You can't avoid eating out. But, what should you do to not suffer the effects of badly-prepared and served food?

Eating out is a temptation most of us succumb to once in a while. But, in case the restaurant in question is not up to the mark, it could turn out to be a painful, stomach-churning experience.

A stomach upset can occur due to one or more of the following factors — poor hygiene, spicy, oily food, food additives, poor storage facilities, bacterial infections such as e-coli and salmonella, parasitic infections such as amoebiosis and helminthiasis (worm infestation), faecal contamination and possible pesticide exposure.

Explaining what happens when outside food does not agree with us, Kannan, consultant surgical gastroenterologist and laparoscopic surgeon, Billroth Hospitals, says: “Stomach upsets due to food poisoning lead to gastroenteritis, which causes irritation and inflammation of the gastro-intestinal tract. About 50 per cent to 70 per cent of gastroenteritis is due to viral infection (noro virus in adults and rotavirus that commonly affects children and for which a vaccine is now available), bacterial infection, parasitic infections, and toxins.”

In its acute phase, gastroenteritis can leave you scurrying from the bed to the bathroom. The symptoms? Diarrhoea, nausea, cramping, abdominal pain and vomiting.

The causes for gastroenteritis are really not far to seek. According to Dr. Kannan: “Kitchen hygiene, cleanliness practices adopted by the cooks and food handlers, quality of the cooking ingredients… all have a bearing on gastroenteritis. Improperly-packaged food stored at the wrong temperature also promotes food poisoning. And, flies that hover around transmit bacteria, fungi and viruses from one place and person to another.”

Says B. Mahadevan, consultant gastroenterologist, Chettinad Hospital: “Any unwashed items are possible sources of infection. The possibility of microbial flora in raw vegetables is high.”

S. Krishnan, HoD Gastroenterology, Apollo Hospital, Chennai, observes that cleaning of utensils is merely cursory in some eateries. Cooking oil is re-used many times over. This could also be responsible for gastrointestinal issues.”

Is hot food better?

Are foods that are steaming hot safer to eat as some people tend to believe? “Not necessarily. Double-fried food may destroy bacteria, but also the nutrients,” says Dr. (Col) Krishnan. “And, hot food is injurious to the mucosa of the gastrointestinal tract, particularly the oesophageal mucosa. In rare cases, this can lead to cancer of the oesophagus,” cautions Dr. Kannan.

So, how is it that some people eat out all the time, and yet not fall sick? Is it just plain luck or are they naturally resistant to infections? Says Dr. Kannan: “The immune system, which varies from person to person, is responsible for a person catching a bug or not.”

Dr. B. Mahadevan elaborates: “Susceptibility is not only based on immunity, but also on various other factors such as gastric acidity. Most bacterial pathogens are highly susceptible to low pH levels, a measure of acidity. Thus, exposure to gastric acid significantly reduces the number of ingested viable bacteria. The virulence and number of organisms ingested also play a part.”

Thankfully, most of the time the condition is self-limiting. The main treatment for food poisoning is getting the fluids back into the body – orally and through IV. Anti-emetic (for vomiting) and anti-diarrhoeal medicines could also be prescribed. Antibiotics are rarely needed except in the case of bacterial infections.

In cases of mushroom poisoning or eating foods contaminated with pesticides, aggressive treatment such as a stomach wash and specific antidotes may be suggested, says Dr. Kannan.

And, what about those who don't have a choice and are forced to eat out on a daily basis? “If one has to survive every day by eating out, he/she should choose a place that is hygienic and stick to basic items with an eye on calorific and nutritive value” advises Dr. Krishnan.

Tips for recovery

Drink plenty of fluids and juices and ORS.

Avoid alcohol and caffeinated or sugary drinks.

Take rest.

After successfully tolerating fluids, add solids gradually, after nausea and vomiting have stopped. Opt for rice, wheat, bread, potatoes, cereals, lean meats and milk

Prevention is better than cure

Wash hands thoroughly before and after meals, after using the toilet and changing a diaper

Keep chopping boards, knives and counter tops clean

Plates should be washed with hot water and soap before food is served.

Do not eat or buy foods past their sell-by or expiry dates.

Never take food that comes in a torn or leaky package

Do not cross-contaminate. Keep raw meat and fish away from other food.

Never leave cooked food out for more than two hours. And, use cooked left -overs within four hours