It’s the ultimate travel nightmare: Eat something sketchy your first night in a new place, and end up hunched over the toilet for the duration of your trip.
This torture is known as food poisoning, and while its symptoms are vicious, the condition is common. The Centers for Disease Control and Prevention (CDC) estimate that 1 in 6 Americans suffers from it every year. And when we’re on the road, the numbers jump: Depending on where and when they travel, between 30 to 70 percent of travelers can come down travellers’ diarrhoea - causing abdominal cramps, vomiting, and diarrhoea - the CDC says.
So how exactly do you wind up stationed around the toilet? And what can you do to beat the misery in the moment and prevent it from happening on your next trip? We asked doctors to break down the experience and offer up solutions to the pain.
What Causes Food Poisoning?
Food poisoning is a generic term that refers to the more than 250 different foodborne diseases that are caused by different microbes and pathogens, explains Dr Daniel Caplivski, director of the Mount Sinai School of Medicine Travel Medicine Program.
Most of the time though, when we fall sick from food or drinks abroad, it’s because of bacteria, viruses, or parasites, says Dr Christian Arbelaez, an emergency medicine doctor at Brigham and Women’s Hospital in Boston. Bacterial causes - from sources like E.coli or salmonella from undercooked meat, raw fish, or runny eggs - are most likely to blame.
The staphylococcus aureus bacteria, which are found in unpasteurised dairy products (and can also grow on salty foods like ham), can also produces a toxin that can lead to vomiting and diarrhea, explains Dr Caplivski.
Plus, it might not be something within the food itself that’s getting you sick - it could be from the person handling your food. Viral infections tend to make their way into your body because the person preparing your food was ill with something like the stomach bug norovirus, Dr Arbelaez notes.
A parasitic infection - from something like giardia, which can be picked up from a surface that’s been contaminated with faeces - can cause foodborne illness, too, notes Dr Arbelaez. You could get this, for example, by drinking water that’s been contaminated with faeces.
Why Food Poisoning Is More Common When You’re Traveling
While foodborne illnesses can be picked up anywhere, it is more common to get sick from them when you are in another country, Dr Caplivski notes.
That’s because you might be exposed to foreign bacteria and illnesses that your body doesn’t know how to handle, he says. Drinking water is a prime example. “When you're in a developing country, the tap water is going to have bacteria or parasites that we are not accustomed to and that we don't have immunity to,” he says.
People who live in these countries can gain immunity to these pathogens just through cumulative exposure, but even then, it’s still possible for locals to get sick. And no, if you’re on a short trip, that’s not enough time to develop such immunity.
Of course, your likelihood of coming down with something nasty depends on where you’re going. According to the CDC, places in the U.S., Canada, Australia, New Zealand, Japan, and countries in Northern and Western Europe are considered low-risk destinations. Intermediate-risk countries include those in Eastern Europe, South Africa, and some of the Caribbean. High-risk areas would be many parts of Asia, the Middle East, Africa, Mexico, and Central and South America.
“The United States has good regulations for the ways foods are handled and prepared. When we go abroad, we can’t always rely on those regulations,” says Dr Arbelaez. Think about this in terms of restaurants. Think about food as a carrier for illness sometimes, says Dr Arbelaez. If the food preparers or restaurants aren’t bound by the same regulations that are here in the U.S., you could wind up sick from contamination.
How You Know You Have Food Poisoning
Normally, the nasty symptoms of food poisoning - like abdominal cramps, diarrhoea, and vomiting - pop up between 30 minutes and six hours after the food or drink in question is consumed. In most cases, the bout of unpleasantness is short, lasting only 24 hours, says Dr Caplivski.
But other symptoms can point to something more serious. If you’re suffering with a fever, serious abdominal cramps, or blood in your stool or vomit, those can signal a bacterial infection. You’ll need an antibiotic to treat that, says Dr Arbelaez.
How to Treat Food Poisoning Abroad
If you’re knocked down with run-of-the-mill food poisoning, here’s what you can do to feel better fast.
When your symptoms first start, you can try an over-the-counter medicine like Pepto-Bismol or Imodium to help with the nausea and diarrhoea, says Dr Arbelaez.
But if you don’t have any meds on hand - and there’s no convenient place where you can pick them up - you can do some low-tech recon: Start rehydrating. Dehydration is one of the major issues doctors worry about with food poisoning, because you’re losing so many fluids, so starting to rehydrate ASAP is key. Stick to bottled water so you don’t get yourself sick again. And also boil your water.
You’ll also need to replenish electrolytes, which are lost when you’re throwing up. If there’s no Gatorade in sight, Dr Arbelaez offers this concoction: If you don’t have bottled water, bring a pot of tap water, six teaspoons of sugar, and one teaspoon of salt to a boil. Let it cool, and drink that slowly so you don’t shock your system and get sick again.
As for foods? If you’re not hungry, keep up with fluids and skip food for the time being. If you’re starving, eat, but avoid food and drink that irritate the intestines like alcohol, coffee, tea, dairy, and spicy and greasy food.
“Usually, we tell people to stick with bland foods for awhile, so that their stomachs can recover,” says Dr Caplivski. Eating heavy or rich foods like milk, sauces, or spices can irritate your stomach and make you feel worse. But crackers, breads, soups, and rice are good food choices - they also contain salt, which helps replenish your electrolytes, he notes.
How to Prevent Food Poisoning When You Travel
Sidestepping foodborne illness has a lot to do with preparation, says Dr Arbelaez. Your first step, he says, should be going to the CDC’s website to look up any travel notices, which will give you an idea of what to expect and what to pack.
Make sure to visit a travel clinic or your primary care doctor, too, for any necessary vaccines, like hepatitis A, which has symptoms similar to food poisoning and can also be spread through food or water, he says.
Depending on where you’re going, you’ll want to look into whether or not your health insurance will work overseas, which will help you know if it’s accepted at nearby hospitals in the event you need assistance. If you’re travelling somewhere remote with no access to hospitals, you may want to consider insurance from a company like International SOS. They offer worst-case-scenario plans that will evacuate you from your area and to a hospital if you fall seriously ill, says Dr Arbelaez. It’s also a good idea to tell the country’s Malaysian Embassy where you’ll be, in the event you’ll need assistance, he notes.
But in most cases, good prep comes down to good packing. Bring medicines like Tylenol, Motrin, Dramamine, Imodium, and Pepto-Bismol, he says. Packing water and Gatorade bottles (or packets) will also be key in rehydrating.
The same goes for hand sanitiser. Washing your hands in contaminated water can backfire, notes Dr Caplivski.
Otherwise, be cautious with water and undercooked foods. Sometimes, it’s the little things - ice cubes made from unfiltered waters, salads washed in dirty water, or fruits washed in local waters - that can make you sick, says Dr Caplivski.
Still worried? Your doctor can prescribe the antibiotic rifaxamin as a preventive or self-treatment measure for traveller’s diarrhea. This may be especially important if you have an underlying bowel condition like Crohn’s disease or ucerative colitis. However, these meds require three dosages a day, and can be expensive. Instead, you can ask your doctor to prescribe other antibiotics like ciprofloxacin or azithromycin beforehand, which you can take if you get sick on your trip, says Dr Caplivski.
Loading up on probiotics before your trip might help beef up your good-for-your-gut bacteria, too, says Dr Caplivski.