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Dr. Anderson: A Foreign Menu

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Dr. Anderson: A Foreign Menu

Doctor Eric Anderson, a charter diplomat of the American Board of Family Practice and a former president of the New Hampshire Academy of Family Physicians, is a regular contributor to Travel Tips 'n' Tales. He is widely traveled and published, having written a travel health column for Travel 50 & Beyond and a weekly online column, Ask The Doctor, for The New York Times Syndicate.

Dr. Anderson invites you to send your questions regarding travel health issues to ericmd@lorrypatton.com

Eating & Drinking in a Strange Land

Dr_Anderson210.jpg Eric Anderson, MD

In keeping with the season, this time of the year everybody seems to over-indulge and eat foods that aren't on their regular menus. Often they end up with indigestion, hung over. Travelers, on the other hand, when traveling to foreign lands, are always confronted with a strange diet. And because it's vacation time, they often over indulge too.

What are some ways to avoid shocking our stomach?

Susceptibility to stomach and intestinal problems varies enormously from patient to patient. We've all met that person with the cast-iron stomach who never has trouble on vacations. For the rest of us it probably helps to start right and avoid alcohol on long flights and eat simple meals until we've started to adjust to any jet lag. Jet lag, itself, can cause indigestion. It makes sense, too, initially, to sample small portions of unknown dishes until our personal tolerances to them become established.

"Cook it, boil it, peel it or forget it!"

Travel doctors consistently remind their patients about the potential for unclean foods to cause infection. Their classic advice is "Cook it, boil it, peel it or forget it!" Hot foods, freshly prepared, are usually safe. Travelers should avoid cold meats in restaurants, raw shellfish and salads, ice cream, food from street vendors, and unpasteurized milk products. Leftovers should be thrown out -- food spoils rapidly in tropical climes.

Anticipating the problems, what about prophylactic antibiotics? Can a stitch in time really save nine?

Yes & No. We've heard plenty about Cipro recently and it's true that it and other less expensive medications like the trimethoprim-sulpha combinations named Bactrim or Septra sometimes have a role helping prevent stomach disorders. Indeed, a person passing through a country that has poor food hygiene may benefit from brief antibiotic coverage for that short visit -- but such attempts at prevention are inappropriate for those spending longer time there. (It's better to build up immunity than suffer drug side-effects from overuse.) In order to assess the risk-benefits of giving you antibiotics, your personal physician, as always, needs to know where you're going and what you're doing. Older travelers or frequent visitors to Third World countries should ask their doctors about the Hepatitis A vaccine. A simple tactic to stay healthy in developing countries is to wash your hands often especially before eating. That's not always possible -- so carry some wet wipes.

What foods should we stay away from?

I guess foods that we know bother us because they will still be a problem even on vacation. Despite the old argument that stress caused stomach disorders, there are no reports I know of suggesting relaxed persons on vacation miraculously stop having problems.

Can we suddenly eat spicy food if we never have before?

I doubt it. Some of what we think are bowel infections often turn out to be food allergies and these tend not to change.

What's the best thing for a hangover?

I don't know. Are there any readers out there with their own pet cures? You can avoid some of a hangover by drinking lots of water because alcohol is a diuretic (it makes you urinate) and dehydration is part of being hung over. The B vitamins may help. Pilots and others with access to oxygen used to swear by its benefits, but I doubt that it helps and you're sure not going to be popular, especially these days, if you start fiddling with the oxygen masks in an airplane cabin. Some of the sports drinks may help settle nausea. Emetrol liquid has been used to treat queasiness and vomiting for many years. Travel sickness antihistamines like Dramamine may also reduce nausea. For hangover headache Tylenol which isn't a stomach irritant makes more sense than aspirin which is.

What should we take if we have a stomach ache?

Antacids help. Classic ones are Maalox but it can cause loose stools in contrast to Tums and Titralac which do the opposite. Gaviscon chewable tablets are useful also and quite pleasant to take (they form a marshmallow-like froth in your mouth so you might look like a dog with rabies!) I like 'em. The old favorite Pepto-Bismol is actually very useful both for diarrhea and vomiting. Just remember it turns the stools black so don't be alarmed by that. OTC (Over the counter) versions of the so-called H2-blockers like Pepcid AC can also be very effective.

When should we consider an upset stomach serious?

Good question. First, if there is significant, unrelenting abdominal pain that clearly worsens as the hours go by. We're not talking here about the abdominal colic associated with diarrhea cramping which can be very painful but it comes and goes. Deep, dull, crippling abdominal pain, on the other hand, suggests a problem that needs to be seen. Second, if a person is losing at both ends, in other words having both continual vomiting and severe diarrhea. Such patients, especially children or the aged, can become dehydrated very quickly. Third, an illness associated with a high or continued fever. Fourth would be if there was evidence of gastro-intestinal bleeding, again from either end. One might be less concerned if the patient definitely has had the appendix removed previously or if the pain was on the left (not appendix) side but strange things can happen so that's not an absolute.

So, is there a final golden rule out there, not yet mentioned, to help us avoid trouble when we sit down in an unknown restaurant in a far-off land?

Yes. Perhaps we should do some reading about the cuisine of a foreign country before we get there. And maybe buy a phrase book in its language that has a section on restaurants. That way we will at least know which item to curse if we end up sitting on our hotel-room throne later in the middle of the night.

» » More articles by Dr. Eric Anderson

NOTE: Lorry Patton's Travel Tips 'n' Tales would like to remind you to always consult with your personal physician before following any medical advice and to please read the Travel Tips 'n' Tales "Terms of Use" found on the bottom of each page of this website. Dr. Anderson's opinions are not necessarily the opinions of Lorry Patton or Travel Tips 'n' Tales.