In today’s New York Times’ Globespotters post, Fresh, Sweet and Seasonal in Mumbai, Dan Packel tells us about the abundance of fresh fruit available in the APMC Fruit Market in Navi Mumbai.  It covers a huge, 22-acre area and sounds delicious.  Not to rain on Dan’s parade, but I did think we should remind travelers of dangers sometimes associated with food when traveling.

According to the CDC, “Traveler’s diarrhea (TD) is the most predictable travel-related illness.”  It hits 30% to 70% of travelers, depending on the destination.  We have covered this subject before, so we don’t need to rehash all of the same information (see Eating Safely: What can I do? and Stop Me If You’ve Heard This One: Where I Met Montezuma); I will stick to fruits and a weird English anomaly.

Simply put, it is better to eat fruit that can be peeled and that you have peeled yourself.  Obviously, wash your hands and the fruit prior to peeling.  This leads me to my English anomaly:  what does unpeeled mean?  Is this fruit that has been peeled, as in “undressed,” or is it yet-to-be peeled.  The CDC makes a very ambiguous statement in its guide on TD –  ”Other risky foods include raw or undercooked meat and seafood, and unpeeled raw fruits and vegetables.”  If it is risky, I assume they mean “peeled.”

Photo by gruntzooki

While Americans were busy consuming 232 million turkeys last year (46 million of them on Thanksgiving), others were passing on the noble bird in favor of a snack of beetles, crickets and other arthropods and insects.  There are many places in the world that have markets full of these delicacies. If you sample this fare while roaming the world, are you being brave or just foolhardy?

In parts of Asia, Africa, South America and Australia insects, including locusts, crickets, beetles, caterpillars, and bamboo worms, are a common snack. Some people eat scorpions, and tradition says that eating the tail (where the stinger is) will make you strong. In China, you can also taste test exotics such as jellyfish, seahorses, starfish, and sea urchins.

Why eat them? Of course there’s the pure adrenaline rush around trying something new and unusual. But there are actually health benefits to eating insects. Pound for pound, insects contain more protein, fat, and carbohydrates than meat, and could help resolve hunger issues around the world.  They can even help address environmental concerns. Thailand’s countryside is drying out, possibly because of global warming, which makes it difficult to farm large animals, so some farmers are switching to raising insects.  

While insects have not yet inspired a holiday feast, many local outdoor markets are brimming with choices on a daily basis.  The Wangfjing Street Market and Donghuamen Night Market got a lot of press during the Olympics, and offer tons of variety. Time Out in China recommends other, less-touristy options.

A few words of caution as you explore: in the interest of general food safety, choose things that are cooked right in front of you and have been prepared on a clean surface. Be sure you know what you’re eating, for example “fugu” in Japan is blowfish which can be poisonous if not prepared correctly.  Finally, please note if you have allergies that blossom into asthma, you want to avoid fried insects! Recent research suggests they contain high levels of histamine.

If you’re an experienced insect eater, we’d like to know this: is it the flavor or the texture that makes the memory?

Ime chortofagos,  is Greek for ”I’m a vegetarian.” A poll from 2005 estimated that 4.7 million adults in the U.S. are vegetarians.  Vegetarians that travel sometimes worry about how to maintain their diet while in a foreign country, but as the population of vegetarians has grown, so have the resources. Here is some advice on what to eat while abroad. (If you are looking for ways to maintain your vegetarian diet in a culturally diplomatic way, check out this HTH Worldwide-sponsored post on Glimpse.)

Where to go? India, Italy, and (perhaps surprisingly) Turkey are often recognized as being vegetarian friendly. India is traditionally vegetarian, with 20%-40% of the population identified as vegetarian. The popularity of pasta in Italy is a safe bet for travelers, and local fare like couscous, hummus, and roast vegetables in Turkey is a nice alternative. Most other countries can accommodate vegetarians as well. The vegetarian website HappyCow allows you to search for restaurants around the world. There is even a vegan-only restaurant search. They also have some helpful traveling tips.

What to avoid? In many countries, vegetarianism is not very common. Occasionally, people may assume that you eat fish, just not meat, so you’ll want to be clear about what you will eat. You should also check to ensure condiments and sauces don’t include meat or fish products. In Japan, for instance, many things are cooked in fish broth, and even convenience food has fish or meat in it.

