I don’t want to jinx myself, but my stomach has done pretty well so far on this trip to India and I thought I’d write a bit about why. Travel in India can be a real treat, and it is a shame if it is ruined by an upset stomach. Unfortunately, my record isn’t very good. 2008 was the first time I made it through an entire trip to India without a major incident knocking me out for a few days — and I’ve been coming here fairly regularly for the past decade. I have some friends who are planning on traveling to India for the first time, and so I thought I’d distill some of my survival tips for travelers with weak stomachs.
Some people seem impervious to stomach problems. But even if you are one of them, you should be careful. Parasites can live in your body for decades, and sooner or later you will pay the price… Most travelers know the simple rules for avoiding unsafe food: don’t eat any fruit you can’t peel yourself, don’t eat salad, don’t drink unfiltered or bottled water, don’t have drinks with ice, etc. but there are some tips which are a little less obvious. For instance, try to eat food which is cooked fresh, and which hasn’t been sitting around. This means that street-side food or popular local eateries might actually be safer than fancy, gleaming, restaurants catering to the middle class. Even though these places look more “modern” and Westernized, they often suffer from low traffic, and the prepared food sits around for a long time. Also look for subtle queues about cleanliness. A place might be old and dingy looking, but if the waiters dress well and the tables are cleared up immediately after customers depart that’s a good sign that they take cleanliness seriously. I don’t eat meat, but if you do, make sure it is cooked all the way through. A street-side barbecue, cooked for a long time over the coals, is probably safer than a delicately prepared restaurant stake. I do eat seafood (the fish in Kerala is divine) — but I avoid eating it if I’m out of eyesight of the ocean.
Unfortunately, no matter how careful you are, eating out in India is fraught with danger. If you do it often enough you will likely get an infection of some kind. Some people claim to develop immunity, but one doctor I’ve spoke to suggest an alternative explanation: people just get used to living with infection. Of course, a certain level of infection might not be bad for you, but still, it is something of a misnomer to think of it as “resistance.” An infection which festers long enough, even if it doesn’t cause discomfort, might cause long term damage to your digestive system. The best way to stay safe is to have home cooked food. If you are staying somewhere long enough you might consider hiring someone to cook for you. That’s what we did while working on our film. If you are traveling to remote places, you might even consider bringing some rice and lentils in your bag.
If you do get sick, you should be prepared. Imodium is your friend. You should also have some handy Oral Rehydration Salts to help you recover from a severe case of diarrhea. If it is just a very mild stomach upset, a friend suggested drinking fresh coconut water, which you can easily get on the street in India. We’ve found that this works very well, and can also function as a kind of rehydration/Gatorade type drink in hot weather. If it is something really serious you will need antibiotics. I hate taking antibiotics because they also kill the good bacteria, and if taken incorrectly can actually strengthen the bacteria. However, it is good to have some just in case. More than once I’ve had infections in India which were so long lasting and debilitating that there was really no other choice. Especially if you want to continue enjoying your trip. Here is a good page with info on antibiotics for travelers:
Now that I’m done scaring you, let me say this: most of the time your stomach will be upset because you aren’t used to the cooking, not because it is unclean or unsafe. It isn’t the spices. It’s the oil. Indians cook with much, much, more oil than I think most people reading this are used to. It varies a lot depending on which region of India you are in, but in Gujarat they put gobs of oil (or ghee) in or on just about everything you eat. Once we were at a hotel restaurant and Shashwati asked the waiter if they could cook with less oil. The waiter replied: “Madam, we use the finest quality oil, only.” I’ve found that if we can control how much oil is used in the food we eat I feel much better the entire time. One of our favorite dishes is idli, a Southern Indian dish you can get throughout India. They are steamed, so there is no oil, and the accompanying coconut chutney and sambar are usually quite safe. Another good stand-by dish is Khichdi in which lentils are cooked in with the steamed rice. Whenever I’m sick this usually sets me straight. It also helps to eat lots and lots of yogurt, which is easy to come by in India. We love Amul brand probiotic yogurt
That’s it for my advice, but I wanted to add a little footnote about why food is so unsafe in India. A big problem is the lack of proper infrastructure for water and municipal waste. Another is historical. The Japanese colonial regime in Taiwan sought legitimacy through its development work, especially with regard to sanitation. There was even a phrase: “sanitary colonialism.” This could be a bit overboard at times, such as when, in an effort to eradicate the rodent population, they required every Taiwanese household to hand over a dead rat to the police inspector. Because some families didn’t have rats other families would sell them theirs. But the legacy of these policies is that food in Taiwan is safe and clean. I’d eat sushi from a stall in the night market without worrying (too much). I’ve gotten sick from restaurant food in NY more often than street food in Taiwan. The British, on the other hand, weren’t really concerned with issues of “development” until they were worried about the Japanese threat during the second World War.