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There's nothing worse than being struck down by a bout of the trots while on holiday. Dr. Sarah Brewer advises on how to keep healthy in the heat
Food poisoning can quickly change your summer holiday from marvellous to a misery. The medical term for food poisoning is gastroenteritis - known more commonly as Delhi belly, Montezuma's revenge or Torremolinos trots - and it's the commonest health problem to strike travellers abroad. Up to half of those visiting tropical regions are affected. Visitors to India are most at risk, closely followed by travellers to Egypt, Morocco, the Gambia, Tunisia and Kenya. Surprisingly, even 10 per cent of visitors to European resorts also succumb.
Food poisoning stems from eating or drinking contaminated food or liquids. Some cases are infective, and are caused by viruses or bacteria. Others are non-infective and linked with chemical pollutants or pre-formed poisons (toxins), such as those produced by staphylococcal bacteria, toxic plankton and some types of mushroom. Food poisoning after eating shellfish is especially common, as all four culprits - viruses, bacteria, toxins or chemicals - can be involved.
Symptoms of food poisoning include stomach pains, vomiting and diarrhoea. In severe cases the victim may develop a fever or even go into shock and collapse. Symptoms usually come on within:
30 minutes, in the case of chemical poisoning, for example accidentally ingesting weed killer
One and 12 hours, if the illness is due to bacterial toxins, for example botulinum toxin
12 and 48 hours, if it results from a bacterial or viral infection, for example salmonella, rotavirus
The worst form of infective diarrhoea is dysentery, in which there is also fever, and blood and slime in the motions. There are two distinct types of dysentery: one due to infection with a group of bacteria known as shigella, and the other due to a single-celled organism known as entamoeba.
Prevention
Keep food properly refrigerated wherever possible. A rise in temperature from just four to eight degrees centigrade can more than double bacterial growth rates. In hot weather, keep packed lunches fridge-fresh in a sandwich box with its own integral ice pack which, when pre-frozen, keeps food chilled for up to six hours.
Take a probiotic supplement containing healthy digestive bacteria such as lactobacilli before, during, and after travelling abroad. This will help to boost intestinal immunity and improve digestion, at a time when your diet is likely to change significantly.
Simple tips for avoiding food poisoning - both at home and abroad - this summer include:
Wash hands thoroughly before preparing foods, and again before eating
Keep your kitchen clean and dry
Keep pets out of the kitchen at all times
Keep separate chopping boards for cooked meat, raw meat, and for other produce such as vegetables
Make sure your fridge is keeping food properly chilled, with fridge temperatures below 5 degrees C and freezer temperature below -18 degrees C.
Clean your fridge regularly and throw away all foods past their use-by date
Store raw meat at the bottom of the fridge, covered, and separate from cooked foods
Defrost frozen produce thoroughly before cooking
Make sure all hot food is cooked thoroughly and served piping hot rather than merely warm
Avoid eating raw eggs and products made from them
Do not eat any products past their use-by date
Tips to help prevent traveller's diarrhoea
If you're travelling abroad, you are especially susceptible to food poisoning, as hygiene may be less strict. Plus you have little natural resistance against foreign bacteria and viruses to which you have not been previously exposed.
For drinking, brushing your teeth, preparing food or cooking, use:
- water from sealed bottles; carbonated is safer than still water as it's less likely to have been filled from the tap
- freshly boiled and cooled water
- water sterilised with purification tablets
Avoid green salads and uncooked vegetables
Only eat fruits that can be peeled
Avoid ice cubes unless made from safe water
Avoid ice creams from unreliable sources
Avoid unpasteurised milk - boil if unsure
Wash hands thoroughly before eating
Avoid food exposed to the sun or to flies
Avoid snacks bought from roadside vendors
Sea, river, swimming pool and even shower water may be contaminated. Keep your head out of the water and try not to swallow any. If water looks obviously murky, don't swim in it.
Treatment
Children, especially young babies, cannot cope with losing too much fluid or salts through diarrhoea. If prolonged, this can rapidly lead to dehydration, low blood pressure and shock. In severe cases, if not treated properly, it can even be fatal. If a baby or young infant develops persistent diarrhoea, always seek medical advice, as they can become dehydrated very quickly. Older children with vomiting and/or diarrhoea are best treated with plenty of fluids in the form of rehydrating electrolyte solutions. Several are available over the counter - ask a pharmacist for advice.
Most doctors now feel that a child with diarrhoea is better off eating a light diet rather than being starved. Although food may pass through to cause diarrhoea motions, some nutrients will be absorbed, and the child will tend to feel less ill - recovery seems to be quicker, too. Offer a light diet (eg Bio yoghurt, thin soup) but avoid fruit and dairy products other than yoghurt, as these can make your symptoms worse. Infective food poisoning can produce temporary lactose (milk sugar) intolerance.
Contact your doctor for further advice if the diarrhoea continues for more than a day. If your child develops a high temperature, abdominal pains, passes blood or becomes excessively drowsy, seek medical advice straight away.
Adults
Drink plenty of fluids to avoid dehydration. Bottled mineral water or plain water that has been boiled and cooled is best if you are unsure of the quality of your tap water. An electrolyte solution (available from chemists) will help to replenish body salts.
When visiting tropical regions, ask your GP about taking antibiotics (on private prescription) and anti-diarrhoea medication with you for use in an emergency. Over the counter anti-diarrhoea medications such as loperamide help to slow down the over-activity in the colon that causes diarrhoea. This helps to improve bowel function by increasing fluid absorption, reducing painful spasms, and returning stool passage to normal.
Bio yoghurt or supplements containing live cultures of probiotic bacteria (eg lactobacilli) can also aid recovery by boosting local immunity.
Caution! Oral contraceptives are less reliable if you have diarrhoea for more than 24 hours. Continue taking the pill but use additional precautions such as condoms for the rest of the cycle.
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