FOOD AND WATER ADVICE
Taking care about what you eat and drink is the single most important health rule while travelling.
Stomach upsets are by far and away the most common health problem experienced by travellers - it is estimated
that between 40 to 50% of travellers will suffer stomach upset during a two-week stay in another country. Most of
these upsets are minor and shouldn't prevent you from enjoying your trip. Nevertheless, many of these infections
can be prevented by taking particular care about how and where you buy your food and water.
Food
Always remember the adage: "Cook it, Peel it, Boil it, or Avoid it!" Salads and fruit should always be washed
with purified water or peeled where possible. Milk products (including ice cream and yoghurt) are always a risk
overseas. Those with a reputable brand name are usually OK but, if you're in a developing country, beware of
products bought from street vendors and of ice cream that has melted and been refrozen. Thoroughly cooked
food is safest but not if it has been left to cool or if it has been reheated. Shellfish (oysters, mussels, squid and
clams) and undercooked meat such as mince should be avoided.
If a place looks clean and well run, then the food is probably safe. If the places ‘feels wrong’ then you are best not
to eat there because your instinct is probably right! In general, places that are packed with travellers or locals
tend to be fine, while empty restaurants are questionable. This makes sense in more ways than one: because
food in busy restaurants is cooked and eaten quite quickly, there is less chance that it has been sitting around for
ages or even reheated.
Nutrition
If the food available in the country is limited or of poor quality or if you're travelling hard and fast you are likely to
be missing meals or you may simply lose your appetite. Either way, you will start to lose weight and your health
may be at risk.
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Set diet priorities before leaving
Pack some of your own food
Choose restaurants that serve healthy food
Order foods that are rich in complex carbohydrates and fibre and low in fat
Choose healthy selections at fast food restaurants
Exercise control in terms of portions
Drink plenty of water
Limit alcohol
Never skip breakfast
Don't overlook the grocery store to buy simple food that you know and like
On extended days, try to eat one meal a day in your room
Exercise
Regard any temptations wisely before plunging!
Foods that travel well include bottled water, boxed juices, herbal teas, instant or dry soups, pull-top cans of fish
and drink, fruit (fresh and dried), raw vegetables and dry cereal packets . NOTE .Fluid is heavy to carry.
The best advice is to eat a well-balanced diet while travelling. Try to eat plenty of grains (rice) and bread. You
can get your protein requirements by eating eggs, tofu, beans, lentils and nuts. Any fruit that you can peel
(bananas, apples, oranges or mandarins for example) is safe and is a good source of vitamins. Remember that
while food is generally safer if it is well-cooked, overcooked food loses much of its nutritional value. Vitamins and
other supplements, such as iron tablets, are a good idea if you are travelling in remote regions or if your diet isn't
well balanced or deficient in some way.
In hot climates make sure that you drink enough fluids - at least a couple of litres of non-alcoholic fluids per day
are a minimum requirement. Not needing to urinate or the passing of dark yellow urine are two important signs
that you need to drink more fluid. Always carry a plentiful supply of good drinking water on long trips and hikes.
Excessive sweating in very hot regions can lead to muscle cramping because of the loss of salt. Usually it is not
necessary to take salt tablets, but you may need to add some salt to your meals.
Water
Ensuring that your water supply is safe is THE best way to stay healthy on any trip. If you are in ANY doubt
at all, then don't drink that water (and that includes ice). Just remember: 'if it doesn't feel right, then it is wrong!' If
you don't know for certain that the water is safe, always assume that it is not.
Bottled water is quite readily available in most developing countries. However, in some places it is not
unknown for bottles to be refilled with tap water. Use only water from containers with a serrated seal and
buy your bottles at shops that have lots of bottled water for sale, not just 'the last one or two'. If in any
doubt buy aerated water which, like beer, is sterile.
Water Purification
The simplest way of purifying water is to boil it thoroughly. Bringing water to the boil, (a rolling boil for at least a
minute) then letting it cool is usually adequate for most needs. At high altitude, however, water boils at a lower
temperature than at sea level so germs are less likely to be killed. Always remember though that you are a visitor
to the country in which you are travelling. Most developing countries have inadequate energy supply for their own
needs, let alone those of travellers. It may prove difficult for you to get enough energy (e.g. wood, coal, etc.) to
boil your water, so be prepared to rely on other sources of water purification.
Filtering the water will not remove all dangerous organisms (pathogens) so; in addition, it should be treated
chemically. Chlorine tablets will kill many pathogens, but not those causing giardia and amoebic bowel disease.
Iodine is an effective water purifier and is available in droplet (Betadine) and tablet form (Potable Aqua). Water
purification packs all contain instructions for use - make sure to follow these carefully as too much iodine can be
harmful. If you run out of iodine droplets or tablets or these products are unavailable where you are, iodine
solution can be used as a "back up" water purifier. The ratio is 5 drops per litre of water (10 drops for cold or
cloudy water) and the solution should be left for one hour before drinking. Vitamin C tablets will neutralise or
disguise the taste of iodine-treated water and are a good idea if you are travelling with children.
