By Sheldon Margen and Dale A. Ogar We can't help you decide where to go on vacation this year, but we can help with some precautions about food, water and sanitation that may help keep you well during your travels. Traveler's diarrhea is one of the most common ailments you are likely to encounter in your travels. Symptoms include diarrhea, nausea, cramps and fever. The nasty little bug is a familiar one: E. coli and is most bothersome in Africa, the Middle East, the Mediterranean countries, Southeast Asia, and Latin and Central America. Unfortunately, if you aren't careful, traveler's diarrhea may be the least of your worries. You could contract cholera, typhoid, hepatitis or worse. If you are traveling to Europe (except for parts of southern Europe), Australia, New Zealand, Canada or Japan, you can probably drink the water and sample all the local cuisines without worry. However, if you are going somewhere else, keep in mind the following precautions: Food Don't eat raw vegetables. Just assume they are contaminated. Lettuce very often contains parasites, so stay away from salads. Make sure that all vegetables have been well cooked. Eat fresh fruit and nuts only if there are no breaks in the peel or shell. Wash all fruits in soap, and rinse in boiled water. Remove the peel before eating. Do not eat any fruit that has been already peeled.
- Many modern hotels, even in the developing countries, purify the water, but if you are at all in doubt, don't drink it.
- Don't even use the tap water to brush your teeth.
- Safe beverages include coffee and tea (if the water has been boiled), bottled wine, beer and canned soft drinks. Bottled soft drinks are iffy, so avoid them.
Do not drink locally bottled water. It may just be tap water put in a bottle for the anxious tourist, but it probably has not been purified. Before you drink anything out of a bottle or can, wipe the top well. Only use straws that come in sealed paper sleeves. Freezing your water won't guarantee safety. Do not put ice cubes into your drinks unless you can make your own from boiled water. If at all possible, purify your own water by boiling it for two or three minutes (a small immersion heater can do the trick). You can also add special purifying chemicals, such as Halzone or iodine. If the water is cloudy to begin with, be sure to let it sit for at least 30 minutes after purification before you drink it. Before you leave on your travels, you might ask your doctor to give you a prescription for drugs that are appropriate for the area you are visiting. Fill the prescription before you leave, just in case. If you do come down with a bug and don't have any prescription medicine, try Pepto Bismol. The most important treatment for diarrhea is replacement of the lost fluids. Drink plenty of clear (boiled) liquids, such as tea; or try canned fruit juices and soft drinks (non-caffeinated if possible). Do not drink milk or consume other dairy products. Salted crackers may help. If you have small children with you, it might be useful to carry along a few bottles of pediatric oral rehydration solution. Children are at great risk for complications from severe diarrhea and dehydration. You should be especially mindful of what they eat and drink.
Traveler's diarrhea is rarely serious, but if the diarrhea is severe and appears to be bloody, you may have dysentery and should seek medical attention right away. Frequent hand washing is usually a good idea, but washing your hands in contaminated water may not do much good. When you're in places where the water supply is iffy, take along premoistened wipes. Remember that vacations are supposed to fun, but it wouldn't take much to turn an expensive trip into a miserable experience. For excellent, up-to-date information on health advisories in various parts of the world, check out the U.S. Centers for Disease Control and Prevention (CDC) Web site. Have a good trip, and send us a postcard. Reviewed July 2008 Sheldon Margen, M.D., is a professor of public health at the University of California at Berkeley. Dale A. Ogar is managing editor of the University of California at Berkeley "Wellness Letter." They are the authors of "The Simply Healthy Lowfat Cookbook," "The Wellness Lowfat Cookbook" and "The Wellness Encyclopedia of Food and Nutrition."
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