How to eat safely in China?

[newforeigner]

I moved to China a month ago. For the past few days, I have severe foul-smelling diaherra. About 10 times/day. I have to pray when I ride the bus. I will need to go to a clinic on tomorrow.

I was told not to drink the tap water. In McDonald's, pizza hut and other restaurants, they serve cold drinks and free water. How can I tell if they made the ice cubes out of tap water, distilled water or boiled water?

The waitress of a fairly expensive restaurant in a shopping mall told me that even Fruit Juice is written on the menu. It is actually a mixture of juice and water. For pure juice, the price goes up from RMB16 to 24. How can we tell if the water if from the tap or boiled one?

Is it a good idea to eat salad? There is no way of telling if they wash the vegetables or not. Even they do, we don't know if they use tap water.

On Monday, I went to a small restaurant near the university for lunch. At night, I had orange juice at Pizza Hut. There were ice cubes even if I asked them not to put anything in. On Wednesday, I ate at the university cafe for lunch. I saw the guy making sandwiches without washing his hands. Last week, the staff at that cafe even served me tap water. I did not know but I suspected she did. She did not get the water from the jar. I heard water hitting the kitchen sink. I checked and found that the location where the lady got the water is where the tap is located. I only ordered the sandwich without any drink. She came and asked me if I need water. How insensitive she was to serve the customer tap water? A punishment for not ordering the drink? In the evening, I went to an upper class restaurant where I have eaten many times before. I had a large dish of cooked vegetables. I started feeling uncomfortable from Monday. However, the diaherra became severe starting Wednesday evening. I even felt pain in my stomach. Sometimes I have to go to the washroom in few minutes intervals.

There are a lot of small restaurants near my university. Most people don't worry about hygiene. They just eat there out of convenience and due to the low cost. They do not know that the medical cost will be much higher if something goes wrong. Some people told me that they found insects eating in several restaurants. In general, are the restaurants in large shopping malls more reliable than the smaller restaurants near any university?

[yonglin]

In my opinion, eating food that you don't prepare yourself always carries a certain risk. In China, eating/drinking some particular things (e.g., raw lettuce, fruit cut by others, cold beverages that are not bottled) typically involves a higher-than-average risk. One way of reducing this risk could be by being more vigilant and using common sense, e.g., sticking to hot food (cooked right before you eat it), hot tea or bottled beverages, and fruit that you wash/peel yourself.

If I were staying in China for the long term, I'd be more worried about toxic chemicals making their way into the food chain in ways that you cannot really notice for a long time.

Anyway, I really hope you feel better soon!

[roddy]

I'm halfway inclined to put severe stomach issues in new arrivals down to stress and culture shock as much as the food. Cut your diet right back to biscuits, bread and drinks from sealed containers until things settle down, then start exploring your options.

[gato]

The onset of diarrhea is likely to be caused by what you ate hours before, not days before. So focus on Wednesday.

[大肚男]

As others have suggested, I would stay away from raw or undercooked food and stick to bottled beverages. I did this when I stayed in China, and I didn't get any problems.

However, keep in mind that sanitary conditions are much worse than the U.S., which will get some Time to get used to.

[外国赤佬]

This is somewhat common for foreigners. But eventually your stomach will adapt to the local bacteria, and you will be able to eat pretty much anything that the Chinese do.

[jkhsu]

Where exactly are you? From another post it seems like you are in Shanghai?

For salads and fresh juices, the only place I trust is Element Fresh. Other than that, reputable 5 star hotels like the Ritz Carlton, Shangri-La, Four Seasons, Grand/Park Hyatt, etc. should be ok. (Yes, I'm a bit conservative when it comes to eating raw vegetables / fruit juices in China)

I always bring my own bottled drinks that I buy from a store that I trust. BTW, you can not trust street vendors or hole in the wall shops that sell bottled water and drinks. Find a well known chain like Family Mart and get your bottled drinks there.

