What You Need to Know About Travelers Diarrhea
Travelers diarrhea, also called “turista” and “Montezuma’s Revenge” effects about 50% of those who travel internationally. Symptoms may include the following
The symptoms above may last anywhere between between 2-7 days depending on the offending pathogen.
It’s important to note that for short term travelers, having one bout of travelers diarrhea will not protect you from contracting it again during the same trip so you must remain vigilant
Diarrhea caused by either bacterial or viral pathogens may take 6-72 hours to show symptoms from time of ingestion. Symptoms after ingesting a bacterial formed toxin may only take a few hours to show. What is important to note is that for some of the protozal pathogens, it could take a couple weeks to show symptoms. You may already be home from your vacation before you begin to have gastrointestinal upset.
How and Why?
The symptoms of travelers diarrhea are caused by bacteria around 85% of the time and a virus about 9% of the time. There is an increased risk of diarrhea while traveling because some of the warm climate travel destinations have less access to clean water and hygienic practices, such as hand washing, may not be a social norm. The lack of access to clean drinking water, and plumbing also contribute to the contamination problem. Flies that land on food and surfaces also spread the pathogens that are the cause of travelers diarrhea.
These tropical destinations may also have limited or unreliable refrigeration or frequent blackouts that can increase the risk of bacteria growth on food due to inadequate temperature control.
Coming into contact with contaminated water while brushing teeth, bathing, swimming in pools, rivers, lakes or oceans can also cause travelers diarrhea.
Although there is no way to 100% prevent travelers diarrhea, there are a few approaches to reduce the risk.
- Watch what you eat and drink
- Practice good hygiene
- Non-antibiotic prophylaxis
- Antibiotic prophylaxes (not a great option)
First and foremost, wash your hands carefully with soap and water before preparing food, eating and after using the restroom. Remember that if the wash water is contaminated then your hands will be too.
When soap and clean water are not available then use either a high alcohol content hand sanitizer or something antibacterial made with essential oils. I like doTERRA On-Guard spray when water isn’t available; it can kill bacteria and it smells good.
It is also a good idea to brush your teeth with bottled water and ensure you are not getting any water in your mouth while bathing or swimming.
Food and Drink
Rules 1-4: Boil it, cook it, peel It or forget it.
Boil it: This means that drinking hot coffee and tea should be OK, as long as it was served while it was very hot. This also means pasteurized foods are also good to eat. Be aware of dairy that has been left non-refrigerated for extended periods.
Cook it: Only eat fully cooked foods that are served hot. This includes fully cooked fruits, vegetables and meats.
Rare meats, soft boiled eggs, sushi, and unpasteurized dairy products and most raw fruits and vegetables are on the do not eat list. Watch out for fancy blender drinks with ice and fresh fruit.
Peel it: Only eat foods that you have peeled and that can be peeled. This means that bananas, citrus, apples and melons are safe, as long as you wash them thoroughly with clean water before cutting them open or peeling them.
The fruits and vegetables that you should avoid are those found in a raw salad, berries (because you can’t peel them) and fruit plates (because the fruit was peeled or cut from someone other than yourself.
A few more tips:
- You can drink bottled water, sodas, and eat canned foods.
- Dry foods like crackers, breads and chips are considered safe.
- Do not drink the water, fountain drinks or any drink with ice in it.
- Don’t eat ice pops or ice cream, or wild game.
- Don’t eat food from street vendors.
- Don’t eat warm moist foods or sauces.
- Acidify the stomach because lower stomach acid can help reduce susceptibility to ingested bacterial pathogens.
- Probiotics to help increase commensal bacteria and make bacterial pathogens unwelcome.
- Anti-viral, Anti Bacterial herbs to help your body destroy bacterial and viruses that get past your stomach.
- Pepto-Bismol: Not for those who are allergic to aspirin, but safer than antibiotics.
*Ask your doctor about specific products, strains and dosage of the above non-antibiotics you can use to help prevent travelers diarrhea.
Prophylactic use of antibiotics to prevent travelers diarrhea is generally not recommended because in addition to increasing the risk of antibiotic resistant bacteria, it can also cause symptoms that can be even worse than the travelers diarrhea it is trying to prevent. Side effects of antibiotics can be diarrhea, candidiasis and pseudo-membranous colitis.
If I Get Travelers Diarrhea
Although uncomfortable, your diarrhea will most likely resolve completely without out special treatment in 5-7days an be greatly improved within 2-3 days. You can try the following to help you stay hydrated and help with recovery.
Re-hydrate with oral rehydration salt solution. Ensure you are using clean water to rehydrate.
Eat simple foods while recovering, such as broths or soups and follow the BRAT diet
- Toasted white bread
Avoid Caffeine and dairy while sick and add back cautiously when you are feeling better.
Anti-Diarrhea medications: I would only recommend this for those with excessive diarrhea or when you need to travel and will not have access to a bathroom. Do not used these if you have a fever or bloody diarrhea.
What to bring on Vacation
- Oral rehydration salts: OTC in most pharmacies. Powdered forms are available for easy traveling.
- Pepto-bismol: OTC in most pharmacies
- Non Antibiotic Preventatives: See above
- Hand-Sanitizer: On-Guard spray or a 60% or more alcohol based product.
When to See A Doctor
See a doctor in the country that you are in if, after 3 days the symptoms have not improved, or you are experiencing high fever of 102 F or higher. Bloody stools and persistent vomiting are also and indication that you should seek medical attention. Muscle cramps, dry mouth, and decreased urine output indicate severe dehydration and the need to seek medical attention. bloody stools severe dehydration or ore sever pain.
Connor BA. Travelers’ Diarrhea – Chapter 2 – 2018 Yellow Book | Travelers’ Health | CDC. https://wwwnc.cdc.gov/travel/yellowbook/2018/the-pre-travel-consultation/travelers-diarrhea. Accessed February 14, 2019.
Yarnell E. Traveler’s Diarrhea. In: Natural Approach to Gastroenterology. 1st ed. seattle: Healing Mountain Publishing; 2011:871-876.
Traveler’s diarrhea – Diagnosis and treatment – Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/travelers-diarrhea/diagnosis-treatment/drc-20352188. Accessed February 14, 2019.