As I emptied myself from both ends for the better part of 36 hours in the hills of northern Ecuador recently (a bad batch of cevichochos, I suspect), I was reminded that we owe our readers an accounting of how we usually manage to stay healthy while we travel.
Fortunately, Audrey and I have each only endured stomach bugs three or four times in the last few years of travel — in places like Vietnam, Uzbekistan, Kazakhstan, Guatemala, and most recently for me, Ecuador.
“You ate on the streets in Burma and never got sick? All that food in China and never sick? India even?”
Yes. That’s correct.
If you follow us, you know that we rarely deny ourselves the joys of exploring local street food and meals in hole-in-the-wall restaurants. And although it appears that we eat with reckless abandon, we do tend to follow some basic guidelines. These are not hard and fast rules (we do break them sometimes) but a philosophy and approach that seem to work for us. The idea is to sharpen our ability to size up eating situations while balancing the reward of authentic local dining with the risks of becoming ill.
In no particular order:
1. Wash your hands often. Then wash them again. Not to sound obsessive-compulsive, but get into the habit of washing your hands before a meal, after a meal and any time you think of it, particularly if you have been holding railings on public transportation or shaking hands at the local market. And don’t skimp on the soap. Carry a tube of anti-bacterial gel for those rare moments when no soap or sink is available.
2. Beware of tempting fruit shakes and drinks made with unpurified water. Those stands may look so good in India, but don’t risk buying a fruit shake off the street unless you are certain the water (or ice!) has been purified. There’s no need to completely deny yourself this pleasure, but just ask first or order it from a tourist-oriented restaurant that has purified water clearly marked on the menu.
During my first visit to India, an Indian-American friend asked his father why he cautioned against drinking sugar cane juice from a street stall. “There!” his father pointed to a giant block of ice being wheeled down the street on a cow cart lined with poop-stained burlap.
3. Cooked is more reliable than fresh. If you have questions about the hygiene of what and where you’re eating, make sure everything is properly cooked. Fried, boiled, or baked, high temperatures kill germs.
When in doubt, avoid the street food dishes with fresh herbs on top. Sure, in places like Thailand and Vietnam, you are probably OK. We also ate loads of fresh herbs in Burma. The point is that we didn’t wholesale avoid them; we made decisions based on the environment.
Same goes for mayonnaise toppings. Assume no refrigeration.
4. When in doubt, take it easy on the meat. Meat insidiously turns faster and meaner than vegetables ever will. You never know how meat has been handled or how long it has stood before it lands in your mouth…and your stomach.
We are certain that leaning vegetarian helped us stay healthy in India and China. Did we eat meat in both countries? Yes, but only when the signs were favorable. In India, we usually reserved meat for spiffy-looking street stalls and formal restaurants that were certain to have refrigeration.
5. Spice is your friend. I have no scientific proof that chili sauce kills bacteria, but I’m inclined to believe that our copious use of hot sauces have served our stomachs well prophylactically. Although the argument continues, some say that good ‘ol black pepper was traditionally used as a preservative.
6a. A little bacteria is a good thing. We’re big believers in maintaining a healthy layer of good bacteria in our stomachs. Experiment a little bit when you travel so that you build up some resistance. If you are a first-time traveler and are accustomed to everything antibacterial and antiseptic, the world overseas will find a way to shock your system. You are likely to experience an adjustment.
So consider keeping things clean, but don’t sanitize everything you touch – living in an anti-bacterial world can put you at risk when you leave the bubble.
6b. Learn to like yogurt. When fighting bad bacteria, make sure you have enough “good” bacteria inside of you. Some people carry probiotics or acidophilus pills to balance and replenish good bacteria. I just like to eat yogurt, particularly the fresh, unpasteurized stuff. The top of the yogurt hierarchy is the homemade stuff (matsoni) from the mountains of Georgia. It just felt healthy.
7. Look for high turnover and low fly-count. Seek out street stalls and restaurants with a high turnover of food. Freshly cooked is better than something that’s been sitting around on a tray for a while. The longer food sits, the more likely it will play host to bacteria. High turnover also implies high traffic, which itself suggests that the food being served is probably pretty good.
Eye the fly-count. Flies are excellent carriers of disease.
8. Check your glass and silverware. Don’t obsess, but give it the once-over. It may be better to drink your soda or beer directly out of the bottle than from a glass (or wipe the glass if you must). Or ask for a straw to drink fruit juices or sodas. Run a napkin over your utensils or ask for a new set if they look unappetizing. Or consider heading somewhere else where the silver is, um, a bit cleaner.
9. Peel your fruits and vegetables. When everything you eat is cooked, you will crave fresh fruits and vegetables. Buy the kind you can peel – bananas, cucumbers, carrots, papayas, avocados, etc. Avoid lettuce or anything with a skin you eat (e.g., tomatoes). If you do, wash them in purified (and slightly chlorinated water).
If you venture to eat cut fruit (see the image above), be mindful of toppings that might be made from unpurified water.
10. Don’t let your guard down on organized tours. Ironically, half of our stomach episodes have occurred on organized treks, once in Vietnam and again in Guatemala. Having assumed the organizers had taken all the necessary precautions, we ate fresh vegetables we would have otherwise avoided. Likely a dirty knife in one case and a dirty mango skin in the other. And we paid for our lapse in judgment.
Honorable Mention: Good old-fashioned luck of the draw. Although we do not recommend relying on pure luck, it bears mentioning that you could throw caution to the wind while traveling, eat on the street 24-7 and never get sick. Likewise, you can follow every healthy travel eating guideline and spend more than your fair share of time in the toilet.
Basically, it’s a crapshoot.