How to order. Check out the International Vegetarian Union. They have translations for vegetarian (and some vegan) phrases in many languages, some with printable cards. They also have lists of common vegetarian recipes—the titles could be helpful when looking through a menu. Just remember to be clear and respectful when communicating your needs, and enjoy the local food!

I recently came across a post on Road Junky where the author recounts a valuable lesson taught by a local woman in Guatemala.  Even though he had survived the local waters in several countries around the world, he refrained from sampling the Guatemalan brew.  Thanks to his guide, he witnessed the path the water took on the way to the spigot and made a smart decision.

I wish I had read this post BEFORE I set out on vacation to Los Cabos, on the Baja Peninsula in Mexico. Specifically, before I headed out to the restaurant recommended for its fish tacos and frittatas by a local fishing captain.  The tacos were every little bit of heaven that he described, but later I endured a hellacious experience that still pains me to recall.

Montezuma’s Revenge, the Cairo Two-Step and my personal favorite the Thai-dal Wave are colloquial names for Traveler’s Diarrhea (TD). Each year, an estimated 10 million travelers develop TD. The primary source of infection is ingestion of contaminated food or water.

The dominant risk factor in developing TD is the travel destination. High-risk destinations include Central American countries, the Middle East, South East Asia and Africa. Young adults and individuals with weak immune systems are at higher-risk for contracting TD, and although it usually resolves itself within three to five days, for those who contract a serious infection, TD can be life-threatening.

Prevention Tips

• Maintain good hygiene and use only safe water for drinking and brushing teeth.
• Use only bottled water and avoid ice.
• Avoid raw fruits and vegetables unless peeled by the traveler.

If handled properly, well-cooked and packaged foods are usually safe. Eating raw or undercooked meat and seafood should be avoided. Dairy products, mayonnaise and cake or desert icing are associated with TD, as are foods or beverages purchased from street vendors or other establishments where unsanitary conditions are present.

With recent developments in technology, some resort destinations now have on-site water purification capabilities. It is wise to “know before you go,” so research whether tap water at hotels is considered safe. 

If you are unlucky enough to become a victim, the most important thing to do is to keep yourself hydrated.  There are many over-the-counter medicines available (Pepto-Bismol, Imodium, etc) to help with the symptoms, but don’t overuse them. If your symptoms do not resolve themselves within a few days, if the diarrhea is severe, bloody and/or accompanied by chills, or if you can’t maintain enough fluids in your system, find a doctor who will see you immediately. (And if you need help finding one, check out www.mpassport.com.)

Escherichia coli (ETEC) - the bacteria that most commonly attacks travelers

A recent post on the Uncornered Market blog addresses the not-so-delicate topic of “how to travel without hugging the bowl.”   Though this is sometimes unavoidable, there are some steps you can take to protect yourself and your vacation from a gastrointestinal attack.

More than 200 foodborne diseases have been identified worldwide and include traveler’s diarrhea, Hepatitis A, typhoid fever, cholera, salmonella, and E. coli. For travelers, the most common foodborne disease is — you guessed it — traveler’s diarrhea.  What causes it? Generally it’s caused by bacteria, often Escherichia coli (ETEC). According to the CDC,  between 20% and 50% of travelers develop diarrhea.

Where should I be extra careful? The World Health Organization (WHO) says, “It most commonly affects persons traveling from an area of more highly developed standards of hygiene and sanitation to a less developed one” and reminds us that “While the risks are greater in poor countries, locations with poor hygiene may be present in any country.”  The CDC says that high-risk destinations are developing countries in Latin America, Africa, the Middle East, and Asia.

What’s wrong in these countries? Developing countries often lack either food regulations or the resources to enforce them. The Codex Alimentarius Commission is a joint organization of the WHO and the FAO (the Food and Agriculture Organization of the United Nations) that suggests voluntary food standards, but countries aren’t required to follow them. You can see the member countries of Codex here.

What can I do to stay healthy? The key is getting rid of the bacteria and viruses that cause disease.  Minimally, use the same judgment abroad that you would use when eating in your own neighborhood: Don’t dine in establishments that don’t appear clean or that have a bad reputation.  Make sure your food is cooked properly — whereas you might like your food a little rare, you may not want to leave that judgment up to the cook in a foreign country.  And when it comes to water, always choose bottled over tap, but know that sometimes bottled water isn’t what it appears to be. A colleague was in a resort recently where we saw employees filling up the bottles from a tap.  Perhaps the source was filtered and fine (many hotels have their own special systems to purify their drinking water), but who knows.  Ice is also a no-no.

