Traveller’s Diarrhoea: 3 Natural Supplements You Need To Travel With Confidence
Having travelled to over forty countries, including many in South-East Asia, Africa and South America, I (unfortunately) know a thing or two about Traveller’s Diarrhoea. Bali Belly, Thailand Trots, Montezuma’s Revenge... you name it, I’ve had it. Traveller’s Diarrhoea affects up to 50% of people holidaying abroad, so if you spend a bit of time overseas, chances are pretty high that you will get caught out at some stage (1). So how can you prevent Traveller’s Diarrhoea yourself naturally so you don’t end up wasting your holiday on the loo? Well, let’s find out!
Here’s a summary of what we’ll be covering:
> What is Traveller’s Diarrhoea and how common is it?
> How to reduce your risk with a few easy choices
> My top three natural supplements to prevent and treat Traveller’s Diarrhoea
What is Traveller’s Diarrhoea exactly?
Technically, Traveller’s Diarrhoea is defined as having at least three unformed stools within a 24 hour period, whilst in a foreign country and with at least one symptom of gastrointestinal disease such as nausea, vomiting, fever, cramps or bloody stools (1). The most common version of events, according to science, is that you get four to five loose or watery stools, maybe with fever and cramping, for between two to four days during the first week of a holiday to a developing tropical country (1).
While diarrhoea is the common symptom, the cause can be a number of intestinal pathogens (Gut Infections). Bacterial pathogens pose the biggest risk, accounting for around 80% of all Traveller’s Diarrhoea, with viral and parasitic infections each accounting for around 10% of reported cases (2) The most common pathogens include:
> Bacteria: Escherichia coli (E. coli), Campylobacter jejuni, Shigella spp. and Salmonella spp.
> Parasite: Giardia lamblia, Entamoeba histolytica, Cryptosporidium parvum, Dientamoeba fragilis and Blastocystis hominis
> Virus: Norovirus and Rotavirus.
The type of pathogen will impact on the type, severity and duration of symptoms, both during the acute phase, as well as the likelihood of developing longer term Irritable Bowel Syndrome (IBS) (3). Bacteria tend to be self-limiting and symptoms go away after a few days with most varieties. On the other hand, parasites can hang around in the gut and pose greater long-term risk, which is why I recommend that my IBS sufferers do a comprehensive stool test to check for these if they have ever experienced Traveller's Diarrhoea in the past.
Risk of Traveller’s Diarrhoea
The risk of Traveller’s Diarrhoea is impacted by a number of factors (2), including:
> Region - high-risk regions include most of Asia, Africa, the Middle East, Central and South America (see ‘Global Risk of Traveller’s Diarrhoea’ map below (4))
> Season - the wet season generally increases prevalence of Traveller’s Diarrhoea
> Type - low budget or adventure travellers are at a greater risk
> Diet - choosing to eat or drink high risk foods such as food from a market or bar/cafe/restaurant
> Experience - no previous travel to a developing region increases your risk, as does a prior episode of Traveller’s Diarrhoea
> Sanitation - you, or those preparing your food can carry pathogens if hands or cooking equipment are not washed thoroughly, particularly before meal times
> Use of proton pump inhibitors - the reduction in stomach acid reduces the body’s ability to kill pathogens in the stomach, before they make it further down the GI tract
> Various other factors can also play a role such as age and genetics.
Basic Tips to Reduce your Risk
Given that poor hygiene practices of local restaurants is thought to be the largest contributor to the risk of exposure to a dangerous pathogen, prevention is not totally within your control, which completely sucks! There are, however, a few basic tips for reducing your risk.
> Safe beverages include those that have been boiled, bottled, or carbonated
> Boiling water for at least one minute will kill most pathogens. The water MUST reach boiling point so if you decide to share some sage tea with the locals at Wadi Rum in Jordan, be wary! It is unlikely the water reached boiling point to make the tea when it was heated briefly on a fire
> Iodine liquid or tablets are an easy and effective way to purify water, although parasites in cyst form can be iodine resistant (see below)
> Ice cubes are often overlooked, as freezing does not kill most pathogens. Ask for no ice cubes or check they use safe, clean water to create them. Most places in Asia are really aware of this
> Carbonation kills bacteria by reducing the pH levels, making them a safer option
> If drinking non-carbonated bottled water, take care to check the seals to ensure they are not discarded bottles refilled with tap water (it happens, especially in Africa)...
> Much of the risk associated with unsafe food has more to do with the water it is prepared with, rather than the food itself
> Avoid salads and raw/uncooked vegetables. If you have to, make sure to ask if they use bottled water to wash the food - the nicer restaurants should
> Stick with thoroughly and recently cooked meats and fish. Buffets are challenging so be wary of this.
> Seems obvious, but steer clear of food from street vendors. I know it can be adventurous and fun, and you may get away with it, but if you have busy travel plans the risk of 4 days on the loo is not worth it.
> Only eat fruit you can peel yourself - don’t touch the pre-peeled varieties often seen on street carts, especially in Asia.