Also, if you're getting sick on cooked vegetables, it's most likely from the oil. Did you just eat the entire plate? Typically, the Chinese will eat like a few pieces of vegetables to go along with some rice. I learned a method to wash the oil off of cooked food from a native Chinese friend of mine. The next time you're at a restaurant, ask for an extra bowl and fill it with either hot (boiled) water or hot tea. Then, wash the vegetables or meat before eating it. When you look at the oil left in the bowl, you'll realize just how much they put in. It's really shocking.

At restaurants, I try to avoid cold dishes or pickled food. You have no idea how long the food has been sitting outside without refrigeration. I'm still appalled at how little the concept of refrigeration is understood in China. While US government standards are probably a bit stringent, many Chinese will leave food out on the table all day at room temperature during the summer with just a net food cover (to prevent bugs).

Finally, as others have said, start with food you trust and then work your way up.

[putonghua73]

Definitely go to the clinic because 10 times a day is debilitating and dehydrating.

I'm halfway inclined to put severe stomach issues in new arrivals down to stress and culture shock as much as the food. Cut your diet right back to biscuits, bread and drinks from sealed containers until things settle down, then start exploring your options.

2nd time I visited Asia - and first time in HK - I suffered the same stomach issues (although not quite 10 times a day, but enough to make the experience unplesant). It was my first time travelling by myself and I rocked up in Mong Kok without the faintest clue as to what I was doing or an itinerary (except I was due to go to Yangshuo a few days later, then to Taiwan to visit my then girlfriend) and hadn't booked accommodation. I finally found the Dragon Inn, and a mixture of stress, culture shock, extreme jet-lag, and getting used to the food meant for the whole time I was in HK (3/4 days) I could barely eat without severe stomach issues. I got to know where the toilets where at any given location!

In fact, I was in danger of dehydration at one point, and I had to force myself to get up and do things due to the extreme humidity and the fact that I felt like death warmed up.

By the time I arrived to Taiwan and met my girlfriend's family 1 1/2 weeks later, I spent the first night making a good impression (after a 14 hour trip from Yangshuo at 04:30 in the morning, to Shenzhen, to Hong Kong via overland, couple of hours spent at the airport, then to Taiwan) by projectile vomiting and suffering acute diaherra. So much so, that my girlfriend's mother took me to the doctor's the next day. After tablets, a couple of hours sleep, and drinking plenty of fluids, I felt well enough to spend 'time' with my girlfriend (*cough*).

I also weighed myself and I lost nearly approx 1 1/2 stone in 2 weeks (approx 21 lbs)! I have pictures of myself with my then girlfriend in Taiwan, and I look super-tanned and super slim.

As Roddy stated, until your body adjusts, stick to bottled water and really boring, basic food - no matter how much the temptation to eat something spicy, etc. I found that congee really helps.

Hope your stomach issues clear up soon. Definitely go to a clinic to see if they can prescribe medicine to at least take the misery of having to carefully time any trips. Last thing you want to happen is to be stuck on a bus in a traffic jam and be caught in a difficult situation. FWIW, I went 16 hours without eating and drinking from Shenzhen to Yangshuo (I had a long-ass wait for the bus due to arriving at lunch-time at the bus-station) because of stomach issues and the thought of having to use a squat toilet at the bus-station. Once I settled at Alf's place in Yangshuo and was able to relax, my stomach issues disappeared.

[newforeigner]

Somebody mentioned that on the newspaper a month ago, it was reported that a lot of distilled water made in China are actually not safe to drink. Anybody heard anything about that?

For bottled water, what do you think of the ones made by Watsons and Coca Cola? At Wal Mart, a bottle of large water from Watsons costs about 12RMB. At Watsons, the same bottle costs about 17RMB. Can I trust that the ones sold at Wal Mart are genuine?

Is it actually safe to eat even cooked seafoods in China? We know that it is not safe to drink tap water. Seafoods drink water. Eating seafoods means drinking the water from the sea indirectly...

