Eating in India

Aug 30th, 2015, 06:25 PM
  #1  
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Eating in India

Hi: we are traveling to southern India in late December, early January and are worried about getting food-borne illness. Would love any tips that healthy India travelers have followed, including restaurants in major southern Indian town, if you have any. Thank you!
GEssa
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Aug 30th, 2015, 06:32 PM
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So glad you asked this question. I have been wondering about the food in southern India after having gotten sick on my last day in northern India. Wondering if I should restrict foods to primarily vegetarian and fish maybe.
dgunbug is offline  
Aug 30th, 2015, 07:25 PM
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Follow food and water precautions. Take a look at www.cdc.gov/travel

In addition, do wash your hands before eating or touching your mouth. Use a hand cleaner if you don't have access to soap and water or if the water is suspect.

Talk with your doctor about what you can take along with you to use should you get ill.
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Aug 30th, 2015, 08:18 PM
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Trying to avoid getting sick in India from food is, in my experience, a futile exercise. You might get sick and you might not and no avoiding one sort of place or eating in upscale restaurants is any help at all. I've traveled for months in India and sometimes I get sick and sometimes I don't. I'm careful but you just can't tell when or from where it will strike.

My last trip, all in the south, both sides, I was quite sick for some time. I finally called a doctor whose advice was "don't eat dairy in the tropics". As I was quite sure one bout was caused by a bad lassi in quite a nice restaurant, I believe him. Another time, in the north, it was I believe a tuna sandwich in a coffee shop in Shimla.

I'm sorry to give you the news, but my feeling is that it's too often part of the India experience. If it's a short trip you may very well be lucky. I tend to be there for a couple of months so the odds against me seem to go up.
MmePerdu is online now  
Aug 30th, 2015, 09:06 PM
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We only went to the north of India, but were concerned because many of our friends had become ill for weeks when shooting a film in the south. We were advised by our travel doctor to take the mild antibiotic Rifaximin as a preventative. (She had also gotten very sick in southern India.)

Rifaximin stays in the intestines and does not get absorbed in the bloodstream, so it is very safe and has virtually no side effects. We weren't sure if we needed it because we spend a lot of time in Latin America (I have lived there) and rarely have gastro issues, but our primary care doctor also said he was a big fan of Rifaximin for India. He said 50% of his patients who travel to India normally get food poisoning or traveler's diarrhea, but 0% who take Rifaximin have become ill.

So we chose to take the Rifaximin. It was very expensive two years ago, but now there is an affordable generic on the market. We were still careful - stayed on a vegetarian diet, avoiding meat, poultry, fish and salads, but we did occasionally have street food approved by our guide. Neither of us got sick and we have been recommending Rifaximin to friends ever since. It is also used to treat gastro issues, but we felt there was very little downside and we would definitely take it again.
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Aug 30th, 2015, 09:21 PM
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Oops - meant to say "...take it again as a preventative."
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Aug 31st, 2015, 06:55 AM
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crosscheck - we have heard about Rifaximin, and are considering it for our upcoming three-week trip to India.

I'm wondering exactly how you took it? Did you begin and stay on it even before you were sick? Take it at the first sign of gastro distress? How long? Dosage?

I, like you, have spent a lot of time in Latin America with little illness - although there have been a couple times I know I had food poisoning and was able to pinpoint the source - however, I am somewhat concerned about staying healthy in India. I plan on sticking to a vegetarian diet, and exercising caution about where I eat.

Thanks in advance for any info.
scdreamer is online now  
Aug 31st, 2015, 08:40 AM
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We did not get sick - sorry if I wasn't clear. We took the Rifaximin solely as a preventative - I think 2 X 200mg tablets a day. Took with food. I guess if you do become ill you can up your dosage - discuss that with your travel doc. But our docs reported that 0% of their patients who took it prophylactically became ill.

I never thought I'd be on Fodors pushing an antibiotic, but I know so many people (including docs who like to travel) who are fans, that it's no-brainer to recommend. It has been prescribed by European doctors for years as a preventative and in the US since 2007. Because of the expense, it had been used mostly by high profile travelers who couldn't risk getting ill (politicians, entertainers, finance people -- see my trip report)...but now it's available as a generic and quite reasonable.

If you're on the fence you could take it for the first week and see how you like it. That's what we did and we ended up staying on it for our two full weeks.
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Aug 31st, 2015, 09:02 AM
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I took a probiotic (I like the one from Trader Joe's) starting a few weeks before my trip and I believe it worked quite well. I did have an upset stomach my final morning in Delhi, but two pepto chews and an hour in bed and I was good to go- and on a food tour no less! I believe this happened as I got lazy/cocky regarding my stomach and two days of forgetting the probiotics and poof!

I ate meat every day, and was sure to use handsanitizer religiously. I did have cipro with me in case something happened but I was good to go. I ate in the same restuarants as a couple I was travelling with and they both got very sick, twice. They however, ordered milkshakes at almost every meal, even against the advice of our (multiple) guides!
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Aug 31st, 2015, 09:30 AM
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I'm someone who regularly gets an attack of GI when I'm away, including in France, the Netherlands, The Gambia, Australia, and even at home in the UK.

