Nb: in Morocco, Delhi belly is designated by a French word, “Tourista” the disease of the “Tourist”. Both of them are colloquial expressions for travellers’ diarrhea.
The Moroccan outrage over the Sanofi advert, which touts its probiotics against the backdrop of a photo of Jemaa El Fna, made me laugh (and the advert too, by the way).
Let’s be honest, the problem of tourista in Morocco is known and talked about by everyone.
And if, as the director general of the tourist office says in a quite pompous way, bringing in the majesty of history, well…
Associating one of the country’s most famous squares, which is also a world heritage site, with food poisoning seriously damages the image of our country by suggesting very explicitly that travelling to Morocco necessarily implies contracting this disease
the association has already been made for a long time, also with Tunisia, Egypt, etc… not by chance! (And Moroccans have similar quenches regarding food on Jemaa Fna)
Why do we get Delhi Belly in Morocco?
Exactly for the same reasons you get it in India !
Even with food prepared in perfect hygienic conditions, stomach disease can occur because of the sudden change. The difference in temperature, the change in eating habits (much less starch, much more vegetables and fresh fruit) combined with the fatigue of the journey and the job you left for a week… the stomach goes on strike and you have two or three days of diarrhoea, often mild. That’s travellers’ diarrhoea, known as the “Delhi belly” or “tourista“. English speaking Canadians will simply call it “stomach flu“.
This disease spoils the first days of your holiday, especially as it is difficult to find well-maintained European toilets everywhere, provided with toilet paper, etc. What would be almost unnoticeable at home becomes a real nuisance.
What to eat to avoid getting stomach disease ?
Fruit and vegetables: wash and peel
The second reason to get travellers’ diarrhoea is that Morocco is not a country where fruit and vegetables are washed for a long time before being wrapped in cellophane and sold in trays in the supermarket. In Europe on in the US, however, even vegetables sold at the market are washed beforehand.
So you have to do it the Moroccan way: wash thoroughly or peel the fruit and vegetables before eating them. And of course, wash your hands. From then on, you can eat raw vegetables and fresh fruit in Morocco, and it would be a real shame to go without. But respecting Moroccan habits, adapted to the environment.
Raw vegetables should always be peeled.
Whether it is in the Moroccan salad or in the various salads, tomatoes and cucumbers are peeled, carrots are cooked, peppers are peeled or cooked (and to peel a pepper you have to put it on the fire). So no risk. I usually leave out the green salad leaf… Grated carrots, orange salads are also peeled, real delights.
Mayonnaise is a risky area. I had one and only one big attack of Delhi belly in Morocco, from a hotel mayonnaise that was not fresh. In restaurants, check that the salad is prepared for you, from various elements, and that it is assembled – and therefore sauced – just before serving you, or better still, ask for the mayonnaise separately, so that you can measure it out yourself. (Many restaurants do it by themselves, serving salad and sauces separately).
Note that mayonnaise is everything but a traditional Moroccan sauce, including raw eggs…
Meat: always very cooked
The Moroccan way of life is all about thoroughly cooked meat, whether it’s on a long-grilled skewer or in a long-simmered tagine. So, lovers of tartars and rare meat (like me… alas!) forget it. The meat is handled without precautions, as it is at home, and customers can feel the piece of meat at the butcher’s stall. The problem is not so much a break in the cold chain, but rather all those hands. The long, thorough cooking of the meat eliminates bacteria.
Buying your own meat
When travelling, Moroccans are used to buying their meat from the butcher, and then taking it to the restaurant next door to be cooked. This guarantees the freshness of the meat, and this is perfectly normal. If you stop in a small town, or on the road, do the same.
Water: spring, tap or bottle?
The quality of water varies greatly in Morocco.
In the big cities, tap water is perfectly drinkable, but it often has a not very pleasant after-taste. You can use the hotel’s water without any problem to brush your teeth or quench your thirst in an emergency, but for the rest, prefer bottled water.
