Staying Alive is a new SmartShanghai column where we talk to doctors about common health problems in China. This is not a substitute for medical care – if you’re really ill, go see the doctor.
For this first round of Stayin' Alive, we talked food poisoning with Dr. Jorge Chedrauy, the Director of Family Medicine at the American Medical Center.
SmSh: How common is food poisoning in Shanghai? Do you see it often in your clinic?
Dr. Chedrauy: I don’t see it on a daily basis but at least on a weekly basis I get a couple of patients that have experienced some type of food poisoning, especially when they go out to eat where they sell the fried rice and the local local eateries. And more so with newcomers. People that are just fresh off the boat, their bodies and their stomachs are not used to the food here. It resolves on its own mostly. It is very common.
SmSh: What are the medical names for the most common bugs that you see here?
Dr. Chedrauy: So the biggest one is always viruses. So the Norovirus is the big one. And then when it comes to bacteria it’s probably Salmonella and E.Coli. Those are the three big ones.
SmSh: Will people build up resistance/immunity to those over time?
Dr. Chedrauy: Not really. It’s like the common cold. You don’t build an immunity against it.
SmSh: Is all street food unsafe?
Dr. Chedrauy: No, I wouldn’t go and generalize like that -- it’s not fair to generalize like that, but you have to be careful. If you have a person that you go to on a regular basis and you trust that person, fine. It’s not that they’re trying to do something bad, it’s just the water that they use to clean the vegetables, the utensils that are used to cut the meat... It is not the safest thing ever. You have to know where you eat.
SmSh: Do you eat street food?
Dr. Chedrauy: All the time. I love my 6rmb fried rice rice. I have one here on the corner [Dagu Lu]. I got hit by food poisoning in the beginning and then never again.
SmSh: So how can you tell if a street food place is safe?
Dr. Chedrauy: You can’t. The short answer to the question is you can’t. Once again, they’re not trying to hurt you or anything like that, it’s just that they don’t know any better, and they’re not going to buy filtered water to clean their vegetables. They’re just going to take it out of the faucet. There’s no way to know. Maybe the next day in the toilet.
SmSh: What do you think about those food quality stickers that you see in restaurants with the frowny and happy faces?
Dr. Chedrauy: That’s a tricky question, I really don’t know what to say regarding that. I mean I know where we come from in the States I can trust them cause they’ve been very well regulated by the FDA. Here in China I would take it with a grain of salt. But once again I’ve only been sick here once and I guess it’s like that app that measures the air quality. You can’t be a slave to it.
SmSh: There are times when I’ve gotten food poisoning where everything I’d eaten seemed really healthy and then I thought "Well, maybe it could have just been a little bit of water when I was brushing my teeth or something." How common is getting sick from a little water?
Dr. Chedrauy: Well a little water is gonna have millions of viruses. So for example yesterday, I didn’t shave because I opened the faucet and the water was coming out yellow. So you know, you never know. A little water can do it. Maybe one of the vegetables in the bunch did not get properly washed and that’s the one that you got. You never know.
Bacteria also comes from meats that are undercooked – salmonella’s a huge one. Chicken’s that’s undercooked, hopefully it won’t have salmonella, but most of the times that’s the case.
Or fish. Food here is very fish-based, and there are two types of fish poisoning that you can get. One is called ciguatera, which is from fish that feed off reefs. Warm water fish, tropical water fish, they eat stuff in the reefs that is poisonous. That poison doesn’t go away with cooking. So you eat that poison, even though you cooked the fish, and you’re going to get sick. Then there’s the other one that comes from leaving the fish outside without refrigeration for a long time and I’m sure that’s very common here.
SmSh: Even if you cook it it’s not going to kill it?
Dr. Chedrauy: Even if you cook it. So, there’s a substance called histamine that’s released by fish that’s left out without proper refrigeration. We release that substance as well when we get an allergic reaction. So the same exact symptoms that we get with an allergic reaction we’d get with that type of fish poisoning. By the way it’s called scrombroid, the one with the histamine. So ciguatera and scrombroid, those are the two fish ones.
SmSh: Have you ever had Hainan chicken rice, that kind of chicken where close to the bone it looks like blood? What’s the deal with that? Is that safe?
Dr. Chedrauy: That’s undercooked. If you see blood it’s undercooked and you could be exposed to salmonella like that. You’ve got to be careful. You kill salmonella with heat so if it’s well-cooked you won’t get it.
SmSh: For someone who maybe doesn’t have a lot of money and wants to avoid having to pay hospital bills, what are the signs that maybe they really should go to the hospital?