Other Fluids
Proprietary fruit juices should be fine to drink but remember that some fruit juices may contain added water. Milk
should always be treated with suspicion in any tropical or developing country as it is often unpasteurised. Boiled
milk is fine as long as it has been stored properly and processed yoghurt is usually good. In third world raw
yoghurt can be dodgy. Tea or coffee are generally OK, but make sure that the water has actually been boiled not
just heated. Remember also to always clean your teeth with purified water rather than water straight from the tap!
Your gums may bleed when you brush your teeth and organisms in the water can enter your system in this way.
Travellers’ Diarrhoea
Travellers' diarrhoea is a very common condition that may affect up to 50% of people who travel to developing
countries. Travellers' diarrhoea can occur for a variety of reasons including a change in the drinking water, type
of food or standards of sanitation. Sometimes it is due to a viral or bacterial infection.
Signs and symptoms:
These include nausea, occasionally vomiting, severe abdominal cramping and profuse watery diarrhoea,
sometimes up to 10 or more loose stools per day. The symptoms generally last for about 24-48 hours, although
they can persist for up to 4 or 5 days in some people.
Treatment:
The symptoms of travellers' diarrhoea are the body's way of eliminating the contaminated food or invading
organism. As such, adults may not require any treatment other than increasing the fluid intake. During and after a
bout of travellers' diarrhoea you may find it more comfortable to "rest" your bowel by avoiding high-fibre foods,
fatty foods, milk and dairy products, caffeine and alcohol. Instead, it is recommended that you drink lots of
(proprietary) fruit juices, tea and "flat" carbonated beverages such as dry ginger ale. These may be easier than
water to keep down, especially if you are nauseated. Persistent vomiting may require treatment with anti-nausea
medications, whereas persistent diarrhoea usually responds to anti-diarrhoeal medications such as loperamide
(Imodium). Loperamide is for symptoms only as it slows the bowel and is contraindicated if severe diarrhoea or
with blood and /or fever. It keeps the “bug” in. Treatment for the infection is needed
The best treatment for travellers' diarrhoea is to prevent it in the first place! Here are some useful tips for avoiding
diarrhoea during your travels.
TIPS FOR AVOIDING TRAVELLERS' DIARRHOEA:
DO:
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Wash your hands frequently and always before eating and after toileting
Eat items that require little handling in their preparation.
Eat only well-cooked and hot food. If eating at a buffet, eat early before the food cools down or the
insects arrive.
Eat only fresh fruits and vegetables that you have peeled or seen prepared in front of you
Avoid those that have been washed in tap water.
Drink hot beverages, such as coffee or tea but make sure the water has been boiled.
Drink bottled water or name-brand carbonated beverages. Check the bottle and that the seals
have not been broken.
Wipe off the rim of any bottle before drinking or pouring from it.
Tie a coloured ribbon around the bathroom faucet as a reminder NOT to drink the tap water or use for
tooth brushing.
DON'T:
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Never drink tap water. Don't brush teeth with tap water.
Never drink fresh. (e.g. from a stream) or standing water.
Avoid any bottled water that has not been opened in front of you.
Avoid ice cubes. If you must have a cool drink then place the cubes in a small, clean, leak proof bag
and place the bag in your drink. Carry the bags with you.
Avoid food sold by street vendors. BUT if you can see them doing the cooking of hot food and it is
well cooked it will be safe!!! Avoid the salad, the yoghurt, or dirty wet plate.
Avoid shellfish or any uncooked seafood.
Avoid uncooked fruits and vegetables. If you can peel clean fruit with clean hands OK
Avoid salads. Unless Suitably washed in appropriate solution
Avoid dairy products. Unless pasteurised and properly packaged
Avoid juices not prepared in front of you. Tap water may have been added.
Minimise swimming and swallowing water unless well chlorinated.
FOR SEVERE DIARRHOEA OR WITH BLOOD AND /OR FEVER Azithromycin 500 mg tablet is good. If
no better in 12 hours take another, if still not much better another tablet in another 12hours. If
not improving after 3 that will not work – SEEK MEDICAL ATTENTION
Azithromycin is a macrolide antibiotic like erythromycin – so do not use if allergic to that group.
Can interact with some medications and should not be used in certain cardiac conditions- e.g.
prolonged QT syndrome. (Can be taken sometimes with loperamide {Imodium} or Diastop for
symptoms)
Quinolones like Ciprofloxin 500 mg twice a day for two to three days another option. Avoid in the
elderly where it may initiate tendon problems and avoid in people who have had tendon
problems- Achilles tendonitis, frozen shoulder, carpal tunnel, tennis elbow etc.) Also the
quinolones very quickly lead to drug resistant bacteria so avoid if possible.