So let me tell you a story.
This is in Uganda. I’ve checked into this budget hotel and you know, I’m hungry. After I buy a sim card for my phone, I ask the lady where her favourite place to eat is. She points across the road to some little place with a blue door. Awesome.
I walk in there and ask the guy behind the counter what they’re cooking. He says they’re serving beef stew and rice today. Perfect. I’ll have a beef stew with rice please.
So I sit down and I’m trying to get my sim card to work, and within a few minutes my food comes. It’s exactly what he said it was – beef stew and rice. I eat some. Nice. I finish the whole plate.
It’s actually my first day in Uganda. And I don’t really have energy to go exploring or anything, so I just sit there fiddling on my phone. After about 45 minutes, my stomach turns a little. Brrrrrrrr.
I dismiss it as just a little tummy rumble. Just getting used to this Ugandan beef, yeah?
Then a few minutes later, another rumble. Hmm.
This goes on for about half an hour and doesn’t concern me too much, I’ve experienced this before even at home. Sometimes you eat too fast, or just eat something funny. But then suddenly I feel a bit of outward pressure with the rumble. I clench my, err, cheeks together, and now I’m all perked up, like a dog hearing rustling outside the window in the middle of the night.
Are my bowels about to explode?
Better visit the bathroom.
I run upstairs to my hotel, which is just a few doors down. As soon as I sit down, I unleash merciless havoc on the toilet.
A class case of traveler’s diarrhea.
What causes traveler’s diarrhea?
That story was back in 2015, and it was pretty clear to me that I got it from that restaurant. Either the beef was bad, or they didn’t wash their spoons properly. Who knows.
But honestly, I don’t know if there’s a difference between traveler’s diarrhea and normal diarrhea. Both are usually caused by eating some crappy food that hasn’t been cleaned or stored properly. Bacteria such as E.Coli gets into your guts and then just starts messing everything up.
The most common culprits are meat that hasn’t been refrigerated or cooked properly, unclean dishes and cutlery, or salads that have been washed with unclean water. Another common cause is people drinking tap water when they shouldn’t. Southeast Asia is a hotbed for this kind of stuff, as are places like India, China, and many parts of Africa.
What are the best ways to prevent traveler’s diarrhea?
After many years on the road travelling to many far-flung places, I’ve had to deal with traveler’s diarrhea several times – notably in Cambodia, Tanzania and Uganda. Some ways of dealing it are just common sense and some work better than others, but after experiencing this unfortunate dilemma several times I now have a decent system on how to prevent it and haven’t had any troubles since.
The first thing I’m going to tell you here is, YES, you do need to take measures to prevent traveler’s diarrhea. Having traveler’s diarrhea is a miserable time and will keep you out of commission and maybe even bed-ridden for up to a week or more. That’s a big chunk of your trip.
If you’re heading somewhere with questionable food safety and want to make sure your guts (and your toilet) stay in good shape, here are my best tips to help you do so:
This is one of your options. Dukoral is an oral vaccine that I’ve taken several times. It should be available from your doctor and in many countries you don’t even need a prescription.
It works by protecting you against both cholera and diarrhea caused by the E.Coli bacteria, presumably in the same way as most other vaccines – by introducing the non-toxic bacteria to your stomach so you can produce antibodies.
I have used this vaccine on several trips, and it works great. The only issue I have with taking things like this regularly is I feel like they impede your body’s ability to deal with these things on its own. If there’s ever a case when I haven’t taken the vaccine, I feel like my body is going to crumble with the slightest bit of bad food (this is total bro science and I have no idea if it’s true, just a personal thing). These days I generally reserve it for when I’m going to a place that’s very questionable – think small villages in rural Ethiopia, something like that. What I do love about it though is the set-and-forget nature of it. You drink the solution twice before your trip – each dose one week apart – then you’re protected for three months. Super easy.
If you are highly susceptible to gut problems and diarrhea, I’d say this is a good option.
Do you know how important probiotics are to your health?
In our guts we naturally have trillions of bacteria. Most of them are good for us. They boost our immune system, help with digestion and most importantly, keep the bad bacteria in check.
