Along with lingering smog and the threat of second-hand smoke, the omnipresent specter of food poisoning is something all Beijingers have to deal with. Even those who shun backstreet eateries in favor of upmarket restaurants and organic produce are never far from a bout of the dreaded Beijing belly.
The good news is, by virtue of living in the capital (even if just for a short while), your stomach should acclimatize to the local bacteria. Expat families are far less likely to fall afoul of questionable food than new arrivals. But by staying in the city long enough, even those with the sturdiest of constitutions are (almost) guaranteed a dodgy stomach at some point.
Despite the abundance of horror stories about poison-laced rat chuan’r and hole-in-the-wall restaurants siphoning gutter oil into the deep fryer, most cases of food poisoning result from ignorance rather than malicious corner-cutting, according to a Beijing-based chef who used to own a popular western restaurant. He spoke to beijingkids on condition of anonymity.
“I think a lot of it isn’t intentional – it’s just the way [kitchen staff]have been trained,” he says. “A lack of education [about]bacteria and food-handling practices is most likely. The temperatures at which bacteria grow are quite unknown in Chinese kitchens.”
Improper hygiene, poor ingredient storage, or insufficient cooking time can all foster the conditions favored by the bacteria responsible for most cases of food poisoning. Other factor is cross-contamination from knives and chopping boards used to handle raw meat.
Common culprits include salmonella and Escherichia coli (better known as E. coli). But many upset stomachs in Beijing are the result of some less familiar foes, according to Dr. Joseph Bush, director of family medicine at Beijing’s Bayley and Jackson Medical Center.
“A lot of the cases I see are [the result of]Bacillus cereus, which comes from rice that’s been standing around for too long, or Staphylococcus aureus from things like potato salad,” he explains. “These bacteria produce a toxin that causes the stomach to secrete extra fluid.”
The source of suffering may also be viral, especially if caused by raw shellfish. Dr. Bush says that there are 100 to 200 enteroviruses that can have a similarly devastating impact on your digestive system.
But while doctors and kitchen workers know the dangers of cheap eats, many take their own calculated risks and encourage sensible precautions rather than abstinence.
“I dine [at low-end restaurants]frequently but I know the possible repercussions each time I eat at a hole-in-the-wall establishment,” says our unnamed chef. “You get what you pay for.”
“Restaurants with too-big menus that aren’t busy may also be guilty of upsetting bowels. Lots of the products will not be rotated or fresh, [so you’re]playing Russian roulette.”
As well as looking for undercooked meat, diners should check for warning signs such as food that has taken on a fizzy, soda-like quality due to carbonation, or a sour or gamy smell.
Similar caution should be applied to food bought and prepared at home. Peeling fruit and vegetables, and avoiding cross-contamination are some of the best ways to protect your family, as is discussing hygiene and food safety with your ayi if she is responsible for making your meals.
When Disaster Strikes
Even the utmost caution is not always enough. So now that you find yourself with the classic symptoms of diarrhea, nausea, stomach cramps, and vomiting, what next?
In August 2012, the Beijing Health Inspection Institute published a set of guidelines for sick diners, which includes keeping the meal receipt for food safety authorities to investigate the offending restaurant. According to one of the city’s officials, we are also advised to “keep any leftovers, or vomit and feces as evidence.”
But while hanging on to your orificial emissions may be a priority for some, your main concern should be hydration, according to Dr. Bush.
“Staying hydrated with drinks like Gatorade or Pocari Sweat will replace the electrolytes, sodium and potassium that you lose,” he says. “But getting any type of fluid down is what’s most important, though milk is a bad idea because it’s hard to digest.”
Rehydration salts, available from most good pharmacies, can also be taken orally to replace glucose and minerals. Antibiotics may be useful after three or four days in some instances, but they are often needlessly over-prescribed with little discernible effect.
Instead, Dr. Bush recommends the BRAT diet, consisting of bananas, rice, apple sauce, and toast (which can extend to BRATTY with the inclusion of tea and yogurt). Although the regime does not necessarily have to be followed to the letter, the implication is that plain, low-fiber foods are the wisest choice. And for many, avoiding food altogether until the symptoms clear is a viable option given that “most of us a little overweight anyway,” he muses.
In many cases, the symptoms will clear within a day or two, but not all are so lucky. Although Italian Chiara Rossi* contracted food poisoning in China over seven years ago, she still lives with the consequences today.
The initial symptoms of fever, diarrhea, and a swollen belly eased after a few days, but persisted intermittently for a month before she saw a doctor and was diagnosed with chronic colitis, an inflammation of the large intestine.
“The problem with chronic colitis is that once you have it, you have to stick with it; there is no real cure,” she explains. “You know that there are certain things that you cannot (or should not) eat and if you do, that your belly will get swollen, that you’ll have a bit of pain, and that you’d better be close to a toilet.”
“The worst ones for me are coffee, milk, and dairy products (mainly soft cheeses) and vegetables like beans, peas, chickpeas, and so on.”
But while cases like Rossi’s are rare, it is not always easy to distinguish between a routine case of food poisoning and something more serious. Medical attention is not usually necessary, but if vomiting lasts for more than two days, you are unable to keep liquids down for more than a day, have a fever, or there is blood in your stool, then it could be a sign of a more serious condition or even a parasitic infection. An inability to urinate, or urine that is unusually dark, can also indicate a worrying level of dehydration and should be cause for a trip to a clinic or hospital.
Babies and small children should always see a doctor for suspected food poisoning, regardless of the severity of their symptoms. Pregnant women should do the same due to potential health complications for mother and child.
Ultimately, it is unjustified to live in fear and deny yourself the city’s many culinary treats. Applying simple precautions to your eating habits can help keep Beijing belly at bay.
*Name changed to protect privacy
Bayley and Jackson Medical Center
After working in private practice and emergency medicine in the US, Dr. Joseph Bush has spent the last 12 years practicing internal and general medicine in China. He now holds the position of director of family medicine at Bayley and Jackson, where he offers consultations in English and other languages via translators. He operates from the Ritan Park branch alongside experts in family medicine, internal medicine, surgery, obstetrics and gynecology, pediatrics, dentistry, optometry, and nutrition, among others.
Mon-Fri 9am-6pm, Sat 9am-5.30pm. 7 Ritan Donglu, Chaoyang District (8562 9990) www.bjhealthcare.com 朝阳区日坛东路7号
photo by Clara-Maya from Flickr
This article originally appeared on p22-23 of the beijingkids February 2014 issue.
Check out the PDF version online at Issuu.com