Food and Drink

TRAVELER​'S DIARRHEA

Travelers’ diarrhea (TD) is the most predictable travel-related illness. Attack rates range from 30% to 70% of all international travelers, depending on the destination and season of travel.  The primary source of TD is eating food or water contaminated with bacteria from someone else's feces. Yep - that's right - poop in what you're eating! 

 

Bacteria in the food/water accounts for 80%–90% of TD while intestinal viruses (such as the dreaded shipboard Norovirus)  account for about5%–8% of illnesses. Protozoa are another category but much less frequent. But campers beware - the bears really do shit in the woods and streams as do the beavers. Don't drink untreated water downstream of them! 

 

SYMPTOMS

Most commonly, the sudden onset of repeated uncontrollable watery stools with great urgency and abdominal cramping. This is not a subtle event.

You could have nausea, vomiting, low-grade fever (less than 101 degrees) and if dehydration sets in, headache and malaise.

HOW IT DIFFERS FROM FOOD POISONING

What is commonly known as “food poisoning” is different. You're going to sit on the john and throw up your toenails, but symptoms usually resolve spontaneously within 12 hours. This malady involves the ingestion of preformed toxins produced by bacteria - not the bacteria themselves. These toxins in a food are what set up the whole family getting sick at the picnic or at a roadside barbecue stand on the drive to the beach. We all have those stories!

 

PREVENTION

 
01. Preventive Medications?

The CDC says NO to preventive medication but YES to Hand Washing! Meds are not effective and overuse sets you up for allergy to the antibiotic or production of bacteria immune to it.

 
02. What's Your Best Defense?

If you're in a city where there is modern water treatment and you're told you can drink the water from the tap you're as safe eating and drinking there as you are at home. 

You will find more and more hotels and restaurants around the world have their own water purification systems on site. That should allow you to eat at your pleasure. 

If neither the municipality or the local establishment has put a barrier between you and contaminated water, pay attention to the CDCs "does and don'ts" that follow.

 

AVOID

  • Eating foods or drinking beverages purchased from street vendors.

  • Eating raw or undercooked meat and seafood.

  • Eating raw fruits and vegetables unless you peel them yourself - with hands not washed in water from a contaminated tap!

  • Drinking tap water - and that includes brushing your teeth, drinking from the glass on the bathroom sink or swallowing water while taking your shower!! My father got giardia brushing his teeth with tap water in Russia. I got giardia swallowing water taking a shower at a campsite in Mongolia.

  • Watch out for those ice cubes! Freezing doesn't kill the bacteria.

  • Drinking tea or coffee that's not boiling hot. Prepared with tepid water temperature will not kill the bacteria. It has to boil! Sister got deathly ill after drinking luke-warm coffee in a nice hotel in India.

 

INSTEAD

  • Drink bottled carbonated beverages, hot boiled tea or coffee, beer, or wine.

  • If camping, drink water boiled or appropriately treated with iodine or chlorine.

  • If eating outside the common tourist haunts, nicer restaurants, or hotel dining rooms, have bottled water opened in front of you. Don't hear the pop? Don't drink the water. Carbonated bottled water, "with gas," is safer than "still water" as the restaurant can't refill a commercial water bottle with tap water that fizzes.

 

TREATMENT

 

Stay hydrated with bottled water or boiled tea.

 

Get out your medication bag. If weak from dehydration, use the rehydration salt packets.

 

Anti-mobility medication - Loperamide is in your travel Medical Bag. It works well in slowing the transit time in the gut. However, it should not be used if there is high fever over 101 or bloody diarrhea because it can increase the severity of disease by delaying clearance of the causative organism. Seek medical advice ASAP.

 

An antibiotic such as Ciprofloxacin (Cipro) 500 mg. If your symptoms are mild and you have gotten diarrhea in check with the first doses of Loperamide - you could skip the antibiotic. Most TD is self-limiting.