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How to Avoid Food Poisoning & Traveler’s Diarrhea in Cusco, Peru

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Mm, gastric distress! Isn’t this a fun topic to talk about? If you’re worried about food poisoning in Cusco, I’ve got ya covered!

Almost everyone I know who’s been to Peru experienced tummy troubles in Cusco. Yep, it’s almost unavoidable, but I did manage to dodge food-borne illness because I was exceedingly careful about what I ate.

I spent about 4.5 months living in Cusco, and I never got food poisoning. Below I tell you exactly how I did it!

*Please note I am NOT a doctor, so do not substitute my personal travel experiences for medical advice. Consult a doctor if you are experiencing any medical issues.

San Blas Plaza in Cusco Peru
San Blas square in Cusco

What’s the most common type of food poisoning in Cusco?

“Food poisoning” is a catch-all phrase for an illness caused by bacteria, parasites, or toxins in food. These are some of the common culprits of food poisoning in Cusco:

  • Giardia (parasite)
  • Salmonella (bacteria)
  • Campylobacter (bacteria)
  • Cyclospora cayetanensis (parasite)

Sources: CDC and Dr. Mark Wise

Is it food poisoning or altitude sickness?

Please note some food poisoning symptoms can be the same as altitude sickness symptoms, and because Cusco is more than 11,000 feet in altitude, you’re likely to experience one or the other. (Be sure to check out the 10 ways I avoided altitude sickness in Cusco.) These shared symptoms include

  • Diarrhea
  • Vomiting
  • Nausea

So if you’re experiencing any of the above, there’s a chance it could be altitude sickness, not food poisoning. It’s tough to tell, so if you’re feeling pretty bad, visit a clinic to see a doctor.

If you’ve purchased travel insurance before your trip (which I hope you did!) check with them to see what your options are and if they’ll cover the cost. When I was in Peru, I used World Nomads travel insurance.

Is it safe to drink the tap water in Peru?

NO. I explain in detail below, but it can contain bacteria and/or parasites that can make foreigners sick because we are not accustomed to them.

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    Is it safe to eat street food in Peru?

    It depends. Generally if the food is cooked and still hot then it’s fine. However, be wary of anything left out in the sun for a long time. BIG MISCONCEPTION: Just because something is frozen does not mean it’s safe. Freezing does not kill the bacteria the way heating does. So, no, that ice cream from a street vendor, though tempting, is probably not the safest thing to eat. I explain street food in more detail below.

    What about the ice in Pisco Sours?

    Pisco Sours, a famous Peruvian alcoholic beverage, serve up a double whammy of potential bacteria: They contain ice AND raw egg. So, drink them with caution. Always ask the establishment if they use ice made from purified water (agua purificada). As for the egg, well, as we all know, raw egg always comes with the risk of salmonella. I don’t mean to scare you though. I had a couple Pisco Sours in Cusco, and they are tasty!

    Food poisoning and traveler's diarrhea in Peru- Here's how to avoid it!

    Avoid Food Poisoning in Cusco By Following These 7 Tips

    #1 Do NOT drink the tap water.

    The number one issue I see with travelers to Cusco is they drink the tap water. You definitely should not do this. Do NOT even brush your teeth with it! Why? There are certain bacteria (and maybe even parasites) in the water that do not get cleaned according to developed countries’ standards. Even the locals typically do not drink straight from the tap (I asked them). If they do, however, they typically do not get sick because they have grown up there and developed immunity.

    I always asked people about this, and I have only anecdotal evidence, so take it for what it’s worth. One of my hosts there was Canadian, and he said he brushed his teeth with the tap water and never suffered any ill effects. However, my American friend came to visit me and she got violently ill (stomach cramps and, I think, vomiting), and the only culprit we could find was that she had been brushing her teeth with the local tap water.

    I stuck to bottled water, which I bought for around 3 Peruvian soles in large bottles from the many little stores in the city. I even used bottled water to brush my teeth.

    Some people love to use the SteriPen because you can carry the small device around and stick it into a glass of water and instantly sanitize it, making it safe to drink. You can also boil the water, which I describe below.

