Wednesday, February 6, 2013


Ask a frequent traveler to name the worst thing that can happen on a trip. I bet most would not say "missing a flight," having your pocket picked," or, "being kidnapped." They would say "getting travelers' diarrhea" (TD), also called "Montezuma's revenge". It's common and it's totally miserable. Some estimates say that if you visit any developing country in Africa, Asia or Latin America you have a 30-50 percent of coming down with it. That may be an exaggeration, but still.....

Let's just talk about the extreme case: not a little tummy upset due to change of diet, but what we all dread on a long-planned and often expensive vacation or an important business trip: bad continuing diarrhea and stomach cramps, sometimes accompanied by headache, vomiting, dizziness, fever, fatigue or similar symptoms. So what causes it?

Usually - though not always, it is some contaminated food or drink. Contaminated by what? Any number of possibilities exist. And that is where part of the problem lies in preventing or treating it. It is estimated that some 80-90% of TD is caused by bacteria (one of the Salmonella, a Shigella, E.coli, Campylobacter, or another bacterium). But the cause could also be norovirus (or, occasionally, some other virus such as rotavirus) or a parasite (such as Giardia lamblia or Entamoeba histolytica ).

So apart from using good hygiene (wash your hands, don't bite your fingernails or hangnails etc.) how can you prevent it?

Let's look at this issue from 2 angles: first, avoiding the TD-cause itself, and secondly, taking something or other so that you won't become ill (or, as ill) even if you are exposed.

To avoid ingesting pathogens from your food and drink, particularly when in risky areas (such as rural areas of many developing countries):

• Don't eat at buffets, or, mass catered events (if you can avoid it) or from street vendors
• Eat food that has been thoroughly cooked and is piping hot when served
• If you are dying for something raw, eat a fruit that has been grown on a tree and can be peeled (such as a banana, mango, papaya).
• Don't drink local water, drinks made locally with water, or, use ice in drinks (unless you have been asusred that it is made from bottled water). Only drink bottled drinks or boiled ones.

As for the other part of the problem - what can you take to prevent yourself from becoming ill even if you do eat or drink something contaminated? There are a range of options that have been suggested, but don't expect any one of them to work 100 percent (4-40% reduction of risk would be more like it!) Here are a few of the most commonly used ones (note again, we do not offer any guarantees):

• Take Pepto-Bismol (check first with your doctor as it is not recommended in certain cases, and not for children). The usually suggested dosage is 2-4 tablets 4x a day. (You may want to carry a bag of prunes along as well, in case of resulting constipation. And of course, you will also be likely to have a black tongue, which could actually work to your advantage if you are kidnapped: they'll think you have some horrible disease and let you go!)
• Take a probiotic such as Lactobacillus GG and Saccharomyces boulardii . The research is ambiguous as to whether this works. But, it is unlikely to harm you.
• Take a prophylactic (preventive) dose of a prescribed antibiotic (While sometimes recommended, the risks could outweigh the potential benefits in many cases. But if you are an olympic athlete, the Secretary of State, or meeting with the head of the Central Bank, you may want to use this approach).
• Revert to some ancient home remedies. These include ones espoused by my mother who always insisted I take garlic along (particularly to avoid parasites). There are many others, including apple-cider vinegar, ginger and more.

The best approach? Living on nutrition bars and coke?

To your good health - and a pleasant trip,


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