Your well-meaning relatives wave as you head out the door for an exotic journey to a strange land. It’s all smiles and excitement until your Aunt Gladys (we all have an Aunt Gladys) rushes up and slips you a packet of pink pills, kisses you on the cheek leaving a fresh, bright red lipstick mark, and says, “Don’t drink the water, dear…”

Your smile turns a little bit uneasy as you turn and head off on your adventure.

Now for the young, and young at heart, not drinking water to avoid traveler’s diarrhea (TD) may seem easy. Simply drinking alcohol! You know rum on the beach and dos cervezas and lime; however, you’ll quickly learn dehydration and hangovers do not make for a memorable trip. And then there is ice, and showers, and brushing your teeth with…water.

Can you brush your teeth with tequila?

The Looming Promise of TD (Traveler’s Diarrhea)

Any change in your environment, foods, spices, and water source can challenge your gut. Your body is accustomed to what it gets on a daily basis. It may have built up immunity to any bacteria commonly found at home.

But when you’re exposed to other cultures, climates, and environments, new things – good and bad – are introduced to your body.

Part of the fun of traveling is experiencing the culture and the food. However, that street vendor may not be working up to food safety standards you expect at home. In areas where water is scarce and/or expensive, the cost of washing hands or fresh foods prior to cooking and serving may be high so it’s not common practice.

At least half of travelers experience TD in various forms and degrees. How bad it is and how long it lasts really depends on what caused it and your own personal health. Those conditions vary so blanket advice is hard to give.

As with everything – if you are traveling outside of the country, talk with your doctor to discuss possible risks and solutions and how to prevent TD based on your personal health history and where you are traveling. Because different “bugs” are found in different regions; each “bug” has its own form of prevention and cure.

Can I Prevent Traveler’s Diarrhea?

Developing countries pose the highest risk. The Centers for Disease Control (CDC) has identified three risk levels:

  • Low: United States, Canada, Australia, New Zealand, Japan, and other countries in Northern and Western Europe
  • Intermediate: Eastern Europe, South Africa, some Caribbean islands
  • High: Most of Asia, the Middle East, Africa, Mexico, and Central and South America

Your first line of defense is your own health prior to leaving home. You’re most likely familiar with the benefits of vitamin and mineral-rich foods, taking a daily multi-vitamin, and some supplements based upon your own health and goals. Boosting the health of your immune system prior to travel may help if you are affected by TD.

Some people may be more susceptible to TB including:

  • Persons with inflammatory bowel diseases (IBD);
  • Those with diabetes;
  • Immuosuppressed persons;
  • People who take H-2 blockers or antacids because a decrease in stomach acidity allows more infectious agents to survive.

Once yoy get to your destination, be aware of your surroundings especially when it concerns what you eat and drink, and the cleanliness of the water and sanitation practices of food servers and preparers. If something doesn’t look or smell right, follow your gut instincts…your gut may thank you later!

Actions you can take to avoid TD

  • Avoid eating undercooked meat or seafood. All raw foods are subject to contamination.
  • Drink bottled beverages, including and especially water.
  • Tap water and dairy products should be avoided. Unpasteurized products may cause problems.
  • Tea and coffee should be prepared with boiled or bottled water.
  • Alcohol is usually fine, but ice cubes may not be.
  • Brush teeth with bottled water (or tequila, I suppose!)
  • Fresh produce may be washed with tap water, be aware of the cleanliness of that water.
  • Try to eat fresh produce which you can peel yourself (bananas, oranges, cantaloupe).
  • Wash your hands before eating. Carry an alcohol-based hand sanitizer if soap and water is not readily available or unclean.
  • If you’re swimming in water that is warm and may include bacteria, consider wearing a nose plug or covering your nose before diving in. This includes pools, fountains (splash pads or spray parks) hot tubs, spas, rivers, streams, lakes, and oceans. You should avoid water that is near storms drains or swimming after a heavy rainfall.
  • Take a preventative dose of bismuth subsalicylate (BSS) which is the active ingredient in Pepto-Bismol (thank you Aunt Gladys). There is research that shows taking either 2oz of liquid or 2 chewable tablets 4 times a day reduces the incidence of TD by about 50%. However, this can cause some side effects including blackening of the tongue and stool, nausea, constipation, and rarely tinnitus. You should avoid this BSS suggestion if you have an aspirin allergy, renal insufficiency, gout, or are taking anticoagulants, probenecid, methotrexate, or if you’re taking aspirin or salicylates for other reasons because the BSS could be toxic. You don’t want to take this for a long time or if you’re under the age of 12 or are a child with a viral infection (may cause Reye syndrome). So…the moral is the pink pill may reduce your risk of TD but it comes with precautions and risks of its own. Talk with your doctor before going this route to see if it’s necessary or advisable based on your destination and your personal health.
  • The CDC has also noted that some people have reported beneficial outcomes when using bovine colostrum as a daily prophylaxis for TD. These are marketed as a dietary supplement, not FDA approved, and has limited clinical trials to support whether it works or not so while it may help some, it cannot be fully recommended to prevent TD.

You’re a Rebel, you drank the water and downed a street taco and now…

You caught a bit of traveler’s diarrhea. Oops…but man, that street taco tasted pretty darn good on the way down!

The good news is that most cases of TD, when not severe or caused by one of the more nasty bugs, will work its way through your system in a few hours, up to 48 hours. Then, you’ll be back on your feet and on to your next food adventure.

Rest and rehydration are your first steps. The CDC says go ahead and take an anti-diarrhea medicine such as Imodium or Lomotil ONLY IF you do not have a high fever, extreme abdominal pain, or bloody stools. If you are experiencing extreme symptoms…head to the doctor.

Rehydration is important, especially in the little people – kids. They will experience dehydration before an adult. Great options are rehydration packs (many found at the local drug store like Walgreens and CVS) which can be mixed with bottled water:

  • Gatorade single serve
  • Pedialyte Powder packs
  • Nuun HydratingElectrolyte Packet
  • Adventure Medical Kits Oral Rehydration Salts (Found at REI)
  • Drip Drop Hydration Powder
  • ORS – Oral Rehydration Solution provided by World Health Organization (WHO)
  • Overly sweet drinks, like soda, should be avoided because they can cause osmotic diarrhea when consumed in large quantities.

If you believe you are going into a high-impact area or your personal health may put you at an extreme risk, talk with your doctor. She may suggest you carry an antibiotic with you and use it as needed rather than going to the local doc. Some developing areas have counterfeit medications or hospitals that are not safe or sanitary. By carrying your own, you can self-treat your symptoms based on your doctor’s recommendation. Antibiotics which may be prescribed are Ciprofloxacin, zithromycin, or rifaximin.

Again, this depends on where you are traveling, your personal health history, and any medications or natural supplements you may be taking.

Quick List of Items to Take:

  • Alcohol-based hand sanitizer
  • Imodium or Lomotil
  • Iodine tablets for water (may remove many “bugs”…but not all)
  • Rehydration packs
  • Refillable water bottles (so you can boil and carry your own)
  • All emergency numbers and pertinent medical information

At the end of the day we all want to enjoy our travels with the greatest amount of good experiences while avoiding preventable bad ones. Be aware, carry what you need, and live life!