You were dreaming of those sunny vacations, but two days after finally settling in, nothing goes as planned. Diarrhea, stomach pain, and nausea take over swimming, lounging, and strolling.
What is Traveler's Diarrhea?
Frequent in tropical and subtropical countries, but also in southern Europe, traveler's diarrhea, also called "tourista," "Montezuma's Revenge," or "Djerbian Syndrome," affects nearly 60% of travelers.
Its name comes from the fact that vacationers arriving from countries where clean drinking water is easily accessible or who are accustomed to drinking mostly bottled water are the most affected. The reason is simple: their bodies are not used to encountering germs in proportions much higher than their daily norm.
Causes of Traveler's Diarrhea
Traveler's diarrhea is the direct result of contamination by germs present in a beverage or food that we consume.
The responsible infectious agents most often involved are bacteria (Escherichia coli, shigella, salmonella, Campylobacter). It can also sometimes be viruses (rotavirus) or parasites (amoebas).
In the case of contamination with E. coli, the bacterium produces toxins that cause water leaks in the intestine, leading to diarrhea. At the same time, other pathogens invade the intestinal mucosa and destroy the intestinal villi, creating inflammation.
The lack of hygiene is primarily to blame - poorly cleaned contaminated foods (mainly raw meats and fish and contaminated fruits and vegetables), and unsafe water (or ice) are at fault.
While the risk tends to be higher in certain poor countries like Egypt, India, Thailand, Pakistan, Morocco, Kenya, Tunisia, the Caribbean, Turkey, Mexico, etc., no country is spared because hygiene can be lacking everywhere as emphasized by the World Health Organization (WHO).
In summary, you can just as easily catch traveler's diarrhea by drinking a glass of water deep in Kerala as by eating ice cream or tartare in Quiberon...
Symptoms of Traveler's Diarrhea
Traveler's diarrhea, which usually occurs at the beginning of the trip, is characterized by liquid, non-bloody diarrhea, often accompanied by abdominal cramps and nausea.
Fever is rare but possible, affecting one in ten patients.
Usually, symptoms disappear within 2 to 3 days, but recovery may take a little longer.
Traveler's diarrhea is usually benign in healthy individuals, but severe forms can occur in vulnerable populations: children under two years old, elderly people, those with a chronic disease (diabetes, heart failure...) or those with weakened immune defenses.
Caution and prevention are therefore essential.
Prevention above all
Although traveler's diarrhea is generally without consequence, it is uncomfortable and debilitating!
Whether you are traveling a few hundred kilometers from home or to the other side of the world, to avoid spending your vacation in the bathroom, doubled over, prevention is essential.
Before you leave, strengthen your intestinal immunity
About twenty days before your departure, take a course of probiotics to strengthen your immunity and allow your intestinal microbiota to better resist pathogenic bacteria.
Numerous studies(1) show the benefits of probiotics in preventing traveler's diarrhea.
At the same time, and for greater efficiency, adopt a diet rich in lysine with prebiotic action and probiotics. This is the perfect time to enjoy fresh fruits and vegetables, discover fermented vegetables like Korean kimchi, and drink fruit kefir or kombucha.
To more globally strengthen your immunity, don't hesitate to also take a course of echinacea and/or royal jelly.
On-site, follow these hygiene tips
It's not often said, but the first and most important hygiene rule to follow is to wash your hands regularly (or use a hand sanitizer), especially before meals and after using the toilet.
Then, regarding any solid or liquid food, it is essential to respect the adage "Boil it, cook it, peel it or forget it."
Set aside anything raw: unpasteurized dairy products and butter, minced meats, sauces like mayonnaise (made from raw egg), shellfish, seafood, and raw fish.
Only drink bottled water uncapped in front of you (or another bottled and uncapped drink). If there isn't any, you can resort to boiled water for at least 15 minutes (tea, coffee).
Avoid ice cubes, ice cream, and reconstituted milk from powder, as it is impossible to know what water was used. For the same reasons, whether dining in an upscale restaurant or in a typical inn, be wary of cold dishes, especially if served on a bed of crushed ice.