Unfortunately many of us have ravaged our gut flora through constant use of antibiotics. Not only do we use them when we’re sick, but it’s also in much of the food we eat. Antibiotics don’t discriminate. They kill both the good and bad bacteria in our body. Sadly it is hard to avoid antibiotic exposure in modern life.
Here’s how this applies to traveler’s diarrhea. If you eat a dodgy salad in Cambodia and get a few nasty bugs in your system, there’s a chance it’s going to shut your body down. But if your gut is healthy with trillions of strong and healthy flora, a few bugs like this won’t be a problem. They’ll knock that sucker out without much trouble at all.
Research is even emerging that a healthy gut is one of the most important aspects of a healthy immune system (studies here and here). And in studies like this one, the medical community been starting to discover probiotics is an effective remedy against traveler’s diarrhea.
I’m guessing it will start becoming more mainstream soon (and it already is) but honestly I’m not too concerned about what the docs think. If I start taking probiotics and stop getting diarrhea, that’s proof enough for me! And myself and many other travellers have been doing so throughout our travels.
What is the best probiotic for traveler’s diarrhea?
You might be thinking, you’ll just pack some probiotics and take them during your trip, everything will be dandy.
Unfortunately it’s not that easy.
Replacing and building a healthy gut takes time, so I would recommend you start taking probiotics at least a month before your trip. In fact, I recommend taking them regularly whether you’re travelling or not!
The thing is, you can’t just grab any probiotic off the supermarket shelf and think you’ll be okay. You need the right type of gut flora, and also the right quantity.
Remember, some studies estimate we have up to 100 trillion bacteria in our guts. If you take a probiotic that contains 250 million units, it’s like a drop in the ocean. It’s no better than just eating a spoonful of yogurt.
So how much do you need?
I try to aim for between 10-20 billion colony forming units per day. Ideally more. If you’re about to go somewhere where your gut will be tested, you can even up it to 50 billion units per day.
I know that sounds like a lot but it’s perfectly safe. You can’t overdose on probiotics unless you really try – any excess will just get passed out in your poop. Even then, this guy tried and still couldn’t do it. I’ve taken up to 100 billion units in a single day and was totally fine, other than a little extra gas.
You also need the right type of probiotic. There are thousands of strains of gut flora out there, and not all of them are shown to be effective against traveler’s diarrhea. In this study I cited earlier, the three that were found to be most effective were Saccharomyces boulardii, Lactobacillus acidophilus, Bifidobacterium bifidum. Luckily the latter two are quite common, but the first can be more challenging to find.
What probiotics should you use?
I’m going to recommend a few here that I use myself.
My favourite, by far, is Onnit’s Total Gut Health.
I’ve recommended Onnit’s products a lot in the past and for good reason. It’s not because they give me free stuff (because they don’t) and it’s not because I’m sponsored (because I’m not). It’s just because they’re amazing. I love how forward thinking and innovative they are and when they put out a product, you know it’s going to be top quality.
These probiotics come in individual sachets of seven pills each, which you’re supposed to take with your biggest meal of the day. They contain 10 billion colony forming units per dose, which includes Saccharomyces boulardii, which is the traveler’s diarrhea killer, as well as Lactobacillus acidophilus, another bacteria proven effective in the study above.
As a bonus they contain some prebiotics such as dandelion and artichoke root, as well as things like ginger root and fennel seed for digestion. Not only great for protecting your gut but just for overall health as well.
They’re not the cheapest probiotics but in my opinion they’re worth every cent. They are however quite bulky to travel with.
My advice is to use them like this: Take them regularly in the lead-up to your trip. They’ll do great things for your gut flora and digestive system, and in reality, protecting your gut flora before your trip is probably the most important thing anyway. Then when you’re actually heading overseas, just take a handful of sachets to take periodically during your trip.
If you’d like to get yourself a box of Onnit’s Total Gut Health you can do so here.
Vitamin Bounty Pro-50
This is a great probiotic to travel with as it doesn’t take up too much space. Each bottle contains 30 servings, and each serving gives you a whopping 50 billion colony forming units. It also contains all three flora that were recommended above (Saccharomyces boulardii, Lactobacillus acidophilus, Bifidobacterium bifidum) which can be quite hard to find!
It doesn’t contain the prebiotic and other digestive support that the Onnit product does, but from a probiotic standpoint this product will have you covered.
