In the 80s I got really sick, too, on a visit to Guatemala (I drank the milk - a bad idea, especially back then). Whatever it was lodged in my appendix which leaked off and on for a year before rupturing and becoming gangrenous - not a recommended weight loss plan.

The good news is I now travel to the area every year and rarely get sick; I've pasted below what I do from a previous thread. It sounds like a lot but it's actually pretty straight forward and keeps my family healthy. I'm splitting 6 weeks between Guatemala and Belize this summer - can't wait!! Happy trails!
_____________________________________

:: I tend to follow the adivce of the CDC for the country/ies I’m visiting:
http://wwwnc.cdc.gov/travel/destinations/list.htm

:: At least be sure you're up to date on routine vaccines like diphtheria/tetanus and measles/mumps/rubella; many adults in the US aren't and some of those illnesses are horrible and still prevalent in developing countries. In my opinion everyone should have Hep A, too.

:: Keep the bugs from biting by wearing long sleeves/pants during buggy times (usually dusk and dawn), using effective, safe repellent (I like Ultrathon and Sawyer's Controlled Release deet products). You can also buy clothes preloaded with permethrin or buy the sprays and do it yourself; even a bandana is handy this way. I've read that any sort of oil will keep sand flies at bay but we haven't had much problem with them in our travels (pray for a steady breeze!) so can't speak about that personally.

:: I only drink bottled water, never tap (unless I purify it or boil it), even on my toothbrush

:: I wash my hands every chance I get

:: I avoid fruit I haven't peeled myself unless I trust the preparer (no bags of yummy-looking cut up mangos from street vendors, but usually I've felt ok in homestays)

:: I avoid lettuce

:: I only eat street food if it's selling quickly and really hot; most careful folks would say avoid it

:: I take shelf stable probiotics on the road; the one I prefer is here:
http://www.iherb.com/Jarrow-Formulas-Jarrow-Dophilus-EPS-60-Veggie-Caps/124?at=0

:: I take a papain and bromelain digestive enzyme capsule just before or after high protein meals to speed digestion; I don't have a preferred brand but here's a link to some information:
http://www.associatedcontent.com/article/1738044/papain_and_bromelain_health_benefits.html?cat=5

:: When I have a touch of diarrhea, I take 2 or 3 cayenne capsules and repeat every few hours - usually kicks it

:: I carry immodium or the like but rarely need it; it shouldn't be used if you're REALLY sick as it keeps the bad bugs in your system longer (can be really dangerous)

:: I get a prescription filled for the antibiotic Ciproflaxin to carry along in case one of us gets REALLY sick (powerful stuff not to be taken lightly) ; it's usually available without a prescription in CA.

We've only been to Belize, but we felt very comfortable eating the food there. It was great, everything seemed very clean, and the food was a lot more sophisticated than we were expecting. We didn't eat any street food, just at restaurants and at our hotels. I've gotten sick every time I've gone to Mexico.

I've never been to Guatemala, can't help with that.

In Belize, I rarely hear of people becoming ill from food/water. On Ambergris, the city tap water is safe to drink, although we choose to mostly drink bottled water.

We eat lots of street food. As in at least once a week. In 25+ trips, never been sick.

I was just talking to my dr yesterday as I got a Hepatitis A shot and she said that even if you buy fruit that can be peeled you should be very careful to wash your hands after cutting and peeling.
It is frustrating to see so much street food that looks good and pass it up but I would say better safe than . We did eat cut up mangoes in Antigua last trip with no ill effects but I am not planning to do it again

It depends a little on where you will be in Guatemala? Antigua restaurant meals are one thing; roadside food in rural areas is another

You're right, vttraveler - if the peels aren't clean and you touch the edible bits with contaminated hands you're increasing your chances of getting sick. We shop in markets and cook for ourselves quite a lot as we travel (part of the fun for us) and disinfect everything before we prepare it.

The comments re: Belize are interesting to me. I visit Guatemala every summer now but have only visited Belize twice - 3rd visit this summer. I've just always used the same precautions there I use in Guatemala and Honduras and hadn't really thought about treating food differently in one CA country to another.

I know you are asking a slightly different question but I follow most of hopefulists suggestions when I travel outside the US. I have one more to add, and that is to try taking a few Pepto Bismol tablets per day as a preventative.

The only time I had more than minor issues I had run out of tabs. I can't really pin down the source, as in the 24 hrs prior I had eaten everything from high end restaurant food to fried fish from Lake Titicaca. Luckily my meds (or time) worked and I back to normal within 48 hrs.

I tried Pepto Bismol tablets years ago on a trip to Mexico. Nasty. I think I'd rather have diarrhea. Never again.

And, children should not take Pepto Bismol if they're ill with fever/nausea/vomiting. It contains Aspirin, which combined with certain viral illnesses can lead to Reyes Syndrome, which can be fatal.

hopefulist, thanks a lot for your tips. But "rarely get sick" sounds a bit scary to me I would never go to a place where there is even 5% chance of getting disenteria.

