I will never turn down the chance to eat a delicious meal. While traveling, especially in poorer countries, that usually means eating on the streets and in hole-in-the-wall cafes. The best flavors come from the streets and these small restaurants, not from hotel dining rooms. But most people assume that eating at these types of places is risky.
It is risky. So how do we get the good stuff without getting sick?
It is all about assessing and managing risk. If you travel long enough you’ll inevitably get sick from the food at some point. But there are a few things I’ve learned from years of traveling and from my days as a professional chef that can help minimize the chances.
Yep. We’re talking about food poisoning. I’ve had serious food poisoning three times while traveling. It’s not fun. But considering the hundreds of days I’ve traveled and the thousands of things I’ve eaten in a big range of countries, three times is actually a very low percentage. I calculate that my odds of getting seriously sick are about 1 in 1,200 everytime I eat something while traveling. I keep my odds low by paying attention to a few key things.
Eat where the locals eat
I think this is the most important safety advice I can give you. Look for busy places that are full of locals. Lots of locals mean the place is probably safe. And the food is likely delicious if lots of other people are eating there.
Here is why: If the place is busy that means a high turnover – you are less likely to get sick if the food is fresh. Locals know where the good quality food is, you do not.
Don’t eat western food
This one only applies when you are in non western countries. Obviously, when you are in Europe or North America you are going to want to eat western food. But when you are anywhere else it’s generally safer to avoid the places catering to a western palate.
Why: Again, it has to do with turnover. In poor countries the locals don’t usually eat at the expensive restaurants that cater to rich tourists. If not enough people go through the door each day, the food isn’t going to be fresh.
Also: Just because it’s a western restaurant doesn’t mean the place uses western food safety standards. Inexperienced travelers often have a false sense of security eating at western places. Suckers.
Finally: Why would you? You traveled across the world, why eat the same type of food you can get at home? Food is one of the easiest ways to experience a different culture.
Fancy is not necessarily safer
Just like with western restaurants, people falsely assume that more expensive or fancy restaurants are somehow safer. That nice elegant dining room and dexterous servers gives a false sense of security. Let me assure you that what is happening back in the kitchen is a totally different beast.
Why: I’ve seen antics in commercial kitchens back in the States. I’ve seen the same in hotel kitchens in Asia. You don’t really want to know. Ok, maybe you do. Anthony Bourdain got famous writing about it in the highly entertaining Kitchen Confidential. You might not want to eat out for a while after reading it.
Cooked is less risk
If the food is steaming hot it’s generally safe to eat. Also check that any meat you are about to eat is cooked through.
Here’s why: Most bacteria can’t survive high temperature and most virus are likewise deactivated. At above 160 degrees fahrenheit (or 71 degrees celsius), you’ve eliminated most, but not all of the nasty critters. At boiling temperature you’ve eliminated almost everything, but again, not 100%.
Freshly made vs pre-prepared and sitting out
I seek out freshly prepared food whenever possible. Food cooked to order is probably much safer than something that’s been sitting out for a while.
This is because: Bacteria really like to grow in warm moist environments. 1 bacteria divides into 2, 2 into 4, 8, 16, 32, 64, 128… 549755813888… Exponential growth. Food sitting at room temperature is a party for bacteria growth.
The 2 hour rule
I do eat food that is pre-made and sitting out at room temperature, but only if I’m pretty sure that it was cooked recently – within the last 2 hours is my rule of thumb.
Why is this: Bacteria take time to grow, something that was cooked a few hours ago is probably still safe to eat. My immune system can handle a little bit of bacteria, but not a ton of bacteria. If food has been sitting out all day I won’t eat it.
Time and temperature: Bacteria growth rate has to do with both time and the environment. In a cool dry climate (like in your fridge) food spoils slowly, in a hot humid climate food spoils very quickly. Anywhere between 39 and 140 degrees fahrenheit (4 – 60 celsius) we call the danger zone in the professional world, food held at that temperature for too long is risky. That’s a big temperature range.
Between temperatures of 70 to 117 fahrenheit (21 – 47 celsius) bacteria grow at an incredible rate, doubling in as little as every 20 minutes. That range includes typical room temperature in most places, and the temperatures you will likely encounter eating on the streets of well, pretty much anywhere.
Temperature, water, acidity, salinity, available oxygen, and other chemicals present all affect the rate of growth. I sometimes account for these factors in my risk assessment, but that is way more complicated than the scope of this article. A safer and easier rule is to just always say no to cooked food that’s more than two hours old.
Watch out for huge batches and large selections
One vender pre-cooks a few huge pots of food, another stall cooks a dozen small pots of food. Both of these situations are potentially a problem.
Turnover: In both situations that food is going to sit there for a long time before it’s all sold. Better would be to find a vendor who only sells one or two things, or who pre-cooks in smaller batches. It’s all about turnover. Also, someone who only makes one thing all day every day is likely going to be very good at making that thing. Delicious.
