100

Montezuma's revenge or Aztec two step in Central America, mummy's tummy, or Cairo two-step in Egypt, Kurtz Hurtz in Uzbekistan, Bombay belly or Delhi belly in India.

A case of the sh-- or Hershey Squirts or The McSh-- in North America, Down Under Butt Chunder in Australia, Karachi crouch in Pakistan, Suryavarman's Revenge in Cambodia.

Kabulitis in Afghanistan, holiday tummy in United Kingdom, Bali belly in Bali, or Taghazout Tummy in Taghazout or Kathmandu quickstep in Nepal.

Beaver fever in Canada, Thailand it's Thai-dal wave. Peacekeepers to Arabic-speaking countries have called it yalla yalla (Arabic for "fast, fast").

In Central Asia, it was ridiculous, with every second backpacker walking around with toilet paper on them, regularly having to make a 'run' for it. In Egypt, half my tour group got sick, by the time we'd converted into a mobile pharmacy!

Regardless of what it's called, what's the best way to try and prevent it?

14
  • 8
    Umm, don't eat bad food! – hippietrail Oct 3 '11 at 20:04
  • 10
    I don't want to see the Google Image Search results if I look up "gastrointeritis prophylactic". – hippietrail Oct 3 '11 at 21:25
  • 5
    Especially if you turn off the SafeSearch ;) – RoflcoptrException Oct 4 '11 at 8:09
  • 3
    Also see Is tea and coffee on the street safe to drink in India? - much of the advice here applies here too as "Delhi belly" is often caused by suspect fluids than anything else. – Ankur Banerjee Oct 4 '11 at 8:45
  • 5
    All questions like this would be better discussed if people would distinguish more between novel conditions, and actual diseases. Any time you travel you will be exposed to some bacteria and other things you are not used to that do not bother the locals. But sometimes you will be exposed to things like cholera that seriously do affect the life-long locals too. @KateGregory well points out that Giardiasis is not something you can "get used to" after you have been in the region a while. Food "tainted" by some local biota may become safe when you adapt, food "tainted" by hepatitis will not. – Colin McLarty Feb 20 '16 at 16:02

17 Answers 17

78

Basically, you can't.

The world is full of gastrointestinal (GI) diseases, even in developed, First World nations. There are some decent steps to trying to minimize your exposure:

  1. Properly cooked foods. Everything heated to a proper internal temperature (depends on the dish, check the USDA's site for guidelines), no sampling the raw chicken dish, etc.
  2. For fruits and veg, if you can't peel it, don't eat it. A tremendous number of GI outbreaks are due to fruit and veg, rather than meat. This includes things like salads - since you can't really peel lettuce, avoid it.
  3. Check if the local water is safe. When in doubt, assume it isn't. You can stick to bottled water, though there's always the distinct chance its being bottled from a contaminated source. Coke/Pepsi etc., and beer are good alternatives. Little known fact, the Coca-Cola company is hugely involved in clean water programs worldwide, because they need it for their product.
  4. Ice. Ice is bad. Its probably made using the local tap-water, and there are many beasties that can survive an encounter with an ice machine.

But when it comes down to it, nearly every traveller makes some sort of safe-eating "mistake" fairly frequently, whether they realize it or not. At the end of the day, your best bet is to talk to your travel physician, and see if you can get a prescription for an antibiotic. Using that in combination with something like Imodium will probably keep your trip mostly on track - shutting down the problem long enough for the antibiotics to treat the source. Unless of course its viral - norovirus, rotavirus etc. In that event, best of luck.

And if it does happen? Stay hydrated. You're losing salts and water, they need to be replaced.