Nb: that was written in 2015. Nowadays, things have really improved in this field, and I’m, personally, avoiding bottled water as much as possible, because of the ocean’s pollution. As much as possible means “with preserving my health”.
In restaurants, the question does not really arise, as Moroccans are used to offering only bottled water to their guests.
In cafés, you are always served water with a coffee. Either a free glass of water or a mini bottle of Sidi Ali (the local mineral water) which is not free. The glass of water never hurts me, but I’ve been living in Morocco for a long time, my stomach is perfectly used to it.
On the road, on a tour, as soon as you are out of the big cities, mineral water is the rule. There are delicious little springs, but in some cases the locals drink water that your stomach won’t tolerate. No risk, unless you are with us and we suggest the Tazzarine spring, it is really wonderful!
Beware of salt
Moroccans don’t eat much salt. Dishes are spiced with pepper, cumin… systematically and vigorously refuse any dish that is too salty, especially meats, as this is the technique used to hide the taste of a past meat. This can also be a mistake on the part of the cook, but if in doubt… and ask for an omelette instead, which must be fresh.
Raib is very popular with Moroccans in summer. This drink based on fermented milk is taken with a flavour, strawberry, mint, pomegranate, it is very good and refreshing. I’ve never had a problem with it, but just be careful: buy it where the Moroccans themselves rush around.
I have my reservations about ice creams, though. They are becoming more common, but you can have real problems with a cold chain that is not respected, even for products in supermarkets. So only in very good restaurants or dedicated places (like Venezia Ice).
Freshly squeezed orange juice from Jemaa El Fna
Rarely dangerous, because of the flow of customers (they are really fresh), not expensive, thirst-quenching… but often well cut in water, which diminishes its taste. So if you feel like it, no problem, but have your glass pressed in front of you. It will taste much better. For the rest of the food offered on Jemaa El Fna (meats, soups, snails…) limit yourself to brochettes and grilled meat!
Travellers’ diarrhoea drugs ?
Prevention: bifidus and probiotics
Sanofi’s drug is part of the large family of probiotics, a kind of food supplement that reinforces the quantity and quality of bacteria naturally present in the body. A sort of medicated raib! Is it useful?
I am quite divided. There are many studies on the effectiveness of probiotics, from which it appears that some of them are effective in preventing traveller’s diarrhoea. But the study was based on different bacteria than those used by Sanofi for its drug. In other words, rather than buying a drug for prevention, take Bifidus … and raib instead.
The role of a drug like Sanofi’s is preventive. However, a study of this drug, Bioflorin, shows that it is not effective in reducing severe diarrhoea caused by Escheria Coli.
Imodium, the classic
Imodium is still the most effective drug treatment in the event of an outbreak of tourista.
It is widely available in Morocco. Its molecule is loperamid, you find it in other drugs like Smecta or Gastrowell.
Always include it in your first-aid kit, and keep a tablet with you for the first few days, so that you don’t have to wait to get back to the hotel in the evening when you go on a trip…
Coca-Cola, Oulmes and mint
Although I am not a fan of everything Coca-Cola stands for, neither of the amount of sugar and chemical ingredients with dubious qualities that are found in this drink, I have to admit that for decades Coca has been a friend of travellers in Africa (and not only). One or two cans a day is a good preventive, or healing, aid.
A large bottle of Oulmes (sparkling water) well loaded with mint syrup, drunk as quickly as possible (try to take at least a third of a litre at a time) is also a sovereign remedy against Delhi belly. It also has the added benefit of rehydrating.
Moroccans also replace mint syrup with fenugreek.
Anti-bacterial wipes, soaps and gels
Finally, always carry wipes or a roll of toilet paper (rarely found in Moroccan toilets).
Bottles of hydro-alcoholic gels are also a must. They do not replace hand washing, but are a good complement when you are in difficult conditions. For example, when hiking in the desert, it is difficult to wash your hands thoroughly before eating the kebabs. Rinsing with water from the well will be completed by a little shot of gel, to eliminate any unhealthy stuff contained in the water (but you can drink the tea made with it without any problem, as it will have boiled).