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 is 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.
As for the cause of the diarrhea itself, I don’t know if there’s a difference between that of 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.
However, when we talk about traveler’s diarrhea, we are often referring to sudden diarrhea we get overseas, especially after eating something seemingly innocent such a salad at a food stall, or a piece of grilled meat.
It is unlikely to get diarrhea from things we eat in our home countries, even if they are slightly contaminated with something, because we’ve been eating those things our whole lives. Our bodies recognise them and can handle them just fine.
However, overseas, many germs are brand new to the body. Our body has never seen them before. This often causes the stomach to reject it and we get stuck to the toilet for a few days. You might also have heard this referred to as Delhi belly, Bali belly or Montezuma’s Revenge.
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 worry about this. You need to take conscious 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, particularly on my first few trips to Africa. It should be available from your doctor and in many countries you don’t even need a prescription.
What does Dukoral do?
It protects 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. What I 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.
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).
I used to reserve it for when I’m going to a place that’s very questionable – think small villages in rural Ethiopia, something like that, but nowadays I don’t take it at all, instead relying on the preventive measures I’ll describe further below.
However if you are highly susceptible to gut problems and diarrhea, and haven’t travelled a lot in the developing world, 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, especially meat and dairy. Almost all commercial livestock is treated with antibiotics, especially cows and chicken. That means traces of antibiotics are found in our milk, cheese, eggs and meat. Most people are constantly ingesting antibiotics on a daily basis.
The problem with antibiotics is they 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. The good bacteria in your gut will knock those suckers 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. Probiotics work.
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, yeah?
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 you start taking them right now, and continue to do so regularly whether you’re travelling or not! I personally take a 50 billion probiotic supplement every day, regardless of whether I’m on the road.
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 really tested, such as rural Asia or Africa, you might to get a product that gives you up 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. In fact, this guy actually did try to overdose and still couldn’t do it.
I’ve taken up to 200 billion units in a single day and was totally fine.
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?
It’s the probiotic that I currently use and have been using for several years now. It’s one of the best probiotics for travelling – both due to its formula and how compact it is to travel with. I highly recommend it.
Each bottle contains 30 servings, and each serving gives you a whopping 50 billion colony forming units (most common probiotic supplements only give you around 1-5 billion).
It also contains all three flora that were recommended to be in probiotics for travel (Saccharomyces boulardii, Lactobacillus acidophilus, Bifidobacterium bifidum) which can be quite hard to find in one supplement!
If you’re worried about getting traveler’s diarrhea, I highly recommend carrying a strong probiotic like this. Multi strain products like this are the best probiotic to prevent traveler’s diarrhea and will keep your gut in fighting shape during your trip.
Of course you can also use any other “good” probiotic from your local pharmacy or health store, but this is the one I like and recommend. Just make sure whatever you use has a sufficient number of units and the right strains!
Remember, taking probiotics before travel is important! You want to start working on your gut health at least a month before your trip, so make sure you get enough. I’d recommend getting a bottle for the 30 days before your trip, and then a second bottle to use during the trip itself. But ideally you should be taking them regularly regardless of whether you’re travelling or not.
Again, I have never had any tummy problems on the road since taking daily probiotics, and I travel to some pretty dodgy places and eat some pretty dodgy things. They really work.
How to travel with probiotics
The most important thing when buying a probiotic for travel with is to make sure it is shelf stable.
This means the probiotic does not need to be refrigerated for the bacteria to stay alive. The obvious reason is – it’s unlikely you’ll be able to keep your probiotics in the fridge at all times, especially if you’re on the move a lot. The Vitamin Bounty probiotic I’ve recommended above is shelf stable.
Secondly, buy a probiotic that has a very high unit count, at least 50 billion plus. When you’re at home, it’s fine to buy 10 to 20 billion unit products and eat them periodically with your meals throughout the day. However when you’re travelling this isn’t practical. You want to be travelling with as few bottles of probiotics as possible, so get the highest count you can. Anything over 50 billion is perfect.
Lastly, take them properly. I find the best way to take probiotics while travelling is to take it first thing in the morning with a big breakfast. Probiotics populate the gut best with food.
Extra tip: Prebiotics
One thing that probiotics need for optimal function is an equal amount of “prebiotics” to support them. Prebiotics are highly fibrous foods that feed probiotic bacteria and help them flourish in the gut. Without sufficient prebiotics, your probiotic supplements will not survive in the gut and will simply die and go to waste.
Some of the richest sources of prebiotics are oats, asparagus, chicory root, jerusalem artichoke, leeks and dandelion greens. I usually try to get my prebiotics from foods, and always eat a lot of oats and asparagus, every day if possible. However during my trips I usually take a prebiotic supplement as well. I’m not too fussy about prebiotics and just take whatever is available at pharmacies around the world. Something like this is the type of thing I usually take.
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 (probiotic bacteria) which populate and protect your gut, just like the probiotic supplements 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. 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.