Food in Faraway Places

From cozy cafés, small food stores, and open-air markets . . . to rice paddies, hillsides with tropical fruit trees, and fishermen hauling in their nets . . . food offers a unique cultural experience for the curious traveler. Americans' growing enjoyment of ethnic foods comes in part from their travel experiences. Savvy travelers take the opportunity to try the adventure of new foods and flavors.

As the world grows smaller and as adventure travel grows in popularity, more business and pleasure travelers (adults and youth) venture to places where sanitation standards are not as high as in the United States. In certain environments, bacteria, parasites, and viruses can transfer to food from poor sanitation or agricultural practices. To help control the spread of disease, immigration forms for entering the United States ask if you've visited a farm; travelers and their baggage also go through an agricultural inspection.

No matter what you call it—Montezuma's Revenge, turista, or something else—travelers' diarrhea most often is caused by contaminated food and/or water. Typically, it lasts no more than three to four days, but that's enough to upset or even ruin an otherwise wonderful vacation—and certainly puts a business trip into a tailspin. The first bout won't "immunize" you from the next. But the good news is that you can reduce your risk by being cautious and careful. Pay attention to everything you eat and drink, remembering the same food safety rules you follow at home.

Food Safety: Ounces of Precaution

Like other types of foodborne illness, travelers' diarrhea is most commonly caused by bacteria—proba-bly 80 percent of the cases. For travelers, improperly handled, contaminated food and drink also can cause E. coli infections, hepatitis, giardiasis, shigellosis, and other contagious diseases. To avoid foodborne illness, the guidelines in "Eating Out Safely!" in this chapter apply no matter where you eat away from home. In less developed areas, you need to take added precautions: "boil it, cook it, peel it, or forget it." For more about foodborne illness, see chapter 12.

  • If you're traveling to developing or rural areas, ask your physician and county health department about immunizations and preventive medication suggested for your travel destination. The Centers for Disease Control and Prevention ( provides food, water, and immunization alerts and advice for travelers in many regions of the world. That includes advice about diseases such as bird flu. If you're traveling with an infant, child, or someone at high risk (see chapter 12), immunizations are a must, as are pre-travel precautions for foodborne and other infectious illness. Even if you're visiting friends and relatives abroad and perhaps staying in their homes, you need pre-travel preventive care.
  • Avoid buffets if food is just rewarmed after sitting for a while, or if it's been kept at room temperature for longer than 1 to 2 hours.

Salads, fruit with peels, raw vegetables (in uncertain areas)

Raw, rare, or partly cooked meat, poultry, or fish

Softly scrambled or sunny-side up eggs (unless the egg is well cooked) Unpasteurized milk

Cheese made from unpasteurized milk Food and drinks sold by street vendors

Fruit peeled by you, cooked vegetables

Well-cooked meat, poultry, or fish

Well-cooked scrambled eggs or hard-cooked eggs

Canned or ultrapasteurized (UHT) boxed milk, or pasteurized milk from a large commercial dairy (ask to be sure)

Cheese made from pasteurized milk

Only commercially bottled drinks and commercially packaged foods from vendors

  • Be aware: A few fish and shellfish contain toxins even when they're cooked; avoid barracuda and puffer fish. Especially in tropical waters of the West Indies, Pacific, and Indian Oceans, a few other fish are occasionally toxic, such as tropical reef fish, red snapper, amber jack, grouper, and sea bass.
  • Like at home, always wash your hands before eating! Remember: Your hands can transfer diarrhea-causing bacteria to your mouth. Carry an antibacterial hand wash, wet wipes, and maybe a small bar of soap.
  • When you aren't sure what you may encounter, carry packable, nonperishable foods. Single-serve foods, sold for lunch boxes, are great for travelers.
  • Check travel guides and talk to staff in the better hotels, or to your tour guide, to find restaurants with high sanitation standards. Restaurants in better hotels usually have high standards. Food and drinks eaten from street vendors increase the chance of illness.
  • If you travel with a baby, breast milk guarantees food safety. If your infant takes formula, prepare it from commercial powder, and boiled or commercially bottled water. For more about infant formula, see "Another Healthful Option: Bottle-Feeding " in chapter 15.

What's Safe to Drink?

You're always smart to play it safe. In developed countries, tap water should be fine.

Better hotels in lesser-developed areas also may filter and chlorinate their tap water to make it safe. Before you use water from the faucet, find out if the hotel has a water purification system. When you're not sure, don't drink or brush your teeth with tap water. Instead, use commercially bottled or canned water with the seal or cap intact. Keep a bottle or can of water in your carry-on bag.

Soft drinks, canned or bottled juices, beer, and wine are safe to drink. Coffee, tea, and other hot beverages are usually safe because the long heating time destroys most and perhaps all of the bacteria, viruses, and parasites that might be present in the water. You also can boil or chemically treat water you drink. The Centers for Disease Control also advise you to dry any wet cans or bottles before opening them, then wiping clean any surfaces where your mouth contacts the can or bottle. For guidelines on treating water to make it safe for drinking, see "SafeEnough to Drink" in chapter 8.

In less-developed areas, avoid beverages made with water or ice cubes—unless you know that commercially bottled water was used. Also avoid bottled water served to you without an intact seal or cap; it may have been refilled with local tap water. Be cautious of locally bottled water because the standards may not be high for bottling. Even crystal-clear water in wilderness areas anywhere, including the United States and Canada, should be treated before drinking it.

If You Do Get Sick...

  • For most cases of travelers' diarrhea, dehydration is the biggest concern. If it strikes you, increase your fluid intake—with plenty of safe water, canned juice, and soup. Canned soft drinks (preferably without caffeine) are okay, too.
  • If the problem persists (more than three or four days) or if your symptoms are severe, seek qualified medical care. Your hotel or tour guide should be able to suggest a physician.
  • Prepare before you travel; talk with your physician at home, and take any precautionary medication recommended. For more about dealing with diarrhea, see "Gastrointestinal Conditions" in chapter 22.
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