Cooked food either hot or cold
Sometimes you’ll encounter food that’s pre cooked and held at hot or cold temperature. So long as the food is held outside of the danger zone it’s relatively safe. It needs to be really cold, or really hot. That is, the food needs to be consistently held below 39 or above 140 fahrenheit to be safe (below 4 or above 60 celsius).
Why: Bacteria grows very slowly (or not at all) at cold and hot temperatures. At these temperatures the risk of getting sick is low.
The cold foods should feel as cold or colder than your food back home in your refrigerator. The hot foods should be at least hot enough that they are uncomfortable to eat. If you can comfortably touch it with your hands, it’s not hot enough.
Peel and wash your own raw fruits and vegetables
If I can peel it it’s safe. If someone else peels it, it might not be.
Why: Plenty of possible contamination is on those nice looking fruits and vegetables. But if you can peel fruits and vegetables you are probably good to go. Washing works too, if you can access clean water.
That cucumber is not harmless. They use manure to fertilize the fields and dozens of people handle the produce before it ultimately ends up on your table. In fact, this CDC study found that nearly half of foodborne illness came from produce.
Watch out for flies
Houseflies are annoying. Flies also carry a lot of diseases and other shit too. Literally, fecal matter. This is hard to avoid in certain places at certain times of the year, but try if you can.
Why: A clean restaurant attracts less flies than a dirty restaurant. A place with a lot of flies is probably dirty in many other ways besides the flies. Flies are a good hint of other possible problems.
Look out for other signs of bad food
Use your best judgement. If something looks, smells or feels off to you take a pass and find another option. I’ve ordered food and only after it was delivered to my table did I realize that it probably wasn’t something I felt comfortable eating. I risked offending and didn’t eat it, but probably saved myself a few days of misery. Food is cheap, food poisoning is expensive.
Trust your senses: You know bad smells and tastes. I’m not talking about unusual or culturally different flavors you are not used to eating. I’m talking about rotten.
Look for signs of good food hygiene
Are they using gloves or tongs? Is there good segregation of ingredients? Are the cooks taking active steps to avoid contamination?Great!
I look for well organized and not chaotic places. Chaos leads to mistakes and corner-cutting, and higher risk for you. A well run restaurant or street stall should be clean. Dirty dishes are removed from the tables quickly and kept separate from the rest of the cooking area. Ideally the person who handles the money does not cook the food. Ideally the cook has a place they can wash their hands.
Pay attention and you’ll start to see the little differences between a place run by someone who cares and someone who doesn’t.
Fermented food is your friend
Whenever I get a chance I eat yogurt, kimchi, fermented pickles, kefir, kombucha, miso or any other locally available fermented foods. Fermented food is full of good bacteria.
Why: Your body is filled with useful microorganisms. In fact, you probably have more microorganisms cells than human cells in your body. By frequently ingesting beneficial critters I encourage them to colonize my gut, hopefully out-competing the bugs I don’t want.
Check the meat, fish and eggs
Most people know that meat, fish and eggs are potentially dangerous. Make sure any animal protein you eat is cooked through, and if you can see how it looks and smells before it’s cooked, even better.
Why: Bacteria love to live on protein. Bacteria and parasites can survive in undercooked meat. If protein is well cooked much of the risk is minimized.
Watch out for starches and sugars
I usually avoid stalls selling fruit juice, unless they look especially clean or have refrigeration. If they clean their surfaces and utensils constantly, and don’t precut their fruit I’ll probably drink it.
Cooked rice, potatoes and other starches that have been sitting out at room temperature are also suspicious, especially if in a moist environment.
Why: Starches and sugars are easily digestible – by you and bacteria. That easy to eat food is another excellent medium for bacteria growth if there is enough available moisture. People frequently overlook the danger of starches, even back in restaurants in the states. Again, use the two hour rule.
Dry is usually safe
Food that is dry or dehydrated or fried or baked until dry is almost always safe.
This is because: Bacteria can’t reproduce without moisture. If food is low moisture content and has been properly cooked and handled, no problem.
But: Some harmful bacterial spores can survive dry and or hot conditions. When the environment is moist again, new bacterial growth can occur.
Ice and water
Ice is a potential source of contamination, but it depends on the country. Water is also problematic. The ice and water restaurants serve might not be safe – it might be made from unfiltered tap water, or it may be contaminated in transport.
How to tell when traveling: With ice I look for clean storage coolers. I also look for ice that looks like it came from a factory, not ice frozen at home with questionable water. Factory ice is usually round, or sold in large blocks and then chipped by hand. But what is safe and not safe really depends on the country.
Water: Also depends on the country. Some places offer safe clean filtered water at restaurants. Keep in mind water safety when showering and brushing teeth as well.
I err on the side of caution and don’t drink water at restaurants if I have any doubt. I’ll eventually get sick again somehow, but I’d rather that be from a delicious meal, not a tasteless glass of water.
