The GP wrote:David-

If I recall statements in another thread, haven't you also used a strategy of a couple shots of tequila or other liquor to kill off the icky things?

Arrived in Delhi about an hour ago and plan to begin this prophylactic procedure momentary.

Katie wrote:David, you probably don't consider me a friend, but please believe me, I tell you as a friend would (and as a friend who's spent some time, sick and healthy, in China, Taiwan, and Hong Kong), food-induced diarrhea is the digestive system on invountary overdrive. It's not merely a matter of time taking its course, it's a matter of your digestive system drastically overclocking. Yes, I understand what you mean by getting the bad stuff out, but don't let your body indulge its impulse to throw the baby out with the bath water. Sometimes bodily functions get out of whack. Take immodium with you, and take it.

Why would I not consider you a friend?

I actually did ask my doctor about Immodium specifically and she said she thought it wasn't a great idea.

Not sure I understand the baby/bath water analogy, but if my stomach hurts, I'm first going with herbal remedies, and if it hurst a lot (with attendant distress), I may go directly to Cipro. And now, I have a five week regimen of malaria medication to start taking...

David Hammond wrote:

Katie wrote:David, you probably don't consider me a friend, but please believe me, I tell you as a friend would (and as a friend who's spent some time, sick and healthy, in China, Taiwan, and Hong Kong), food-induced diarrhea is the digestive system on invountary overdrive. It's not merely a matter of time taking its course, it's a matter of your digestive system drastically overclocking. Yes, I understand what you mean by getting the bad stuff out, but don't let your body indulge its impulse to throw the baby out with the bath water. Sometimes bodily functions get out of whack. Take immodium with you, and take it.

Why would I not consider you a friend?

I actually did ask my doctor about Immodium specifically and she said she thought it wasn't a great idea.

Not sure I understand the baby/bath water analogy, but if my stomach hurts, I'm first going with herbal remedies, and if it hurst a lot (with attendant distress), I may go directly to Cipro. And now, I have a five week regimen of malaria medication to start taking...

Yes, I similarly have been advised on multiple occasions by doctors to avoid Imodium under certain circumstances related to traveler's diarrhea (and if you're not keenly aware of the circumstances, better to stay away, right? That was my rule). I'm curious about Cipro however. Whereas once this was the recommended fix, over the last several years I have always been prescribed Zithromax . . . can't remember why, but I thought it was because there were strains of bacteria that were proving resistant to Cipro, particularly in Southeast Asia. Of course, I'm not a doctor so I'm certainly not here to give advice (other than recommending a visit to a doctor), just to share my personal experiences.

David: two things you should definitely put in your stomach (besides booze) - brain (bheja) curry and nihari. And of course kabobs. And biryani. Enjoy.

David Hammond wrote:Basic takeaway: eat it hot, drink it canned.

I'd add to that strategy: wash your hands early and often.

Before my India trip I visited the travel clinic @ Northwestern. Besides the numerous vacines (dengue fever etc..) they perscribed some super meds in case of Ghandi's revenge. 3 pills, one, to be taken upon onset of distress, the other two on alternate days following. The cost was nearly $200. Which brings me to Darjeeling in the foothills of the Himalaya's where my mates and I got hit in the bowels from what we believe was banana lassi (so good and so worth it). All three of us got it and will say that it was quite the bonding experience, sharing our room and one terlit. sick, funny... the sounds eminating from that tiled room... We ran out of tp and called down for more. 2 scratchy rolls arrived but only lasted a few hrs. Our second call brought a shy but obviously humored maid w/a silver tray of mulitple rolls stacked as if a pyrimid. The hand off was made, the rolls used and in my illness, my overpriced meds forgotten until I unpacked them @ home.

Wondering why they don't do banana lassi here? Enjoy.