No problems at all in Sri Lanka - and I ate everything going - milk in tea, salads, seafood, fruit bought from road-side stalls - everything you are warned against. We did take hand sanitiser, but took no antibiotics etc.

No, I don't understand it either.
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Aug 31st, 2015, 11:27 AM
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Sri Lanka, for a number of reasons I suspect, is known as "India Lite". That may explain a great deal, also if you haven't traveled in India.
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Aug 31st, 2015, 03:21 PM
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Crosscheck, do you live in the U.S.? I don't think the generic version of rifaximin is on the market yet. I believe it exists only as the brand product Xifaxan. The manufacturer still holds the patent.

The generic is available in other countries, but there's some question about erratic differences from batch to batch with the generics.

Unless the FDA has recently approved the generic version and I didn't hear about it ...
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Aug 31st, 2015, 03:53 PM
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It appears Jeff is correct about no generic in the US and this puts it out of my range: "Price quotes received on February 21, 2013 for Xifaxan 550 mg in the Denver Metro area were between $23.57 and $26.72 per tablet."

However this may be helpful: "In India it is available under the brand names Ciboz and Xifapill."

Both above from https://en.wikipedia.org/wiki/Rifaximin
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Aug 31st, 2015, 05:42 PM
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I've read that the soonest the U.S. patent would expire would be 2017, but more likely later. Canada has not approved the generic either, even though a few Canadian companies are selling it mail order to U.S. customers. Health Canada, their FDA counterpart, recommends not buying Canadian generic rifaximin.

Because of the expense, would prescription insurance even pay for the brand Xifaxan? It is approved for certain liver and GI medical conditions, and it would probably be covered in those cases. For traveler's diarrhea? I can see an insurance company saying, no, we'll pay for Cipro instead. It's a lot less expensive.
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Sep 1st, 2015, 12:01 AM
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Hi,

As long as you stick to the high-class restaurants located either in hotels or in tourist areas you should be fine. Ask for non-spicy dishes if you're not used to Indian spices.

I'm not sure where in South India you're planning to go. Below are some articles on good restaurants in Kochi, Hyderabad and Chennai.

www.remotetraveler.com/kochi/restaurants/

www.remotetraveler.com/hyderabad/restaurants/

www.remotetraveler.com/chennai/restaurants/


Happy and safe travels!!
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Sep 1st, 2015, 12:49 AM
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Jeff - We do live in the U.S. When we took the Rifaximin (brand name Xifaxan) in 2012, it was indeed about $25 a pill, but our insurance covered 50%. I was wrong about the two pills a day -- we each took one, not sure of the dose. Still not cheap, but as I said, our travel doctor talked us into it.

Then, in 2013 we were going to Peru and the same doc suggested Rifaximin again. This time we scored: She gave us four discount rebate coupons (something like these: http://www.rxpharmacycoupons.com/xif...oupon.html)and the pills were only $1.50 each. Sadly, we had to cancel that trip because our son broke his thumb the day before we were leaving and we thought he needed surgery.

We ended up giving the pills back to our doctor before they expired. She then told us that Rifaximin was becoming generic in Canada and the U.K. version (Xifaxanta) was also available online (I guess that was before the Health Canada warning). http://www.canadianpharmacyking.com/...old+in+the+USA

So, you're right - not generic yet in the U.S., but in my opinion worth getting in India, when changing planes at Heathrow, or with a coupon here in the U.S.
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Sep 1st, 2015, 04:49 AM
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Sharpen - I'm afraid you can get sick anywhere...even in highly acclaimed restaurants and hotels. We ate something bad at our last meal in karims in Delhi and I later saw an article in the New York Times listing it as one of the top restaurants. Fortunately my trip was not ruined - only my journey back home where I suffered miserably on the airplane and for a full week afterward. Still, I plan to return in February and will consider sticking mainly to vegetarian meals.
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Sep 1st, 2015, 05:10 AM
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As you stated, rifaximin works by staying in the GI tract and not being absorbed. From what I read, the problem with the generic product is that some are absorbed into the body in significant amounts. The quality control is lacking in some of them.
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Sep 2nd, 2015, 11:43 AM
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A couple of people here seem to saying the south is more of a problem than the north? Is that a good rule of thumb?
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Sep 2nd, 2015, 11:55 AM
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Regarding north vs south, I've spent 2 months in India 3 times. Twice in the north, once in the south. One of the 2 times I was in the north I was sick, and 1 of the 1 times in the south I was sick. That could mean 50% in the north and 100% in the south. Unless I go to the south again and don't get sick, then the odds would be the same. My long-winded way of saying, I don't think there's really any way to know.

I will say, however, that at no time was I ever afflicted only south of the waistline. All 3 times I was as sick as I think it's possible to be from food, short of dying, or so it seemed. A British doctor who I'd had dinner with on one of the occasions was concerned it was worse than just food poisoning. Maybe cholera, if I recall. It turned out not to be, fortunately, but I am saying don't underestimate the power of eating something bad in India. You might very well wish you were dead.
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