How to avoid and treat travelers’ diarrhea

Feb 7, 2021

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Eating is a fun way to explore a place and culture, but it poses the risk of spending part of a trip doubled over after eating or drinking something contaminated by bacteria, viruses or parasites. Most people are exposed to some amount of contaminated foods, but travel often exposes us to new ones or higher doses that can defeat the immunity we have already built up. And it’s not a rare occurrence — 30% to 70% of travelers come down with what’s known as travelers’ diarrhea, according to the Centers for Disease Control and Prevention.

What’s worse is that a bout of diarrhea might not be the end of it. One in 10 cases of traveler’s diarrhea develop into irritable bowel syndrome, a gastrointestinal disorder, according to Dr. Mark Pimentel, the executive director of the medically associated science and technology program at Cedars-Sinai in Los Angeles. An estimated 1 in 6 people in the United States experience IBS, with symptoms varying from constipation to nausea and ranging from mild to severe. It’s a long-term condition with no known cure.

Much of the risk depends on where and when you travel, but Pimentel said some general precautions can keep most stomachs healthy and happy.

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Mind the water

Contaminated water is a major source of bacteria that can sicken even the healthiest individuals. It’s common in developing countries — you can check the CDC website to see if a particular destination has safe drinking water. If not, rely on bottled water for drinking and brushing your teeth. If you want to avoid plastic, there are reuseable water bottles with filtration built in that remove bacteria and viruses. While out and about, beware of ice cubes and drinks like smoothies that may have water or ice as a hidden ingredient.

Occasionally, restaurants refill water bottles locally and put new caps on. If that looks to be the case, order sparkling water, which can’t be easily refilled. The carbonation is also acidic enough to kill bacteria. And there is always the option to skip water entirely and stick with soda, beer or wine, which Pimentel said are safe bets.

Related: How you can safely drink the tap water anywhere in the world

Avoid raw fruits and veggies

If you’re in a place where water is an issue, fresh fruits and vegetables have to be chosen with care. If you are craving fruit, pick something you can peel so you remove the part that was washed with water. Fresh salads, while usually healthy, are filled with vegetables that get doused in local water. Consider this tip as a doctor’s note to pick a greasier (and cooked) option.

Choose your street food wisely

For destinations like Mumbai and Bangkok with a rich street food culture, it’s a shame to miss out on delicious regional eats. One tip from the late and great Anthony Bourdain is to follow the locals. Spots that rely on repeat customers instead of one-off tourists are places that need to keep people healthy.

Related: The cheapest Michelin-starred meals around the world

Pimentel also suggests looking for food that is extremely hot and well cooked. If you can, get the food right off the burner when it’s hottest. And skip the garnishes, like herbs or fruits and veggies, which for the aforementioned reasons could be the Achilles’ heel of an otherwise safe meal.

Satay Hawker Singapore
A hawker working on the famous Satay Street in Singapore. (Photo by Aaron Massarano/Getty Images)

Start your caution on the plane

Being kind to your belly starts on the way to your destination if you’re flying. The pressurization on a plane lets the gas in your gut build up and it can take hours to dissipate. If you want to get off the plane ready to travel and eat comfortably, skip foods that will make you gassy, like beans and processed carbs. Carbonated drinks like soda can also cause the gas to build up and should be avoided. Instead, stick with lean meats, nuts and vegetables such as lettuce, tomatoes, zucchini and avocados.

Related: It’s not just you: Why everyone gets gassy and bloated on airplanes

Travel with supplies

Taking care of traveler’s diarrhea early can help prevent IBS from developing, according to Pimentel. Before traveling, sensitive people should consult with a doctor who might prescribe antibiotics, like rifaximin and ciprofloxacin. The International Society of Travel Medicine has a list of travel clinics where people can search for a local option.

But it’s not a bad idea for everyone to stock up on charcoal tablets, which can calm your digestive system and reduce gas, as well as something with bismuth in it like Pepto Bismol, which provides relief along with its antibacterial properties. One thing that doesn’t work? Probiotics. They can cause bloating and distension, making you feel much worse.

Related: Rx for jail? What to know before taking your meds abroad

If it does happen, keep calm and hydrated

Despite best efforts, travelers can still pick up a bug. In that unfortunate event, it’s important to stay hydrated, and for comfort, it’s probably best to stick close to a bathroom. Many issues clear up after a day, but if it lasts more than a few days or there is blood in the stool, see a doctor.

Bottom line

Getting traveler’s diarrhea is no fun, but there are steps you can take to avoid it. Depending on where you go, consider sticking with bottled water, skipping uncooked veggies and fruits, and when it comes to street foods, pick the hottest food available at the busiest stalls. If you are at a higher risk of getting sick, make sure to consult a doctor before going abroad. And if all else fails, take some time off and stay hydrated (with bottled water).

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