Jazzfood wrote:Before my India trip I visited the travel clinic @ Northwestern. Besides the numerous vacines (dengue fever etc..) they perscribed some super meds in case of Ghandi's revenge. 3 pills, to be taken upon onset of distress, the other two on alternate days following. The cost was nearly $200. Which brings me to Darjeeling in the foothills of the Himalaya's where my mates and I got hit in the bowels from what we believe was banana lassi (so good and so worth it). All three of us got it and will say that it was quite the bonding experience, sharing our room and one terlit. sick, funny... the sounds eminating from that tiled room... We ran out of tp and called down for more. 2 scratchy rolls arrived but only lasted a few hrs. Our second call brought a shy but obviously humored maid w/a silver tray of mulitple rolls laid out as if a pyrimid. The hand off was made, the rolls used and in my illness, my overpriced meds forgotten until I unpacked them @ home.

Wondering why they don't do banana lassi here? Enjoy.

Hoping you find a way to work this story into your new gig!!!!!!!!

Here is a patient information pamphlet from Uptodate, an online textbook.

Patient information: Travelers’ diarrhea (The Basics)
Written by the doctors and editors at UpToDate

What is travelers’ diarrhea? — Travelers’ diarrhea is runny or watery bowel movements in people who are traveling. It is usually caused by bacteria but can also be caused by a virus or parasite.

You are more likely to get travelers’ diarrhea if you travel in:

Asia (except Singapore and Japan)
Africa
South America, Central America, and Mexico
Countries around the Mediterranean Sea, including Israel
Caribbean islands

What are the symptoms of travelers’ diarrhea? — The main symptom is runny or watery bowel movements about 4 to 14 days after arriving. Other symptoms can include:

Feeling sick
Loss of appetite
Cramps in the lower belly
Nausea and vomiting
Fever
Gas and bloating – Feeling like the belly is full, with pain in the middle or top of the belly.
Blood in the bowel movements
Feeling as though you need have a bowel movement even if you just did, or like you need to get to the toilet in a hurry

Travelers’ diarrhea usually lasts 1 to 5 days, but some people are sick for a week or longer.

Should I see a doctor or nurse? — If your doctor or nurse gave you antibiotics to take for diarrhea, you can take them instead of going to a doctor or nurse in another country. But you might need to see a doctor or nurse if:

You are sick for 10 to 14 days or longer.
You have a fever of 102ºF (40ºC) or higher.
You have severe belly pain.
You have bloody diarrhea or you are vomiting.
The antibiotics you took did not help.

Will I need tests? — Probably not. If you see a doctor or nurse, he or she will ask where you traveled and what you did. If the doctor thinks a parasite might be causing the diarrhea, he or she might ask for a bowel movement sample. Testing it can show if you have a parasite. But this is not usually needed.

How is travelers’ diarrhea treated? — The most important treatment is getting enough fluid. That’s because diarrhea can cause the body to lose fluid. Adults with mild diarrhea can drink lots of fluids with water, salt, and sugar. Soup broth and water mixed with juice are good choices. If you are drinking enough, your urine will look light yellow or almost clear.

If you have diarrhea more than 4 times a day, you can drink an “oral rehydration solution.” You can buy this in a packet at the pharmacy. Mix it with bottled or boiled drinking water.

Other treatments include:

Antibiotics – These medicines fight infections.
Medicines that ease diarrhea, such as loperamide (brand name: Imodium®) diphenoxylate (sample brand name: Lomotil®), or bismuth subsalicylate (sample brand names: Pepto-Bismol® or Kaopectate®) – These medicines can help, but they can also cause other health problems. Bismuth salicylate might not be safe for pregnant women or people who take aspirin for another condition. You should only take loperamide or diphenoxylate if you are also taking antibiotics.

Can travelers’ diarrhea be prevented? — You can reduce your chances of getting travelers’ diarrhea by being careful about what and how you eat and drink. While you are traveling:

Do not drink tap water. Drink bottled carbonated drinks, beer, wine, or hot tea or coffee instead. Brush your teeth with bottled water.
Do not use ice in drinks. Ice is usually made from tap water.
Do not eat food from carts or stands in the street.
Do not eat sauces set out on restaurant tables. These include salsa and ketchup.
Do not eat fresh foods at room temperature. These include guacamole, fruit or chicken salads, and buffet food on a steam table.
Do not eat foods or drinks made with unpasteurized milk.
Ask for drinks in the bottle, without ice. If you drink from a glass, use a straw.
Do not eat fruits unless they have a peel and you have peeled them yourself.
Make sure meat and seafood are well done and eggs have a firm yolk.

