What are the most effective ways to avoid traveler’s diarrhea. How can you protect yourself from foodborne illnesses while traveling abroad. What precautions should you take with water and food when visiting developing countries.

Understanding Traveler’s Diarrhea: Causes and Prevalence

Traveler’s diarrhea is the most common travel-related illness, affecting tourists visiting various parts of the world. It is particularly prevalent in countries across Asia (excluding Japan), the Middle East, Africa, and South and Central America. While rarely life-threatening, this condition can significantly disrupt travel plans and cause considerable discomfort.

Why does traveler’s diarrhea occur? The primary reason is exposure to unfamiliar bacteria. When individuals from resource-rich countries visit resource-limited areas, they may encounter common bacteria in food that, while harmless to locals, can be problematic for visitors whose immune systems are not accustomed to these microorganisms.

Common Bacterial Culprits

According to a study in Gastroenterology & Hepatology, over 60% of traveler’s diarrhea cases are attributed to the following bacteria:

• Escherichia coli
• Shigella
• Campylobacter
• Salmonella
• Aeromonas
• Plesiomonas
• Non-cholera Vibrios

The severity of traveler’s diarrhea can vary widely, ranging from mild discomfort to severe symptoms. In cases where diarrhea is accompanied by blood, immediate medical attention is crucial.

Essential Food Safety Practices for Travelers

One of the most effective ways to prevent traveler’s diarrhea is by being vigilant about food choices and consumption habits. How can you ensure the safety of the food you eat while traveling?

Choose Freshly Cooked, Hot Meals

Opt for meals that are cooked to order and served hot. This practice significantly reduces the risk of bacterial contamination. Avoid food from vendors where items have been exposed for extended periods or where sanitation practices appear questionable.

Be Cautious with Raw Foods

Raw foods pose a higher risk of contamination. When consuming fruits and vegetables, it’s advisable to purchase them from grocery stores and peel them yourself. This precaution helps minimize exposure to potentially harmful bacteria on the surface of produce.

Water Safety: A Critical Aspect of Traveler’s Health

Water safety is paramount in preventing traveler’s diarrhea. In many developing countries, tap water can harbor harmful bacteria and viruses. What precautions should you take regarding water consumption?

Stick to Bottled Water

Always carry bottled water with you when traveling. This practice ensures that you have access to safe drinking water at all times. When ordering beverages, request them without ice, as ice is often made from tap water and can introduce harmful microorganisms.

Shower Safety

An often-overlooked aspect of water safety is shower water. When visiting resource-limited countries, it’s advisable to keep your mouth closed while showering. This simple precaution can prevent accidental ingestion of potentially contaminated water.

The Antibiotic Debate: To Pack or Not to Pack?

Historically, travelers from the United States were often advised to carry antibiotics as a precautionary measure against traveler’s diarrhea. However, this practice has come under scrutiny in recent years. Why has the medical community shifted its stance on pre-packing antibiotics?

The Rise of Antibiotic Resistance

Decades of antibiotic use by travelers has contributed to the development of antibiotic-resistant strains of bacteria, such as E. coli. This resistance can render antibiotics ineffective in treating infections.

Impact on Beneficial Bacteria

Another concern is that antibiotics can eliminate beneficial bacteria in the gut, which play a crucial role in protecting against infections. This disruption of the gut microbiome can potentially leave travelers more vulnerable to other health issues.

Current Recommendations

The Centers for Disease Control and Prevention (CDC) now advises consulting with a doctor before deciding to take antibiotics on overseas trips. This personalized approach ensures that the benefits and risks are carefully weighed for each individual traveler.

Alternative Prevention and Treatment Options

Given the changing stance on antibiotics, what alternatives are available for preventing and treating traveler’s diarrhea?

Over-the-Counter Options

Products like Pepto-Bismol or generic bismuth formulations can be helpful in managing symptoms. These medications work by reducing inflammation and neutralizing stomach acidity. It’s worth noting that bismuth-containing products may cause a harmless black discoloration of stool.

Professional Medical Treatment

In cases of severe traveler’s diarrhea, seeking professional medical care is crucial. Hospitals or medical facilities in your travel destination can prescribe appropriate medications for treatment. A study published in Clinical Infectious Diseases found that a combination of antibiotics, typically including single-dose azithromycin, levofloxacin, and rifaximin with loperamide, was most effective for rapid symptom relief.

