Food poisoning avoidance tips....
 

Delhi belly, bombay bottom, calcutta colon... Vietnamise volcano etc etc. We've all had it no doubt.

Before I head to South East Asia, who's got some good tips for avoiding it ??

I've got a few but please add more. I'm pretty immune to a lot of it now but that's because I've had it bad more than a few times and follow these rules.

Don't eat the meat in India.... An Indian man from London told me that he visits all over India 10 times a year and the only time he gets ill when he returns is if he eats the meat. Go Veggie. Most the country is anyway. For good reason... If I think back, it was always meat dishes that made me ill.

Brush your teeth with local water but don't drink it. Evidence shows minor exposure is the best way to acclimatise to a new variety of bacteria. Biting your nails helps also. Apparently.

Buy bottled or boil your water... Or only drink from where locals do. Giardia lives in even the cleanest of rivers.

Always carry a good strong antibiotic if you get hit. Ciprofloxicine is good. There is a specialised one for Giardia.


Bring em on..

I had read a couple suspected the ice as a cause to their attack, water was bottled.
In thailand feces is used as a fertilizer so as good as the salad may look-know this from personal experience avoid it.

Having lived in Malaysia for 2 years now, I've actually rarely had any problems with food. Asians love their meat on the bone which is something westerners probably aren't used to but I would't avoid it for that reason. The usual common sense rules apply, if the place looks dirty, the food probably is too. If you're coming through Malaysia though, the food is one of the highlights (and SE Asia generally) so hit me up if you need any info.

heat is the answer
 

I adopt the theory that heat will kill pretty much anything a bit dodgy. So I try to eat only hot food which has been possible mostly. If it's not REALLY hot I send it back to be cooked some more. When cooking myself I add plenty of colour, usually black!

My biggest issue has been water ( so I reckon anyway) even buying bottled water. I have been suspicious a couple of times when opening a new bottle of water....."did that seal crack open or not, did you hear it go? " After that copious amounts of loo roll follows the next day.........

So far never had it bad on a trip .......should have kept quiet :eek3:

smell it!
 

I've been traveling/living in Nepal, India and some other SE countries over the last 10 years or so. Only had the acute diarrhea the first time I was in India (body temp. 40C and over, loosing consciousness, totally incapacitated for 4 days.) and since learnt the lesson.

Here are my rules:

* Only drink bottled/boiled water.
* Always have a bottle of hand sanitizer in your pocket and USE it often.
* Eat cooked food. I've eaten freshly cooked food just off a stove in some very dirty places and it was fine.
* If you're going to have a salad in a restaurant, make sure it's a decent restaurant (presence of many tourists is a good rule of thumb). At home wash your veggies in cool boiled/bottled water.
* Smell your food before eating. If it's iffy, don't risk it.

The one time I got the poisoning, it was from a Lassi (a fruit yogurt drink) in a fancy restaurant. It had a very slight smell of rotten eggs. You could just about feel it. It tasted fine, but the consequence hit me so hard, I couldn't get up to crawl to the pharmacy :funmeterno:

Speaking of pharmacies, they are very good in India and Nepal. It is prudent to carry some sort of antibiotics, but if you do get the diarrhea, you should still go to the local pharmacy and get all the other medicines that will help you with rehydrating, etc. Local drugs IMHO fit the local bugs better.

On a brighter note, juices in SE Asia are a godsend and it would be a shame to miss the pleasure of riding up to, say a sugarcane juice stall, and not drink the wonderful nectar jeiger. Just go by your intuition ;) If it looks fresh out of the machine, it's probably good. If it's been sitting there for who knows how long, it's not worth it. You can use your own glass too, but I never do.

Good luck ))

I got ill 5 days into my morocco tour. Was down for about 2 days, but still had to ride one of them.

There is little you can you do really.

You can take alcohol handwash for when you visit bathroom, but the chef has just cooked your food, gone to the toilet, washed his ass with is hand and water only then served your hot food.

Salad is washed in the local (contaminated) water, and left out in the open (for millions of flies to contaminate). Eggs are left on window sills with 40c of desert sun burning down on them.

Cheese, milk, ice cream are all made from unpasteurised milk.

Fruit is often contaminated by flies and insects.

You could eat pre-packed foods and drink bottled water, but really do you want to miss out on all those tastes and flavours from around the world?

Another thing that makes it more difficult is that you can't buy strong antibiotics in the UK, so you just have to ride it out.

