‘EAT STREET FOOD – BUT STAY AWAY FROM ICE’: HOW TO AVOID SICKNESS ON HOLIDAY, ACCORDING TO A DOCTOR
By now, we’re all well-versed in the fine art of swerving food poisoning while abroad. We avoid grubby restaurants. We’re wary of dodgy oysters. Depending on the destination, we think twice about brushing our teeth with tap water.
And we’re right to be cautious. After all, more than 800 tourists recently took legal action against their travel company after developing gastric illnesses while on holiday in Cape Verde, and though food hygiene practices have come a long way, similar stories still pop up in the news on a regular basis.
We asked Dr Richard Dawood, a specialist in travel medicine at the Fleet Street Clinic, to clarify the best practices when it comes to drinking tap water abroad, the safest foods to eat (and avoid) while on holiday, and other top tips on how to avoid developing a dreaded stomach bug while far away from home.
What are the main causes of food poisoning?
“Travellers’ diarrhoea is incredibly common, affecting about two fifths of all travellers abroad. Mostly it is mild, and symptoms clear up without treatment in 24 to 48 hours, but more serious episodes also occur, resulting in disrupted travel plans and even hospital treatment.
“Risks are higher in warm temperatures, lower income countries or wherever hygiene is poor, but can be a problem anywhere: a few months ago I got caught up in an outbreak of shigella dysentery at an upmarket establishment in the USA. During the Covid pandemic, general hygiene awareness increased, and hand sanitisers became ubiquitous, which certainly reduces the risk.
“The commonest causes are bacteria such as E.coli, campylobacter, salmonella and shigella. Viruses, especially norovirus, can also be a problem, especially in closed settings such as cruise ships, which is why they go to great lengths to enforce good hygiene. And parasites, especially giardia, cause diarrhoea, often persisting after returning home.”
Are there any foods to avoid while abroad?
“Heat is a powerful and reliable way of inactivating or killing the pathogens that cause travellers’ diarrhoea, so any food that has been freshly and thoroughly cooked should be safe. From a safety perspective, undercooked or raw food is inevitably less reliable.
“We are conditioned to thinking of fresh food such as salads and raw vegetables as being ‘healthier’ but these can be difficult to prepare safely in countries with poor hygiene. So it is much safer to stick to food that is cooked thoroughly and served hot.
“On a menu, pick something that absolutely has to be cooked to order, for example an omelette, or a plate of chips. Avoid anything pre-made, that could have been left sitting around at warm temperature, or handled by many people. Buffet foods are notorious.”
How do I know if I can drink tap water abroad?
“When travelling, other than in an obviously safe Western environment, it is best avoided. Use bottled water at meals and for brushing teeth, and avoid ice in drinks. Coconut water – freshly opened – is also safe, and a personal favourite.
“Chlorine dioxide tablets are simple, cheap and reliable. Water bottles with an inbuilt filter can also be safe – stick to ones that are especially designed for travel.”
What are the hygiene red flags at restaurants?
“Dirty toilets, dirty plates, a general sense of poor hygiene. Street food can be safer than other options, if you can actually see the food being cooked in front of you, to high temperature and served hot.”
What should I do if I experience food poisoning symptoms while abroad?
“For adults, a simple approach is to decide whether your symptoms are mild, moderate or severe. If mild or moderate, focus on fluid replacement – drink plenty of oral rehydration solution and consider controlling diarrhoea symptomatically with loperamide.
“Moderate or severe diarrhoea (especially if accompanied by fever or blood, like dysentery) may require antibiotic treatment. Medication to treat vomiting can also be helpful. It is sensible to buy a travellers’ diarrhoea kit containing these items for self-treatment if you are travelling to risk areas or if medical treatment may be difficult to obtain.
“For diarrhoea persisting on return, a PCR test can screen for the ‘top 20’ possible causes and give pinpoint results within little over an hour, enabling rapid treatment. In about 20 per cent of cases, we find that more than one organism is to blame.”
Is it true that a traveller’s gut adjusts to overseas water over time?
“This is not an approach to be relied on!”
2025-04-02T09:32:25Z