Making sure you eat and drink safely is one of the most important things you can do to stay healthy while traveling and probably the most difficult to do.
Avoiding “the runs” is nearly impossible
If you travel for long periods of time, no matter how careful you are, at some point you are probably going to get hit with traveler’s diarrhea. Your goal is to “minimize” your risks, understanding that there are too many variables which you can’t control to be able to eliminate all risk. It all starts with food or liquids that contain bacteria. The bacteria get into these food or liquids through water from un-purified water sources, contamination from food handlers with poor hygiene, or poor kitchen hygiene such as chopping veggies on the same cutting board where raw meat was chopped, or any other contamination during the food’s journey from butcher or garden to the kitchen.
Many sources of contamination
According to the CDC, the sources of possible contamination are varied and many. For example, if a hen’s reproductive organs are infected, the yolk of an egg can be contaminated in the hen before it was even laid. If fields are sprayed with contaminated water, fruits and vegetables can be contaminated before they are harvested. Fish may acquire toxins from the smaller sea creatures they eat. Think of your mouth as your body’s main disease-entry barrier. Your goal is to try to ensure that no harmful bacteria (or parasites) get past that barrier.
It’s not just food that gets contaminated…watch out for the dishes
You have probably heard travel recommendations to only eat food that is freshly cooked and piping hot and to avoid precooked food that sits around in steam tables or buffets, or street food stalls. That’s still great advice. However, if this piping hot food is served on a plate with utensils that were washed in contaminated water in the back of the restaurant, your food will eventually cool off and get pushed around through the bacteria on the plate and get contaminated again. If your bottled water, or pop, or juice gets poured into a glass that was washed in tap water, you are now drinking a possibly contaminated drink. If you get ice with your drink, you are doubly blessed, essentially drinking the questionable local tap water.
Your server (or you) may be the problem
Maybe the restaurant you are eating at advertises its cleanliness to attract customers, proudly claiming that dishes are washed in a dishwasher with chlorinated water, and that all vegetables and salad greens are soaked in disinfectant solutions. Sounds great. Then your server who doesn’t bother to wash his hands after using the bathroom picks up your plate and delivers your newly cleaned and personally contaminated plate to you. The “sanitized” salad greens or vegetables may be infected with salmonella or e-coli which cannot be removed by soaking or rinsing with anti-bacterial solutions. E-coli bacteria can burrow into greens or vegetables and form a protective biofilm to protect itself. The only way to get rid of e-coli from food is to heat it to a sufficient temperature…rinsing or soaking can eliminate some bacteria, but not e-coli.
You’ve also been advised to only drink bottled liquids with the cap still on and sealed (in case your bottled water is just a bottle filled with tap water). But if the server has contaminated hands, or you yourself have contaminated hands from something you touched earlier, then the outside of the bottle may be contaminated with bacteria that will infect you. Don’t forget that your own hands can also be a source of contamination if you’ve handled anything with bacteria on it since you last washed them.
Heat kills bacteria
Anyway, back to our goal, which is to consume only non-contaminated food and fluids… The only easy reliable way to kill bacteria in foods is to heat them to a high enough temperature for a long enough time. You often see recommendations to heat foods to 160-165°F to kill harmful bacteria. This is true, but in practice heating foods to that temperature may overcook them and make them less palatable. The solution is to heat the food at a lower temperature but for longer amounts of time. To kill salmonella in chicken you can heat it to 160°F for 14 seconds, or you can heat it to 148°F for about 3 minutes. For beef you can heat it to 140°F for 12 minutes to kill all bacteria, or at 145°F for 4 minutes. If you are cooking foods at lower temperatures than 140°F you need to cook them a lot longer. At 135°F you need to cook foods for about 36 minutes, and at 130°F you need to cook them for about 115 minutes. Normally, food handling guidelines say that steam tables should maintain food temperatures at 140°F. Since it’s not really feasible for you to carry around a food thermometer with you and measure the temperatures of food you get in restaurants, you will need to learn to estimate how hot the food got by looking at what you are eating and making some assumptions. A rare steak is usually heated to 130-139°F , so it’s safe to assume that if you are eating a rare steak grilled for 3 min per side, that any salmonella or e-coli in that steak are probably still viable. If the steak is cooked medium (pink but not bloody), then it probably got up to 140+ for long enough that you are safe.
What about liquids? To purify water at sea level, it must be brought to a rolling boil for one minute. At 1000 meters (3280’), boil it for two minutes, and at 2000 meters (6560’), it should be boiled for three minutes, because water boils at lower temperatures at higher altitudes. If you are eating foods that are prepared in boiling water, such as rice, beans, boiled potatoes, etc., then the foods’ internal temperatures must still reach the aforementioned levels for sufficient time in order to be disinfected. Foods like soups and stews that have been simmering for hours in a pot and are served piping hot are usually a safe bet as long as they are at 140°F when you receive them. Again the iffy part of the scenario is how the dishes were washed and the cleanliness of the food handlers.
You will find that in many countries where food and water-borne illnesses are a problem that meat tends to be cooked well-done and they drink a lot of tea or coffee and never use ice drinks. We recently had a woman from Kyrgyzstan over to our house for dinner and were grilling steaks and she asked for her steak well-done (no pink) and her iced tea without ice. She said that people in her country actually feel that ice can make you sick.