If you can’t find bottled water or soft drinks, you can make your drinking water safe by:

Boiling it for 3 minutes (let it cool before drinking)
Adding 5 drops of tincture of iodine to 4 cups of water and waiting 30 minutes - Tincture of iodine is a liquid you can buy at most pharmacies or camping goods stores.
Using a water treatment filter from a camping or sports store

Wash your hands after going to the bathroom, changing diapers, blowing your nose, touching animals, or taking out the trash.

If you have a serious health condition, travelers’ diarrhea could cause you to lose too much water. This can be dangerous and even cause death. If you are going on a trip, talk to your doctor or nurse ahead of time. He or she might give you antibiotics to take while you are traveling.

Been sick twice in my travels- in Darjeeling and Istanbul. In the latter, the Dr. said "you ate donar kabab on the street". I replied from my bed "is that a question?". He said "No. You ate donar kabab on the street." Correctamundo.

While I do try to take some of the above precautions i.e. the ice, the peeled fruit, the purchase of expensive antibiotics pre trip, you know you're an LTH'r when you prefer to take your chances than miss out on the food. The reason I travel, and imagine many reading this do (our pal Hammond in particular) is to experience new things from other cultures, not to play it safe dining w/other Americans @ a Hilton. For us, the gamble is worth it. You miss too much by trying to control too much. But then, I don't wear a helmet when I ride my bike.

For me, life is not meant to be lived playing it safe. It's meant to be held on to w/all your might screeming "what a ride".

Nice summary about some of the misconceptions regarding traveler's diarrhea in the NY times a couple months ago:
When the Mango Bites Back

Delhi was our favorite stop on our recent trip to India. The city has a lot to offer in terms of history and interesting neighborhoods, and it didn't hurt that the weather was pretty mild when we were there. We strategically stayed near Old Delhi so we could really explore it, and that was certainly where the most action was. The food culture of Old Delhi is tremendous, though really you don't have to stray too far from the famous Karim's to eat a wide variety of delicious foods.



The area right around the Jama Masjid is ground zero of Old Delhi's food culture. We walked around the Old Delhi a good amount and while we saw a good number of interesting food stalls, nothing compared to the variety and quality of options right next to each other on Matya Mahal.



The crown jewel of the neighborhood is the much lauded Karim's. We ended up making it there for breakfast on one day and for dinner on another. Their breakfast options are paya and nihari, and both were absolutely outstanding. They come with a layer of golden ghee on top, which we saw other tables ladling off the top. I think this is a good idea because the richness of the dishes could be a little much, particularly that early in the morning, but the intensity of flavor in both stews was undeniable. The paya is made with trotters which are stewed until they are soft and gooey. The nihari is made with beef shanks and I picked up the distinct flavor of anise to go along with the myriad of other spices they use. Both were rib-sticking stews that stayed with you long after the meal.



They serve all their dishes with a tandoori bread that is impossibly light with a nice chewiness. The bread had a touch of sourness and a buttery flavor even though it wasn't greasy at all. One of my favorite parts of eating in India were all the different fresh bread preparations. All their breads are cooked very quickly and served piping hot. The bread they serve at Karim's is typical of the neighborhood and it complemented the rich and spicy stews perfectly.

We returned for dinner the next night and I have to admit I didn't enjoy it as much as breakfast. We ordered the mutton pasanda, the chicken burra, the mutton biryani, and a seekh kebab. The mutton pasanda was delicious but it was pretty similar in flavor to the breakfast curries. They do an excellent job with the meat based gravies, but they're not that different from one another. The chicken burra had great charcoal grilled flavor, but was dry in parts and seemed pretty plain by Indian standards. I enjoyed it but it didn't stand out. The mutton biryani really surprised me. The biryani itself tasted like buttered rice. So many tables around us were ordering it and I read so much about it, I felt like we'd misordered because it was just so unremarkable. The mutton wasn't cooked with the rice but rather stewed unlovingly then haphazardly thrown in the middle of the rice. Fortunately, the seekh kebab stole the show and made the return trip worth it. Wow, that seekh kebab puts the rest to shame. It was incredibly tender (and fatty I'm sure) and had a robust spiciness accented heavily by turmeric that stained the plate it was served on. I'm a big fan of ground meat kebabs and this was one of the best I've had. If I ever return to Delhi I can see myself ordering a dozen of these and a large plate of yogurt and just going to town. All in all Karim's is definitely worth visiting. The meat based curries, tandoori bread, and charcoal grilled kebabs are fantastic. There are a number of restaurants serving similar cuisine in the area, but none of them have anywhere close to the volume Karim's is putting out.