Dr. Chedrauy: Well there’s a few. The big thing we have to be careful of when it comes to food poisoning is dehydration. Especially in kids. So dehydration is when, for example in a kid, if the kid doesn’t cry, no tears come out, if the skin is kind of doughy, if he doesn’t go to a bathroom, if he doesn’t pee.
In adults it’s more being very sleepy, not wanting to do anything, those are all signs of dehydration. It’s a huge red flag so that’s when you have to call a doctor. Also, if more than four days go by and you still have diarrhea, call the doctor. If you see blood in your diarrhea, call a doctor.
SmSh: No matter if it’s bright or if it’s dark?
Dr. Chedrauy: Doesn’t matter. It’s blood. Call the doctor. Normally those types of diarrhea require antibiotic treatment. Fevers of more than 101 Fahrenheit, call the doctor. Normally, this also requires antibiotic treatment. So those are the big ones. It’s good to save money but not at the expense of your health.
SmSh: A few times I’ve gone to a local hospital and they’ve given me antibiotics and I didn’t know the name, so I went home, looked it up and I saw that actually, maybe this antibiotics been banned in the US for something like tendon damage...
Dr. Chedrauy: Right, so you’re gonna get this all the time and the fact of the matter is that no medication is totally benign. There are some medications that are banned in the States that are not banned in Europe, and vice versa. It’s not that China’s the only place that they use the medication.
A lot of the times, and I’ve seen this on a very regular basis, patients go to a Chinese hospital or a Chinese clinic and then they come back with a box full of medications and they’re not good for that specific [ailment]. So it’s better to spend a little extra money to go to an international clinic or an expat clinic and make sure that you get the right treatment.
A lot of times these medications that they give you at Chinese hospitals, they’re just about to expire and they need to get rid of them. Or maybe the doctor doesn’t know any better. I don’t want to talk bad about the Chinese doctors, I’m sure many are good, but I’ve had bad experiences. If there’s antibiotics to be given, make sure that it’s at least the right antibiotic.
SmSh: What’s the first thing I should do when I can feel food poisoning coming on? Like when you get that bloated stomach…
Dr. Chedrauy: So unless any of the red flags that I mentioned are prevalent we treat food poisoning symptomatically, because, once again, it resolves on its own. So for diarrhea: anti-diarrheals. If it’s nausea: any anti-nausea medication.
SmSh: Are there any over the counter medicines you’d recommend for this?
Dr. Chedrauy: Yeah! For diarrhea for example, Imodium (易蒙停) is a big one. Normally Imodium you’d take two pills initially and then one pill for every time you go to the bathroom. If it’s nausea you can get over the counter Zofran (枢复宁) and take it every eight hours as needed. It helps with the nausea and vomiting.
And very importantly, when you have food poisoning you shouldn’t just stop eating altogether. You should eat, but you should eat stuff that helps with forming your stool again and trying to renew all the bacteria that you’ve lost from your gut.
We recommend eating things like bread, rice, applesauce — all the things that help you get your digestion back on track. Avoid dark colas, sodas, like Coca-Cola, Pepsi — stuff like that. Gatorade normally does not help you with rehydration. It’s an urban myth I think.
SmSh: Really? I always drink Gatorade when I’m sick, because of the electrolytes.
Dr. Chedrauy: Well it’s electrolytes but they’re not in the same proportion that you need. There are oral rehydration solutions like Pedialyte that have proper electrolytes.
Those are the ones that I normally recommend before anything else. If it’s a little kid, we start with Pedialyte or water, giving them very small sips, trying to avoid vomiting and then once the stomach is settled we can give them more but always try to keep kids very, very well hydrated.
SmSh: What about those little packets of oral hydration salts you can buy from the Chinese pharmacy for like two kuai?
Dr. Chedrauy: That’s very common in developing countries because it’s so much cheaper than buying a bottle of Pedialyte. It’s the same thing, so as long as you do it in the proper volume you should be good.
SmSh: Last question: What’s the worst case of food poisoning you’ve ever seen?
Dr. Chedrauy: Back when I was working in Chicago we had a case of cholera, which is not a disease that you see in the States. Seeing a disease that you don’t usually see in a country walk in through your hospital door, it’s cause for concern. So I think that was like, the big one.
SmSh: One of my friends moved to Shanghai and nobody told him not to drink tap water, so he just drank tap water straight for about a year. One day he had to go to the bathroom and it was super painful and he ended up shitting out a foot-long tapeworm.
Dr. Chedrauy: I guess that’s common but damn, a foot-long tapeworm…He was probably skinny after that. Well the moral of the story is don’t drink tap water.
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Dr. Jorge Chedrauy is the Director of Family Medicine at the American Medical Center and is also part of the American Board of Family Physicians.
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