I have toured around Thailand Vietnham Laos Cambodia etc and just eat in busy local places with a fast turn over and never a problem interestingly Egypt always seems a problem but best to try local food
Safe riding
Paul

No ice
No salads
Wash your hands
Make every other c*** wash their hands
Hot food comment above very sensible
Bottled water filtered through lifesaver filter or puritabbed.
Pray.
:smile2:

Getting others to wash hands always challenging but great if it happened

You can go to your doctor before a trip and get a prescription for some broad-spectrum antibiotics. While you're at it, get the strongest painkillers they'll let you have.

Praying is probably your best bet. Unless you have the iron willed determination to avoid every possible source of infection and travel round in a kind of drug reinforced sanitation bubble something will get you - even if it's only dehydration from not being able filter drinking water fast enough. The first time I ever flew to The Gambia you had to queue up outside in the sun for immigration and after half an hour or so the tourist authority started offering glasses of water to those still waiting. Everyone took them - including me - only realising afterwards what they'd done. And yes, I spent the next couple of days sat on the toilet.

Adding puritabs to a bottle of water in a restaurant near Bamako got me into a somewhat heated discussion with the manager who thought it was insulting that I didn't trust his hygiene stds and much laughter from the other diners who concluded I was some kind of effete Westerner too weak even to cope with water :(

There's lots of mention of antibiotics in the posts above but I would suggest you avoid them as far as possible. Using antibiotics, especially broad spectrum, before your trip actually wipes out the good bacteria in the gut, read How antibiotics destroy your immune system

In the past I've tried to supplement the good bacteria by using probiotics before a trip, read Probiotics vs antibiotics

If you have travellers diarrhoea the best course of action is to take lots of water with some small quantity of light, mild food. You should only take an antibiotic such as ciproflaxin if stool testing reveals the need for this, read Traveller's Diarrhoea, Loose Stools When Travelling

I carry a supply of loperamide (slows the bowel movement) in case I really have to travel, but it's better to just 'sit it out' and let nature take its course.

There's a world of difference between travellers diarrhoea and food poisoning. The last time I had food poisoning was in Peru and I thought I was dying. And didn't care. Every half hour there would be an explosion from one end of the body or the other. I spent the night lying on the toilet floor hoping the explosions didn't coincide.

I was on a trekking holiday in Morocco a few years back when 9 of the party of 16 came down with stomach upset (so clearly a restaurant problem). We quickly ran out of rehydration salts so I made up some using a mix of 1 litre of water to 5 teaspoons of sugar and 1 teaspoon of salt. I put in more salt than normal as it was extremely hot and I reckoned they were low on salts anyway.

I agree poor personal hygiene can lead to stomach upsets. Washing your hands before eating is vital and in Morocco (for example) every snack place and restaurant has a sink in the corner to wash your hands. But I would question the use of alcohol wipes, there's nothing better than soap and water, read Soap and water is superior to alcohol rub and antiseptic wipes

In India I avoid meat, but then I've spent most of my time in the south where it tends to be vegetarian anyway.

I confess I only drink bottled water in India, but in Morocco I always drink the local tap water which is fine for me (note however that some people have a more delicate stomach and would be upset by drinking water from a different part of their own country). The Moroccan water company (ONEP) has won awards for its water treatment technology and exports its know-how to other countries.

Despite spending several months a year in foreign climes I can't remember the last time I had an upset stomach. As Paul15 writes above, high turnover street food outlets are a good bet for avoiding trouble.

.

I too avoid major antibiotics, on my first visit to Thailand in March last I had a bad case of the squirts and I took Imodium and electrolyte drinks to keep myself hydrated. On my trip I drank those bacterial yoghurt drinks every couple of days and up till now (as I am still over here) I have not had a problem since

Wayne


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If traveling with others it is a discussion worth having. I wouldn't be traveling very long with anyone who did not regularly and appropriately wash their hands.

Nope, the rest of the advice is your best bet....:smile2:

Very sound advice from Tim. There is lots of evidence that probiotics help recovery from D&V and also that they help to replace good bacteria in the Gut.
Overuse of antibiotics is a worldwide problem, which is why countries with responsible healthcare systems don't let you buy them over the counter! They are not required in most cases of food poisoning, or lots of other infections!! Over use of antibiotics has directly led to the rise of resistant bacteria.