9
  • 44
    The whole reason the Chinese drink so much tea is because the water is unsafe for drinking, and boiling the water sterilizes it. This is even in the better-developed parts, such as Hong Kong. One time I made the mistake of using tap water to take an aspirin for a headache, and then very soon I had TWO problems. – fluffy Oct 3 '11 at 22:06
  • 2
    Okay point for taking along antibiotics, but if you take those you should most definitely take some packs of electrolyte salts which you can mix in water in order to keep hydrated. And very important too is to make sure to take pro-biotic medicine after the misery is over, otherwise your stomach will have a hard time getting back in shape and it's even easier to have "yalla yalla" again (or any other illness in fact). – Pitt Nov 30 '12 at 17:20
  • 3
    @pnuts: That's how I got it in Egypt, I was careful to only drink bottled water but figured the small amount of water used to wet my toothbrush couldn't hurt. Learnt my lesson! – Pyritie Jun 26 '15 at 12:00
  • 1
    Properly cooked foods can also be extended to boiled water. Nothing wrong with drinking (tap) water that has been boiled several minutes. But make sure that it was not just 'heated'. – user40521 Aug 10 '16 at 12:37
  • 5
    Be careful with the Imodium Antibiotics combination. If it is viral (in some countries it is more likely to have some viral stuff - e.g. trekking in nepal and using the (cleaned) spring water there) you become a bioreactor if you use Imodium. – Gnusper May 10 '17 at 11:51
28

Some elementary precautions:

  1. Drink no water or other liquid unless it has been boiled or bottled or canned. Be careful using ice; it may have been made from tap water.

  2. Avoid eating at roadside food stands; sanitation levels are low. Avoid eating any place where there is evidence of poor sanitation, e.g. flies. Stick with the better restaurants, or with "home cooked" food.

  3. Don't eat anything that hasn't been cooked or peeled immediately prior to eating. That includes bread, unless it is fresh bread, or just unwrapped.

  4. Be careful with utensils. Wash them in boiled, or at least very hot water.

  5. Carry pills for dysentery and similar ailments.

11

My friend and doctor also told me to take some malt liquor (eg. vodka or whisky) with me and have a shot after a meal. It's supposed to help you also with digesting as well as prevent some "stomach sensations".

1
10

To memorize and teach it (your kids etc.):

Wash it, peel it, cook it, or forget it.

You have been warned about ice made from tap water. You will often find yourself in situations where "coke" is understood, "no ice" is not. Learn these 2 words in the language of the country you board.

8

One of:

  1. Peel it

  2. Boil it

  3. Throw it away

Only drink bottled water that has a seal on the cap (they can refill the bottles). Bring hand sanitizer (with a high alcohol content).

2
  • 4
    And always crush the bottle before throwing away. This helps in preventing refilling of the bottle. Just my 2 cents. – noob Jul 30 '14 at 5:16
  • 2
    +1 for saying to check the seal. I've seen street vendors in India openly refilling water bottles from a tap. – Richard Smith Nov 1 '15 at 20:09
7

Specifically related to Egypt (but may be relevant in other countries):

I was told by an Egyptian tour guide that one of the things that causes illness amongst British tourists is the richness of the food especially fats/oils and sugar content as this is much higher then we are used to. So his advice was to avoid all Egyptian food and stick to plain 'western' foods if at all possible.

Obviously tap water is to be avoided but having said that a (British) friend of mine worked out in Cairo for several years and claimed that he could drink the water!

4
  • 14
    If richness of food is to be incriminated, Delhi belly would be present at a high level in the USA. – mouviciel Oct 5 '11 at 7:48
  • 9
    You will often find travellers that have remained in the location for a while (and locals) can drink the water with no problem, because after their initial encounter their bodies and immune system have adjusted to the local environment; so just being told by locals the water is fine is not reason enough to trust it; if your visit is short and it is not worth suffering a night to adjust, better to stick to bottles. – moonshadow Feb 4 '13 at 19:40
  • 2
    I got the same warning (years ago, when it was not commonly used in my country) for olive oil in Italy. – user40521 Aug 10 '16 at 12:38
  • When I was in Egypt, it was the "western" foods that caused the problems. When we ate local produce and meals there was much less of an issue. – Laconic Droid Nov 23 '18 at 16:02
6

I would add:- sterilize your hands frequently and always before eating. If you distrust the water, use an alcohol gel.

5

One aspect where I radically disagree with most of the "common-sense advice" usually given in this regard is the part about avoiding street stalls and street food. In some parts of the world (specifically, for what pertains my experience, S-E Asia) it could be argued that getting food from a street vendor is even safer than getting it in a "proper" restaurant. Food tends to be fresher (with refrigerators and machines you can make bad food appears still edible) and most important, you can judge its freshness, given how everything is under your eyes. In a restaurant, on the other hand, you have absolutely no certainty that hygienic rules are followed, moreover you get absolutely no possibility of checking if they are washing their pots with sewer water or not. To clarify: there are definitely street vendors that do that, but at least you can see them doing it.

