​FOOD AND WATER PRECAUTIONS

Traveller's diarrhea is the most common "tropical" disease encountered, affecting 30-50% of travellers. It commonly lasts 3-5 days and is usually not severe. This article discusses how to reduce your chances of developing diarrhea. The advice given here may be too rigorous for some destinations, so you may want to tailor these to your trip.

DRINK
Don't drink water from the tap. Don't have water poured for you into a glass in a restaurant. No ice cubes. Ask for bottled water, carbonated even better, and in a restaurant have it brought unopened to the table. When buying bottled water, check that the label looks proper, that the cap seal looks intact and clicks when turned. Clean water should be used to brush teeth. If none is available, you can put your toothbrush under the hot water tap if that water is too hot to touch.
Beer, wine and soft drinks are usually safe though you should buy the latter in a can or bottle, not as a fountain drink. Fruit juices poured from a pitcher are worrisome, as tap water may have been added. Tea is usually a safer drink as it has been at least boiled. 
If you have facilities for boiling, one minute of boiling will purify water. In many cases just bringing water to a boil will be enough. Adding a pinch of salt or shaking boiled water will restore some of the taste. At high altitude a somewhat longer boiling time is recommended. Where boiling is impractical, other purification methods are available. Popular now are Pristine water purification drops.  Ultraviolet wands are another option, although they are more expensive.

Dairy
Regarding dairy, try to ensure that they have been pasteurized before consuming. This includes milk, ice cream, butter, yoghurt and cheese. In some countries, a particular brand has a good reputation. Cheeses imported from Europe are usually safe. Canned, long life or powdered milk is generally acceptable.

Fruit and vegetables
Avoid salads in restaurants, cooked being preferable. On the other hand, you can buy fruits and vegetables in a market or store and eat them - if you peel them or wash them well in clean water. Fruit and vegetables are most often contaminated on the outside surface, not inside, from soil, people's hands, unclean water they were freshened up with. Leafy vegetables such as lettuce though are difficult to clean. These need to be disinfected with iodine, for example, and then rinsed in clean water. 

Meat
Meat should be well cooked and hot when it comes to the table. Order all meat well-done. If you cut into your meat and it is not well cooked throughout, send it back. If it is not hot, send it back. Pork is trickier than beef in general.

Try to avoid cold buffets, sauces and street vendors.  

Shellfish
Clams, mussels and oysters may be among the worst culprits for causing diarrhea in travellers. Fish is usually OK. Shrimp and lobster are somewhere in  between. If this is too severe a restriction for seafood lovers, then at least try to ensure that the seafood is fresh, has been well-cooked and that the restaurant has a good reputation.

Safer foods
Foods that have been in boiling water such as rice, pasta, vegetable soups are generally safe to eat. Dry things are often low risk, such as bread and crackers. Sweet pastries are often acceptable while creamy pastries are not.

You may be thinking, "There's nothing I can eat!" These rules can sometimes be relaxed in restaurants of good reputation with better hygiene and on resorts. Many delicious local dishes can be eaten - just order those that are cooked.

Treating traveller's diarrhea
We suggest to our travellers that they pack two medications to treat diarrhea if it occurs: Imodium and the right antibiotic. We write the prescription for the proper antibiotic, depending on the itinerary. Imodium can be used for a milder case and we recommend it for adults only. Antibiotics are reserved for more severe cases. In all cases, a good intake of fluids, eating bland foods and avoiding dairy for a while are suggested.
Our clinic stocks oral rehydration salts as well, these being most useful for the elderly and infants as well as people with conditions where dehydration would be especially important to avoid.