Eat to beat traveller’s diarrhoea

When you’re on a busy trip with a tight schedule, you can’t afford to be ill. Whether it’s a holiday or a business trip, there’s nothing worse than being sick in a strange hotel or landing back home exhausted and drained after a bout of abdominal upset. Nicknamed “Delhi Belly”, “Montezuma’s Revenge”, “Tourista” or the “Jamaican Runs”, traveller’s diarrhoea is the most common affliction for those travelling overseas and is so named because the cause is often simply the change in food or water.

Unfortunately, if you’re doing business in developing countries, you’re also more likely to encounter food that is contaminated and that harbours dangerous bacteria, viruses or parasites such as E. coli, Shigella, Salmonella, Rotavirus and Giardia.

Whichever one strikes you, the symptoms are embarrassingly similar – diarrhoea, aka the trots or the runs, abdominal pain and vomiting, sometimes accompanied by nausea and a fever. Anyone who’s had it needs no reminder.

To avoid ruining your next trip, keep the following 10 key food safety tips handy. They apply to developing countries, especially those with warm or tropical climates or where hygiene is poor like South-East Asia, Africa, the Middle East and South America.

High-risk destinations include India, Nepal, tour boats on the Nile and poorer areas outside the main cities of any developing country.

Top 10 Traveller’s Tips

1. Eat freshly-cooked meals that are served hot. Avoid dishes that are kept lukewarm for hours (as with buffets or street stalls). If buying from street stalls, buy from somewhere where you can watch the food being cooked in front of you.
2. Drink bottled water – check that the seal is intact before you purchase. Use this water to wash fruit and brush your teeth. Cans and bottles of beer, wine and soft drink are safe.
3. Avoid ice, as it is usually made from local (contaminated) water.
4. Peel fruit yourself. Avoid fruit and vegetable garnishes that have been overly handled like the elaborate carved fruit in Bangkok.
5. Avoid salads. Order cooked vegetables instead.
6. Avoid raw meat, chicken and fish, including superb Japanese sushi unless you are taken to a good restaurant by locals.
7. Be wary of raw shellfish like oysters. Freshly-caught, well-cooked seafood should be OK.
8. Avoid unpasteurized and unrefrigerated milk, yoghurt, custard, ice cream and cream-based desserts. UHT “long life” milk is safe.
9. Be extra scrupulous about hand-washing before eating and after the toilet. Also whenever you come in from outside, wash your hands. This breaks the infection cycle and be careful about touching your face with your hands while you’re out – we all do it without being aware of it but it can result in transferring nasties near your nose and mouth.
10. Some foods can be poisonous or even fatal. Fugu fish (blowfish), a delicacy in Japan, is the cause of numerous bouts of illness from its poison and kills around 100 Japanese each year. It is usually only available at special restaurants licensed to serve it after it has been expertly cleaned to remove the poison. Also, steer clear of wild mushrooms or strange berries as they may be poisonous.

If you lose this information, remember the old saying:

“Boil it, cook it, peel it - or forget it”.

Treating tummy troubles

If you are unfortunate enough to succumb, remember the best treatment is simply to drink plenty of fluids, at least 3 litres each day, as fluid loss through the bowel is significant.

• Water is fine, boiled or bottled, but a rehydration drink such as Hydralyte or Gastrolyte is better as it replaces lost electrolytes and is recommended for children.
• You can make your own rehydration brew by dissolving 8 teaspoons of sugar and ½ teaspoon of salt in one litre of safe boiled water. Alternatively, sip weak black tea, sports drinks, mineral water or well-diluted fruit juice (1 part juice to 4 parts safe water).

There’s no need to starve yourself. If you feel like eating, try bland carbohydrate foods like boiled rice, oats, dry toast, banana, plain noodles, cracker biscuits or mashed potato. Read more at my post on Eat to Beat Gastro and Diarrhoea.

The BRAT Diet for diarhoea

Many backpackers and frequent travellers swear by the BRAT diet (Bananas, Rice, Applesauce, Toast). There are many variations on this diet; a friend’s doctor prescribed honey, rice and salt for gastro problems years ago and I remember as child being given diluted flat lemonade and dry crackers or plain toast.

• The idea behind them all is to provide electrolytes, fluids and starch in low-fibre form. To read more about the BRAT diet, see my post here.
• Avoid or limit milk products, alcohol, fatty and spicy foods.

There’s usually no need to see a doctor unless the diarrhoea is severe or has not improved after two to three days. Anti-diarrhoeals should not be taken unless you absolutely must or have to get on a plane as they can make things worse in the long run.

For further information and to obtain sachets of rehydration powder and antibiotics (as well as vaccinations), visit a Traveller’s Medical and Vaccination Centre.