fertilizer for their vegetables and other crops), had a damn fine time of it, enjoyed myself immensely, and eaten plenty of exotic dishes. I am hardly a squeamish or paranoid traveler or eater, but I have never one time gotten sick, so whatever I'm doing works for me. And I felt compelled to share it in good faith in response to the question.

I recently escorted a group of 90 to Ixtapa. I told them to avoid a picturesque little shack-restaurant about a mile down the beach from our "big fancy hotel." The waiters at our hotel had told me that many touristas had gotten sick there and I shared that information with the group.

Of course about twenty of them believed that I was a wimp who didn't know what I was talking about... and off they went to have a real "authentic" native experience, complete with frozen margaritas. They came back later that evening laughing and talking about what a great time they'd had and what a silly worrywart I was and how everyone who had listened to me had "missed out." Sure enough, by the next day, every single one of them (those who had the margaritas as well as those who had not) was sick and I had to deal with it. One of them got so sick there was even some question as to whether or not she was well enough to get on our plane to fly home; she had to be hospitalized immediately upon our return.

And by the way, in my post I also said, "just use common sense," which you seemed to have overlooked, but which you basically repeated: "just use your head." Obviously a roasted turnip is not the same as shave ice.

EDIT: I'd like to add that it appears to me that you write well enough to have adequately expressed your own opinion, without ridiculing mine.

[Jaymes]

I'm going to throw a tire-iron into the cogs by proposing an exacerbation to the usual hazards of travel or even eating away from home or, worse, even staying home! I want to phrase this in the form of a question, actually, because I have no proof or scientific information to support my premise.

My husband began taking one of the well publicized prescription 1-a-day acid preventative capsules several years ago.  Since then, perhaps 2 years, he has had 3 episodes of severe stomach flu/food poisoning/digestive chaos, lasting from a week to 10 days each in spite of medical intervention.  I recently read that one of the major reasons for stomach acids was to kill dangerous bacteria.  Is it at all possible that the use of the acid suppressors increased my husband's susceptability to whatever bacteria caused his upsets?  Has anyone else experienced  this joint phenonenon?  Inquiring minds want to know.

I have been told that the practice of taking a Pepto Bismol daily, or something similar, as a prophylactic can mess up your digestive tract so that you are worse off than had you not.

[bourdain]

JAYMES--My scorn was directed entirely at Hilton, Radisson, Sheraton and similar institutions--and the whole idea of staying in them--not at you personally. (If "your" waiter AT the Hilton is talking to "you"--"you" must, presumably BE AT the Hilton--was the conceit). In fact I have no idea that you personally ever stayed in those hideous, generic, air-conditioned necropolae--and from your entirely reasonable reply--you rarely do. In fact--you sound like you travel like a champion.So feel free to tell me to go piss up a rope for my inexactitude. I am a known repeat offender in this area..I was, not unusually for me--whipped into a frenzy by the very thought of avoiding food stalls--and tormented by the grim memories of way too many hungover mornings in the mass-feeding breakfast pens of chain hotels..waking up in faraway places with no idea where I am--so confused by the cookie-cutter architecture, the climate control, the terrible sameness, the hordes of defeated, unhappy looking business travellers and package tourists lind up for their cold croissants and watery eggs, that I sit there, grinding my teeth and hating the world.

Another--more positive suggestion-might be, when one finds oneself abroad--particularly in the East, is to find the seediest expat watering hole--particularly hang-outs for foreign press-, English teachers, NGOs-where local ( indigenous)journos and long time expat residents hang out and mix. There's always somebody, I found, who can point you in the direction of a local gourmand. For some reasons, the French, having been terrible colonisers, often make superb travellers and expats, blending right in nicely. So maybe bring some smelly cheese.

Again, apologies for appearing to suggest that you personally have seen the world only through the smoked glass windows of a passing tour bus (as so many--tragically have). Twas not my intention nor my asumption. Hyperbole? Moi?