The WHO has five basic guidelines that they cover in their traveler’s brochure Prevention of foodborne disease: Five keys to safer food.   You should also check out the CDC destination pages — each page has country specific tips about food and water. For instance, the guide for France recommends avoiding unpasteurized dairy and washing hands, while the guide for Kenya adds comments about water, street vendors, and cooked food.

Do you have any destination-specific advice to share or, worse, horror stories from the proverbial trenches?

Sitting down to a steaming bowl of paella–rice, broth, chorizo, clams and mussels–with a pitcher of Sangria is a fiesta for the tastebuds. It’s also a gastronomic adventure that can lead to serious illness caused by allergies, bacteria or Hepatitis A.

If you have a food allergy and are planning a trip abroad, you may have checked out our previous post.  But if you think you’re allergy-free, think again. Did you know that allergies often develop for the first time during your adult years? In fact, a shellfish allergy is the most common type to develop at a later age. According to the National Institute of Allergy and Infectious Diseases, seafood allergies affect only 0.6 percent of children but 2.8 percent of adults. So if it’s been a while since you sat down to crunch some crustaceans (crab, lobster, shrimp) or munch some mollusks (clams, oysters mussels, snails, squid, conch), consider the following:

• If you have family history of allergies (including hay fever or asthma), your chances of being allergic to shellfish increase.
• Most shellfish allergies are relatively mild and sometimes resemble food poisoning (which, as we all know, isn’t any fun).  
• Rarely, a shellfish allergy can trigger anaphylactic shock. Anaphylasis is a medical emergency that requires treatment with an epinephrine (adrenaline) injection (experienced travelers often carry an “epi” pen) and a trip to the emergency room.

If you have any symptoms after eating shellfish, even if mild, you should see a doctor — quick treatment helps avoid more or prolonged problems. It’s also important to consider the proximity of competent medical care. If you’re going to be far from reliable emergency services, don’t eat the escargot.  Yes, escargot, or land snails, are mollusks too and bear the same risks as their sea-dwelling brethren (not really brethren — all land snails are hermaphrodites, but that is a whole other story). 

If you decide that strong risk factors and poor medical options warrant avoiding shellfish, remember that you won’t be using menus replete with allergy warnings. Be aware of the potential for cross-contamination, and the sneaky places shellfish can pop up — like in condiments of East Asian food. Check out this listing of shellfish risks by world cuisines.

Some notes of caution: In some areas the favorite local dish can get you into some serious health problems, like the one recounted in a recent Wall Street Journal article.  In Santiago, Chile a bowl of mariscal contaminated with E coli had near tragic results for a young college student.  Also, be aware that mollusks harvested from waters polluted by sewage often carry the Hepatitis A virus, which they ingest when they feed. No amount of washing can remove the contagion.  So eat raw clams and oysters at your own risk. Even high-end restaurants in cities like Venice have served up “Hep A on the half shell.” We’ll cover hepatitis, its various strains and the immunization that is available in an upcoming post.

There’s been a lot of attention paid to food allergies in the last couple years. But what happens to folks with food allergies when they travel overseas?

At least 12 million Americans suffer from food allergies And 90% of all food allergy reactions are caused by 8 foods:  milk, soy, eggs, wheat, peanuts, tree nuts, fish and shellfish.  Country music star Trace Adkins  championed this cause when he appeared on the Celebrity Apprentice last year and raised awareness for the Food Allergy & Anaphylaxis Network (FAAN), an organization dedicated to  educating and advocating for Americans living (and of course traveling) with food allergies.  

So what happens to this education once a person with a food allergy leaves the country?  Americans are spoiled by the mandated labeling that appears on packaged foods and even restaurant menus. But in a foreign country, this helpful information might not appear or you may not be able to translate it. The downside could be significant.

The good news is that there are tools available to help you manage this risk. Select Wisely offers translation cards that you can keep in your wallet and refer to when you are ordering foods in unfamiliar territory. mPassport® offers you the ability to translate phrases to allow you to communicate your allergies in many different languages.  Words certainly take on value when you realize that knowing five simple ones such as “I am allergic to peanuts,” can save your life.   

What it means is that you can have food allergies and still be free to travel the world. Just do your homework before you board the plane. Sure, you can go on vacation and just eat bread (as long as you don’t have a gluten allergy), but if you want to get the full experience of a foreign culture, you’ll want to get a taste for the local cuisine.