    #2 If you must use tap water, bring it to a rolling boil for AT LEAST three minutes.

    If you do end up using Cusco’s tap water, be sure to boil it first. A few things to note about this: Bringing tap water to a rolling boil for at least one minute does effectively kill most bacteria, viruses, and protozoa, according to the Centers for Disease Control and Prevention. However, it will not rid the water of other pollutants, such as chemicals.

    Also, because Cusco is at high altitude, you must boil water longer than the standard recommended time. The CDC recommends that at altitudes higher than 6,562 feet, water should be boiled for three minutes. I’ve read other sources that recommend even longer boiling times for Cusco (since it is at more than 11,000 feet), anywhere from five to 12 minutes.

    #3 Stick to hot, cooked foods, or anything you can peel. Avoid raw items in general.

    Rice beans and veggies in Cusco
    Piping hot = good

    There’s a common phrase that doctors tell you regarding food while traveling: boil it, cook it, peel it, or forget it! The reasoning behind this is proper cooking often eliminates harmful bacteria and parasites. Also, fruits covered in a thick skin keep out bacteria.

    While in Cusco, I never ate raw foods like salads or unpeeled fruits and vegetables. If I did eat veggies at restaurants, I stuck to ones that were cooked and hot. At home, I ate fruits that I peeled after thoroughly washing with soap and boiled/bottled water.

    #4 Always wash your hands.

    This tip is a no-brainer and one you should use anywhere in the world ;). Finding soap is rare in many Peruvian bathrooms, so always carry some with you or carry hand sanitizer.

    Headed to Machu Picchu? Check out these tours!

    (Also, toilet paper is a rarity in Peruvian public bathrooms, so carrying tissues or travel wipes is also a good idea.)

    #5 Avoid street food.

    street food in cusco peru
    My Peruvian host and fellow guests enjoying some grilled meats on the Cusco streets. I refrained.

    Hardcore travelers will roll their eyes at this one, and that’s fine. It depends on what’s important to you. I really didn’t want to risk any chance of contracting parasites or harmful bacteria, so I didn’t eat street food. Well, I take that back: My first few days I drank fresh-squeezed juice from the stands in San Pedro market, and never got sick. However, I decided not to risk it anymore so I stopped drinking those (but oh my gosh they were SO good).

    These are the street foods you’ll commonly see in Cusco:

    1. Grilled meats – These should be okay as long as they’re piping hot and well cooked.
    2. Raw cheese – My Peruvian host told me NOT to eat these because they are not pasteurized and might be hard on my unaccustomed stomach.
    3. Boiled quail eggs – I had these once from a vendor outside the San Pedro Market and was fine.
    4. Soups – I never ate these if they came from outdoor stalls; they should be fine as long as they’re boiling hot and not tepid.
    5. Ice cream (helado) – I’d avoid these because bacteria is NOT killed by being frozen, only by being boiled.
    6. Fried dough (picarones) – These are deep fried dough (like donuts) and are pretty safe to eat since they’re dumped into a vat of boiling oil.

    #6 Take Pepto Bismol as a prophylactic (preventative measure).

    Taking Pepto Bismol (the brand name for bismuth subsalicylate) may actually kill bacteria and reduce the risk of getting sick from food while traveling. A study conducted in Mexico in 1987 showed that taking two Pepto Bismol tablets four times a day reduced the risk of traveler’s diarrhea by more than 60 percent! For more info about using Pepto Bismol as a prophylactic, check out these articles on WebMD and NPR.

    The jury is still out on this though, as little research has been done. However, when I was in Cusco I often would take Pepto Bismol chewables after eating out at a restaurant and, again, I never got sick. It’s impossible to tell if it’s because of the Pepto Bismol though. Be sure not to take this for long periods of time (more than three weeks) as that could be harmful.

    #7 Do your research before eating at a restaurant.

    palta a la reina cusco peru

    In general, when traveling, eat only at restaurants frequented by lots of locals and tourists alike. Take a quick glance at the kitchen and where the food is kept. Make sure they’re using clean practices, and that the food is properly covered, heated and/or refrigerated.