If we want to expand the question, there is an issue at hand. Can you reduce significantly the probability of getting food-related issues? Definitely yes. Should you? It depends. You can be extremely attentive, eat only western food, sanitise constantly, avoid any food and beverages that is not prepared in front of your eyes, and hundreds of other tricks. Point is, is it worthy? Is it worthy to travel to another country, and avoid the excitement of discovering a new food, because you are only eating western food to avoid diarrhea? The answer is that there is a trade-off between security and enjoyment of travel, and everyone has to decide a certain limit under and over which is not willing to go.

2
  • Props for the final paragraph. I fully accept in certain countries my stomach will just get sick. Doesn't stop me going. – Mark Mayo Oct 7 '20 at 20:40
  • 1
    +1. If anything eating Western food in non-Western countries is risky to me: I stopped getting sick in India once I switched to a 100% local vegetarian diet. – lambshaanxy Dec 22 '20 at 4:59
4

Always wash your hands after handling money. Of course if you don't trust the water this is best done using some kind of hand sanitizer.

Why You Shouldn't Put Your Money Where Your Mouth Is (Wall Street Journal article)

4

While these steps are certainly inconvenient and inhibiting, there is no easier way to really be sure to avoid the Delhi belly. I personally wouldn't go to these lengths, but they are the answer to the question.

  • Get an ozonizer and take it with you in your luggage. Immerse fruits, vegetables, dishes, and other food-related items in water and ozonize them before consumption.

enter image description here

You can also ozonize the drinking water itself. Ozonization will kill nearly all harmful organisms from the water and from the surfaces of items immersed in the water. It's better if you use filtered water for this. If you use tap water for this, ozonize longer, and splash some bottled water over each item before use/consumption.

  • Bring a small, portable induction cooker and a pot. Get takeaway food and boil everything yourself for several minutes before consumption.

enter image description here

enter image description here

  • Always wash your hands and make sure they are also free of tap water before touching anything related to food.

The ozonizer and induction cooker are somewhat inhibiting while trying to enjoy a holiday. So I might prefer to take a chance rather than follow them. But if you really need to "avoid the Delhi belly", then I recommend using them.

3

I've been to China, Egypt, and Peru without any digestive upset. This advice is specialized for the type of travel I go on, tours organized by a competent tour company, and won't work for other situations:

Eat and drink only what is offered at the hotels, on the bus, on the boat, or at restaurants recommended by the tour director. This meant no street food in China :-(

Drink only the water that is handed out on the bus, placed in the hotel rooms and cabins, or on the tables at meals. Don't drink even apparently bottled water not from those sources.

Use hand sanitizer after each restroom visit and before each meal.

Tooth brushing took some care, using bottled water to moisten my toothbrush etc.

2
  • isn't bottled water bought from chain supermarkets fine though? – Formagella Aug 29 '16 at 13:57
  • @Formagella Depends on how well you trust the chain. An organized tour by a competent tour company should provide plenty of bottled water without going to supermarkets. – Patricia Shanahan Aug 29 '16 at 14:26
2

Lived in various countries in SE Asia for 5 years. You just accept that sometimes you get sick. However, sure you can do things to lower the chances. A lot of good advice has been given. Like someone else here I also don’t agree that ‘good’ restaurants always help. In those places they’re often far less likely to throw expired food out, especially with foreign food, because the ingredients are highly expensive for them. That’s not to say you should go to a place where the flies can be seen laying eggs in the food, but there are some middle grounds here. I have rarely gotten as sick as when I was on an expensive tourist trip with visiting family and we exclusively ate in a resort. 3 out of 5 people got terribly sick there. It’s anecdotal, I know, but I have heard the same from other people too over the years.