If you feel like having fruits, choose only those that can be peeled and only consume those bought individually. Some dishonest sellers may add water to their fruits sold by weight to make them heavier. Peel them yourself after washing your hands. Therefore, avoid ready-made salads and fruit salads.
When Traveler's Diarrhea Strikes
If prevention has not been sufficient and symptoms of traveler's diarrhea appear, it is generally sufficient to apply a few simple tips to reduce discomfort and prevent your condition from deteriorating.
The Right Reflexes
The first reflex is above all to avoid dehydration due to diarrhea.
It is essential to drink a lot, while of course continuing to follow hygiene rules: bottled water, broths, herbal teas. You can mix six level teaspoons of sugar and one level teaspoon of salt in a liter of clean drinking water to make your own rehydration drink.
Contrary to popular belief, cola drinks are not very effective, and their acidity tends to increase inflammation of the digestive tract. But if that's the only bottled and uncapped drink available, it's still better than not drinking anything.
Consume high-dose probiotics for emergency action at a rate of 3-5 doses per day(2). They reduce the intensity of symptoms and allow for quicker recovery. Orodispersible formulas are particularly useful and exist for this purpose.
Do not rush to take anti-diarrheal medications, which, although available over the counter, are not harmless and have contraindications to be aware of. Also, avoid intestinal antiseptics as they have not been proven effective in traveler's diarrhea.
In terms of diet, set aside vegetables and fruits, whether raw or cooked (except for well-cooked bananas and carrots), and adopt a diet based on cooked cereals - ideally white rice, tapioca, rusks, dry biscuits, honey, grilled meats, and fish.
Even if you don't have an appetite, do not fast, as you need nutrients to compensate for the losses caused by diarrhea. Instead, eat small amounts fractionally.
Abdominal cramps are common with traveler's diarrhea. To relieve them, you can use lemon balm known for its antispasmodic properties as its components soften the tissues of the smooth muscle of the digestive tract.
Artichoke, in the form of a full-spectrum suspension of fresh plants, can also be useful as it has a disinfectant action that will limit diarrhea and spasms.
To optimize your recovery and recover more quickly, continue your probiotics treatment at a rate of one to two doses for 20 days.
To fully rebuild the intestinal microbiota disrupted by traveler's diarrhea and to fight against intestinal permeability, associate it with glutamine. This will allow you to regain digestive comfort after these few difficult days.
Knowing that chronic digestive disorders such as irritable bowel syndrome often occur following an
episode of intestinal infection, due to insufficient restoration of mucosal integrity, this measure is far from trivial.
Then, the water losses due to diarrhea will most certainly have led to a loss of mineral salts, including magnesium.
It will therefore be wise to take a course of it to fill or prevent a deficiency that would prevent you from regaining strength.
When to Consult?
Normally, traveler's diarrhea subsides within 2 to 3 days. If symptoms persist, it is important to consult, especially if:
- you have a high fever and/or great fatigue,
- your eyes are sunken and surrounded by dark circles,
- you vomit a lot,
- your thoughts are confused,
- your stools contain blood, mucus, pus,
- you have signs of dehydration: chills, dark urine, thirst, dry mouth, dry skin, general weakness, loss of appetite, drowsiness, headaches, difficulty breathing, rapid heartbeat...
Traveler's diarrhea is a very common condition and can be avoided by applying prevention beforehand (taking probiotics) and on-site, during your stay (hand washing, food vigilance, and strict hygiene).
However, despite these precautions, you are never completely safe. Remember to take probiotics with you to be able to implement emergency treatment to limit symptoms and the duration of the condition as well as lemon balm and/or artichoke in Full-Spectrum Suspension of Fresh Plants (SIPF) to alleviate stomach pains.
McFarland, L. V. (2007). Meta-analysis of probiotics for the prevention of traveler's diarrhea. Travel medicine and infectious disease, 5
Guandalini, S. (2011). Probiotics for prevention and treatment of diarrhea. Journal of clinical gastroenterology, 45, S149-S153.