Safe and Unsafe Food and Drinks
The following food and drinks should be considered potentially contaminated:
- Any water not from a sealed bottle that you opened
- Any ice not made from bottled water that you opened.
- Any drinks made with unsafe water or ice.
- Fruit juices that you didn’t see coming out of a commercial package
- Dairy products made from unpasteurized milk, including gelato, ice cream, yogurt, cream, butter, cheeses (check labels to verify pasteurization)
- Cold meats of any kind
- Cold buffet foods or foods from lukewarm steam tables (below 140°F)
- Foods made with mayonnaise left out for any length of time
- Eggs raw or partially cooked (runny or soft)
- Raw vegetables, leafy greens, sprouts
- Raw fruits with skins that cannot be removed without a knife (including melons, grapes, berries, mangoes, papayas, apples, pears, tomatoes, etc.)
- Fruits with peels that are unpeeled when you get them
- Oysters and raw shellfish (even cooked these are iffy, due to other toxins and contaminants in shellfish, plus usually short cooking times)
- Raw fish, especially tuna or sushi made from raw fish
- Any cooked food that you suspect has been reheated after being cooked or not cooked to a sufficient temperature (rare meats, veggies like sprouts in a stir fry that are still crisp, tec.).
- In general, avoid any food that has been cooked beforehand and has been sitting around, buffets, etc.
The following foods and drinks should be considered safe:
- Drinks made from water that was boiled for a least 1 minute, including coffee, tea, and hot chocolate (non-dairy creamer is ok, avoid adding milk or cream)
- Canned milk
- Packaged or bottle drinks (juice, pop, beer, wine, etc.)
- Alcoholic beverages
- Any commercial foods that came in a sealed package
- Any meals cooked at high heat for long enough and served hot
- Meat cooked well-done or medium-well
- Fully cooked eggs
- Fully cooked vegetables or fruits with skins (peeled is better)
- Soups and stews that have been simmering and are served hot
- Nuts and other shelled foods (wash shells before cracking)
- Condiments, salad dressing, mayonnaise in sealed packages
- Pasteurized yogurt, milk, cream in sealed containers
- Pasteurized cheeses (check labels)
- Fruits with skins that you can peel yourself without a knife (oranges, bananas, avocado, etc.) (wash skins first)
- Baked goods, breads, cakes, pies, cookies
Taking care of your hydration needs and making sure you always have clean water available can be a hassle, since you either have to buy bottled water or boil tap water to purify it. I like cold water and don’t particularly like drinking room temperature water, which, in the tropics, it more like lukewarm water. It’s not always easy to find bottled water when you need it, particularly when you are traveling in more remote areas. Because you don’t want to get caught in a situation where you are left with no option but to drink unsafe water, I recommend you do the following:
- Carry a water bottle with you. I have a nice insulated HydroFlask 21oz water bottle that keeps my liquids cold for about 24 hours. I carry it with me everywhere. If I didn’t have it, I’d be much less likely to drink adequate water, since I like it cold. Since we usually stay at places with kitchens, we keep large 2L or gallon bottles of clean water in the fridge we use to refill our water bottles whenever we are back at our place. You can usually find stores that sell gallon (or larger) containers of water, rather than the smaller bottles, which are much more expensive. If you have a kitchen, you can boil water and store it in the fridge. The downside to this is that the local water may not be that great to drink, even with the germs killed, due to other contaminants. We’ve never had to boil water, except when trekking. If you are traveling in a very hot remote area, you may want to carry a larger collapsible water bladder with you, such as those made by Camelbak, Osprey, Platypus, or MSR. They hold anywhere from 1.5L to 10L. A 2.5L or 3L bladder is probably a good size for most needs.
- It’s also a good idea to carry some sort of water purification device or chemicals. There are several “water purifiers” on the market that claim to destroy (through UV light) or filter out all bacteria, parasites, and viruses (with chemical help). Steripen is a UV device that can sterilize water. First Need has pump filtration devices that can completely filter water. In addition, you can go old school and use purification tablets (e.g. Katadyn Micropur, or Potable Agua) or drops (e.g. Aquamira) to clean your water of harmful bugs. We carry tablets, since they weigh next to nothing, and have actually used them from time to time when we had difficulty finding bottled water.
Additional Food and Water Germ Management
There are several other things you can bring with you on your trip to help minimize germ exposure. I’ll just list them here with justifications.
- Carry hand sanitizer gel\liquid. If you carry a small bottle with you everywhere and use it prior to handling food or drinks you can help minimize germs getting from your hands to your mouth.
- Carry disinfectant wipes. You can use these to wipe off anything that has been handled by others or to clean your hands as well.
- Bring a light mug and spork (spoon\fork) and carry them with you. When you get drinks have them served directly into your cup, rather than using a re-usable cup, potentially rewashed in unsafe water. Same for eating utensils. Use your spork, or separate spoon and fork rather than the restaurant’s.
Finally, preventing germs from getting into your mouth (or other orifices) also requires you to keep your body and especially your hands clean. It’s easy to forget that we also pose a germ danger to ourselves. Washing your body and hands with soap in potentially contaminated water from a tap is probably less dangerous than not washing at all. Avoid using tap water for brushing your teeth or rinsing your toothbrush. Use bottled water for that and keep a bottle in the bathroom for that purpose (also to remind yourself not to use tap water) if you are staying for a longer time. Try to keep your clothes as clean as you can also.