Across the street from Karim's is Haji Tea Point which specializes in halwa puri. That was probably the second most popular restaurant in the area, though unlike Karim's, the place was filled exclusively with locals. When we walked in the door, they quickly ushered us to a cramped table upstairs next to the AC. At first we thought they were putting us in the crappy seats away from the action, but as the AC was blowing into the hot and crowded room, we realized they had hooked us up with the best seats in the house. They have other items on the menu, but nearly everyone is ordering the halwa puri, so naturally we followed suit. That and two Indian teas.



Halwa is a sweet, semolina based paste that has a pleasant nutty flavor. They serve it with fried bread and a watery potato curry. The combination makes for a lot of interesting contrasts, though the crispy yet chewy puri really makes the dish. The tea is made with frothed milk that is sitting in a large container in the front. They mix up what seems like 50% milk and 50% tea (and plenty of sugar) that results in a light and creamy beverage that goes perfectly with the sweet and savory breakfast.



The same tea is served at Saleem Tea Stall just down the street. There, you can watch them mix the tea to order, skimming the frothiest (and fattiest) part of the milk from the top. They also serve coffee which they brew by straining hot water through grounds held in a small strainer directly into the cup. I'd recommend Haji Tea Stall if you're looking for a quick breakfast with a cup of tea and Saleem Tea Stall if you'd just like to sip some tea or coffee before getting on with your day.



Also on the same block is a shop specializing in the greasiest parathas I've ever eaten. They're rich but man are they good. I don't have much to say about this paratha other than clearly they use a lot of ghee and the result is the biggest gut bomb I've ever seen in a loaf of bread. But I'd gladly get another one, though probably to share with 3 or 4 friends next time around.



The final stop on this block has to be the dairy shop right at the street corner. They serve kheer and lassis and both were excellent. The kheer is thick with a strong accent of cardamom and plenty of pistachios on top. The lassi is incredibly thick, with a layer of skin on top, and the creamiest yogurt you've ever tasted. They serve it in a ceramic cup which I suppose helps keep it cool. The lassi is one of the most memorable items from the trip since it was miles better than any other lassi I've had.

I'd just like to reiterate that to this point, all the food I've described can be found on the same short block in the shadow of the Jama Masjid. It is one of the most dense food neighborhoods I've ever encountered and really we only hit about half the restaurants in the area. This is a must visit place for any food-lover visiting Delhi.



Still in Old Delhi, but a 15 minute walk from Jama Masjid is the Bade Miya Kheer shop. We discovered this on our own but upon googling it I've come to learn that it is quite famous in Delhi. And with good reason, their kheer is pretty special.



As far as I can tell, they make a different style of kheer than I'm accustomed to. There were no spices I could detect and the result was closer to a thick custard than the liquid kheer I've had at so many Indian buffets. The thickness is accented by a nice layer of skin that the store owner carefully placed on top as he was serving us. The flavor is rich and creamy with a subtle nuttiness that rounds it out beautifully. It made sense that they didn't spruce this up with nuts or spices since the flavor of the pudding stood so successfully on its own.



Up on the main road, Chadni Chowk, a short walk from the Red Fort is the famous snack shop Haldiram's. I was intent on trying pani puri, but all the warnings kept me from trying it on the street. So we went to the most famou pani puri shop in Delhi, and our patience was rewarded.



They take their pani puri very seriously at Haldiram's. The puris and the sauces all come sealed in plastic to really underscore that it's safe to eat. The puris were nice and crispy and the sauces were a nice contrast of sweet and spicy. Each bite is quite enjoyable, though honestly, I think I like the version at Chicago's Annapurna better. The flavors are just a little brighter. Not sure if the street pani puris pack a bigger punch, or if this is just a dish that is done pretty well on home turf, nonetheless for those curious about trying pani puri (or gol goppa as it's called in some parts), Haldiram's is probably as safe an option are you're going to get.