As far as peeling, then washing hands, etc - may be it is easier to carry a water container, and wash the fruits sold in the streets ? Also, if food is taken with some alcohol (like beer), does it become safer ? I was 1 day in Mexico (on a cruise), was drinking beer only, and was not eating anything out of fear of diarrhea

do you all suggest anit- malaria meds I will be in cayo ?

I, too, generally follow CDC recommendations for travel.

http://wwwnc.cdc.gov/travel/destinations/belize.htm

Speak with a physician who knows something about travel medicine, do some reading and make an informed decision.

plsflgd - Yeah, I see your point. My guess is I'm a different sort of traveler than you are, though, so given the way I travel getting a bit of diarrhea some trips isn't much or surprising. I'll be in Guatemala for 3 weeks this summer, for example, mostly living with a local family in pretty humble surroundings. In Belize half my time I'll be in very rustic surroundings including a Maya village stay way off the beaten track. I think, too, that sometimes diarrhea or wobbly stomach is simply from a change of food - we eat very little fat and make nearly everything from scratch including our own yogurt and whole grain bread and pastas at home so 'foreign' food is a change up.

cmazza - That's a personal choice based on your own level of risk tolerance, how long you'll be in a malarious area, and other things you'll do to keep the bugs away like wearing long sleeves, sleeping in a sealed room or under a mosquito net, etc.

Healthy travels, all!

I'd also suggest wearing mosquito repellent if you're comfortable doing that. When we were hiking in the Cayo area, the mosquitoes were fierce. We were there right after a rain.

Getting food poisoning has ruined a very expensive vacation for me (I can't even recall a few days, my fever was so high....) and I'm now pregnant so I'm trying to be particularly cautious about my trip to GUA this year. I'm a total believer in probiotics.... expensive but worth it.

I read there are traces of ecoli bacteria in the water so I disinfected my utensils, glasses, dishes in a big pot of boiling/steaming water for 10 min after washing them. For fruits and veggies, I was rinsing them with a vegetable disinfectant soap. I tried to wash my hands alot but hand sanitizer is what kills bacteria that might be on your hands after washing with clean water. I also tried to remind myself to not let water go into my mouth when showering.... (I know this all sounds like overkill....)

And while the Pepto tablets are a little gross (gives you dark stools) I read in a medical journal that it is one of the few things that really works if people take it consistently with every meal . The idea is that it coats your stomach making it very difficult for bad bacteria to attach to/colonize your intestines. That's like 6 Pepto tabs a day -- most people can't follow through with this, esp for a long, 4 wk trip. There's a site on-line that's for Dr's Without Borders (or similar) and it rec this method for physicians taking trips abroad.

I think it's impossible to *completely* avoid exposure to bacteria that our bodies are unfamiliar with, but preparing our gut so that it's less susceptible to illness once the bacteria is there is a good approach, IMO....

hopefulist, on a partially related topic: could you elaborate about staying with a local family in Belize ? I man, how did you get matched with them, and make sure it is safe ?

It's the 3 weeks in Guatemala when I'll mostly be living with a local family. I travel solo and lead groups to Spanish immersion programs in Guatemala or Honduras (and once to Mexico) in the summers and the schools have networks of local host families. It's an incredibly enriching and cheap way to travel and, for me, addictive.

In Belize the closest I'll come is a village visit in the Mopan Maya village of Santa Elena in Toledo District. You can read about 2 village programs in that part of Belize here:
http://www.southernbelize.com/mayanvillages.html

Here's a description of them by Joshua Berman,the author of Moon Belize:
http://www.moon.com/destinations/belize/punta-gorda-and-the-toledo-villages/vicinity-punta-gorda/village-guesthouses-and-homestays

I also have heard of this option but haven't looked into it:
http://www.monkeybaybelize.org/homestay.html

Hope that helps!

Re: safety, it's a bit of a leap of faith but if you choose a school or organization with a good reputation it's likely to be a good setup. We're staying at Hickatee Cottages in Punta Gorda for some of our southern Belize time and Kate was really helpful as I figured out my options for village stays and local transportation to get there and away.

fishee - I just reread your post and you should be really cautious considering Pepto when pregnant; I googled and came up with this site:
http://www.thelaboroflove.com/articles/is-pepto-bismol-safe-to-take-during-pregnancy

I love how thorough you are! Yes, I can't take the Pepto this time around since I can't take that much of any medication for 3 weeks. I'm a bit nervous about it and really hope the probiotics are sufficient (along with my hyper paranoid kitchen practices). I'm going to miss eating churrasco and liquados off the street this year....

Along these same lines - what about the cooking schools? I've seen many cooking schools mentioned in Antigua and elsewhere. How do you manage sanitation in those situations? Or are they generally considered to be safe?