Digestive Health Digestive Health Basics

Taming Travelers' Tummies

By Christine Haran

Even if you're vacationing in what seems like Eden, if you've got travelers' diarrhea (TD), chances are that are you're not going to be able to appreciate your blissful surroundings for a few days. Each year, almost half of international travelers consume contaminated water or food that leads to diarrhea.

People are most likely to contract TD when visiting developing countries—destinations that are becoming more and more common with adventuresome travelers. Locals in these areas are protected from TD-related bacteria because their bodies produce protective antibodies that visitors lack. Fortunately, most cases of diarrhea resolve within a few days on their own, but more severe TD may require treatment. Below, David Perlman, MD, an infectious diseases physician at Beth Israel Medical Center and a professor of medicine at the Albert Einstein College of Medicine in New York City, explains how best to avoid and prepare for Montezuma's revenge.

What is travelers' diarrhea (TD)?
One of the most common infectious people pick up when they travel is infectious diarrhea. It is a form of intestinal infection you get from ingesting certain bacteria such as E. coli, or, less commonly, viruses or parasites.

What are the symptoms?
When people develop travelers' diarrhea, they may feel nauseous and then they may develop loose or watery stools. This can progress so that they have diarrhea more than four times a day, and the diarrhea can have blood or mucous in it. They may also develop significant abdominal cramps and fever.

What are the high-risk destinations?
The highest risk areas for travelers' diarrhea are Africa, Central and South America, the Middle East and most of Asia. Certain other destinations, the Caribbean, the Pacific islands, Israel, Japan, are more intermediate risk. You're most at risk in the developing countries.

Of course, it also depends on the nature of the travel. There are different sorts of travelers. Someone who flies on an air-conditioned jet, gets in an air-conditioned limo, goes to an air-conditioned hotel and only drinks bottle water is at substantially lower risk than someone who's hiking or trekking and getting their water from streams.

Who is at increased risk?
There are some differences in people's individual risks. One of your body's main defenses against getting intestinal infections is the acid your stomach makes. Your stomach can make acid that kills germs on their way in. So if you're taking medications that shut off your stomach acid, antacid medicines, you may be at greater risk of getting travelers' diarrhea because that host defense is shut off. People who are immunocompromised, such as those with HIV infection, leukemia or lymphoma, are also at higher risk.

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