Buying bottled water is annoying, expensive and wasteful, so I use this reliable and cheap little filter when I travel.
What about dishes washed in untreated water?
Have the plates and utensils been washed in filtered water? I doubt it. In much of the world clean water is too rare and valuable for that. And it doesn’t really matter.
Why not: So long as the dish, spoon or glass looks clean and dry it’s probably ok. A clean dry dish is pretty safe. If it’s wet wipe it dry. If it looks dirty ask for another one. If the restaurant is unable or unwilling to offer you clean utensils, it’s probably a good indication that you should eat elsewhere.
Local knowledge matters
Each country or region is different. I’ll happily eat raw fish just about anywhere in Japan – they have a long tradition of serving it and it’s generally safe to eat. Raw fish in Thailand is probably ok, I’ll eat it so long as I like the looks of the restaurant. I wouldn’t dare touch raw fish in Nepal.
Again, if you eat what and where the locals eat you’ll avoid most of the risk.
Wash your hands
Wash your hands every chance you get. Often “food” poisoning is contracted from pathogens spread from things or people you touch, not the food you ate. This is probably the second most important thing you can do to minimize risk.
Use hot water if you can. Scrub vigorously for at least 20 seconds. I mean it, actually scrub those mits – the mechanical motion is what removes bacteria and it takes 20 to 30 seconds to remove a significant portion of the bacteria. Soap helps too obviously, but less than the action of scrubbing.
Look at the person handling your food
Are they sick? Do they have visible cuts? Are their clothes covered in spilled food? Are they doing something else obviously unsafe? Take a pass. A huge portion of foodborne illnesses are passed on by the person who handles your food.
Exercise and sleep helps
Staying in shape and getting plenty of sleep is also important. If your body is already stressed you are more likely to get sick. I know you are excited to start your trip right away, but it’s better to take it easy for a day or two after that long transcontinental flight. Build in rest days to your itinerary.
Exercise your immune system too
When I’m back home I don’t stress about every little thing. If something falls on the floor at my house I’ll probably pick it up and eat it – I like to keep my immune system trained. Paradoxically I’m less likely to get sick while traveling because I ignore food safety while at home. Not worrying about it keeps my immune system exercised. Use it or lose it.
I don’t go to the doctor for little sicknesses, and I basically have to be dieing before I’ll take an antibiotic. Antibiotics should be reserved for extreme cases. We overprescribe in the Western world and it’s catching up with us. People who use antibiotics frequently are much more likely to get sick while traveling – they have no natural defenses left.
There will always be risk
The steps you take to minimize risk do not guarantee you will avoid getting sick. Sometimes shit happens. There is no way to avoid 100% of the risk of getting sick. But you can lessen your chances significantly. Eat where the locals eat, actually wash your hands, look for food cooked to order if possible, and if you have to eat prepared food try to find the freshest option. Use all of your senses and pay attention to any clues. Avoid the tourist restaurants.
If you do get sick, don’t worry about the cause
It takes anywhere from 2 hours to 2 weeks for the symptoms of food poisoning to show up. When you are traveling you have no way to pinpoint the exact source of contamination. Even at home the source of foodborne illnesses are very hard to track unless there is a full blown outbreak. Accept the situation and don’t try to assign blame. It doesn’t really matter if it was your last meal, something you ate last night, or something you ate last week. Whatever you ate is in the past, so don’t stress too much about it.
I love it when people say they just know it was the “___________” that made them sick. Um, yeah maybe it was that. But probably not.
What to do if you get food poisoning
The most important thing to do is to stay hydrated. Dehydration is the fastest way to end up in the hospital. If your pee is dark yellow, or you have a decrease in urination that’s a pretty good sign that you are not drinking enough. Dry throat and mouth is another clear indication. Feeling dizzy is another sign of dehydration.
Even if you feel like you can’t hold any fluids in, you need to keep drinking. Rehydration salts help, coconut water works great.
Let your body catch up. You might have to change plans and hunker down for a few days. Don’t try to keep traveling, that will just make things worse.
Eat simple foods once vomiting and diarrhea has passed
Bananas, bread, crackers, plain rice. Keep it simple and in small quantity until your appetite returns.
If it gets significantly worse or lasts for more than three days it’s time to see a doctor
Also seek medical attention immediately if you have a high fever, bloody or dark stools, bloody vomit, severe stomach pain or if you are not able to control dehydration.
Most cases of food poisoning are mild and your immune system will generally take care of the problem. But, food poisoning can kill if untreated. If it is serious you need to get help.
Don’t let fear of getting sick stop you
I’ve eaten at plenty of high end restaurants, and while the food is usually good at the fancy places, you are mostly just paying a premium for the location and service. I’ve been to some good restaurants over the years, but the best meals of my life are all from small mom and pop kind of places.
Good food is everywhere in “unsafe” countries and missing out because of unwarranted fear of getting sick is a shame. With a little knowledge and good judgement getting sick is not really that big of a risk.