Unsafe Food Can Turn Trip Into Ordeal

Dr. Sheldon Margen is professor of public health at UC Berkeley; Dale A. Ogar is managing editor of the UC Berkeley Wellness Letter. They are the authors of several books, including "The Wellness Encyclopedia of Food and Nutrition."

Summer is here, and that means vacation time is upon us once again.

In theory, this is a great idea. Take a few weeks off, explore the planet, get to know your kids, commune with nature, see the sights. On the other hand, vacations can also mean that you spend a lot of money, run yourself ragged, get to know your kids too well, and, if you're not careful in some of the more interesting parts of the world, the only sights you'll see might be from the bathroom of some overpriced hotel.

Unfortunately, there's not much we can do about your kids, your budget or your stress level, but we can give you some advice about eating and drinking when you're far from home.

Traveler's diarrhea is one of the most common ailments you are likely to encounter in the less developed parts of the world. The symptoms include the standard diarrhea (two to five times a day) along with nausea, cramps and fever. The nasty little bug primarily responsible is a familiar one, E. coli, and it is most bothersome in places such as Africa, the Middle East, Southeast Asia and Latin America. Unfortunately, if you aren't careful, this may be the lesser of all the evils that could befall you. The outcome could also be cholera, typhoid, hepatitis or worse.

If you are traveling to Europe (except for parts of southern Europe), Australia, New Zealand, Canada or Japan, you can probably drink the water and sample all the local cuisines without worry. However, if you are going somewhere else, the following precautions should always be taken.


* Do not eat raw vegetables; assume they are contaminated. Lettuce very often contains parasites as well, so stay away from salads. Make sure all vegetables have been well cooked.

* Eat fresh fruit and nuts only if the skin has no breaks in the peel or shell. Wash all fruits in soap and rinse in boiled water. Remove the peel before eating.

* Be sure that all meat and fish are thoroughly cooked and try to eat them while still hot. This will lower your risk of getting tapeworm or trichinosis. Some restaurants leave food sitting around for hours and then reheat it in a microwave before serving. This may or may not protect you against many microorganisms. If in doubt, ask how the food was prepared.

* Try to eat only fish that was freshly caught. Do not eat uncooked fish such as sushi, ceviche or fish eggs (caviar). No matter where you are (even at home), avoid raw shellfish.

* Take extra care with milk and other dairy products, especially if they have not been pasteurized or properly refrigerated.

* Avoid perishable food that is sold without refrigeration (especially from street vendors). Pay special attention to cold cuts, pastries, custards, meat salads and fish.


* Many modern hotels, even in the developing countries, purify the water, but if you are at all in doubt, do not drink the water or use it for brushing your teeth.

* Safe beverages include coffee and tea (if the water has been boiled), bottled wine, beer and canned soft drinks. Bottled soft drinks are iffy, so avoid them. And do not drink locally bottled water: It may just be tap water put in a bottle for the anxious tourist--it probably has not been purified.

* Before you drink anything out of a container (like a can), wipe the top off well. Only use straws that come in sealed paper sleeves.

* Freezing water is apparently no guarantee of safety. Do not put ice cubes in your drinks unless you can make your own from boiled water.

* If possible, purify your own water by boiling it for two or three minutes (a small immersion heater can do the trick), or add special purifying chemicals such as Halzone or iodine. If the water is cloudy to begin with, let it sit for at least 30 minutes after purification before you drink.

Before you leave home, you might want to ask your doctor to give you a prescription for drugs that are appropriate for the area you are visiting.

If you do come down with a bug and don't have any prescription medicine, try taking some Pepto- Bismol. The most important treatment for diarrhea is replacement of the fluids lost. Drink plenty of clear (boiled) liquids such as tea. Do not drink milk or other dairy products. If you have small children with you, it might be useful to carry along a few bottles of pediatric oral rehydration solution that are now readily available.

Traveler's diarrhea is rarely serious, but if the diarrhea is severe and appears to be bloody, you may have dysentery and should get medical attention right away.

Vacations are supposed to be a time for relaxation and fun, but it wouldn't take much to turn an expensive trip into a miserable experience. If you are traveling with children, be especially watchful of what they eat and drink because the effects of food- or water-borne illness can be even more devastating for them.

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