Water, Water Everywhere, But When is it Safe to Drink?
10 Tips
On Obtaining Safe Water and Other Beverages When You Travel


By Karl Neumann, MD, FAAP
 
Two diners sit in a restaurant overseas. One asks the waiter for a glass of water. The other says he wants the same, but the last time he was at this restaurant he was served water in a dirty glass, and became ill. The waiter listens, goes, and returns with two glasses, and asks, “Which one of you asked for a clean glass?”
 
When you travel, drinking lots of water helps you stay fit – as long as the water is fit to drink. Being well-hydrated helps counteract some of the vagaries of travel: in-flight low humidity, fatigue and jetlag; altitude, and hot and cold environments. Minimal dehydration occurs even before you feel thirsty, subtly affecting your mental and physical abilities.

But available drinking water is not always fit to drink. Micro-organisms that cause intestinal upsets may be present in tap water in developing countries and sometimes aboard cruise ships and planes.

Here’s how to get the metaphorical clean glass:

1. Always drink bottled water when traveling. Water everywhere contains some micro-organisms. While your body is accustomed to the ones in your tap water at home, those in water elsewhere - even where sanitation is good - may be sufficiently different to cause mild discomfort the first few days you drink it. Such discomforts are often blamed on jetlag and fatigue. Remedies for these include drinking water. If you drink tap water, your “remedy” worsens your discomfort. The more water you drink, the more likely you will ingest sufficient organisms to make you ill.

Drink bottled water if you take antacids. These reduce stomach acidity. Acidity helps kill organisms. Bottled water is prudent if you have diabetes or an immune problem, or are pregnant or elderly. Intestinal illnesses are more troublesome under these conditions.

2. All bottled water is not created equal. Bottled water is merely subterranean spring water or treated tap water, and unless optimally processed, is no better than tap water. Where sanitation is poor, opt for well-known international brands. Local brands may contain organisms and sometimes chemicals and other contaminants (in a worst-case scenario, arsenic in southern Asia).

 

Drinking carbonated bottled water adds a layer of safety. Carbonation acidifies water, killing organisms. Such water is known everywhere as “with gas,” “avec gas, or “con gas”) even by waiters who speak no English.

Some bottled water is mineral water and contains calcium, sodium and other minerals, often in large amounts. These may exacerbate certain heart and kidney problems. Read labels. Some overseas spas tout their waters as therapeutic for virtually anything that ails you, claims that are largely unproven.

 

3. When in doubt, bag it! Ice is acceptable in areas where sanitation is good; a cube or two is unlikely to contain sufficient organisms to cause illness. But where sanitation is suspect, cubes are generally made from tap water, often in difficult-to-clean ice machines. For ice addicts, I suggest you cool your drinks by placing ice in a leak-proof plastic bag, and inserting the bag into your drink.

4. When “ No ice, please” falls on deaf ears. When you ask for no ice in a drink that conventionally takes ice, you will inevitably get ice. When you remind the waiter of your request, he or she will summarily remove the ice, but how?

a) Remove it (with their hands) and fill the glass with more of the drink?
b) Pour out the drink and fill the same glass with a new drink?
c ) Get a new glass with a fresh drink?

In “a” and “b,” the water from the melting ice is in your drink or adhering to your original glass. So, make sure it’s “c.”

5. Even 100-proof liquor on the rocks does not make for a 100% foolproof drink. Alcohol does reduce the number of organisms in a drink, but slowly. The rate depends on the amount of alcohol in the drink, the size of the ice cubes, and types of organisms in the ice. If you’re drinking at a bar, odds are the bar will close before your drink is safe.

6. Canisters and special taps in hotel rooms labeled “safe to drink” ain’t necessarily so. Water in canisters is re-filled from tanks wheeled down the hall, a process subject to lapses in sanitation. Water from special taps requires optimum disinfecting, proper storing and clean pipes.

7. To paraphrase Ira Gershwin: “You’ve got ribbon.” To avoid abdominal problems, tie a brightly colored ribbon around the tap, a reminder to use bottled water, even when brushing your teeth.

On the other hand, when tap water is too hot to touch, it is generally safe. It is essentially “pasteurized,” having remained heated in the heater and pipes sufficiently long to kill organisms.

Boiled water is always safe. Carry an electrical coil, a current converter and a socket adapter, available in travelers’ supply catalogues. Boiling for a few seconds (yes, seconds) suffices to kill organisms. Note, boiling does not remove chemicals and other impurities.

8. Opt for humdrum canned beverages over tempting fresh fruit drinks from street vendors. Fruit drinks are usually squeezed in impossible-to-clean equipment and may be diluted with tap water and contain ice.

9. In the wilderness, never drink water from streams, lakes or springs. Crystal clear water in pristine surroundings may contain organisms from birds, animals, and humans. Boil or disinfect all natural water. Disinfectants and filters are available at sporting goods stores and on the Internet. Follow instructions on labels.

10. Recreational water is for swimming, not swallowing. Even at well-maintained swimming facilities swimmers placing their heads underwater tend to have more intestinal illnesses than swimmers who do not, and waders have fewer illnesses than swimmers. Factors increasing risk include: crowding, babies in diapers, and no chlorination (lakes and rivers).

Karl Neumann, MD, FAAP is the Director of the Family Travel and Immunization Center of Forest Hills in New York City. He is Clinical Associate Professor of Pediatrics at the Weill Medical College of Cornell University, Clinical Associate Attending Pediatrician at the New York Presbyterian Hospital/Cornell Medical Center, and an Attending Pediatrician at the Long Island Jewish Hospital.

He is co-editor of the International Child Health Newsletter of the American Academy of Pediatrics and the editor of the newsletter of the International Society of Travel Medicine. He has written chapters on traveling with children for most major textbooks and on travel medicine. For 12 years (1980-1992), he wrote a newspaper column, The Healthy Traveler, which appeared in New York Newsday, Los Angeles Times, Washington Post, Chicago Tribune, Miami Herald, and numerous other leading newspapers. He has had feature articles in the New York Times and most major travel magazines. For 15 years (1987-2002), he wrote and published Traveling Healthy Newsletter which was widely read by physicians around the world. He is Editor Emeritus of the Publication Committee of Wilderness Medical Society. He lectures frequently on travel medicine in this country and abroad.

Look for Karl Neumann’s Tips on FOOD When Traveling, in the next MyKindofHoliday.com.