Food poisoning

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Food poisoning and its main symptom diarrhea is undoubtedly the most common traveller's illness. In many ways it's unavoidable: no matter how fanatical you are about food preparation, any dishes are still liberally sprinkled with millions of airborne bacteria. At home, due to this constant exposure, odds are very high that you're already immune to them; you're far more likely to run into problems in places where the bacteriological fauna are new to you, and hence Delhi Belly, the Pharaoh's Curse, Montezuma's Revenge and their many friends.

Prevention

There's an old adage for eating in the Third World:

Boil it, cook it, peel it, or forget it.

This seems simple, but in practice it's a tough road to follow, the problem being not so much the risk of accident as the risk of temptation. For example, the following items are highly likely to cause problems:

• tap water
• ice
• milk
• fresh fruits and vegetables

Test: It's another sweltering hot day in Delhi and that vindaloo you just ate is still scorching your throat, so how about a nice strawberry shake to cool you down? If you said "Sure!", you just passed an intestinal death sentence on yourself: that shake contains every single one of the four banned items. The ice that makes it cold has either been made from tap water or, worse yet, comes from the factory in huge blocks that are often literally dragged down the street. Milk spoils very quickly in the tropics, and those yummy leafy veggies and unpeeled fruits have been washed in that same parasite-laden tap water — if at all.

Having read this, your instinctive reaction will be to panic and to head for the nearest expensive, air-conditioned, friendly tourist restaurant where the kitchen is hidden from view. Bad move. They're still using the same ingredients, stored with the same levels of hygiene or lack thereof, but because it's a tourist restaurant their business model relies on catching a couple of tourists a day, instead of feeding a crowd of locals. This, in turn, means that those same ingredients have, more probably than not, been sitting around a long time waiting for you.

What to do then? It's a numbers game, but here are a few guidelines to improve your odds of escaping unscathed:

• Choose a popular restaurant (or street stall). Many people (especially locals!) means that the food isn't left sitting around, and more likely than not, it also means the chow is good and the price is right.
• Choose cooked dishes that are made on demand. Things like fried rice and fried noodles are popular in the tropics for a reason. Buffet-style meals, on the other hand, may appear cheap but (unless extremely popular) are very risky indeed.
• Dishes that are kept boiling hot — in practice this means hot drinks and soup — are also a pretty good option. Fiery curries and the like are not quite as good, but they're usually OK largely thanks to the disinfectant properties of most spices. On the flip side, excessive spices alone may be enough to upset your stomach's balance, so it's best to avoid these at least for the first few days.
• Avoid meat, fish and especially shellfish; go visit the market to find out why. Eating ground meat (meatballs etc) or anything not well-done is especially risky, not only due to food poisoning but because of the risk of things like trichinosis. Additionally, things like barbecues and roast chicken have to be prepared in advance, and who knows how long they have been sitting there?
• Drink only beverages from untampered bottles and cans, and check the seals first! Don't let waiters pour stuff in the kitchen, because you won't be getting what you expect. Reputable restaurants will open their drinks in front of you for this very reason.

The good news is that in a couple of days you'll start to acclimatize to the local bacteria and your odds of getting sick will start to decrease. The bad news is that it only takes one fly in the wrong place at the wrong time to foil all your precautions, and that if you stick around for a while a run-in with food poisoning is, alas, more or less inevitable.

Treatment

So one day your luck runs out, and you find yourself feeling distinctly queasy. Runny bowels or simple diarrhea don't really qualify for food poisoning , and dysentery is in a league of its own, but if you...

• feel sick and dizzy
• get a fever
• start to feel like you need to throw up

...then, well, congratulations. The first thing to do is to get the acute phase over with: head for the toilet, kneel in front of the bowl (hopefully not a squattie) and let go. You won't start to feel better until you start throwing up, and you won't get this over with until your stomach is empty, so just do it. Do not attempt to eat anything, and do not drink anything other than water yet. When there's nothing left, wash your mouth, brush your teeth and go to bed. You'll feel more alive in the morning. If, however...

• the acute symptoms persist for more than two days, or
• there is blood or pus in your feces, or
• you are getting chills as well as fever

...you may have something worse and should see a doctor.

Do not, repeat, do not take any antidiarrheal or antiemetic drugs. These will just block up the nasty stuff in your system and you'll risk turning (relatively) harmless food poisoning into something much worse. A doctor may prescribe antibiotics in severe cases, but this is usually overkill.

For the next few days, you will find that your appetite has all but disappeared. Don't force yourself to eat, but do be sure to rehydrate yourself: water (boiled, if not bottled), weak tea (sweetened), flat soda, diluted fruit juice are all good. Drinking a glass or two an hour till everthing stops running out the other end should stop you becoming too dehydrated. You can get Oral rehydration solutions or sachets from a pharmacy but they are essentially the same as a teaspoon of sugar, a teaspoon of salt and some flavouring added to a glass of water.

If you feel like eating something, stick to bland, stomach-friendly foods like rice, porridge, crackers, bread. But be aware that food for you is also food for any bug that has made you sick, so take it slowly and stop if things get worse. Avoid dairy products initially as these delay recovery. Do not, under any circumstances, consume alcohol.

See also 

Cryptosporidiosis, Tropical diseases

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