My stomach was so so good on Monday and Tuesday. On Wednesday, I had sandwich at a cafe at school. The guy took my money and then went on to make the sandwich without washing his hand. He came out from the kitchen, played blackjacks with others, and then went back to the kitchen to cook for me. In the evening, I ordered fried rice and a dish of vegetable at a nice, seemingly clean and popular, Taiwanese restaurant called something like Bellagaio. I have eaten there for about 10 times without any problem. The dish of vegetable came first. It was a very large portion. It was like they double the amount for me that night. The rice came in half an hour later when I was almost done with the vegetable. About 10 minutes after eating at the restaurant, I started having severe foul-smelling diaherra.

[gato]

Hmm. That must have been the meal. But you didn't have any meat or fish that night?

I find it hard to believe that fried rice and vegetable would cause diarrhea unless the cook just took a dump and didn't wash his hands.

The two times I got it in China was through eating pork dumplings and fish. They were probably undercooked.

[abcdefg]

I moved to China a month ago. For the past few days, I have severe foul-smelling diaherra. About 10 times/day. I have to pray when I ride the bus. I will need to go to a clinic on tomorrow.

Go to a clinic or hospital ASAP (as soon as possible.) This is not "stress or culture shock" like post #3 implied. If it were, it would have started immediately after arrival, not after being here three weeks or a month.

Are you running a fever? (In other words, is your oral temperature over 38 degrees Celsius?) If so, that makes it even more urgent. If you don't have a thermometer, buy one at any pharmacy (even Watsons.) It's called a ti wen biao and is written 体温表。Copy these words out and show them to the staff.

Do you have vomiting as well as diarrhea? If so, that also makes the situation more urgent.

Don't just go to a pharmacy and buy "stomach medicine," even if you go with a Chinese friend. You don't really know what is wrong and neither do they. You need a diagnosis before you can get appropriate treatment. You can easily be given the wrong kind of medicine by pharmacy staff. What might have worked well for a friend several months ago may very well not be what is best for you now, at this point in time.

You need the services of a physician in a medical setting, clinic or hospital, as stated above. You might need some laboratory tests. Your university may have a medical facility on campus. If not, they will be able to make a recommendation. Take a Chinese friend to translate and help you navigate the system.

We can discuss future preventive measures after you get the current acute ailment under control.

[newforeigner]

Thanks for the concern. No fever, no vomiting, only diarrhea. I had tuna sandwich for lunch at the cafe at school. For dinner, I had fried rice and a large dish of vegetable. Yes, I ate the entire plate of vegetable.

I checked with several people about that cafe. They told me that they have not heard any bad thing about it. However, they served me tap water and touched the sandwich without washing the hands nor wearing a glove, I doubt their level of hygiene. That place is also expensive. They charge 29 RMB for the sandwich. They only put a few tuna in it.

[abcdefg]

Thanks for the concern.

You're welcome.

No fever, no vomiting, only diarrhea.

That's good. Now go get medical attention for the diarrhea as soon as it's convenient to do so.

[pancake]

abcdefg: If this is inappropriate, then I apologise, but perhaps you would be willing to offer me some advice since I just don't trust local doctors at all.

A few days ago I woke up around 3am feeling extremely cold. I was literally shivering. I tried to get back to sleep, without success. Around 4am or so, I suddenly had to go to the bathroom to vomit (mostly gastric acid). I immediately felt much better and was finally able to get some sleep.

The next day, I checked my body temperature. I had a fever of 38.7 degress (as measured from under the armpits). By this time I had developed a diarrhoea as well, though the nausea from last night was mostly fading away. Nevertheless, I found it difficult to eat much of anything, except some bananas and one 馒头, all washed down with a home-made rehydration cocktail of sugar and salt.

The third day, I am now able to eat pretty normally and the appetite is back to ~70% of what I would consider normal. The diarrhoea is gone. I haven't taken my temperature, but the fever seems like it's fading too. What's left is a persistent cough, it just seems like my mucus production has kicked into overdrive...

