Keep Food Safe Blog

Avoid Foodborne Illness when Traveling Abroad

by Robin Woo, FDA Center for Food Safety and Applied Nutrition

Traveling to other countries – and staying healthy – requires planning, preparation, self-discipline, and vigilance.

The Food and Drug Administration (FDA) inspects international facilities that make FDA-regulated products to ensure that those products are safe for consumers. So some FDA staffers travel a lot. Here are some precautions they take to keep from getting sick during a trip.

Before You Go

Research. Learn where to find reliable medical care at your destination. Good resources include:

• The Centers for Disease Control and Prevention (CDC) Travelers' Health¹
• The CIA World Fact Book^{2 3}
• U.S. Department of State Travel Information⁴

While in Developing Countries

Avoid tap water. This includes water from the tap and beverages with ice. Don’t drink when brushing your teeth or bathing. In developing countries, water may be contaminated by bacteria, parasites, and viruses that cause hepatitis, cholera, and typhoid fever. Even a small amount of contaminated water can make you ill.

Drink safe beverages.

• Boiled water – One minute of boiling should adequately disinfect most water, but boiling water for 3 minutes is recommended.
• Treated water – Commercial iodine or chlorine tablets provide substantial protection if used according to directions.
•  Beverages made with boiled water and served steaming hot (such as tea and coffee).
• Bottled water or canned beverages.  Because water on the outside of cans and bottles may be contaminated, they should be wiped clean and dried before being opened.

Water contaminated with fuel or toxic chemicals will not be made safe by boiling or disinfection; travelers should use a different source of water if they suspect this type of contamination.

Avoid raw fruits and vegetables. This includes salads and uncooked vegetables. These may be contaminated or may have been rinsed with unsafe water. Eat only food that has been cooked and is still hot, or fruit that you know has been washed in safe water and you have peeled yourself.  

Other foods to avoid include:

• Raw or undercooked meat, poultry, seafood, and eggs
• Unpasteurized milk and milk products, especially soft cheeses
• Prepared food that has been left unrefrigerated for several hours, especially food containing meat, poultry, eggs, and dairy products
• Food prepared by street vendors

Eat safe foods.

• Thoroughly cooked fruits and vegetables
• Fruits with a thick covering (citrus fruits, bananas, and melons) that have been washed in safe water and that you peel yourself
• Thoroughly cooked meat, poultry, eggs, and fish
• Dairy products from large commercial dairies, such as ultra-pasteurized (shelf-ready) milk or hard cheeses

If you get sick

Remember that adequate fluid intake is essential to preventing dehydration. So it’s important to keep drinking safe water even if you have diarrhea. The most common cause of “Travelers' Diarrhea” can be treated with over-the-counter products, used according to directions.  Effective drugs that control the frequency of diarrhea include Lomotil, lomodium, and Kaopectate. Find reliable medical help if you have severe abdominal cramps or pain, high fever, blood or mucus in your stool, and/or severe dehydration.

Don't use EnteroVioform. This drug, widely distributed abroad for treating diarrhea, has been linked to nervous system complications.

Getting to the Core of the Issue: Apple Juice and Arsenic

As a parent and grandparent myself, I understand the concern over recent reports that arsenic has been found in apple juice, especially since it is a staple in many children’s daily diets.

We here at the U.S. Food and Drug Administration (FDA) are familiar with the issue of arsenic being found in certain food and beverage products, but I realize that hearing this may be new to you. I would like to take the time to make sure you understand why it is there, how it got there and if you should be concerned. 

Why is there arsenic in fruit juice products?

Arsenic is present in the environment as a naturally occurring substance and as a result of contamination from human activity, such as from the use of certain pesticides and fertilizers. It is found in water, air, food and soil.

There are two types of arsenic: organic and inorganic. The inorganic forms of arsenic are the harmful forms, while the organic forms of arsenic are essentially harmless. Because both forms of arsenic have been found in soil and ground water, small amounts may be found in certain food and beverage products, including fruit juices and juice concentrates.

What is the FDA doing to protect the public against arsenic in fruit juice products?

The FDA has been testing for arsenic contamination in juice products for several years as part of FDA programs that look for harmful substances in food. We have been aggressively testing samples of both domestic and imported fruit juices and juice concentrates, and have not found evidence that juice is unsafe for consumers young or old. 

I have heard reports of test results showing high levels of arsenic in apple juice products. Are they true?

Unless we can determine that the test methods used were for inorganic arsenic and that the method was accurate and properly performed, we are not able to specifically address the test results. It is important to remember that test results for total arsenic do not distinguish between the essentially harmless organic forms of arsenic and the harmful inorganic forms of arsenic. It would be inappropriate to draw conclusions about the safety of a product based on the total arsenic level. 

When the FDA wants to determine if a food has unsafe levels of arsenic, we test the food specifically for the harmful, inorganic forms of arsenic. It is common to test for total arsenic as a quick and easy way of seeing how much arsenic is in the sample. However, a total arsenic test does not tell us how much inorganic arsenic is in the sample. In fact, organic arsenic can make up the bulk of total arsenic in some foods. If you want to know if there are harmful amounts of arsenic in the sample, you must test specifically for inorganic arsenic.

Does the FDA have a response to the information recently reported on the Dr. Oz Show?

The FDA is aware of the episode of the Dr. Oz Show that aired on Sept. 12, 2011, where test results for arsenic in apple juice were discussed. The FDA has reviewed the test results performed by EMSL Analytical, Inc., on behalf of the Dr. Oz Show, and we can confirm that the results that were revealed are for total arsenic. The results do not distinguish between the essentially harmless organic forms of arsenic and the harmful inorganic forms of arsenic. Therefore, these results cannot be used to determine whether there is an unsafe amount of arsenic in the juice tested by the Dr. Oz Show.

Did the FDA test any of the samples tested by the Dr. Oz Show?

On Sept. 10-11, 2011, the FDA completed laboratory analysis of the same lot of Gerber apple juice that was tested by the Dr. Oz. Show, as well as several other lots produced in the same facility. The FDA’s testing detected very low levels of total arsenic in all samples tested. These new results were consistent with the FDA’s results obtained in the FDA's routine monitoring program and are well below the results reported by the Dr. Oz Show. The FDA has concluded that the very low levels detected during our analysis are not a public health risk and the juice products are safe for consumption.

Are apple and other fruit juices safe to drink?

Yes. There is currently no evidence to suggest a public health risk from fruit juices, including apple juice. 

Where can I get more information?

• FDA: Apple Juice is Safe To Drink http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm271394.htm
• Arsenic and Apple Juice: Questions and Answers http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm271595.htm
• Letters from FDA to The Dr. Oz Show Regarding Apple Juice and Arsenic http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm271746.htm