Carolyn. Shhh! Can't talk about this out loud, in case it jinxes us. But so far, after 3+ months of travelling and living in Costa Rica, Ecuador and Peru, we have not had any stomach issues or diarrhea - maybe a little constipation now and then - but really, we are all in good shape, digestively speaking.
The reality of eating and drinking in Central and South America is that foreign travelers have to be careful. It is not possible for us to safely drink the tap water (actually, we did every day in Costa Rica - but not wise in Ecuador or Peru).
The caution about tap water also extends to anything it might have been used to wash or mix with. For example the fruit juice on a menu may be mixed with tap water, and the crushed ice in the yummy-looking slushie drink that Cooper desperately wants is almost certainly made from tap water. It's also not recommended to eat a tossed green salad or any other raw fruits or vegetables that have been washed with tap water and not cooked or peeled.
On the restaurant scene, there are generally two options: tourist restaurants and local restaurants. The general thinking is that tourist restaurants will use purified water to wash their salad veggies, etc...while the local restaurants will not. (Because the kiss of death for a tourist restaurant would be for a customer to get sick from eating or drinking there, and then report it on Trip Advisor).
So one could argue that the safe bet to protect delicate tourist stomachs is to eat at the safer tourist restaurants. But you miss a lot of local culture and yummy different food that way. And the cost? Eating at a tourist restaurant is expensive, no surprise. In Peru, a full dinner at the little place around the corner filled with local folks will cost 4 soles, or $1.60 CDN per person. Whereas dinner in a tourist spot will cost 40-50 soles or more per person...over ten times as much.
We try to balance both. After all, we like to think we are travelers, not tourists. So we don't want to stick with the standard tourist fare, we want to be more adventurous. And for our year-long travelling budget, it's certainly more affordable to eat at the small local places. We really like working on our Spanish language skills in the local places too. But to eat here means we knowingly restrict what we will order, avoiding any food or drink that might be connected with bad water. After a while, Vern and I get really desperate for a crisp green salad (Cooper not so much, though he's thrilled at the prospect of chicken fingers and fries on a tourist menu), so off we go to a touristy place where we feel we can trust their water practices.
Which brings us to Arequipa where we are renting an apartment for a month. Because we want to "live like a local". Except that we still can't drink our own tap water like the locals do. (We chatted with an American ex-pat who has lived in Peru for 8 years - and he said it took him 6 months of being sick, drinking the local tap water, before his stomach got used to it and now it's OK for him).
So our kitchen routines here have an extra step: I boil big pots of water daily, for about 10-15 minutes. Then let them cool. We've got room temp pitchers, refrigerated pitchers, and ice-cube trays all with 'good' water. When we wash lettuce for salads, we pour water from the pitcher on the counter into a bowl, instead of running the tap from the sink. It's great - still no digestive issues!
It's been SO NICE to prepare our own food, in our own kitchen. Great to explore the local grocery stores and markets; we've tried some new fruits and veggies that we've never seen or heard of before, and we always wash them carefully in our purified water! We've also enjoyed trying to re-create some of our favourites from home (eg: How to make tacos when there are no Old El Paso taco kits on the shelf? Where is the bacon...plenty of other pork cuts, but no bacon? There are no salad dressings in the grocery store, so oil & vinegar should be fine - but the 'veggie' oil is made from cotton? All the milk is on the shelves - not refrigerated - with expiry dates in 6 months?).
We leave our Arequipa apartment in 10 days to resume our travels in Peru and beyond. It will be good. It will be a return to the restaurant scene. We'll continue to make good food and water choices, and fingers crossed, our stomachs will remain healthy!
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