> If you have time, check restaurant ratings online. We visited a 5 star seafood buffet in Africa that was recommended to us by the local people, which completely backfired. I was chained to the toilet within 4 hours of our meal. A few days later we were looking at restaurant reviews on TripAdvisor and found about 5 reports of food poisoning from other people who had eaten there recently. Epic fail!
> Cook your own - we like to explore local farmers markets and make our own food at least some of the time when travelling to avoid having to eat out three meals a day. That's why we love staying in apartments or in an Airbnb.
> Wash your hands with soap or natural antibacterial liquids, particularly before meal times and dry thoroughly in case the water you are using to wash is contaminated
> Clean your teeth using bottled or boiled water
> Keep your mouth closed when showering or having a bath
Preventative Natural Supplements
The basics only get you so far. And given the risk of Traveller’s Diarrhoea, I always take these three natural supplements with me whenever I travel. They give me some security that I should be healthy enough to participate in all of the activities I have crammed into my travel adventure. It’s no guarantee, but these products have not failed me and are about as close as you’ll get to perfect protection.
1. Saccharomyces boulardii
S. boulardii or Sacch.B is a tropical strain of yeast (found in the skin of the lychee!) and a very well researched probiotic (5). It is particularly effective at plugging up Traveller’s Diarrhoea and restoring levels of good bacteria. It prevents bacteria from attaching to the walls of your intestines, meaning the bacteria are eliminated from the body during your next bowel movement. I take 1 capsule, 3 times a day with meals while travelling as a preventative and dose up to 6 per day if I start feeling unwell. Make sure you look for a product that is shelf-stable and doesn’t require refrigeration (just isn’t practical when travelling).
I use Thorne Research, Sacro-B, 60 vege caps that you can get off iHerb here. The bottle says to take capsules away from food but you can take it on an empty stomach or with your meal.
2. Oil of Oregano
Oregano oil is a portable, liquid antimicrobial that is cheap and a proven pathogen killer (6). Make sure you use a brand that has at least 60% carvacrol, the active ingredient. Take 5 to 10 drops either straight into your mouth or diluted in a glass of water 3 times a day with meals whilst travelling. If you start experiencing travel diarrhoea symptoms you can take a 20-30 drop dose up to 3 times per day. It’s surprisingly powerful stuff so some people might not tolerate it quite so well. As an alternative, you can use a Goldenseal/Echinacea blend that is a little more gentle.
I like to take Natural Factors, Oil of Oregano, 30ml bottle that you can source off iHerb here. This is an organic product with 80% carvacrol.
Iodine has been shown to kill all pathogens, including bacteria, yeasts, viruses and parasites within 30 seconds of direct contact. This makes it a great water purifier and one that is easily available in liquid form at pharmacies around the world (7). If you have already been infected, it’s not so effective, but is a great way to stop the bad bugs ever getting into your system.
A note on iodine: Some people are allergic to iodine. Pregnant women and people with thyroid issues should consult their doctor before using iodine treatment for water purification. You may want to look into Citric Acid as an alternative.
With these three natural supplements and a few smart choices whilst travelling, you should be able to minimise the risk of Traveller’s Diarrhoea. After some of the hideous experiences I have had, I’d much rather put in the effort and minimal added expense of these supplements than hugging the toilet bowl and missing out on all the holiday fun and adventure.
If you’re interested in a really comprehensive eGuide about how to prevent traveller's diarrhoea, I have created one for my travel health blog HERE. It covers:
> How to make safe choices with water, food and sanitation
> 'Good, better and best' food choices in developing countries like parts of Asia, Africa and South America
> 5 key supplements that you need to take to prevent traveler’s diarrhea on your next holiday
I love it when my clients can travel with confidence and come home feeling better than when they left.
Diemert, D. J. (2006). Prevention and Self-Treatment of Traveler’s Diarrhea.Clinical Microbiology Reviews, 19(3), 583–594. LINK
De la Cabada Bauche, J., & DuPont, H. L. (2011). New Developments in Traveler’s Diarrhea. Gastroenterology & Hepatology, 7(2), 88–95. LINK
Connor, B. (2005). Sequelae of traveler's diarrhea: focus on postinfectious irritable bowel syndrome. Clin Infect Dis, 41 (Suppl 8), S577-86 LINK
Brunette, G. (2015). CDC Health Information for International Travel 2016. New York: Oxford University Press LINK
McFarland, L. V. (2010). Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World Journal of Gastroenterology: WJG, 16(18), 2202–2222 LINK
Nazzaro, F., Fratianni, F., De Martino, L., Coppola, R., & De Feo, V. (2013). Effect of Essential Oils on Pathogenic Bacteria. Pharmaceuticals, 6(12), 1451–1474 LINK
Backer, H., & Hollowell, J. (2000). Use of iodine for water disinfection: iodine toxicity and maximum recommended dose. Environmental Health Perspectives, 108(8), 679–684 LINK