Hydration: A Key Component in Managing Traveler’s Diarrhea

Maintaining proper hydration is crucial when dealing with traveler’s diarrhea. How can you ensure adequate fluid intake during this condition?

Importance of Fluid Replacement

Diarrhea leads to significant fluid loss, making it essential to replenish these fluids continuously. Always keep bottled water on hand and drink frequently, even if you don’t feel thirsty.

Oral Rehydration Solutions

In cases of severe dehydration, the CDC recommends using oral rehydration solutions. These specially formulated drinks, available at local drugstores or online, help replace not just water but also essential electrolytes lost during bouts of diarrhea.

Cultural Sensitivity and Food Safety

While prioritizing health and safety, it’s equally important to approach local cuisines and eating habits with cultural sensitivity. How can travelers balance health concerns with respect for local culinary traditions?

Embracing Local Food Culture Safely

Instead of completely avoiding local cuisine, seek out reputable establishments that cater to both locals and tourists. These venues often maintain higher hygiene standards while still offering authentic local flavors.

Educating Yourself on Local Practices

Before your trip, research local food preparation and eating customs. This knowledge can help you make informed decisions about what to eat and how to eat it safely, without offending local sensibilities.

Long-Term Travel and Building Immunity

For those embarking on extended travel or considering relocation to a different country, the concept of building immunity to local microbes becomes relevant. How does prolonged exposure affect susceptibility to traveler’s diarrhea?

Gradual Adaptation

Over time, the human body can adapt to local microbial environments. Long-term travelers or expats may find that their susceptibility to traveler’s diarrhea decreases as their immune system becomes accustomed to local bacteria.

Maintaining Vigilance

However, it’s crucial to maintain good hygiene and food safety practices even as you adapt. While your risk may decrease, it doesn’t disappear entirely, and caution remains advisable.

Traveler’s diarrhea, while common, doesn’t have to be an inevitable part of your journey. By following these preventive measures and understanding the risks, you can significantly reduce your chances of experiencing this uncomfortable condition. Remember, the key to a healthy trip lies in a combination of preparedness, caution, and respect for local conditions. With these strategies in place, you can focus on enjoying your travel experiences to the fullest, knowing you’ve taken important steps to protect your health.

Four Tips to Prevent Traveler’s Diarrhea

Traveler’s diarrhea is the most common travel-related illness. Here’s how to prevent it from happening on your next vacation.

By Brian MastroianniMedically Reviewed by Michael Natter, MD

Reviewed: August 10, 2022

Medically Reviewed

There are steps you can take to prevent traveler’s diarrhea.Alamy

Local food gone wrong: It may not be a tourist’s worst nightmare, but it’s certainly one of the most uncomfortable.

Traveler’s diarrhea, the top travel-related illness, can take place anywhere, but it occurs most in countries in Asia (exception: Japan). It’s also common in countries in the Middle East, Africa, and South and Central America, according to the Centers for Disease Control and Prevention (CDC). (1)

Traveler’s diarrhea is rarely life-threatening, but if nothing else, it can make an otherwise pleasant trip go south quick.

“If you’re from a resources-rich country and travel to a resource-limited country, some of the common bacteria that might be found in food that wouldn’t be very harmful to the local population could be harmful to you because you don’t have an immune system that is used to that bacteria,” says Christine Lee, MD, in the gastroenterology, hepatology, and nutrition division at Cleveland Clinic.

According to a study in Gastroenterology & Hepatology, more than 60 percent of traveler’s diarrhea cases are caused by the following bacteria: (2)

• Escherichia coli
• Shigella
• Campylobacter
• Salmonella
• Aeromonas
• Plesiomonas
• non-cholera Vibrios

“Traveler’s diarrhea could be mild to severe; it’s a wide range and a case-by-case situation,” says Dr. Lee. “If you find yourself experiencing diarrhea that is very bloody, you should be very concerned and head to an ER immediately.”

Lee outlines four tips to help prevent traveler’s diarrhea.

1. Watch What You Eat

Are you buying from vendors whose food looks like it’s exposed for long periods of time? Where sanitization practices might be sketchy?