If you’re worried about getting traveler’s diarrhea, I highly recommend carrying a strong probiotic like this. It will be a great safeguard against traveler’s diarrhea and will keep your gut in good shape during your trip. I find the best way to use this while travelling is to take it first thing in the morning with a big breakfast. Probiotics populate the gut best with food.
Of course you can also use any other “good” probiotic from your local pharmacy or health store, but these are the two I like and recommend. Just make sure whatever you use has a sufficient number of units and the right strains!
3. Probiotic foods
Have you ever heard people tell you that you should eat more yogurt if you’re having tummy problems? People used to say this to me all the time. Especially when travelling in places where diarrhea is common, the girls would always be telling me to eat more yogurt. Even doctors and nurses have told me this in many places.
The reason is simple: yogurt is a fermented food, and therefore contains live cultures which populate and protect your gut, just like the probiotics we talked about above. They basically achieve the same thing. The same goes for other fermented foods that are recommended for probiotic reasons, such as sauerkraut, kimchi, kombucha and kefir.
When I learned this I started adding yogurt to my travel diet immediately, usually stopping by a supermarket to buy some every day.
However, there’s a few reasons I don’t recommend relying solely on probiotic foods and here’s why:
Unless there’s a swanky health store where you’re travelling to (unlikely in most places where you’re susceptible to traveler’s diarrhea) it can be hard to find a high quality yogurt with live cultures. Even then, you don’t know how many or what strain of probiotics you’re getting, plus a lot of the yogurts these days are processed and flavoured with sugars and preservatives. The same goes for other fermented foods.
There is also a problem with storage and refrigeration. In fact, my friend Jodi actually got food poisoning from yogurt that she suspects wasn’t refrigerated properly. Too ironic.
But the main reason I don’t rely on foods is – you can’t travel with them. It’s just not practical to pack a jar of sauerkraut or yogurt in your suitcase or backpack and take it around the world. Unlike probiotic supplements, which are ideal for travelling with, it can be hard to guarantee that you’ll get enough probiotics each day when just relying on food sources.
For that reason I don’t recommend relying just on probiotic food. Of course, do eat it whenever you get the chance – I try and have a bottle of sugar free yogurt or kefir every day while travelling (check the packaging to make sure there are live cultures present). But in my opinion it’s best to have probiotic supplements with you as well to ensure you get a constant daily dose.
4. Anti-diarrheal medicines
When I first started travelling, my doctor gave me Loperamide tablets, also known as Imodium. This is a drug that gets to work in the large intestine and slows down bowel movements, meaning your poop has more time to “bulk up”, so to speak. I’ve used this a couple of times earlier in my travels and while it works, I haven’t used it since then.
The reason I don’t like these pills is because they are reactive rather than preventive. Usually you’re supposed to wait until you actually get diarrhea, and then use the pills to treat it. I prefer to be a bit more proactive and just not get diarrhea in the first place. Using a vaccine like Dukoral or preparing your gut with healthy probiotics makes a lot more sense to me. However, I do still have Loperamide tablets in my toiletry bag from many years ago – I guess they’re there for peace of mind more than anything!
Other tips for preventing food poisoning and traveler’s diarrhea
There are also many common sense things you can do to keep you and your stomach safe.
- Always sanitise your hands before you eat! I carry a basic hand sanitiser everywhere (just like this one). The world is filthy and every car door, bus seat, dollar bill and ticket machine is crawling with germs. Of course this doesn’t mean you need to wear gloves or anything stupid like that, but always clean your hands before you eat.
- Drink bottled or boiled water. At home the tap water may be safe to drink, but in many countries around the world you are not supposed to drink tap water. In most developing countries bottled water is ridiculously cheap anyway – a day’s worth of water often doesn’t even cost a dollar.
- Try to eat in busy places. This means the food turnover is high and they won’t be serving you meat and vegetables that has been sitting around for days. Contrary to what most say, I find street food is also great because you can watch the food getting cooked right in front of you. If anything looks unclean, you can see it! This is unlike many restaurants where everything is done behind closed doors.
Hope that helps. Good luck and safe travels!
Disclaimer: Obviously I am not a doctor, and this article should not be taken as medical advice. The above is based on my personal experience only. You should consult your own medical professionals before starting any treatment plan.