Traveler’s diarrhea: avoiding the runs

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(First of two parts)

Traveler’s diarrhea is nobody’s favorite topic — until they have it.

There is solid data showing a fair chance of having your digestive system act up when you travel. This may range from mild discomfort to severe illness impacting your journey — and even prematurely terminating the trip. This could include belly aches, cramps, diarrhea, nausea or vomiting. Some travelers, on the other hand, get constipated. (I have had patients state they wish they had that problem!)

Most cases of traveler’s diarrhea are benign; that is, while on occasion distressing, they are not serious. This condition usually arises from your body’s adjusting to new conditions, and it passes naturally in a matter of days. Many cases, however, are more serious, with not just the discomfort described above but with dehydration and weakness which can severely impact a traveler’s ability to travel.

Diarrhea is an increase in the number of stools, which may be loose and unformed or watery. Dysentery occurs if blood or mucous is in the stool, and you may also have a fever. Cholera is an intense watery diarrhea with flecks of mucous, like rice water, which can dehydrate you rapidly. Dysentery and cholera are both serious conditions.

There are many causes of traveler’s diarrhea. They can include germs, food poisoning, stress, jet lag and even irritable bowel syndrome. Among germs, viruses and bacteria are the main culprits; protozoa and worms are other infections which can upset the intestinal tract.

There are many myths about avoiding traveler’s diarrhea, but most are truly without foundation. A traveler can minimize risk but not completely avoid risk. Risk varies with many factors: the type of travel (e.g., adventurous/rustic versus luxury), the season of travel (rainy season?), the destination (poor rural village or modern megalopolis), the type of restaurants frequented, the type of food eaten, your hygiene and underlying health (e.g., washing hands and people with acidic stomachs have better protection against traveler’s diarrhea).

With some intestinal infections, there can be an unfortunate complication: a persistent change in the intestinal function which may last weeks to years in some cases. This is a post-infectious malabsorption syndrome and can be due to low-grade persistent infection or to the damage left behind from the infection even though the germ may be long gone.

Some gastrointestinal infections can be avoided or diminished with vaccination. These include hepatitis A, typhoid and polio.

So what can you eat? In general, anything that is freshly cooked or piping hot is safe. The hotter, the fresher and the steamier, the safer the food will be. Reheated or warm foods, like those in buffets, are more likely to carry germs.

Avoid raw food as much as possible, and be careful about salads. Thick-skin fruits that you peel yourself are generally safe, such as bananas. Thin-skin fruits, like apples, should be taken whole (not precut unless you know their knife was clean), wiped or washed, then peeled and eaten. Salads can be problematic anywhere: simple washing does not always remove all germs.

Freshly boiled water is safe, such as steaming-hot freshly brewed tea, coffee and soup. Beer and wine are usually safe. Carbonated sodas are also safe, but beware of adding ice, which is often made from tap water. Bottled water is usually safe, but make sure the seal on the cap is intact and that there aren’t any particles floating in the water. Carbonated water is safer than flat water, but it’s not as hydrating.

Please wash your hands before handling foods and after visiting the toilet.

The old adage “Cook it, wash it, peel it or forget it” doesn’t always work. You could be in a 5-star hotel without a germ in the neighborhood, but if the guy making your food (who is typically a local) doesn’t wash his hands or cuts meat on the same board as salad, then there is little you could do to stop it.

So enjoy the food — local cuisine is one of the delights of travel — but in moderation. Then if you get traveler’s diarrhea, learn how to treat it on your own.

Healthy travels!

In the next issue: managing the runs on the run.

Dr. Spira is medical director of the Travel Medicine Center, 131 N. Robertson Blvd., Beverly Hills, CA 90211; visit www.healthytravel.com.

Please login or subscribe to ITN to read the entire post.

(First of two parts)

Traveler’s diarrhea is nobody’s favorite topic — until they have it.

There is solid data showing a fair chance of having your digestive system act up when you travel. This may range from mild discomfort to severe illness impacting your journey — and even prematurely terminating the trip. This could include belly aches, cramps, diarrhea, nausea or vomiting. Some travelers, on the other hand, get constipated. (I have had patients state they wish they had that problem!)

Most cases of traveler’s diarrhea are benign; that is, while on occasion distressing, they are not serious. This condition usually arises from your body’s adjusting to new conditions, and it passes naturally in a matter of days. Many cases, however, are more serious, with not just the discomfort described above but with dehydration and weakness which can severely impact a traveler’s ability to travel.

Diarrhea is an increase in the number of stools, which may be loose and unformed or watery. Dysentery occurs if blood or mucous is in the stool, and you may also have a fever. Cholera is an intense watery diarrhea with flecks of mucous, like rice water, which can dehydrate you rapidly. Dysentery and cholera are both serious conditions.

There are many causes of traveler’s diarrhea. They can include germs, food poisoning, stress, jet lag and even irritable bowel syndrome. Among germs, viruses and bacteria are the main culprits; protozoa and worms are other infections which can upset the intestinal tract.

There are many myths about avoiding traveler’s diarrhea, but most are truly without foundation. A traveler can minimize risk but not completely avoid risk. Risk varies with many factors: the type of travel (e.g., adventurous/rustic versus luxury), the season of travel (rainy season?), the destination (poor rural village or modern megalopolis), the type of restaurants frequented, the type of food eaten, your hygiene and underlying health (e.g., washing hands and people with acidic stomachs have better protection against traveler’s diarrhea).

With some intestinal infections, there can be an unfortunate complication: a persistent change in the intestinal function which may last weeks to years in some cases. This is a post-infectious malabsorption syndrome and can be due to low-grade persistent infection or to the damage left behind from the infection even though the germ may be long gone.

Some gastrointestinal infections can be avoided or diminished with vaccination. These include hepatitis A, typhoid and polio.

So what can you eat? In general, anything that is freshly cooked or piping hot is safe. The hotter, the fresher and the steamier, the safer the food will be. Reheated or warm foods, like those in buffets, are more likely to carry germs.

Avoid raw food as much as possible, and be careful about salads. Thick-skin fruits that you peel yourself are generally safe, such as bananas. Thin-skin fruits, like apples, should be taken whole (not precut unless you know their knife was clean), wiped or washed, then peeled and eaten. Salads can be problematic anywhere: simple washing does not always remove all germs.

Freshly boiled water is safe, such as steaming-hot freshly brewed tea, coffee and soup. Beer and wine are usually safe. Carbonated sodas are also safe, but beware of adding ice, which is often made from tap water. Bottled water is usually safe, but make sure the seal on the cap is intact and that there aren’t any particles floating in the water. Carbonated water is safer than flat water, but it’s not as hydrating.

Please wash your hands before handling foods and after visiting the toilet.

The old adage “Cook it, wash it, peel it or forget it” doesn’t always work. You could be in a 5-star hotel without a germ in the neighborhood, but if the guy making your food (who is typically a local) doesn’t wash his hands or cuts meat on the same board as salad, then there is little you could do to stop it.

So enjoy the food — local cuisine is one of the delights of travel — but in moderation. Then if you get traveler’s diarrhea, learn how to treat it on your own.

Healthy travels!

In the next issue: managing the runs on the run.

Dr. Spira is medical director of the Travel Medicine Center, 131 N. Robertson Blvd., Beverly Hills, CA 90211; visit www.healthytravel.com.