It’s important when traveling to a new place to avoid these mistakes and eat foods that are cooked to order and served hot, Lee says. Avoid eating anything raw or that has been sitting out for hours on end, and peel all fruits and vegetables yourself after purchasing them from a grocery store.

2. Close Your Mouth in the Shower

In most developing countries, tap water can contain harmful bacteria and viruses and is not safe to drink. Always have bottled water on you when traveling and order any other beverages without ice, which is usually made from tap water.

Lee also tells visitors visiting resource-limited countries to close their mouths when showering, since shower water is another way they might ingest harmful bacteria.

3. Be Careful About Bringing Antibiotics With You

In the past, doctors would often suggest that people from the United States pre-pack antibiotics with them in case traveler’s diarrhea strikes. But Lee says the “pendulum has swung” in the opposite direction. Lee explains that decades of travelers from resource-rich countries to the developing world has bred antibiotic-resistant E.  coli, for instance, which would render antibiotics useless.

“Another point about pre-packing antibiotics involves the fact that a lot of antibiotics can wipe out the good bacteria that can help protect you from infections,” she adds.

The CDC recommends that you always ask your doctor first before taking any antibiotics with you on a trip overseas. (1)

What is a good alternative? Lee says that packing something like Pepto-Bismol, which reduces inflammation and neutralizes acidity in the stomach, can help. And don’t be alarmed if you notice the pink Pepto-Bismol substance turns your stool color black. Lee says this is a normal reaction. She says you can buy any generic brand of bismuth in a drug store.

And if you do get a severe case of traveler’s diarrhea, visit a hospital or medical facility right away so they can prescribe you medication for treatment. A study published in Clinical Infectious Diseases found that a combination of antibiotics, typically a single-dose azithromycin, levofloxacin, and rifaximin with loperamide were the most frequent treatments administered for rapid response. (3) These are all prescriptions that would be given to you by a doctor to help you with your symptoms.

4. Drink Lots of Fluid

If you do get traveler’s diarrhea, keep your bottled water at hand, Lee adds. It’s important to stay hydrated and replace fluids that have been lost by your body.

If you’re severely dehydrated, the CDC advises to find oral rehydration solutions at local drugstores or online to replace necessary fluids.

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Editorial Sources and Fact-Checking

1. Traveler’s Diarrhea. Centers for Disease Control and Prevention. May 3, 2022.
2. De la Cabada Bauche J, DuPont HL. New Developments in Traveler’s Diarrhea. Gastroenterology & Hepatology. February 2011.
3. Riddle MS, Connor P, Fraser J, et al. Trial Evaluating Ambulatory Therapy of Travelers’ Diarrhea (TrEAT TD) Study: A Randomized Controlled Trial Comparing 3 Single-Dose Antibiotic Regimens With Loperamide. Clinical Infectious Diseases. December 15, 2017.

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the 6 Foods to Have and the 6 to Avoid

What to Eat With Diarrhea: the 6 Foods to Have and the 6 to Avoid

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This article was medically reviewed by Jason R. McKnight, MD, MS, a family medicine physician and clinical assistant professor at Texas A&M College of Medicine. 

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If you have diarrhea, make sure to eat foods that are light on the stomach like soup and crackers.

Stephanie Starr / EyeEm/ Getty Images

• When you have diarrhea, avoid greasy, sugary, and spicy foods.  
• Eat foods that are easy on the stomach like soup, boiled vegetables, crackers, and lots of liquids.
• The BRAT diet (bananas, rice, applesauce, and toast) can help over short periods of time as well.

If you have diarrhea, food may be the last thing on your mind. However, it’s crucial to stay hydrated and get adequate nutrition during a bout of diarrhea, says Deepti Mundkur, MD, a primary care physician with her own practice in San Diego. According to the Cleveland Clinic, dehydration is one of the biggest dangers of diarrhea.

Some foods can make an upset stomach worse, so it is important to eat foods that are easy on the tummy. Boiled vegetables, low-fiber starches, lean poultry, crackers, soup, and eggs are some of the foods that are recommended for patients with diarrhea, says Mundkur.

On the other hand, foods to avoid include spicy foods, sugary foods, dairy products, and  foods with a high fat content. You should also avoid foods that give you gas.

