Wise is a family doctor and runs The Travel Clinic in Toronto,
Canada, He is the author of the book, THE TRAVEL DOCTOR, and
is the chairman of the board of Canadian Feed The Children
We asked Mark to give us some of his practical advice for
avoiding stomach upsets and diarrhea when we are off exploring
the world. He writes...
affects close to one third of travellers...
travellers to far flung places, some things never
change. Baggage gets lost, bugs bite, and 'poop'
happens! By the latter, I refer to the fact that
around 30% of you off to warmer climes will experience
traveller’s diarrhea, more affectionately
known as Montezuma’s Revenge, Delhi Belly,
Tourista and much more.
does this continue to be the case, you ask? Poverty.
And where there is poverty, you will generally find
problems with hygiene and sanitation, meaning the
food and water. The 7-star hotel is certainly less
of a risk than the Peruvian ceviche stand in the
street, but as I often say, you are only as safe
as the last person, or fly, to handle your food.
majority of cases of traveller’s diarrhea
are due to bacterial infections, with E. coli accounting
for the majority. This bug usually causes a mild
case of the runs which gets better in a few days,
with or without treatment. What I suffered through
in the ‘70s in Ecuador was much worse, and
was likely caused by a more virulent bacterium,
such as Salmonella, Shigella or Campylobacter. While
not the most enjoyable moment of my traveller career,
it certainly remains one of the most memorable.
ounce of prevention...
don’t preach total obsessiveness when it comes
to one’s culinary habits in the tropics and
developing countries, but I do suggest common sense
and some caution, as well as some preparedness.
'Boil it, bottle it, peel it, cook it …. or
forget it' still makes a great deal of sense. But
let me elaborate.
you plan to boil your water, just bring it to a
rolling boil for a minute or two. Any longer will
rob you of your fuel and your water. When it comes
to bottled water …buyer beware. Look for that
unbroken seal, and don’t patronize that cute
boy selling bottles from behind the taco stand.
If you are a bit further off the proverbial beaten
path, you might want to disinfect your water with
products on the market (ask your travel doctor for
her/his suggestions), or use one of the many water
filters that are available. Beer, wine and carbonated
drinks should all be safe, though the ice added
to drinks may definitely be suspect. I say, avoid
the ice completely.
that is cooked is definitely safer than that skewer
of mystery meat being offered to you at the bus
stop. So by all means, eat in the markets, but eat
what is cooked, make that 'well cooked', and cooked
in front of your very own eyes. Fruits should not
present a problem, just peel them. If you just absolutely
crave that Caesar salad, then you really need to
soak your romaine in some chlorine, a.k.a. bleach
(sodium hypochlorite, 5% - 2 drops per litre) or
a product called AQUATABS®.
trip to the druggist...
from being picky, is there anything else you can
do or take to prevent diarrhea? Yes, you could take
Dukoral, an oral vaccine, prior to travel. This
will reduce your overall risk of getting sick by
about 30%. You could also take Pepto Bismol (2 tablets
or tbsp 4 times a day), which has been shown to
reduce the risk by about 50%. Pepto Bismal will
also turn your stools and tongue black. Don't panic.
It's nothing to worry about. Probiotics, grapefruit
seed extract, oregano, and 'a scotch' a day are
other less proven preventative measures.
the above guidelines increases your chance of a
diarrhea free holiday, but does not guarantee it.
Hence, go prepared, just in case. The treatment
of diarrhea should be fairly straight forward. Firstly,
stay hydrated. This can be accomplished with water,
but better still, with solutions containing some
salt, some bicarbonate and some sugar. Soup with
salt, tea with sugar, flat Coke, or oral rehydration
salts should all suffice. Imodium, or loperamide,
may tide you over if you want some symptomatic relief,
but please use it in small quantities, or you may
not defecate again for several months.
your doctor before you travel. Recalling that acute
diarrhea is most often a bacterial event, then it
makes sense that an appropriate antibiotic may be
helpful, especially if you are very uncomfortable,
not getting better, or just have this weird craving
to get better faster. Ask your doctor for a brief
(3 day) script for ciprofloxacin or azythromycin.
This can be used with or without loperamide for
the quickest relief.
(1) Can I shower
in the local water – yes, just keep your mouth
(2) Are the ice
cubes with the holes OK? – the holes are fine,
but don’t trust the ice.
(3) If I eat all
the local food and drink the local water at the
beginning of my trip, will I become immune –
don’t count on it.
(4) Is all diarrhea
infectious? - No, not all diarrhea is infectious.
Too much sun, too much booze, bowls of fruit and
a change in time zones may all conspire to change
the consistency of your stools. Some travellers
react in the opposite way, and they would crave
a loose bowel movement or two. On the subject of
constipation -- drink plenty of water and pack prunes
to be snacked on as needed.
plays a big role in who succumbs to Montezuma’s
Revenge. Some travellers break all of the rules
and get off unscathed. Others are quite anal (excuse
the adjective), and still get sick. Well, that’s
the joy of travel. You never know what’s going
to happen from one day to the next. So exercise
that caution and common sense … and have the
best time of your life.