As many as 50% of all international travelers get diarrhea. Dysentery. The runs. The skids. The squirts. The squiggles. The mung. Flux. Smooth moves. Loose bowels. Loose stools. Code brown. Backdoor trots. Poo sweats. Aztec two-step. And let’s not forget: Montezuma’s revenge.
It doesn’t matter what you call it. Life sucks when you’ve got the shits.
And you’ve got a 50% chance of getting them, so hold on tight. This topic is split into two sections. This article is about the prevention of traveler’s diarrhea. Part two will be about treatment.
Usually it’s a bacteria, like E. Coli that comes from contaminated food or water. It can also be caused by a virus or a protozoa. Symptoms for bacterial and viral infections usually start 6-8 hours after eating contaminated food. Usually they last a few days and the problem resolves itself.
Protozal infections, usually Giardia or Cryptosporidium, can remain in your system 1-2 weeks before symptoms appear and can last months if not treated. Giardia is rare for travelers. It is more common among back country hikers who drink unpurified stream water that has unknowingly been contaminated by animal feces.
Usually, the only symptom of traveler’s diarrhea (TD) is the need to use the toilet immediately. Although it can cause abdominal cramps, dehydration and slight fevers.
Rarely is TD life threatening. Most cases resolve themselves in 3-5 days. However, those few days are still miserable, especially if you are unsure about the severity of your illness.
There is no definitive set of rules that will prevent TD. Even those who follow the strictest regime are still susceptible. Be smart when making decisions, don’t ruin a perfectly good adventure for fear of getting a little diarrhea.
Drink from sealed containers. The easiest way to avoid waterborne bacteria, is to only drink from sealed containers. Be careful though. Many places are getting awfully sneaky about resealing opened containers. Carbonated beverages are the best bet.
Purify Water. When you aren’t sure of the source, or are drinking from a stream or lake, always use chemicals or a filtration system to purify the water. We recommend iodine tablets or a SteriPEN.
Eat where you can see the kitchen. Is it clean? Is cooked and raw food stored separately? It pays to be a little nosy before ordering that beef kabob.
Street vendors. There is a debate in the travel health world about the safety of eating from street vendors. Honestly, I don’t think a trip is complete without having at least one hearty meal from a cart. I also believe that with street vendors you know exactly what you are getting. You can watch them cook it. See if the food is kept cold, or hot. There is no mystery.
Others (including the CDC), believe that street vendors should be avoided, because of potentially “unhygienic conditions”1. I think the conditions in the kitchen behind closed doors are likely more unhygienic. At least on the street they can’t hide the rat problem. Use common sense and don’t be afraid to be choosy about your vendor.
Buffets are bad. Here’s a crash course in food bacteria. All food has some bacteria in it. It’s not all bad. Cooking, washing or peeling generally removes the bacteria. However, after the food has been prepared, bacteria will start to grow again. This is why buffets are bad.
Food that is served piping hot is likely to have been prepared recently, and bacteria hasn’t had the chance to grow on it. Buffet food may have been sitting out for hours, and who knows how many dirty hands may have touched it.
Raw fruit & veggies. Peel them, cook them, or wash them. End of story. Salads are bad news when you can’t see the kitchen. But fresh fruit from a market is just fine.
Be especially wary of fruit smoothies. Random piles of previous sliced fruit mixed with questionable ice is just asking for a week on the toilet. Find a place that stocks unpeeled fruit or has refrigeration.
Watch out for dairy products. Most dairy products need to be refrigerated. Unless it’s just-out-of-the-udder fresh, look for food that’s been stored in an ice box. I still remember the first glass of cold milk I had in Africa, after traveling for 2 months without any. It came in a bag, and still had chunks of ice in it. Amazing.
Undercooked meat and seafood. We have a rule: if you are more than an hour’s drive from the ocean, do not eat sushi. Unless of course, you enjoy food poisoning. In which case, someone’s gotta eat the sashimi special.
Not to say that you shouldn’t order steaks rare, or eat piles of oysters on a half shell. In many places, it is perfectly safe. If you’re in doubt about the freshness or ability to maintain constant refrigeration, then order that meat well-done.
Seafood toxins. Be very careful of the types of seafood you are eating, and make sure to read up on your destinations before attending the seafood buffet. There are a few terrible, life-threatening illnesses that come from fish. Frighteningly, most of these diseases do not have a cure.
Reef fish such as barracuda and moray eel can carry lots of toxins and probably should be left alone. Also shell-fish like muscles, oysters, scallops and clams, should be avoided especially around red-tides. More information on seafood toxins is available on the CDC site.
Pepto-Bismol. The CDC claims, that if you drink 2oz of that god-awful pink medicine every day, your chances of getting traveler’s diarrhea are reduced from 40% to 14%. Personally, having to swallow that crap for my entire trip is worse than getting the shits. It’s up to you though.
Although TD is not a fun experience, it’s also not likely to kill you, or even ruin your trip. Be smart about what you are eating and drinking, but don’t let a few extra hours on the toilet get in the way of enjoying your destinations finest cuisine.
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