You may have heard of the BRAT diet of bananas, rice, applesauce, and toast, which is a traditional remedy for diarrhea. It isn’t a diet that you should go on long term, but can be helpful over short periods of time. 

Here are some foods you should eat when you have diarrhea, to help ease your symptoms and speed up your recovery. 

1. Low-fiber starches and cereals 

While fiber is a critical nutrient that adds bulk to stool and keeps your bowel movements regular, a low-fiber diet is recommended when you have diarrhea since it makes digestion easier and reduces the frequency of bowel movements. Mundkur says boiled rice, noodles, wheat, or oats can help, especially if you have watery stools.  

2. Boiled vegetables 

Raw vegetables can be harder to digest and can cause discomfort in the form of gas and bloating, so boiled vegetables may be easier on your system when you have diarrhea. Mundkur recommends opting for boiled vegetables like green beans, potatoes, and carrots.

3. Soup and crackers

Soup can help replenish your fluid and nutrient levels, whereas crackers are helpful since they typically have a high salt content. Diarrhea can result in considerable loss of fluid and electrolytes, which are minerals like sodium and potassium, so eating salty foods can help restore them.

4. Lean chicken or turkey

Greasy foods with a high fat content can make your diarrhea worse, so opt for low-fat meat options like skinless chicken or turkey. Mundkur recommends baking the meat and eating it unseasoned, since spices and seasonings can irritate your system. You can use dry or fresh herbs, like basil, parsley, thyme, rosemary, oregano, or cilantro to flavor the meat, says Mundkur.

5. Eggs

Cooked eggs are safe to consume when you have diarrhea. Opt for preparations that don’t involve a lot of butter, cheese, or seasonings, like scrambled eggs seasoned with salt.

While the BRAT diet, consisting of bananas, rice, applesauce, and toast, was once prescribed to treat diarrhea, the International Foundation for Gastrointestinal Disorders says that this diet is not nutritionally adequately for long periods of time. However, you can eat these foods when you have a short bout of diarrhea.

If you don’t have an appetite, or if you have nausea or vomiting in addition to diarrhea, Mundkur says you can stick to only liquids for a short while, until you’re able to tolerate some food. Liquids are easier to digest and can help prevent bowel irritation. 

6. Bananas 

The carbs in bananas are easy to digest and aren’t too hard on the gut, registered dietitian nutritionist Beth Warren, told Women’s Health. They also help poop to pass through the intestines more easilly.

Liquids to drink when you have diarrhea:

• Water
• Applesauce 
• Diluted fruit juice
• Clear soup or broth 
• Weak, decaffeinated tea or coffee 
• Electrolyte-rich drinks, like Gatorade or Pedialyte
• Frozen popsicles
• Gelatin
• Coconut water
• Oral hydration solution products.

6 types of foods you should avoid eating if you have diarrhea

These are some foods that tend to worsen diarrhea. Mundkur recommends checking with your doctor about what foods might trigger diarrhea for you if you have it chronically (i.e. over an extended period of time or very frequently), individually, as food intolerances can lead to diarrhea. 

1. Foods high in fat

Foods that have a high fat content can make diarrhea worse, resulting in more trips to the bathroom as well as greasy and smelly stools. Mundkur says this can happen because diarrhea can sometimes temporarily affect your body’s ability to absorb fat. Fat typically takes longer to digest so it slows down the movement of food through your system; however, if your body is unable to digest fat, food may pass through your system a lot faster.

“Foods with a high fat content should be avoided until gut function returns to normal after a severe bout of diarrhea,” says Mundkur. Some foods to avoid include fried foods, meat dishes with added fat or a high fat content, nuts, and creamy sauces or dressings. 

It’s also worth noting that the reverse can also happen sometimes — you may develop fat malabsorption, which is the inability to digest fats, and that can lead to chronic diarrhea, says Mundkur. 

2. Dairy products

According to Mundkur, you may not be able to adequate digest dairy products while you have diarrhea, and sometimes up to several weeks or months after your illness. Dairy products to avoid include milk, cheese, cream, and butter; yogurt however is the exception because it’s a probiotic that can help treat diarrhea, says Mundkur. “Plain yogurt is best since the added sugars in flavored yogurt are not easy on the gut during an episode of diarrhea,” she says.