Even if you are vomiting, keep drinking water, you will absorb some.

When we and my dad drove down through West Africa to the Gambia we did all the things you shouldn't do, ate from roadside stalls, etc etc etc and never got sick. when we got back to the UK we went for a pub meal to celebrate and both got viscous food poisoning. Like someone said, you can get food poisoning anywhere!!

As I think I said before and as Tim has said, alcohol wipes are not a substitute for handwashing. Some bugs are only removed by soap and water. Norovirus for example is not killed by alcohol handrub.

Only take loperamide etc if you really need to get somewhere. it's just holding the bugs in, better to let it all out.

Using common sense. I had a prawn cocktail in a hotel in The Gambia and had to spend the next week within 10 yards of the toilet. Really stupid mistake, especially for a healthcare professional!!

That's some great advice there Moggy! I'm no health care pro but traveled enough to prove out most of what you say through empirical evidence! :thumbup1: Spot on!

Staying hydrated so important. I worked with UNICEF/World Vision in Cambodia filming their hydration stations in small rural villages. They gave kids a powder like Pedia-lite, mixed with clean water. Free and distributed widely. Not a bad thing to pack for travelers too.
Plus one on probiotics too for gut health/resistance and recovery.

So many kids die from untreated Diarrhea, don't drink enough or drink more tainted water. They then become dehydrated. Even with I.V.'s. too late for many.

In 7 years in Latin America (on and off) I got sick every time I moved to a new region. Most people can adapt to local bacteria once in an area for a while, but as said, common sense should prevail. Don't get cocky!

But certain things will nearly ALWAYS nail you: Not so fresh Shrimp, fresh picked berries and a few other tempting delights. That said I've eaten a ton of Shrimp in Mexico, but always fresh, sold at reputable place with lots of trade.

I too ate in local markets, rarely got sick. But once moved to another country or area I'd usually have a "period of adjustment", then after a week or two, I'd be OK again. Constantly on the move is tough for your system to keep up and deal with constant onslaught of bugs.

Another good reason for hand washing is Hepatitis. I got Hep C in Bolivia, very mild case. I believe due to several shots of Gamma Globulin the previous year. Seemed to help with quick recovery. (just 2 weeks!!)

I consumed LOTS of fresh squeezed juices while traveling: Ginger, Carrot, Apple, Beet, Orange. Juices will keep you alive and speed recovery from whatever ails you ... just make sure the place is clean, veggies washed and bring your own GLASS! Mega Food!

Many long time travelers get ill once home. A fairly common thing. bier

Hep C is blood and body fluid borne, nothing to do with hand-washing - that is A, E. As you say, you most likely got it from globulin shots....
Oral re-hydration salts good for kids, not so much for adults.
Antibiotics have their place in suspected bacterial diarrhea - the old, the young, the febrile, bloody stool, raised white blood cell count, chronic illness, immune compromise.

Yea, I screwed up ... in those days the version I got was called "infectious" Hepatitis ... I've forgotten the current letter designation ... but you mainly get it from contact with feces. (the needle/blood one we called "Serum" Hep)

Quite an epidemic of Gringos getting infectious Hep back then... from Guatemala to Bolivia ... it was everywhere.

As I understand it .. gamma glubulin is meant to prevent Hep ... or increase your resistance to it?? Doc's are divided on effectiveness. But NO ONE ever saw someone go from Yellow Eyes, Gray poop, root beir brown pee ... to NORMAL in two weeks. (Minimal recovery time from Hep is two months for most)

No one has ever been able to explain why I recovered so quick ... and most don't believe it's possible. But I had the lab work that showed Red cell vs. White cell count and all that, and full report on my condition when diagnosed.

I attribute my luck to the Gamma Glob ... but I ain't no Doc. (but what else could it be?)
:innocent:

Sexual contact, intravenous drug abuse, blood transfusion, shared razor or toothbrush.....and that's just for starters! :smartass:

wouldn't really agree with that, bugs love a warm moist environment, so even if the hotel boiler kills them, which is unlikely, they'll be in the pipework. Also more chance of nasties like legionnaires.

The 'boiler' is unlikely to actually boil water, which is whats required for killing bugs. 10 minutes preferably.

