Travel Tip Tuesday | Something No One Wants When Travelling

Travel Trip Tuesday | Travelers’ Diarrhea

Many traveler ills stem from misunderstanding or ignorance of how to minimize the risk of non-life-threatening illnesses like travelers’ diarrhea. It is the most common infection that affects some travelers - not some rare tropical disease!  Keep in mind that there is also a range of nontropical, noninfectious causes of diarrhea that are not related to travelers but may occur coincidentally. 

There are as many names for travelers’ diarrhea as there are the kinds of germs that cause it. There is gastroenteritis, food poisoning, upset stomach, Montezuma’s revenge, gyppy tummy, Delhi belly, Tandoori trots, Aztec two-step, and the runs to name a few. The most common culprit causing this malady is known as enterotoxigenic Escherichia coli or ETEC. These little buggers cause the outpouring of water and salt into the bowls resulting in 24 to 48 hours of frequent trips to the bathroom. Studies have shown that ETEC is responsible for 40% of travelers’ diarrhea, especially in Africa and Central and South America. 

The vast majority of travelers’ diarrhea is caused by poor food handling practices. Contaminated hands that are not clean can carry millions of harmful microbes which will find their way into food and water, and breed to produce millions more microbes thus producing harmful bacteria that causes intestinal symptoms. The good news is that none of these microbes survives cooking. Well-cooked piping hot meals are safe, but food that is cooked and allowed to go cold and then is handled by someone is risky. Cold dishes are not an option because of the possibility of being poorly stored or touched with dirty hands. Salads are sometimes grown in the contaminated ground and low-growing fruit, or any fruit that cannot be peeled can be risky.

Dehydration is the biggest concern of travelers’ diarrhea. The key challenge when you begin a bout of diarrhea is to replace the lost fluids, even if you don’t feel like drinking or eating anything. During diarrhea, the stomach and intestines don’t absorb fluids efficiently so the fluids that you drink must be taken with a mixture of water, salt, and a carbohydrate like sugar. There are several brands of oral rehydration salt (ORS) solutions available that prevent dehydration by replenishing lost fluids and restoring key electrolytes. Antidiarrheal medications like Imodium and Lomotil can reduce the symptoms but do not treat the infection. For severe diarrhea, as defined by the World Health Organization as three or more loose stools within eight hours, you may want to take an antibiotic. Many wise travelers pack ORS, anti-diarrheal medication, and a course of antibiotics just in case. The basic takeaway is if you get travelers’ diarrhea, drink, drink, drink!

We have put together the following tips to keep in mind to avoid travelers’ diarrhea:

1) The Mantra - peel it, boil it, cook it, or forget it.

2) Choose freshly cooked piping hot food rather than reheated food or food kept lukewarm on a buffet.

3) Avoid salads, especially lettuce and other un-cleanable fruits like berries.

4) Avoid mayonnaise, it can carry Salmonella.

5) Avoid fried rice because it can be made with leftover unrefrigerated ingredients that are not adequately reheated.

6) Only drink boiled milk, in some countries, milk is not pasteurized, even if it says it is, it is best to ask for boiled milk to be on the safe side. 

7) Forget ice cream in developing countries where power cuts make it difficult to store.

8) Never have a cold drink with ice. Often ice is made with dirty water or handled with dirty hands. 

9) Drink bottled water. Colas and other carbonated drinks should be safe. Beware of homemade drinks that involve a lot of handling when being made. If you need really safe water, ask for it to be boiled. After boiling, the next best thing is to treat water with chemicals like an iodine purification tablet.

Even the most careful traveler sometimes suffers a bout of diarrhea so always keep the tips above in mind and travel with rehydration packets, just in case.