There is nothing more inconvenient than catching a tummy bug whilst on holidays or travelling. My worst experience of this was as a 20 year old volunteering in a hospital in New Dehli. I was living with a family in the slums and essentially lived, and ate, how they did. I felt very proud of myself for immersing myself deeply into their culture until the third day when I was struck down pretty bad with “delhi belly”. This was made worse by the fact that it was during their hottest, and most humid season, not to mention the fact that I didn’t have access to an actual toilet. At one point I considered admitting myself to the hospital I was working at and hooking myself up to a drip but through rest and adequate hydration with water and rehydration salts, I was over the worst of it after 2-3 days but it certainly changed my attitude when it comes to travel and now I won’t fly anywhere without a couple of packs of dioralyte in my bag – just in case!
My case is not unique and it is estimated that travellers diarrohea can affect as many as 2 to 6 in 10 travellers. It is usually caused by eating food, or drinking water, contaminated by bugs such as bacteria, viruses and parasites, or it can be spread from person to person. In addition to diarrohea, symptoms include; fever, vomiting, and tummy pain. In most cases it causes a mild illness and symptoms clear within 3 to 4 days.
However there are a few things that you can do in the run up to your trip, and whilst you’re away to prevent the dreaded holiday belly ruining your trip.
Before you go away
There are probiotics containing certain strains of bacteria (Saccharomyces boulardii and a mixture of Lactobacillus acidophilus and Bifidobacterium bifidum) that appear to be effective in preventing traveler’s diarrhoea. It is not something doctors routinely prescribe but it they are generally safe and appear to be effective. If you do wish to take a probiotic supplement, gut specialist dietician, Dr.Megan Rossi, suggests to start on the day of travel and stop on the day of return. If you don’t want to take a supplement you can stock up on probiotic-rich foods such as kefir (fermented milk drink), kombucha (fermented sweet tea), kimchi (fermented Chinese cabbage), sourdough bread and yoghurts which contain active, live cultures.
Prebiotics are a source of food for probiotics to grow, multiply, survive and thrive in the gut. They essentially act as the fertiliser for our gut garden of microbes. Prebiotics are soluble fibres which are found in foods such as; artichokes, onion, garlic, chicory, asparagus, and leeks. However, one big thing to note is that these fibre rich foods can make you bloat and a little gassy which may be made worse when you fly. This is all down to physics because as the atmospheric pressure drops in the cabin, the air inside our gut expands to fill the space. To avoid feeling uncomfortable, and saving other passengers from potentially smelly farts, you can load up on these foods in the weeks before you travel but cut them down, or out, 24 hours before you fly so that you have time to digest them fully – but don’t forget to reintroduce once you land!
Just incase you do get ill when you’re away, pack some anti-diarrhoeal tablets such as Loperamide (a.k.a.Imodium) and rehydration salts such as dioralyte in your wash bag or first aid kit. It can also be quite useful to carry a thermometer also – especially if you are travelling with kids!
While you’re away
I don’t want you to worry about getting sick whilst you’re abroad and I fully encourage that you immerse yourself in the culture and try new things – including the local food! However there are a few things to keep in mind to try ensure you stay well on your trip;
Wash your hands
Sounds really obvious but it is the simplest, most effective way of preventing the spread of bugs to you or to other people. If you can’t get access to water, carry a little bottle of hand sanitizer.
Bottled water or cooled, boiled water
When you can’t be sure of the purity of the local water, then it should go without saying that you should avoid the local tap water – including ice in your drinks. Even if locals drink it without any problems, your stomach may not have the right bacteria to protect you from becoming ill. If you want to reduce the amount of bottles you buy, you can also try boiling the water and drinking it cool. This is the most reliable method of removing bugs, but will not remove dirt.
There are no vaccines that prevent travellers diarrhoea as a whole. However, there are some other vaccines that you may need for your travel, such as hepatitis A, typhoid, etc. You may also need to take malaria tablets depending on where you are travelling. Speak to your GP 8 weeks before you travel and check out the Fit for Travel website.
Avoid raw or undercooked food.
Freshly prepared, well-cooked food, served hot, is generally safe but as a rule of thumb try to avoid uncooked meat, fish or eggs, and and consider swapping your salads for cooked vegetables instead.
Buffets can also be a bit of a danger zone as, unless you can ensure the food is fresh, it might have been lying around for a couple of hours. Many people avoid street vendors because they worry about contamination or the quality of the food, however more often than not they cook it fresh in front of you and have a high turnover of food so it may actually be better than buffet restaurants.
What to do if you do get sick
In most cases, traveller’s diarrhoea does not need any specific treatment. The most important thing is to make sure that you drink plenty of fluids to avoid lack of fluid in your body. As a rough guide, drink at least 200 mls after each bout of diarrhoea (note: This extra fluid is in addition to what you would normally drink!) If you are struggling to keep water down at all and suspect that you are becoming dehydrated, you should seek medical advice.
Rehydration salts are also very useful and are easy to carry with you. They are sold in sachets and contents are simply added to water. They won’t stop or reduce diarrhoea. However, the small amount of sugar and salt helps the water to be absorbed better from the gut into the body.
You can also take an antidiarrheal medicine (e.g. Loperamide) as mentioned earlier. If you forget to pack them you should be able to get them in a pharmacy where you are travelling.
When you return
Despite all these measures, if you still caught a bug whilst travelling the best thing you can do when you get home is try to support your healthy gut bacteria through a good diet – lots of fibre and probiotic rich foods! You may also wish to try a probiotic supplement for a couple of weeks. Despite these measures, if you’re still having digestive symptoms after a couple of weeks after returning, please speak to your GP.