Hep B can live on a surface for upto 2 weeks. It's an extremely tough bug and can easily be passed by means other than sexual contact. I don't generally shag my patients! but because I work in ED, I still have to be vaccinated because it is classed as a high risk area with frequent contact with bodily fluids. It really pisses me off when I see blood splashed on peoples notes etc because Hep will easily survive on there. All you need is a route of access, like a cut on your hand, and away you go!

There is a big thing here at the minute about not eating canned fruit because of hep A contamination because the pickers don't wash their hands after going to the toilet!

I did say not required in MOST cases of food poisoning. of course they have their place, just not as much as a lot of people think!

you've misread me mate. I KNOW how I got the HEP, what I'm talking about is WHY I recovered from it so quickly.

(BTW, in my case no sexual, blood or needle exposure ... just nasty conditions in dirty communal bathrooms in funky Hotels and restaurants with very low cleanliness standards)

Chill brother, I was pulling your leg.....

It was the other stuff he got through his dodgy sexual activities:blushing:

yes, it was, but there is no value in offering advice on enteritis through contaminated water and ignoring all other risks which you may be increasing exposure to, although it might be going a bit off topic, such as legionella, which is classically found in hot water supplies. Whilst it is not a gastric infection (it's more like a pneumonia) it is found in water systems. actual contamination is commonly from ones that have a degree of misting such as showers, hot tubs etc and it can lead to diarrhoea as well as respiratory symptoms.It can be effectively controlled by maintaining a circulating temp of greater than 50C, but this will not be possible throughout the system, which is why it tends to be found around outlets such as showers where the temperature has dropped.

You will not maintain a temperature of greater than 60C thoroughout the water system, and cannot guarantee that temperature will be maintained at all. Whilst it is a UK requirement that hot water is stored above 60C, for the control of legionella, the same is not true of other countries.

I'm not sure about why you say clostridium is not an intestinal pathogen, it most definately is, but is not caught from contaminated water. it's spore forming bacteria which causes infectious diarrhoea so is most likely to be passed through poor hand hygene. Usually though it is only a risk to those with compromised gut flora. It typical starts after the guts normal flora has been compromised, for example by antibiotic therapy so not that relevant to a discussion of water disinfection

Here is the UK guidance on drinking water, which advises NOT drinking from the hot tap, due to the risk of legionella and bacteria growth, despite the quality of UK water supplies

http://www.gov.scot/Resource/Doc/158461/0042948.pdf

All the resources I have ever seen (including WHO guidelines) recommend boiling water as the only method for heat decontamination of drinking water. This then needs to be followed by correct storage if re contamination is to be avoided.
The part of the above text you have put in quotes is unreferenced so no one is able to verify your source material. You have supplied an incomplete reference to the Mayo clinic, but their site confirms what I have already said about travelers diarrhoea and advises against drinking tap water (it makes no distinction between hot or cold)

http://www.mayoclinic.org/diseases-c...n/con-20019237

I have never seen any recommendation to drink warmed water or water from the hot tap. I have seen a number of recommendations that you do not drink water from the hot tap!!
I shan't be drinking water out of the hot water supply thanks!

rather than unsubstantiated opinions on a forum, people may like to look at the WHO guidance on travelers diarrhoea and how to make drinking water safe, which is drawn from properly researched sources!!



http://www.who.int/water_sanitation_.../sdwtravel.pdf

and here is a link to the Mayo clinics advice on travelers diarrhoea

http://www.mayoclinic.org/diseases-c...n/con-20019237

self edit as the offending post this referred to has been removed

OK.....

No personal attacks. Stick to the topic at hand. Thanks.

Tut - you killjoy.

I likes a good argument, I do...... I was enjoying that exchange.....

I'm sure it was all friendly banter, wasn't it boys??

I broke my own rules... I spent two days with horrendous food poisoning and fever in a stinking hot grass hut in Northern Thailand.

I'd had a few alcoholic beverages and ate a Kebab from a street vendor. It looked suspect and my 'gut feeling' told me I shouldn't but I was hungry and not thinking clearly... beer

It was in a very touristic town and they would rather sell you raw, dirty or uncooked meat than lose a customer.

When people come and come so quickly, you're unlikely to see the same customer twice anyway....

Just once more:

No personal attacks. That means no calling other posters names, whether by emoticon ("abusive troll") or implication ("personality disordered narcissists").

Contributions to the thread, more or less on topic or vaguely related, are fine.

Lighthearted banter is also fine, of course. Some of the recent posts don't qualify.

Thanks for staying on track.

Mark