While the pani puris were good but not great, the dahi bhalla papdi chaat was a home run. Papdi chaat is a typical snack of chick pea crackers topped with yogurt, and dahi bhalla is a snack of lentil doughnuts topped with yogurt. I saw this item on a couple menus, so we finally tried it at Haldiram's and the combination really worked. The lentil doughnut was pretty spicy which added an interesting dimension to a dish that really highlights the contrast between crunchy and gooey. The tamarind chutney was sweet without being cloying and supported the spiciness of the dish really well. This was a dish that really featured the flavor and texture contrasts that makes chaats so much fun to eat. All the dishes we ordered at Haldiram's were solid, but this one really stood out.

Haldiram's
Chadni Chowk Road, close to Red Fort



One night in Delhi we were hoping to escape from the polluted maelstrom, so we hopped a taxi up to the Hauz Khas neighborhood. It's technically pedestrian only, though this meant there was only one lane of traffic and a honk every 10 seconds rather than 10 honks per second. Still it was an oasis of calm and made for a lovely and romantic evening. They have a charming park that features a large fenced area with hundreds of deer grazing and relaxing, a river walk promenade with joggers and families taking a stroll, and our favorite part was the ruins. What the ruins lacked in size they made up for in charm. We arrived as the sun was setting and the park was filled with young couples climbing the various buildings and taking fun pictures amid a backdrop of 500 year old buildings. This struck me as something that makes Delhi so special. The city may be quickly modernizing, but there are pockets of history throughout the city that the citizens experience on a daily basis. The area also has lots of boutiques and a wide variety of restaurants.



We decided to eat dinner at the Golconda Bowl. They specialize in Hyderabadi cuisine. They have an extensive menu but they put particular emphasis on the haleem, the nihari, and of course the biryani. We had nihari for breakfast that morning so we elected to try the haleem and the biryani. The haleem was unlike anything I'd had before. It's a lentil and wheat porridge that's stewed for a long time with lamb. The lamb is shredded into thin strands resulting in a rich and hearty stew. The version at the Golcondoa Bowl had an earthy, smoked quality to it which made it quite complex and tasty. After eating at so many downscale restaurants we appreciated the attention to detail and quality of this higher end restaurant, quite a contrast from some of the hotel meals that disappointed so thoroughly earlier in the trip.



In addition to the haleem we had to try the biryani. Hyderabad is famous for its take on biryani and this version did not disappoint. We asked if lamb or chicken would be better and the waiter informed us that the meat is added on top and does not impact the flavor of the rice. Once again I was surprised to learn that the meat isn't part of the preparation of the biryani. We ended up ordering chicken, but the meat felt like an after thought. The rice on the other hand was delicate and delicious. The waiter (I think he was the manager, he spoke excellent English) encouraged us to eat the biryani with our fingers since that would really accentuate all the spices. Hard to say if that's true or not, but it was kind of fun to eat with our fingers in a nice restaurant. Each grain of rice was infused with an array of spices. Saffron and cardamom were the most apparent though I'm sure there were quite a few others. The perfume-like aroma and delicate flavors were really noteworthy, particularly since so much of Indian cuisine is robust and in-your-face. The skill of the kitchen was on full display and made this an excellent counterpoint to the muscular street cuisine we ate on the rest of the trip.

The Golconda Bowl
Hauz Khas Village, Delhi
http://www.facebook.com/TheGolcondaBowl

I suppose I should add a data point to the discussion on Delhi Belly that seems to be front of mind whenever trips to India come up.

We ate on the street nearly every day including all the raw cilantro and onion toppings as well as whatever chutney was being served (including the ubiquitous and delicious green chutney). We skipped the street pani puris, the limeade, sugar cane, and juice stands, and didn't buy any fruit on the street since there were so many warnings and drank only bottled water. Really we barely felt limited at all and used standard travel discretion. In the end we had a lot of fantastic food, experienced a lot of the local culture, and most importantly avoided any stomach problems at all.