1

There are lots of excellent answers here addressing food and water safety, which is all very important. But prophylaxis can also help prevent serious illness, and prompt treatment if you feel unwell can vastly reduce the symptoms and duration of the illness and help stabilize things if you need to continue traveling. The US Centers for Disease Control's Yellow Book (Health Information for International Travel)—the bible of travel medicine—has a chapter on Travelers' Diarrhea that's well worth reading in full, including this section:

Nonantimicrobial Drugs for Prophylaxis

The primary agent studied for prevention of TD, other than antimicrobial drugs, is bismuth subsalicylate (BSS), which is the active ingredient in adult formulations of Pepto-Bismol and Kaopectate. Studies from Mexico have shown that this agent (taken daily as either 2 oz. of liquid or 2 chewable tablets 4 times per day) reduces the incidence of TD by approximately 50%. BSS commonly causes blackening of the tongue and stool and may cause nausea, constipation, and rarely tinnitus.

Travelers with aspirin allergy, renal insufficiency, and gout, and those taking anticoagulants, probenecid, or methotrexate should not take BSS. In travelers taking aspirin or salicylates for other reasons, the use of BSS may result in salicylate toxicity. BSS is not generally recommended for children aged <12 years; however, some clinicians use it off-label with caution to avoid administering BSS to children aged ≤18 years with viral infections, such as varicella or influenza, because of the risk for Reye syndrome. BSS is not recommended for children aged <3 years or pregnant women. Studies have not established the safety of BSS use for periods >3 weeks. Because of the number of tablets required and the inconvenient dosing, BSS is not commonly used as prophylaxis for TD.

The use of probiotics, such as Lactobacillus GG and Saccharomyces boulardii, has been studied in the prevention of TD in small numbers of people. Results are inconclusive, partially because standardized preparations of these bacteria are not reliably available. Studies are ongoing with prebiotics to prevent TD, but data are insufficient to recommend their use. There have been anecdotal reports of beneficial outcomes after using bovine colostrum as a daily prophylaxis agent for TD. However, commercially sold preparations of bovine colostrum are marketed as dietary supplements that are not Food and Drug Administration (FDA) approved for medical indications. Because no data from rigorous clinical trials demonstrate efficacy, there is insufficient information to recommend the use of bovine colostrum to prevent TD.

The chapter goes on to discuss prophylactic antibiotics ("at this time, prophylactic antibiotics should not be recommended for most travelers"), and most importantly: treatment options if you do get sick ("The risks associated with the use of prophylactic antibiotics should be weighed against the benefit of using prompt, early self-treatment with antibiotics when moderate to severe TD occurs, shortening the duration of illness to 6–24 hours in most cases"), including oral rehydration therapy, antimotility agents, and antibiotics.

This answer is, of course, not medical advice, but the CDC's recommendations are a great start for a conversation with your doctor, who can assess the risks and benefits of different medical approaches and their suitability to your medical history, or better yet, you can talk to a specialist at a travel health clinic if one is available to you. In other words, after discussing it with a doctor, you may want to consider a layered defense:

  • Intake: Careful selection of food and drinks, avoiding ice and anything else related to tap water, handwashing before eating, etc...
  • Prophylaxis: Consider prophylactic Pepto-Bismol/Bismuth subsalicylate if indicated by your doctor and not incompatible with other medical conditions you may have or other drugs you may be taken. 8 tablets/day is a lot to carry and take, but it may be worth it if you're going to a high risk area, getting sick would really derail your travel plans, or you know you're particularly prone to TD while traveling.
  • Treatment: Carry a range of medications to deal with the problem if you do get sick. Over-the-counter antidiarrheal medications can start working quickly, and your doctor may consider it appropriate to prescribe antibiotics to bring with you in case you need them (if this is the case, you should naturally follow all the instructions and take the entire course of antibiotics as directed if you've been given more than one dose). Being prepared can significantly reduce the amount of time you're sick and limit the disruption to your trip, and it's far easier than trying to track down the medicine you need in a foreign country while you're feeling horrible.
0

Assuming you're already infected and have the signs of a stomach disease, you may attempt to reduce the intensity of the symptoms. One recommendation I've heard from a couple of people is to take psyllium (Metamucil) supplements. Psyllium is basically soluble fiber and helps both with constipation and with diarrhea. It should also reduce other symptoms, such as excessive gas formation.