    Now, anyone who’s actually been to Peru will be laughing by this point. The cleanliness standards there are lower than what you’d expect in the U.S. I don’t think I ever saw someone wear gloves while they were handling food (then again, when I visited Portland, Oregon, may food truck workers handled food with their bare hands too).

    But they do have health inspections in Cusco. In fact, sometimes you’ll see a restaurant closed down with a notice hanging on the outside that they failed a health inspection. Whatever the case, always do your research before eating somewhere new.

    Here’s a little hack I used: Before eating at a restaurant in Cusco, I would always Google the restaurant’s name + “food poisoning” or “traveler’s diarrhea” to see if any reviews came up from patrons who got sick there. I also went to TripAdvisor reviews and did a search in the search bar for “food poisoning” or “traveler’s diarrhea” or “sick.”

    That’s pretty extreme and only for someone super cautious (AKA me). Also, take bad reviews with a grain of salt. Food poisoning has an incubation time of anywhere from a few hours to a couple months, so it can be very difficult to trace the source of contamination. When you see an angry review claiming someone got sick at a restaurant, it may very well be that they got sick somewhere else. It’s tough to tell.

    More Cusco Restaurant Food Safety Tips:

    • If you want to be extra safe, stick to foods that have been boiled, fried, or cooked in some way, and don’t eat the salads or anything that may have been washed with tap water.
    • Stick to bottled drinks or hot beverages. Don’t drink anything that has ice, unless the restaurant uses purified water to make its ice. 
    • Don’t be afraid to ask if they use purified water to wash their uncooked vegetables and fruits and to make ice. When in doubt, don’t consume it.

    What to Do If You Get Food Poisoning in Cusco or Traveler’s Diarrhea in Peru

    Welcome to the club! Food poisoning in Cusco is so common it’s practically a rite of passage. You are certainly not alone. It’s going to be okay. You’ll probably experience diarrhea, nausea, vomiting, stomach cramps, and maybe even a fever.

    See a local doctor. My reasoning is that local doctors will understand local bugs and common illnesses. In Cusco clinics, you can get blood and stool tests done quickly to determine what kind of bacteria and/or parasite you have.

    Many people are afraid to go to the doctor in Cusco because they don’t know how much it will cost and they don’t speak Spanish, but prices in Cusco are very cheap and because there are so many tourists there, you’ll usually find someone who’s able to speak English. Again, contact your travel insurance company to see what is covered by your insurance plan.

    Most of the time you’ll be prescribed antibiotics, such as Cipro, or antiparasitics, such as Flagyl. It may take a few days or weeks, but you should be feeling better soon.

    In the interest of full disclosure, I did experience some gastric distress in Cusco on my last month I was there (so about four months in). I thought I had contracted bacteria or parasites from the food, since it’s so common. My most chronic symptoms were heartburn, indigestion, and bloating. Several doctors visits and stool and blood tests later, it was confirmed that I did not have any bacteria or parasites. Finally, a functional medicine doctor ran non-traditional lab tests and found that I did have some bacterial and/or yeast overgrowth, likely caused by a diet high in sugar and carbs. I went on an elimination diet, and thankfully, my symptoms went away! So while I was so sure Peru was the problem, it turns out my unhealthy diet was probably to blame. (This is a reminder to eat healthy and take care of yourself!)

    Buen Provecho! Enjoy Your Food!

    I hope all this talk about ways to avoid food poisoning in Cusco doesn’t cause you avoid all food there. Peruvian food is among my favorite to eat, so definitely get out there and try it!

    Even if you do get sick, it’s a very common ailment that usually passes quickly.

    Enjoy Peru!

    Travel items I recommended in this post:

    *Please note I am NOT a doctor, so please do not substitute my personal travel experiences for medical advice. Consult a doctor if you are experiencing any medical issues.

    Don't forget travel insurance to protect your trip in case of injury or delays! Get World Nomads