Given that my condition seems to be improving pretty quickly, would you agree with my own amateur assessment that there is no need for me to go to the hospital for their compulsory dose of IV-antibiotics?

I don't mean to impose so I totally understand if for whatever reason, you don't feel like responding. Nonetheless, any and all advise offered would be greatly appreciated.

[Scandinavian]

pancake, it is possible to find good doctors, maybe worth looking further into. generally the only problem I see with the doctors is that they always want to prescribe some Chinese Medicine even when they say "everything is fine"

note: I am not in anyway trained to give medical advice, but you should not need antibiotics if you fever is dropping. Antibiotics helps for infections, fever is the body's natural response to, among other things infections. Also, when you say "get a dose of IV-antibiotics" you have to remember that antibiotics always has to be taken as prescribed, always complete the entire prescription even when the symptoms are gone.

[langxia]

@pancake :　that sounds like you had food poisening. Had it again some months ago after eating something in a bakery where the mayonnaise probably turned bad. Or back in Europe when I cooked something with tofu and didn't put it into the fridge and still ate it the other day If you are puking, diarrhoea, and find it difficult to eat stuff it is most likely food poisening and if you feel allready better my guess (I'm not a doctor) is that you don't need to worry.

[CQVIP]

Many people have this same problem in a short period of time when the first come to China. In my opinion, your sitiation is not merely caused by the insanitary food (We admit that there are problems with the food and dirinks in China.) But there is another reason, the differences of dietary habit between China and other countries . I don't know which country are you come from where do you stay in China now. In south China, people usually eat rice and put pepper in dishes. In north China, the wheat food is the staple food. And the cooking stytle varies with different areas. Your stomach can not bear the the changing

dietary habits. So you may feel uncomfortable the first time you come to China. So I suggerst you take some light diet. You may eat bread or egg, and drink some fresh milk. For lunch and dinner, you may eat some wheaten food, beef and fish which contains enough protein. I think you will adatp to Chinese eating habit gradually.

As for the unhealthy drinks you mentioned, some restaurants did offer customer tap water or unboiled water. So you'd better buy pure water and store it in your fridge. If you are eating in a restaurant, you can also ask for pure water (in fact, many restaurants have bottled pure water, it's cheapter than other dirinks, so they usually don't ask you if you want some pure water.) don't drink COCA-COLA or juice (unless you can make sure it's fresh pure fruit juice). In this way, you can spend less but drink healthily. It's "Two birds, one stone" thing, right?

Hope you feel better soon and have a nice journey in China!

[abcdefg]

#14 @pancake -- Sounds like you did a good job with self treatment and are now on the mend. I wouldn't go to the doctor myself at this point if I were in your shoes.

Don't know what to say about the cough and cannot speculate on how it might be connected.

...I just don't trust local doctors at all.

A big problem with the Chinese medical system (one of several) is that the doctors often derive income from testing and treatment. Leads to abuse. But it's probably best not to rely on internet doctors too much either, since they never can know the whole picture.

[pancake]

Thanks for the advice (especially abcdefg's)!

pancake, it is possible to find good doctors, maybe worth looking further into. generally the only problem I see with the doctors is that they always want to prescribe some Chinese Medicine even when they say "everything is fine"

With all due respect, that is far from "the only problem" with Chinese doctors.

note: I am not in anyway trained to give medical advice, but you should not need antibiotics if you fever is dropping. Antibiotics helps for infections, fever is the body's natural response to, among other things infections. Also, when you say "get a dose of IV-antibiotics" you have to remember that antibiotics always has to be taken as prescribed, always complete the entire prescription even when the symptoms are gone.

Yes, I know. Now go tell that to the hospitals instead...

[liuzhou]

I'm finding it quite interesting that almost every example of the food you are blaming is western fast food.

McDonalds, Pizza Hut, sandwiches, salads etc.

Perhaps you should try eating the local food which the locals eat and don't get sick. They aren't very good at western food.

The only time I've had food poisoning in 15 years in China was from some Wall's Magnum ice cream.