However it doesn't treat the underlying cause and shouldn't be considered a replacement for proper medicine, if it's needed for the particular disease one might be having. But it's nevertheless a good thing to have in your first-aid kit when traveling.

enter image description here

0

I have accepted that I can't really avoid it without going to great lengths, and plan for it, with an acclimatization period of a few days in every new area.

On my first trip to India, I basically stayed on bottled water and prepackaged sealed food until I arrived at the first place, and then switched to local food and tap water. Given that this was in Himachal Pradesh, that was probably a gentle introduction.

It took about two days to get back to normal digestion, and a repeat of that when I went to Delhi, but from that point on I had no trouble, even when refilling my water bottle from the tap at the train station, and on the second trip, I felt comfortable eating street food before taking overnight trains.

My first visit to the US went similarly, except they don't have a good train network there.

Bring a few packs of electrolyte solution, and you should be fine.

0

Here is advice specific to China (not Taiwan, not other parts of Asia):

As mentioned in Patricia's answer, avoid the street food. The workers come from rural areas, where the idea of germs or diseases being spread through human contact is unknown. Even in Shenzhen (a tier 1 city), there are still people touching meat with their bare hands to inspect the quality of the meat, without washing their hands before and after. These workers then prepare the food without gloves, and you know what happens next.

The quality of produce in the wet markets / supermarkets is also suspect, due to the widespread soil and water contamination, and the heavy use of pesticides to boost yields. The food provided on the tour buses or restaurants is sourced from safer suppliers, so it is more likely to be safe.

Bottled water handed to you on the tour bus / restaurants is safe. The major brands are 农夫山泉 or 怡宝 - C'estbon, whereas other brands may have quality issues. Bottled water sold on the street is often filled with tap water and then packaged to look like bottled water, so avoid buying from these sources.

China’s Food Safety Issues Worse Than You Thought

-2

I've been in a lot of places, ate everything in every condition, in Indonesia even forgot about not drinking tap water, never ever done something listed in these answers, and never ever ever had a single problem.

The only way to avoid Delhi Belly: improve yourself. Seriously, we as human being have a great potential for adaptation, we have huge resistances and can easily override most basic viruses like those that cause the problem listed above. But...we destroy all of this by never using our body; it's like a training, so to say.

So, I'm not suggesting to go eat poison or drink spoiled water, but at least let your body use its potential. Seriously, from some of the other answers: "never eat street food". Well, no. Eat only street food. You'll have your hell belly ONCE, your body will strengthen, and the next travel in a totally different country you'll eat stones without problems.

Human body has been engineered to highest level to allow us to do lot of things, but all answers above just put people in a cage that will shrink day after day, to the point that even eating spicy cooked at their home will hurt their stomach. Let your body do its magic, for god sake.

4
  • 1
    While I do agree with this kind of living at home, I do not feel it should be done in countries where diseases are nasty, strong and common. – Willeke Aug 16 '16 at 15:18
  • @Willeke, ok, a bit of intelligence is required, obviously: not saying to go to India and drink tap water or eat food in the dirtiest condition for the first time, but...seriously, there are people who do not eat street food at the Camden food stands for fear to get poisoned. I've got the luck to be tough when it comes to traveling and I love it, but too many people around are just ruining their defence mechanisms (and their holidays, subsequently) by not using them at all. – motoDrizzt Aug 16 '16 at 15:27
  • (just for fun: all those years, the only time I got a Delhi Belly has been this previous Monday, the 8th...for a caffe latte at Costa :-D And after a week...I still feel pretty bad, go figure :-DDDD) – motoDrizzt Aug 16 '16 at 15:29
  • 2
    Ah, finally someone who doesn’t suggest missing out on most of the culinary culture when visiting a country. Some bacterias also taste great ! (See blue cheese for example.) And while there’s no point in drinking tap water when you can drink bottled water, you definitely want your stomach to be able to withstand street food and more generally what locals eat (versus tourist-targeted food). Food is such an important part of discovering a different culture. – Cimbali Jul 2 '19 at 20:57

Your Answer

By clicking “Post Your Answer”, you agree to our terms of service, privacy policy and cookie policy

Not the answer you're looking for? Browse other questions tagged or ask your own question.