3. Spicy foods

Spicy foods and seasonings can irritate your digestive system and add to your discomfort, so avoid them while you have diarrhea. Moreover, what makes spicy food so spicy going down might also make it spicy coming back out. Therefore, do your rump a favor and season your food with just salt or herbs instead, since that can help replenish your electrolyte levels. 

4. Sugary foods

Sugar can make diarrhea worse because it causes the gut to release a lot of water, resulting in loose stools. Avoid sugary foods and drinks, even those with artificial sweeteners like stevia and aspartame, like baked goods, candy, and soda when you have diarrhea.

5.

Foods that cause gas

Certain foods tend to cause gas and should be avoided when you have diarrhea, as they can worsen diarrhea and add to your discomfort. These foods include:

• Beans and legumes, like kidney beans and chickpeas, since they are high in fiber and contain certain raffinose, a complex sugar that is hard to digest
• Vegetables like broccoli, cabbage, cauliflower, and Brussels sprouts, since they also contain raffinose
• Chewing gum, as it can make you swallow a lot of air, leading to gas
• Aerated drinks, like soda pop, since they are carbonated and have a lot of gas

6. Salad

The insoluble fiber in salad can irritate the lining of the digestive tract, but it is OK to eat soft, cooked vegetables such as carrots. 

Treating diarrhea

Most cases of diarrhea are caused by viral infections, says Mundkur. They often clear up on their own, without requiring any treatment. But you can take over-the-counter medications like Pepto-Bismol or Kaopectate for relief. 

“If vomiting and severe diarrhea limit your ability to hydrate yourself, it is time to seek care at a clinic or hospital for intravenous (IV) repletion of fluids,” says Mundkur.

When to seek medical treatment for diarrhea: 

• Fever
• Dizziness
• Yellow urine
• Less urine than usual

If your diarrhea is caused by a bacterial infection, Mundkur says you may experience severe diarrhea, fever, and bloody stools; however, antibiotics can help treat the infection if it’s bacterial.  

On the other hand, persistent blood in your stools could also be an indication of something more serious. “Sometimes colon cancer can cause diarrhea and blood in the stool, so it is important to talk to your primary care physician about whether you need a colonoscopy,” says Mundkur.

Insider’s takeaway 

If your diarrhea is mild,  it will likely get better on its own. You can take over-the-counter medications for relief and make it a point to get adequate nutrition and hydration to avoid dehydration. 

Spicy foods, sugary foods, dairy products, foods high in fat, and foods that cause gas can worsen your symptoms, whereas low-fiber starches, boiled vegetables, soup, crackers, lean meats, and eggs may be easier to digest. 

If you don’t feel like eating or you are unable to keep food down, you can drink liquids for a few hours until you’re able to eat something. It may be easier to eat small portions of food more frequently, rather than attempting to eat a large meal at one go. However, if you are unable to stomach any foods or liquids, you should seek medical attention.

Sanjana Gupta

Author

Sanjana has been a health writer and editor since 2014. She has written extensively for platforms like Livestrong.com, Verywell Mind, and Times Internet. Her work spans various health-related topics, including fitness, nutrition, mental health, and wellness. Sanjana balances her love for chocolate with a penchant for fun workouts like aerial yoga and kickboxing.

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What are the types of diarrhea?

Depending on the duration :

• Acute – lasts from several hours to 2 weeks. A person is considered to have diarrhea if they have had loose stools 3 times in the last 24 hours.
• Persistent diarrhea lasts 2 to 4 weeks.
• Chronic diarrhea – more than 4 weeks.

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Depending on the mechanism of occurrence :

• Osmotic diarrhea – when there is an osmotically active substance in the intestine that draws fluid into the lumen.
• Secretory diarrhea – when the intestinal wall secretes a large amount of chloride ions, which draw water with them.
• Inflammation of the intestinal wall is also characterized by increased secretion of fluid into the intestinal lumen.
• If the intestines contract very intensively, the liquid from the food bolus does not have time to be absorbed, as a result, the stool becomes liquid.

Why does diarrhea occur?

