General Food and Water Related
The food in Thailand is wonderful, and eating is a part of the travelling experience. If you read all of the following and take certain precautions (especially a hepatitus A vaccination), you will run little chance of any serious ailment, and it will be a relatively minor health risk compared to other things in your life. Nearly all ex-pats have gotten diarrhea here, some fairly frequently upon initial arrival until their bodies accomodate, but a very small percentage have gotten anything serious.
You are advised to not drink the tap water. Though it is said to exceed specifications of cleanliness in many places, and some people drink it, you could experience several problems. One is leaking pipes in transit to your tap. Another is that the harmless byproducts of dead bacteria and viruses can also trigger an immune response in your body causing diarrhea and/or nausea. Most people use the tap water for brushing their teeth. The ThailandGuru uses it for cooking, too.
People generally drink bottled water here. To arrange for large amounts of bottled water to be delivered to your home regularly, the ThailandGuru can help line up a water vendor and/or dispensing apparatus.
Ice is not sterilized by freezing.
In general, you can get by using common sense. Food in hotels and major restaurants is usually quite safe. On the street from sidewalk vendors, hot foods should be safe, as well as cooked foods which have been allowed to cool but haven't been sitting out all day and nite, and where there aren't flies. The main problems come from uncooked or poorly cooked foods, those which have sat out for a long time after cooking, and things handled by vendors who are not sanitary with their hands, such as fruits and vegetables.
Thai food is usually spicy. This is consistent with other tropical regions, and indeed started the spice trade centuries ago (before the technology of refrigeration), as some spices help to preserve food from rapid onset of bacteria. However, spices can also cause stomach upsets among the unaccustomed.
DO NOT EAT SHELLFISH! Repeat: Do not eat shellfish! Even if they're sold from your favorite grocery store or a nice restaurant, and all the Thais eat them in abundance and don't get sick at all, you should resist as an expat. Countless times, expats have gotten very sick, occasionally necessitating even ambulance and hospital treatment, while all their Thai dining companions were unaffected at all. Several expats have also gotten sick after Pizza Hut seafood pizzas, but none have when the mussels were removed. "Mai ow hoy." (Don't want mussels/oysters.)
Diseases and Precautions
There are many intestinal parasites, bacteria and viruses which can be transmitted via food, water and eating utensils. Usually, the most serious one is hepatitus A.
Hygiene is often not good in Thailand. The ThailandGuru has gone to the toilets of respectable restaurants in foreigner areas and shopping malls and seen the kitchen staff leave the toilet cubicle without washing his hands, and looking inside didn't see any toilet paper or even soap. (Thais often use only water and soap, not toilet paper, to clean themselves.) Vendors of sliced up fruits on the streets often come from slums in Bangkok.
Dirty glasses and eating utensils are something you should check for every time, as well as debris in water and ice.
Shellfish such as mussels, oysters and clams should be avoided. Steaming them is often ineffective in making them safe to eat.
Make sure meat is cooked well, especially pork.
When you get diarrhea and/or vomiting, the most important thing is to avoid dehydration.
The usual doctor's prescription is a drug to stop the symptoms (diarrhea and/or vomiting), an antibiotic to help your body deal with bacteria, and electrolyte beverages to rehydrate. In more severe cases, you will feel better after an intravenous infusion of fluid.
When given an antibiotic, it is important to finish the treatment, not stop when the symptoms go away. This is because you will usually feel better before all the bacteria are fought off. The small amount of surviving bacteria will be the toughest strain. If you don't fight it off, then you will get a relapse of tougher bacteria. It's simple natural selection. This is called drug resistance.
When you start eating again, you usually start with bland foods such as dry toast or crackers. Carbohydrates are the easiest thing for a squeamish stomach to deal with, from simple carbohydrates (sugars) to complex ones (starches). Fat and protein are not as easy.
You are strongly advised to learn about hepatitus A and get a vaccination.
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