Fare Warning: Better to Be Safe Than Sorry and Sick

Savvy travelers know they must be careful in destinations where the sanitation isn’t up to standards: They don’t drink the water, and they pass up food from street vendors. They also know the mantra about food in unknown regions: “Cook it, peel it or forget it.”

But just when road veterans think they know everything about minimizing their risk of food-borne illness, along comes research like the recent guacamole study: Texas researchers evaluated tabletop sauces at Mexican restaurants and found that some were crawling with disease-producing organisms.

As surprising and disgusting as that was, it proves that food safety is an ever-evolving challenge. To stay current, travelers should consider checking in with their physician or a travel medicine specialist before departing. They might also strengthen their resolve to follow his or her advice; research shows that only 5% of travelers earn a perfect score at observing food and drink precautions. Travelers should also consider checking established Web sites, including those of the federal Centers for Disease Control and Prevention (www.cdc.gov) and the World Health Organization (www.who.int), for bulletins and updates related to food dangers on the road. WHO also posts “A Guide on Safe Food for Travellers” at www. who.int/fsf/brochure/trvl1.htm.

The recent Texas study is a good example of a newly recognized risk. Researchers at the University of Texas-Houston Medical School evaluated tabletop sauces from Mexican restaurants in Houston and in Guadalajara, Mexico--including red sauces, green sauces and guacamole. They found that 47 of the 71 sauces from Guadalajara were contaminated with E. coli, a leading cause of traveler’s diarrhea, versus 10 of the 25 sauces from Houston. And the average level of contamination was 1,000 times higher in the Guadalajara sauces.

The problem is not just that the sauces often sit out on the tables all day, says Dr. Charles Ericsson, director of the Travel Medicine Clinic at the medical school and an author of the study. Many customers’ hands--some not clean--are in and out of the sauces, he says, and the preparation may not have been sanitary to begin with.

He advises travelers not to eat the sauces in Mexican restaurants, even if they are in chilled dishes. “Just because [the container] feels cold doesn’t mean the original ingredients weren’t contaminated,” he says.

To avoid other food-borne illness, Ericsson advises travelers to “stick to freshly prepared food that is cooked and too hot to put in your mouth” when served. Once it cools, it should be safe. Foods that are too hot to taste are at about 160 degrees Fahrenheit or more, he says--and that temperature should kill disease-causing organisms. If a food meant to be served hot isn’t, Ericsson advises travelers to send it back.

Salads are also “notoriously associated” with food-borne illness, Ericsson says. Again, it has to do partly with the number of hands, some unclean, that are in and out of the serving bowls.

In general, table-service dining is safer from a food-contamination point of view than dining at salad bars or buffets, according to Christine Bruhn, an expert in food safety and the director of the Center for Consumer Research at UC Davis. Food-safety authorities in the U.S. advise restaurants to rotate buffet foods in specific ways, such as removing an old tray of food and replacing it with a new one, rather than pouring new food on top of what remains in the tray, she says. But these are only guidelines; the regulations vary from state to state.

And you also need to watch the customers, Bruhn says. They have been known to dip a finger in the salad dressing, for instance, to evaluate taste.

Choosing table service over buffet is probably wise, she says, for anyone with reduced immunity--and that doesn’t just mean those with immune deficiency disorders. After about age 50, she says, your stomach isn’t as well equipped to handle contaminated food as it once was.

Dr. Brian Terry, a Pasadena physician with a special interest in travel medicine, tells his traveling patients that it’s fine to eat salads “if you’re going to Japan, Western Europe or Canada.” But in developing countries, forget about salads, he suggests.

In countries with poor sanitation, Ericsson tells travelers to avoid most raw food. One exception, he says, is food that can be peeled; contaminants will probably be eliminated with the skin.

Some raw fruits are more likely to be contaminated than others, Terry says: “Berries are notorious because there are lots of nooks and crannies, and they are hard to clean.”

He tells travelers to be wary of dairy products in developing countries because they may not be pasteurized. Skip the mayonnaise, he says.

And what about drinking bottled water? Can you be sure it’s safe everywhere?

Regulating organizations are different in the United States and overseas, says Stephen Kay, a spokesman for the International Bottled Water Assn. In the U.S., bottled water is regulated by the Food and Drug Administration and by individual state regulations. Other countries may not agree to follow similar standards set down by the World Health Organization.

Bottled water beats tap water in regions of substandard sanitation, but there’s still no guarantee that a bottle bought overseas won’t have organisms in sufficient quantities to cause illness, Ericsson says. He suggests choosing bottled water with plastic rather than metal caps because “plastic caps are harder to tamper with”--making it easier to spot a used bottle that has been refilled with tap water by a profit-minded restaurant owner or food vendor. Spending a little more for a brand name might be wise too, he says.

Terry tells his traveling patients not to drink from a carafe of water marked “bottled water” in a hotel room in developing countries.

According to the World Health Organization, other drinks, such as hot tea, wine, beer, carbonated soft drinks or juices that are bottled or otherwise packaged, should be safe.

Ice cream can be contaminated, according to the World Health Organization. If in doubt, pass it up.

Fish and shellfish can contain poisonous biotoxins, the CDC says, even when well cooked. Ciguatoxin, the most common type of seafood biotoxin, is found in barracuda, red snapper, sea bass and many tropical reef fish.

Fish in the scombroid family, such as yellowfin tuna, mackerel and bluefin, can cause poisoning because of high levels of a substance called histidine in their flesh. When these fish are improperly refrigerated or preserved, the histidine converts to histamine, causing flushing, vomiting, diarrhea and itchy welts.

Terry tells travelers to consider the source of the fish and exercise common sense. If you’re sportfishing in areas with potentially contaminated fish, don’t eat your catch. But if it’s from a hotel dining room, it’s probably OK.

Another commonly overlooked habit that can go a long way toward reducing illness on the road, Terry says, is simple hand-washing. “People don’t wash their hands often enough,” he says, sometimes because they don’t have access to soap and water before eating. “Take along antiseptic towelettes.”

Travelers who decide to break a few rules--remember, that’s 95% of us--should consider packing an over-the-counter anti-diarrheal remedy, Ericsson says, and asking their doctor for a prescription antibiotic to take if diarrhea sets in.