The most common cause of diarrhea is intestinal infections. They can be caused by pathogenic bacteria, viruses, fungi. The most common diseases are salmonellosis, shigellosis, typhoid fever and paratyphoid fever, infections caused by Escherichia coli (escherichiosis), rotavirus infections.

Other possible causes of diarrhea:

• Inadequate, irregular diet, dietary errors, alcoholism.
• Intolerance to certain foods associated with a lack of certain enzymes or food allergies. The most common conditions are: celiac disease (gluten intolerance), lactose (milk sugar) intolerance, fructose (fruit sugar) intolerance.
• Crohn’s disease is a chronic inflammatory bowel disease, in which infiltrates (areas of compaction), ulcers, abscesses, fistulas form on the intestinal wall, which then scar and lead to a narrowing of the intestinal lumen.
• Nonspecific ulcerative colitis is an inflammatory disease in which ulcers, pseudopolyps, scars form on the intestinal wall.
• Misuse of laxatives.
• Prolonged uncontrolled use of antibiotics – leads to a violation of the composition of the microflora in the intestine, the growth of fungi.
• Dysbacteriosis is a violation of the intestinal microflora. By itself, it is not a separate disease, it is always associated with some other pathology.
• Traveler’s diarrhea – occurs in some people who travel long distances. It is assumed that this condition occurs due to the fact that “unfamiliar” strains of bacteria, viruses penetrate into the body, a person consumes a lot of fruits and fiber while traveling.
• Runners’ diarrhea – occurs in some people who run. During intense physical activity, blood is redistributed between different parts of the body, as a result, the intestinal wall receives insufficient blood supply.
• Radiation therapy and chemotherapy in oncological diseases. One of the complications of treatment can be loose stools.
• Some forms of bowel cancer.
• Endocrine disorders: Addison’s disease (a condition in which the adrenal glands produce too little hormone), hyperthyroidism (an excess of thyroid hormone).

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There are other possible causes of diarrhea. In order to correctly establish the diagnosis and prescribe effective treatment, one examination by a doctor is often not enough, an examination is required, which may include a general and bacteriological analysis of feces, endoscopic studies (sigmoidoscopy, colonoscopy), ultrasound of the abdominal organs, biochemical blood analysis and other methods. Visit a gastroenterologist and undergo an examination at the international clinic Medica24.

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Contents

• What are the types of diarrhea?
• Why does diarrhea occur?
• Other possible causes of diarrhea:

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Diarrhea (indigestion, diarrhea) is frequent, repeated loose stools. Diarrhea signals that the function of absorption of electrolytes and water is impaired in the intestine.

Causes

The most common causes of diarrhea are various infections, viruses, bacteria (dysbacteriosis), parasites and the toxins they cause. With diarrhea caused by acute intestinal infections, microorganisms (viruses) disrupt the digestive process or completely block the intestines. The reason for dysbacteriosis is that a large number of unusual bacteria develop in the intestines, which suppress the natural microflora. Another cause of diarrhea is chronic diseases of the digestive system. In some cases, the cause of diarrhea may be a lack of B vitamins, F, niacin.

Symptoms of diarrhea

The main symptom of diarrhea is an increase in the frequency of bowel movements (more than twice a day) with liquid stools. Also, with diarrhea, there is a decrease in appetite, nausea, bloating and rumbling of the abdomen, flatulence, abdominal pain, signs of anemia and dehydration. Depending on the etiology of diarrhea, signs of the diseases against which it arose may appear. The stool itself can be watery, with an admixture of mucus, with blood inclusions, and light.

Diagnosis of diarrhea in Israel

Diarrhea has severe symptoms. An important point in the diagnosis is the study of feces. A proctological examination is carried out, during which anal fissures, fistula, etc. are detected. To detect possible tumors, damage and inflammation of the intestinal mucosa, ulcerative formations, in Israel they use instrumental examination methods such as gastroscopy, sigmoidoscopy, colonoscopy and irrigoscopy. Bacteriological culture will show the presence of parasite eggs. With the help of ultrasound, an examination of the internal organs of the abdominal cavity is carried out to determine the extent of the inflammatory process in the digestive tract.

Treatment of diarrhea in Israel

Treatment of diarrhea should first of all begin with the elimination of the cause that contributed to diarrhea.